This is why I blog: from rock bottom to top tier

Last July we wrote about the 40th anniversary of the Apollo 11 moon landing and spoke of Buzz Aldrin’s autobiography about his battle with alcoholism in the years following. The post drew a comment from a reader who I’ve renamed “Anon.”

Thank you so much for this post.
I am a recovering drug addict and am in the process of applying to graduate programs. I have a stellar GPA, have assisted as an undergraduate TA, and have been engaged in research for over a year.
I also have felony and was homeless for 3 years.
I don’t hide my recovery from people once I know them, but I sometimes, especially at school, am privy to what people think of addicts when they don’t know one is sitting next to them. It scares me to think of how to discuss my past if asked at an admissions interview. Or whether it will keep me from someday working at a university.
I’ve seen a fair amount of posts on ScienceBlogs concerning mental health issues and academia, but this is the first I’ve seen concerning humanizing addiction and reminding us that addiction strikes a certain amount of the population regardless of status, family background or intelligence.
I really appreciate this post. Thank you.

Regular readers know that while I am not a substance abuse researcher, many drugs of abuse do come from my research area, natural products. Think cocaine, morphine and other opiates, psilocybin, mescaline, etc.
I also have special compassion for folks with the biochemical predisposition to substance dependence, especially as I come from a long line of alcoholics including my beloved father who I lost way too early.
With that said, I’m sure you understand how Anon’s comment hit me and how grateful I was for her appreciation. So moving was her comment in fact that I raised it to its own post. Since many of you readers are in academia and serve on graduate admissions committees, I figured you’d have some good advice for Anon.
Well, you did. Here’s the comment thread as a reminder.
And guess what? I got this e-mail from her a couple of days ago.

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Dear Dad, With Love (repost)

This is a repost of my reflections on my father who passed away 13 years today. It took me 12 years to write the following eulogy and remembrance. While quite personal, I posted it here last year because I felt that my experiences were quite universal, shared by the families of the ten or twenty million alcoholics in the US and the hundreds of millions worldwide. Moreover, I wanted to provide a face for my colleagues who work in the area of substance abuse and a reminder for my clinical colleagues of the people behind those they may dismiss as drunks and junkies.

In becoming one my most most highly-read and highly-commented posts, I thought I would share it again this year, especially for the new readers who’ve come on board in the last twelve months.


This post originally appeared at Terra Sigillata on 12 March 2009.

Today marks 12 years since you died.

Well, it might have been today, possibly yesterday, I hope not too many days ago.

You see, you died alone in your apartment you rented from your sister downstairs. Yet no one checked on you as your mail accumulated Monday and Tuesday. One of your drinking buddies from the Disabled American Veterans post told me proudly at your funeral that he probably had with you your last beer that Saturday night. So, maybe it was the 8th or 9th?

When I think back, though, I believe you died some eight years earlier, just after your 50th birthday party. For your wife, my Mom, it was even long before that – she is a saint for staying with you as long as she did – no offense, Dad – and I know she still loves you no matter what.

Our family runs rich with depression and alcoholism but you died exceptionally early; my Dad – the young, fit, handsome fella you were in those pictures with little me at the Jersey shore, at home, or with me in that horrible Easter outfit – had died back then and was replaced for the last eight, ten, fourteen years by someone else.
dad and me 1966 515px.jpg
dad 04 Easter 1966 515px.jpg

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Former date rape drug reincarnated as answer to unmet medical needs

Just a quick post on an article that caught my eye: Jazz Pharmaceuticals of Palo Alto, CA, has announced that the US FDA has accepted their new drug application (NDA) filing for JZP-6, or sodium oxybate, for the treatment of pain and fatigue associated with fibromyalgia.
The NDA was based on positive outcomes of two, Phase III clinical trials – those randomized, placebo-controlled double-blind trials that serve as the gold standard for drug efficacy. The company expects an approval decision from FDA by October 2010.
Jazz has already garnered approval for sodium oxybate under the brand name Xyrem® for the treatment of daytime sleepiness in patients with narcolepsy. The company stresses, however, that the drug has not yet been approved for symptoms associated with fibromyalgia.
200px-4-hydroxybutanoic-acid.pngThe item of note here is that sodium oxybate is another name for the sodium salt of gamma-hydroxybutyrate or GHB, a sedative that resembles the inhibitory neurotransmitter GABA but also has its own receptors in the central nervous system. GHB was implicated as far back as the early 1990s on college campuses where young men who lacked any other redeeming qualities to attract women used it to dope the drinks of their dates.
But here we see the study of a drug of abuse giving rise to a useful pharmaceutical, first in narcolepsy and, soon perhaps, for fibromyalgia.
It is a paradox of pharmacology that a sedative like GHB would prevent excessive sleepiness or fatigue. But a similar paradox exists with the use of the stimulant methyphenidate in hyperactivity conditions.
Now that I’ve seen the business reports, I’ll turn to some of my CNS pharmacology colleagues to help explain the neurobiology.
However, this compound demonstrates to me the unanticipated benefits of funding research that aims to investigate drugs of abuse.
Beneficial therapeutic agents come when and where you may least expect them.

What’s the buzz?: Synthetic marijuana, K2, Spice, JWH-018

ResearchBlogging.orgThis post was chosen as an Editor's Selection for ResearchBlogging.org
Welcome to those of you arriving via Reddit from a very kind referral by Travesura. Please feel free to make any comments or ask any questions in the comment box at the end of this post.

My field of natural products pharmacology was founded by indigenous cultures who recognized that plants and fungi contain compounds that produce altered states of consciousness, leading to their most common use in religious ceremonies. While we may most often associate these naturally-occurring drugs with hallucinogens, the arguably most common natural product in use today is marijuana or Cannabis sativa. Indigenous to India and China, Cannabis has been the subject of increasing decriminalization worldwide due in part to its clinical, medicinal effects in multiple sclerosis, cancer, and AIDS.
K2 assortment.jpg

Over the last few months, I’ve seen reports of a so-called “synthetic marijuana” being sold on the internet with stories most commonly coming from England and Germany and, in the US, from Kansas, Missouri, and Arizona. In fact, the St. Louis Post-Dispatch reports today that a bill has been brought before the Missouri House Public Safety Committee seeking to add this product to the state’s list of illegal drugs.

I became intrigued as to why anyone would go through the trouble of making a synthetic marijuana when the real thing is so readily cultivated worldwide, albeit illegally in most locales.

So what is it?

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NIDA researchers Hinds (Kentucky) and Torres (Pittsburgh) given Presidential Early Career Award

Hearty congratulations this morning to a group of early-career investigators who received this award yesterday in Washington, DC:

The Presidential Award for Early Career Scientists and Engineers was established in 1996 and is the highest honor bestowed by the U.S. government on outstanding scientists and engineers beginning their independent careers. [emphasis mine] Awardees are selected on the basis of two criteria: pursuit of innovative research at the frontiers of science and technology; and a commitment to community service as demonstrated through scientific leadership, public education or community outreach. Winning scientists are awarded a research grant for up to five years to further their studies in support of critical government missions. This year, eleven federal departments and agencies nominated 100 young scientists and engineers who showed exceptional promise for leadership in science and technology. Drs. Hinds and Torres are 2 of 12 NIH grantees to receive the prestigious PECASE award.

According to the NIDA press release:

Bruce J. Hinds, III, Ph.D., associate professor of chemical and materials engineering at the University of Kentucky, is being recognized for his work to improve the delivery of drugs that treat nicotine dependence through a novel skin patch. Gonzalo E. Torres, Ph.D., assistant professor of neurobiology at the University of Pittsburgh School of Medicine, is being cited for his research on cellular and molecular regulation in the brain and its relationship to psychiatric disorders and drug addiction.

As I’ve remarked previously, NIDA is one of the NIH Institutes and Centers with a very active public relations and news office so this was the only press release I found. However, ten other NIH-funded scientists also received the PECASE; here’s the complete list:

Thomas P. Cappola, M.D., Sc.M. (University of Pennsylvania School of Medicine)
His research on the use of genetic and genomic approaches for studying ventricular remodeling in humans is supported by a grant from the National Heart Lung and Blood Institute (NHLBI).
Pablo A. Celnik, M.D. (Johns Hopkins Hospital)
His research on the underlying mechanisms of plasticity in the central nervous system in order to develop novel therapeutic approaches that promote recovery of function following an injury is supported by a grant from the Eunice Kennedy Shriver National Institute on Child Health and Human Development (NICHD).
Felicia D. Goodrum, Ph.D. (University of Arizona)
Her research on hematopoetic progenitor cells and their influence on latency in human cytomegalovirus infections is supported by a grant from the National Institute on Allergy and Infectious Diseases (NIAID).
Bruce J. Hinds, III, Ph.D. (University of Kentucky)
His research on the use of gated carbon nanotube membranes for transdermal drug delivery is supported by a grant from National Institute on Drug Abuse (NIDA).
Helen H. Lu, Ph.D. (Columbia University)
Her work on the use of biomimetic scaffolds to promote chondrocyte-mediated regeneration of the interface between soft tissue and bone is supported by a grant from the National Institute on Arthritis Musculoskeletal and Skin Diseases (NIAMS).
Ulrike Peters, Ph.D., M.P.H. (Fred Hutchinson Cancer Research Center)
Her research on selenium and the interaction of genetic variations and nutrition on cancer prevention is supported by the National Cancer Institute (NCI).
Jeremy F. Reiter, M.D., Ph.D. (University of California at San Francisco)
His research on the role of the proto-oncogene Smoothened and its interaction with the primary cilium in the development of cancer is supported by a grant from the National Institute on Arthritis Musculoskeletal and Skin Diseases (NIAMS).
Marisa Roberto, Ph.D. (The Scripps Research Institute)
Her research on neuropeptides, neuronal function and synaptic communication related to alcohol and other drugs of abuse is supported by a grant from the National Institute on Alcoholism and Alcohol Abuse (NIAAA).
Erica Ollmann Saphire, Ph.D. (The Scripps Research Institute)
Her studies on the role of glycoproteins in the pathogenicity and immunogenicity of Ebola virus is supported by a grant from the National Institute of Allergy and Infectious Diseases (NIAID).
Oscar E. Suman, Ph.D. (Shriner’s Hospital for Children, University of Texas Medical Branch)
His research on supervised and structured aerobic and resistance exercise on muscle mass and bone mass in severely burned children is supported by a grant from the Eunice Kennedy Shriver National Institute on Child Health and Human Development (NICHD).
Kristin V. Tarbell, Ph.D. (National Institutes of Health Intramural Research Program)
Her research on the role of dendritic cells on T cell mediated autoimmune diseases such as diabetes is supported by the National Institute on Diabetes and Digestive and Kidney Diseases (NIDDK).
Gonzalo E. Torres, Ph.D. (University of Pittsburgh)
His research on cellular and molecular regulation of monoamine transporters in brain and the relationship to psychiatric disorders and drug addiction is supported by a grant from the National Institute on Drug Abuse (NIDA).

We often don’t do enough in the biomedical sciences to promote the work of early-career investigators. But these people are our future. Their current work and future promise should be promoted and, more importantly, supported financially.
Congratulations to all of this year’s Presidential Early Career Award recipients.

NIDA Director Dr. Nora Volkow answers some questions on the Monitoring the Future Survey

On December 14 (last week), the US National Institute on Drug Abuse (NIDA) released the findings on adolescent drug use and trends as determined from the 35th annual Monitoring the Future (MTF) survey (press release). The ambitious survey is conducted with NIDA funding* by the University of Michigan’s Institute for Social Sciences led currently by Dr. Lloyd Johnston. The larger survey began in 1975 with only high-school seniors and was expanded in 1991 to include 8th and 10th graders to improve the ability to measure changes as a population progresses through school. A very detailed white paper on the MTF methodology is available as a PDF from the University of Michigan.
This year’s survey included 46,348 students from 386 public and private schools in the United States. The good news is that methamphetamine use and cigarette smoking rates are decreasing in adolescents, although smokeless tobacco use is increasing. Cocaine and hallucinogen use have also declined but previous declines in marijuana use have stabilized. Perhaps the biggest concern is that the use of prescription drugs, opioids in particular, has increased sharply. Prescription drug abuse is increasing in adults but even I’m surprised that kids are getting into the act as well.
Backstory – the part where the blogger says things you wouldn’t see in formal journalism
Although I’m not a substance abuse researcher, I have taught in the area to pharmacy and medical students since 1992 and many drugs of abuse are themselves naturally-occurring plant or fungal products. But I wouldn’t say that this blog is on the NIDA radar, so let me share with you this backstory as to why we have this post today:
I’ve got to hand it to NIDA for their public outreach and responsiveness. They contracted with Ogilvy Public Relations Worldwide and we were approached by their senior account executive, Chris Heydt, for our interest in participating in a live chat session the on the 15th with NIDA Director, Dr. Nora Volkow. If you don’t know much about Dr. Volkow and the remarkable person and scientist that she is, you must read this 2006 story by Bill Snyder in Lens, a Vanderbilt Medical Center publication. Her work was also recognized last week by Inserm, the French analog of the NIH:

Each year, it honors researchers for their contributions to basic and clinical research that enhance public health. Dr. Volkow’s selection acknowledges her innovative imaging research showing drug addiction to be a disease of the brain that usurps the reward circuitry and leads to compulsive behaviors.

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Unfortunately, the chat had to be canceled at the last moment, understandably given the competing press interest following the annually anticipated release of the survey results. However, Chris got back to me with apologies and said that Dr. Volkow would respond via e-mail to any questions I had prepared and, lo and behold, I received the following answers yesterday via her staff assistant, Susan Schlossberg.
What I like about NIDA is that they contracted with Ogilvy, a PR firm with a history of respectful cultivation of bloggers as detailed by their 2007 code of ethics in approaching bloggers.
So, I have to say that NIDA gets it. And I’m also impressed by the professionalism at Ogilvy.
But, now to the questions I had for Dr. Volkow. I was primarily interested in cultural influences on drug use in adolescents, particularly with regard to substance choice. Most of my 12th grade year’s drug abuse was comprised of sitting in my buddy Tommy’s Firebird in the Sumner Ave. parking lot of Seaside Heights, New Jersey, drinking warm Budweiser in the soft summer rain (because that’s what Bruce Springsteen wrote about in Jungleland.) So, I kicked off my three questions with a reflection on a trend which claimed Pimp C two years ago.

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Update: Rocky Mountain High and the Serious Side of Colorado Medical Marijuana

Update: New ScienceBlogs colleague, Sharon Astyk at Casaubon’s Book, brought my attention to the fact that this local southern Colorado story has been picked up by CNN.
Although I originally wrote this post rather tongue-in-cheek, some scientific evidence has accumulated for the benefits of cannabis in neuropathic pain, cancer pain and nausea, as well as muscle spasticity in multiple sclerosis. For what appears to be a subset of individuals, marijuana is superior to prescription drugs in terms of efficacy and side effect profile. Equivocal results with a standardized cannabis extract oromucosal spray product have just been reported in this review.
In 2000, Coloradans voted to approve Amendment 20 to the state constitution which permits dispensaries to provide marijuana to up to 200 approved patients. This cap has since been lifted, leading to a sharp increase in medical marijuana use in the state.
Patients enroll with the Colorado Medical Marijuana Registry of the Colorado Department of Public Health and Environment (four-page PDF description here, forms here). As of 31 August 2009, the state reported that 14,377 patients hold registry cards; consistent with the known clinical efficacy of marijuana, the most commonly approved use is for muscle spasms, representing 29% of approved users.
As one might suspect, marijuana dispensaries of various sorts have sprouted up all across the state. With regulation developing slowly, some resemble glorified head shops while other are sterile clinical offices. As a result, Westword, the local independent weekly, has enlisted two dispensary reviewers who are each state-certified medical marijuana patients. Westword’s Joel Warner wrote in greater detail back in February about the literal Wild West of Colorado’s medical marijuana industry.
An even more unclear area is who is actually authorized to grow cannabis to wholesale to dispensaries. Currently, one applies to be a “care-giver” but one is only a care-giver if a registered patient lists one as such – an odd chicken-or-the-egg arrangement. In late October, the state ruled that care-givers/growers must do more than provide cannabis; they must also provide supportive medical or social services. A hearing had been scheduled for this Wednesday, 16 December, to repeal this supportive care stipulation but the CDPHE has now indicated the hearing is postponed.
So, the state of medical marijuana in Colorado is very much in a state of flux.

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A. Thomas McLellan, Deputy Director of the US Office of National Drug Control Policy

By way of my substance abuse blogger colleague, The Discovering Alcoholic, I learned of yesterday’s New York Times article by Sarah Kershaw on Dr. A. Thomas McLellan. McLellan is a psychologist and drug abuse researcher with over 400 peer-reviewed publications to his credit. He held an academic appointment at the University of Pennsylvania School of Medicine and was scientific director of the Treatment Research Institute which he co-founded in 1992 with Jack Durell, MD, and other researchers from Penn’s Center for the Studies of Addiction.
However, McLellan is not a career bureaucrat like many in Washington (“I hate Washington,” he is quoted as saying.). Beyond being a substance abuse researcher, he has experienced firsthand the pain and suffering of addiction:

But the loss of his younger son, who overdosed on anti-anxiety medication and Scotch last year at age 30 while his older son was in residential treatment for alcoholism and cocaine addiction, changed his perspective.
“That’s why I took this job,” said Dr. McLellan, who was sworn in as the deputy director of the Office of National Drug Control Policy in August. “I thought it was some kind of sign, you know. I would never have done it. I loved all the people I’ve worked with, I loved my life. But I thought maybe there’s a way where what I know plus what I feel could make a difference.”
Married to a recovering cocaine addict, Dr. McLellan has been engulfed by addiction in life and work. His own family has been a personal battleground for one of the country’s most complex and entrenched problems, while as an expert he has been a leading voice for the idea that addiction is a chronic illness and not a moral issue. [emphasis mine]

McLellan notes that his experience in substance abuse research and treatment did not make him any better prepared for facing the addiction challenges of his sons:

“If it has to happen, better it happens to me, I’m an expert, right?” Dr. McLellan said. “I didn’t know what to do and none of my buddies knew what to do, and let me tell you they were experts. So I said, ‘What the hell are we doing?’ “

Kershaw’s article speaks in greater depth about the shift in drug abuse policy from one of a “war on drugs” to one of treatment and prevention. Even McLellan’s boss, former Seattle police chief, R. Gil Kerlikowske, has had family members with substance abuse issues.

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NIDA Launches Medical Curricular Resources on Substance Abuse and Dependence

I missed this note on Friday at the Wall Street Journal Health Blog but the National Institute on Drug Abuse (NIDA) has made available some great new curricular resources through their Centers of Excellence for Physician Information Program (NIDA CoEs) (press release)

“Physicians can be the first line of defense against substance abuse and addiction, but they need the resources and the training,” said NIDA Director Dr. Nora D. Volkow. “Our long term goal is for doctors to incorporate screening for drug use into routine practice like they currently screen for other diseases; to help patients that are abusing to stop; and to refer more serious cases to specialized treatment.”
Three themes have emerged in this first wave of CoE offerings: the importance of communication in the doctor-patient relationship, particularly around sensitive issues; the recognition that substance abuse may play an integral role in many disorders physicians treat, even when not the presenting condition; and the crucial part physicians can play in both identifying substance abuse in their patients and reducing their risk of developing a substance use disorder.

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Second confirmed poppy tea death in Boulder, Colorado

Papaver somniferum.jpgThe Boulder County coroner announced today that the July death of a Boulder teen was indeed due to opioid intoxication from preparation of a poppy pod tea.

Jeffrey Joseph Bohan, 19, of Boulder, was found dead in his friend’s Boulder home about 6 p.m. July 21 after drinking poppy-pod tea the night before with his brother, according to Boulder police.
Investigators suspected the Fairview High graduate, who was going to Colorado State University, died from the psychoactive tea, which is brewed from the plant that produces opium. But they couldn’t be sure until the Coroner’s Office confirmed Monday that Bohan’s cause of death was morphine overdose, and his manner of death was accident.

Here is also coverage from The Boulder Daily Camera.
This marks the second death in Boulder from young adults mixing up decoctions of seeds or pods from the poppy, Papaver somniferum. We reported in March on the death of CU-Boulder student, Alex McGuiggan, in March.
In a subsequent post, we expanded on a commenter’s story of his own efforts to raise awareness of the dangers of poppy seed tea following the death of his own son. Commenter Tom’s site can be viewed at Poppy Seed Tea Can Kill You (http://poppyseedtea.com).
Extracts from poppy pods can contain up to 10% morphine and 1-5% codeine together with several other benzomorphan compounds. Seeds themselves are intrinsically devoid of morphine but the drug can remain on the seeds in reasonable quantities simply from their processing. The Santa Clara County crime laboratory investigating the death of Tom’s son determined that a tea made with the same seeds he used contained 259 µg/mL of morphine.
Depending on the starting material, however, the extract may also contain thebaine, a natural intermediate used for semi-synthetic opioid synthesis that causes intense nausea, vomiting, and even convulsions.

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