Fracture.

Playing soccer has been a hobby/passion/thing to do for the majority of my life.

There’ve been no significant injuries to speak of. Until now.

So let’s talk about ‘the knee’ and pain.

new brace and crutches

A reckless and ridiculous challenge during my last game resulted in a minor fracture of the knee – and some major sit-on-my-butt time.

(Probably best that I go no further in describing the tackle, lest my blood begins to boil once more.)

So, I’ve got a near future filled with crutches, an immobilizer brace, ice, anti-inflammatory drug. Luckily, the future doesn’t hold surgical interventions! For now.

A swollen left knee

* *

Treatment for dummies (like me):

The treatment depends on the type of fracture. If you have an open wound with the fracture (I didn’t!), you may need treatment to control bleeding or prevent infection. You may need surgery to:

1) Remove all small fragments of bone
2) Wire the kneecap fragments together, if possible
3) Remove the kneecap if it has shattered
4) Your provider may put your leg in a brace, splint, knee immobilizer, or cast to keep your knee from moving while it heals.
5) Your healthcare provider may prescribe pain medicine.

**

Pain medication? Well yes. I have been using Extra Strength Advil. And the occasional beer. Sometimes I think I need something stronger. Other times, no.

The National news last night discussed the rise of the opioid crisis and located one of the hot zones in Ohio. The story by Vik Adophia was powerful, well-conceived and executed.

(It’s worth noting that the state of Ohio is suing 5 major drug companies for precipitating the opioid epidemic. The manufacturers of the prescription painkillers are: Purdue Pharma LP, Johnson & Johnson’s Janssen Pharmaceuticals Inc unit, a unit of Endo International Plc, Teva Pharmaceutical Industries Ltd’s Cephalon unit and Allergan Plc.)

Here are some of the top stories related to pain and opioids in the past few days.

Trump declares opioid abuse a national emergency in U.S.

Drug industry faces ‘tidal wave’ of litigation over opioid crisis

Canadian health advocates eye Portugal’s drug model to combat opioid crisis

Record number of drug-related deaths, as opioid crisis hits UK

**

After the knee injury, I immediately thought of Christopher Nolan’s Batman trilogy.

So what’s the future hold…

**

I also thought of Kobe  Bryant’s injury history. And as you can see – the Mamba’s knees featured regularly.

**

Stay tuned for periodic updates.

UK Drugs Strategy – July 2017 – Same old, same old?

This past week the UK Government released a Drugs Strategy. Here is some of the reaction to the document, which is available here.

Media Roundup.

*

From The Independent:

 

The Government’s latest policy relaunch aimed at tackling illegal drugs amid soaring death rates has been heavily criticised by campaigners who say it fails to get to grips with the problem.

The UK Drug Strategy 2017 was announced by the Home Office as its flagship initiative to reduce use of illicit substances and improve addiction recovery rates.

Drug misuse has been falling in recent years, figures show. Some 2.7 million 16- to 59-year-olds in England and Wales took illegal drugs in 2015-16, down from 10.5 per cent a decade ago.

However, the latest available figures also reveal deaths are soaring. Some 3,674 drug poisoning deaths involving legal and illegal substances were recorded in 2015, up from 3,346 in 2014 and the most since comparable records began in 1993. Cocaine deaths reached an all-time high in 2015, and deaths involving heroin and/or morphine doubled over three years to reach record levels.

The new Home Office strategy identifies new emergent threats, including drugs previously known as legal highs such as Spice – the drug blamed for causing a “zombie plague” in city centres, which is now causing havoc in the prison system.

Chemsex drugs like crystal meth, GHB/GBL and mephedrone, which are taken before or during sex to boost the experience, are also identified as a growing problem among users who expose themselves to blood-borne infections and viruses, according to the strategy.

It promises “targeted interventions” and close collaboration between sexual health services and other relevant groups, as well as more help for addicts to find houses and jobs and better controls at borders.

However, it immediately came under fire from people and organisations campaigning to reduce the harm caused by drugs.

Some argued that by refusing to countenance any sort of decriminalisation it could never make any serious dent in a trade controlled by organised criminals at an estimated cost to society of £10.7bn a year.

Models in countries such as Portugal were cited, where decriminalising drugs and treating their use as a health issue has reduced consumption, addiction and funding for criminals.

*

From the Daily Mail:

The Government has ‘no intention’ of making cannabis legal in the UK, officials have announced in a new blitz on drugs.

Despite a growing body of evidence showing the world’s favourite recreational drug to be safe, possession will remain punishable with jail.

Experts have slammed the Home Office’s controversial decision, describing it as a ‘missed opportunity’ to legalise the herb.

But ministers pointed to various studies that have shown cannabis to be detrimental to human health, with significant links to schizophrenia.

Such worrying associations have existed for decades, and were responsible the decision to reclassify the drug to a Class B nine years ago.

In recent years, Spain, South Africa, Uruguay and several states in the US have made cannabis legal for recreational use.

Pressure has been increasing on the UK to follow suit and update its drug policy, with many citing weed’s medicinal properties.

But Ian Hamilton, a drug researcher based at York University, told MailOnline the UK’s updated stance shows it’s falling behind.

‘Missed opportunity’ 

He said: ‘The government has missed an opportunity to provide less harmful ways of people accessing and using cannabis.

‘The UK is falling behind many other countries who are adopting progressive policies towards drug use.

‘These countries have embraced the evidence and recognise that punishing people who use drugs does not improve their health and adds to social inequality.’

Cannabis is currently a Class B drug in the UK, and anyone found in possession can face up to five years in prison.

*

From The Guardian:

The wait is finally over for those of us working in the drug policy and drug treatment sectors. The Home Office published its new drug strategy on Friday, two years after its planned deadline in 2015. Sadly, however, this is not a case of good things coming to those who wait. For a 50-page document, there’s very little in the new strategy that can earn it its name.

Against a backdrop of increasing policy innovation in the wider world, the main aims of this strategy are largely unchanged from the previous 2010 version. There’s still a focus on recovery, rather than harm reduction. A continued commitment to tackling the problems caused by drugs through the criminal justice system, rather than through the health system. A point blank refusal to consider decriminalisation, or any reforms to the Misuse of Drugs Act.

Worse, what good initiatives there are in the strategy – and there are some – seem to have been dreamed up by minds unfettered by the reality of public health, criminal justice and policing systems squeezed to breaking point.

Andy Burnham, giving the keynote address at a conference in Manchester last week aimed at developing a more connected response to the city’s rising spice epidemic, echoed the thoughts of many in these fields: “Where is the money? Our frontline services are being overwhelmed. I didn’t hear any mention of any extra funding in the radio this morning. It seems quite hollow, what was being said.”

First then, for the good news. Greater efforts are going to be made to provide effective, evidence-based drug prevention and education to young people. Gone are the school visits from the trite ex-user or the finger-wagging police officer: effective resilience training is in.

Prisoners, too, are to be given more help into recovery, their progress monitored closely. Far clearer and more explicit guidelines have been given on the value of opioid maintenance treatments, which allow so many people with opioid dependence to live their lives, and crucially, prevent overdoses.

The people who slip through the cracks of dual diagnosis from mental health and problem substance use are to be better catered for, rather than shunted between services reluctant to take on complex and demanding cases.

Of the rather pedestrian reforms, these are the brightest spots. However, with cuts to local authority public health budgets totalling £85m this year, and ringfenced drug treatment budgets expected to be cut by £22m, it’s anyone’s guess as to where the money will come from for such initiatives. More likely that these reductions will further eat into essential services such as needle exchanges, and hamper local authorities’ ability to properly assess the performance of the services they commission.

(Read the whole article using the link above)

*

From The Huffington Post:

The Government’s new drugs strategy has been condemned as “business for usual” for failing to embrace radical solutions to soaring drug deaths.

The Home Office announced its long-awaited strategy that pledges to crack down on drug dealers and cut demand by expanding education on drugs and alcohol and expanding the Prevention Information Service.

Writing on HuffPost UK, Home Secretary Amber Rudd said the plan would target “unscrupulous drug dealers” while trying to do more to “protect the vulnerable – to prevent them falling into the cycle of drug abuse and to help them turn their lives around”.

While the new strategy does call a rise in drug deaths “dramatic and tragic”, it was condemned as “business as usual” by one advocate for change.

Niamh Eastwood, executive director of drug law experts Release, told HuffPost UK the strategy should have mooted ending criminal punishment for possession, following the lead of other countries.

*

If you have other stories and media accounts that you think should be added, get in touch.

Are you an Anti-Vaxxer?

Why do we question vaccines? And who are the thought leaders involved? Are they respectable, or are they hacks? And, more importantly, what can we glean from past debates about vaccines? In Elena Conis’s new book, we get a sense of this – and so much more.

conis book image

In the newest edition of Social History of Medicine, I review Elena Conis’s new book, Vaccine Nation: America’s Changing Relationship with Immunization.

In tracing over 50 years of vaccine controversy, we get to know the key institutions, opinion leaders, and major ideas that have driven debates. We are exposed to federal law, feminism, and, oh yeah, Jenny McCarthy and the mass media.

She began her career in 1993 as a nude model for Playboy magazine and was later named their Playmate of the Year. McCarthy then parlayed this fame into a television and film acting career. She is a former co-host of the ABC talk show The View.

McCarthy has also written books about parenting and has become an activist promoting research into environmental causes and alternative medical treatments for autism. In particular, she has promoted the idea that vaccines cause autism and that chelation therapy helped cure her son of autism.

Both claims are unsupported by medical consensus, and her son’s autism diagnosis has been questioned. McCarthy has been described as “the nation’s most prominent purveyor of anti-vaxxer ideology”, but she has denied the charge, stating: “I am not anti-vaccine…”

jenny_mccarthy

In Conis’s book, we get a better understanding of how someone like McCarthy can drive the policy process and shape our View on vaccines.

Here is a brief excerpt from the review:

“Vaccines are significant medical interventions that naturally induce powerful economic, social, and political reactions. Vaccines have helped shaped narratives about American scientific and technological ingenuity, as well as therapeutic progress, yet they have also been ‘cast in the image of their own time’ (p. 10), The pathway to effective, accepted vaccines has been neither simple nor straightforward.

In Elena Conis’s penetrating new book, Vaccine Nation, this fluid negotiation over vaccines for polio, pertussis and Human papillomavirus (HPV), among others, is on full display. We are exposed to a ‘wildly diverse set of influences, including Cold War anxiety, the growing value of children, the emergence of HIV/AIDS, changing fashion trends, and immigration’, that have shaped vaccine acceptance—as well as resistance (pp. 2–3). Conis, a former journalist, offers punchy and accessible prose as she skilfully traces the ebb-and-flow of vaccine history from the 1960s to the present.”

*

If you’re interested, PBS has done a great job covering anti-vaccination in the U.S.

The Rise of Big Cannabis on Shaw TV

The Rise of Big Cannabis Symposium that I recently aired on Shaw TV in Saskatoon, Prince Albert, Moose Jaw and Swift Current stations.

The first airing was this weekend on March 19th @ 9:30pm

Other dates to follow:
March 21st – 11pm
March 23rd – 9:30pm
March 24th – 10pm
Bonus airing in Saskatoon on March 27th – 11pm

In the Weeds: Understanding Government Action and Canada’s Marijuana Industry

What is happening with Canadian marijuana policy? We seem to be stuck in the weeds. And there’s a fog of confusion. According to Jim Bronskill, there are the 9 major factors that have driven the Canadian government’s “federal marijuana moves” over the past few months. The key source for him was a November 2015 ministerial briefing presentation, which was called “Legalizing & Regulating Marijuana.”

Interesting, this story made it onto both CTV and Global News, although CBC did not run with it immediately.

9 MAIN SOCIAL, POLITICAL, AND ECONOMIC DRIVERS:

Canadian marijuana usage rates 11 per cent of the population age 15 and older used marijuana in the past year, according to a 2013 survey. Use was highest among 20-24 year-olds at 26 per cent. The presentation characterizes this as “relatively low overall rates of usage” and points to evidence that use declines with age.

Evidence of health benefits and risks There is some evidence of limited therapeutic benefit to marijuana use for managing symptoms of chemotherapy, neuropathic pain and treatment-resistant epilepsy in children. But the health-community consensus is that regular recreational usage carries risks, including long-term cognitive ones for those under 25.

International legal framework — Canada is party to a global legal framework on psychotropic drugs, including the 1961 Single Convention on Narcotic Drugs. It does not allow for legalization but allows leeway on the kinds of sanctions imposed. The International Narcotics Control Board expressed regret over Uruguay’s decision to legalize marijuana, but it is not clear what practical impact this has had, Health Canada notes. A UN special session on the World Drug Problem is slated for next month.

Canadian regime for medical marijuana — The 2013 Marijuana for Medical Purposes Regulations attempted to shift the medical marijuana industry to licensed producers, away from home growers. But thousands of Canadians were allowed to possess or grow marijuana pending a court ruling that came down last month.

Domestic legal context — The court ruling handed down in February affirmed the right of people to grow their own medical marijuana. The presentation, drafted before the ruling, says the decision and others from the courts could affect government choices on the new legal regime.

Role of provincial and territorial governments — The federal and provincial / territorial governments would be able to regulate in many of the same areas concerning access to legal marijuana. The federal government could set minimum standards, but provinces and territories might enact more stringent requirements on where pot is consumed, retail sale locations or minimum age for purchase. Achieving a national approach will require close co-operation.

Experience of other jurisdictions — While Uruguay adopted tight government control, Colorado and Washington states chose models that spurred involvement of commercial interests, increasing risks to health and safety. Early lessons from the U.S. reinforce the need to take time to implement a legalized model, figuring out the complexities of how best to protect public health.

Law enforcement issues — Organized crime groups are heavily involved in the marijuana trade. Illicit grow operations exist in all parts of Canada. Police-reported drug-impaired driving incidents are a small fraction of actual drug-impaired driving incidents, as it is difficult to recognize the signs. Given all this, a national approach will require police agencies to work together.

Youth justice — The Youth Criminal Justice Act requires police to consider use of measures such as warnings and referrals to community programs for those ages 12 through 17. Careful consideration will need to be given to how the new regime will be enforced when it comes to young people.

For more, check this out.

Twin Addictions? Zombies (i.e., The Walking Dead) and Bath Salts

In 2015, we are grappling with the addictive properties of The Walking Dead. Based on the best-selling comic book and developed for TV by Frank Darabont, the series has proven to be as enduring and enslaving as many popular drugs.

walking-dead

With only a month left in Season 6, many questions surround the future of Rick, Daryl, and the rest. The zombie hordes have broken through the wall. Ron has set his sights on Carl and the next episode, which is called “Start to Finish,” will likely see the end of a character. But who will it be? Who’s going to lose a body part or two? Tune in…

But zombies don’t only frequent the big and small screen. They don’t simply occupy pages of novels and graphic novels. Quite the opposite. In recent years, drug addicts on bath salts have been portrayed as nightmarish zombies tearing at the flesh of unwitting victims. Let me explain.

bath salts

Bath salts are examples of new classes of designer drugs, which are sometimes referred to as “legal highs.” These are substances with psychotropic effects that have been or are marketed and distributed for recreational use by exploiting gaps in existing drug legislation. Another popular example is the synthetic cannabinoids (“fake marijuana”) marketed under names such as Spice.

In 2012, the Americans made bath salts illegal through the Synthetic Drug Abuse Prevention Act and then with the Synthetic Cathinones Control Act a year later. At roughly the same time, Canada introduced measures to ban the key ingredient in bath salts, methlyenedioxypyrovalerone (MDPV).

The move to schedule and control the drug was surely warranted, yet one can easily detect how the drug was sensationalized as part of this process. Lurid and grotesque stories were reported about bath salts, including the naked zombie attacker who was shot by police in Miami while biting a victim’s face. Rudy Eugene, the face-chewing “zombie,” wasn’t on any bath salts, contrary to a majority of the stories.

Yet, the nation went into full-on moral panic mode. From PBS and Spin to Forbes and GQ magazine, the public was exposed to the new menace in American society. It was the stuff of nightmares. It was a Zombie Bath Salt Apocalypse.

The Big Picture

Cathinones are naturally occurring amphetamine-like substances that come from Khat, a plant found in eastern Africa which has been chewed since at least the tenth century. Synthetic cathinones, not surprisingly, are lab-created derivatives of this compound, dating back to 1928 or so.

By the 1990s, the use/misuse of the synthetic cathinones began to pop up on radar screens and became an issue with law enforcement and government officials.

Before the recent regulation in the past few years, the designer “bath salts” were purchased from dealers, through online distributors, or at book stores, gas stations, and head shops. They got the nickname because they resembled the everyday Epsom salts that bath-lovers pour in their water when they take a soothing soak.

But there are trade names as well: “Ivory Wave,” “Purple Wave,” “Ocean Burst,” “Monkey Dust,” “Sextacy,” “Vanilla Sky,” and “White Lightning” are just some of the varieties one can put in the body rather than the bathtub. Tough to detect, they can be snorted, smoked, or injected.

And the effects of these are similar to MDMA. Users have reported increased energy and empathy, more sociability, and mental and sexual stimulation. The negative side effects of bath salts, on the other hand, have included difficulty breathing, fatigue, insomnia, muscle twitching, nausea, paranoia, violent behavior, and tachychardia.

A Vicious Circle

Compared to traditional psychotropic drugs (cocaine and LSD, for instance), there is relatively scant medical information available. That has not prevented its assignment to the category of Schedule I, meaning it has no known and accepted medical use.

Yet certain researchers raise interesting points. One is that classifying bath salts as schedule I substances without pre-clinical or human research is very problematic.

This move restricts the number of laboratories and institutions with licenses to study the bath salts. As a result, finding an accepted medical use becomes even more difficult, even though there have been suggestions that bath salts could be a viable alternative to amphetamines in dealing with Attention Deficit Hyperactivity Disorder (ADHD) or severe, treatment-resistant Depression.

This is, in short, a case of the snake eating its tail, and one does not have to look any further than LSD to detect some historical parallels. In the late 1960s, the recreational abuse of LSD as well as the anti-authority, counter-cultural, and outright malevolent images associated with it helped to scuttle research. Now, after over forty years, LSD has begun to make a slow return, and perhaps even a comeback.

lsd

Hyperbole and inaccurate information played a role in the scheduling and controlling of LSD, in other words. This was also the case when it was reported that crazed Mexicans who smoked marijuana went on vicious rampages, or when it was reported that Chinese workers were raping white women in opium dens while customers were “Chasing the Dragon.” With bath salts, which are the latest in a long line of drugs used for their euphoric effects, this hyperbole was readily apparent.

No, bath salts will not turn you into a cannibalistic criminal like Rudy Eugene in Miami. And, no, bath salts will not give you super strength. But the media had no problems in pushing such narratives on news consumers.

Should we be surprised about this type of journalism? Or that it dovetailed with the first synthetic cathinone legislation in 2012, which was passed the same month as the attack? Far from. If anything, the history of drug policy demonstrates how predictable this is.

In the future, the best way to avoid cowering in bed (or hiding behind a big wall) in the face of an imminent zombie bath salt apocalypse is with candor. It’s probably best not to cut off avenues of research or focus on gory thoughts about face-chewing.

the-walking-dead

And, at the very least, it would be prudent to recognize the challenges and dangers of designer drugs like bath salts, even as we place them in a longer history of drugs. This way, like Rick and Daryl, we can create a proactive strategy for evading the zombie hordes.