Current Issues

https://doi.org/10.1016/j.drugpo.2018.06.018Get rights and content

Abstract

Background

Medically Supervised Injection Centres (MSICs) are legally-sanctioned facilities where users can consume pre-obtained drugs under medical supervision. Although there is a substantial body of research exploring their effectiveness, there have been few attempts to quantify outcomes across studies. In order to determine the impact of the body of research as a whole, outcomes from studies were synthesised using meta-analysis.

Methods

Literature sources were identified through searches in four bibliographic databases. Inclusion in the final review was dependent on the study meeting certain eligibility criteria, including a minimum of pre-test, post-test, control group designs. Data were extracted and pooled in a meta-analysis using both fixed and random effects methods.

Results

Eight studies met the inclusion criteria. Overall, MSICs had a significant, but small, positive effect on outcomes based on the fixed effect analysis and no effect based on random effect analysis. The results of the independent outcome analyses showed that MSICs had a significant favourable result in relation to drug-related crime and a significant unfavourable result in relation to problematic heroin use or injection. MSICs were found to have no effect on overdose mortality or syringe/equipment sharing.

Conclusion

Whilst the effectiveness of the early versions of MSICs remains uncertain, this should not rule out continuing to test and develop MSICs in locations where public injecting and other drug-related harms are a major problem. It is important, however, that evaluation research publishes replicable data to enable future meta-analyses and to expand the body of knowledge in the field.

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Medical research has confirmed that the body’s endocannabinoid system is a finely regulated and highly complex system which is involved in the detailed regulation of essentially all body systems including the brain and cardiovascular systems and stem cell niches.  

Studies have shown that the rate of use of cannabis by expecting mothers closely parallels that in the wider community.  In fact given the long half-life of cannabis in tissues even were a maternal habitual smoker to stop when she discovered her pregnancy, her infant would continue to be exposed to her on-board cannabinoid load for several months afterwards during critical periods of organogenesis.  And other studies show that the father’s cannabis use is even more damaging than the mothers’.

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EXCLUSIVE: NAS - neonatal abstinence syndrome - affects babies whose mothers have abused drugs during pregnancy, leaving their babies to go cold turkey after birth. 22:26, 28 JUL 2018

Three babies a day are having treatment for drug addiction ­after being born hooked on ­heroin or cocaine.

Shock figures from NHS Digital show hospitals dealt with 5,000 cases of ­addicted tots over the last four years.

NAS – neonatal abstinence syndrome – affects babies whose mums have abused drugs during pregnancy.

When the umbilical cord is cut, the supply of drugs suddenly stops, so the addicted infant goes cold turkey.

Typical symptoms include high-pitched or incessant crying, tremors, vomiting and sweating.

But babies can also suffer dehydration, diarrhoea, fevers and even seizures.

Some may need medication to treat severe withdrawal symptoms, usually from the same family of drugs as the substance that the baby is ­addicted to.

Once the signs of withdrawal are controlled, the dosage is gradually decreased to help wean the baby off the drug.

Figures from the NHS show the problem is countrywide.

“Yet none of the women we support wanted to end up in this position. Most are victims of childhood sexual trauma and domestic violence.

"The shame and guilt they feel is huge. But all they need is help and support to break the cycle.

“A mum might come to us on baby four or five. Her previous children have all been taken into care.

“By getting her through treatment, addressing her underlying issues and enabling her to keep her child, we break that cycle of repeat removal.”

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Lauren M. Jansson, MD1Chloe J. Jordan, PhD2Martha L. Velez, MD1

JAMA. Published online July 16, 2018. doi:10.1001/jama.2018.8401 

Increasing public attention has recently been paid to the opioid epidemic and attendant effects on prenatally exposed infants and children. 1Current literature has emerged proposing marijuana as a safe alternative to opioids in addressing pain 2 and cannabis legalization as a way to decrease opioid fatalities. 3 As a result, perceptions of cannabis safety have increased, and the prevalence of marijuana use among pregnant women has expanded; past-month cannabis use among pregnant US women increased from 2.4% to 3.9% between 2002 and 2014. 4 Further, cannabis potency has been substantially increasing over the past 4 decades in the United States, and will likely continue to do so as extraction procedures of active components improve.

Although cannabis does have known medical utility for some conditions, its associated acute and long-term psychoactive effects on brain function are also known. Expanding use of cannabis among pregnant and lactating women (as likely will occur with legalization) may lead to increased risk from fetal and child exposures if the teratogenic potential of cannabis remains underappreciated …The exogenous supply of cannabinoids resulting from THC exposure can adversely affect fetal growth as well as structural and functional neurodevelopment. 6

Prenatal THC exposure has been documented to adversely affect infant neurobehavior and child development up through the teen years,5and postnatal exposures may compound prenatally acquired deficits. Neurobehavioral effects associated with prenatal THC exposure range from dysregulated arousal and motor difficulties at birth to disturbed sleep, memory impairment, aggression, and other developmental and behavioral concerns in childhood. 5

Despite these risks, it appears that clinicians are not addressing cannabis use during pregnancy or lactation; in one study of 74 lactation professionals, 85% encouraged breastfeeding among marijuana-using mothers. 7 Most national breastfeeding guidelines (eg, the American Academy of Pediatrics and the American College of Obstetricians and Gynecologists) have remained steadfast in recommending against cannabis use during lactation….

The medical community should advise pregnant women to avoid perinatal THC exposure and intervene for women needing treatment, for children at risk for neurobiological and developmental problems, or for dyads at risk for negative outcomes associated with an untreated substance use disorder. Advice from medical professionals should be consistent: pregnant and lactating women should be advised to avoid cannabis use, and women (and men) caring for developing children also should be advised to maintain abstinence. Treatment programs for women with CUD should be available and accessible, and gender and culturally specific, particularly during pregnancy and postpartum periods. Converging, systematic research is necessary at both the preclinical and clinical levels to address insufficient evidence regarding maternal cannabis use 9 and to fully understand the short- and long-term effects of perinatal THC exposure, the effects of maternal cannabis use on fetal outcomes, and the consequences of polysubstance use in treatment and intervention efforts.

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We wanted to make sure you had seen four key studies just into play

  • groundbreaking study in The Lancet found that marijuana use over four years actually made it harder for patients to cope with chronic pain, and did not reduce their use of opioids.
  • study in Frontiers in Psychiatry found that increasing self-exposure to non-medical marijuana was a predictor of greater odds of opioid dependencediagnosis.
  • study in the International Review of Psychiatry found an increased rate of serious mental illness in states that had legalized medical marijuana.
  • In JAMA: "(The) associated acute and long-term psychoactive effects on brain function (of marijuana) are...known. Expanding use of cannabis among pregnant and lactating women (as likely will occur with legalization) may lead to increased risk from fetal and child exposures if the teratogenic potential of cannabis remains underappreciated."

Additional Resources on Link Between Marijuana and Opioids

These articles follow other warnings from medical professionals: the recent editorial published in the Journal of the Society for the Study of Addiction, which cautions against drawing policy conclusions from population studies, and the editorial comment from the American Society of Addiction Medicine on February 20, 2018. And don't forget NIDA's rigorous study showing pot users are twice as likely to have abused opioids and have an opioid use disorder than non-marijuana users.

SAM has published a one-pager describing the overwhelming link between marijuana and opioid abuse. While not every marijuana user will go on to use heroin, nearly all heroin users previously abused marijuana. We need smart policies that discourage use, get people back on their feet, and restore people to participate in and contribute to society. States that have legalized marijuana, by contrast, see increased drugged driving, increased arrests of minority youth, and increased emergency room visits. Colorado is experiencing the highest number of drug overdoses in its history. Legalization is a failed experiment.

Sincerely, Dr. Kevin Sabet President, Smart Approaches to Marijuana (SAM)                         

Affiliated Fellow, Yale University

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