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You did not die in vain

March 16, 2003

Diminished Interleukin-6 Response to Proinflammatory Challenge in Men and Women after Intravenous Cocaine Administration

John H. Halpern, Michelle B. Sholar, Julie Glowacki, Nancy K. Mello, Jack H. Mendelson and Arthur J. Siegel

Alcohol and Drug Abuse Research Center, McLean Hospital, Harvard Medical School (J.H.H., M.B.S., N.K.M., J.H.M., A.J.S.), Belmont, Massachusetts 02478; and Departments of Psychiatry (J.H.H.) and Orthopedic Surgery (J.G.), Brigham and Womens Hospital, Harvard Medical School, Boston, Massachusetts 02115

Address all correspondence and requests for reprints to: John H. Halpern, M.D., Alcohol and Drug Abuse Research Center, McLean Hospital, 115 Mill Street, Belmont, Massachusetts 02478-9106. E-mail:


Cocaine abuse is associated with increased rates of infections, including human immunodeficiency virus, and cocaine has immunomodulatory effects in experimental animal and cellular models. When challenged by antigens, tissues release cytokine polypeptides that signal a complex balance of cellular and humoral immune responses. Placement of indwelling venous catheters also leads to surrounding tissue inflammation, mediated partially by local production and release of the proinflammatory cytokine, IL-6. Thus, catheter placement provides a model for examination of cocaines immunological effects. Thirty healthy men and women with a history of cocaine use participated in this study of neuroendocrine and immunological responses to iv injection of 0.4 mg/kg cocaine or saline placebo. After injection, blood samples were collected from the antecubital vein of the opposite arm via an indwelling venous catheter at 2, 4, 8, 12, 16, 20, 30, 40, 60, 80, 120, 180, and 240 min. Cocaine, ACTH, cortisol, and dehydroepiandrosterone concentrations peaked at 8, 12, 40, and 20 min, respectively. Stimulation of IL-6 at 240 min was markedly reduced in subjects receiving cocaine compared with subjects receiving placebo (3.85 0.49 vs. 11.64 2.21 pg/ml; P = 0.0019, by two-tailed t test). Gender and menstrual cycle phase did not significantly influence most endocrine or IL-6 measures, although the small number of subjects limits the power of these comparisons. Because cocaine stimulates the hypothalamic-pituitary-adrenal axis, IL-6 suppression may be a consequence of corticosteroid release. Cocaine-induced suppression of proinflammatory IL-6 may mediate impaired host defenses to infections.

January 30, 2003
Below I am posting a commentary that I read in a daily newsletter that I subscribe to, from JoinTogether Online.
President Bush, in his State of the Union address January 28, announced that he has proposed a new 600 million dollar program to treat Americans with addictions. Bravo, President Bush!! Way to go!!!!!!

Bush Proposes $600-Million Treatment Voucher Program


Special Report
By Bob Curley

Saying that "too many Americans in search of treatment cannot get it," President Bush used his Jan. 28 State of the Union address to unveil a $600-million proposal to help people with addiction get help with their recovery.

Bush said the "Recovery Now" program would fund vouchers that addicted individuals could use to get treatment at their choice of programs, including those that rely on faith-based methods. The money, allocated over three years, would allow an additional 300,000 people to get addiction treatment, Bush said.

"Tonight, let us bring to all Americans who struggle with drug addiction this message of hope: The miracle of recovery is possible, and it could be you," said Bush.

Recovery advocates were ecstatic to hear Bush's ringing endorsement, especially in such a high-profile setting. "It propelled me out of my seat, cheering -- and then I burst into tears," said Susan Rook, director of communications and outreach for Faces and Voices of Recovery. "For the president of the United States to talk in the State of the Union about the 'miracle of recovery' puts recovery on the national agenda ... For the first time in history, the solution was placed front and center instead of the problem, and that's extraordinary."

"In my lifetime I've never heard a president name the disease and so strongly identify the remedy," agreed John Avery, public-policy director for NAADAC/The Association for Addiction Professionals. "He said recovery is possible, and that's powerful language and great presidential leadership on this issue."

"The skepticism in policy circles has been that people cycle in and out of treatment and that it doesn't work," added Avery. "The president said no -- recovery happens."

Concerns About Funding, Faith

However, enthusiasm for the president's plan was somewhat tempered by concerns about its chances of being funded by Congress in the face of a massive federal budget deficit, and worries about the implications of opening up federal addiction funding to faith-based programs.

Avery pointed out that the House of Representatives failed to fully fund Bush's treatment budget for 2003, although he said that the Republican-dominated Congress might be more willing to support a plan that is couched in the language of religion.

During the State of the Union, Bush touched upon addiction's impact on personal morality, and went out of his way to praise faith-based treatment programs. "Our nation is blessed with recovery programs that do amazing work," said Bush. "One of them is found at the Healing Place Church in Baton Rouge, La. A man in the program said, 'God does miracles in people's lives, and you never think it could be you.'"

Tonja Myles, cofounder of the Healing Place Church, sat in the front row of the spectator's gallery near first lady Laura Bush, as did Henry Lozano, head of the faith-based Teen Challenge of California and co-chair of the President's Advisory Council on Drug-Free Communities.

Addiction experts acknowledge that faith and religion have played an integral part in recovery programs since the founding of Alcoholics Anonymous, and can be effective. "We don't have a problem with faith-based providers," said NAADAC's Avery. "Our concern is with what kind of treatment is being provided. Historically, faith-based programs have been in the field all along ... We welcome anyone who wants to provide effective, evidence-based services."

"I've discussed the voucher proposal with the president and consider it an important first step in addressing the lack of access to treatment for people who are chemically dependent," said Rep. Jim Ramstad (R-Minn.), who has freely discussed his own addiction and recovery. "I agree with the president that faith-based treatment centers should not face discrimination by the federal government in providing treatment because I've seen, firsthand, their positive treatment outcomes."

Faces and Voices' Rook called Bush's framing of the recovery issue a "wake-up call" for the traditional treatment community. "He doesn't use all of the 'appropriate' language of the recovery community, but he is typical of the larger recovery community," she said. "There are many pathways to recovery."

Assessment, then Vouchers

Still, many remain wary that faith-based programs will be exempted from state and federal regulations that apply to other treatment programs, as was the case when President Bush helped establish Texas' faith-based funding initiative in the mid-1990s.

"ASAM's commitment to quality in treatment leads us to recommend that any system of vouchers that may be established be used only for treatment by programs that are accredited and licensed by the appropriate state agency, making them subject to quality assurance, regulation and inspection by the state," said Lawrence S. Brown, Jr., M.D., MPH, FASAM, president of the American Society of Addiction Medicine.

But John Walters, director of the White House Office of National Drug Control Policy (ONDCP), said that Recovery Now would increase, not decrease, accountability. According to ONDCP, individuals would be assessed and receive a voucher to pay for an appropriate level of treatment. States would be required to monitor the outcomes of the voucher program, and to make adjustments based on the extent to which improved client outcomes are achieved in a cost-effective manner.

"The new initiative is designed to allow treatment providers, faith-based and other community organizations, workplaces, and schools to help drug users receive the treatment and support services that are best suited to their individual needs," according to ONDCP.

"We know that treatment works," said Walters. "But we also know that there are too many Americans who, for a variety of reasons, cannot access the treatment they need. By giving people a choice, and the direct means to help connect them with effective treatment, we will be able to more directly help drug users who have recognized their problem."

The accountability measures built into the voucher proposal represent a fundamental shift from current public funding streams, which typically measure success in terms of the number of clients served. "The measure is not output of a system, but person-specific measures of function," noted NAADAC's Avery, who said the voucher proposal embraces many of the key concepts of the federal National Treatment Plan, such as client-need driven services and multiple points of entry into treatment.

"The devil is in the details, which will become apparent in the budget in the weeks and months ahead," said William Moyers, vice president of external affairs for the Hazelden network of treatment programs. "It's uncertain now whether the president intends for this money to go to unlicensed faith-based programs without trained professionals, or to the kinds of recovery programs we know well. But I feel some reason for optimism that recovery from addiction is an important issue in Washington right now."

By Pat Ford-Roegner

As state legislatures convene throughout the country for the 2003 session, budget deficits and slumping revenues will dominate the agenda. Many state programs will suffer cuts as lawmakers try to make our public ends meet.

One area where cuts cannot be afforded is the treatment of alcohol and drug use disorders.

Alcohol and drug treatment is already underfunded to the point that five million Americans who need treatment cannot obtain it because the health care system simply lacks the capacity to care for them.

Why is addiction treatment so poorly funded?

Individuals with alcohol and drug use disorders are often viewed as a helpless cause, a waste of resources, or unworthy of care due to their own actions.

Nothing could be further from the truth.

Chemical dependency is a real and complex disease. The misuse of drugs or alcohol extends beyond mere choice. While the path to addiction begins with the act of drug consumption, a person's ability to choose not to take drugs can be compromised. Alcohol and drugs change brain chemistry and functioning and often lead to compulsive or uncontrollable use even in the face of extremely negative consequences.

Substance use disorders are more rightly seen as a brain disease, not a moral failure.

The good news is that alcohol and drug use disorders can be effectively treated. A study by the Physician Leadership on National Drug Policy concludes that alcohol and drug treatment is as effective as treatments for illnesses such as diabetes, asthma and hypertension.

Not only is treatment medically effective, it is cost effective.

For every dollar spent on alcohol and drug treatment at least seven dollars is saved in terms of health care costs, increased productivity, and reduction in accidents.

The potential savings of treatment cannot be underestimated, when you consider that the annual social cost of alcohol and other drug disorders is over $300 billion.

Treatment is also better and cheaper than prison. Offenders who receive treatment as part of their sentence have lower recidivism rates than their counterparts who receive no treatment.

Unfortunately, the lack of funding for treatment is most notable in our state and federal prison systems. State officials report that 70 to 85 percent of inmates need some type of substance use disorder treatment, but less than 15 percent actually receive treatment.

As a result, we see a revolving door for people who commit crimes either on drugs or for drugs or both. Incarceration without treatment does not address addiction, it merely interrupts the cycle.

And how does the cost of treatment compare to incarceration?

Intensive inpatient alcohol or drug treatment costs roughly half of what it costs to imprison a person. And yet funding still lags.

But treatment is not only elusive for those who cannot afford insurance and those behind bars. Fully employed Americans who think they have comprehensive health care coverage also have trouble obtaining alcohol and drug treatment.

Some insurance companies offer limited or restricted alcohol and drug treatment coverage.

There are often higher co-payments and deductibles for alcohol and drug treatment. There are more stringent limits on inpatient care and outpatient treatment for addiction than for other diseases. Also, the annual and lifetime expenditure caps are more restrictive for substance use disorders than for other diseases.

In short, patients in need of alcohol and drug treatment are discriminated against based on their disease.

Given the social cost of substance use disorders and existence of effective treatment, the above facts and figures are unacceptable.

State legislatures should strengthen funding for alcohol and drug treatment and approve parity legislation that ensures equal health care coverage for all diseases. Our nation's long-term health and economic well-being depend on it.

Unfortunately, health and social service programs, including alcohol and drug treatment, are among the first cut in times of fiscal crisis. The tragic irony is that these services are most needed when the economy is slumping. An uncertain economic future means fewer jobs, less secure health coverage, and increased alcohol and drug use.

Representing the nation's frontline addictions counselors, I encourage legislators to shield alcohol and drug treatment from budget cuts. Treatment is a wise investment that yields healthier and more productive citizens.

Pat Ford-Roegner is executive director of NAADAC, The Association for Addiction Professionals.

Current Major Drug Threats


Street Names: Meth, Speed, Ice, Chalk, Crank, Fire, Glass, and Crystal.

Physical Effects: Methamphetamine is a toxic, addictive stimulant. Meth use dilates the pupils and produces temporary hyperactivity, euphoria, a sense of increased energy, and tremors.

Dangers: Methamphetamine use increases the heart rate, blood pressure, body temperature, and rate of breathing, and it frequently results in violent behavior in users. Methamphetamine is neurotoxic, meaning that it causes damage to the brain. High doses or chronic use have been associated with increased nervousness, irritability, and paranoia. Withdrawal from high doses produces severe depression. Chronic abuse produces a psychosis similar to schizophrenia and is characterized by paranoia, picking at the skin, self absorption, and auditory and visual hallucinations. Violent and erratic behavior is frequently seen among chronic, high-dose methamphetamine abusers.

Description: Meth can be smoked, snorted, injected, or taken orally, and its appearance varies depending on how it is used. Typically, it is a white, odorless, bitter-tasting powder that easily dissolves in beverages. Another common form of the drug is crystal meth, or ice,named for its appearance (that of clear, large chunky crystals resembling rock candy). Crystal meth is smoked in a manner similar to crack cocaine and about 10 to 15 hits can be obtained from a single gram of the substance.

Distribution Methods: Meth is frequently sold through social networks and is rarely sold on the streets.

Meth-Related Emergency Department Episodes: 1998 - 11,491; 1999 - 10,447; 2000 - 13,513.
                                     Source: Drug Abuse Warning Network.


MDMA (Ecstasy)

Street Names: Ecstasy, E, Fantasy, XTC, Adam, Clarity, Lovers Speed.

Physical Effects: MDMA produces both amphetamine-like stimulation and mild mescaline-like hallucinations. It is touted as a feel good drug with an undeserved reputation of safety. MDMA produces euphoria, increased energy, increased sensual arousal, and enhanced tactile sensations.

Dangers: MDMA users often experience muscle tension, involuntary teeth clenching, nausea, blurred vision, faintness, chills, and sweating. In addition, MDMA can produce significant increases in heart rate and blood pressure similar to those associated with amphetamine use. MDMAs effects usually last 3 to 6 hours, but users report that confusion, depression, sleep problems, anxiety, and paranoia may occur even weeks after the drug is taken. MDMA is neurotoxic and chronic use may result in long-lasting, possibly permanent brain damage that causes learning and memory impairment. In high doses, MDMA can cause extreme increases in body temperature that lead to muscle breakdown and kidney and cardiovascular system failure. This condition, called malignant hyperthermia, can be fatal.

Description: MDMA is ingested and sold in tablet or pill form. Traffickers frequently embellish MDMA tablets with brand names, designs, and logos for marketing purposes. Among the more popular logos are butterflies, lightening bolts, and four-leaf clovers.

Distribution Methods: MDMA is most often distributed at raves, which are all-night dance parties.

MDMA-Related Emergency Department Episodes: 1,143 in 1998; 2,850 in 1999; 4,511 in 2000;
                                    Source: Drug Abuse Warning Network, 2000


Street Names: Oxy, OC, Oxycotton, and Killer.

Physical Effects: OxyContin, a central nervous system depressant, is a prescription painkiller. The active ingrediant in OxyContin is oxycodone, which has similar effects to those of heroin. OxyContin contains a much larger amount of oxycodone than do similar painkillers (Percocet and Percodan, for example). OxyContin stimulates the the opioid receptors in the central nervous system and brings about effects ranging from analgesia, to respiratory depression, to euphoria.

Dangers: With prolonged use of OxyContin, abusers become physically dependent. Overdoses can cause convulsions, comas, or death.

Description: OxyContin comes in tablet form. Some abusers chew the tablets. Others crush them and snort the substance or dilute it in water and inject it.

Distribution Methods: Because it is a legal drug that is diverted from legitimate sources, OxyCondit is obtained very differently than illegal drugs. Pharmacy robberies, forged presciptions, and theft of the drug from patients with a legitimate prescription are ways that abusers access OxyContin. Some abusers (with or without legitimate complaints) visit numerous doctors to receive prescriptions. This method is called Doctor Shopping.

Oxycodone-Related Emergency Department Episodes: 5,211 in 1998; 6,429 in 1999; 10,825
                                    in 2000.  Source: Drug Abuse Warning Network, 2000.


Street Names: Big C, Blow, Coke, Flake, Lady, Nose Candy, Snow, and Rock.

Physical Effects: Cocaine is a powerfully addictive stimulant. Cocaines immediate physical effects are euphoria, increased energy, reduced fatigue, and mental clarity. These effects are short-lived and are replaced by the coke crash, which includes depression, irritability, and fatigue.

Dangers: Short term effects of cocaine use include increased heart rate, temperature, and blood pressure; dilated pupils, and muscle spasms. In addition, users often become extremely physically addicted to cocaine and even first-time users run the risk of death from heart attack. Long-term use of cocaine can cause severe medical and psychological problems such as convulsions, paranoia, and extreme aggression. Long-term use can be fatal, as it may result in heart attacks, seizures, strokes, respiratory failure, or cerebral hemmorage.

Description: Cocaine is usually distributed in one of two forms: Cocaine Hydrochloride is a white, crystalline powder. It is either snorted or dissolved in water and injected. Crack is cocaine hydrochloride that has been processed with ammonia or sodium bicarbonate (baking soda) and water into freebase cocaine. Crack looks like chunks, chips, or rocks and can be smoked.

Distribution Methods: Cocaine is usually transported to this country from South America.

Cocaine-Related Emergency Department Episodes: 172,014 in 1998; 168,763 in 1999; 174,896
                                    in 2000.  Source: Drug Abuse Warning Network, 2000.

National Families in Action
Drug Abuse Update Online




Current Update



Group Collects 107,000 Signatures to Legalize Marijuana in Nevada

June 21, 2002 -- The march to legalize drugs pushes on.

Nevadans for Responsible Law Enforcement turned in 107,000 petition signatures for a ballot initiative that will legalize possession of up to 3 ounces of marijuana for recreational use for everyone over age 21. The effort is financed by the Washington D.C.-based Marijuana Policy Project (MPP). The measure also requires the state to grow, tax, and distribute marijuana to retail stores for sale to the public. To place the initiative on the ballot, the group needs 61,000 valid signatures. The validation process is under way. Because ballot initiatives change the state's constitution, voters would have to approve the initiative again in 2004 before it could become law.

Meanwhile, MPP is collecting signatures in Washington D.C. to place a medical marijuana initiative on that city's 2002 ballot. D.C. voters approved such an initiative in 1998, but Congress invalidated the results. Since the medical marijuana initiative drive began in the mid-1990s, critics have charged that advocates are using the issue as a wedge to legalize marijuana for all use. The introduction of the Nevada legalization petition confirms critics' concerns. A spokeswoman for Nevadans for Responsible Law Enforcement says similar efforts are under way in other states.

The Marijuana Reform Party of New York will try to win 50,000 votes in the 2000 election to become an official political party. It hopes to persuade the state legislature to legalize marijuana for medical use.

Legalization advocates have also tried to move their agenda via a second initiative strategy, which they publicize as "treatment rather than incarceration" for nonviolent drug offenders. However, the fine print in these initiatives not only greatly weakens drug laws, but makes it difficult for addicts to get to and stay in treatment. The Drug Policy Alliance (the Lindesmith Centers East and West, Drug Policy Foundation, Campaign for New Drug Policies, Americans for Medical Rights, and others) sponsored California Proposition 36, which voters passed in the 2000 election. Prop 36 was financed by George Soros, Peter Lewis, and John Sperling, the same three men who funded all the medical marijuana initiatives passed to date. While promoted as a measure for first-and second-time offenders, the average Prop 36 participant has 14 prior arrests, 3 felony convictions, and 5 misdemeanor convictions, according to The Los Angeles Times. Preliminary reports say that nearly half of those released from prison fail to show up for treatment.

The Drug Policy Alliance announces that it is "circulating petitions to put the Treatment Instead of Jail for Certain Non-Violent Drug Offenders Initiative of 2002' on the November 2002 ballot in Washington DC." The Alliance claims that "this initiative will offer treatment instead of incarceration for first- and second-time non-violent drug offenders."


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June 02, 02
Please take a few moments to read and respond to the notice below:

Cadbury Schweppes Marketing Candy Ecstasy to Australian Teenagers

May 31, 2002 - An Australia subsidiary of Cadbury Schweppes has produced a new candy that looks like the illegal drug ecstasy. 

"The sugar-free '24-7' mints are marketed by Cadbury in push-button packs containing white pill-shaped mints.   An official website for the mints features '24-7' adventures in a nightclub with a cartoon DJ shaking a container of the mints as he mixes dance music," says the Australian newspaper, The Advertiser.

Australian health officials have expressed concern about a product made to look like an illegal drug being marketed to impressionable teenagers. 

They are also concerned that someone could surreptitiously replace the mints with ecstasy because they look so similar.  The health officials have set up a working group to explore how to regulate such a product.

Interested readers who wish to prevent Cadbury from marketing '24-7' mints in the U.S. may wish to write Brad Irwin, President, Mott's Inc. (Mott's parent company is Cadbury Schweppes, London), P.O. Box 3800, Stamford, CT 06905-0800.

Sources:  "Lollie Resembling Drug Causes Concern," Australian Broadcasting Company, May 12, 2002; "Concerns Over Mints Shaped Like Ecstasy Drug," The Advertiser, May 29, 2002; Mott's Inc. corporate website at


Pubdate: Fri, 29 Sep 2000
Source: Collegiate Times (VA)
Copyright: 2000 Collegiate Times

Fax: (540)231-5057
Address: 363 Squires Student Center, Blacksburg, VA 24061-0546


It's been said marijuana is less harmful then alcohol and cigarettes and nowhere near as addictive. 

Proponents of legalization make lots of different arguments about the benefits of the drug and the "uselessness" of punishing users, but all of these are dangerous and erroneous beliefs. 

The effects of marijuana are well documented in many studies.  Some effects include dizziness, trouble walking, bloodshot eyes, and trouble judging distances and colors (

It's also been reported that smoking five marijuana cigarettes in a week does the same damage to your lungs as does smoking a pack of cigarettes a day for the same period (

Denise Kandel, an addiction epidemiologist at Columbia University, analyzed data from the U.S.  National Household Survey on Drug Abuse and concluded about 15 percent of teenagers report three or more symptoms of dependence from a list of six possible symptoms; anything from "feeling dependent" to being unable to quit to needing more and more of the drug each time ( "Marijuana Special Report,"
, Feb.  21, 1998 ). 

Since all of these symptomatic elements also apply to alcohol, it shows marijuana is just as addictive as alcohol.  Alcohol already causes one fatality every 32 minutes -- do we really want to take a chance with adding marijuana to the mix ( National Highway Transportation Safety Administration )

Legalizing marijuana is a no-brainer: it is a horrible idea that would cause an unending amount of problems.  Alcohol alone causes an enormous number of traffic accidents -- do you really want that number increased?

The November Coalition, an interest group for the legalization of marijuana, states on their website that marriages suffer because of absent spouses who are incarcerated because of drug use. 

The judicial system, they claim, has no respect for families during prosecution.  That's marvelous -- we should stop prosecuting all criminals that have families to keep things fair. 

In that case, serial killer Ted Bundy shouldn't have been given the death penalty for butchering young women, he should still be free.  He has family.  Brilliant idea. 

Some proponents of legalization say the U.S.  Government is violating citizens' rights to choose by not legalizing drugs.  I could turn around and say, "My constitutional right to own dangerous assault weapons is being infringed upon," and it will sound just about as stupid and dangerous. 

Assault weapons are banned for a good reason -- they are far too dangerous and unnecessary.  Marijuana, likewise, is banned because it is far too dangerous. 

The November Coalition goes so far as to say due to the "politics of prohibition" regarding marijuana, marijuana prices are up to $2500 per pound , cocaine is 5 times more valuable than gold per ounce and "it is folly for government to defy human nature" (

It's also human nature to get into fist fights over disagreements, to lie, cheat and steal to get what we want.  Let's go ahead and make fraud and assault legal, while we're at it, since those things are human nature, too. 

What truly frightens me are the people for legalization who don't realize their arguments can be applied across the board to a variety of topics no one in their right mind would legalize. 

A lot of people claim marijuana is useful for medicinal purposes, for example treating glaucoma, and it should be legal so more people could get it. 

The FDA has stringent guidelines regarding drugs on the market.  Each one goes through rigorous testing to ensure usefulness and no harmful side effects. 

Introducing a drug before it's ready is dangerous.  You wouldn't risk that with Viagra or Prozac so don't risk it with marijuana. 

Even Libertarian Presidential Candidate

Harry Browne got into the act saying, "It is not the government's business to tell people what they should or should not put in their bodies" (
).  He also claims he would pardon every non-violent drug offender to make room for rapists, murderers and the like who got out on early release and parole. 

This says a great deal about how a lot of marijuana advocates feel that marijuana use is not a crime and should not be punished. 

There is nothing wrong with imprisoning people for using marijuana, as it is still a crime. 

If something must be changed, reform the parole and probation laws, but don't let criminals off. 

As long as it is the law, it should and must be enforced. 

What advocates fail to realize is marijuana use is harmful, dangerous and still a crime, and just like murder, it must not be swayed by popular votes. 

It must be punished. 
MAP posted-by: Doc-Hawk

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Below you will find information on critera to be met for inclusion in Drug Court. I firmly believe that John would be alive today if he had been convicted on the possession of marijuana charge. I wonder still what happened to the evidence that was "lost" by the Spotsylvania County Detective that charged my son? If convicted, my son stood a good chance of being able to attend Drug Court.

Offered January 17, 2002

A BILL to amend the Code of Virginia by adding a section numbered 18.2-254.1, relating to drug treatment court programs.

Patrons-- Houck, Deeds, Edwards and Williams
Referred to Committee for Courts of Justice

Be it enacted by the General Assembly of Virginia:

1. That the Code of Virginia is amended by adding a section numbered 18.2-254.1 as follows:

18.2-254.1. Drug treatment court.

A. Administrative oversight for implementation of the drug treatment court shall be conducted by the Office of the Executive Secretary of the Supreme Court of Virginia with the assistance of a state drug treatment court advisory committee. The Office of the Executive Secretary shall be responsible for: (i) providing oversight for the distribution of funds for drug treatment courts; (ii) providing technical assistance to drug treatment courts; (iii) providing training for judges who preside over drug treatment courts; (iv) providing training to the providers of administrative, case management, and treatment services to drug treatment courts; and (v) monitoring the completion of evaluations of the effectiveness and efficiency of drug treatment courts in the Commonwealth.

B. A state drug treatment court advisory committee shall be established to: (i) evaluate and recommend standards for the planning and implementation of drug treatment courts; (ii) assist in the evaluation of their effectiveness and efficiency; and (iii) encourage and enhance cooperation among agencies that participate in their planning and implementation. The committee shall be chaired by the Executive Secretary of the Supreme Court or his designee and shall include a member of the Judicial Conference of Virginia who presides over a drug treatment court, the agency head or his designee from the Department of Corrections, Department of Criminal Justice Services, Department of Juvenile Justice, Department of Mental Health, Mental Retardation and Substance Abuse Services, Community Corrections and Pretrial Services, Commonwealth Attorney's Association, Public Defender Commission, Circuit Court Clerk's Association, Virginia Sheriff's Association, Virginia Association of Chiefs of Police, and two representatives designated by the Virginia Association of Drug Courts.

C. Each jurisdiction or combination of jurisdictions that intends to establish a drug treatment court or continue the operation of an existing court shall establish a local drug treatment court advisory committee. Jurisdictions that establish separate adult and juvenile drug treatment courts may establish an advisory committee for each such court. Each advisory committee shall ensure quality, efficiency, and fairness in the planning, implementation, and operation of the drug treatment court that serves the jurisdiction or combination of jurisdictions. Advisory committee membership shall include the following: (i) the drug treatment court judge; (ii) the attorney for the Commonwealth; (iii) the public defender or a member of the local criminal defense bar in jurisdictions with no public defender; (iv) the clerk of the court in which the drug treatment court is located; (v) a representative of the Virginia Department of Corrections or the Department of Juvenile Justice from the local office that serves the jurisdiction or combination of jurisdictions; (vi) a representative of Community Corrections or Pretrial Services; (vii) a local law-enforcement officer; (viii) a representative of the Department of Mental Health, Mental Retardation and Substance Abuse Services or a representative of local drug treatment providers; (ix) the drug court administrator; (x) the county administrator or city manager; and (xi) anyone else selected by the drug treatment court advisory committee.

D. Each local drug treatment court advisory committee shall establish criteria for the eligibility and participation of offenders who have been determined to be addicted to or dependent upon drugs. Subject to the provisions of this section, the establishment of a drug treatment court shall not limit the discretion of the attorney for the Commonwealth to prosecute any criminal case. Anyone convicted of a violent felony, as defined in 17.1-805 or 19.2-297.1, within the preceding ten years, shall not be eligible for participation in any drug treatment court.

E. Each drug treatment court advisory committee shall establish policies and procedures for the operation of the court to attain the following goals: (i) effective integration of drug and alcohol treatment services with criminal justice system case processing; (ii) enhanced public safety through intensive offender supervision and drug treatment; (iii) prompt identification and placement of eligible participants; (iv) efficient access to alcohol, drug, and related treatment and rehabilitation services; (v) verified participant abstinence through frequent alcohol and other drug testing; (vi) prompt response to participants' noncompliance with program requirements; (vii) ongoing judicial interaction with each drug court participant; (viii) ongoing monitoring and evaluation of program effectiveness and efficiency; (ix) ongoing interdisciplinary education and training in support of program effectiveness and efficiency; and (x) ongoing collaboration among drug treatment courts, public agencies, and community-based organizations to enhance program effectiveness and efficiency.

F. Participation by an offender in a drug treatment court is voluntary and only after a written plea agreement entered into by and between the offender and the Commonwealth with the concurrence of the court. The court may defer further proceedings and place the defendant in the drug treatment court upon terms and conditions as set out in the plea agreement and as determined by the local drug treatment court advisory committee. Upon successful completion, the judge shall dispose of the case in the manner prescribed by the plea agreement and the applicable policies and procedures adopted by the local drug treatment court advisory committee.

G. Nothing in this section precludes the establishment of substance abuse treatment programs pursuant to the provisions of 18.2-251.

H. Each offender shall contribute to the cost of the substance abuse treatment he receives pursuant to guidelines developed by the drug treatment court advisory committee.

I. Nothing contained in this section shall confer a right or an expectation of a right to treatment for a defendant.

J. The Office of the Executive Secretary of the Supreme Court of Virginia shall, with the assistance of the state drug treatment court advisory committee, develop a statewide evaluation model and conduct ongoing evaluations of the effectiveness and efficiency of all local drug treatment courts. A report of these evaluations shall be submitted to the General Assembly annually by December 1. Each local drug treatment court advisory committee shall submit evaluative reports to the Office of the Executive Secretary as requested.

Legislative Information System

18.2-251. Persons charged with first offense may be placed on probation; conditions; screening, assessment and education programs; drug tests; costs and fees; violations; discharge.

Whenever any person who has not previously been convicted of any offense under this article or under any statute of the United States or of any state relating to narcotic drugs, marijuana, or stimulant, depressant, or hallucinogenic drugs, or has not previously had a proceeding against him for violation of such an offense dismissed as provided in this section, pleads guilty to or enters a plea of not guilty to possession of a controlled substance under 18.2-250 or to possession of marijuana under 18.2-250.1, the court, upon such plea if the facts found by the court would justify a finding of guilt, without entering a judgment of guilt and with the consent of the accused, may defer further proceedings and place him on probation upon terms and conditions.

As a term or condition, the court shall require the accused to undergo a substance abuse assessment pursuant to 18.2-251.01 or 19.2-299.2, as appropriate, and enter a treatment and/or education program, if available, such as, in the opinion of the court, may be best suited to the needs of the accused based upon consideration of the substance abuse assessment. This program may be located in the judicial district in which the charge is brought or in any other judicial district as the court may provide. The services shall be provided by (i) a program licensed by the Department of Mental Health, Mental Retardation and Substance Abuse Services, by a similar program which is made available through the Department of Corrections, (ii) a community corrections program established pursuant to 53.1-180, or (iii) an ASAP program certified by the Commission on VASAP.

The court shall require the person entering such program under the provisions of this section to pay all or part of the costs of the program, including the costs of the screening, assessment, testing, and treatment, based upon the accused's ability to pay unless the person is determined by the court to be indigent.

As a condition of probation, the court shall require the accused (i) to successfully complete the treatment or education program, (ii) to remain drug and alcohol free during the period of probation and submit to such tests during that period as may be necessary and appropriate to determine if the accused is drug and alcohol free, (iii) to make reasonable efforts to secure and maintain employment, and (iv) to comply with a plan of at least 100 hours of community service for a felony and up to twenty-four hours of community service for a misdemeanor. Such testing shall be conducted by personnel of the supervising probation agency or personnel of any program or agency approved by the supervising probation agency.

The court shall, unless done at arrest, order the accused to report to the original arresting law-enforcement agency to submit to fingerprinting.

Upon violation of a term or condition, the court may enter an adjudication of guilt and proceed as otherwise provided. Upon fulfillment of the terms and conditions, the court shall discharge the person and dismiss the proceedings against him. Discharge and dismissal under this section shall be without adjudication of guilt and is a conviction only for the purposes of applying this section in subsequent proceedings.

Notwithstanding any other provision of this section, whenever a court places an individual on probation upon terms and conditions pursuant to this section, such action shall be treated as a conviction for purposes of 18.2-259.1, 22.1-315 and 46.2-390.1, and the driver's license forfeiture provisions of those sections shall be imposed. The provisions of this paragraph shall not be applicable to any offense for which a juvenile has had his license suspended or denied pursuant to 16.1-278.9 for the same offense.

(Code 1950, 54-524.101:3; 1972, c. 798; 1975, cc. 14, 15; 1976, c. 181; 1979, c. 435; 1983, c. 513; 1991, c. 482; 1992, cc. 58, 833; 1993, c. 410; 1997, c. 380; 1998, cc. 688, 783, 840; 2000, cc. 1020, 1041; 2001, cc. 430, 450, 827.)

18.2-250.1. Possession of marijuana unlawful.

A. It is unlawful for any person knowingly or intentionally to possess marijuana unless the substance was obtained directly from, or pursuant to, a valid prescription or order of a practitioner while acting in the course of his professional practice, or except as otherwise authorized by the Drug Control Act ( 54.1-3400 et seq.).

Upon the prosecution of a person for violation of this section, ownership or occupancy of the premises or vehicle upon or in which marijuana was found shall not create a presumption that such person either knowingly or intentionally possessed such marijuana.

Any person who violates this section shall be guilty of a misdemeanor, and be confined in jail not more than thirty days and a fine of not more than $500, either or both; any person, upon a second or subsequent conviction of a violation of this section, shall be guilty of a Class 1 misdemeanor.




  Today is January 23, 2003. The article below appeared in today's newspaper. This is a step in the right direction, charges like this will send a message to the public that contributing to someone's death can leave you legally responsible.

                                                                                                                                                            Charges follow fatalities

Man charged with involuntary manslaughter in wreck that killed four young people.

July wreck killed four

A 33-year-old Spotsylvania County man has been charged with four counts of involuntary manslaughter in connection with a July 5 crash that killed four young people and badly injured a fifth.

Billy Teal of 9707 Colby Terrace is accused of regularly providing alcohol and marijuana to underage people at his home, according to state Alcoholic Beverage Control special agent Lisa Wright.

One of those alleged gatherings took place shortly before the grisly July 5 crash on Brock Road. A vehicle that had just left Teal's home crashed into a tree and a concrete pillar before overturning.

The driver, 19-year-old Stephens S. Payne Jr., and three of his passengers--Amanda Maciulewicz, 14, Kelli Jenkins, 18, and Travis Meadows, 22--were killed in the crash. Meadows lived with Teal.

A fifth person in the car, 16-year-old Lacey Walker, survived but is still suffering from the effects of the wreck.

A special grand jury that has been meeting since October secretly issued indictments against Teal last week, Wright said. Teal turned himself in to authorities yesterday.

In addition to the manslaughter charges, Teal is charged with six counts of contributing to the delinquency of a minor, eight counts of aiding and abetting and one count of distributing marijuana.

Wright said a lengthy investigation showed that teen-agers have been regularly gathering at Teal's home to drink and smoke marijuana for at least two years. Some contributed money in ex-change for illegal substances, she said.

"It was known as the place to go if you were underage and wanted a place to drink," said Wright, who was assisted in the investigation by special agent Carter Wells.

The investigation is continuing, Wright said, and charges against at least one other person are anticipated.

State police at the time estimated that Payne's 2002 Mitsubishi Lancer was traveling between 80 and 100 mph when the car went out of control on a sharp curve.

The speed limit in that area was 45 mph, but a caution sign just before that curve urged drivers to slow to 30 mph.

Rescue workers described the scene as one of the worst they'd encountered in recent years. One victim landed in a tree after the crash.

Teal's home was well known to Spotsylvania authorities even before the crash. The home, a trailer, has been raided three times in recent years by county narcotics officers, according to court records. Marijuana and related paraphernalia were seized each time.

The most recent raid occurred in April. In an affidavit for the April search, police said they'd received a number of complaints about drug activity there. They had an informant make a controlled buy before raiding the home several days later.

Teal was already facing a possession of marijuana with an intent to distribute charge. A trial on that charge is scheduled for Feb. 21.

Date published: Fri, 01/24/2003

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The Free Lance-Star newspaper

Crack-cocaine sentences must continue to be harsh

Date published: Sun, 04/21/2002

I am writing this letter because I need the help of your readers. I just found out that the United States Sentencing Commission is planning to ask Congress to change drug laws to reduce differences in punishments involving crack cocaine and powder cocaine.

This is a change that the Justice Department does not think is necessary. I am so afraid that in changing this law, Congress may reduce the sentence for an offense involving crack cocaine. I urge anyone who reads this letter to write your congressman or congresswoman to plead that this does not happen.

I buried my son last month. He died from an overdose of crack cocaine. He battled his addiction for five years. He was only 21 years old, which means that there are people out there selling crack to 16-year-old boys.

We, as a community and as a nation, need to do something about this. Please, don't bury your head in the sand and think that this could never happen to your son or daughter, because it can happen to anyone.

The crack dealers that my son bought his drugs from were arrested on multiple charges, and my son was back at their house the same night buying more crack. Crack does not discriminate by race or background, crack kills.

I begged my son to get off crack, and he tried so hard, but in the end the crack won. Please write letters to our leaders asking for more money to find and punish these predators of our young sons and daughters.

Please ask, in the name of my son, Jonathan Ray Atkinson, that sentences not be reduced for possession or trafficking of crack cocaine. I can never do another thing for my son but put flowers on his grave, but together we may be able to save another young life.

Bonnie Atkinson


Drug abuse can ruin human lives--in any neighborhood

Date published: Sun, 05/05/2002

I am writing to express my heartfelt appreciation for the letter from Bonnie Atkinson ["Crack cocaine sentences must continue to be harsh," April 21], and for her candor in sharing the devastation that can result from drug addiction.

I also have buried my son. He was 19 years old. Although my child did not die of a drug overdose, and had successfully fought the battle to overcome addiction, I, too, have experienced the heartbreak of seeing what drugs can do to a life.

Ms. Atkinson so rightly urges parents to understand that this scourge is a tragedy that can happen to anyone. It is not something that happens only to "bad" kids from less-than-desirable families.

It happens to bright, promising kids with responsible parents. It happens in the suburbs, the city and the country. And those who peddle this misery also come from all backgrounds and all types of families.

Everything possible should be done to maintain strong sentencing guidelines for these merchants of death and destruction who walk our streets.

Ms. Atkinson states that she can no longer do anything for her son but put flowers on his grave, a thought that I have often had myself during lonely visits to the cemetery. I would venture to say, however, that, in her willingness to share such personal heartbreak with the public in an effort to increase awareness, she honors her son's memory in a very special way.

Those of us who have suffered the unspeakable tragedy of losing children can do no more than to try to reach out through our own grief to find ways to make the world a little better however we are able. In so doing, we can hope to keep a little part of our children alive by spreading the love we feel for them to others.

Carolyn Pankratz



My paycheck is plucked for all of the wrong reasons

I am sick to no end of the term "sensitivity training." Don't get me wrong, I'm not for abusing people, but why do we need "training" to be human beings?

Most of us don't and that's not what sensitivity training is about. This training is used to silence unpopular opinions.

For example, the fact that I'm sick of a third of my paycheck going to fund projects that I get no use from means that I need sensitivity training.

Apparently I should happily foot the bill, as should you, to find out which ketchup is truly the thickest. Who cares? Why not fund a project to find out why the average cost of a home in Fredericksburg is nearly $200,000, when the average Fredericksburg income is about $30,000? That would be something I could get behind.

Maybe we could fund a study on the actual life expectancy of someone inadvertently blocking a sale item at Wal-Mart on Saturday afternoon.

I'm sure I have some opinions that you would find less than sensitive, but I'm not very happy about my tax dollars supporting a whole family because someone decided drug addiction was a disability instead of a crime. I, personally, have no sympathy for these people. If you do, then you should start a charity, where other like-minded folks can contribute and make a difference in the lives of junkies everywhere.

Don't tell me it's a disease, because it started with an illegal choice, just like bank robbing.

Paul Greene


Date published: Sun, 07/21/2002

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Fighting addiction is a legitimate use of tax money

I am responding to a letter written by Paul Greene of Spotsylvania ["My paycheck is plucked for all of the wrong reasons," July 21]. Mr. Greene is a prime candidate for sensitivity training. He needs a lesson in compassion for his fellow human beings.

Greene's reason for not having sympathy for drug-addicted people is that their problem is the result of an illegal choice. Mr. Greene should check his facts. A high percentage of people addicted to drugs are addicted to pain medications prescribed by their doctors for various ailments. There are over 14 million people addicted to drugs in this country.

My question is, if a family member became addicted to a drug, would it be right to turn your back on that relative because he or she made an illegal choice and became overpowered by it? That family member could become one of the 120,000 people who die annually in our country due to an addiction.

The president of our country fought and overcame addictions in the past, and look where he is today. I am one of the people Greene referred to who would start a charity for those unfortunate souls that are suffering from the disease of addiction. I feel that addiction is a disease. It is a cancer that has invaded our society.

Does Mr. Greene condemn children that are drug-addicted? If so, then he condemns my son. My son is dead from an addiction. We need more money for prevention education, for rehabilitation and for whatever will stop this. If my tax dollars will go to help anyone affected by drug use, then I am proud to support such a cause.

Sensitivity training was invented to help our society protect itself from people like Mr. Greene. If he is ever so unfortunate as to become one of the 14 million people addicted this year, he should know that our tax dollars will be there for him.

Bonnie Atkinson


Date published: Fri, 08/02/2002


Drug sentencing reform just a start, some insist: War on drugs a failure, they say, and treatment should replace jail time

by Noel S. Brady
Journal Reporter

A new state law to reduce prison terms for small-time drug dealers owes its passage largely to veteran Prosecutor Norm Maleng of King County.

An ardent supporter of the bill, Maleng worked with its chief sponsor, Rep. Ruth Kagi, D-Shoreline, to craft a politically palatable first step toward drug sentencing reform.

But a growing coalition of lawmakers, attorneys, medical professionals and social activists would have preferred to see drug-policy reform move a giant step further.

They believe the war on drugs has failed and that the only way to solve the drug problem is to divert money away from prosecution and imprisonment of all nonviolent drug offenders and use the funds to treat them.

``The bill that was passed was an important first step in the right direction,'' said Roger Goodman, director of the King County Bar Association's drug police reform project. ``But there's much more to be done. Unfortunately, the war on drugs is not over, and it will never be won.

``It (the new legislation) is probably all that could be expected this year.''

Locke signed a twice-revised version of House Bill 2338 on Monday, saying it was designed to protect communities from violence and launch a smarter approach to crime and punishment when it comes to narcotics.

``(It) changes the way we sentence low-level drug offenders, reducing the prison time for first-time heroin and cocaine offenders and investing the savings into expanded treatment,'' Locke said. ``This will strengthen drug court programs across the state, helping addicts change their lives and become productive citizens.''

The new law reduces prison terms for low-level drug dealers by about six months for first-time offenses, which previously came with two-year prison terms. The measure also takes the money saved through reducing inmate housing costs and sends it straight to drug treatment and prevention programs.

Maleng said the new law could mean an additional $8.2 million a year dedicated to helping offenders put drugs behind them.

``Arrest, prosecution and imprisonment were never supposed to be the entire strategy to combat drugs,'' he said. ``Drug abuse is a complex issue that cannot be successfully battled without a comprehensive strategy that incorporates treatment as an equal partner with law enforcement.''

That's where Maleng and the drug-policy reform coalition differ.

The organizations that joined the Washington state and King County bar associations in making reform recommendations last December say nonviolent drug offenders should not be prosecuted or imprisoned at all.

A more effective approach for dealing with narcotics trafficking and drug addiction, they say, is to target the root causes, such as poverty, mental illness, lack of education and other social ills. The legal system isn't set up to do that.

Under the new law, ``people with drug problems will still be firmly under control of the judicial system,'' Goodman said. ``As for those who don't get in trouble with the law, there's still an enormous lack of resources.''

Still, Goodman said the new law leaves him optimistic that the state is moving toward full-scale reform.

``We were pleasantly surprised by half the Republican caucus voting in support of this bill,'' he said.

Andy Ko, who directs drug policy reform efforts by the American Civil Liberties Union state organization, agreed with Goodman that the outlook is positive.

The next step, he said, will be for the state to show its commitment by seeing that money saved in corrections is used for drug treatment. The state must attack the underlying problems of drug abuse, he said.

``The public is way ahead of the legislators on this issue,'' Ko said. ``But there's an awful lot of work left to be done.''

Noel Brady can be reached at or 425-453-4252.


Eastside Journal
1705 132nd Avenue N.E.
Bellevue, WA 98005-2251
Phone: 425-455-2222
Fax: 425-635-0602
All materials Copyright 2002 Horvitz Newspapers, Inc.
REMEMBER THIS ON ELECTION DAY! Drug offenders, users and dealers alike, should be treated IN JAIL! If my son were in jail, he may be alive today! I tried numerous times to have my son arrested. This may sound harsh, but I told several members of the Spotsylvania Sheriff's Department that if my son were in jail, it may save his life. Now it is too late. I will be working on getting a bill passed, I have no idea how to do this, but you can bet that I will learn fast! My intention is to have a law passed that a family member can have someone arrested if they test positive for crack cocaine, once arrested, either go to jail and recieve treatment there, or be sent to mandatory drug rehab for several months, or both. I will keep you updated on my progress in this area.                               

18.2-252. Suspended sentence conditioned upon substance abuse screening, assessment, testing, and treatment or education.

The trial judge or court trying the case of any person found guilty of violating any law concerning the use, in any manner, of drugs, controlled substances, narcotics, marijuana, noxious chemical substances and like substances, shall condition any suspended sentence by first requiring such person to agree to undergo a substance abuse screening pursuant to 18.2-251.01 and to submit to such periodic substance abuse testing, to include alcohol testing, as may be directed by the court. Such testing shall be conducted by the supervising probation agency or by personnel of any program or agency approved by the supervising probation agency. The cost of such testing ordered by the court shall be paid by the Commonwealth and taxed as a part of the costs of such criminal proceedings. The judge or court shall order the person, as a condition of any suspended sentence, to undergo such treatment or education for substance abuse, if available, as the judge or court deems appropriate based upon consideration of the substance abuse assessment. The treatment or education shall be provided by a program licensed by the Department of Mental Health, Mental Retardation and Substance Abuse Services, by a similar program available through the Department of Corrections if the court imposes a sentence of one year or more or, if the court imposes a sentence of twelve months or less, by a similar program available through a local or regional jail, a community corrections program established pursuant to 53.1-180, or an ASAP program certified by the Commission on VASAP.

(Code 1950, 54-524.101:4; 1973, c. 473; 1975, cc. 14, 15; 1979, c. 435; 1998, cc. 783, 840; 2000, cc. 1020, 1041.)
This is great, but something needs to be done for/about the individuals who are not caught or prosecuted. This is were we need to have a law stating that someone, at the request of another individual, has to take a mandatory drug test and be prosecuted and treated based on the results of that drug test. This could save a life.

Spanis Cambodian Chinese | Korean Vietnamese
 Drugs & Terror


 Drugs and Terror: Understanding the Link and the Impact on America

"It's so important for Americans to know that the traffic in drugs finances the work of terror, sustaining terrorists, that terrorists use drug profits to fund their cells to commit acts of murder. If you quit drugs, you join the fight against terror in America."

President George W. Bush

There is an undeniable link between acts of terror and illicit drugs. Law enforcement officials around the world have long recognized this close connection, but a changing world and recent events have made this link more relevant in the daily lives of all Americans. The bottom line is simple: terror and drug groups are linked in a mutually-beneficial relationship by money, tactics, geography and politics. Americans must understand that our individual choices about illicit drug use have the power to support or undermine our nation's war on terrorism.

Drugs form an important part of the financial infrastructure of terror networks. Twelve of the 28 terror organizations identified by the U.S. Department of State in October 2001 traffic in drugs. Drug income is the primary source of revenue for many of the more powerful international terrorist groups. The Revolutionary Armed Forces of Colombia (FARC) receives about $300 million from drug sales annually. The United Self Defense Forces of Colombia (AUC) relies on the illegal drug trade for 40-70 percent of its income. Peru's Shining Path is more dependent on drug money than ever before. And the Taliban regime in Afghanistan, which provided safe haven to Osama Bin Laden and his Al Qaeda network, used revenues from opium and heroin to stay in power. In 2000, Afghanistan was responsible for more than 70 percent of the world's opium trade, resulting in significant income to the Taliban.

Drug traffickers and terrorists use similar methods to achieve their criminal ends. Most importantly, they share a common disregard for human life. Many drug trafficking organizations engage in acts that most people would consider terrorist in nature. These include gruesome public killing of innocents, large-scale bombings intended to intimidate government, kidnapping and torture. These organizations prey on young people both to grow their ranks and to keep their illegitimate businesses operating. Money laundering, arms-for-drugs exchanges and use of phony documents are common among terrorist and drug groups.

Drug traffickers and terrorist organizations both attack the underpinnings of legitimate government institutions to achieve their objectives, or enjoy the protection of governments that condone terror or drug trafficking. Drug traffickers and terror groups are both drawn to regions where central government authority is weak. If a terror group already controls a region and has excluded or neutralized legitimate government institutions, drug production only requires a business deal.

The growing link between terrorists and the drug trade contributes to an increased threat to America. Drug and terrorist organizations are taking advantage of the global economy to expand the scope, scale and reach of their activities and, as a result, their ability to harm American citizens and to damage U.S. interests is dramatically expanding. As state sponsors for their activities become scarce, terrorists are increasingly dependent on drug financing. The combined force of their alliance poses an enhanced threat to regional stability, American national security and the future of our country's youth.

Parents, educators, faith and community leaders recognize that youth drug use is a serious issue in this country, and they work tirelessly to educate children about the dangers of substance abuse. Today there is a new reason to continue this important effort: the illegal drug trade is linked to the support of terror groups across the globe. Buying and using illegal drugs is not a victimless crime-it has negative consequences that can touch the lives of people around the world.

September 11th has brought the complex and horrific reality of terrorism into the lives of all Americans. Many are asking, "How did this happen?" and "What can I do?" The link between terror and drugs is an important part of the puzzle, as is the recognition that individual decisions about using drugs have real-world consequences.

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National Institute on Drug Abuse
Research Report Series

Cocaine Abuse and Addiction

What is Cocaine?

Coca plantCocaine is a powerfully addictive stimulant that directly affects the brain. Cocaine has been labeled the drug of the 1980s and '90s, because of its extensive popularity and use during this period. However, cocaine is not a new drug. In fact, it is one of the oldest known drugs. The pure chemical, cocaine hydrochloride, has been an abused substance for more than 100 years, and coca leaves, the source of cocaine, have been ingested for thousands of years.

Pure cocaine was first extracted from the leaf of the Erythroxylon coca bush, which grows primarily in Peru and Bolivia, in the mid-19th century. In the early 1900s, it became the main stimulant drug used in most of the tonics/elixirs that were developed to treat a wide variety of illnesses. Today, cocaine is a Schedule II drug, meaning that it has high potential for abuse, but can be administered by a doctor for legitimate medical uses, such as a local anesthetic for some eye, ear, and throat surgeries.

There are basically two chemical forms of cocaine: the hydrochloride salt and the "freebase." The hydrochloride salt, or powdered form of cocaine, dissolves in water and, when abused, can be taken intravenously (by vein) or intranasally (in the nose). Freebase refers to a compound that has not been neutralized by an acid to make the hydrochloride salt. The freebase form of cocaine is smokable.

Cocaine is generally sold on the street as a fine, white, crystalline powder, known as "coke," "C," "snow," "flake," or "blow." Street dealers generally dilute it with such inert substances as cornstarch, talcum powder, and/or sugar, or with such active drugs as procaine (a chemically-related local anesthetic) or with such other stimulants as amphetamines.

What is crack?

Crack is the street name given to the freebase form of cocaine that has been processed from the powdered cocaine hydrochloride form to a smokable substance. The term "crack" refers to the crackling sound heard when the mixture is smoked. Crack cocaine is processed with ammonia or sodium bicarbonate (baking soda) and water, and heated to remove the hydrochloride.

Because crack is smoked, the user experiences a high in less than 10 seconds. This rather immediate and euphoric effect is one of the reasons that crack became enormously popular in the mid 1980s. Another reason is that crack is inexpensive both to produce and to buy.

What is the scope of cocaine use
in the United States?

Trends in 30-day prevalence of cocaine abuse among eighth, tenth, and twelfth graders, 1991-1998
Trends in 30-day prevalence of cocaine abuse

In 1997, an estimated 1.5 million Americans (0.7 percent of those age 12 and older) were current cocaine users, according to the 1997 National Household Survey on Drug Abuse (NHSDA). This number has not changed significantly since 1992, although it is a dramatic decrease from the 1985 peak of 5.7 million cocaine users(3 percent of the population). Based upon additional data sources that take into account users underrepresented in the NHSDA, the Office of National Drug Control Policy estimates the number of chronic cocaine users at 3.6 million.

Adults 18 to 25 years old have a higher rate of current cocaine use than those in any other age group. Overall, men have a higher rate of current cocaine use than do women. Also, according to the 1997 NHSDA, rates of current cocaine use were 1.4 percent for African Americans, 0.8 percent for Hispanics, and 0.6 percent for Caucasians.

Crack cocaine remains a serious problem in the United States. The NHSDA estimated the number of current crack users to be about 604,000 in 1997, which does not reflect any significant change since 1988.

The 1998 Monitoring the Future Survey, which annually surveys teen attitudes and recent drug use, reports that lifetime and past-year use of crack increased among eighth graders to its highest levels since 1991, the first year data were available for this grade. The percentage of eighth graders reporting crack use at least once in their lives increased from 2.7 percent in 1997 to 3.2 percent in 1998. Past-year use of crack also rose slightly among this group, although no changes were found for other grades.

Data from the Drug Abuse Warning Network (DAWN) showed that cocaine-related emergency room visits, after increasing 78 percent between 1990 and 1994, remained level between 1994 and 1996, with 152,433 cocaine-related episodes reported in 1996.

National Institute on Drug Abuse
Research Report Series

Cocaine Abuse and Addiction

How is cocaine used?

The principal routes of cocaine administration are oral, intranasal, intravenous, and inhalation. The slang terms for these routes are, respectively, "chewing," "snorting," "mainlining," "injecting," and "smoking" (including freebase and crack cocaine). Snorting is the process of inhaling cocaine powder through the nostrils, where it is absorbed into the bloodstream through the nasal tissues. Injecting releases the drug directly into the bloodstream, and heightens the intensity of its effects. Smoking involves the inhalation of cocaine vapor or smoke into the lungs, where absorption into the bloodstream is as rapid as by injection. The drug can also be rubbed onto mucous tissues. Some users combine cocaine powder or crack with heroin in a "speedball."

Cocaine use ranges from occasional use to repeated or compulsive use, with a variety of patterns between these extremes. There is no safe way to use cocaine. Any route of administration can lead to absorption of toxic amounts of cocaine, leading to acute cardiovascular or cerebrovascular emergencies that could result in sudden death. Repeated cocaine use by any route of administration can produce addiction and other adverse health consequences.

How does cocaine produce its effects?

A great amount of research has been devoted to understanding the way cocaine produces its pleasurable effects, and the reasons it is so addictive. One mechanism is through its effects on structures deep in the brain. Scientists have discovered regions within the brain that, when stimulated, produce feelings of pleasure. One neural system that appears to be most affected by cocaine originates in a region, located deep within the brain, called the ventral tegmental area (VTA). Nerve cells originating in the VTA extend to the region of the brain known as the nucleus accumbens, one of the brain's key pleasure centers. In studies using animals, for example, all types of pleasurable stimuli, such as food, water, sex, and many drugs of abuse, cause increased activity in the nucleus accumbens.

Cocaine in the brain - In the normal communication process, dopamine is released by a neuron into the synapse, where it can bind with dopamine receptors on neighboring neurons. Normally dopamine is then recycled back into the transmitting neuron by a specialized protein called the dopamine transporter. If cocaine is present, it attaches to the dopamine transporter and blocks the normal recycling process, resulting in a build-up of dopamine in the synapse which contributes to the pleasurable effects of cocaine.
Dopamine uptake in the brain blocked by cocaine

Researchers have discovered that, when a pleasurable event is occurring, it is accompanied by a large increase in the amounts of dopamine released in the nucleus accumbens by neurons originating in the VTA. In the normal communication process, dopamine is released by a neuron into the synapse (the small gap between two neurons), where it binds with specialized proteins (called dopamine receptors) on the neighboring neuron, thereby sending a signal to that neuron. Drugs of abuse are able to interfere with this normal communication process. For example, scientists have discovered that cocaine blocks the removal of dopamine from the synapse, resulting in an accumulation of dopamine. This buildup of dopamine causes continuous stimulation of receiving neurons, probably resulting in the euphoria commonly reported by cocaine abusers.

As cocaine abuse continues, tolerance often develops. This means that higher doses and more frequent use of cocaine are required for the brain to register the same level of pleasure experienced during initial use. Recent studies have shown that, during periods of abstinence from cocaine use, the memory of the euphoria associated with cocaine use, or mere exposure to cues associated with drug use, can trigger tremendous craving and relapse to drug use, even after long periods of abstinence.

Short-term effects of cocaine
Increased energy
Decreased appetite
Mental alertness
Increased heart rate and blood pressure
Constricted blood vessels
Increased temperature
Dilated pupils

What are the short-term
effects of cocaine use?

Cocaine's effects appear almost immediately after a single dose, and disappear within a few minutes or hours. Taken in small amounts (up to 100 mg), cocaine usually makes the user feel euphoric, energetic, talkative, and mentally alert, especially to the sensations of sight, sound, and touch. It can also temporarily decrease the need for food and sleep. Some users find that the drug helps them to perform simple physical and intellectual tasks more quickly, while others can experience the opposite effect.

The duration of cocaine's immediate euphoric effects depends upon the route of administration. The faster the absorption, the more intense the high. Also, the faster the absorption, the shorter the duration of action. The high from snorting is relatively slow in onset, and may last 15 to 30 minutes, while that from smoking may last 5 to 10 minutes.

The short-term physiological effects of cocaine include constricted blood vessels; dilated pupils; and increased temperature, heart rate, and blood pressure. Large amounts (several hundred milligrams or more) intensify the user's high, but may also lead to bizarre, erratic, and violent behavior. These users may experience tremors, vertigo, muscle twitches, paranoia, or, with repeated doses, a toxic reaction closely resembling amphetamine poisoning. Some users of cocaine report feelings of restlessness, irritability, and anxiety. In rare instances, sudden death can occur on the first use of cocaine or unexpectedly thereafter. Cocaine-related deaths are often a result of cardiac arrest or seizures followed by respiratory arrest.

What are the long-term
effects of cocaine use?

Long-term effects of cocaine
Irritability and mood disturbances
Auditory hallucinations
ocaine is a powerfully addictive drug. Once having tried cocaine, an individual may have difficulty predicting or controlling the extent to which he or she will continue to use the drug. Cocaine's stimulant and addictive effects are thought to be primarily a result of its ability to inhibit the reabsorption of dopamine by nerve cells. Dopamine is released as part of the brain's reward system, and is either directly or indirectly involved in the addictive properties of every major drug of abuse.

An appreciable tolerance to cocaine's high may develop, with many addicts reporting that they seek but fail to achieve as much pleasure as they did from their first experience. Some users will frequently increase their doses to intensify and prolong the euphoric effects. While tolerance to the high can occur, users can also become more sensitive (sensitization) to cocaine's anesthetic and convulsant effects, without incre?g the dose taken. This increased sensitivity may explain some deaths occurring after apparently low doses of cocaine.

Use of cocaine in a binge, during which the drug is taken repeatedly and at increasingly high doses, leads to a state of increasing irritability, restlessness, and paranoia. This may result in a full-blown paranoid psychosis, in which the individual loses touch with reality and experiences auditory hallucinations.

What are the medical complications of cocaine abuse?

Medical consequences of cocaine abuse
Cardiovascular effects
  • disturbances in heart rhythm
  • heart attacks

Respiratory effects

  • chest pain
  • respiratory failure

Neurological effects

  • strokes
  • seizures and headaches

Gastrointestinal complications

  • abdominal pain
  • nausea
here are enormous medical complications associated with cocaine use. Some of the most frequent complications are cardiovascular effects, including disturbances in heart rhythm and heart attacks; such respiratory effects as chest pain and respiratory failure; neurological effects, including strokes, seizure, and headaches; and gastrointestinal complications, including abdominal pain and nausea.

Cocaine use has been linked to many types of heart disease. Cocaine has been found to trigger chaotic heart rhythms, called ventricular fibrillation; accelerate heartbeat and breathing; and increase blood pressure and body temperature. Physical symptoms may include chest pain, nausea, blurred vision, fever, muscle spasms, convulsions and coma.

Different routes of cocaine administration can produce different adverse effects. Regularly snorting cocaine, for example, can lead to loss of sense of smell, nosebleeds, problems with swallowing, hoarseness, and an overall irritation of the nasal septum, which can lead to a chronically inflamed, runny nose. Ingested cocaine can cause severe bowel gangrene, due to reduced blood flow. And, persons who inject cocaine have puncture marks and "tracks," most commonly in their forearms. Intravenous cocaine users may also experience an allergic reaction, either to the drug, or to some additive in street cocaine, which can result, in severe cases, in death. Because cocaine has a tendency to decrease food intake, many chronic cocaine users lose their appetites and can experience significant weight loss and malnourishment.

Research has revealed a potentially dangerous interaction between cocaine and alcohol. Taken in combination, the two drugs are converted by the body to cocaethylene. Cocaethylene has a longer duration of action in the brain and is more toxic than either drug alone. While more research needs to be done, it is noteworthy that the mixture of cocaine and alcohol is the most common two-drug combination that results in drug-related death.

What treatments are effective
for cocaine abusers?

There has been an enormous increase in the number of people seeking treatment for cocaine addiction during the 1980s and 1990s. Treatment providers in most areas of the country, except in the West and Southwest, report that cocaine is the most commonly cited drug of abuse among their clients. The majority of individuals seeking treatment smoke crack, and are likely to be poly-drug users, or users of more than one substance. The widespread abuse of cocaine has stimulated extensive efforts to develop treatment programs for this type of drug abuse. Cocaine abuse and addiction is a complex problem involving biological changes in the brain as well as a myriad of social, familial, and environmental factors. Therefore, treatment of cocaine addiction is complex, and must address a variety of problems. Like any good treatment plan, cocaine treatment strategies need to assess the psychobiological, social, and pharmacological aspects of the patient's drug abuse.

Pharmacological Approaches

There are no medications currently available to treat cocaine addiction specifically. Consequently, NIDA is aggressively pursuing the identification and testing of new cocaine treatment medications. Several newly emerging compounds are being investigated to assess their safety and efficacy in treating cocaine addiction. For example, one of the most promising anti-cocaine drug medications to date, selegeline, is being taken into multi-site phase III clinical trials in 1999. These trials will evaluate two innovative routes of selegeline administration: a transdermal patch and a time-released pill, to determine which is most beneficial.Cocaine Addiction Treatment manual covers Disulfiram, a medication that has been used to treat alcoholism, has also been shown, in clinical studies, to be effective in reducing cocaine abuse. Because of mood changes experienced during the early stages of cocaine abstinence, antidepressant drugs have been shown to be of some benefit. In addition to the problems of treating addiction, cocaine overdose results in many deaths every year, and medical treatments are being developed to deal with the acute emergencies resulting from excessive cocaine abuse.

Behavioral Interventions

Many behavioral treatments have been found to be effective for cocaine addiction, including both residential and outpatient approaches. Indeed, behavioral therapies are often the only available, effective treatment approaches to many drug problems, including cocaine addiction, for which there is, as yet, no viable medication. However, integration of both types of treatments is ultimately the most effective approach for treating addiction. It is important to match the best treatment regimen to the needs of the patient. This may include adding to or removing from an individual's treatment regimen a number of different components or elements. For example, if an individual is prone to relapses, a relapse component should be added to the program. A behavioral therapy component that is showing positive results in many cocaine-addicted populations, is contingency management. Contingency management uses a voucher-based system to give positive rewards for staying in treatment and remaining cocaine free. Based on drug-free urine tests, the patients earn points, which can be exchanged for items that encourage healthy living, such as joining a gym, or going to a movie and dinner. Cognitive-behavioral therapy is another approach. Cognitive-behavioral coping skills treatment, for example, is a short-term, focused approach to helping cocaine-addicted individuals become abstinent from cocaine and other substances. The underlying assumption is that learning processes play an important role in the development and continuation of cocaine abuse and dependence. The same learning processes can be employed to help individuals reduce drug use. This approach attempts to help patients to recognize, avoid, and cope; i.e., recognize the situations in which they are most likely to use cocaine, avoid these situations when appropriate, and cope more effectively with a range of problems and problematic behaviors associated with drug abuse. This therapy is also noteworthy because of its compatibility with a range of other treatments patients may receive, such as pharmacotherapy.

Therapeutic communities, or residential programs with planned lengths of stay of 6 to 12 months, offer another alternative to those in need of treatment for cocaine addiction. Therapeutic communities are often comprehensive, in that they focus on the resocialization of the individual to society, and can include on-site vocational rehabilitation and other supportive services. Therapeutic communities typically are used to treat patients with more severe problems, such as co-occurring mental health problems and criminal involvement.



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