Thoughts from the void: Cannabis and Harm Reduction

Even where harm reduction services are available, they are not necessarily accessible. Punitive drug control laws, policies and law enforcement practices have been shown to be among the largest obstacles to health care in many countries. Criminalization of drug use and harsh punishments (such as incarceration, high fines or removal of children from their parents) discourage the uptake of HIV services, drive people underground and lead to unsafe injecting practices, and increase the risk of overdose. Women who use drugs face higher rates of conviction and incarceration than men who use drugs, contributing to the increased levels of stigma and discrimination they face in health-care settings. In effect, criminalization of drug use and possession for personal use significantly and negatively impact the realization of the right to health.'

- UNAIDS.ORG

- US DEA

'In recent years, we have seen synthetic opioids, such as illicitly manufactured fentanyl, drive many overdose deaths with cocaine- and methamphetamine-related deaths also increasing at alarming rates. The COVID-19 pandemic has exacerbated the overdose epidemic, as necessary pandemic restrictions made it harder for individuals with addiction to receive the treatment and support services they need. These factors contributed to the more than 93,000 drug overdose deaths in 2020. As a Nation, we need a strong response to America’s overdose epidemic and an investment in prevention, harm reduction, treatment and recovery services, as well as strategies to reduce the supply of illicit drugs. '

- US White House Briefing, Overdose Awareness Week, August 2021

'Many participants reported more than one substitution. About 45% reported substituting cannabis for alcohol, 31% substituted it for tobacco, and 26% substituted it for illicit drugs. A whopping 69% reported substituting cannabis for prescription drugs.

Unsurprisingly, opioids were the most common among pharmaceutical substitutions, at 35%. Antidepressants and anti-anxiety prescriptions came in close behind at 21%.

Detailed questions revealed that chronic pain and mental health issues were the two most common reasons participants took cannabis, both at just under 30%.'

- Leafly

"As to the evil sequelæ so unanimously dwelt on by all writers, these did not appear to us so numerous, so immediate, or so formidable as many which may be clearly traced to over-indulgence in other powerful stimulants or narcotics, viz., alcohol, opium, or tobacco."

- William O'Shaugnessey , Eminent 19th Century British Physician

Along with the prohibition of cannabis, starting from the mid-19th century in British-ruled India, a number of things happened. Alcohol, especially the Western variety, emerging from distilleries and breweries, replaced palm toddy, home made arrack, and other natural liquors and beverages in many Western colonies. Tobacco usage increased, with the backing of European politicians and businessmen, and with the growth of multinational tobacco companies reached all corners of the earth and all ages. The pharmaceutical industry took off like never before, riding on the increased availability and usage of opium. Besides opioids, the legal and illegal pharmaceutical industry churned out other synthetic drugs, such as cocaine, amphetamines, synthetic cannabinoids, barbiturates, benzodiazepines, sedatives, cathinones, novel psychotropic substances, etc. In the place of cannabis, used for nutrition, industry, spirituality, recreation and medicine, by the vast majority of the working classes and poorer sections of society all over the world for thousands of years, society was provided with the option of tobacco, opium, western alcohol, and synthetic pharmaceutical drugs, in keeping with European and North American recreational preferences.

Cannabis, as a universal medicine with anti-inflammatory, analgesic/anodyne, anaesthetic, diuretic, stimulant, sedative, intoxicant, aphrodisiac, disinfectant, antiphlegmatic/expectorant, tonic, antispasmodic, astringent, haemostatic, purgative, ecbolic, digestive, prophylactic, laxative, hypnotic, refrigerent, antiperiodic, soporific, parturifacient, antidote, diaphoretic, carminative, excitant, heating properties, treated dozens of conditions. The pharma industry exploited the vacuum caused by its prohibition, introducing one medication per condition, and in many cases, a combination of prescription medicines to treat a condition.

Today, people worldwide regularly consume a daily cocktail of pharmaceutical prescription medicines, often numbering more than a dozen. In addition to prescription medicine usage, there has been a huge increase in the non-medical usage or abuse of prescription drugs i.e. more and more people are using prescription drugs for recreation purposes without medical supervision. Opium based pharmaceutical drugs known as opioids have become so popular and addictive that the US declared an opioid epidemic in 2018, with deaths in the range of 70,000. Opioid based addiction is not just restricted to the over the counter painkillers, but soon shifts to heroin, as tolerance builds and cheap heroin becomes accessible, and finally the addiction graduates to highly lethal opioids, like fentanyl, resulting in death. Another effect of prohibition of the medicinal, traditional, safe and recreational cannabis, and the evolution of the pharma industry, is that now many people set up home labs and make their own medications such as a range of synthetic cannabis like Spice, or other dngerous drugs like methamphetamine, or cocaine, which are extremely difficult to detect, but are very freely available. Many persons who seek natural cannabis get sucked into the usage of synthetic drugs and are, in no time, hooked to it. The worldwide heroin, amphetamine and cocaine networks that have grown with cannabis prohibition are powerful enough to provide substantial funding for arms, and armies around the world. The number of nations involved in cocaine and heroin manufacture, smuggling and trade is mind boggling. Suffice to say that the US is the world's largest consumer of heroin, cocaine and methamphetamine. The US is also the champion of global cannabis prohibition. The Wall Street Journal reported in 2020 that - 'The estimated 93,331 deaths from drug overdoses last year, a record high, represent the sharpest annual increase in at least three decades, and compare with an estimated toll of 72,151 deaths in 2019, according to provisional overdose-drug data released Wednesday by the Centers for Disease Control and Prevention....An estimated 57,550 people died of overdoses from synthetic opioids, primarily fentanyl, an increase of more than 54% over 2019, according to Robert Anderson, chief of the mortality statistics branch at the CDC’s National Center for Health Statistics. “Definitely fentanyl is the driving factor,” he said. Overdose deaths from opioids overall rose nearly 37%, according to the CDC data. Deaths from overdoses of methamphetamine and cocaine also rose, the CDC said.'

Cannabis is the harm reduction solution par excellence. Instead of being the gateway drug that it is so often wrongly made out to be, it is in fact an exit drug that can help get people off much more dangerous drugs like prescription drugs, novel psychoactive substances (NPS), synthetic cannabis, methamphetamine, opioids, alcohol, tobacco, cocaine, etc. The amount of cannabis normally ingested under recreational conditions compared to the amount that could potentially kill you i.e its safe to lethal dosage ratio is in the order of around 1:40000. With most of the above listed drugs, the ratio could be as low as 1:2 for drugs like fentanyl or 1:6 for alcohol. The number of deaths due to cannabis since it began being used by humans tens of thousands of years ago is about zero whereas already the number of deaths from opioids run into hundreds of thousands per year and from alcohol and tobacco run in the millions per year. In India, it is said that 1200 people die every day to tobacco alone.

One of the main intentions of the British government for prohibiting cannabis in India was to increase the sales of opium, from which it derived much greater revenues than from cannabis which was freely available everywhere and used by the poorest classes. Regarding the use of cannabis, as a harm reduction alternative to opioids, PolitiFact reports that - 'The analysis looked at nine separate studies involving a total of 7,222 participants across the U.S., Canada and Australia that "found a much higher reduction in opioid dosage, reduced emergency room visits, and hospital admissions for chronic non-cancer pain by (medical cannabis) users, compared to people with no additional use of" medical cannabis. Those studies confirm Larson’s assertion: There was a 64% to 75% reduction in opioid dosage when patients supplemented their chronic pain treatments with medical cannabis, and 32% to 59% of cannabis users reported a complete end to opioid use.' The US cannabis advocacy group, NORML reports that - 'The study’s authors concluded: “These observations are encouraging given the uncertainty surrounding the impact of cannabis legalization policies during the ongoing opioid overdose crisis in many settings in the United States and Canada, particularly among PWID [people who inject drugs] who are at increased risk for drug-related harm. The accumulating evidence from preclinical and epidemiological studies linking cannabis use to opioid use behaviors further supports the evaluation of the therapeutic benefits of cannabis and specific cannabinoids (e.g., CBD and THC) for people living with opioid use disorder.”

As far back as the 19th century, many medical experts and knowledgeable persons had warned about the harms of alcohol, and the risks it posed if cannabis was prohibited in India. As an example, we can see the evidence of Surgeon-Lieutenant-Colonel Crombie, appearing before the Indian Hemp Drugs Commission, 1894-95. He states that - "I believe that the habit of using ganja moderately is absolutely harmless; but I think even the moderate use of alcohol is liable to produce tissue changes in the long run. Further, I here refer entirely to the native community; and it is my observation that when a native takes to alcohol, it is extremely difficult for him to remain moderate; and in life assurance work, of which I have a good deal, I always advise an extra premium in the case of any native who indulges in alcohol even in the most moderate way, and utterly refuse to accept a native life if there is evidence of the consumption of alcohol to any considerable extent which would still be considered moderate in the case of Europeans. My experience leads me to hold the same views of the effects of alcohol on the lower classes. A native who takes to liquor is lost. As regards the excessive use, I would still place alcohol first. I regard it as most deleterious." Regarding the use of cannabis as a harm reduction alternative to alcohol, Science Direct reports that - 'Following medical cannabis initiation, 44% (n=419) of participants reported decreases in alcohol use frequency over 30 days, and 34% (n=323) decreased the number of standard drinks they had per week. Younger age (<55 years old) and higher rates of alcohol use prior to medical cannabis initiation were associated with greater odds of reducing alcohol. Specific intention to use medical cannabis to reduce alcohol consumption resulted in greater odds of reducing and/or ceasing use altogether.'

Tobacco, which replaced cannabis in many places around the world after the Europeans discovered it in 17th century South America, kills tens of millions of people every year. Regarding the use of cannabis as a replacement for tobacco, NORML writes - 'Authors concluded: “Results from this retrospective survey of medical cannabis users suggest that initiation of medical cannabis use was associated with self-reported reductions and/or cessation of T/N [tobacco/nicotine]. … In light of the significant morbidity, mortality, and health care costs related to T/N dependence, future research should further evaluate the potential of cannabis-based treatments to support efforts to reduce or cease T/N use.”'

With regard to th use of cannabis to replace cocaine, Science Direct reports - 'Overall, our data suggest that CBD can prevent the development of cocaine addiction, and, when administered during cocaine abstinence, may be of help in avoiding relapse to drug-seeking and in ameliorating the memory disturbances provoked by chronic consumption of cocaine.'

The PLOSONE Journal, reiterating the overall harm reduction capabilities of cannabis, as against the use of synthteic pharmaceutical prescription drugs, reports that - 'The vast majority of study participants engaged in daily, intensive cannabis use at the same time as they cycled on and off other substances that were perceived as much more harmful (primarily alcohol, fentanyl, heroin and meth). While most participants derived significant pleasure from the use of cannabis, no participants in our study described using cannabis for purely recreational purposes. A number of participants explicitly framed cannabis as a form of mental health and substance use treatment that was more effective and “healthier” than the long-term use of psychopharmaceuticals and medication-assisted substance use treatment (e.g., opioid agonist therapies). Cannabis use was also understood to ameliorate some of the harms of, or even facilitate transitions out of, periods of street-based homelessness.'

Many people who have got addicted to deadlier drugs, have often been sold those drugs as substitutes, due to the lack of availability of natural cannabis, or as cheaper alternatives because of the high cost of illegal cannabis, or because the drug dealer hopes to make a bigger profit through up selling the deadlier drugs. For many people, the usage of synthetic drugs is a result of the stigma created around cannabis by society and the media, and the glamor associated with the synthetic drugs and promoted by the elite.

The replacement of deadly drugs with natural cannabis can be a very effective way forward in addressing the issue of drug addiction and rehabilitation. Rehabilitation centers, physicians and caregivers need to explore the option of using cannabis as a harm reduction alternative. Legalizing cannabis for adult recreational use will go a long way as a preventive mechanism in cutting off the demand for dangerous drugs, which may be precisely the reason why it is not being done world wide. Many countries today talk about decriminalizing all drugs, but the step that would be most effective would be the legalization of adult recreational cannabis first so that society has a safe alternative and then decriminalizing the synthetic drugs and using education to curb the usage of the more dangerous drugs. Harm Reduction Journal reports that - 'Four themes emerged during analyses: “sort of legal,” “mitigating harm through legalization,” “Increasing acceptance,” and “seeking safety when purchasing cannabis.” Despite their limited knowledge of cannabis regulation, the majority of the participants supported recreational cannabis legalization from a harm reduction perspective. Most participants did not believe that cannabis legalization had affected their use behavior. However, participants, especially cannabis users, perceived that recreational cannabis legalization created a context where cannabis use was legally, socially, and behaviorally “safer” than in an illegal context, even for those below the legal age of sale.' The Netherlands, Spain and Portugal have followed the approach of classifying cannabis as a soft drug but have not entirely legalized it. Uruguay, Canada, Malta and Luxembourg have fully legalized recreational cannabis. Many US states have gone ahead with full adult recreational use legalization of cannabis. Many European, African and Asian countries, such as Morocco, Thailand, South Africa, Mexico, Colombia, the Czech Republic, and Germany are starting to wake up to these changes.

Besides the direct harms through cannabis prohibition there are a number of indirect harms. For ex. the high incidence of HIV among persons who inject drugs (PWID) is alarming. This is mostly prevalent in poorer societies where needle reuse and sharing is common, especially to inject heroin or methamphetamine. Another harm is that the adulteration of drugs increases the risk of death, especially, since many of these drugs originate from home labs and other crude manufacturing units where product purity is the least concern and maximizing profits is the most. Also the sections of society most prone to harm are the poorest, the indigenous communities, the youth and the minorities.

Then there is the harm caused by the war on drugs, essentially a war on cannabis, with a few synthetic drugs thrown in to try and mask the real target of the war. Any pro-cannabis action is met with opposition by the synthetic pharmaceutical industry, medical industry, petrochemical industry and its allied chemical fertilizer and construction industry, timber industry, textile industry, alcohol and tobacco industry. These industries, through their influence over governments and policy makers, have ensured that no one who associates with cannabis is spared. The targets are mostly minorities, indigenous communities, poor farmers and those who speak out against the system that keeps cannabis prohibited. The numbers of persons incarcerated for cannabis related crimes world wide is in the millions. The numbers that have been killed is unknown. The number of cannabis varieties that have gone extinct through uncontrolled extermination of the plant is unknown. The actual number of cannabis plants that have been destroyed by the war on drugs to date probably runs in the trillions.

Cannabis's role in harm reduction is not restricted to the area of drugs. Cannabis has harm reduction abilities on a planetary scale. It can reduce the harms caused by the petrochemical industries, replacing non-biodegradable materials with bio-degradable materials in the areas of plastics and construction. It can replace timber for paper. It can replace water-intensive cotton and synthetic fabrics in the textile industry. It can reduce the need for resource intensive rice and wheat in agriculture. It can reduce the use of harmful synthetics in the wellness and cosmetic industry. It can reduce the need for harmful synthetic fertilizers and pesticides. These are just some of the areas in which cannabis offers solutions to a world hurtling towards man-made climate catastrophe.

So the taking out of the picture of one organic traditional medicinal recreational herb has resulted in its replacement by alcohol, tobacco, prescription drugs, heroin, cocaine, methamphetamine, synthetic cannabis, novel psychotropic substances (NPS) , cathinones, to name just a few. In the 100 years or so since cannabis prohibition began, these drugs have probably killed in the hundreds of millions, and possibly billions, much more than all the wars in human history combined. The reintroduction of cannabis as a legal recreational drug worldwide will surely once again serve to reverse the process, weaning people off the deadly alternatives that have been made available and replacing these dangerous drugs with the wholesome herb once again. That is the harm reduction potential of cannabis. Yet, cannabis's potential for harm reduction is not recognized and appreciated at all. Or maybe it is just repeatedly ignored deliberately. We are not talking about individuals here but supposedly responsible and accountable organizations like governments and their health departments, as well as an organization like the UN and its health arm, the WHO. The persons profiting from the current situation, such as the world wide drug cartels, the pharmaceutical companies, politicians, law enforcement agencies, drug enforcement agencies, prison systems, medical industry, drug rehabilitation centers, NGOs, alcohol and tobacco industries, etc., who all stand to benefit from cannabis prohibition, continue to exert vast influence on the decision makers.

Cannabis continues to be classified as the most dangerous drug with the most risk of abuse and it is projected world wide as such, while the real threats to health, life and society continue to take their toll. Cannabis's potential, as the harm reduction mechanism beyond compare, continues to be ignored.

The following list of articles taken from various media speak about the above subject. Words in italics are the thoughts of yours truly at the time of reading the article.

'“[T]he ability of WPE [whole-plant cannabis extract] to reduce opioid reward and drug seeking behavior appears quite robust and of great clinical utility,” authors concluded. “Additional systematic research is required to fully evaluate the potential for CBD to serve as an adjunct treatment for opioid use disorder.”

A limited number of clinical trials have previously demonstrated the ability of CBD to mitigate subjects’ cravings for various substances, including heroin, tobacco, and cannabis. Other studies indicate that CBD may also play a role in mitigating symptoms of opioid withdrawal. According to a 2020 review paper, “[E]vidence … demonstrates the potential [of] cannabis to ease opioid withdrawal symptoms, reduce opioid consumption, ameliorate opioid cravings, prevent opioid relapse, improve OUD treatment retention, and reduce overdose deaths.”'

https://norml.org/news/2023/03/23/cbd-administration-mitigates-opioid-cravings-in-animals/

Smoke that joint (the natural one with the right balance of THC and CBD not synthetic skunk with predominantly THC) when you drink to protect your liver..

"In conclusion, we demonstrate that CBD treatment significantly attenuates liver injury induced by chronic plus binge alcohol in a mouse model and oxidative burst in human neutrophils. CBD ameliorates alcohol-induced liver injury by attenuating inflammatory response involving E-selectin expression and neutrophil recruitment, and consequent oxidative/nitrative stress, in addition to attenuation of the alcohol-induced hepatic metabolic dysregulation and steatosis. These beneficial effects, coupled with the proven safety of CBD in human clinical trials and its current orphan drug approval by FDA for various indications suggest that it may have therapeutic potential in liver disease associated with inflammation, oxidative stress, metabolic dysregulation and steatosis."

https://www.nature.com/articles/s41598-017-10924-8

'Timely introduction and full-scale implementation of accessible harm reduction programmes can prevent HIV infections, as well as many cases of viral hepatitis B and C, tuberculosis and drug overdose. The United Nations system is united in promoting harm reduction services and decriminalization of personal possession of drugs, based on the evidence that harm reduction and decriminalization provide substantial public and personal health benefits and do not increase the number of people with drug dependency. Despite this position, reflected in the United Nations system common position supporting the implementation of the international drug control policy through effective inter-agency collaboration, in reality less than 1% of people who inject drugs live in countries with the United Nations-recommended levels of coverage of needles, syringes and opioid substitution therapy, and the funding gap for harm reduction in low- and middle-income countries sits at a dismal 95%.

Even where harm reduction services are available, they are not necessarily accessible. Punitive drug control laws, policies and law enforcement practices have been shown to be among the largest obstacles to health care in many countries. Criminalization of drug use and harsh punishments (such as incarceration, high fines or removal of children from their parents) discourage the uptake of HIV services, drive people underground and lead to unsafe injecting practices, and increase the risk of overdose. Women who use drugs face higher rates of conviction and incarceration than men who use drugs, contributing to the increased levels of stigma and discrimination they face in health-care settings. In effect, criminalization of drug use and possession for personal use significantly and negatively impact the realization of the right to health.'

https://www.unaids.org/en/resources/presscentre/pressreleaseandstatementarchive/2021/november/20211101_international-drug-users-day

'“The United States is facing an unprecedented crisis of overdose deaths fueled by illegally manufactured fentanyl and methamphetamine,” said Anne Milgram, Administrator of the Drug Enforcement Administration. “Counterfeit pills that contain these dangerous and extremely addictive drugs are more lethal and more accessible than ever before. In fact, DEA lab analyses reveal that two out of every five fake pills with fentanyl contain a potentially lethal dose. DEA is focusing resources on taking down the violent drug traffickers causing the greatest harm and posing the greatest threat to the safety and health of Americans. Today, we are alerting the public to this danger so that people have the information they need to protect themselves and their children.”

These counterfeit pills have been seized by DEA in every U.S. state in unprecedented quantities. More than 9.5 million counterfeit pills were seized so far this year, which is more than the last two years combined. DEA laboratory testing reveals a dramatic rise in the number of counterfeit pills containing at least two milligrams of fentanyl, which is considered a lethal dose. A deadly dose of fentanyl is small enough to fit on the tip of a pencil.

Counterfeit pills are illegally manufactured by criminal drug networks and are made to look like real prescription opioid medications such as oxycodone (Oxycontin®, Percocet®), hydrocodone (Vicodin®), and alprazolam (Xanax®); or stimulants like amphetamines (Adderall®). Fake prescription pills are widely accessible and often sold on social media and e-commerce platforms – making them available to anyone with a smartphone, including minors.'

https://www.dea.gov/press-releases/2021/09/27/dea-issues-public-safety-alert-sharp-increase-fake-prescription-pills

'A team of researchers affiliated with the University of California at Irvine and with Pennsylvania State University assessed the relationship between medical cannabis legalization laws and cigarette initiation among adolescents.

They concluded: “Our results indicate lower odds of initiating cigarettes, in every age group (8 years old or younger, 9-10, 11-12, 13-14, 15-16, 17 years old or older) in states with MMLs [medical marijuana laws] when compared to non-MML states. … Further research should evaluate how MMLs and recreational marijuana policies are associated with e-cigarette initiation and use.”'

https://norml.org/news/2021/08/19/study-medical-cannabis-laws-associated-with-declines-in-youth-cigarette-use

'While it is true that the revised provision, as was the case in the prior language, states that federal funds cannot be used to pay for marijuana, the spokesperson initially avoided commenting on the new deletion of the broader prohibition on grants going to entities that otherwise allow patients to use medical cannabis to treat substance use or mental disorders.

“You can see from our recent press releases that SAMHSA’s priorities are to expand opportunities for people to get into treatment, as well as to grow the behavioral health workforce,” he added in response to a follow-up question. “Funds from SAMHSA, a federal agency, cannot be used to purchase a federally prohibited substance.”'

https://www.marijuanamoment.net/federal-agency-loosens-marijuana-related-grant-funding-restrictions-for-mental-health-treatment/

'Cocaine use disorder (CUD) is a major public health issue associated with physical, social, and psychological problems. Excessive and repeated cocaine use induces oxidative stress leading to a systemic inflammatory response. Cannabidiol (CBD) has gained substantial interest for its anti-inflammatory properties, safety, and tolerability profile. However, CBD anti-inflammatory properties have yet to be confirmed in humans. This exploratory study is based on a single-site randomized controlled trial that enrolled participants with CUD between 18 and 65 years, randomized (1:1) to daily receive either CBD (800mg) or placebo for 92 days. The trial was divided into a 10-day detoxification (phase I) followed by a 12-week outpatient follow-up (phase II). Blood samples were collected from 48 participants at baseline, day 8, week 4, and week 12 and were analyzed to determine monocytes and lymphocytes phenotypes, and concentrations of various inflammatory markers such as cytokines. We used generalized estimating equations to detect group differences. Participants treated with CBD had lower levels of interleukin-6 (p=0.017), vascular endothelial growth factor (p=0.032), intermediate monocytes CD14+CD16+ (p=0.024), and natural killer CD56negCD16hi (p=0.000) compared with participants receiving placebo. CD25+CD4+T cells were higher in the CBD group (p=0.007). No significant group difference was observed for B lymphocytes. This study suggests that CBD may exert anti-inflammatory effects in individuals with CUD.'

https://www.nature.com/articles/s41386-021-01098-z

'The enactment of state-level, adult-use marijuana legalization laws is not associated with increases in either drug treatment admissions, violent crime, or overdose deaths, according to a comprehensive analysis published by the National Bureau of Economic Research.

A team of economists reviewed nationally representative data across all 50 states and the District of Columbia to “comprehensively explore the broader impacts of RMLs [recreational marijuana laws], providing some of the first evidence on how marijuana legalization is affecting illicit drug use, heavy alcohol use, arrests for drug and non-drug offenses, and objectively-measured adverse drug-related events including drug-related overdose deaths and admissions into substance abuse treatment services.”'

https://norml.org/news/2021/07/22/analysis-adult-use-legalization-laws-not-linked-to-increases-in-violent-crime-problematic-substance-abuse

'Recreational marijuana laws (RMLs), which legalize the possession of small quantities of marijuana for recreational use, have been adopted by 18 states and the District of Columbia. Opponents argue that RML-induced increases in marijuana consumption will serve as a “gateway” to harder drug use and crime. Using data covering the period 2000-2019 from a variety of national sources (the National Survey of Drug Use and Health, the Uniform Crime Reports, the National Vital Statistics System, and the Treatment Episode Data Set) this study is the first to comprehensively examine the effects of legalizing recreational marijuana on hard drug use, arrests, drug overdose deaths, suicides, and treatment admissions. Our analyses show that RMLs increase adult marijuana use and reduce drug-related arrests over an average post-legalization window of three to four years. There is little evidence to suggest that RML-induced increases in marijuana consumption encourage the use of harder substances or violent criminal activity. '

https://www.nber.org/papers/w29038

'The estimated 93,331 deaths from drug overdoses last year, a record high, represent the sharpest annual increase in at least three decades, and compare with an estimated toll of 72,151 deaths in 2019, according to provisional overdose-drug data released Wednesday by the Centers for Disease Control and Prevention....

An estimated 57,550 people died of overdoses from synthetic opioids, primarily fentanyl, an increase of more than 54% over 2019, according to Robert Anderson, chief of the mortality statistics branch at the CDC’s National Center for Health Statistics. “Definitely fentanyl is the driving factor,” he said. Overdose deaths from opioids overall rose nearly 37%, according to the CDC data.

Deaths from overdoses of methamphetamine and cocaine also rose, the CDC said.'

https://www.wsj.com/articles/u-s-drug-overdose-deaths-soared-nearly-30-in-2020-11626271200

'It appears that cannabidiol and cannabinoid receptor 1 (CB1R) antagonists have potential for treating drug-craving and drug-seeking behaviour, based on evidence from preclinical animal models. Ligands which inhibit the action of cannabinoid degradation enzymes also show promise in reducing opioid withdrawal symptoms and opioid self-administration in rodents. Agonists of CB1R could be useful for treating symptoms of opioid withdrawal; however, the clinical utility of these drugs is limited by side effects, the potential for cannabinoid addiction and an increase in opiate tolerance induced by cannabinoid consumption. The mechanisms by which cannabinoids reduce opioid addiction-relevant behaviours include modulation of cannabinoid, serotonin, and dopamine receptors, as well as signalling cascades involving ERK-CREB-BDNF and peroxisome proliferator-activated receptor-a. Identifying the receptors involved and their mechanism of action remains a critical area of future research.'

https://epistemehealth.com/index.php/nab/article/view/14

'Overall, our data suggest that CBD can prevent the development of cocaine addiction, and, when administered during cocaine abstinence, may be of help in avoiding relapse to drug-seeking and in ameliorating the memory disturbances provoked by chronic consumption of cocaine.'

https://www.sciencedirect.com/science/article/pii/S0278584621001494

'Results

Between 2015 and 2019, perceived risk associated with regular use decreased from 52.6% to 42.7%, an 18.8% relative decrease (p < 0.001). Decreases in perceived risk were detected in particular among those never married (a 32.6% relative decrease), those who binge drink (a 31.3% relative decrease), use tobacco (a 26.8% relative decrease), have kidney disease (a 32.1% relative decrease), asthma (a 31.7% relative decrease), heart disease (a 16.5% relative decrease), chronic obstructive pulmonary disease (a 21.5% relative decrease), two or more chronic conditions (a 20.2% relative decrease), and among those reporting past-year emergency department use (a 21.0% relative decrease) (ps < 0.05).'

https://agsjournals.onlinelibrary.wiley.com/doi/10.1111/jgs.17213

'Subjects ages 55 and older, as well as those who expressed intentions to quit tobacco, were most likely to reduce their tobacco/nicotine use.

Authors concluded: “Results from this retrospective survey of medical cannabis users suggest that initiation of medical cannabis use was associated with self-reported reductions and/or cessation of T/N [tobacco/nicotine]. … In light of the significant morbidity, mortality, and health care costs related to T/N dependence, future research should further evaluate the potential of cannabis-based treatments to support efforts to reduce or cease T/N use.”'

https://norml.org/news/2021/05/27/initiation-of-medical-cannabis-precedes-self-reported-reductions-in-tobacco-use

'Findings: Following principles of harm reduction and risk minimization, we suggest cannabis be introduced in appropriately selected CNCP [Chronic non-cancer pain] patients, using a stepwise pproach, with the intent of pain management optimization. We use a structured approach to focus on low dose cannabis (namely, THC) initiation, slow titration, dose optimization and frequent monitoring.

Conclusion: When low dose THC is introduced as an adjunctive therapy, we observe better pain control clinically with lower doses of opioids, improved pain related outcomes and reduced opioid related harm.'

https://www.frontiersin.org/articles/10.3389/fphar.2021.633168/full

'Researchers reported that participants assigned to use CBD-dominant cannabis during the trial period “drank fewer drinks per drinking day, had fewer alcohol use days, and fewer alcohol and cannabis co-use days compared with the other groups.” Subjects assigned to the other two groups reported no changes in their drinking patterns.

Authors acknowledged that the results were “consistent with preclinical work suggesting that CBD may be associated with decreased alcohol consumption.” Separate studies have previously indicated that CBD may reduce subjects’ cravings for other controlled substances, including tobacco and heroin. '

https://norml.org/news/2021/04/29/study-use-of-cbd-dominant-cannabis-associated-with-reduced-alcohol-intake

I estimate the total global deaths in 2020 to be somewhere in the range of 60-70 million people from all causes of death such as non-communicable diseases, communicable diseases and injuries. Covid with approx. 2 million deaths in 2020 would account for something like 3-4% of all deaths. Compare that with the top cause of death in 2019, ischaemic heart disease, that I estimate accounts for around 9-10 million deaths or 15-16% of deaths in 2020. So the world has stopped addressing causes of death that are responsible for 96-97% of deaths and focused completely on an alleged disease that accounts for 3-4% of deaths. To top it all, I firmly believe that many of the persons who have died in 2020 from other causes of death have been given the Covid tag as cause of death to boost the numbers and thus support the global havoc that governments, health officials, the medical industry, pharma industry and petrochemical industry have wrecked. Even if this is not the case, Covid only accounts for under 5% of all causes of death, totally not acceptable or justifiable for the oppression that has happened in the past year of the world's people and still continues today...What a terrible global crime by these charlatans...the second worst in human history in terms of global impact after prohibition of cannabis. Cannabis would have not only mitigated such global crimes by clipping the wings of these charlatans but even addressed most, it not all, leading causes of global deaths...

Mar 31, 2021 4:45:52pm

'It was revealed that CBD (10 and 50 µg/5 µL) microinjection profoundly inhibited both phases of MET [Methamphetamine]-induced CPP [conditioned place preference] without any side effect on the locomotion in animals were treated by MET injection over conditioning phase. Also, CBD's inhibitory impact was more potent in the acquisition phase than the expression phase of MET-induced CPP. Ultimately, the current research reported that CBD could be a beneficial compound to treat drug abuse however more investigations are needed.'

https://www.sciencedirect.com/science/article/abs/pii/S0166432821000450

'Findings
Across the sample (N=96), individuals drank approximately 29% fewer drinks (95% Confidence Interval (C.I.) 18%-39%, p<.001) and were 2.06 times (95% C.I. 1.37-3.08, p<.001) less likely to have a binge-drinking episode on days that cannabis was used compared with days cannabis was not used. These patterns were observed in males, females and the infrequent and frequent cannabis use groups. Findings were inconclusive regarding differences in the association between cannabis use and alcohol outcomes when comparing males and females and when comparing infrequent and frequent cannabis use groups.

Conclusions
Heavy drinkers engaged in treatment to reduce their alcohol consumption who also use cannabis appear to increase their cannabis use on days when they reduce their alcohol consumption.'

https://onlinelibrary.wiley.com/doi/10.1111/add.15407

'“The results of the Tilray Observational Patient Study (TOPS) add to a growing body of evidence that cannabis use can lead to a reduction in the use of prescription drugs, alcohol, tobacco, and other substances” Philippe Lucas, lead study author, said in a press release.

“In light of the devastating impacts of the opioid overdose crisis in Canada and around the world, research examining the potential influence of cannabis on opioid use may be of particular importance to public health, and these findings could inform harm reduction strategies to mitigate the significant morbidity and mortality associated with opioids,” he said.

There were also similar reductions in the four other drug categories that the study investigated: non-opioid pain medication, anti-depressants, benzodiazepines and anti-seizure drugs.'

https://www.marijuanamoment.net/medical-marijuana-leads-to-reduced-opioid-use-new-study-finds/

'Growing evidence indicates that CBD has therapeutic potential in reducing drug reward, as assessed in intravenous drug self-administration, conditioned place preference and intracranial brain-stimulation reward paradigms. In addition, CBD is effective in reducing relapse in experimental animals. Both in vivo and in vitro receptor mechanism studies indicate that CBD may act as a negative allosteric modulator of type 1 cannabinoid (CB1) receptor and an agonist of type 2 cannabinoid (CB2), transient receptor potential vanilloid 1 (TRPV1), and serotonin 5-HT1A receptors. Through these multiple-receptor mechanisms, CBD is believed to modulate brain dopamine in response to drugs of abuse, leading to attenuation of drug-taking and drug-seeking behavior. '

https://www.mdpi.com/1422-0067/22/1/134

'Four themes emerged during analyses: “sort of legal,” “mitigating harm through legalization,” “Increasing acceptance,” and “seeking safety when purchasing cannabis.” Despite their limited knowledge of cannabis regulation, the majority of the participants supported recreational cannabis legalization from a harm reduction perspective. Most participants did not believe that cannabis legalization had affected their use behavior. However, participants, especially cannabis users, perceived that recreational cannabis legalization created a context where cannabis use was legally, socially, and behaviorally “safer” than in an illegal context, even for those below the legal age of sale.'

https://harmreductionjournal.biomedcentral.com/articles/10.1186/s12954-020-00442-8

'The analysis looked at nine separate studies involving a total of 7,222 participants across the U.S., Canada and Australia that "found a much higher reduction in opioid dosage, reduced emergency room visits, and hospital admissions for chronic non-cancer pain by (medical cannabis) users, compared to people with no additional use of" medical cannabis.

Those studies confirm Larson’s assertion: There was a 64% to 75% reduction in opioid dosage when patients supplemented their chronic pain treatments with medical cannabis, and 32% to 59% of cannabis users reported a complete end to opioid use.'

https://www.politifact.com/factchecks/2020/nov/20/lyle-larson/studies-show-cannabis-can-lower-opioid-dosage-stud/

'Highlights
- Following medical cannabis initiation, 44% (n=419) of participants reported decreases in alcohol use frequency over 30 days, and 34% (n=323) decreased the number of standard drinks they had per week.
- Younger age (<55 years old) and higher rates of alcohol use prior to medical cannabis initiation were associated with greater odds of reducing alcohol.
- Specific intention to use medical cannabis to reduce alcohol consumption resulted in greater odds of reducing and/or ceasing use altogether.'

https://www.sciencedirect.com/science/article/abs/pii/S0955395920303017

'There were no between-group differences based on demographic, experiential, or attitudinal variables. We found that 50.8% were able to stop all opioid usage, which took a median of 6.4 years (IQR=1.75–11 years) after excluding two patients who transitioned off opioids by utilizing opioid agonists. For those 29 patients (47.5%) who did not stop opioids, 9 (31%) were able to reduce opioid use, 3 (10%) held the same baseline, and 17 (59%) increased their usage. Forty-eight percent of patients subjectively felt like cannabis helped them mitigate their opioid intake but this sentiment did not predict who actually stopped opioid usage. There were no variables that predicted who stopped opioids, except that those who used higher doses of cannabis were more likely to stop, which suggests that some patients might be able to stop opioids by using cannabis, particularly those who are dosed at higher levels.

Conclusions: In this long-term observational study, cannabis use worked as an alternative to prescription opioids in just over half of patients with low back pain and as an adjunct to diminish use in some chronic opioid users.'

https://www.liebertpub.com/doi/10.1089/can.2019.0039

'A converging line of evidence is indicating that cannabinoids may have an opioid-sparing effect. This property, well validated in preclinical studies, allow when both drugs are co-administered to reduce the dose of opioids without loss of analgesic effects. A meta-analysis of pre-clinical studies indicated in 2017 that the median effective dose (ED50) of morphine administered in combination with delta-9-tetrahydrocannabinol (delta-9-THC) is 3.6 times lower than the ED50 of morphine alone (Nielsen et al., 2017). However, very few studies have been conducted in humans to validate this effect. This narrative review provides an update on whether or not cannabinoid drugs can be used to produce an opioid sparing effect.'

https://www.sciencedirect.com/science/article/abs/pii/S027858462030381X

'Results. Between 2005 and 2018, at-least-daily cannabis use was associated with swifter rates of injection cessation (adjusted hazard ratio [AHR]=1.16; 95% confidence interval [CI]=1.03, 1.30). A subanalysis revealed that this association was only significant for opioid injection cessation (AHR=1.26; 95% CI=1.12, 1.41). At-least-daily cannabis use was not significantly associated with injection relapse (AHR=1.08; 95% CI=0.95, 1.23).

Conclusions. We observed that at-least-daily cannabis use was associated with a 16% increase in the hazard rate of injection cessation, and this effect was restricted to the cessation of injection opioids. This finding is encouraging given the uncertainty surrounding the impact of cannabis policies on PWID during the ongoing opioid overdose crisis in many settings in the United States and Canada.'

https://ajph.aphapublications.org/doi/abs/10.2105/AJPH.2020.305825

'The study’s authors concluded: “These observations are encouraging given the uncertainty surrounding the impact of cannabis legalization policies during the ongoing opioid overdose crisis in many settings in the United States and Canada, particularly among PWID [people who inject drugs] who are at increased risk for drug-related harm. The accumulating evidence from preclinical and epidemiological studies linking cannabis use to opioid use behaviors further supports the evaluation of the therapeutic benefits of cannabis and specific cannabinoids (e.g., CBD and THC) for people living with opioid use disorder.”'

https://norml.org/news/2020/08/27/study-cannabis-associated-with-increased-cessation-of-iv-opioid-use

'Few differences in cannabis risks were found across modes of use. Frequency of use remains the most significant predictor of cannabis related risks. However, findings suggest that multimodal may be indicative of high risk cannabis use patterns and is an important target for screening and intervention.'

https://www.sciencedirect.com/science/article/abs/pii/S0306460320307504

'Results
Bisexual men had higher medical (6.4% versus 4.1%; aROR=1.93[1.29–2.88]) and non-medical stimulant use 6.6% versus 2.4%; aROR=2.23[1.44–3.44]) than heterosexual men. Bisexual women had higher non-medical stimulant use (6.8% versus 1.6%; aROR=1.54[1.23–2.93] than heterosexual women. Female (aROR=0.70[0.62–0.78]) and male (aROR=0.74[0.66–0.82]) heterosexuals in MML states had lower odds of medical stimulant use than in non-MML states. Bisexual men in MML states had lower odds of medical (aROR=0.36[0.21–0.61]) and non-medical stimulant use (aROR=0.48[0.29–0.81]) than bisexual men in non-MML states. Similar patterns emerged for bisexual women's non-medical use (aROR=0.57[0.40–0.81]).

Conclusion
Prescription stimulant use was higher in non-MML states for most LGB subgroups. MMLs may differentially impact stimulant use, primarily for bisexual men and women. States enacting MMLs should consider potential impacts on drugs other than marijuana, especially among LGB populations.'

https://www.sciencedirect.com/science/article/abs/pii/S0955395920302012?dgcid=author

'They concluded, “In the first randomized clinical trial of cannabidiol for cannabis use disorder, cannabidiol [doses of] 400 mg and 800 mg were safe and more efficacious than placebo at reducing cannabis use.”

Prior clinical trials have reported that CBD administration is associated with reduced cravings for both heroin and tobacco. A literature review published in the journal Substance Abuse: Research and Treatment previously concluded, “CBD seems to have direct effects on addictive behaviors.”'

https://norml.org/news/2020/08/06/clinical-trial-cbd-administration-associated-with-greater-likelihood-of-cannabis-abstinence-among-those-seeking-to-quit

'Results

The vast majority of study participants engaged in daily, intensive cannabis use at the same time as they cycled on and off other substances that were perceived as much more harmful (primarily alcohol, fentanyl, heroin and meth). While most participants derived significant pleasure from the use of cannabis, no participants in our study described using cannabis for purely recreational purposes. A number of participants explicitly framed cannabis as a form of mental health and substance use treatment that was more effective and “healthier” than the long-term use of psychopharmaceuticals and medication-assisted substance use treatment (e.g., opioid agonist therapies). Cannabis use was also understood to ameliorate some of the harms of, or even facilitate transitions out of, periods of street-based homelessness.'

https://journals.plos.org/plosone/article?id=10.1371%2Fjournal.pone.0236243

'The use of prescription stimulants is lower in states where medical cannabis is legal as compared to those jurisdictions where it remains prohibited, according to data published in the International Journal of Drug Policy.

Researchers affiliated with Columbia University in New York and with Boston University assessed the association between the enactment of medical marijuana laws and prescription stimulant use by gender and by sexual identity.'

https://norml.org/news/2020/07/30/study-medical-cannabis-access-states-associated-with-lower-rates-of-prescription-stimulant-use

'The question, of course, could be asked: Why did you ever try narcotics? Why did you continue using it long enough to become an addict? You become a narcotics addict because you do not have strong motivations in any other direction. Junk wins by default. I tried it as a matter of curiosity. I drifted along taking shots when I could score. I ended up hooked. Most addicts I have talked to report a similar experience. They did not start using drugs for any reason they can remember. They just drifted along until they got hooked. If you have never been addicted, you can have no clear idea what it means to need junk with the addict's special need. You don't decide to be an addict. One morning you wake up sick and you're an addict.' - Prologue, Junky, William S Burroughs, 1977, originally published in 1953

So governments, the pharmaceutical industry and the medical industry cut off the supply of natural intoxicants like cannabis, opium, coca and palm toddy. They create refined and much more potent extracts from these natural materials. They control the supply and stock of these chemical drugs. They use the doctor-pharmacist route to administer these drugs to the public legally and the peddler-narcotics agent-rehabilitation center route to administer these drugs illegally. The individual is not allowed to grow or procure these intoxicants from nature. He must rely on the system to get his intoxicant and pay the maximum price for it. To realize more and more profits the system creates more and more potent chemical intoxicants moving further and further away from natural territory into synthetic chemically constructed territory. As the toxicity and addictive power of these drugs increase, the public gets addicted to an even greater extent and pays even more for any available intoxicant. Profits rise and fuel the growth of the system tremendously. The individual pays for the system, pays for the synthetic drug, pays for the treatment which is further synthetic drugs and eventually pays with his life for the synthetic intoxicant. Legalize all natural drugs - opium, coca, cannabis and toddy to name a few. Most importantly, legalize cannabis, the universal drug of the world...

'Almost 500 participants said they endorse using marijuana one hour before, or up to four hours after, exercising. And based on data from the questionnaire, those who did use cannabis in that timeframe worked out longer than consumers who didn’t pair the activities. Specifically, those who engaged in co-use worked out an average of 43 minutes longer for aerobic exercise and 30 minutes longer for anaerobic exercise.

What’s behind the trend?'
https://www.marijuanamoment.net/study-finds-marijuana-motivates-people-to-exercise-smashing-lazy-stoner-stereotype

'According to the survey, 81 percent of respondents believe that tobacco cigarettes are "very harmful." Fifty-one percent of respondents similarly view alcohol as "very harmful." By contrast, only 26 percent of those surveyed ranked marijuana as "very harmful." '

https://norml.org/news/2019/08/29/poll-americans-view-cigarettes-and-alcohol-as-more-harmful-than-cannabis

'Unfortunately for all of us, opportunities for this sort of thing to happen are legion. A few years ago a team of Food and Drug Administration scientists discovered that when malathion and certain other organic phosphates are administered simultaneously a massive poisoning results - up to 50 times as severe as would be predicted on the basis of adding the toxicities of the two. In other words, 1/100 of the lethal dose of each compound may be fatal when the two are combined. The discovery led to the testing of other combinations. It is now known that many pairs of organic phosphate insecticides are highly dangerous, the toxicity being stepped up or 'potentiated' through the combined action. Potentiation seems to take place when one compound destroys the liver enzyme responsible for detoxifying the other. The two need not be given simultaneously. The hazard exists not only for the man who must spray this week with one insecticide and the next week with another; it exists also for the consumer of sprayed products. The common salad bowl may easily present a combination of organic phosphate insecticides. Residues well within the legally permissible limits may interact.'
- Silent Spring, Rachel Carson, 1962

'"Unregulated illicit market cannabis products, like products in an unregulated marketplace, are of variable quality and may put some consumers at risk," Armentano said. "These incidents linked to the use of unregulated, illicit market vapor cartridges reinforce the need for greater market regulation, standardization, and oversight — principles which NORML has consistently called for in the cannabis space. Consumers must also be aware that not all products are created equal; quality control testing is critical and only exists in the legally regulated marketplace."'

https://norml.org/news/2019/08/29/hospitalizations-linked-to-use-of-unregulated-vapor-cartridges

'The overall displacement or cannibalization of tobacco by cannabis products in California alone amounted to $84.5 million overall from 2017-2018 (not including 2017 e-cigarettes, figures for which were not available). The shifts amounted to $33.8 million for cigarettes, $8.3 million for non-cigarette tobacco, and $42.6 million for e-cigarettes (in 2018 only).

Across the U.S. overall, the 2018 spending shifts amounted to $4.3 billion for alcohol: (1.54% of that market), $1.3 billion for pharmaceuticals (1.10%), and $219 million (0.22%) for tobacco.'
https://newfrontierdata.com/marijuana-insights/altria-pmi-merger-confirms-longtime-predictions-marks-industry-progression/

'“These data reveal a predominant use of prefilled THC cartridges sold through informal and unregulated markets, although the origin of these products further back in the production and distribution chain is unknown,” the report states.

The report goes on to say that it’s unclear if the cause of the illness is THC or “a substance associated with prefilled THC cartridges, such as a cutting agent or adulterant.”'
https://mjbizdaily.com/cdc-reports-majority-of-patients-sickened-in-vape-epidemic-used-marijuana-vaporizer-devices-many-from-illicit-market

'CannaSafe also tested 10 of the unregulated cartridges for pesticides. All 10 tested positive.

The products all contained myclobutanil, a fungicide that can transform into hydrogen cyanide when burned.'
https://www.nbcnews.com/health/vaping/tests-show-bootleg-marijuana-vapes-tainted-hydrogen-cyanide-n1059356

'After discussing the data limitations of the study, the authors concluded that “it indeed seems to be the case that legalizing the recreational use of marijuana results in fewer marijuana related arrests and court cases” and that while law enforcement sources voiced various concerns, several “indicated that methamphetamine and heroin were much larger problems for their agencies than was marijuana.”

The team “saw no evidence that marijuana legalization had an impact on indicators in border states,” adding that they “found no indications of increases in arrests related to transportation/trafficking offenses.”'
https://www.marijuanamoment.net/study-funded-by-feds-debunks-myths-about-marijuana-legalizations-alleged-harms/

'Most of these modifiers of consciousness cannot now be taken except under doctor's orders, or else illegally and at considerable risk. For unrestricted use the West has permitted only alcohol and tobacco. All the other chemical Doors in the Wall are labelled Dope, and their unauthorized takers are Fiends.' - The Doors of Perception, Aldous Huxley, 1954.

'They are the latest generation of bioplastics, which are plastic materials produced from renewable sources such as agricultural by-products, straw, wood chips, sawdust and recycled food waste -- and now hemp.

Hemp seems to satisfy some plant-based plastics researchers looking for alternatives to plastic waste that has filled landfills and oceans.'
https://www.upi.com/Top_News/US/2020/02/24/Products-made-from-hemp-based-plastics-enter-consumer-market/8661582241399/

'Cannabis use is increasing among those ages 65 and older, according to data published in the journal JAMA Internal Medicine.

Researchers affiliated with the New York School of Medicine assessed trends in self-reported cannabis use among seniors. They reported that 4.2 percent of seniors acknowledged engaging in past-year cannabis consumption in 2018, up from 2.4 percent in 2015 and 0.4 percent in 2006.

The study's findings are consistent with those of prior papers similarly reporting an uptick in marijuana use among older Americans. According to a 2019 study published in the journal Gerontology & Geriatric Medicine, marijuana use among seniors is associated with self-reported improvements in pain management, day-to-day functioning, and in their overall health and quality of life'
https://norml.org/news/2020/02/27/seniors-more-frequently-turning-to-cannabis

The cannabis death count..
https://twitter.com/JohnFetterman/status/1253277973635117056

'Cannabis exposure does not negatively impact the lungs in a manner consistent with tobacco, nor is it similarly linked to elevated rates of either COPD (chronic obstructive pulmonary disease) or lung cancer, according a literature review published in the journal Addiction.

A team of New Zealand researchers reviewed clinical trial data assessing the impact of cannabis smoke exposure on the lungs. They report that "the effects of smoking cannabis on the lungs are distinct from tobacco."

Specifically, they write: "[I]t has been pragmatic to assume that cannabis and tobacco would have similar respiratory effects. ... The research that has been done, however, offers a different story. The most common serious respiratory consequences from smoking tobacco are Chronic Obstructive Pulmonary Disease (COPD) and lung cancer. Epidemiological evidence that smoking cannabis causes either of these is scant."'
https://norml.org/news/2020/04/23/review-cannabis-smoke-exposure-is-distinct-from-tobacco-not-associated-with-copd-or-lung-cancer

'There is still very limited awareness of the nature of the threat. This is an era of specialists, each of whom sees his own problem and is unaware or intolerant of the larger frame into which it fits. It is also an era dominated by industry, in which the right to make a dollar at whatever cost is seldom challenged. When the public protests, confronted with some obvious evidence of damaging results of pesticide applications, it is fed little tranquilizing pills of half truth. We urgently need an end to these false assurances, to the sugar coating of unpalatable facts. It is the public that is being asked to assume the risks that the insect controllers calculate. The public must decide whether it wishes to continue on the present road, and it can only do so when it is in full possesion of the facts. In the words of Jean Rostand, 'The obligation to endure gives us the right to know.' - Silent Spring, Rachel Carson, 1962

'When it comes to withdrawal, Armentano said research has found symptoms to be mild and short-lived.

“Like with most matters specific to cannabis,” he said, the new findings “need to be placed in appropriate context.”

He compared cannabis withdrawal to withdrawal symptoms when someone stops using tobacco or alcohol.

“The profound physical withdrawal effects associated with tobacco are so severe that many subjects who strongly desire to quit end up reinitiating their use. In the case of alcohol, the abrupt ceasing of use in heavy users can be so severe that it can lead to death,” Armentano said.

“Simply withdrawing from caffeine can lead to a number of adverse side effects, like rebound headaches,” he added. “But we do not arrest 600,000 Americans annually for their use of caffeine.”'
https://www.healthline.com/health-news/marijuana-withdrawal-symptoms-are-real-for-regular-users

'The purpose of this Notice is to inform potential applications to the National Institute on Drug Abuse (NIDA) and National Institute on Aging (NIA) of special interest in grant applications to conduct rigorous research on cannabis and potentially addictive, psychoactive prescription drug use (specifically opioids and benzodiazepine) in older adults. This program will focus on two distinct older adult populations (over the age of 50): (1) individuals with earlier use onset of cannabis and the specified drug classes who are now entering older age, or (2) individuals who initiate use of cannabis and the specified drug classes after the age of 50. Insights gained from this initiative have the potential to inform the public and health care systems regarding use of cannabis and prescription opioids and benzodiazepines in older populations.'
https://grants.nih.gov/grants/guide/notice-files/NOT-DA-20-014.html

'The question is frequently asked: Why does a man become a drug addict?

The answer is that he usually does not intend to become an addict. You don't wake up one morning and decide to become a drug addict. It takes at least three months' shooting twice a day to get any habit at all. And you don't really know wht junk sickness is until you have had several habits. It took me almost six months to get my first habit, and then the withdrawal symptoms were mild. I think it is no exaggeration to say it takes about a year and several hundred injections to make an addict' - Prologue, Junky, William S Burroughs, 1977, originally published in 1953

Hey junkie, this dope is not against you. Of course he believes that his dope is a much better intoxicant, more versatile medicine and more useful to the planet than your junk but that doesn't mean he intends to ban your junk in retribution for you helping to get his dope banned. What he does want, however, is that you start growing your own plant at home like him. In this way, you source your junk directly from the plant instead of putting money in the pockets of chemists who increasingly make more and more toxic stuff that destroy you, me and the planet. Your money is making the chemist pay the government to arm itself and protect him while pushing you and me closer to death. Growing your own plant will give you organic healthy junk in the best possible way, directly from the plant, like how it used to be for thousands of years, making you sustainable and the planet sustainable..yes, you can go green too..don't remain snowblind..we need your eyes too, to steer the planet away from man-made chemical disaster...

'Moreover, many of the studies have overlooked the proliferation of fentanyl as a driver of opioid overdose mortality in the United States, which may negate any potential effect of medical cannabis on overdose deaths. It can only be concluded that additional research might help to identify a range of alternative non-opioid medications and non-pharmacological treatments that could be effective in pain management. The issue of whether increased accessibility of cannabis could reduce the medical and non-medical use of pharmaceutical opioids and their negative impact remains inconclusive.' - United Nations Office on Drugs and Crime, World Drug Report 2020, https://wdr.unodc.org/wdr2020/field/WDR20_BOOKLET_4.pdf

'Out of the nearly 9,000 respondents, 5 per cent reported ever using cannabis and had used opioids in the past year, among whom 43 per cent had used opioids daily and 23 per cent had used cannabis in the past 30 days. Although the results are based on a small number of respondents, of the 450 who reported ever using cannabis and past-year opioid use, 41 per cent reported a decrease or cessation of opioid use as a result of cannabis use, 46 per cent reported no change in opioid use and 8 per cent reported an increase in opioid use' - United Nations Office on Drugs and Crime, World Drug Report 2020, https://wdr.unodc.org/wdr2020/field/WDR20_BOOKLET_4.pdf

'More than half of the studies, however, have shown that cannabis and alcohol are substitutes, meaning that the increased use of one substance reduces the use of the other. Other researchers have also suggested that cannabis, especially cannabis for medical use, may serve as a substitute for alcohol, tobacco and other drugs, including prescription drugs.' - United Nations Office on Drugs and Crime, World Drug Report 2020, https://wdr.unodc.org/wdr2020/field/WDR20_BOOKLET_4.pdf

'At the baseline, in the first quarter of 2018, nearly 14 per cent of Canadians (12.2 per cent of women and 15.8 per cent of men) reported that they had used cannabis, including cannabis products for medical purposes, in the past three months. The highest prevalence rates were reported among those aged 25–34 (26 per cent) and 15–24 (23 per cent). By the beginning of 2019, the prevalence of use in the past three months had increased to 17.5 per cent, and it remained close to that level until the third quarter of 2019 (17.1 per cent). While the prevalence of cannabis use in the past three months rose in most age groups in 2019, the most marked increase was observed in the oldest age group (65 and older), for which the prevalence nearly doubled in comparison with 2018. There also seems to be a larger proportion of new users among older adults than in other age groups: while 10 per cent of new cannabis users were aged 25–44 in the second and third quarters of 2019, more than one quarter were aged 65 and older.' - United Nations Office on Drugs and Crime, World Drug Report 2020, https://wdr.unodc.org/wdr2020/field/WDR20_BOOKLET_4.pdf

'And in spite of the evidence linking cigarettes with lung cancer, practically everybody regards tobacco smoking as being hardly less normal and natural than eating. From the point of view of the rationalist utilitarian this may seem odd. For the historian, it is exactly what you would expect. A firm conviction of the material reality of Hell never prevented mediaeval Christians from doing what their ambition, lust or covetousness suggested. Lung cancer, traffic accidents and the millions of miserable and misery-creating alcoholics are facts even more certain than was, in Dante's day, the fact of the Inferno. But all such facts are remote and unsubstantial compared with the near, felt fact of a craving, here and now, for release or sedation, for a drink or a smoke.' - The Doors of Perception, Aldous Huxley, 1954.

'The abolition of governments will merely rid us of an unnecessary organization for the commission of violence and for its justification.

'But there will then be no laws, no property, no courts of justice, no police, no popular education', say people who intentionally confuse the use of violence by governments with various social activities.

The abolition of the organization of government formed to do violence does not at all involve the abolition of what is reasonable and good, and therefore not based on violence, in laws or law courts, or in property, or in police regulations, or in financial arrangements, or in popular education. On the contrary, the absence of the brutal power of government which is needed only for its own support, will facilitate a more just and reasonable social organization, needing no violence. Courts of justice, and public affairs, and popular education, will all exist to the extent to which they are really needed by the people, but in a form which will not involve the evils contained in the present form of government. Only that will be destroyed which was evil and hindered the free expression of the people's will.'
- Leo Tolstoy - The Kingdom of God and Peace Essays

'The fisheries of fresh and salt water are a resource of great importance, involving the interests and the welfare of a very large number of people. That they are now seriously threatened by the chemicals entering our waters can no longer be doubted. If we could divert to constructive research even a small fraction of the money spent each year on the development of even more toxic sprays, we could find ways to use less dangerous materials and to keep poisons out of our waterways. When will the public become sufficiently aware of the facts to demand such action? - Silent Spring, Rachel Carson, 1962

'The objectives of the current cannabis legislation in Canada are to keep cannabis away from young people (under 18 years of age), to prevent criminals from profiting from the distribution and sale of cannabis and to safeguard public health and safety by allowing adults (aged 18 and older) legal access to cannabis. Under the constitutional division of powers in Canada, the federal Government and provincial governments have different responsibilities. As the provinces historically developed their own systems to regulate the sale of alcohol, a similar approach has been applied to regulate the non-medical use of cannabis products.' - United Nations Office on Drugs and Crime, World Drug Report 2020, https://wdr.unodc.org/wdr2020/field/WDR20_BOOKLET_4.pdf

Fundamental to programming is the avoidance of hard coding values that are likely to change, that need translation and that need to be used in different functions based on varying conditions. This is to avoid duplication, ambiguity and re-programming. These values are kept in configuration files that are accessed and amended as needed. This is even more true for medicines that need to be controlled based on nature of harm and use. The idea of globally agreed lists of medicines with harmful substances requiring tight control is good provided laws regarding these are universal, fair and consistent at regional, country or state levels. A key operational issue is that even these global lists are not updated fast enough considering the latest scientific knowledge and that new harmful synthetic substances are rapidly churned out of pharmacy labs. Worse, natural cannabis, peyote, psilcybin, etc. proven over thousands of years to be much more safer in their natural form than the recently created synthetic drugs, continue to remain in these global lists, significantly hampering their objective and efficiency, diverting precious resources and greatly damaging global public health. The Indian NDPS Act is like one of the worst examples of programming with a list of substances hard coded into it and a bunch of rules copy pasted around it, existing over and above the IPC. 20kgs of hashish or 500g of THC will get you the death sentence. Fentanyls, the leading cause of global drug overdose deaths, synthetic cannabinoids and synthetic cathinones, etc. are not even on the list...
Jul 21, 2020, 4:09 PM

'The percentage of chronic pain patients using cannabis therapeutically is increasing, according to data published in the journal Advances in Therapy.

Investigators affiliated with Harvard Medical School assessed trends in cannabis use among pain patients in a nationally representative sample during the years 2011 to 2015.

Authors reported, “Over the course of our study, … we identified a significant and progressive increase in the number of patients using cannabis. In patients with chronic pain, cannabis use more than doubled during this period.”

They reported that the average age of chronic pain patients who consumed cannabis was 45 and that the majority of users were lower on the socioeconomic scale than were non-users.'

https://norml.org/blog/2020/07/14/cannabis-use-rising-among-chronic-pain-patients/

'I have never regretted my experience with drugs. I think I am at better health now as a result of using junk at intervals than I would be if I had never been an addict. When you stop growing you start dying. An addict never stops growing. Most users periodically kick the habit, which involves shrinking of the organism and replacement of the junk-dependent cells. A user is in continual state of shrinking and growing in his daily cycle of shot-need for shot completed.' - Prologue, Junky, William S Burroughs, 1977, originally published in 1953

'Nearly three in four licensed health care professionals in Washington state endorse the use of medical cannabis as a substitute for opioids in patients with chronic pain, according to survey data published in the journal Cannabis and Cannabinoid Research.

Researchers with the University of Washington School of Nursing surveyed a random sampling of actively licensed health care professionals legally permitted to provide medical cannabis authorizations in the state of Washington.

Of eligible respondents, 72 percent agreed with the statement, “Medical marijuana should be used to reduce the use of opioids for non-cancer pain.” Several studies [links] report that pain patients enrolled in state-sponsored cannabis access programs reduce or eliminate their use of opioid pain relievers over time.'
https://norml.org/blog/2020/07/15/survey-majority-of-health-care-professionals-endorse-cannabis-use-instead-of-opioids-in-chronic-pain-patients/

'“The evidence described in the present systematic review indicates that CBD is a promising adjunct therapy for the treatment of cocaine dependence due to its effect on cocaine consumption, brain reward, anxiety, related contextual memories, neuroadaptations and hepatic protection as well as its anticonvulsant effect and safety,” the study authors concluded.

“The clinical administration of CBD leads to a reduction in the self-administration of cocaine and, consequently, the amount of the drug consumed. Moreover, the reward induced by cocaine is blunted by CBD treatment.”'
https://www.marijuanamoment.net/cbd-is-a-promising-therapy-in-treating-cocaine-misuse-meta-study-finds/

'Drug overdose deaths involving selected drug categories are identified by specific multiple cause-of-death codes. Drug categories presented include: heroin (T40.1); natural opioid analgesics, including morphine and codeine, and semisynthetic opioids, including drugs such as oxycodone, hydrocodone, hydromorphone, and oxymorphone (T40.2); methadone, a synthetic opioid (T40.3); synthetic opioid analgesics other than methadone, including drugs such as fentanyl and tramadol (T40.4); cocaine (T40.5); and psychostimulants with abuse potential, which includes methamphetamine (T43.6). Opioid overdose deaths are identified by the presence of any of the following MCOD codes: opium (T40.0); heroin (T40.1); natural opioid analgesics (T40.2); methadone (T40.3); synthetic opioid analgesics other than methadone (T40.4); or other and unspecified narcotics (T40.6).'
https://www.cdc.gov/nchs/nvss/vsrr/drug-overdose-data.htm

'In short the Department of Agriculture embarked on its program without even elementary investigation of what was already known about the chemical to be used - or if it investigated, it ignored the findings. It must also have failed to do the preliminary research to discover the minimum amount of the chemical that would accomplish its purpose. After three years of heavy dosages, it abruptly reduced the rate of application of heptachlor from 2 pounds to 1 and 1/4 pounds per acre in 1959; later on to 1/2 pound per acre, applied in two treatments of 1/4 pound each, 3 to 6 months apart. An official of the Department explained that 'an aggressive methods improvement program' showed the lower rate to be effective. Had this information been acquired before the program was launched, a vast amount of damage could have been avoided and the taxpayers could have been saved a great deal of money.' - Silent Spring, Rachel Carson, 1962

'Results:
Sixty-five articles were included (64 in humans, one in animals). We synthesised findings into categories: patterns of use, substitution practices, economic relationship, substance use disorders, policy evaluation, others and animal studies. Overall, 30 studies found evidence for substitution, 17 for complementarity, 14 did not find evidence for either, and four found evidence for both.

Conclusions:
Overall, the evidence regarding complementarity and substitution of cannabis and alcohol is mixed. We identified stronger support for substitution than complementarity, though evidence indicates different effects in different populations and to some extent across different study designs. The quality of studies varied and few were designed specifically to address this question. Dedicated high-quality research is warranted'
https://journals.sagepub.com/doi/10.1177/0269881120919970

'Junk is a cellular equation that teaches the user facts of general validity. I have learned a great deal from using junk: I have seen life measured out in eyedroppers of morphine solution. I experienced the agonizing deprivation of junk sickness, and the pleasure of relief when junk-thirsty cells drank from the needle. Perhaps all pleasure is relief. I have learned the cellular stoicism that junk teaches the user. I have seen a cell full of sick junkies silent and immobile in separate misery. They knew the pointlessness of complaining or moving. They knew that basically no one can help anyone else. There is no key, no secret someone else has that he can give you.' - Prologue, Junky, William S Burroughs, 1977, originally published in 1953

'Current users and PU [past users] took MC [Medical Cannabis] to address pain (65.30%), spasms (63.30%), sleeplessness (32.70%), and anxiety (24.00%), and 63.30% reported it offered “great relief” from symptoms. Participants reported that MC is more effective and carries fewer side effects than prescription medications.'
https://www.nature.com/articles/s41394-019-0208-6

'Ours is the age, among other things, of the automobile and of rocketing population. Alcohol is incompatible with safety on the roads, and its production, like that of tobacco, condemns to virtual sterility many millions of acres of the most fertile soil. The problems raised by alcohol and tobacco cannot, it goes without saying, be solved by prohibition. The universal and ever-present urge to self-transcendence is not to be abolished by slamming the currenty popular Doors in the Wall. The only reasonable policy is to open other, better doors in the hope of inducing men and women to exchange their old bad habits for new and less harmful ones. Some of these other, better doors will be social and technological in nature, others religious or psychological, others dietetic, educational, athletic. But the need for frequent chemical vacations from intolerable selfhood and repulsive surroundings will undoubtedly remain.' - The Doors of Perception, Aldous Huxley, 1954.

'The purpose of this systematic review was to explore available peer-reviewed evidence related to the use of cannabis as a potential alternative to opioids in the treatment of chronic pain. The Johns Hopkins Nursing Evidence-Based Practice model was used to review 32 peer-reviewed articles published between 2008 and 2018. Findings suggest cannabis as a promising alternative to opioids and supports the medical use of cannabis as a safer first-line pharmacological treatment for chronic pain compared to opioids. The use of cannabis as a safer alternative to opioids can promote social change directly and indirectly across a variety of social and economic dimensions due to increased access to medication at reduced cost, elimination of opioid-related death due to overdose, diminished individual and social harms related to cannabis. A medical alternative to opioids may also lead to a reduction of the inequitable incarceration of cannabis users across demographic categories of ethnicity and race.'
https://search.proquest.com/openview/a69d6774a45ea04c630c10a84ea2cc8e/1?pq-origsite=gscholar&cbl=18750&diss=y

'“It’s a lot safer than alcohol. It’s safer than narcotics. It ought to be used more widely and we can’t even study it that easily because of the way it’s regulated,” he said. “You know what, I called the DEA—they said, ‘we don’t want this to be illegal. Your government ought to change that. But we got to enforce the law.’ I call the FDA that regulates the drugs, they say, ‘we think it ought to be used, but until the DEA says it’s allowed, we can’t let people prescribe it everywhere.”

While Oz didn’t disclose specifics about his conversations, such as who he spoke to or when the phone calls happened, it is the case that federal marijuana reform outside of Congress falls largely within the jurisdictions of both agencies. And DEA has denied multiple rescheduling requests, justifying the inaction by stating that FDA has determined that cannabis doesn’t have proven medical value and carries a risk of abuse.'
https://www.marijuanamoment.net/dr-oz-claims-dea-and-fda-blame-each-other-for-keeping-marijuana-illegal/

'“Marijuana is less habit forming than opiates and carries virtually no risk of fatal overdose, thus it has been wrongly classified,” says Rajiv Kafle, a prominent legalisation activist. “Moreover, when the drug was banned it was done without proper scientific research. Studies have shown that the chemical cannabidiol found in marijuana has beneficial medical properties.”Activists also say that marijuana can help control crime and wean the dependency on other hard drugs. The most vivid proof of that is KC, who did heroin for 22 years. He says marijuana coul be added to harm reduction in drug rehab in Nepal if it was available legally.“Take it from me, marijuana was my saviour. It made my pain bearable and took away my addiction to heroin. Believe me, many heroin addicts like me would give up heroin,” says KC. Activists say that legalising marijuana will help patients to get high quality cannabis for their conditions, and by regulating the drug, the government can keep a tab on the criminality associated with it.'
https://archive.nepalitimes.com/article/nation/undo-hash-ban,3657

'The victim is always and ever the deceived, foolish, working folk - those who with blistered hands have built all those ships, fortresses, arsenals, barracks, cannon, harbours, steamers, and moles, and all these palaces, halls, platforms, and triumphal arches; who have set up and printed all these newspapers and pamphlets, and have procured and brought all these pheasants and ortolans, oysters, and wines that are consumed by the men who are fed, brought up, and kept by them, and who are deceiving them and preparing the most fearful calamities for them. It is always the same kindly, foolish folk, who stand open-mouthed like children, showing their healthy white teeth, naively delighted by dressed-up admirals and presidents with flags waving above them, and by fireworks and bands of music; and for whom, before they have time to look around, there will be neither admirals nor presidents nor flags nor bands, but only a desolate battlefield, cold, hunger, and anguish - before them murderous enemies and behind them relentless officers preventing their escape - blood, wounds, suffering, putrefying corpses, and a senseless unnecessary death.'
- Leo Tolstoy - The Kingdom of God and Peace Essays

'The main concern for the authorities in a number of countries has been the emergence of new synthetic opioid receptor agonists (NPS with opioid effects), often fentanyl analogues, in recent years. Although fewer in number than other NPS categories, they have proved to be particularly potent and harmful, leading to increasing numbers of overdose deaths, in particular in North America and, to a lesser extent, in Europe and other regions.' - United Nations Office on Drugs and Crime, World Drug Report 2020, https://wdr.unodc.org/wdr2020/field/WDR20_BOOKLET_4.pdf

'An analysis of NPS reported to UNODC suggests increasing diversification in the NPS market until 2015, followed by a trend towards stabilization in the number of new substances arriving on the market in individual countries, at an overall rate of more than 500 NPS per year, with 528 synthetic NPS and 13 plant-based NPS reported in 2018. While there was a decrease in the number of new synthetic cannabinoids arriving on markets worldwide over the 2014–2018 period, the number of NPS with stimulant effects increased, and the number of newly emerging NPS with opioid effects rose sharply, from 7 substances in 2014 to 48 in 2018. That increase represents a rise from 2 per cent of all NPS in 2014 to 9 per cent in 2018.' - United Nations Office on Drugs and Crime, World Drug Report 2020, https://wdr.unodc.org/wdr2020/field/WDR20_BOOKLET_4.pdf

'In March 2019, the Commission on Narcotic Drugs decided to schedule four substances (all fentanyl analogues) under the Single Convention on Narcotic Drugs of 1961 as amended by the 1972 Protocol and a further five substances under the Convention on Psychotropic Substances of 1971, thus raising the total number of psychoactive substances under international control to 282 as at the end of 2019. By comparison, the number of NPS identified by authorities worldwide and reported to UNODC is already more than three times that figure, having reached a total of 950 in December 2019, up from 892 in December 2018 and 166 in 2009.' - United Nations Office on Drugs and Crime, World Drug Report 2020, https://wdr.unodc.org/wdr2020/field/WDR20_BOOKLET_4.pdf

'I have learned the junk equation. Junk is not, like alcohol or weed, a means to increased enjoyment of life. Junk is not a kick. It is a way of life.' - Prologue, Junky, William S Burroughs, 1977, originally published in 1953

'Where data are available, they show a steady decline in the use of NPS in Europe, but such substances have established themselves in some marginalized groups in society, such as the homeless or people in prison, among whom the smoking of synthetic cannabinoids has been identified as a problem. In Europe, the use of NPS in prisons was reported by 22 countries, with synthetic cannabinoids identified as posing the main challenge and health risks (16 countries), whereas the use of synthetic cathinones in prisons was reported by 10 countries, NPS with opioid effects by six, and new benzodiazepines by four countries. In Latvia, the use of synthetic opioids in prisons has also been linked to an increase in overdose cases and in injecting drugs and sharing needles among prisoners who use drugs.' - United Nations Office on Drugs and Crime, World Drug Report 2020, https://wdr.unodc.org/wdr2020/field/WDR20_BOOKLET_4.pdf

'Data on the United States also indicate a marked decline in the use of NPS. In particular, the prevalence of synthetic cannabinoid use among twelfth-grade students fell from 11.4 per cent in 2011 to 3.3 per cent in 2019. Similarly, the use of ketamine fell from 1.7 to 0.7 per cent over the same period, and the use of “bath salts” (synthetic cathinones) dropped from 1.3 per cent in 2012 to 0.6 per cent in 2018, the most recent year for which data are available. This happened in the context of a deterioration in the reputation of many of those substances among young people, in parallel to several waves of controls of synthetic cannabinoids and synthetic cathinones at the national level during the 2010–2012 period and later at the global level, as well as the control of ketamine at the national level in 1999. Over the 2000–2019 period, the annual prevalence of ketamine non-medical use among twelfth-grade high-school students fell drastically, from 2.5 per cent to 0.7 per cent' - United Nations Office on Drugs and Crime, World Drug Report 2020, https://wdr.unodc.org/wdr2020/field/WDR20_BOOKLET_4.pdf

'The 2019 drug use survey in India estimated that nearly 1 per cent of the population aged 10–75 had misused pharmaceutical opioids in the past year and that an estimated 0.2 per cent of the population (2.5 million people) were suffering from drug use disorders related to pharmaceutical opioids. Although the breakdown by type of pharmaceutical opioids misused in India is not available, buprenorphine, morphine, pentazocine and tramadol are the most common opioids misused in the country.' - United Nations Office on Drugs and Crime, World Drug Report 2020, https://wdr.unodc.org/wdr2020/field/WDR20_BOOKLET_4.pdf

'Morphine hits the backs of the legs first, the the back of the neck, a spreading wave of relaxation slackening the muscles away from the bones so that you seem to float without outlines, like lying in warm salt water. As this relaxing wave spread through my tissues, I experienced a strong feeling of fear. I had the feeling that some horrible image was just beyond the field of vision, moving, as I turned my head, so that I quite never saw it. I felt nauseous. I lay down and closed my eyes. A series of pictures passed, like watching a movie. A huge, neon-lighted cocktail bar that got larger and larger until streets, traffic, and street repairs were included in it; a waitress carrying a skull on a tray; stars in a clear sky. The physical impact of the fear of death; the shutting off of breath; the stopping of blood.' - Junky, William S Burroughs, 1977, originally published in 1953

'The non-medical use of tramadol among other pharmaceutical drugs is reported by several countries in South Asia: Bhutan, India, Nepal and Sri Lanka. In 2017, 130,316 capsules containing tramadol and marketed under the trade name “Spasmo Proxyvon Plus (‘SP+’)” were seized in Bhutan.

In Sri Lanka, about 0.2 per cent of the population aged 14 and older are estimated to have misused pharmaceutical drugs in the past year. Among them, the non-medical use of tramadol is the most common, although misuse of morphine, diazepam, flunitrazepam and pregabalin have also been reported in the country. The misuse of more than one pharmaceutical drug (including tramadol) is also a common pattern among heroin users who may use them to potentiate the effects of heroin or compensate for its low level of availability. Recent seizures of tramadol suggest the existence of a market for the drug: in April and September 2018, 200,000 and 1.5 million tablets of tramadol were respectively seized by customs in Sri Lanka.' - United Nations Office on Drugs and Crime, World Drug Report 2020, https://wdr.unodc.org/wdr2020/field/WDR20_BOOKLET_4.pdf

'The trafficking and availability of tramadol for its non-medical use is a public health concern, but limited distribution of tramadol for medical use would also pose a public health concern, in particular in Africa, where there is a chronic shortage of pain medications. There are no data on the availability and use of tramadol for medical purposes, but data on internationally controlled substances clearly highlight the gaps in the accessibility of pain medications. The general lack of access to opioid-related pain medications under international control is a specific problem for developing countries, which is even more pronounced in countries in West and Central Africa than in other parts of the world.

Against this background of a de facto non-availability of internationally controlled opioids for pain medication for large sections of the population in West and Central Africa, tramadol – even though it is under national control in some West African countries – is in fact a widely available opioid in those countries, used for both medical purposes (including outside prescription) and for non-medical purposes' - United Nations Office on Drugs and Crime, World Drug Report 2020, https://wdr.unodc.org/wdr2020/field/WDR20_BOOKLET_4.pdf

'This system, however - deliberately poisoning our food, then policing the result - is too reminiscent of Lewis Carroll's White Knight who thought of 'a plan to dye one's whiskers green, and always use so large a fan that they could not be seen.' The ultimate answer is to use less toxic chemicals so that the public hazard from their misuse is greatly reduced.' - Silent Spring, Rachel Carson, 1962

'In the Sudan, while population-based estimates of the extent of substance use are not available, research suggests that the drug scene has rapidly changed, especially with the increasing non-medical use of pharmaceutical drugs among young people, including tramadol, benzodiazepines, cough syrups and antihistamines, trihexyphenidyl, anticonvulsants and neuropathic pain agents such as pregabalin and gabapentin.' - United Nations Office on Drugs and Crime, World Drug Report 2020, https://wdr.unodc.org/wdr2020/field/WDR20_BOOKLET_4.pdf

'In North Africa, tramadol is reported as the main opioid used non-medically in Egypt, where scientific literature about tramadol misuse is more available than elsewhere in the subregion. An estimated 3 per cent of the adult population misused tramadol in 2016, the latest year for which data are available, while 2.2 per cent were diagnosed with tramadol dependence. In drug treatment, tramadol was also the main drug, accounting for 68 per cent of all people treated for drug use disorders in 2017. A cross-sectional study conducted over the period 2012–2013 among 1,135 undergraduate college students in Egypt showed that 20.2 per cent of male and 2.4 per cent of female students had misused tramadol at least once during their lifetime, resulting in an overall lifetime prevalence of 12.3 per cent The average age of initiation of non-medical use of tramadol was around 17 years. Polydrug use was also quite common, with the majority of respondents (85 per cent) reporting use of either tobacco, alcohol or cannabis with tramadol. Among those who had misused tramadol, 30 per cent were assessed to be tramadol dependent.' - United Nations Office on Drugs and Crime, World Drug Report 2020, https://wdr.unodc.org/wdr2020/field/WDR20_BOOKLET_4.pdf

'He located a doctor in Brooklyn who was a writing fool. That croaker would go three scripts a day for as high as thirty tablets a script. Every now and then he would get dubious on the deal, but the sight of money always straightened him out.' - Junky, William S Burroughs, 1977, originally published in 1953

'The non-medical use of tramadol is of particular concern among young people in many countries in that subregion. For example, a cross-sectional study among 300 young people in western Ghana found that while the majority (85 per cent) of respondents knew someone who misused tramadol, more than half of the young people interviewed had used tramadol themselves for non-medical purposes, and one third of the users reported misusing 9–10 doses of tramadol per day. Another qualitative study from Ghana reported curiosity, peer pressure and iatrogenic addiction as the three main factors for initiation and continuing non-medical use of tramadol, while perceived euphoria, attentiveness, relief from pain, physical energy and aphrodisiac effects were mentioned as some of the reasons for continuing non-medical use of tramadol.' - United Nations Office on Drugs and Crime, World Drug Report 2020, https://wdr.unodc.org/wdr2020/field/WDR20_BOOKLET_4.pdf

Cannabis meets all these criteria plus it it naturally growing worldwide and has been used for tens of thousands of years...no need for a new drug, we just need to bring it back..reefer madness had clouded even Huxley's mind at the time that this was written...

'What is needed is a new drug which will relieve and console our suffering species without doing more harm in the long run than it does good in the short. Such a drug must be potent in minute doses and synthesizable. If it does not possess these qualities, its production, like that of wine, beer, spirits and tobacco will interfere with the raising of indispensible food and fibres. It must be less toxic than opium or cocaine, less likely to produce undesirable social consequences than alcohol or the barbiturates, less inimical to the heart and lungs than the tars and nicotine of cigarettes. And, on the positive side, it should produce changes in consciousness more interesting, more intrinsically valuable than mere sedation or dreaminess, delusions of impotence or release from inhibition.' - The Doors of Perception, Aldous Huxley, 1954.

'The drug use survey in Nigeria reveals tramadol to be a more accessible opioid than heroin, although it is still relatively costly if used frequently. While use of tramadol appears to cost about one third the price of heroin ($3.60 versus $10 per day of use in the past 30 days), in a country where the minimum wage of a full-time worker is around $57 per month, regular tramadol use still poses a considerable financial burden on users and their families. There is no information on the prevalence of drug use in other West African countries, but treatment data reveal tramadol to be the main drug of concern for people with drug use disorders. Tramadol ranks highly among the substances for which people were treated in West Africa in the period 2014–2017. This was particularly the case in Benin, Mali, the Niger, Nigeria, Sierra Leone and Togo.' - United Nations Office on Drugs and Crime, World Drug Report 2020, https://wdr.unodc.org/wdr2020/field/WDR20_BOOKLET_4.pdf

'If people tell you that all this is necessary for the maintenance of the existing order of life and that this social order, with its destitution, hunger, prisons, executions, armies and wars, is necessary for society, that still more miseries will ensue were that organization infringed; all that is said only by those who profit by such an organization. Those who suffer from it - and they are ten times as numerous - all think and say the contrary. And in the depth of your soul you yourself know it is untrue, you know that the existing organization of life has outlived its time and must inevitably be reconstructed on new principles, and that therefore there is no need to sacrifice all human feeling to maintain it.'
- Leo Tolstoy - The Kingdom of God and Peace Essays

'At the global level, Germany was the second largest consumer of opioid pain relievers, with an estimated 28,862 S-DDD per million population per day for medical use in 2017, followed by Austria, Belgium and Switzerland. In Germany, the number of pharmaceutical opioids overall and the number of people receiving opioid treatment have increased over the past few decades; in most instances, prescriptions were given for non-chronic cancer pain. A review of scientific literature from Germany published between 1985 and 2016 showed that out of the 12 studies reviewed, 6 studies reported a prevalence for patients with medical use of any opioid for long-term treatment of non-cancer chronic pain ranging from 0.54 to 5.7 per cent, while four studies reported a prevalence for patients with medical use of opioids at 0.057 to 1.39 per cent of the population' - United Nations Office on Drugs and Crime, World Drug Report 2020, https://wdr.unodc.org/wdr2020/field/WDR20_BOOKLET_4.pdf

'The clandestine manufacture of fentanyls within North America is thus not really a new phenomenon and has the potential to increase in importance following the recent control of fentanyls substances in China. Moreover, the clandestine manufacture of fentanyl has already spread beyond North America to neighbouring subregions, as a clandestine fentanyl laboratory was dismantled in the city of Santiago, Dominican Republic, in 2017. At the same time, there is a risk that other countries with a large and thriving pharmaceutical sector may become involved in the clandestine manufacture of fentanyls. In 2018, for example, authorities of India reported two relatively large seizures of fentanyl destined for North America. Furthermore, according to United States authorities, in September 2018, the Directorate of Revenue Intelligence of India, in cooperation with DEA of the United States Department of Justice, dismantled the first known illicit fentanyl laboratory in India and seized approximately 11 kg of fentanyl' - United Nations Office on Drugs and Crime, World Drug Report 2020, https://wdr.unodc.org/wdr2020/field/WDR20_BOOKLET_4.pdf

'According to United States authorities, most of the fentanyls destined for the North American market have been manufactured in China in recent years, from where they were either shipped directly to the United States, mostly through postal services, or were first shipped to Mexico and, to a lesser extent, Canada and then smuggled into the United States. However, after the introduction by China in May 2019 of drug controls based on generic legislation with regard to the fentanyls, which effectively brought more than 1,400 known fentanyl analogues under national control in China, early signs suggest that fewer fentanyls were smuggled from China to North America. At the same time, attempts to manufacture fentanyl and its analogues inside North America are increasing, notably in Mexico, by means of a method using precursor chemicals smuggled into the subregion from East Asia and South Asia.' - United Nations Office on Drugs and Crime, World Drug Report 2020, https://wdr.unodc.org/wdr2020/field/WDR20_BOOKLET_4.pdf

'The current crisis of fentanyls appears to be more supply-driven than earlier waves of increases in the use of pharmaceutical opioids or heroin. Fentanyls are being used as an adulterant of heroin, are used to make falsified pharmaceutical opioids, such as falsified oxycodone and hydrocodone – and even falsified benzodiazepines – which are sold to a large and unsuspecting population of users of opioids and other drugs; users are not seeking fentanyl as such.

It seems that some local distributors are not able to distinguish between heroin, fentanyl and fentanyl laced heroin, nor between diverted pharmaceutical opioids and falsified opioids containing fentanyl. A general problem with fentanyls is dosing by nonprofessional “pharmacists”, where small mistakes can lead to lethal results. Furthermore, as the overdose death data suggest, even people using cocaine and psychostimulants, such as methamphetamine, are also exposed – probably unintentionally – to fentanyls or other potent synthetic opioids mixed with those substances' - United Nations Office on Drugs and Crime, World Drug Report 2020, https://wdr.unodc.org/wdr2020/field/WDR20_BOOKLET_4.pdf

'There are several varieties of writing croakers. Some will write only if they are convinced you are an addict, others only if they are convinced you are not. Most addicts put down a story worn smooth by years of use. Some claim gallstones or kidney stones. This is the story most generally used, and a croaker will often get up and open the door as soon as you mention gallstones. I got better results with facial neuralgia after I had looked up the symptoms and committed them to memory. Roy had an operation scar on his stomach that he used to support his gallstone routine.' - Junky, William S Burroughs, 1977, originally published in 1953

'There is a great incentive for trafficking organizations to expand the fentanyl market: the large associated revenues. Compared with heroin, the production costs of single-dose fentanyls are substantially lower. For instance, it may cost between $1,400 and $3,500 to synthesize 1 kg of fentanyl, which could bring a return of between $1 million and $1.5 million from street sales. For comparison, 1 kg of heroin purchased from Colombia may cost $5,000 to $7,000,99 around $53,000 at the wholesale level in the United States and around $400,000 at the retail level in the United States. With fentanyls, the logistics for supply are also more flexible because fentanyls can be manufactured anywhere and are not subject to the climatic conditions or the vulnerable conditions required for the largescale cultivation of opium poppy.' - United Nations Office on Drugs and Crime, World Drug Report 2020, https://wdr.unodc.org/wdr2020/field/WDR20_BOOKLET_4.pdf

'All factors driving fentanyl use converged from 2013 onwards in the United States and Canada, which may explain the unprecedented spread of the fentanyls in those markets: factors such as the diffusion of simpler, more effective methods of manufacture of synthetic opioids and their analogues (primarily fentanyls), assisted by the availability on the Internet of instructions for their manufacture; a shift from preparation by a limited number of skilled chemists to preparation by basic “cooks” who could simply follow the posted instructions; the discovery of ever more fentanyl analogues; a lack of effective control of precursors and oversight of the industry; expanding distribution networks that reduced the risk of detection through the use of postal services and the Internet; and increased licit trade including e-commerce.' - United Nations Office on Drugs and Crime, World Drug Report 2020, https://wdr.unodc.org/wdr2020/field/WDR20_BOOKLET_4.pdf

'In 2018, approximately 10.3 million people (3.7 per cent of the population aged 12 years or older) had misused opioids in the past year in the United States. Most of them, 9.9 million (3.6 per cent of the population aged 12 years and older), reported non-medical use of pharmaceutical opioids, while almost 800,000 reported past-year use of heroin (comprising just 8 per cent of the total population who reported past-year misuse of opioids).' - United Nations Office on Drugs and Crime, World Drug Report 2020, https://wdr.unodc.org/wdr2020/field/WDR20_BOOKLET_4.pdf

'Overall, in 2018 overdose deaths attributed to synthetic opioids, comprising mainly fentanyls, accounted for nearly half of the total overdose deaths in the United States. Among the reasons for the high number of overdose deaths attributed to fentanyls are their often small lethal doses relative to other opioids: fentanyl, for example, is approximately 100 times more potent than morphine, and carfentanil may be as much as 10,000 times more potent than morphine for an average user. A lethal dose of carfentanil for a human can be as low as 20 micrograms.

The rapid expansion of fentanyl use in the United States is also visible in the data on seizures and the drug samples analysed, with a considerable increase since 2014 in the number of samples identified as fentanyl. In 2018, fentanyl accounted for 45 per cent of the pharmaceutical opioids that were identified in different samples, while oxycodone accounted for 14 per cent' - United Nations Office on Drugs and Crime, World Drug Report 2020, https://wdr.unodc.org/wdr2020/field/WDR20_BOOKLET_4.pdf

'According to the survey, 81 percent of respondents believe that tobacco cigarettes are "very harmful." Fifty-one percent of respondents similarly view alcohol as "very harmful." By contrast, only 26 percent of those surveyed ranked marijuana as "very harmful." '
https://norml.org/news/2019/08/29/poll-americans-view-cigarettes-and-alcohol-as-more-harmful-than-cannabis

'The type of substance used, the route of administration and the health of the user all have an impact on the risk of overdose. Most overdose deaths are linked to the use of opioids, primarily the injection of heroin or synthetic opioids, while polydrug use is also very common, including the combination of heroin or other opioids with other central nervous system depressants, such as alcohol or benzodiazepines, which bears particularly high risks. Using/injecting alone is also a risk factor for overdose death.'
http://www.emcdda.europa.eu/publications/topic-overviews/content/faq-drug-overdose-deaths-in-europe_en#section3

'As I began using stuff every day, or often several times a day, I stopped drinking and going out at night. When you use junk you don't drink. Seemingly, the body that has a quantity of junk in its cells will not absorb alcohol. The liquor stays in the stomach, slowly building up nausea, discomfort, and dizziness, and there is no kick. Using junk would be a sure cure for alcoholics. I also stopped bathing. When you use junk the feel of water on the skin is unpleasant for some reason, and junkies are reluctant to take a bath.' - Junky, William S Burroughs, 1977, originally published in 1953

Happy Ganja Day to the lovers, friends and supporters of the divine herb. As we celebrate this day, let us not forget the millions who are imprisoned or face criminal action because of their association with the herb and its current worldwide illegal status. Let us not forget the millions who continue to suffer from physical and mental conditions and their lack of access to the medicinal properties of the plant. Let us not forget the millions who are addicted to heroin, methamphetamine, prescription drugs, alcohol, tobacco, novel psychoactive substances, synthetic cannabinoids and other dangerous substances without access to the natural, recreational herb. Let us hope that the opponents of the herb find reason and understanding in the coming days. Let us also look forward to the fast approaching inevitable day when the herb is finally free once again and available to every living being worldwide as it was always meant to be.

'We know that even single exposures to these chemicals, if the amount is large enough, can precipitate acute poisoning. But this is not the major problem. The sudden illness or death of farmers, spraymen, pilots, and others exposed to appreciable quantities of pesticides are tragic and should not occur. For the population as a whole, we must be more concerned with the delayed effects of absorbing small amounts of pesticides that invisibly contaminate our world.

Responsible public health officials have pointed out that the biological effects of chemicals are cumulative over long periods of time, and that the hazard to the individual may depend on the sum of the exposures recieved throughout his lifetime. For these very reasons the danger is easily ignored. It is human nature to shrug off what may seem to us a vague threat of future disaster. 'Men are naturally most impressed by disease which have obvious manifestations.' says a wise physician, Dr. Rene Dubos, 'yet some of their worst enemies creep on them unobtrusively.' - Silent Spring, Rachel Carson, 1962

'There are differences in the age distribution of the drug-induced cases (see bar chart). Drug-related deaths in most countries in the west of Europe are among older people than in eastern countries (see map). This mirrors, in part, the ageing populations of opioid users in western countries.'
http://www.emcdda.europa.eu/publications/topic-overviews/content/faq-drug-overdose-deaths-in-europe_en#question9

'Drug-related deaths predominantly affect men: there are 35.8 deaths per million men aged 15-64 years, which is almost four times the number of drug-related deaths among women (9.3 deaths per million women aged 15-64 years).

In 2017, the highest overdose mortality rate was seen in men, with 57 deaths per million men aged 35-39 years.'
http://www.emcdda.europa.eu/publications/topic-overviews/content/faq-drug-overdose-deaths-in-europe_en#question7

'It is estimated that at least 8238 overdose deaths occurred in the European Union in 2017. This rises to an estimated 9461 deaths if Norway and Turkey are included, representing a stable figure (an increase of 0.7 %) compared with the revised 2016 figure of 9397. These overall numbers must be understood as underestimations, as there are limitations to drug-induced deaths data, particularly to European cumulative totals.

According to the latest available data, it is estimated that there were at least 8799 deaths in 2017 among those aged 15-64 years old in Europe.'
http://www.emcdda.europa.eu/publications/topic-overviews/content/faq-drug-overdose-deaths-in-europe_en#question2

'We were having trouble filling the scripts. Most drugstores will only fill a morphine script once or twice, many not at all. There was one drugstore that would fill all our scripts anytime, and we took them all there..' - Junky, William S Burroughs, 1977, originally published in 1953

'Although overdose receives less attention as a benzodiazepine-related adverse event, benzodiazepines are the second-most common medication class involved in pharmaceutical overdose deaths, and overdose deaths that involve benzodiazepines increased more than 6-fold from 1996 through 2014. More than 75% of benzodiazepine-related deaths involve opioids, and evidence continues to accumulate that use of benzodiazepines is associated with increased risk of opioid-related overdose and mortality. Given that older adults experienced the largest absolute increases in opioid-related mortality between 2001 and 2016 and also experience the highest rates of coprescribing of opioids and benzodiazepines, benzodiazepine prescribing may be associated with increased opioid-related morbidity and mortality among older adults.'
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7125434/

Huxley misses a point or two here..no drug will be universally perfect for all. There will always be a minority (better that than a majority) for whom any drug will be incompatible given different mental and physical constitutions. Also his obsession and faith in the Western system of synthesizing something that can be had in measured doses like pills or alcohol is unnecessary for natural intoxicants where margins are much larger and safer..cannabis is the ideal...peyote and psilocybin too where it is available but not to the extent of cannabis...nature has done the work already, no need for pharmacologists and neurologists to re-invent the wheel...

'Although obviously superior to cocaine, opium, alcohol and tobacco, mescalin is not yet the ideal drug. Along with the happily transfigured majority of mescalin takers there is a minority that finds in the drug only hell or purgatory. Moreover, for a drug that is to be used, like alcohol, for general consumption, its effects last for an inconveniently long time. But chemistry and physiology are capable nowadays of practically anything. If the psychologists and sociologists will define the ideal, the neurologists and pharmacologists can be relied upon to discover the means whereby that ideal can be realized or at least (for this kind of ideal can never, in the very nature of things, be fully realized) more nearly approached than in the wine-bibbing past, the whisky-drinking, marijuana- smoking and barbiturate-swallowing present.' - The Doors of Perception, Aldous Huxley, 1954.

Some people chose opium, alcohol and prescription drugs, instead of cannabis, for their recreation and medicine. That's fine, since everybody has the right to choose their sources of recreation and medicine. But what was unacceptable was that they banned cannabis, the medicine and recreation of millions of people, especially the poor and the labouring classes worldwide. Now, after decades of overdosing on their drugs, these people are dying from the side effects and the loss of health and immunity. Instead of changing their recreational and medical diet to a more sustainable one, these people have now confined billions of humans, again mostly the poor and labouring classes, while continuing to prescribe their dangerous drugs as medication for all. The cannabis plant must be legalized, for recreational and medicinal use, and made available for all who wish to use it. For those addicted to opium and prescription drugs, the recognition that the path they are following is unsustainable must happen as soon as possible. Also, the recognition that the majority of the world has always paid the price for the misadventures of these people, and continues to do so, must happen as soon as possible to stop the oppression of the majority, increasing deaths and damage to the planet.
Apr 19, 2020, 12:42 PM

'Cannabis alone will not end opioid use disorder and associated morbidities and mortality. However, the introduction of ever more powerful opioids like fentanyl and carfentanyl into the illicit drug market and the resulting day-to-day increase in opioid overdoses highlights the immediate need for innovative short and long term intervention strategies to add to current efforts like ORT, heroin maintenance programs, supervised consumption sites, the depenalization of substance use, and increased education and outreach on the potential harms associated with both prescription and illicit opioid use. The growing body of research supporting the medical use of cannabis as an adjunct or substitute for opioids creates an evidence-based rationale for governments, health care providers, and academic researchers to seek the immediate implementation of cannabis-based interventions in the opioid crisis at the regional and national level, and to subsequently assess their potential impacts on public health and safety'
https://harmreductionjournal.biomedcentral.com/articles/10.1186/s12954-017-0183-9

'Medical and adult-use marijuana laws have the potential to lower opioid prescribing for Medicaid enrollees, a high-risk population for chronic pain, opioid use disorder, and opioid overdose, and marijuana liberalization may serve as a component of a comprehensive package to tackle the opioid epidemic.'
https://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2677000

'“Fentanyl deaths are up, a 45 percent increase; that is not a success,” said Dr. Dan Ciccarone, a professor of family and community medicine at the University of California, San Francisco. “We have a heroin and synthetic opioid epidemic that is out of control and needs to be addressed.”Synthetic drugs tend to be more deadly than prescription pills and heroin for two main reasons. They are usually more potent, meaning small errors in measurement can lead to an overdose. The blends of synthetic drugs also tend to change frequently, making it easy for drug users to underestimate the strength of the drug they are injecting. In some parts of the country, drugs sold as heroin are exclusively fentanyls now.'
https://www.nytimes.com/interactive/2018/11/29/upshot/fentanyl-drug-overdose-deaths.html

'A single execution carried out dispassionately by prosperous and educated men with the approval and participation of Christian minister and presented as something necessary and even just, perverts and brutalizes men more than thousands of murders committed by uneducated working people under the influence of passion. An execution such as Zukhovsky proposed to arrange, which was to arouse in men a sentiment of religious emotion, would have the most depraving influence imaginable.

Every war, even the briefest, with the expenditure usual to war, the destruction of crops, the plundering, the licensed debauchery and murders, the sophisticated excuses as to its necessity and justice, the exaltation and glorification of military exploits, patriotism and devotion to the flag, the feigned solicitude for the wounded, and so on, does more to deprave people in a single year than millions of robberies, arsons, and murders committed in hundreds of years by individual men under the influence of passion.'
- Leo Tolstoy - The Kingdom of God and Peace Essays

'Seventy-two percent of individuals [in the US study] who reported substitution said they had completely ceased opioid use, 68 percent said they stopped taking benzodiazepines and 80 percent got off SSRI anti-depression medication.'

About 70 percent [in the Canadian study] said they used marijuana as a substitute for prescription drugs—35 percent for opioids, 11 percent for anti-depressants, eight percent for anti-seizure medications, four percent for sleeping pills and muscle relaxants and four percent for benzodiazepines.'
https://www.marijuanamoment.net/patients-are-substituting-marijuana-for-addictive-pharmaceutical-drugs-two-new-studies-show/

'A lot of nonsense has been written about the changes people undergo as they get a habit. All of a sudden the addict looks in the mirror and does not recognise himself. The actual changes are difficult to specify and they do not show up in the mirror. That is, the addict himself has a special blind spot so far as the progress of the habit is concerned. He generally does not realize that he is getting a habit at all. He says there is no need to get a habit if you are careful and observe a few rules, like shooting every other day. Actually, he does not observe these rules, but every extra shot is regarded as exceptional. I have talked to many addicts and they all say they were surprised when they discovered they actually had the first habit. Many of them attributed their symptoms to some other cause.' - Junky, William S Burroughs, 1977, originally published in 1953

'In addition to alcohol, some older adults have also been found to be drug abusers (Li and Jackson, 2016). These drugs include prescription drugs and illicit drugs. Older people are reported to have the highest prescription-drug abuse rate of any other age group (Briggs et al., 2011). Among the prescription drugs, benzodiazepines and opioid analgesics are frequently prescribed to individuals aged 65 years and older. In Australia’s aged care services, around 4.4 percent of residents report misusing opioids or benzodiazepines (Li and Jackson, 2016).'
http://journals.sagepub.com/doi/full/10.1177/2055102917708136

It appears that cigarettes are available in certain shops and through home delivery..alcohol is if you know how to pull the right strings..all this provided you can fork out the price and provided the cops have not taken a special interest in the same, given their new roles as public health officials..but one thing I found missing are beedis, yes, my preferred trip in the absence of ganja (which is like most of the time these days). The small shops that sold the beedies remain closed even while super market businesses thrive..even the small grocery shop where I last purchased beedies said he was out of stock..apparently the cops had been around asking him where he was getting his beedis from and that he should not be selling them...yes, Covid, the disease of the elite, by the elite and for the elite.. Want to smoke beedi?? Here, have a paracetamol or disinfectant or hydroxychloroquine...Mama's gonna keep you right here under her wing, she won't let you fly, but she might let you sing, Mama's gonna keep baby cozy and warm...
Apr 28, 2020, 8:39 PM

'The study, conducted by researchers at the Johns Hopkins University School of Medicine and published in the forthcoming issue of the Journal of Substance Abuse Treatment, asked 200 people with past-month opioid and marijuana use whether their symptoms of opioid withdrawal improved or worsened when they consumed cannabis.

Of the 125 respondents who used marijuana to treat their withdrawal, nearly three-quarters (72 percent) said it eased their symptoms, while only 6.4 percent said it made them worse. Another 20 percent reported mixed results, and three people (2.4 percent) said cannabis didn’t seem to have an obvious effect either way.'
https://www.marijuanamoment.net/cannabis-may-ease-opioid-withdrawal-symptoms-johns-hopkins-study-finds/

'From 1999 to 2017, 399 230 poisoning deaths involved opioids, of which 263 601 (66.0%) were male, and 204 560 (51.2%) were aged 35 to 54 years. Alcohol co-involvement for all opioid overdose deaths increased nonlinearly from 12.4% in 1999 to 14.7% in 2017. By opioid subtype, deaths involving heroin and synthetic opioids (eg, fentanyl; excluding methadone) had the highest alcohol co-involvement at 15.5% and 14.9%, respectively, in 2017. Benzodiazepine co-involvement in all OODs increased nonlinearly from 8.7% in 1999 to 21.0% in 2017. Benzodiazepines were present in 33.1% of prescription OODs and 17.1% of synthetic OODs in 2017. State-level rates of binge drinking were significantly correlated with alcohol co-involvement in all OODs (r=0.34; P=.02). State benzodiazepine prescribing rates were significantly correlated with benzodiazepine co-involvement in all OODs (r=0.57; P<.001)'
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7146101/

'The major features of cellular organization, including, for instance, mitosis, must be much older than 500 million years old - more nearly 1000 million,' wrote Geroge Gaylord Simpson and his colleagues Pittendrigh and Tiffany in their broadly encompassing book entitled Life. 'In this sense the world of life, which is surely fragile and complex, is incredibly durable through time - more durable than mountains. This durability is wholly dependent on the almost incredible accuracy with which the inherited information is copied from generation to generation.' But in all the thousand million years envisioned by these authors no threat has struck so directly and so forcefully at that 'incredible accuracy' as the mid-20th century threat of man-made radiation and man-made and man-disseminated chemicals. Sir Macfarlane Burnet, a distinguished Australian physician and a Nobel Prize winner, considers it 'one of the most significant medical features' of our time that, 'as a by-product of more and more powerful therapeutic procedures and the production of chemical substances outside of biological experiences, the normal protective barriers that kept mutagenic agents from the internal organs have been more and more frequently penetrated.' - Silent Spring, Rachel Carson, 1962

'Health harms are increasing among the estimated 200,000 people who inject drugs (PWID) in the United Kingdom (UK). Since 2012, there has been a steady increase in hospitalisations for serious bacterial infections, a doubling of opioid-related deaths [2], and outbreaks of invasive and infectious diseases among PWID, particularly among those who are homeless. The recent outbreak of coronavirus (COVID-19) is of particular concern, given vulnerability to respiratory problems among PWID in the UK, many of whom also smoke (crack cocaine, heroin, tobacco) and have a much higher incidence of chronic obstructive pulmonary disease (COPD) than the general population [4].

Drug-related deaths in the UK are higher than any European Union (EU) country; in the year before Britians exit they accounted for one third of all reported in the EU country and, in the year prior to Britain’s exit, accounted for a third of all reported in the EU [5]'
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7145770/

'As a habit takes hold, other interests lose importance to the user. Life telescopes down to junk, one fix and looking forward to the next, "stashes" and "scripts," "spikes" and "droppers." The addict himself often feels that he is leading a normal life and that junk is incidental. He does not realize that he is just going through the motions in his non-junk activities. It is not until his supply is cut off that he realizes what junk means to him.' - Junky, William S Burroughs, 1977, originally published in 1953

'Researchers concluded: "In this study, we observed dynamic changes in opioid distribution for eleven opioids used for pain and OUD [opioid use disorder] within Colorado, and two carefully selected comparison states, Utah and Maryland, from 2007 to 2017. Colorado, after legalizing recreational marijuana, had a significant decrease in prescription opioids distributed for pain. The findings from this geographically limited study were challenging to interpret because, while analgesic opioid use was unchanged in Utah, Maryland also had a significant decline [though this decline was not as significant as was observed in Colorado.] Other national research more clearly showed that marijuana policies were associated with reductions in analgesic opioid use. This appears to be an empirically informed public policy strategy which may contribute to reversing the US opioid epidemic."'
https://norml.org/news/2020/05/21/study-prescription-opioid-distribution-falls-following-adult-use-marijuana-legalization

'Student substance use rates, at least once during the month before COVID-19, were 31.1% tobacco, 58.2% alcohol, 1.7% cannabis, 1.5% Ritalin or similar substances, 13.8% pain relievers, and 6.5% sedatives. Males more than females use tobacco (i.e., cigarettes) (47.6% vs. 27.2%; p < 0.001) and cannabis, which are prohibited in both countries (4.6% vs. 1.0%; p = 0.002). Females more than males use pain relievers (15.9% vs. 5.2%; p = 0.001). Secular more than religious students use cigarettes (40.8% vs. 24.4%; p < 0.001), alcohol (62.9% vs. 54.8%; p < 0.017), cannabis (4.0% vs. 0.2%, p < 0.001), and sedatives (9.4% vs. 4.3%; p =0.003). Russian students, compared to those from Belarus, use more tobacco (33.9% vs. 21.0%; p = 0.001) and pain relievers (16.0% vs. 5.6%; p < 0.001). Those who reported last month substance use before COVID 19 report their use increased as a COVID-19 consequence. Among substance users, the following increases were reported: 35.6% tobacco, 29.6% alcohol, 27.3% cannabis, 16.7% Ritalin or similar substance, 18.2% pain relievers, and 23.5% sedatives. Russian and Belarusian students under quarantine/strict self-isolation conditions had a significantly higher rate of alcohol use than those not restricted (34.3% vs. 24.6%; p = 0.017)'
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7241583/

'Results: Of 100 patients enrolled into the study, 61 were male with a mean age of 34.01 ± 14.65 years and 39 were female with a mean age of 40.6 ± 7.49 years. Sixty-five patients survived (Table 1). Mean hospitalization period was 2.69 ± 2.12 h (range; 30 min to 5.5 h) and 94.7 ± 40.4 in non-survivors and survivors, respectively. The most common cause of poisoning was drug overdose in 78 patients.

Discussion: [L]actate concentration. However, lactate concentration is an established prognostic marker for the evaluation of patients with elevated anion gap metabolic acidosis, selected drug overdoses (metformin and acetaminophen), selected chronic drug toxicities (stadivudine), and chemical poisoning (aluminum phosphide and cyanide).

As the report of national drug and poisoning information center of Iran provided, 60% of all contacts per year are related to poisoning. Lactic acidosis is the condition where lactate concentration increase instantly to more than 5 mmol/dL. Type A lactic acidosis occurs in oxygen distribution dysfunction due to hypotension or cyanosis. Type B lactic acidosis occurs in sepsis, liver dysfunction, diabetes, and drugs such as biguanides, acetaminophen, and sorbitol.

Creatine kinase supplies energy in body organs with different types in brain (CK1), myocardium (CK2), and muscle (CK3) whose change is considered to be due to organ damages. Usually, existence of CK in blood defines the organ injuries including myocardial infarctions, rhabdomyolysis, autoimmune myositis, and kidney injuries.'
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7191820/

'Results: Cannabis Users self-reported significantly better QOL [quality of life] [t(1054)=-4.19, p<0.001], greater health satisfaction [t(1045)=-4.14, p<0.001], improved sleep [children: t(224)=2.90, p<0.01; adults: [t(758)=3.03, p<0.01], lower average pain severity [t(1150)=2.34, p<0.05], lower anxiety [t(1151)=4.38, p<0.001], and lower depression [t(1210)=5.77, p<0.001] compared with Controls. Cannabis Users reported using fewer prescription medications (rate ratio [RR]=0.86; 95% confidence interval [CI]: 0.77–0.96) and were less likely to have a past-month emergency department visit (RR=0.61; 95% CI: 0.44–0.84) or hospital admission (RR=0.54; 95% CI: 0.34–0.87). Controls who initiated cannabis use after baseline showed significant health improvements at follow-up, and the magnitude of improvement mirrored the between-group differences observed at baseline.

Conclusions: Cannabis use was associated with improved health and QOL. Longitudinal testing suggests that group differences may be due to the medicinal use of cannabis. Although bias related to preexisting beliefs regarding the health benefits of cannabis in this sample should be considered, these findings indicate that clinical trials evaluating the efficacy of defined cannabinoid products for specific health conditions are warranted.'
https://www.liebertpub.com/doi/full/10.1089/can.2019.0096

'Around 269 million people used drugs in 2018, up 30 per cent from 2009, with adolescents and young adults accounting for the largest share of users. More people are using drugs, and there are more drugs, and more types of drugs, than ever. Seizures of amphetamines quadrupled between 2009 and 2018. Even as precursor control improves globally, traffickers and manufacturers are using designer chemicals, devised to circumvent international controls, to synthesize amphetamine, methamphetamine and ecstasy. Production of heroin and cocaine remain among the highest levels recorded in modern times.' - Ghada Waly, Executive Director, United Nations Office on Drugs and Crime, World Drug Report 2020, https://wdr.unodc.org/wdr2020/field/WDR20_BOOKLET_1.pdf

'In the longer run, the economic downturn and associated lockdowns have the potential to disrupt drug markets. Rising unemployment and lack of opportunities will make it more likely that poor and disadvantaged people engage in harmful patterns of drug use, suffer drug use disorders and turn to illicit activities linked to drugs – either production or transport. And drug trafficking organizations are likely to exploit the situation by providing services to the vulnerable and boosting their ranks with new recruits. With Governments less able to respond, these shifts could quickly take root and become the new reality for many communities' - United Nations Office on Drugs and Crime, World Drug Report 2020, https://wdr.unodc.org/wdr2020/field/WDR20_BOOKLET_1.pdf

'In 1937, weed was placed under the Harrison Narcotics Act. Narcotics authorities claim it is a habit-forming drug, that its use is injurious to mind and body, and that it causes the people who use it to commit crimes. Here are the facts: Weed is positively not habit forming. You can smoke weed for years and you will experience no discomfort if your supply is cut off. I have seen tea heads in jail and none of them showed withdrawal symptoms. I have smoked weed myself off and on for fifteen years, and never missed it when I ran out. There is less habit to weed than there is to tobacco. Weed does not harm the general health. In fact. most users claim it gives you an appetite and acts as a tonic to the system. I do not know of any other agent that gives as definite a boot to the appetite. I can smoke a stick of tea and enjoy a glass of California sherry and a hash house meal.' - Junky, William S Burroughs, 1977, originally published in 1953

'Drug markets are becoming increasingly complex. Plant-based substances such as cannabis, cocaine and heroin have been joined by hundreds of synthetic drugs, many not under international control. There has also been a rapid rise in the non-medical use of pharmaceutical drugs. Roughly 500 NPS are found on the national markets of Member States each year. Currently, most of those are stimulants, followed by synthetic cannabinoid receptor agonists and a smaller number of opioids. However, while the overall number of NPS has stabilized, the proportions have changed. Opioid NPS accounted for just 2 per cent of the number of NPS identified in 2014 but by 2018 that figure had risen to 9 per cent. Opioid NPS, many of them fentanyl analogues, have proved both potent and harmful, fuelling overdose deaths in North America and to a lesser extent in other regions. In North America, fentanyls are either used as adulterants in heroin and other drugs (including cocaine and methamphetamine) or used to make falsified pharmaceutical opioids. Some evidence suggests NPS stimulants are also being injected in Europe: a study of residues in discarded syringes in six European cities found that many were tainted with stimulant NPS.' - United Nations Office on Drugs and Crime, World Drug Report 2020, https://wdr.unodc.org/wdr2020/field/WDR20_BOOKLET_1.pdf

'An estimated 192 million people used cannabis in 2018, making it the most used drug globally. In comparison, 58 million people used opioids in 2018. But that lower number of users belies the harm associated with opioids. This group of substances accounted for 66 per cent of the estimated 167,000 deaths related to drug use disorders in 2017 and 50 per cent of the 42 millions years (or 21 million years) lost due to disability or early death, attributed to drug use.' - United Nations Office on Drugs and Crime, World Drug Report 2020, https://wdr.unodc.org/wdr2020/field/WDR20_BOOKLET_1.pdf

'In West, Central and North Africa, the opioid crisis is fuelled by tramadol; in North America, by fentanyls. Although those subregions have little in common in terms of economics, demographics or general patterns of drug use, both are struggling with an opioid crisis fuelled by substances that are easy to access and cheap to produce.' - United Nations Office on Drugs and Crime, World Drug Report 2020, https://wdr.unodc.org/wdr2020/field/WDR20_BOOKLET_1.pdf

Ganja in the Indian sub-continent...

'The urge to transcend self-conscious selfhood is, as I have said, a principal appetite of the soul. When, for whatever reason, men and women fail to transcend themselves by means of worship, good works and spiritual exercises, they are apt to resort to religion's chemical surrogates - alcohol and 'goof-pills' in the modern West, alcohol and opium in the East, hashish in the Mohameddan world, alcohol and marijuana in Central America, alcohol and coca in the Andes, alcohol and the barbiturates in the more up-to-date regions of South America.' - The Doors of Perception, Aldous Huxley, 1954.

'Ease of manufacturing and low production costs helped to seed both crises, as did the context of an absence of international regulations on tramadol and many fentanyl analogues or their precursors. Both crises were inflamed by the availability of the substances on pharmaceutical and illicit markets – making it more difficult to detect and prevent their misuse.' - United Nations Office on Drugs and Crime, World Drug Report 2020, https://wdr.unodc.org/wdr2020/field/WDR20_BOOKLET_1.pdf

'The stimulant scene is dominated by cocaine and methamphetamine, and use of both substances is rising in their main markets. Some 19 million people used cocaine in 2018, fuelled by the drug’s popularity in North America and Western Europe. Roughly 27 million people used amphetamines that same year, methamphetamine being the most used ATS [amphetamine type substance] in South-East Asia. Use of methamphetamine in these two subregions has been expanding for two decades, according to most available indicators. Cocaine and methamphetamine can coexist in some markets by acting as substitutes for each other, so that use of one drug rises when the other goes down, or by feeding the same market with parallel increases and declines.' - United Nations Office on Drugs and Crime, World Drug Report 2020, https://wdr.unodc.org/wdr2020/field/WDR20_BOOKLET_1.pdf

'I once kicked a junk habit with weed. The second day off junk I sat down and ate a full meal. Ordinarily, I can't eat for eight days after kicking a habit.' - Junky, William S Burroughs, 1977, originally published in 1953

'Some 11.3 million people are estimated to have injected drugs in 2018, a practice that accounts for roughly 10 per cent of HIV infections worldwide. More than 1 million people who inject drugs are living with HIV and 5.5 million are living with hepatitis C. Of the roughly 585,000 deaths attributed to drug use in 2017, half were due to liver diseases caused by hepatitis C, which continues to mostly go untreated among people who inject drugs. Opioid shortages caused by COVID-19 restrictions could lead to users substituting with more readily available substances such as alcohol or benzodiazepines, or to mixing with synthetic drugs. More harmful patterns of use may emerge as some users switch to injecting, or to more frequent injecting' - United Nations Office on Drugs and Crime, World Drug Report 2020, https://wdr.unodc.org/wdr2020/field/WDR20_BOOKLET_1.pdf

'Synthetic drugs can be produced in virtually every country. The COVID-19 measures could have an effect on synthetic drug production if they lead to a reduction in the availability of precursor substances that are either diverted from the legal trade or produced illicitly. Where precursor chemicals are supplied from within a region and trafficking has not been impeded (for example, in South-East Asia), the production of synthetic drugs is only marginally affected by the restrictions stemming from the measures to control the spread of COVID-19. Also, where there is domestic manufacture using domestic precursors as is the case with mephedrone and other popular synthetic drugs in the Russian Federation, no major impact on the domestic drug market has been visible.' - United Nations Office on Drugs and Crime, World Drug Report 2020, https://wdr.unodc.org/wdr2020/field/WDR20_BOOKLET_1.pdf

'Many countries have reported drug shortages at the retail level, with reports of heroin shortages in Europe, South-West Asia and North America in particular. Drug supply shortages can go together with an overall decrease in consumption (for example, of drugs that are mostly consumed in recreational settings such as bars and clubs) but may also, especially in the case of heroin, lead to the consumption of harmful domestically produced substances, as well as more harmful patterns of drug use by people with drug use disorders. In terms of alternatives, some countries in Europe have warned that heroin users may switch to substances such as fentanyl and its derivatives. An increase in the use of pharmaceutical products such as benzodiazepines and buprenorphine has also been reported, to the extent that their price has doubled in some areas.' - United Nations Office on Drugs and Crime, World Drug Report 2020, https://wdr.unodc.org/wdr2020/field/WDR20_BOOKLET_1.pdf

'A bizarre happening in the United States during the prohibition era around 1930 was an omen of things to come. It was caused not by an insecticide but by a substance belonging chemically to the same group as the organic phosphate insecticides. During the period some medicinal substances were being pressed into service as substitutes for liquor, being exempted from the prohibition law. One of these was Jamaica ginger. But the United States Pharmacopeia product was expensive, and bootleggers conceived the idea of making a substitute Jamaica ginger. They succeeded so well that their spurious product responded to the appropriate chemical tests and decieved the government chemists. To give their false ginger the necessary tang they had introduced a chemical known as triorthocresyl phosphate. This chemical, like parathion and its relatives, destroys the protective enzyme cholinesterase. As a consequence of drinking the bootleggers' product some 15,000 people developed a permanently crippling type of paralysis of the leg muscles, a condition called 'ginger paralysis'. The paralysis was accompanied by destruction of the nerve sheaths and by degeneration of the cells of the anterior horns of the spinal cord.' - Silent Spring, Rachel Carson, 1962

'Harmful patterns deriving from drug shortages include an increase in injecting drug use and the sharing of injecting equipment and other drug paraphernalia, all of which carry the risk of spreading blood-borne diseases, such as HIV/AIDS and hepatitis C, as well as COVID-19. Risks resulting from drug overdose may also increase among people who inject drugs and who are infected with COVID-19.' - United Nations Office on Drugs and Crime, World Drug Report 2020, https://wdr.unodc.org/wdr2020/field/WDR20_BOOKLET_1.pdf

'People with drug use disorders are particularly vulnerable to comorbidities that can lead to a poor outcome if they become infected with COVID-19. The same is true for anyone who uses drugs regularly. People who use opioids have a high risk of comorbidities such as chronic obstructive pulmonary disease, whereas stimulant users are particularly susceptible to inflammation of and damage to the lung tissue. Users of both drug types may already have a compromised immune system and an increased risk of cardiovascular diseases. These underlying conditions can put people who use drugs regularly at a high risk of complications and mortality if they become infected with COVID-19' - United Nations Office on Drugs and Crime, World Drug Report 2020, https://wdr.unodc.org/wdr2020/field/WDR20_BOOKLET_1.pdf

'When you're sick, music is a great help. Once, in Texas, I kicked a habit on weed, a pint of paregoric and a few Louis Armstrong records.' - Junky, William S Burroughs, 1977, originally published in 1953 - Junky, William S Burroughs, 1977, originally published in 1953

'The economic downturn caused by the COVID-19 crisis has the potential to worsen levels of drug production, trafficking and use. The crisis may exacerbate the socioeconomic situation of vulnerable groups, who in turn may increasingly resort to illicit activities as a coping mechanism to compensate for the loss of licit income and employment. Once restrictions related to COVID-19 are lifted, economic shocks may also prompt an increase in drug consumption, as observed in the past. Pairing drug related programmes with the development interventions that Governments are launching to contain the negative socioeconomic consequences of the crisis can help prevent a possible further increase in the number of people with substance use disorders linked to the effects of the COVID-19 pandemic.' - United Nations Office on Drugs and Crime, World Drug Report 2020, https://wdr.unodc.org/wdr2020/field/WDR20_BOOKLET_1.pdf

Going through the executive summary of the 2020 World Drug Report, I find that there is no change in tune from the world drug control agencies. The report says that abuse of all forms of synthetic drugs are rapidly growing including opioids, amphetamines and benzodiazepines. It also says that Covid 19 is likely to exacerbate drug usage and that novel psychotropic substances synthesized in labs are growing rapidly. It says that national budgets for drug control have been slashed significantly over the last few years. Along with all this it also continues to say that cannabis was the most consumed and largest seized drug in the world. It also shows that the majority of persons in jail are for cannabis. It also seems more focused on curbing cannabis cultivation by poor farmers than focusing on synthetic drugs that kill. It talks about how 80% of the world suffers without access to pain medication and then goes on to say that cannabis needs to be closely monitored and claims of its use are only personal testimonials without clinical trial backing. It also does not miss the opportunity to say that THC is not as benign as CBD even though no statistic of cannabis related deaths exist. It says that adolescent use in places where cannabis has been legalized have not increased, states that alcohol is much more responsible for violence than drugs, but expresses concern about big tobacco and alcohol companies looking to enter cannabis businesses...how typical...
Jul 3, 2020, 4:18 PM

'Opioids, which include opiates (heroin and opium) and pharmaceutical and other synthetic opioids, are a major concern in many countries because of the severe health consequences associated with their use. For example, in 2017, the use of opioids accounted for nearly 80 per cent of the 42 million years of “healthy” life lost as a result of disability and premature death (disability-adjusted life years, or DALYs) and 66 per cent of the estimated 167,000 deaths attributed to drug use disorders.' - United Nations Office on Drugs and Crime, World Drug Report 2020, https://wdr.unodc.org/wdr2020/field/WDR20_Booklet_2.pdf

'Although global estimates are not available, the nonmedical use of pharmaceutical opioids is reported in many countries, in particular in countries in West and North Africa and the Near and Middle East (tramadol), and in North America (hydrocodone, oxycodone, codeine, tramadol and fentanyl).' - United Nations Office on Drugs and Crime, World Drug Report 2020, https://wdr.unodc.org/wdr2020/field/WDR20_Booklet_2.pdf

'With the exception of Nigeria, where 4.6 million people were estimated to have used opioids – mainly tramadol – in 2017, population-level prevalence estimates of the use of opioids are not available for countries in West, Central and North Africa. However, many countries in those subregions report high levels of non-medical use of tramadol. For example, in Egypt, 2.5 per cent of male and 1.4 per cent of female students aged 15–17 had misused tramadol in the past year. Students in that country also reported the use, to a lesser degree, of heroin or opium/morphine in 2016. Furthermore, data on the provision of treatment suggest that the prevalence of the non-medical use of opioids is quite high in Egypt. Tramadol tablets available in some parts of Africa are reportedly intended for the illicit market and may be of a dosage higher than usually prescribed for medical purposes.' - United Nations Office on Drugs and Crime, World Drug Report 2020, https://wdr.unodc.org/wdr2020/field/WDR20_Booklet_2.pdf

'The opioid crisis continues in North America, with a new record level in the number of opioid overdose deaths attributed to the use of fentanyl and its analogues. These substances are added to heroin and other drugs as adulterants and are also sold as counterfeit prescription opioids, such as oxycodone or hydrocodone, and even as counterfeit benzodiazepines, to a large unsuspecting population of users of opioids and other drugs. In 2018, in the United States, 10.3 million people or 3.7 per cent of the population aged 12 and older had misused opioids in the past year. Of those people, 9.9 million (3.6 per cent of the population) reported the non-medical use of prescription opioids while nearly 800,000 reported past-year use of heroin.' - United Nations Office on Drugs and Crime, World Drug Report 2020, https://wdr.unodc.org/wdr2020/field/WDR20_Booklet_2.pdf

'There are also signs of increasing non-medical use of pharmaceutical opioids in Western and Central Europe, as reflected in the increasing proportion of treatment admissions for the use of those substances in recent years. In 2017, users of pharmaceutical opioids, including misused methadone, buprenorphine, fentanyl, codeine, morphine, tramadol and oxycodone, accounted for 22 per cent of all clients entering drug treatment in the subregion for opioid use disorders (as their primary drug).' - United Nations Office on Drugs and Crime, World Drug Report 2020, https://wdr.unodc.org/wdr2020/field/WDR20_Booklet_2.pdf

'I had 1/16-ounce of junk with me. I figured this was enough to taper off, and I had a reduction schedule carefully worked out. It was supposed to take twelve days. I had the junk in solution, and in another bottle distilled water. Every time I took out a dropper of solution out to use it, I put the same amount of distilled water in the junk solution bottle. Eventually I would be shooting plain water. This method is well known to all junkies. A variaion of it is known as the Chinese cure, which is carried out with hop and Wampole's tonic. After a few weeks, you find yourself drinking plain Wampole's Tonic.

Four days later in Cincinnati, I was out of junk and immoblized. I have never known one of these self-administered reduction cures to work. You find reasons to make each shot an exception that calls for a little extra junk. Finally, the junk is all gone and you still have your habit' - Junky, William S Burroughs, 1977, originally published in 1953

'A major drug use survey carried out recently in India found that in 2018, 2.1 per cent of the population aged 10–75, a total of 23 million people, had used opioids in the past year. Among opioids, heroin is the most prevalent substance, with a past-year prevalence of 1.1 per cent among the population aged 10–75; this is followed by the non-medical use of pharmaceutical opioids, with a past-year prevalence of almost 1 per cent, and by opium at almost 0.5 per cent. In general, the past-year use of opioids is much higher among men (4 per cent of the male population) than women (0.2 per cent of the female population). Moreover, 1.8 per cent of adolescents aged 10–17 are estimated to be past-year opioid users. Of the 23 million past-year opioid users, roughly one third, or 7.7 million people, suffer from opioid use disorders. Compared with earlier estimates from a survey carried out in 2004, overall opioid use in India is estimated to have increased fivefold.' - United Nations Office on Drugs and Crime, World Drug Report 2020, https://wdr.unodc.org/wdr2020/field/WDR20_Booklet_2.pdf

'Around 27 million people worldwide, corresponding to 0.5 per cent of the adult population, are estimated to have used amphetamines, including amphetamine, methamphetamine and pharmaceutical stimulants, in the past year. The past-year prevalence of the use of amphetamines is particularly high in North America (2.3 per cent of the population aged 15–64) and Australia and New Zealand (1.3 per cent). The past-year use of amphetamines in Asia, as a percentage of the population, is at a similar level (0.5 per cent) to the global average. Nearly half of the global estimate of past-year users of amphetamines (12.7 million people) reside in Asia, although the region is home to 60 per cent of the global population aged 15–64' - United Nations Office on Drugs and Crime, World Drug Report 2020, https://wdr.unodc.org/wdr2020/field/WDR20_Booklet_2.pdf

'The type and form of amphetamines used vary considerably between regions and subregions. In North America, the non-medical use of pharmaceutical stimulants and methamphetamine is most prevalent; in East and South-East Asia and Oceania (Australia and New Zealand), it is methamphetamine; and in Western and Central Europe and the Near and Middle East, it is amphetamine. In the latter subregion, amphetamine is commonly known as “captagon”. In many countries in South and Central America, especially those that have reported recent survey data, the non-medical use of pharmaceutical stimulants is more common than the use of other amphetamines. The non-medical use of weight loss pills is reportedly more prevalent among women than among men, with pills such as sibutramine hydrochloride monohydrate (sold under the brand names Aderan and Ipomex) and phentermine (sold under the brand names Duromine and Suprenza), along with methylphenidate and amphetamine, reported to be the most commonly misused pharmaceutical stimulants in those subregions' - United Nations Office on Drugs and Crime, World Drug Report 2020, https://wdr.unodc.org/wdr2020/field/WDR20_Booklet_2.pdf

'In 2018, methamphetamine use declined among young adults (aged 18–25), but increased significantly among adults aged 26 and older. This excludes institutionalized and homeless populations, however, both of which may be affected by disproportionately higher rates of drug use. In recent years, reported methamphetamine per gram purity levels in the United States have averaged more than 90 per cent, while prices have declined by a further 18 per cent over the past year to $56 per pure gram.48 Although in the United States, methamphetamine has historically been mixed with heroin to create a “speedball”, such combinations are increasingly rare. Recent forensic laboratory reports indicate that, while still comparatively rare, there are combinations of methamphetamine, fentanyl and fentanyl analogues on the United States drug markets.' - United Nations Office on Drugs and Crime, World Drug Report 2020,
https://wdr.unodc.org/wdr2020/field/WDR20_Booklet_2.pdf

'European wastewater analysis confirms the patterns of use of amphetamines reported in household survey data, which point to an overall prevalence of amphetamine use in Europe that is higher than that of methamphetamine, as methamphetamine use is predominant in only a few countries.

Wastewater analyses, conducted in 140 cities in 33 countries across Europe, suggest that the quantity of amphetamine consumed per capita over the period 2011–2019 was 1.7 times larger in 2019. In most of the cities included in the analysis, amphetamine was the most consumed substance of the amphetamines group in 2019 (or the latest year available)' - United Nations Office on Drugs and Crime, World Drug Report 2020, https://wdr.unodc.org/wdr2020/field/WDR20_Booklet_2.pdf

'More than one third (9.9 million people) of the estimated global number of users of amphetamines are in East and South-East Asia. The increased use of methamphetamine, both in the form of tablets and crystalline methamphetamine, continues to be reported in the subregion. A recent household survey conducted in Indonesia in 2017 reported past-year prevalence of the use of amphetamines at 0.5 per cent, or roughly 1 million past-year users, 850,000 of whom were past-year users of methamphetamine. Similarly, in the Philippines, on the basis of a 2016 household survey, 1.1 per cent of the population aged 10–69, or approximately 850,000 people, were estimated to be past-year users of methamphetamine, while in Thailand 1.3 per cent of the population (653,000 people) aged 12–65 were estimated to be past-year users of methamphetamine tablets, whereas 0.7 per cent of the population (372,000) used crystal methamphetamine in 2019.' - United Nations Office on Drugs and Crime, World Drug Report 2020, https://wdr.unodc.org/wdr2020/field/WDR20_Booklet_2.pdf

'There were three shots a day. One at seven a.m., when we got up, one at one p.m., and one at nine p.m. Two old acquaintances had come in during the afternoon, Matty and Louis. I ran into Louis as we were lining up for the evening shot.
"Did they get you?" he asked me.
"No. Just here for the cure. How about you?"
"Same with me," he answered.
With the evening shot, they gave me some chloral hydrate in a glass. Five new arrivals were brought to the ward during the night. The ward attendant threw up his hands. "I don't know where I'm going to put them. I've got thirty-one dope fiends in here now." - Junky, William S Burroughs, 1977, originally published in 1953

'In other countries in East and South-East Asia, the number of drug treatment admissions is the only indicator available to provide information on the extent of drug use. With the exception of Viet Nam, all countries in the subregion continued to report methamphetamine as the primary drug of concern in drug treatment admissions in 2018 (or the latest available year). While China does not report data on drug treatment admissions, the majority of registered drug users (nearly 60 per cent) in 2018 comprised users of synthetic drugs (mainly methamphetamine)' - United Nations Office on Drugs and Crime, World Drug Report 2020, https://wdr.unodc.org/wdr2020/field/WDR20_Booklet_2.pdf

'Globally, an estimated 19 million people were pastyear users of cocaine in 2018, corresponding to 0.4 per cent of the global population aged 15–64. The main cocaine markets continue to be North America and Western and Central Europe, with a prevalence of use of 2.1 per cent and 1.4 per cent, respectively, while the highest prevalence of past-year cocaine use is in Australia and New Zealand, at 2.2 per cent of the population aged 15–64. Cocaine use is also higher than the global average in Central America (0.7 per cent) and South America (1.0 per cent).' - United Nations Office on Drugs and Crime, World Drug Report 2020, https://wdr.unodc.org/wdr2020/field/WDR20_Booklet_2.pdf

'In South America, 2.8 million people, or almost 1 per cent of the population aged 15–64, were estimated to be past-year cocaine users in 2018. With nearly 1.5 million past-year cocaine and “crack” cocaine users, Brazil is the largest cocaine market in South America. The use of cocaine base paste, which was previously confined to countries where cocaine is manufactured, has spread to many countries in South America. However, such use is difficult to estimate since people who use cocaine base paste are usually from socially marginalized groups that are not well captured by household surveys.' - United Nations Office on Drugs and Crime, World Drug Report 2020, https://wdr.unodc.org/wdr2020/field/WDR20_Booklet_2.pdf

'In Africa, the increasing proportion of people treated for opioid use disorders likely reflects the increasing use of opioids, especially tramadol, in West and Central Africa. In that subregion, opioids (heroin and tramadol) were, after cannabis, the second most common drug type for which people accessed drug treatment services over the period 2014–2017.' - United Nations Office on Drugs and Crime, World Drug Report 2020, https://wdr.unodc.org/wdr2020/field/WDR20_Booklet_2.pdf

'The increase in treatment demand related to cannabis use disorders in some regions warrants special attention. There is great variability in the definition and practice of what constitutes treatment of cannabis use disorders. Treatment at present consists of behavioural or psychosocial interventions, such as cognitive behavioural therapy (in which irrational, negative thinking styles are challenged and the development of alternative coping skills is promoted) and motivational interviewing (in which a user’s personal motivation to change their own behaviour is facilitated and engaged). These interventions may vary from one-time online contact or screening and brief intervention in an outpatient setting, to a more comprehensive treatment plan including treatment of other comorbidities in an outpatient or inpatient setting. Some of the factors that may influence the number of people in treatment for cannabis use disorders include changes in the number of people who actually need treatment; changes in the treatment referral system; changes in awareness of potential problems associated with cannabis use disorders; and changes in the availability of and access to treatment for cannabis use disorders.' - United Nations Office on Drugs and Crime, World Drug Report 2020, https://wdr.unodc.org/wdr2020/field/WDR20_Booklet_2.pdf

'Opioids (predominantly heroin) remain the main drug for which people undergo drug treatment in Europe (in particular Eastern and South-Eastern Europe) and Asia, accounting for nearly 50 per cent of all treatment admissions in 2018. Compared with users of other drugs, those with opioid use disorders entering treatment tend to be older, in their midthirties, and between one quarter and one third of them are first-time entrants. This corresponds to findings published in scientific literature, for instance studies from Europe, which suggest that there is an ageing cohort of opioid users in Europe.' - United Nations Office on Drugs and Crime, World Drug Report 2020, https://wdr.unodc.org/wdr2020/field/WDR20_Booklet_2.pdf

'The cure at Lexington is not designed to keep the addicts comfortable. It starts at one-quarter of a grain of M[orphine] three times a day and lasts eight days-the preparation now used is a synthetic morphine called dolophine. After eight days, you get a send-off shot and go over in "population." There you recieve barbiturates for three nights and that is the end of medication.
For a man with a heavy habit, this is a very rough schedule. I was lucky, in that I came in sick, so the amount given in the cure was sufficient to fix me. The sicker you are and the longer you have been without junk, the smaller the amount necessary to fix you.' - Junky, William S Burroughs, 1977, originally published in 1953

'Treatment for the use of amphetamine-type stimulants is more common in Asia (predominantly for the use of methamphetamine) and Oceania (based on data from Australia and New Zealand) than in other regions. As is the case with cannabis users, people who are in treatment for disorders related to the use of amphetamines tend to be younger – in their mid-twenties – than users of opioids in treatment, and the majority of them also tend to be first-time entrants. People receiving treatment for the use of methamphetamine account for more than three quarters of those in treatment in Brunei Darussalam, Cambodia, the Lao People’s Democratic Republic, the Philippines, Singapore and Thailand' - United Nations Office on Drugs and Crime, World Drug Report 2020, https://wdr.unodc.org/wdr2020/field/WDR20_Booklet_2.pdf

'It is also important to acknowledge that the nature of treatment interventions differs by drug type. This may have an impact on the provision of and referrals to treatment for the use of different drugs and on retention into treatment, all of which directly influence drug treatment coverage by drug type. For the treatment of disorders related to the use of cannabis and psychostimulants, there are currently no pharmacological interventions available, thus behavioural interventions are the only available and effective treatment, whereas for opioid use disorders, pharmacological treatment – opioid agonist and antagonist treatment – along with psychosocial interventions, are the mainstay. Data show, for example, that the higher the level of provision of opioid substitution treatment, the better the coverage of treatment for opioid use disorders.' - United Nations Office on Drugs and Crime, World Drug Report 2020, https://wdr.unodc.org/wdr2020/field/WDR20_Booklet_2.pdf

'The health consequences of drug use can include a range of negative outcomes such as drug use disorders, mental health disorders, HIV infection, hepatitis-related liver cancer and cirrhosis, overdose and premature death. The greatest harms to health are those associated with the use of opioids and with injecting drug use, owing to the risk of acquiring HIV or hepatitis C through unsafe injecting practices.' - United Nations Office on Drugs and Crime, World Drug Report 2020, https://wdr.unodc.org/wdr2020/field/WDR20_Booklet_2.pdf

'Injecting drug use is a significant public health concern and causes morbidity and mortality owing to the risk of overdose and blood-borne infections (mainly HIV and hepatitis B and C), transmitted through the sharing of contaminated needles and syringes and other drug paraphernalia or risky sexual behaviour in some groups and subsequent severe immunosuppression, cirrhosis, neoplastic disease and inflammation sequelae. Social and physical effects can further aggravate potential underlying mental health conditions.' - United Nations Office on Drugs and Crime, World Drug Report 2020, https://wdr.unodc.org/wdr2020/field/WDR20_Booklet_2.pdf

'Owing to the criminalization of drug use, punitive laws, stigma and discrimination against people who use or inject drugs in many parts of the world, conventional survey methods have been found to underestimate the actual population size because of the hidden nature of PWID [persons who inject drugs]; therefore, only indirect methods have been shown to reflect the situation of PWID with greater accuracy. Overall, new or updated estimates of PWID were available for 40 countries in 2018.' - United Nations Office on Drugs and Crime, World Drug Report 2020, https://wdr.unodc.org/wdr2020/field/WDR20_Booklet_2.pdf

'The prevalence of PWID [persons who inject drugs] aged 15–64 in 2018 continues to be the highest in Eastern Europe (1.26 per cent) and Central Asia and Transcaucasia (0.63 per cent). Those percentages are, respectively, 5.5 and 2.8 times higher than the global average. More than a quarter of all PWID reside in East and South-East Asia, although the prevalence itself is relatively low (0.19 per cent). The three subregions with the largest numbers of PWID (East and South-East Asia, North America and Eastern Europe) together account for over half (58 per cent) of the global number of PWID. It is noteworthy that, as in previous years, while three countries – China, the Russian Federation and the United States – account for just 27 per cent of the global population aged 15–64, they are home to almost half (43 per cent) of all PWID.' - United Nations Office on Drugs and Crime, World Drug Report 2020, https://wdr.unodc.org/wdr2020/field/WDR20_Booklet_2.pdf

'The dolophine suspends the sickness, but when the medication stops the sickness returns. "YOu don't kick yout habit in the shooting gallery," an inmate told me. "You kick it over here in population." - Junky, William S Burroughs, 1977, originally published in 1953

'Injecting drug use is estimated to account for approximately 10 per cent of HIV infections worldwide and 30 per cent of all HIV cases outside Africa, while in the eastern countries of the WHO European Region more than 80 per cent of all HIV infections occur among PWID [persons who inject drugs]. PWID are estimated to be 22 times more likely than people in the general population to be living with HIV.' - United Nations Office on Drugs and Crime, World Drug Report 2020, https://wdr.unodc.org/wdr2020/field/WDR20_Booklet_2.pdf

'The largest number of PWID [persons who inject drugs] living with HIV reside in Eastern Europe, East and South-East Asia and South-West Asia, which together account for 67 per cent of the global total. Although the prevalence of HIV among PWID (9.3 per cent) is below the global average, a fifth of the global number of PWID living with HIV reside in East and South-East Asia.

A small number of countries continue to account for a large proportion of the total global number of PWID living with HIV. In 2018, for example, PWID living with HIV in China, Pakistan and the Russian Federation accounted for almost half of the global total (49 per cent), while PWID in those three countries comprise only a third of all PWID worldwide.' - United Nations Office on Drugs and Crime, World Drug Report 2020, https://wdr.unodc.org/wdr2020/field/WDR20_Booklet_2.pdf

'PWID [persons who inject drugs] are a key population affected by hepatitis C. Global estimates suggest that 71 million people worldwide were chronically infected with hepatitis C in 2017 and that 23 per cent of new hepatitis C infections and one in three hepatitis C-related deaths are attributable to injecting drug use. Hepatitis C-related morbidity and mortality continue to rise, mainly as a result of cirrhosis, hepatocellular carcinoma and death in cases of untreated hepatitis C' - United Nations Office on Drugs and Crime, World Drug Report 2020, https://wdr.unodc.org/wdr2020/field/WDR20_Booklet_2.pdf

'UNODC, WHO, UNAIDS and the World Bank jointly estimated the prevalence of hepatitis C among PWID [persons who inject drugs] worldwide in 2018 to be 48.5 per cent, or 5.5 million (range: 4 million to 7.8 million) people aged 15–64. This estimate is based on estimates in 108 countries, covering 94 per cent of the estimated global number of PWID.' - United Nations Office on Drugs and Crime, World Drug Report 2020, https://wdr.unodc.org/wdr2020/field/WDR20_Booklet_2.pdf

'Although data coverage was low in the Caribbean, the highest prevalence of hepatitis C among PWID [persons who inject drugs] was found in that subregion, at 76 per cent, followed by East and South-East Asia, Western and Central Europe, North America, and Central Asia and Transcaucasia, where it ranged between 61 and 54 per cent. In North Africa, a hepatitis C prevalence of 25 per cent was found among PWID, compared with a combined prevalence in the general population (>15 years) in North Africa and the Middle East estimated at 3.1 per cent. In Central Asia, a hepatitis C prevalence of 54 per cent was found among PWID, compared with a range of 0.5 to 13.1 per cent among the general population' - United Nations Office on Drugs and Crime, World Drug Report 2020, https://wdr.unodc.org/wdr2020/field/WDR20_Booklet_2.pdf

'Cole did not have a habit at this time and he wanted to connect for some weed. He was a real tea head. He told me he could not enjoy himself without weed. I have seen people like that. For them, tea occupies the place usually filled by liquor. They don't have to have it in any physical sense, but they cannot have a really good time without it.' - Junky, William S Burroughs, 1977, originally published in 1953

The number of deaths, loss of life years through premature death and disability, and comorbidities due to the usage of various drugs should be a clear indicator of which drugs need to be most controlled and which the least. In addition to this, the nature of treatment is also an indicator of severity of drugs involved and drug abuse. It is clearly evident from all reports and statistics that synthetic drugs are responsible for nearly all the deaths, comorbidities and disabilities. It is also evident from the type of treatment recommended for cannabis use disorder, essentially counseling, the seriousness and threat from this disorder. Yet, cannabis users are the most jailed and referred for treatment by the criminal justice system. Drug seizures are largest for cannabis. Drug enforcement focuses most on cannabis. Cannabis users are more than half the drug law prisoners in global jails. Public health policies continue to lump cannabis with these dangerous synthetic drugs, cannabis continues to be ostracized and continues to face the maximum action. Its users, probably the most wise among users of all drugs including pharmaceuticals, alcohol and tobacco, continue to be discriminated against, ostracized and harmed the most by a society that cannot or refuses to recognize the real threats that it faces...
Jul 4, 2020, 4:20 PM

'Top Trump administration officials say drug overdose deaths are surging amid the coronavirus pandemic, driven by increased substance use due to anxiety, social isolation and depression.

A White House drug policy office analysis shows an 11.4 percent year-over-year increase in fatalities for the first four months of 2020, confirming experts’ early fears that precautions like quarantines and lockdowns combined with economic uncertainty would exacerbate the addiction crisis'
https://www.politico.com/news/2020/06/29/pandemic-unleashes-a-spike-in-overdose-deaths-345183

'The Gallup poll, published Tuesday, asked 1,028 Americans in all 50 states and the nation’s capital whether they deemed 21 different behaviors or policies, from using birth control to the death penalty, moral or not. More respondents viewed marijuana use as acceptable than they did abortion, pornography, having children outside of marriage and wearing fur.'
https://www.nj.com/marijuana/2020/06/most-americans-see-smoking-weed-as-morally-acceptable-survey-finds.html

'While the annual prevalence of methamphetamine use more than doubled from 0.3 to 0.7 per cent of the population aged 12 and older in the United States over the period 2008–2018, the number of psychostimulants involved in drug poisoning deaths in the United States rose from 1,302 to 12,676 deaths over the same period, equivalent to an almost 10-fold increase. This increase may have been inflated by an increasing number of contaminations of psychostimulants with opioids (such as fentanyl and its analogues); however, psychostimulant-related deaths excluding any involvement of opioids still showed an eightfold increase, from 807 deaths in 2008 to 6,271 deaths in 2018.' - United Nations Office on Drugs and Crime, World Drug Report 2020, https://wdr.unodc.org/wdr2020/field/WDR20_Booklet_3.pdf

'In the United States, most methamphetamine is sold as methamphetamine. However, there have also been reports of tablets sold as “ecstasy” that contained methamphetamine instead (notably in Missouri). The sale of methamphetamine in the form of falsified Adderall tablets is a new phenomenon, with laboratories manufacturing such falsified medicaments found in a number of states, in particular Georgia and California. The expansion of methamphetamine trafficking has also gone hand in hand with the increasingly common practice of mixing methamphetamine with fentanyls. This practice has proved to be particularly harmful and has contributed to the rapid rise in methamphetamine-related deaths in recent years.' - United Nations Office on Drugs and Crime, World Drug Report 2020, https://wdr.unodc.org/wdr2020/field/WDR20_Booklet_3.pdf

'A junkie runs on junk time. When his junk is cut off, the clock runs down and stops. All he can do is hang on and wait for non-junk time to start. A sick junkie has no escape from external time, no place to go. He can only wait.' - Junky, William S Burroughs, 1977, originally published in 1953

'Practically all the major transnational criminal organizations in Mexico seem to be involved in the smuggling of methamphetamine to the United States. They include the Sinaloa Cartel, the Jalisco New Generation Cartel, the Juárez Cartel, the Gulf Cartel, the Los Zetas Cartel and the Beltrán-Leyva Organization. In parallel, outlaw motorcycle gangs continue to be involved in the distribution of methamphetamine within the United States. The increased involvement of Mexican organized crime groups in the trafficking of drugs other than cocaine has contributed to the spread of methamphetamine trafficking from the western United States to the whole country over the past decade, including states in the eastern part of the country that had previously been spared from the large-scale harmful use of methamphetamine.' - United Nations Office on Drugs and Crime, World Drug Report 2020, https://wdr.unodc.org/wdr2020/field/WDR20_Booklet_3.pdf

'While the typical purity of methamphetamine tablets encountered in East and South-East Asia has remained relatively stable in recent years (mostly within a range of 15 to 25 per cent), retail prices of methamphetamine tablets have decreased sharply in several countries in the subregion, which, when combined with the increases in quantities seized, suggests that the supply of methamphetamine may have outstripped demand in East and South-East Asia' - United Nations Office on Drugs and Crime, World Drug Report 2020, https://wdr.unodc.org/wdr2020/field/WDR20_Booklet_3.pdf

'The average purity of crystalline methamphetamine in East and South-East Asia continues to remain very high, again suggesting an abundant supply of the drug. The average purity of samples analysed in China reached 95 per cent in 2018 and other countries in the subregion (Brunei Darussalam, Cambodia, Indonesia, Malaysia and Viet Nam) reported purity levels of between 70 and 90 per cent. While purity has remained high, retail prices of crystalline methamphetamine have decreased in several countries in the subregion in recent years, including Cambodia, Indonesia, Japan, the Lao People’s Democratic Republic, Malaysia and Myanmar, pointing to an increase in the availability of crystalline methamphetamine in the subregion. In Indonesia, Thailand and Viet Nam, retail prices of crystalline methamphetamine have actually more than halved over the past decade. At the same time, the average purity of crystalline methamphetamine rose in Thailand from 90 per cent in 2011 to around 95 per cent in 2019, with almost all (99 per cent) of the crystalline methamphetamine samples analysed in 2019 showing purity levels of over 90 per cent.' - United Nations Office on Drugs and Crime, World Drug Report 2020, https://wdr.unodc.org/wdr2020/field/WDR20_Booklet_3.pdf

'All in all, tablet and crystalline methamphetamine prices in several countries in the region reached their lowest level over the past decade despite a record number of seizures being made every year during the same period. The decrease in prices also appears to have contributed to an increase in the use of methamphetamine and, subsequently, in more methamphetamine-related treatment demand. Thus, there have been sharp increases in methamphetamine-related treatment admissions reported in recent years by several countries in South-East Asia, including a more than 30-fold increase in the number of treatment admissions for the use of methamphetamine reported by Malaysia over the period 2011–2018.' - United Nations Office on Drugs and Crime, World Drug Report 2020, https://wdr.unodc.org/wdr2020/field/WDR20_Booklet_3.pdf

'This shift from China as the main location of methamphetamine manufacture and trafficking to other countries in East and South-East Asia is also indirectly reflected in trafficking data reported by Australia. China and Hong Kong, China, were the two main embarkation points for methamphetamine trafficked to Australia in 2015, whereas in the fiscal years 2016/17 and 2017/18 the most important embarkation points were the United States, followed by Thailand and Malaysia. In fact, in 2018, the Australian authorities reported that the importance of China as a source country for methamphetamine had declined while there has been an emerging trend in the growth of quantities of seized methamphetamine originating in South-East Asia, mainly in the Mekong region, including the Lao People’s Democratic Republic, Myanmar and Thailand.' - United Nations Office on Drugs and Crime, World Drug Report 2020, https://wdr.unodc.org/wdr2020/field/WDR20_Booklet_3.pdf

'Most of the methamphetamine available in East and South-East Asia is sourced within the subregion. The dynamics of methamphetamine manufacture and trafficking within that subregion are, however, less well understood than in others as the available indicators show partly contradictory patterns. Although in previous years, China and Myanmar were identified as the most frequently identified countries of “origin”, “departure” and “transit” in East and South-East Asia, manufacture of methamphetamine may now be more widely spread across the subregion, although it is not clear whether frequently mentioned departure countries, such as Malaysia or Thailand, are also the countries of origin or mainly transit countries for methamphetamine manufactured in Myanmar. In fact, Myanmar reported Thailand and the Lao People’s Democratic Republic as main destination countries for methamphetamine shipments in 2018, while Malaysia reported Thailand as the main departure country' - United Nations Office on Drugs and Crime, World Drug Report 2020, https://wdr.unodc.org/wdr2020/field/WDR20_Booklet_3.pdf

'There was a raw ache in my lungs. People vary in the way junk sickness affects them. Some suffer mostly from vomitting and diarrhea. The asthmatic type, with narrow and deep chest, is liable to violent fits of sneezing, watering at eyes and nose, in some cases spasms of the bronchial tubes that shut off the breathing. In my case, the worst thing is lowering of blood pressure with consequent loss of body fluid, and extreme weakness, as in shock. It is a feeling as if the life energy has been shut off so that all the cells in the body are suffocating. As I lay there on the bench, I felt like as if I was subsiding into a pile of bones.' - Junky, William S Burroughs, 1977, originally published in 1953

'While methamphetamine trafficking flows from East and South-East Asia to countries outside the subregion remain modest, some smuggling to destinations around the world was reported, mainly smuggling from Malaysia, Thailand and Myanmar in 2018 or, when the period is extended to the past five years, mainly from China and Thailand. Destinations outside the subregion included countries in South Asia, the Near and Middle East (Saudi Arabia as well as Israel), Oceania (Australia and New Zealand), North America (the United States as well as Canada), Western Europe (notably Switzerland as well as Italy, Germany, France, Spain and Iceland), Eastern Europe (notably the Russian Federation) and Africa (notably South Africa) over the period 2014–2018' - United Nations Office on Drugs and Crime, World Drug Report 2020, https://wdr.unodc.org/wdr2020/field/WDR20_Booklet_3.pdf

'Methamphetamine found in Australia and New Zealand is both locally manufactured and, to a larger extent, imported from North America and Asia. In the fiscal year 2017/18, methamphetamine was mainly smuggled into Australia from the United States, followed by Thailand, Malaysia, the United Arab Emirates, Canada, China (including Hong Kong, China), Mexico, Lebanon, Viet Nam and India.

The United States was also the main source country of the methamphetamine found in New Zealand in 2018, followed by Canada and, in SouthEast Asia, by Malaysia and the Lao People’s Democratic Republic' - United Nations Office on Drugs and Crime, World Drug Report 2020, https://wdr.unodc.org/wdr2020/field/WDR20_Booklet_3.pdf

'Of the total number of amphetamine laboratories reported dismantled worldwide in the period 2014–2018 (749 laboratories), more than half were dismantled in Europe (417), most notably in Western and Central Europe (316) and, to a lesser degree, in Eastern Europe (100). Overall, 16 European countries reported the dismantling of clandestine amphetamine laboratories over the period 2014– 2018, in particular the Netherlands. The Netherlands, followed by Poland, Lithuania and Belgium, were the most frequently identified source countries of amphetamine in Europe.

Amphetamine from South-Eastern Europe was reported as being mainly sourced from Bulgaria and Turkey. However, it is likely that such statistics are heavily skewed as a number of countries, in particular in the Middle East, where large-scale amphetamine manufacture has been reported, have a very limited capacity to dismantle laboratories and thus are not appropriately represented in these statistics' - United Nations Office on Drugs and Crime, World Drug Report 2020, https://wdr.unodc.org/wdr2020/field/WDR20_Booklet_3.pdf

'The manufacture of counterfeit “captagon” tablets, that is, amphetamine tablets mixed with caffeine, in the Near and Middle East is more widespread than the manufacture of amphetamine in South Asia or in East and South-East Asia. Indications received from other countries in the subregion pointed to the existence of clandestine laboratories manufacturing “captagon” tablets in the period 2014–2018, in particular in the Syrian Arab Republic and Lebanon, intended partly for domestic consumption and partly for the more lucrative markets of Saudi Arabia and the Gulf States, as well as the Sudan and Libya. In addition, Iran (Islamic Republic of) and Jordan have been identified by other countries in the subregion as possible countries of origin of amphetamine shipments. Jordan reported that all of the amphetamine found on its market originated in either the Syrian Arab Republic or Lebanon.' - United Nations Office on Drugs and Crime, World Drug Report 2020, https://wdr.unodc.org/wdr2020/field/WDR20_Booklet_3.pdf

'Although data for 2018 were unavailable for key countries in the Near and Middle East, more than half (54 per cent) of the global quantity of amphetamine seized in the period 2014–2018 was reported in the Near and Middle East/South-West Asia. Of the rest, some 24 per cent was seized in Europe (including 14 per cent in Western and Central Europe), 13 per cent in the Americas (including 7 per cent in North America), 6 per cent in Africa (mostly in North Africa) and 1 per cent in Oceania (mostly in Australia). The regional totals for Europe and the Near and Middle East/South-West Asia show larger seizures of amphetamine than of methamphetamine over the period 2014–2018, suggesting that the availability of amphetamine may be still greater than of methamphetamine in those regions' - United Nations Office on Drugs and Crime, World Drug Report 2020, https://wdr.unodc.org/wdr2020/field/WDR20_Booklet_3.pdf

'In the Near and Middle East/South-West Asia, the quantities of methamphetamine seized increased markedly in 2018. However, the marked decline in the reported quantities of amphetamine seized in recent years (-37 per cent in 2017 and -80 per cent in 2018) seems to be largely a statistical artefact. Some of this decline may have been related to changes in the categorization of stimulants seized, for example, “prescription stimulants” instead of “amphetamine”. Even more important has been the hiatus in the reporting of seizures to UNODC by some countries known to be affected by major amphetamine trafficking activities. There is plenty of evidence that trafficking in amphetamine, in particular of “captagon” tablets, has also continued in the Near and Middle East in recent years. INCB, for example, in its most recent annual report noted the following: The manufacture and trafficking of counterfeit “captagon” continued to seriously affect the countries of the Middle East, which not only are destination markets for those drugs but are also increasingly becoming a source of counterfeit “captagon”…Political instability and unresolved conflicts, poverty and the lack of economic opportunities in some parts of the subregion have contributed to increased trafficking in…“captagon”' - United Nations Office on Drugs and Crime, World Drug Report 2020, https://wdr.unodc.org/wdr2020/field/WDR20_Booklet_3.pdf

'Instability and conflict in the Middle East contributed to the trafficking in falsified “captagon” in the subregion. A lack of control and monitoring led to an increase in the manufacture of “captagon” tablets in some countries over the period 2014–2018, which turned into an additional source of income for terrorist and insurgency groups in the Middle East. Captagon was originally the trademarked brand name of a medicinal product containing fenetylline, until the substance was placed under international control in 1986. While the diversion of fenetylline from existing stocks might have continued until the end of the 1990s, those stocks, some of which were apparently located in Bulgaria, became depleted. However, the “captagon” name and logo continued to be used even though the composition of the counterfeit tablets had changed, and increasingly, seized “captagon” tablets were found to contain amphetamine, often mixed with caffeine and other substances.' - United Nations Office on Drugs and Crime, World Drug Report 2020, https://wdr.unodc.org/wdr2020/field/WDR20_Booklet_3.pdf

'The doctor asked a few questions and looked at my arms. Another doctor with a long nose and hairy arms walked up to put in his two cents.
"After all, doctor," he said to his colleague, "there is the moral question. This man should have thought of all this before he started using narcotics."
"Yes, there is the moral question, but there is also a physical question. This man is sick." He turned to a nurse and ordered half a grain of morphine.
As the wagon jolted along on the way back to the precinct, I felt the morphine spread through all my cells. My stomach moved and rumbled. A shot when you are very sick always starts the stomach moving. Normal strength came back to all my muscles. I was hungry and sleepy.' - Junky, William S Burroughs, 1977, originally published in 1953

'The two countries most frequently reported as countries of origin of amphetamine (mainly “captagon”) seized in the Near and Middle East/South-West Asia in the period 2014–2018 were Lebanon and the Syrian Arab Republic, which together accounted for some 40 per cent of all mentions of countries of origin reported by the authorities in the subregion. Final destinations are mostly countries in the Near and Middle East, most notably Saudi Arabia and various other Gulf countries, in particular the United Arab Emirates and Qatar, using both direct and indirect routes.' - United Nations Office on Drugs and Crime, World Drug Report 2020, https://wdr.unodc.org/wdr2020/field/WDR20_Booklet_3.pdf

'Large-scale trafficking of “captagon” from Jordan to Saudi Arabia has also been documented. In two separate incidents, in January and March 2018, customs authorities in Saudi Arabia foiled attempts to smuggle “captagon” tablets into the country. Prior to that, a total of about 6.3 million tablets of the substance were recovered during operations at the border with Jordan in 2017. Although some of those tablets may have originated in neighbouring countries, in January 2018, Jordan also dismantled a clandestine laboratory manufacturing “captagon” that was mainly destined for markets in Saudi Arabia and neighbouring countries.' - United Nations Office on Drugs and Crime, World Drug Report 2020, https://wdr.unodc.org/wdr2020/field/WDR20_Booklet_3.pdf

'Unlike other plant-based drugs, for which cultivation and production is concentrated in only a limited number of countries, cannabis is produced in almost all countries worldwide. The cultivation of cannabis plants was reported by 151 countries in the period 2010–2018 – countries home to 96 per cent of the global population – and was reported through either direct indicators (such as the cultivation or eradication of cannabis plants and the eradication of cannabis-producing sites) or indirect indicators (such as seizures of cannabis plants and the origin of cannabis seizures reported by other Member States).' - United Nations Office on Drugs and Crime, World Drug Report 2020, https://wdr.unodc.org/wdr2020/field/WDR20_Booklet_3.pdf

Afghanistan and Mexico source the heroin and morphine. Mexico, Thailand, Myanmar and China source the methamphetamine. The Middle East and Eastern Europe sources the amphetamine. The US consumes heroin, cocaine and methamphetamine. Europe consumes heroin, morphine, methamphetamine and amphetamine. Asia consumes heroin, morphine and methamphetamine. Australia consumes methamphetamine. The Middle East consumes heroin and amphetamine. West Asia consumes heroin and methamphetamine. All countries grow and consume cannabis. Opioids, methamphetamine and amphetamines kill the most in terms of drug deaths, cannabis kills none. Who are the leading opponents to cannabis legalization and leading enforcers of global anti-cannabis policy? The countries involved the most in heroin, morphine, amphetamines and methamphetamines. They put on a mask of concern about harms from drugs, produce, sell and consume the most dangerous synthetic drugs and vehemently oppose cannabis legalization worldwide while clandestinely feeding their habits and protecting their sources. They use arms and armies to protect and promote their synthetic drug habits, and drug money to fund and wage a war on cannabis everywhere, pushing man and planet ever closer to death on massive scales and away from the safe, healing cannabis herb...
Jul 10, 2020, 1:14 PM

'Harm Reduction International monitored prison decongestion measures adopted around the world between March and June 2020 in response to COVID-19, and found evidence of such schemes in 109 countries. We tracked criteria for eligibility and implementation of the measures. Noting that UN experts recommended countries release "those charged for minor and non-violent drug and other offences" in the context of COVID-19, we further focused on how these measures impact on people in prison for drug offences.

Despite a scarcity of official information, we found that around a fourth of countries implementing decongestion schemes explicitly excluded people incarcerated for drug offences; effectively prioritising punitive approaches to drug control over the health of the prison population and the individual'
https://www.hri.global/covid-19-prison-diversion-measures

'A few minutes later a nurse came in with a hypo. It was demerol. Demerol helps some, but it is not nearly as effective as codeine in relieving junk sickness.' - Junky, William S Burroughs, 1977, originally published in 1953

'As a further factor, in most countries the highest prevalence of drug use is found among adolescents and young adults, in particular those aged 18–25. Over the period 2000–2018, the population in that age group grew significantly in developing countries – by 18 per cent, thus raising the overall vulnerability to drug use in those countries. In developed countries, by contrast, the population in that young age group decreased by 10 per cent over the same period.' - United Nations Office on Drugs and Crime, World Drug Report 2020, https://wdr.unodc.org/wdr2020/field/WDR20_BOOKLET_4.pdf

'The lack of disaggregated data makes it impossible to obtain a global overview of drug use as distributed between urban and rural areas and to analyse interacting global trends in urbanization and drug markets. From the information available, it seems that drug use is more prevalent in urban areas than in rural areas, in both developed and developing countries, with the exception of some major rural drug-producing areas. Urbanization has also been found to be a general risk factor for drug use; for example, data from school surveys in Colombia and Mexico show the prevalence of use of some drugs being up to 60 per cent higher in urban areas than in rural areas. Data on drug law offences including possession and trafficking of drugs in Germany and Austria confirm the same patterns with main cities showing higher per capita offences than the national average (typically around 50 per cent higher in 2018)'- United Nations Office on Drugs and Crime, World Drug Report 2020, https://wdr.unodc.org/wdr2020/field/WDR20_BOOKLET_4.pdf

'A study conducted in India in the Chandigarh area, that city being the capital of the two neighbouring States of Punjab and Haryana, also suggested there are higher levels of drug use in urban slum areas than in rural areas. If this information were to be validated across all countries, the rapid urbanization of the past decade could be an element that explains, at least partially, the growth in the global drug market. In this context, urbanization becomes a crucial element when considering future dynamics in drug markets, in particular in developing countries, where growth in urbanization is more pronounced than in other countries.'- United Nations Office on Drugs and Crime, World Drug Report 2020, https://wdr.unodc.org/wdr2020/field/WDR20_BOOKLET_4.pdf

'This suggests that while people with higher socioeconomic status may have a greater propensity to experiment, it is among the lower socioeconomic classes that the most negative impact of the onset of recreational drug use is found, with a higher proportion of people becoming dependent. This suggests that poverty is associated with drug use disorders. Indeed, poor people living on the margins of society tend to be more vulnerable to slipping from recreational drug use into full-scale drug abuse and drug dependence because treatment facilities for intervening at an early stage in a drug career are often unavailable or unaffordable for such population groups. In this context, drug use itself may exacerbate poverty and marginalization, thus creating the potential for a vicious cycle' - United Nations Office on Drugs and Crime, World Drug Report 2020, https://wdr.unodc.org/wdr2020/field/WDR20_BOOKLET_4.pdf

'Over the past two decades, drug markets have become increasingly complex in terms of variety and combinations of substances used and trafficked, manufacturing processes and the organizational structure of drug trafficking organizations. There has been a rapid emergence of new substances, as well as new mixes of controlled and non-controlled substances, with an increasing misuse of pharmaceuticals, which poses new challenges for both drug demand and supply control efforts at the national, regional and global levels.' - United Nations Office on Drugs and Crime, World Drug Report 2020, https://wdr.unodc.org/wdr2020/field/WDR20_BOOKLET_4.pdf

'In the late 1990s, some 230 psychoactive substances were under international control, of which a handful dominated the global drug markets, most notably cannabis, cocaine, opium, heroin, amphetamines and “ecstasy”. Two decades later, the situation has changed, as there are now far more substances on the market. A number of synthetic NPS (i.e. psychoactive substances that mimic the properties of substances already under international control) emerged on the drug markets in the past decade, including synthetic cannabinoids, cathinones, phenethylamines, piperazines and various fentanyl analogues, resulting in a new wave of scheduling of such substances at the international level, with the total number of substances under international control rising from 234 in 2014 to 282 in 2018. At the same time, the number of NPS rose from 166 substances over the period 2005–2009 to 950 substances by the end of 2019. Worldwide, in recent years authorities have identified more than three times as many NPS as there are psychoactive substances under international control' - United Nations Office on Drugs and Crime, World Drug Report 2020, https://wdr.unodc.org/wdr2020/field/WDR20_BOOKLET_4.pdf

'It is possible to detach yourself from most pain - injury to teeth, eyes, and genitals present special difficulties - so that the pain is experienced as neutral excitation. From junk sickness there seems to be no escape. Junk sickness is the reverse side of junk kick. The kick of junk is that you have to have it. Junkies run on junk time and junk metabolism. They are subject to junk climate. They are warmed and chilled by junk. the kick of junk is living under junk conditions. You cannot escape from junk sickness any more than you can escape from junk kick after a shot.' - Junky, William S Burroughs, 1977, originally published in 1953

'Beyond internationally controlled substances, the legal status of many substances in the market differ from country to country, and sometimes within countries. This creates quite complex production and trafficking patterns in which some substances are under national control in some countries but not in others, leaving ample opportunities for producers and traffickers of the substances to select countries depending on the legal status of those substances in the respective jurisdictions, while also quickly adjusting to new controls wherever and whenever they may occur. The multiplicity of substances currently in the market challenges the effectiveness of national and international interventions because the elimination of one substance from the market easily leads to replacement by another.' - United Nations Office on Drugs and Crime, World Drug Report 2020, https://wdr.unodc.org/wdr2020/field/WDR20_BOOKLET_4.pdf

'The situation is particularly complex for the opioids group, as both legally and illegally produced substances satisfy the non-medical demand for opioids. While illegally produced opiates, such as heroin, used to dominate the non-medical demand for opioids, the illicit opioid markets in many countries have become far more diversified over the past two decades, with a number of pharmaceutical opioids that have started to cover a substantial part of the market for opioids for non-medical purposes.

This is creating an additional challenge for drug use prevention because, unlike the traditional hard drugs such as heroin, pharmaceuticals are often not perceived as harmful. In terms of drug control, this requires a careful equilibrium between maximizing accessibility for medical use while minimizing availability for non-medical use. It should be noted that the use of pharmaceuticals for non-medical purposes is not limited to opioids. There is also a substantial market for stimulant pharmaceuticals for non-medical use, particularly in Latin America and the Caribbean' - United Nations Office on Drugs and Crime, World Drug Report 2020, https://wdr.unodc.org/wdr2020/field/WDR20_BOOKLET_4.pdf

'The growing complexity of drug markets can be also seen in the manufacturing processes of synthetic drugs. In the past, a limited number of precursor chemicals was used to manufacture synthetic drugs, such as amphetamine (manufactured mostly from P-2-P), methamphetamine (manufactured mostly from ephedrine and pseudoephedrine, or from P-2-P in North America) and “ecstasy” (mainly manufactured from 3,4-MDP-2-P). This has changed over the past two decades. As the key precursors mentioned above are all under international control, traffickers have been looking for alternatives. Over the years, different strategies have been adopted by traffickers to overcome controls using as alternative precursors substances that were not equally well controlled in all countries, noncontrolled pre-precursors and so-called “designer precursors”, that is, chemicals specifically designed to circumvent existing precursor control systems. Pharmaceutical preparations containing controlled precursor chemicals have also been used to supply precursors because, although controlled, they are exempt from a number of control mechanisms such as the system of pre-export notifications' - United Nations Office on Drugs and Crime, World Drug Report 2020, https://wdr.unodc.org/wdr2020/field/WDR20_BOOKLET_4.pdf

'The growing complexity of drug markets can be also observed in the organizational structure of the actors involved. There has been a general trend over the past two decades towards an increasing fragmentation of the serious and organized crime landscape and the emergence of more groups and looser networks. Organizations based on loose cooperation across criminal networks have proved more resilient to law enforcement interventions than other types, as a network that gets dismantled can, in general, be easily replaced by another. The landscape of the global illicit drug trade has thus become more complex, is rapidly evolving and is facilitated by new technology such as encrypted communications software and the darknet.' - United Nations Office on Drugs and Crime, World Drug Report 2020, https://wdr.unodc.org/wdr2020/field/WDR20_BOOKLET_4.pdf

'The shift away from purely hierarchically organized crime groups, characterized by an extensive division of labour within such organizations, also entails the emergence of new groups engaged in specific activities, covering only limited aspects of drug manufacture and logistics or specific areas such as money-laundering and the investment of drug proceeds. Moreover, a number of new groups have emerged in recent years, bypassing many of the traditional actors, purchasing and selling drugs online through the darknet to end users. They make use of private or public postal services to transport drugs to anonymous post office boxes from which they are collected by the end users. The payment is made in parallel by means of cryptocurrency transactions on the darknet' - United Nations Office on Drugs and Crime, World Drug Report 2020, https://wdr.unodc.org/wdr2020/field/WDR20_BOOKLET_4.pdf

'Polydrug use is not a recent trend. It remains a public health concern because the use of multiple drugs potentially increases risks and exacerbates dependence. The management of polydrug use remains a complex and challenging task because treatment is often less successful for individuals who use multiple substances. Moreover, it is difficult to find evidence to address the question about whether the complexity of the drug markets has increased over the past two decades in terms of the number of substances and combinations involved in polydrug use.' - United Nations Office on Drugs and Crime, World Drug Report 2020, https://wdr.unodc.org/wdr2020/field/WDR20_BOOKLET_4.pdf

'I was too weak to get out of bed. I could not lie still. In junk sickness, any conceivable line of action or inaction seems intolerable. A man might simply die because he could not stand to stay in his body.' - Junky, William S Burroughs, 1977, originally published in 1953

'There is evidence that the number of polydrug users has increased in the United States and in the United Kingdom because in both countries the ratio of the aggregated number of users of individual drugs compared with the total number of drug users has followed an upward trend. It is still difficult, however, to assess the actual impact of this trend in terms of health consequences.' - United Nations Office on Drugs and Crime, World Drug Report 2020, https://wdr.unodc.org/wdr2020/field/WDR20_BOOKLET_4.pdf

'However, polydrug trafficking is not limited to Europe and can also be found in other regions and subregions, including North America, South America, Asia, Oceania and Africa. For a number of years, for example, polydrug trafficking organizations have been dismantled in the United States. A recent example was the dismantlement in July 2019 of an organization involving more than 50 people selling counterfeit oxycodone pills (containing fentanyl), methamphetamine, cocaine, heroin and benzodiazepine pills, as well as various types of weapons.' - United Nations Office on Drugs and Crime, World Drug Report 2020, https://wdr.unodc.org/wdr2020/field/WDR20_BOOKLET_4.pdf

'Demand-driven dynamics of drug markets are the result of changing patterns of drug use and the desire of users to experiment with new substances, which may lead to an increasing number of users starting a new habit. The establishment of the tramadol market for recreational use in certain regions may have initially been generated by an increased demand based on the supply available for medical use. But once a demand was generated, a new supply-driven phenomenon further expanded the market with illicitly manufactured products that were not part of the medical market' - United Nations Office on Drugs and Crime, World Drug Report 2020, https://wdr.unodc.org/wdr2020/field/WDR20_BOOKLET_4.pdf

'Increases in drug use have at times also been supply driven, as users react to growing supply and the attendant falling prices by increasing their consumption of those drugs. This was the case with cocaine in recent years, among other drugs. Some of the recent changes in drug markets, such as the opioid crisis in North America and the rapid emergence of a synthetic drug market in the Russian Federation and Central Asia, can also be defined as supply driven phenomena. The expansion of the synthetic drugs market in the Russian Federation seems to be mainly linked to the Hydra darknet platform. While there may now be an established user-based demand for synthetic drugs, the initial trigger was new suppliers. The rise of fentanyl in North America was not defined by a new demand either but was the result of opportunities seized by drug suppliers to reduce costs and thus increase profit margins.' - United Nations Office on Drugs and Crime, World Drug Report 2020, https://wdr.unodc.org/wdr2020/field/WDR20_BOOKLET_4.pdf

'While the main drug treatment interventions in Asia and Europe continue to be linked primarily to opiates, in Africa to cannabis, and in South America to cocaine, in North America there has been a shift over the past decade from the predominance of cocaine to an increasing importance of opioids. Marked shifts in the main drug for which patients receive drug treatment can also been observed at the subregional level. In a number of countries in East and South-East Asia, for example, methamphetamine has emerged as the predominant drug; in the Near and Middle East, “captagon” tablets (amphetamine), and along the eastern coast of Africa, heroin, have emerged as the predominant drugs.' - United Nations Office on Drugs and Crime, World Drug Report 2020, https://wdr.unodc.org/wdr2020/field/WDR20_BOOKLET_4.pdf

'Although in Europe opioids continue to be the predominant main drug for which people seek drug treatment, cocaine has become more common in Spain and methamphetamine remains the main drug of concern in Czechia. Within the amphetamines group, different patterns have developed in different subregions. For example, amphetamine continues to be the primary ATS of concern in Europe and in the Middle East, while methamphetamine has emerged as the primary ATS of concern in East and South-East Asia and in North America.' - United Nations Office on Drugs and Crime, World Drug Report 2020, https://wdr.unodc.org/wdr2020/field/WDR20_BOOKLET_4.pdf

'England and Wales and Australia are examples of places where cocaine and amphetamines have competed for their share of the stimulant market over the past 20 years. Germany and the United States are examples of places where cocaine and amphetamines have together led the changes in the stimulant market. Within the stimulant markets, there are also examples of substitution effects in the “ecstasy” market. In England and Wales, for example, trend data on the use of “ecstasy”, mephedrone and NPS in the period 2005–2019 suggest that first mephedrone and later NPS filled the market space left by the decreasing supply of “ecstasy”, mainly due to a supply shortage, until 2012. Once --“ecstasy” started to regain its previous share, the other substances declined sharply' - United Nations Office on Drugs and Crime, World Drug Report 2020, https://wdr.unodc.org/wdr2020/field/WDR20_BOOKLET_4.pdf

'In the context of the long-term dynamics of the global drug market, there are many different changes that have affected selected geographical areas. Within the past two decades some regions have seen a gradual transformation of their drug markets: methamphetamine has become the predominant drug in South-East Asia, amphetamine (“captagon’’) in the Middle East, North America has been confronted with the opioid crisis, Africa has seen an expansion of its domestic heroin market, and countries in North and West Africa are now facing a tramadol crisis. More recently, two subregions, the Near and Middle East/South-West Asia and the Russian Federation/ Central Asia, appear to have been affected by rapid changes in their drug markets, with new drugs taking a substantial share of the drug market.' - United Nations Office on Drugs and Crime, World Drug Report 2020, https://wdr.unodc.org/wdr2020/field/WDR20_BOOKLET_4.pdf

'He asked the question they all ask. "Why do you feel that you need narcotics, Mr Lee?"
When you hear this question you can be sure that the man who asks it knows nothing about junk.
"I need it to get out of bed in the morning, to shave and eat breakfast."
"I mean physically."
I shrugged. Might as well give him his diagnosis so he will go. "It's a good kick."
Junk is not a "good kick." The point of junk to a user is that it forms a habit. No one knows what junk is until he is junk sick.
The doctor nodded. Psychopathic personality.'
- Junky, William S Burroughs, 1977, originally published in 1953

'In the past few years, the manufacture and use of methamphetamine have emerged in the Near and Middle East/South-West Asia, subregions that until recently were dominated by use of “captagon”. Methamphetamine manufacture and consumption used to be largely unknown in those subregions. Initially reported by only one country in the subregion (Israel), the number of countries reporting seizures of methamphetamine has increased in subsequent years. Overall, eight countries in the Near and Middle East/South-West Asia reported seizures of methamphetamine in the period 2000–2009, rising to 14 countries in the period 2010–2018. The bulk of the methamphetamine seized, however, continued to be seized by the Islamic Republic of Iran.' - United Nations Office on Drugs and Crime, World Drug Report 2020, https://wdr.unodc.org/wdr2020/field/WDR20_BOOKLET_4.pdf

'Much of the methamphetamine production in these subregions was originally intended for exports to the rapidly growing markets of East and South-East Asia, but domestic markets also appear to have started to emerge in the Near and Middle East/ South-West Asia in recent years. Of 15 reporting countries in these subregions, 12 countries reported the use of methamphetamine by 2018 (or the latest year for which data are available). In the absence of scientific data for the Near and Middle East/South-West Asia, qualitative information on trends in methamphetamine use reported by national authorities to UNODC give an indication of the threat experienced by the region. National authorities have reported a clear upward trend in methamphetamine use in those subregions. Methamphetamine appears to have emerged in the Near and Middle East/South-West Asia as the main ATS used in the Islamic Republic of Iran (2009– 2018) as well as in Iraq (2016 and 2017), Lebanon (2014–2017), Bahrein (2016), Afghanistan (2015 and 2016), Israel (2014 and 2015) and Kuwait (2003, 2009, 2013' - United Nations Office on Drugs and Crime, World Drug Report 2020, https://wdr.unodc.org/wdr2020/field/WDR20_BOOKLET_4.pdf

'The emergence of methamphetamine use in Iraq was reported in 2012, when, on the basis of data from medical and psychiatric hospitals, outpatient clients, health centres, surveys of medial patients and prisoners and law enforcement reports, the primary drugs of concern in Iraq were found to be “captagon”, crystalline methamphetamine and tramadol. A study conducted in 2015 reported that drug users in Iraq thought that cannabis was “very difficult” to obtain while “captagon” and methamphetamine were “very easy” to obtain. Both official and media sources report a recent rapid increase in methamphetamine use in Iraq. Initially, law enforcement sources in Iraq suggested that methamphetamine was mainly smuggled into the country from the neighbouring Islamic Republic of Iran, across the long shared border, being smuggled to Basra in the south in particular. However, there have been reports of the clandestine manufacture of methamphetamine inside Iraq. In November 2016, for example, the Iraqi National Security Agency discovered methamphetamine laboratories in Basra and in the south-eastern province of Maysan.' - United Nations Office on Drugs and Crime, World Drug Report 2020, https://wdr.unodc.org/wdr2020/field/WDR20_BOOKLET_4.pdf

'In this context, INCB raised concerns over large-scale exports of pseudoephedrine preparations from Jordan to the Kurdish region of northern Iraq. While the officially reported estimate of pseudoephedrine used in Iraq in 2018 was approximately 10 tons, notified shipments of pseudoephedrine preparations sent through the Pre-Export Notification Online system were three times that amount. Those shipments took place even though the national authorities objected.' - United Nations Office on Drugs and Crime, World Drug Report 2020, https://wdr.unodc.org/wdr2020/field/WDR20_BOOKLET_4.pdf

'The non-medical use of pharmaceutical opioids is not a new phenomenon. It has been observed for decades as part of the polydrug use pattern among high-risk or regular opioid users. What characterizes the most recent opioid crisis is the emergence of non-medical use of pharmaceutical opioids as the main phenomenon, leading to alarming rates of dependence and overdose deaths at the national level. The subregions most affected by this crisis are North America and West, Central and North Africa, where different opioids and different dynamics are driving the threat. In North America, the introduction of fentanyl and its analogues (fentanyls) in the drug market has resulted in a syndemic of use of opioids characterized by an unprecedented increase in opioid overdose deaths' - United Nations Office on Drugs and Crime, World Drug Report 2020, https://wdr.unodc.org/wdr2020/field/WDR20_BOOKLET_4.pdf

'After a junk cure is complete, you generally feel fine for a few days. You can drink, you can feel hunger and pleasure in food, and your sex drive comes back on you. Everything looks different, sharper. Then you hit a sag. It is an effort to dress, get out of a chair, pick up a fork. You don't want to do anything or go anywhere. You don't even want junk. The junk craving is gone, but there isn't anything else. You have to sit this period out. Or work it out. Farm work is the best cure.' - Junky, William S Burroughs, 1977, originally published in 1953

'In West, Central and North Africa and the Middle East, tramadol – a pharmaceutical opioid not under international control – has emerged as a major opioid of concern. The drug, in addition to being diverted from the legal market, is mainly trafficked into those subregions in dosages higher than what is prescribed for pain management, with an increasing number of people with tramadol use disorder entering treatment.' - United Nations Office on Drugs and Crime, World Drug Report 2020, https://wdr.unodc.org/wdr2020/field/WDR20_BOOKLET_4.pdf

'From what is known, it is possible to identify common threats and different dynamics in the two opioid crises, in Africa and in North America: • The ease of manufacturing, easy accessibility and low-cost production make the illicit markets for tramadol and fentanyls substantially more profitable for traffickers than are other opioids such as heroin. • The large-scale manufacture of tramadol and fentanyls for the illicit market started in a context of an absence of international regulations on tramadol and many fentanyl analogues or their precursors. • The interchangeability (or substitution) of fentanyl and tramadol within the pharmaceutical and illicit drug markets makes it more difficult to address their misuse. Their non-medical use is also seen in the context of self-medication, and thus carries less stigma or is countered by lesser legal sanctions than is the case with other controlled drugs.' - United Nations Office on Drugs and Crime, World Drug Report 2020, https://wdr.unodc.org/wdr2020/field/WDR20_BOOKLET_4.pdf

'Although geographically disconnected, the areas that were initially affected by the opioid crisis in Canada and the United States have experienced remarkably similar market dynamics, which can be broadly described in the following sequential steps: (a) High rates of prescriptions for pharmaceutical opioids leading to diversion and an increase in the non-medical use of pharmaceutical opioids, opioid use disorders and an increase in opioid overdose deaths (b) Regulations introduced to reduce diversion and non-medical use of pharmaceutical opioids (e.g., tamper-proof formulations to prevent injecting) (d) Fentanyl (illicitly manufactured in clandestine laboratories) and its analogues emerge as adulterants in heroin and stimulants (cocaine and methamphetamine) and are sold as falsified pharmaceutical opioids, resulting in massive increases in deaths attributed to fentanyls (e) Fentanyls emerge as the dominant opioid in opioid overdose deaths, as well as contributing to overdose deaths attributed to other drugs (g) Fentanyl-related deaths are the main contributor to total opioid overdose deaths;' - United Nations Office on Drugs and Crime, World Drug Report 2020, https://wdr.unodc.org/wdr2020/field/WDR20_BOOKLET_4.pdf

'The scientific literature has attempted to understand the reasons for the sudden rise of fentanyls in preexisting opioid markets. It seems that an interplay between a number of external factors and local market dynamics played a role in the spread of the opioid crisis in North America. Some of the factors that have led to the rise and continued presence of fentanyls include: (a) the diffusion of simpler and more effective methods of manufacture of synthetic opioids and their analogues (primarily fentanyls); (b) a lack of effective control of precursors and oversight of the manufacture industry; (c) expanding distribution networks; (d) reduced smuggling risks because of new methods of trafficking within the expanded licit trade; and (e) pre-existing market conditions (demand for opioids and potential supply shocks)' - United Nations Office on Drugs and Crime, World Drug Report 2020, https://wdr.unodc.org/wdr2020/field/WDR20_BOOKLET_4.pdf

'The rate of prescription of opioids in the United States fell to 51.4 prescriptions per 100 persons (a total of more than 168 million opioid prescriptions) in 2018 from a peak of 81.3 opioid prescriptions per 100 persons (or 255 million opioid prescriptions) in 2012. The opioid prescription rate in the southern United States remains high, however, with most states in the region reporting opioid prescription rates of 64 or more per 100 persons in 2018. A number of factors at work, including advertising by the pharmaceutical industry, physicians’ prescription practices, dispensing and medical culture and patient expectations have, since the new millennium, resulted in high prescription rates and dosages of opioids given for an extended duration of care, primarily for the management of acute to chronic non-cancer pain. These practices have also enabled the diversion and misuse of pharmaceutical opioids, together with a greater risk of opioid use disorders among those with a legitimate prescription.' - United Nations Office on Drugs and Crime, World Drug Report 2020, https://wdr.unodc.org/wdr2020/field/WDR20_BOOKLET_4.pdf

'When a junkie off junk gets drunk to a certain point, his thoughts turn to junk.' - Junky, William S Burroughs, 1977, originally published in 1953

'Overall, these PROs underscore four key points: 1) individuals are substituting cannabis for prescription drugs, independent of whether they identify themselves as medical users (medical users are doing so at almost five times the odds of non-medical users) and independent of legal access to medical cannabis; 2) this practice increases in frequency with age, up to 65 years, and is more common in females, particularly female medical users, and Native American/Asians/Pacific Islanders; 3) the most common classes of substitution were narcotics/opioids, anxiolytics/benzodiazepines and antidepressants; and 4) the odds of reporting substituting cannabis for prescription drugs were more than one and a half times greater among those reporting the use of cannabis to manage pain, anxiety and depression than among those using it to manage only one of these three conditions. Stated differently, pain, anxiety and depression seem to represent a comorbidity triad that is associated with greater substitution frequency.'
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5422566/

Try not to mix the pot

'Although there's been limited research on marijuana's potential drug interactions, here's what doctors know about how marijuana interacts with other medications:'
https://www.livescience.com/56439-how-marijuana-interacts-with-medicines.html

'NPS users report a range of reasons behind their preference for NPS as opposed to traditional drugs such as cannabis, cocaine and heroin, including typical lack of detectability, greater affordability, lack of stigma, and relative ease of online acquisition. Recently, however, the phenomenon of using prescription drugs in an idiosyncratic way to resemble, or counteract, the effects of NPS, has increasingly been described. This phenomenon refers not only to high potency opioids (e.g., fentanyl) and ‘exotic’/designer benzodiazepines—molecules already having been reported to be addictive—but also: gabapentinoids, a range of stimulants, antipsychotics, antidepressants and image- and performance-enhancing drugs (IPEDS, e.g., anabolic steroids, vitamins, clenbuterol and salbutamol). Among over-the-counter drugs, the two most common agents reportedly ingested in intentional abuse cases are the antitussive, dextromethorphan, and loperamide, a common antidiarrhoeal drug.'
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5924409/

'The paper, published in the journal Frontiers In Psychiatry, ultimately determined that CBD plays on the endocannabinoid system in ways that empower people with substance use disorders to use less of a harmful substance even though the compounds doesn’t necessarily curb withdrawal symptoms.'
https://www.marijuanamoment.net/study-shows-how-marijuana-component-cbd-can-help-people-with-substance-use-disorders/

'Cannabis lowers blood pressure, dilates the arteries and reduces body temperature an average of one-half degree, thereby relieving stress. Evening cannabis smokers in general report more restful sleep. Using cannabis allows most people a more complete rest with a higher amount of “alpha time” during sleep as compared with prescription or sleep-inducing patent sedatives. Prescription sleeping pills (the so called “legal, safe and effective” drugs) are often just synthesized analogs of truly dangerous plants like mandrake, henbane and belladonna. As late as 1991, doctors, pharmacists and drug companies were fighting off new legislation to restrict these often abused compounds (L.A. Times, April 2, 1991). Unlike Valium, cannabis does not potentiate the effects of alcohol. It is estimated that cannabis could replace more than 50% of Valium, Librium, Thorazine, Stelazine, other “-zine” drugs and most sleeping pills. It is unconscionable that, over the past two decades, tens of thousands of parents have committed their own children, aged 11 to 17, to be treated by massive doses of so-called “-zine” drugs in order to get them off pot, at the urging of parent groups, the PDFA, the feds and administrators and doctors from federally approved, private and high-profit drug rehabilitation centers. Often, “-zine” drugs do work to stop these youths from using pot. They also stop a kid from loving his or her dog, too – and children stand a one-in-four chance of suffering from uncontrollable shaking for the rest of their lives.* But at least they’re not high. *The U.S. Centers for Disease Control in Atlanta said that 20-40% of “-zine” drug users have or will develop permanent lifetime palsies (shakes), November 1983. These prescription neurotoxins are chemically related to the pesticide and warfare nerve gas Sarin. Hundreds of private drug-rehabilitation centers and their leaders keep this policy alive and in front of the media, often quoting discredited reports from NIDA or DEA (see Chapter 15, Debunking Gutter Science) – because they earn fat profits selling their useless or destructive “marijuana treatment” for children.' - The emperor wears no clothes by Jack Herer

'Heroin users had a high probability of developing amyloidosis, nephrotic syndrome and progression to end-stage renal disease (ESRD). They also had a higher chance of developing rhabdomyolysis as compared to non- Heroin users and were seen to be co-infected with hepatitis C virus (HCV) as well as Human Immunodeficiency Virus HIV. Controlled prescription drugs (CPD) opioids were significantly shown to lead to renal failure (p<0.001) A post mortem case series on cocaine users showed hypertensive- ischemic nephropathy in most cocaine users. Levamisole adulterated cocaine users were prone to be anti-neutrophil cytoplasm antibodies (ANCA) positive after long term drug use with a 100% prevalence of anti-myeloperoxidase antibodies. Amphetamine case series showed varied effects such as rhabdomyolysis leading to renal failure, malignant hypertension with hypertensive changes on biopsy and in one case series, death of all the subjects due to AKI and rhabdomyolysis.'
https://bmcnephrol.biomedcentral.com/articles/10.1186/s12882-017-0794-0

'CBD is an exogenous cannabinoid that acts on several neurotransmission systems involved in addiction. Animal studies have shown the possible effects of CBD on opioid and psychostimulant addiction, while human studies presented some preliminary evidence of a beneficial impact of CBD on cannabis and tobacco dependence. CBD has several therapeutic properties on its own that could indirectly be useful in the treatment of addiction disorders, such as its protective effect on stress vulnerability and neurotoxicity.'
http://journals.sagepub.com/doi/full/10.4137/SART.S25081

'An addict may be ten years off the junk, but he can get a new habit in less than a week; whereas someone who has never been addicted would have to take two shots per day for two months to get any habit at all. I took a shot daily for four months before I could notice withdrawal symptoms. You can list the symptoms of junk sickness, but the feel of it is like no other feeling and you can not put it into words. I did not experience this junk sick feeling until my second habit.' - Junky, William S Burroughs, 1977, originally published in 1953

'The results, recently published in the journal Brain Structure and Function, show that not only were the effects in these three categories different, but also that the group using both nicotine and cannabis more closely resembled the control (non-user) group in brain connectivity. The isolated nicotine and isolated cannabis users showed equally less connectivity in general.'
https://www.sciencedaily.com/releases/2018/08/180828133934.htm

'According to Stanley Watson, co-director of the Mental Health Research Institute at the University of Michigan, Ann Arbor, and a report author, the panel found no evidence that medical use of marijuana leads to abuse of other illicit drugs. Beyond the harm due to smoking, marijuana has side effects no worse than for any other approved medication, the panel found.'
http://www.sciencemag.org/news/1999/03/pot-herbal-medicine

'“We found that better ability to manage negative emotions may help explain why the hallucinogen users were less violent,” she said. “These findings add to the literature on the positive use of psychedelics and suggest that future research should explore the potential for psychedelic therapies to help address the international public health priority of reducing domestic violence,” she added. '
https://www.hindustantimes.com/health/users-of-psychedelic-drugs-less-likely-to-be-violent-towards-their-partners/story-PwNfkSVnhiteDiLXdmoFSJ.html

The three addictions of petrochemicals, pharmaceuticals and weapons have made the world a most toxic and deadly place. Even though some nations have got richer in the short term through embracing these addictions and supplying them to poorer nations worldwide, overall the damage has been lethal across not just human but all forms of life. Both rich and poor nations need to wean themselves off these three deadly addictions and adopt healthier, sustainable options even if this means lesser money to be made than through them. One healthy and sustainable option to tackle all three addictions simultaneously is the extremely versatile ganja. All nations must try and consider the usage of the herb to de-addict and detoxify themselves from the three deadly addictions to try and make the world a more livable and healthier place. The beauty of this remedy is that the same can be applied at the global level of nations as well as the grassroots level of each individual. Another beauty of this remedy is that it is an immensely pleasurable way to de-addict ourselves. The third beauty of this remedy is that you could even become wealthy through it. Even if you don't become richer monetarily, you will become richer health-wise and even the biggest fool surely knows that health is wealth and addiction is death..

Legalize natural cannabis to provide a safe alternative for the vulnerable from deadly synthetic drugs
https://www.youtube.com/watch?v=tQQMYlHOntA

'C[ocaine] is hard to find in Mexico. I had never used any good coke before. Coke is pure kick. It lifts you straight up, a mechanical lift that starts leaving you as soon as you feel it. I don't know anything like C for a lift, but the lift lasts only ten minutes or so. Then you want another shot. You can't stop shooting C - as long as it is there you shoot it. When you are shooting C, you shoot more M[orphine] to level the C kick and smooth out the rough edges. Without M, C makes you too nervous, and M is an antidote for an overdose. There is no tolerance with C, and not much margin between a regular and a toxic dose. Several times I got too much and everything went black and my heart began turning over. Luckily I always had plenty of M on hand, and a shot of M fixed me right up.' - Junky, William S Burroughs, 1977, originally published in 1953

Legalize it UK so that natural varieties of cannabis can be available again. It's about time.
https://www.youtube.com/watch?v=bdkrZF8pQu4

There seems to be an association between the users of concentrates/edibles and the non-medical users of prescription drugs. These users seem to have a tendency to want to get extra or
maximum high and also a desire to do this discreetly to avoid detection at the same time. This might be an interesting profile to focus on as a part of harm reduction initiatives as this profile of users seem most likely to harm themselves and/or others.'

RESULTS:Illicit drug use was associated with being non-Hispanic white (AOR=3.0, 95% CI 1.8-5.1), use of cannabis concentrates (AOR=2.8, 95% CI 1.6-4.9), while self-reported medical cannabis use was associated with lower probability of illicit drug use (AOR=0.5, 95% CI 0.3-0.9). The odds of prescription drug misuse were increased for participants who reported use of cannabis edibles (AOR=2.0, 95% CI 1.1-3.5), and decreased with age (AOR=0.9, 95% CI 0.8-1.0) and for those who used cannabis alone (AOR=0.5, 95% CI 0.3-0.9).

CONCLUSION:Use of alternative cannabis forms, but not cannabis use frequency, were associated with greater odds of other drug use. Self-reported medical cannabis use, but not MCP [medical cannabis patient] status, decreased probability of illicit drug use.'
https://europepmc.org/abstract/MED/30861391

'Junk is a biological necessity when you have a habit, an invisible mouth. When you take a shot of junk you are satisfied, just like you ate a big meal. You don't want another shot right away. But using C[ocaine] you want another shot as soon as the effect wears off. If you have C in the house, you will not go out to a movie or go out at all until the C is all gone. One shot creates an urgent desire for another shot to maintain the high. But once the C is out of your system, you forget about it. There is no habit to C.' - Junky, William S Burroughs, 1977, originally published in 1953

'RESULTS: PWID [persons who inject drugs] born after 1980 were more likely to initiate drug use with prescription opioids and non-opioids and had higher levels of polysubstance prior to injection initiation, compared to individuals born before 1980. Overall mortality was high: 2.59 per 100 person-years (95% CI: 2.27-2.95 per 100 person-years). Compared to the US population, the highest SMRs were observed among participants between 40-44 years of age, with especially high mortality among women in this age group (SMR:29.89, 95% CI: 15.24-44.54). CONCLUSIONS:Mirroring national trends, the profile of PWID in Baltimore has changed with increased prescription drug abuse and high levels of polysubstance use among younger PWID. Interventions need to reach those using prescription drugs early after initiation of use in order to reduce transition to injecting. Urgent attention is warranted to address premature mortality, particularly among middle-aged and female PWID.'
https://europepmc.org/abstract/MED/30830944

'The whole reason that this market is successful is because of the controlled substance status of cannabis and THC otherwise I don't think that this would even exist as a shadow of what it currently
is'
https://www.youtube.com/watch?v=cLD3AKoyV5Q

'British people statistically take more MDMA in one session than any other country on the planet. And not just a little bit more: on average, Brits take 420 milligrams per session. To put that in
perspective, Germans, the same people who invented minimal techno and nightclubs that stay open for 60 hours – take only 200 milligrams. It’s still one of the safest drugs to take, but last year, ecstasy-related deaths reached their highest level in a decade, and now it’s back in the headlines. Some people say it’s drug dealers’ responsibility for selling pills that are dangerously strong and cut with adulterants. Other people point to the government, who have failed to reduce the supply of ecstasy
and are refusing to embrace harm reduction strategies that have worked in Europe. In this episode of High Society, we find out what’s making ecstasy so dangerous again, and how that danger can
be reduced.'
https://www.youtube.com/watch?v=zZMETFXFE24

'Junk takes everything and gives nothing but insurance against junk sickness. Every now and then I took a good look at the deal I was giving myself and decided to take the cure. When you are getting plenty of junk, kicking looks easy. You say, "I'm not getting any kick from the shots any more. I might as well quit." But when you cut down into junk sickness, the picture looks different.' - Junky, William S Burroughs, 1977, originally published in 1953

Legalize marijuana to reduce the likelihood of people taking up dangerous synthetic drugs for recreation purposes.

'A few years ago, a new synthetic drug called Flakka appeared in Florida. It wasn’t long before viral videos and sensationalized news reports of alleged Flakka overdoses started to spread across the internet, and people began comparing its effects to that of a zombie outbreak. One supposed incident involved a person who allegedly ate off a homeless man’s face on the side of a highway. The drug’s effects are often compared to that of bath salts, and include hallucinations, “superhuman" strength, and a state of “excited delirium” that is credited with driving the lunatic actions of some users. However, Flakka can be easily altered or changed, and reports have emerged that its recent incarnation has surfaced under a slightly new chemical—and just as dangerous—structure. VICE’s Matt Shea travels to Florida to meet both users and distributors to discover what’s really behind this zombie drug.'
https://www.youtube.com/watch?v=7xu3RO4l1EA

Legalize recreational marijuana in the UK

'Investigative reporter Livvy Haydock meets the people manufacturing and selling counterfeit Xanax pills, which hit the headlines recently with over 200 deaths in the UK since 2015 attributed to fake copies of the drug. She meets a dealer selling fake Xanax to 14-year-olds, as well as another who uses customers as human guinea pigs to test whether their product is safe.'
https://www.youtube.com/watch?v=umEnHLlPVh0

'During the year or so I was on junk in Mexico, I started the cure five times. I tried reducing the shots, I tried the Chinese cure with a solution of hop and Wampole's medicine. Every time you take some of the hop solution you add an equal amount of Wampole's medicine. In ten days or so you are drinking plain Wampole's Tonic, and the reduction was so slow you never noticed.
That is the theory of the Chinese cure. What generally happens is this: You start taking a little more hop solution than your schedule allows and that means you put in more Wampole's and dilute the hop that much quicker. After a few days you don't know how much there is in there and you take it all to be sure. So you wind up with a worse habit than you had before the Chinese cure.' - Junky, William S Burroughs, 1977, originally published in 1953

https://norml.org/marijuana/fact-sheets/item/marijuana-and-the-gateway-theory

It is becoming increasingly important to legalize cannabis as one of the key harm reduction strategies as the proliferation of much deadlier drug cocktails in the form of NPS increases all over the world. NPS usage is likely to turn into treatment resistant substance use epidemics in the absence of alternatives for users in the form of traditional drugs like cannabis.'

Our findings support other research, which identified that the rapid proliferation of NPS use may be changing drug taking habits. Several individuals reported NPS alleviating withdrawal symptoms including cravings, from other substances and in some cases completely substituted with NPS.'
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5924394/

'“Long-term cannabis users, who are aged 40 or older, therefore, have been used to lower potency cannabis in the past, which can now no longer be sourced,” Mr Hamilton said.'
https://www.telegraph.co.uk/education/2018/06/15/rise-middle-aged-pothead-huge-rise-over-40s-becoming-addicted/

'An eating habit is the worst habit you can contract. It takes longer to break than a needle habit, and the withdrawal symptoms are considerably more severe. In fact, it is not uncommon for a junkie with an eating habit to die if he is cut off cold turkey in jail. A junkie with an eating habit suffers from excruciating stomach cramps when he is cut off. And the symptoms last up to three weeks as compared to eight days on a needle habit.' - Junky, William S Burroughs, 1977, originally published in 1953

'Of the more than 12,000 people surveyed worldwide who said they used magic mushrooms in 2016, just 0.2 percent said that they needed emergency medical treatment, according to the survey. At the opposite end, the drug that resulted in the most emergency medical treatments was methamphetamine: Nearly 5 percent of the 1,500 people who reported using it said they wound up needing treatment, the Global Drug Survey found.

The rates of people needing emergency medical treatment after drinking alcohol last year was 1.3 percent, and for marijuana use, 0.6 percent, according to the survey.'
https://www.livescience.com/59251-recreational-drug-use-survey.html

'This nationwide population-based cross-sectional study delineated that nurses had a nearly four-fold risk for OSHA (overdose for sedatives, hypnotics, and antipsychotics) than other HCPs. Younger nurses (< 35 years) had higher risks for OSHA than their respective younger controls in the general population. Younger nurses, registered nurses, and nurses from clinics, local hospitals, and regional hospitals had higher risks than their respective nurse controls, which suggests that more attention
should be given to the occupational health of these populations'
http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0202004

Natural flowering plants and concentrates with balanced ratios of cannabinoid compounds are better...
'Although concentrate users were similar to other cannabis users on many demographic, substance use, and health measures, frequent concentrate users in our survey had higher THC exposure across
different forms of cannabis administration and were more likely to report a need to use more cannabis to get the feeling they desired, which may be associated with increased tolerance and dependence. Higher strength concentrated products may be associated with long-term consequences in terms of higher drug exposure and greater risk for dependence, pointing to a need to examine enduring effects on neurobiology, mental health, and behavior in concentrate users'
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6111049/

'When you kick the spike you get worse until you hit the third day and you think, this is it: You couldn't feel worse. But the fourth day is worse. After the fourth day relief is dramatic. And on the sixth day there is only a pale shadow of junk sickness.
But with an eating habit you can look forward to at least ten days of horrible suffering. So when you are taking a cure with hop you have to be careful not to get an eating habit. If you can't make it on schedule, best go back to the needle.' - Junky, William S Burroughs, 1977, originally published in 1953

'Our study indicated recreational drugs, especially poppers (amyl nitrites), were prevalent among MSM (men who have sex with men) and use of poppers was significantly associated with sexual risk
behaviors including group sex and UAI (unprotected anal intercourse). Given high prevalence of HIV among MSM, popularity of poppers use may further fuel the epidemic within this subpopulation. Thus, close attention should be given to the dynamics of poppers use and interventions targeting to both poppers use and sexual risk behaviors are needed to prevent the spread of HIV transmission in China.'
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6131870/

Instead of being the gateway drug that marijuana is made out to be this is closer to the truth..of course if you just can't get enough and wanna fly like the celebs then the sweet leaf is never enough..nothing is..and the pusher who senses that will always try to up sell you the hard drugs to maximize his profits just like any other middleman..

'However, most importantly, DCRs (drug consumption rooms) - which are already implemented in eight European countries, Australia, and Canada – are proven to improve health outcomes for people who do use drugs.

DCRs prevent deadly overdoses from taking place, as healthcare professionals oversee people’s drug use and are therefore able to administer naloxone – a medication that reverses opioid overdoses – when necessary. Across the world, there has never been a fatal drug overdose within a DCR.

Another important benefit of opening DCRs in Greece is that such facilities reduce the spread of infectious diseases, thanks to the provision of sterile equipment. As the European Monitoring Centre on Drugs and Drug Addiction has found, Greece currently has one of the EU's highest rates of newly-diagnosed HIV cases attributed to injecting drug use, with Athens having one of the higher rates within the country.'
https://www.talkingdrugs.org/greece-health-ministry-plans-drug-consumption-rooms

'I knew that I did not want to go on taking junk. If I could have made a single decision, I would have decided no more junk ever. But when it came to the process of quitting, I did not have the drive. It gave me a terrible feeling of helplessness to watch myself break every schedule I set up as though I did not have control over my actions.' - Junky, William S Burroughs, 1977, originally published in 1953

'A Municipal Drug Strategy is based on two key premises. First, that a punitive, criminal justice-driven response to people who are involved with drugs fails to meet the needs and respect the rights of these individuals, their families and their communities. Second, that those who are closest to the harm and suffering arising from a flawed drug policies and problematic drug use are best placed to identify and implement solutions.

The approach is generally organized around four core domains: prevention, treatment, emergency response/public safety, and harm reduction. Critical to the development of a Municipal Drug Strategy is meaningful engagement of diverse local stakeholders, including government, first responders, health care providers, and directly impacted communities.'
http://www.drugpolicy.org/resource/municipal-drug-strategy-lessons-taking-drug-policy-reform-local

'Regarding more direct health impacts, a core component of Prop 47 was to reinvest savings from reduced incarceration to buttress substance use disorder and mental health treatment, with grants totaling $103 million awarded to 23 city and county agencies in mid-2017. Prop 47 generated debate about whether arrestees would lose the incentive to enroll in treatment without a felony threat, which remains to be evaluated. Alternatively, populations accessing treatment or the proportions entering through voluntary versus court-referred admissions may change.'
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6050868/

'The root cause of the explosive growth in new, untested ‘legal highs’ is in the fact that well-known and relatively benign substances, including cannabis, are widely prohibited. A legalised and regulated supply of mild drugs, as is currently emerging in several US states including Alaska, Washington, Oregon and Colorado, as well as in Uruguay, would remove much of the incentive to play catch with the law by developing new substances.'
https://www.cell.com/current-biology/fulltext/S0960-9822(15)00719-8

'I had never been able to drink before when I was on the junk, or junk sick. But eating hop is different from shooting the white stuff. You can mix hop and lush.
At first I started drinking at five in the afternoon. After a week, I started drinking at eight in the morning, stayed drunk all day and all night, and woke up drunk the next morning.Every morning when I woke up, I washed down benzedrine, sanicin, and a piece of hop with black coffee and a shot of tequila. Then I lay back and closed my eyes to piece together the night before and yesterday. Often, I drew a blank from noon on. You sometimes wake up from a dream and think, "Thank God, I didn't really do that!" Reconstructing a period of blackout you think, "My God, did I really do it?" The line between saying and thinking is blurred. Did you say it or just think it?' - Junky, William S Burroughs, 1977, originally published in 1953

'Joe Rogan Experience #1136 - Hamilton Morris'

https://www.youtube.com/watch?v=PBQD55bLoy8

'Having a transparent methodology for providing an evidence base for drug policy which still needs to be perfected is better than having no methodology at all. After the careful analysis of the strengths and weaknesses of the MCDHS/MCDA methodology, it is important to identify areas of drug/substance harms that need to be urgently (re)assessed. Given that the current major issues with the public health concerns are related to increased opioid and stimulant use, shifts in nicotine use, and cannabis regulation, it makes sense to make the assessment of harms in these categories with the improved methodology a priority.'

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6109763/

'In addition to connecting people who use drugs to services, safe consumption sites also provide people with monitored care that is key to preventing overdoses. With fentanyl being slipped into an increasing range of street drugs, the possibility of overdose has risen enormously. Having staff on hand trained in administering Narcan, an opioid overdose reversal drug, could cut down on the 100 or so people who die from drug-related overdoses in the city each year.'
http://www.sfweekly.com/news/california-senate-passes-landmark-safe-consumption-site-bill/

'After ten days of the cure I had deteriorated shockingly. My clothes were spotted and stiff from the drinks I had spilled all over myself. I never bathed. I had lost weight, my hands shook, I was always spilling things, knocking over chairs, and falling down. But I seemed to have unlimited energy and a capacity for liquor I never had before. My emotions spilled out everywhere. I was uncontrollably social and would talk to anybody I could pin down. I forced distastefully intimate confidences on perfect strangers. Several times I made the crudest sexual propositions to people who had given no hint of reciprocity.' - Junky, William S Burroughs, 1977, originally published in 1953

'While the original purpose of syringe exchange programs was to reduce transmission of blood-borne infections among PWID, programs in the USA rapidly evolved into multi-service organizations. In addition to basic syringe exchange, the programs have provided a wide range of additional health and social services to people who use drugs (and also often to community members who do not use drugs). These services include condoms, referrals to substance abuse treatment, HIV, hepatitis C virus (HCV), HBV counseling and testing, and naloxone for overdose. Of particular importance is education about overdose and the distribution of naloxone to drug users, their friends and families for reversing overdoses.'
https://harmreductionjournal.biomedcentral.com/articles/10.1186/s12954-017-0178-6

'Coming full circle, MBIs (mindfulness-based interventions) are some of the newest additions to the armamentarium of addictions treatment. It is perhaps no coincidence that the rise of MBIs has been co-incident with advances in the neuroscience of substance use disorders. In recognizing that addiction is, in large part, mediated by cognitive and behavioral automaticity propelled by alterations to hedonic regulatory systems in the brain, this perennial form of human suffering may be especially tractable to treatment approaches like mindfulness that enhance top-down conscious control over bottom-up automatic habits and motivational drives. Insofar as the original purpose of many mindfulness meditation practices was to extinguish craving by revealing the “middle way” between attachment to pleasure and aversion to pain, MBIs may ultimately provide a skillful means of liberating the individual from the push and pull of hedonic dysregulation underlying addiction.'
https://ascpjournal.biomedcentral.com/articles/10.1186/s13722-018-0115-3

'Within a cohort of 146 patients initiated on medical cannabis therapy, 45.2% patients successfully discontinued their pre-existing benzodiazepine therapy. This observation merits further
investigation into the risks and benefits of the therapeutic use of medical cannabis and its role relating to benzodiazepine use.'
https://www.liebertpub.com/doi/10.1089/can.2018.0020

'Ike took a very severe view of my drinking. "You're drinking, Bill. You're drinking and getting crazy. You look terrible. You look terrible in your face. Better you should go back to stuff than drink like this." - Junky, William S Burroughs, 1977, originally published in 1953

'Rollins listened to my account of the previous evening. "You're going to get your head blown off carrying that gun," he said. "What do you carry it for? You wouldn't know what you were shooting at. You bumped into trees twice there on Insurgentes. You walked right in front of a car. I pulled you back and you threatened me. I left you there to find your own way home, and I don't know how you ever made it. Everyone is fed up with the way you've been acting lately. If there's one thing I don't want to be around, and I think no one else particularly wants to be around, it's a drunk with a gun."' - Junky, William S Burroughs, 1977, originally published in 1953

'I got drunk on the fifty pesos. About nine that night, I ran out of money and went back to my apartment. I lay down and tried to sleep. When I closed my eyes I saw an Oriental face, the lips and nose eaten away by disease. The disease spread, melting the face into an amoeboid mass in which the eyes floated, dull crustacean eyes. Slowly, a new face formed around the eyes. A series of faces, hieroglyphs, distorted and leading to the final place where the human road ends, where the human form can no longer contain the crustacean horror that has grown inside it.I watched curiously. "I got the horrors," I thought matter of factly.' - Junky, William S Burroughs, 1977, originally published in 1953

'Ike came back from the bathroom with the works and began cooking up a shot. He kept talking. "You're drinking and you're getting crazy. I hate to see you get off this stuff and on something worse. I know so many that quit the junk. A lot of them can't make it with Lupita. Fifteen pesos for a paper and it takes three to fix you. Right away they start in drinking and they don't last more than two or three years." - Junky, William S Burroughs, 1977, originally published in 1953

'I lay there trying to control the fear. I did not know much about uremic poisoning. A woman I knew slightly in Texas died of it after drinking a bottle of beer every hour, night and day, for two weeks. Rollins had told me about it. "She swelled up and turned sorta black and went into convulsions and died. The whole house smelled like piss!"' - Junky, William S Burroughs, 1977, originally published in 1953

'When you give up junk, you give up a way of life. I have seen junies kick and hit the lush and wind up dead in a few years. Suicide is frequent among ex-junkies. Why does a junkie quit junk of his own will? You never know the answer to that question. No conscious tabulation of the disadvantages and horrors of junk gives you the emotional drive to kick. The decision to quit junk is a cellular decision, and once you have decided to quit you cannot go back to junk permanently any more than you could stay away from it before. Like a man who has been away a long time, you see things different when you return from junk.'
- Junky, William S Burroughs, 1977, originally published in 1953

'Withdrawal symptoms are allergic symptoms: sneezing, coughing, running at the eyes and nose, vomiting, diarrhea, hive-like conditions of the skin. Severe withdrawal symptoms are shock symptoms: lowered blood pressure, loss of body fluid and shrinking of the organism as in the death process, weakness, involuntary orgasms, death through collapse of the circulatory system. If an addict dies from junk withdrawal, he dies of allergic shock.'
- Junky, William S Burroughs, 1977, originally published in 1953

'All the symptoms of shock can be produced by an overdose of histamine. Histamine is produced by body tissue wherever injury occurs. Histamine enlarges blood vessels so that extra blood comes to the place of injury. When a blood vessel is enlarged, its walls are stretched thin and porous and so fluid escapes. Loss of blood leads to lowered blood pressure. Excess histamine leads to lowering of blood pressure and shock, as occurs in serious injury. Adrenaline is the body's defense against excess histamine, and before the specific antihistamine drugs, was the only chemical antidote for histamine poisoning.'
- Junky, William S Burroughs, 1977, originally published in 1953

'It would seem that junk is the only habit-forming drug. Cats cannot be addicted to morphine, as they react to an injection of morphine with acute delirium. Cats have a relatively small quantity of histamine in the blood stream. It would seem that histamine is the defense against morphine, and that cats, lacking this defense, cannot tolerate morphine. Perhaps the mechanism of withdrawal is this: Histamine is produced by the body as a defense against morphine during the period of addiction. When the drug is withdrawn, the body continues to produce histamine.'
- Junky, William S Burroughs, 1977, originally published in 1953

Officially sponsored myth 1 -'"All drugs are more or less similar and all are habit forming."

This myth lumps cocaine, marijuana and junk together. Marijuana is not at all habit forming and its action is almost the direct opposite from junk action. There is no habit to cocaine. You can develop a tremendous craving for cocaine, but you won't be sick if you can't get it. When you have a junk habit, on the other hand, you live in a state of chronic poisoning for which junk itself is the specific antidote. If you don't get the antidote at eight-hour intervals, and enough of it, you develop symptoms of allergic poisoning: yawning, sneezing, watering of the eyes and nose, cramps, vomiting and diarrhea, hot and cold flushes, loss of appetite, insomnia, restlessness and weakness, in some cases circulatory collapse and death from alergic shock....When I say "habit-forming drug" I mean a drug that alters the endocrinal balance of the body in such a way that the body requires that drug in order to function. So far as I know, junk is the only habit forming drug according to this definition.'
- Junky, William S Burroughs, 1977, originally published in 1953

Officially sponsored myth 2 - '"A drug habit is formed instantly, on first use, or at most, after three or four shots." From this notion derive the stories of people becoming addicts after using a few "headache pills" given them by the Sympathetic Stranger. Actually, a non-user would have to take a shot every day for at least a month to get any kind of habit. The Stranger would go broke handing out samples. But a cured addict, even if he has not used it for years, can get a new habit in a few days. He is allergic to junk.'
- Junky, William S Burroughs, 1977, originally published in 1953

Officially sponsored myth 3 - '"Once a habit is formed escape is almost impossible." Actually, a habit is easily cured. The usual cure takes from ten days to three weeks. You don't need any "will power." If the cure is done right there is very little discomfort.'
- Junky, William S Burroughs, 1977, originally published in 1953

Officially sponsored myth 5 - '"Addicts never get enough. They have to keep raising the dosage. They need more and more. Finally, I quote from a recent movie called Johnny Stool Pigeon - They tear the clothes off their skinny bodies and die screaming - for more junk."
This is preposterous. Addicts get enough and they do not have to raise the dosage. I know addicts who have used the same dose for years. Of course, addicts do occasionally die if they are cut off the junk cold. They don't die because they need more and more. They die because they can't get any.'
- Junky, William S Burroughs, 1977, originally published in 1953

'Federal and state narcotic authorities put every obstacle in the way of addicts who want a cure. No reduction cures are given in city or state institutions. Two hundred dollars is minimum for a ten-day cure in a private sanatorium. Hospitals are forbidden by law to give addicts any junk. I knew an addict who needed an operation for stomach cancer. The hospital could not give him any junk. Sudden withdrawal of junk plus the operation would likely have killed him so he decided to skip the operation.'
- Junky, William S Burroughs, 1977, originally published in 1953

'Lexington and Forth Worth are the only two public institutions in the U.S. that give reduction cures. Both are usually full. According to bureaucratic regulations, anyone seeking admission to either hospital must send an application (in triplicate, of course) to Washington and wait several months to be admitted. Then he must stay at least six months. In Louisiana a man could be arrested as a drug addict if he applied for the cure.'
- Junky, William S Burroughs, 1977, originally published in 1953

'"Nembies": after the phrase, "to take the edge off," Burroughs first draft glossary continued; "Sometimes injected intravenously. If you miss the vein you will surely get an abcess. Barbiturates are more dangerous than junk because a user of barbiturates - eight or more capsules per day - gets the horrors when he is cut off barbiturates, and he is subject to epileptic fits with frequent head injury from flopping around on concrete floors. He is most likely to find himself cut off in a place where the floors are concrete."
- Junky, William S Burroughs, 1977, originally published in 1953

So we contaminate our environment, food and water with dangerous man-made chemicals in the pursuit of quick money. These chemicals cause cancers in our bodies. To treat these cancers we make dangerous synthetic drugs, in the pursuit of quick money, that not only fail to treat the cancers, but also result in a collapse of most other body systems. This leads to a weakening and collapse of humans on increasingly larger scales as time goes by. But we do nothing to stop the contamination and weakening of our bodies that evolved over hundreds of millions of years and the contamination of our environment, food and water. Instead we continue searching for more powerful man made chemicals, to make more money faster, in the name of medicine for our environment, bodies and minds believing that we are masters of nature or, if not that, smarter than nature, whom we can fool like our gullible fellow men...but nature is not looking to make more money faster..she only deals in life and death...

Cannabis and the Medical Industry

https://ravingkoshy.blogspot.com/2020/11/cannabis-and-medical-industry.html

With no scientific basis global drug laws are invalid
https://ravingkoshy.blogspot.com/2020/06/with-no-scientific-basis-global-drug.html

A Look At The NDPS Act 1985 From A Cannabis Perspective
https://ravingkoshy.blogspot.com/2020/08/a-look-at-ndps-act-1985-from-cannabis.html

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