09/17/17 Doug McVay

Feds release the results of the annual National Survey on Drug Use and Health, Senator Orrin Hatch introduces a bill for pharmaceutical research on marijuana, and the Justice Department digs in its heels in opposing marijuana law reform.

Century of Lies
Sunday, September 17, 2017
Doug McVay
Drug War Facts
Download: Audio icon col091717.mp3



SEPTEMBER 17, 2017


DEAN BECKER: The failure of drug war is glaringly obvious to judges, cops, wardens, prosecutors, and millions more now calling for for decriminalization, legalization, the end of prohibition. Let us investigate the Century Of Lies.

DOUG MCVAY: Hello, and welcome to Century Of Lies. Century Of Lies is a production of the Drug Truth Network for the Pacifica Foundation Radio Network, on the web at DrugTruth.net. I'm your host Doug McVay, editor of DrugWarFacts.org.

It’s been a busy week, so let’s get to it. First up, the National Survey on Drug Use and Health is an annual survey conducted by the federal Substance Abuse and Mental Health Services Administration. It's intended to measure the use of various substances by people in the US aged 12 and older, both illegal drugs such as heroin, cocaine, and methamphetamine, and also the legal drugs intended for social use, which are alcohol, tobacco, and, in a growing number of states, marijuana. The survey also tries to assess the illegal use of legal prescription drugs.

Obviously, there are problems with any survey of that nature. Hello, we’re conducting a survey on behalf of the federal government and we’d like you to tell us how often and in what ways you break the law, and don’t worry, we’re not going to tell the police, or your employer, or the ex-spouse who wants custody of the kids. You can trust us because we’re the government and we’re just here to help you.

Personally, I find it hard to believe that they can get anyone to admit anything. Heck, people lie all the time about their legal drug use. You know: just had the one beer, only smoke half a pack a day, always take my prescription medications exactly how the doctor said and I never take an extra painkiller or wash any of it down with a shot of whiskey. People just lie.

Still, the NSDUH, as it’s known, is the best tool we have currently for assessing the levels of substance use by adults in the US. These days, the new NSDUH gets released in early September. The feds held a news conference to present an overview of the results. Most of it was officials trying to spin the numbers and justify current policy, but there was a bit in the middle where an agency official actually discussed the results. Here’s that part.

The voice you’re about to hear is that of Elinore McCance-Katz, MD, Assistant Secretary for Mental Health and Substance Use in the Department of Health and Human Services. Audio comes to us courtesy of C-SPAN.

ELINORE MCCANCE-KATZ, MD, PHD: Every year, the National Survey on Drug Use and Health, or NSDUH, as we call it, surveys 67,500 Americans about their use of substances, and about their difficulties with symptoms of mental illness.

I want to start by thanking the participants who shared their time with surveyors and had the courage and honesty to share sensitive information and to help shed light on these important issues. You also heard Secretary Price mention our leadership at SAMHSA. It's my privilege to work with these leaders, but I also want to acknowledge our SAMHSA staff, who work very, very hard on the NSDUH every year, and who also work in communities and with our states and stakeholders to improve the behavioral health of the nation.

So I do want to recognize all of the people who work at SAMHSA. I've had the opportunity very recently to meet them, one by one, and I have been very impressed.

So, NSDUH has been completed every year since 1990, and so we have a lot of years of data now. And even though, as Darrell mentioned, the study was redesigned in 2015, there are a number of measures that we're able to trend and they do show consistency from prior years. For example, tobacco and alcohol use are trending downward by age group, and prescription drug misuse also appears to be modestly decreasing.

But there are also areas of concern that we see from the NSDUH, and I'm going to spend my time talking about those areas. But first, let's talk for a minute about the prevalence of mental and substance use disorders in America, and this is data that the NSDUH gives us every year.

What we learned in 2016 is that 18.3 percent of people over the age of 12 in the United States, or 44.7 million people, had a mental illness. And 23 percent of those people had a serious mental illness. Now, when I say serious mental illness, what I mean is that these are people who are diagnosed with a mental illness that is of such a severity that it impairs activities of their lives.

And, in addition, we have another 20 million people, or 7.5 percent of the population, who meet diagnostic criteria for a substance use disorder, and when we look more closely at that data, we see that 37 percent of them struggled with illicit drugs, 75 percent of them struggled with alcohol, and 12 percent struggled with both illicit drugs and alcohol.

When we look more closely at the illicit substances used by Americans, what we see is that by far and away, marijuana remains the most frequently used illicit substance in this country, at 13.9 percent of our population, and after that, is psychotherapeutic drugs. Now, psychotherapeutic drugs is a category of prescribed medications that have abuse liability, and there are four categories of those, of those psychotherapeutic drugs. They are stimulants; sedative/hypnotics; anxiolytics/tranquilizers; and opioid medications.

And what you'll see in just a moment is that opioid medications are the majority of the misused psychotherapeutic drugs. You see at the bottom heroin, 948,000 people or 0.4 percent of the population are currently heroin users. If we look, take a deep look, at opioid use in the United States, we see that millions of people are continuing to misuse prescription pain relievers, 11.8 million people were opioid misusers. That's 4.4 percent of our population. And 11.5 million were prescription opioid misusers.

And if we look more closely at the medications that are being used by people who engage in this behavior, we see that the majority are misusing hydrocodone, followed by oxycodone, and then far fewer misuse prescribed formulations of fentanyl, at 228,000. We see 948,000 heroin users, and 641,000 people report that they misuse both heroin and prescription pain medications.

But, when we look at the adverse outcomes that we're seeing from opioids, we can see that it is not driven by increases in numbers of users, and so what we've shown you here is NSDUH data that tells us that for 2016, heroin use is flat in the United States. We're not seeing big increases in the number of heroin users. Similarly for prescription pain relievers, we actually have seen a small decline in the number of people that are misusing prescription pain relievers.

We have about 2.1 million Americans who meet diagnostic criteria for opioid use disorder, and would need treatment for those disorders, and what you see on the right side of the slide is that only 21 percent obtained treatment for their opioid use disorder, and of those 21 percent, 37.5 percent of people that are heroin users got treatment versus only 17.5 percent of people who are prescription pain reliever addicted.

And, that's important, because the other thing that we're seeing is the large, stunning increase in deaths related to heroin use. And so, what I'm showing you here is that NSDUH tells us that in 2002, we had 404,000 Americans that were heroin users. By 2016, that number increases to 948,000. But when we look at deaths from heroin, we see that in 2002, we had just a little over 2,000 deaths, but by 2016, this is estimated data from CDC, it looks like they're going to tell us 13,219 people died of heroin use.

So 230 percent increase in heroin users over that 2002 to 2016 time period, 630 percent increase in deaths. People in this country who are using heroin are being poisoned. This is hugely, hugely concerning, and it really underscores the need that we increase access to treatment, and get people the prevention services, the treatment services, and the recovery services that they need.

I now want to take just a few minutes to talk about another finding that's very concerning from the National Survey on Drug Use and Health, and that is the prevalence of serious mental illness in young adults. We call them transitional age youth, aged 18 to 25, and what we see here is that in 2008, 3.8 percent had serious mental illness, but that has risen in 2016 to 5.9 percent.

And, we also see that just a little over half of these young adults were able to access treatment. So two million people, and just a little over half of them were able to access treatment for their serious mental illness. These are the most serious disorders, these are the ones that affect people's ability to function, and only half of the people in this age group with those disorders were able to access the care that they needed.

And this has big consequences, because when people have serious mental disorders, they will have increases in adverse consequences, such as suicidality, and what we see from the National Survey on Drug Use and Health is that in this age group, the 18 to 25 year olds, we see a significant increase in serious thoughts of suicide, a significant increase in people making a plan to commit suicide, and a statistically significant increase in the number of people who attempted suicide.

So, why is this happening? The National Survey on Drug Use and Health is a national survey. We can't make inference from it as to why this is happening, but, one thing that we can glean from the National Survey is that we have large numbers of youth that are using illicit substances, 8 million 18 to 25 year olds, 23 percent of that population. There are 38 percent of individuals that are in that age group who engage in binge alcohol use.

Now, when I say binge alcohol use, what I mean is if you're a man, you would drink five or more drinks at a session, and if you're a woman, you'd drink four or more drinks. That's how we define binge alcohol use. And ten percent of this age group are what we define as heavy alcohol users, and those are people who have five or more binges a month.

Why is that important? Because we know that substance misuse and addiction is highly correlated with mental illness. And we know that these disorders frequently co-occur. And so while we don't know for sure that this is what's driving these increases in serious mental illness in this age group, it certainly deserves consideration.

And, we see that for all age groups, and for individuals with both substance use and mental disorders, it's very difficult for them to access treatment. We have to do better. This is data that tells us that we are not getting the job done for the people of America. We see that if you have a substance use disorder, only 7 percent of people got specialty care that they needed. If you had any mental disorder, 57 percent did not receive treatment. Similar findings for people with co-occurring disorders.

For people with serious mental illness, as Secretary Price mentioned, 35 percent get no treatment. These are people who are terribly impaired by mental illness. We have to do better. For youth that are aged 12 to 17, we see significant rates of major depression, and 59 percent of them got no treatment.

DOUG MCVAY: That was Doctor Elinore McCance-Katz presenting the results from the newest National Survey on Drug Use and Health, or NSDUH, at a news conference on September Seventh, audio courtesy of C-SPAN. Doctor McCance-Katz is the Assistant Secretary for Mental Health and Substance Use in the Department of Health and Human Services and head of the Substance Abuse and Mental Health Services Administration. That assistant secretary job is a new position. The SAMHSA boss used to be an administrator level position, but now it’s an assistant secretary, so a higher paygrade. Federal bureaucrats and people obsessed with hierarchical management structures will probably find that significant.

You are listening to Century of Lies, a production of the Drug Truth Network for the Pacifica Foundation Radio Network, on the web at DrugTruth.net. I’m your host Doug McVay, editor of DrugWarFacts.org.

A conservative Republican member of the US Senate has introduced legislation for research into medical marijuana. Senator Orrin Hatch from Utah spoke on the Senate floor on September Thirteenth to introduce the Marijuana Effective Drug Studies, or MEDS, Act. The bill is co-sponsored by Nebraska Republican Senator Ben Sasse [sic: it's co-sponsored by Senator Brian Schatz, D-HI]. Here now is Senator Hatch.

SENATOR ORRIN HATCH (R-UT): I am joining Senator Schatz today to introduce the Marijuana Effective Drug Studies Act, or MEDS Act, which has the potential to benefit millions of Americans who are suffering from a wide range of conditions, including cancer, severe epilepsy, post-traumatic stress disorder, residual effects after a stroke, or chronic pain.

It is high time to address research into medical marijuana. Our country has experimented with a variety of State solutions without properly delving into the weeds on the effectiveness, safety, dosing, administration, and quality of medical marijuana.

Now, all puns aside, it will surprise no one that I am strongly against the use of recreational marijuana. I worry, however, that in our zeal to enforce the law, we too often blind ourselves to the medicinal benefits of natural substances, like cannabis. While I certainly do not support the use of marijuana for recreational purposes, the evidence shows that cannabis possesses medicinal properties that can truly change people's lives for the better, and I believe we would be remiss if we threw out the baby with the bath water.

In many cases, the compounds found in cannabis are the only hope for Americans who suffer from chronic medical conditions, such as severe epilepsy. Take the difficult case of a young man from Eagle Mountain, UT, who suffers from a number of different epileptic disorders and developmental ailments. My friend regularly takes 17 pills on a daily basis. Yet he continues to have seizures regularly. The current treatment for his condition, with no guarantee of success, would be invasive brain surgery.

This poor family is seeking help, yearning for a way for their child to live a safe and healthy life. Compounds found in marijuana could significantly mitigate the severity of my friend's seizures and even help him lead a normal life, but current regulations prevent the development of any such treatment from going forward. So this young man is left to suffer. Luckily, the MEDS Act changes that. It updates the law for the 21st century, allowing for groundbreaking research on the potentially lifesaving benefits of medical marijuana.

Compounds found in marijuana have shown promise for treating a wide range of diseases and disorders, but because of bureaucratic red tape and fear, there is a lack of sufficient evidence about the safety and efficacy of these compounds.

As a result, millions of Americans are using marijuana for medicinal purposes without there being the rigorous scientific evidence that we require all medications to have before we allow them to be prescribed in this country. There are currently no Federal quality control measures for marijuana grown for medicinal purposes, nor is there any quality control for the marijuana-based medications that patients eventually use.

Prescribers do not have guidance on appropriate doses, routes of administration, or even the safety of this medication for populations such as children or the elderly. This lack of oversight creates a dangerous environment that puts American lives at risk.

As we continue to encourage the development of new therapies for those with severe medical problems, we must be unrelenting in our insistence on scientific rigor. Using only anecdotal information poses a significant public health risk.

We lack the science to support the use of medical marijuana products like CBD oils, not because researchers are unwilling to do the work but because of bureaucratic red tape and over-regulation.

Under current law, those who want to complete research on the benefits of medical marijuana must engage in a complex application process and interact with several Federal agencies. These regulatory acrobatics can take researchers over a year, if not more, to complete, and the longer researchers have to wait, the longer patients have to suffer.

Currently, the FDA estimates that a drug takes a minimum of 7 years to move from initial studies to FDA approval. The regulatory hoops that researchers have to jump through significantly delay the production of potentially life-changing medications that Americans need.

To develop more information about marijuana's therapeutic potential, we need robust basic and clinical research. The MEDS Act would encourage this research through reduced regulatory interference, and it would expand sources of research-grade marijuana with the assurance of a quality-controlled product.

My proposal would also allow for the commercial production of drugs developed from marijuana once they have been approved by the FDA. I am pleased with the legislation that Senator Schatz and I have been able to craft surrounding CBO oil and medical research. We are committed to seeing that this bill becomes law.

Mister President, before I yield the floor, I would like to take a moment to share my perspective on the broader discussion of medical marijuana and its implications in my home State of Utah. In Utah and across the Nation, opioid abuse continues to ravage good, hard-working families who have fallen captive to the tyranny of addiction.

While some people are using these prescription drugs appropriately, others are abusing them at alarming rates. Because Utahns have watched their family members, friends, and neighbors grapple with this epidemic, many are seeking nonnarcotic alternatives that can help with pain. Medical marijuana is just one such alternative, and after careful, deliberative thought, I've concluded that it is an alternative worth pursuing.

Now let me be clear. My support for medical marijuana research does not mean that I believe that marijuana is a harmless substance. Much to the contrary, I continue to believe that marijuana can lead to broader drug abuse, and I'm deeply concerned by the cottage industries springing up in States in which marijuana has been legalized both for medical and recreational use.

So let me be clear. I am still very much opposed to the legalization of recreational marijuana, but I strongly support research into the medicinal benefits of marijuana, and I remain committed to helping patients find the help they need, whether they suffer from cancer, severe seizures, or any other chronic disorder.

In crafting a new regulatory framework to harvest the medicinal benefits of marijuana while also mitigating its harmful effects, we must ensure that any marijuana-derived medications are prescribed by qualified physicians or other healthcare providers.

Also, if we make medical marijuana accessible to those who really need it, we should not increase access to recreational marijuana, nor should we do anything to promote the industry that has developed around marijuana dispensaries.

DOUG MCVAY: That was Senator Orrin Hatch, Republican from Utah, speaking on the Senate floor about his new bill, the Marijuana Effective Drug Studies Act. That audio came to us courtesy of the US Senate. You may have heard something about Hatch’s new bill, now you know why it’s nothing to get excited about. For real reform, we need legislation like the bill that’s been introduced by Senator Cory Booker, the Democrat from New Jersey. The Marijuana Justice Act.

What’s needed is de-scheduling, taking marijuana out of the Controlled Substances Act and treating it like St. John’s Wort or ginkgo biloba or ginseng or willow bark or any of the other plants that you can buy off the shelves at most grocery stores or vitamin shops.

Unfortunately, that’s not the position being taken by the current administration. We still have a minute left in the show, so let’s give a listen to what Deputy Attorney General Rod Rosenstein had to say recently about the Justice Department’s current position on marijuana. He spoke at an event sponsored by the Heritage Foundation on September Fourteenth.

ROD ROSENSTEIN: Yeah, this is an interesting challenge. Yeah, the attorney general's been very clear, our position of the United States, because it's reflected in law, marijuana is illegal. And, it's a controlled substance and there are no authorized uses for it, with very limited exceptions for research approved by DEA.

But there are several states that have decriminalized marijuana, so they're not enforcing it under state law, and in some states, they're actually licensing certain marijuana growers. The Department responded to this several years ago, in a series of memos that were intended to provide guidance for US Attorneys in those districts about when they should prosecute marijuana cases.

And it was largely an effort to kind of codify the traditional principles of federal prosecution, that is, as I mentioned, we have discretion, we have limited resources, how do we determine which cases we're going to pursue, and so it set forth certain conditions for evaluating which cases to pursue.

Now that's been perceived in some places almost as if it creates a safe harbor, but it doesn't, and it's pretty clear that it doesn't, that is, even if under the terms of the memo you're not likely to be prosecuted, doesn't mean that what you're doing is legal or that it's approved by the federal government, or that you're protected from prosecution in the future.

And so, we are reviewing that policy. We haven't changed it, but we are reviewing it. We're looking at the states that have legalized, or decriminalized, marijuana, trying to evaluate what the impact is, and I think there's some pretty significant evidence that marijuana turns out to be more harmful than a lot of people anticipated, and it's more difficult to regulate than I think was contemplated ideally by some of those states.

So we're going to take that all into consideration, and then make a determination whether or not to revise that policy.

DOUG MCVAY: That was Deputy Attorney General Rod Rosenstein, speaking a few days ago at an event sponsored by the Heritage Foundation, a far-right thinktank in Washington, DC.

The drug war never ended. Harm reduction, decriminalization, legalization, and other drug policy reforms have made great advances over the past few years. We still have a very long way to go, and the people who oppose reform and are against reducing the harms from drug use are back in control at the federal level.

I started working on legalization and drug policy reform back in the bad old days of the Reagan administration. You don’t want to know the kinds of things I was called back then just for daring to question the drug war, some of them things that the FCC would not allow me to repeat on air. So yeah, we still have a long way to go, and it’s an uphill struggle, yet we have made incredible progress in the past few decades. We have turned this country around and we are going to keep going. Forward ever, backward never.

And that's it for this week. Thank you for joining us. You have been listening to Century of Lies. We're a production of the Drug Truth Network for the Pacifica Foundation Radio Network, on the web at DrugTruth.net. I’ve been your host Doug McVay, editor of DrugWarFacts.org. The executive producer of the Drug Truth Network is Dean Becker. Drug Truth Network programs are available via podcast, the URLs to subscribe are on the network home page at DrugTruth.net.

The Drug Truth Network is on Facebook, please give its page a like. Drug War Facts is on Facebook too, give its page a like and share it with friends. Remember: Knowledge is power. Follow me on Twitter, I'm @DougMcVay and of course also @DrugPolicyFacts.

We'll be back next week with thirty more minutes of news and information about the drug war and this century of lies. For now, for the Drug Truth Network, this is Doug McVay saying so long. So long!

For the Drug Truth Network, this is Doug McVay asking you to examine our policy of drug prohibition: the century of lies. Drug Truth Network programs archived at the James A. Baker III Institute for Public Policy.