Carrie Feibel, KQED, Author at �鶹Ů�� Health News

With The Rise Of Legal Weed, Drug Education Moves From ‘Don’t’ to ‘Delay’

Carrie Feibel, KQED — Thu, 07 Jun 2018 09:00:31 +0000

California legalized marijuana in 2016, and this past New Year’s Eve eager customers lined up in the darkness outside medical marijuana dispensaries across the state, ready to start shopping at the stroke of midnight.

The effect has gone beyond the cannabis cash register. Everyone has seen the ads or heard the chatter — and that includes minors, though marijuana remains illegal for those under 21.

“Coming out of SFO [San Francisco] airport, there are billboards for [a weed delivery service] that say ‘Marijuana is here,'” said , a psychologist who conducts research at University of California-San Francisco on adolescent drug use. “I’m not sure parents were expecting to see so many images of cannabis all over.”

The rollout of legal recreational marijuana in California and other states doesn’t appear to have led to any big changes in substance abuse prevention yet.

But drug prevention education in schools has evolved significantly since the “Just Say No” days of the ’80s — and now typically takes an approach that’s more appropriate for the era of ubiquitous weed access. It’s one that emphasizes decision-making and critical thinking skills instead of abstinence.

One approach is the curriculum — an evidence-based course of study that has been used in about 20 schools in the San Francisco Bay Area.

It, and other drug abuse education today, draws on decades of rigorous effectiveness research and the newest teaching techniques.

The PSAs that Gen-Xers may remember — the egg in a frying pan (““), or the boy calling out his dad’s drug use (““) — live on as memes but are no longer used in information campaigns.

“Those scare-tactic-based programs have tended to quite clearly not work, based on most of the research that evaluated its effectiveness,” Ramo said. “Today, there is an entirely different mindset about school-based prevention.”

In a nutshell, the focus now is on facts, not fear. Also conspicuously absent are simplistic dictates like “Just say no.” Instead, teachers spur students to examine data, speculate on motives, discuss risks and deliberate on their own goals and values.

Ashley Brady explains the increase over time in marijuana potency to a class of eighth-graders at Marin Primary and Secondary School in Larkspur, California. (Carrie Feibel/KQED)

Ashley Brady, a Being Adept instructor, was completely open about her method when she stood in front of the eighth-graders at Marin Primary and Middle School, a private school in Larkspur.

“I’m not here to tell you what to do today. Not at all,” she began. “I’m here to give you the most up-to-date information possible so that you can make your own healthy, informed decisions.”

Brady then jump-started a fast-paced, fact-filled discussion on brain chemistry and physiology. She showed an animated video about how marijuana affects dopamine pathways in the brain. Then she led a discussion about marijuana “edibles” and how the liver metabolizes them.

“It can take up to 30 minutes to maybe even an hour or two before it really hits you,” she said. “When somebody eats an edible and they don’t really feel the effects, what do you think happens?”

“They eat more!” a student called out.

“They eat more,” Brady nodded. “Yeah, an hour, an hour and a half later? Boom! Like a freight train, they’ve been hit, and, you know, can barely move or can barely talk, that kind of thing. So they may have to go to the hospital.”

True, that sounds a little scary, but it’s presented neutrally, as a consequence at the end of a sequence of decisions.

Where the legalization of the marijuana industry has affected the content of these lessons is on the subject of potency. Brady told the students that legalization has spurred competition and innovation among suppliers, to the point where they’re now churning out extremely potent and precisely calibrated forms of pot called “concentrates,” which comes in various forms.

Brady ran through their names: oil, bubble, shatter, wax and dabs.

“They call it a ‘dab’ because one tiny little nail head [of it] — I mean I’m talking like the end of my pinky — one tiny, little nail head is the same as three joints hitting the system all at once,” she said. “So it’s a lot stronger than it used to be.”

Tests of THC levels in marijuana samples over the years back this up. Whereas a typical joint in the ’70s probably had a THC level of 4 to 5 percent, at best, growers are now breeding strains of cannabis that produce buds with THC levels as high as 20 to 30 percent.

The concentrates are in another category altogether. Processed concentrates sold at dispensaries now regularly test at 80, even 90 percent.

“It’s not the same drug,” Brady told the students. People sometimes vomit from concentrates. Some people hallucinate and have even become psychotic.

And yes, she added, it can be addictive. Not just psychologically, but physically. People do go into THC withdrawal and do go to rehab for pot addiction.

Still, as she described the transformation of marijuana from a relatively mild intoxicant to a potentially debilitating one, Brady never once said “that’s why you shouldn’t” or even “so please be careful.”

Afterward, the students applauded this approach.

“It made you feel more mature, and that you’re in control,” said Devon Soofer, 13. “This [class] was actually telling you the long-term effects and what it can actually do to you. So it actually made you feel like, ‘Wow, this is actually really bad,’ and not just being forced not to do it.”

Subsequent units in the Being Adept curriculum give students concrete tools: They rehearse what to do or say at parties, and talk about better ways to cope than using cannabis — or any substance.

Ramo, who serves as a scientific adviser to Being Adept, decried “the overwhelming stress, anxiety, depression, suicidality that is so pervasive among teens in the United States today, especially in high-intensity educational areas, like a lot of schools in the Bay Area are.”

“Addressing that problem is key,” she added, as is “having teens come up with solutions to manage their stress, that they actually would use.”

‘Delay, Delay, Delay’

So if drug educators aren’t telling students “Don’t!” anymore, what are they telling them to do? Overtly, they’re not demanding teens do anything, because teens are naturally resistant to the authoritarian approach — and some of them may resist to the point of doing the opposite.

Jennifer Grellman, a in Kentfield, Calif., and the founder of Being Adept, summed up the strategy in three words: “Delay, delay, delay.”

“The way to handle that with your kids is to say: ‘You know, you don’t have to use this now. Maybe you want to use it someday, but not today, not now. It will always be there.’ Just tell them to wait.”

Grellman said that advice may be more palatable for some teens, and therefore easier for parents to deliver.

They’re not forbidding something (and possibly making it more enticing). They’re not saying “never.”

The instructors put a special emphasis on a less visible risk: the potential damage to their brains.

“More research is coming out looking at the ways in which all different kinds of substances can hijack normal brain functioning, and particularly so in adolescence,” Ramo explained.

“In heavily cannabis-using teens, there are some particularly important implications of using cannabis on the frontal lobe, and that interrupts a type of thinking called ‘executive functioning.'”

Also worrisome is a substantial body of research showing that using any potentially addictive substance while the brain is still developing — whether alcohol, marijuana, nicotine or other drug — triggers neurological changes that can lead to addiction.

“The earlier teens start using, the more heavily they use in adolescence, the more likely it is that they’ll go on to have problems throughout their adulthood,” said Ramo.

Being Adept instructors don’t say it outright, but the message is clear: If you’re not going to abstain, just push it off for a while. Your brain is too vulnerable right now.

The Role of Parents

Grellman said parents should talk about drugs and alcohol with their kids often — as early as fourth grade. For California parents, she suggests using the new billboards or marijuana ads as a prompt to bring up the topic.

Broach the subject obliquely: What do people at your school think about those ads? Do any of your friends know what a dab actually is? Did you see this article on the seventh-grader getting expelled for pot in his locker? What do you think about that?

She said to listen to what they say and discuss it — try not to lecture, but be clear about your expectations, and your values around drugs and alcohol.

At every school where Being Adept is taught, Grellman offers a “Parents Night,” where parents can learn how to navigate those conversations. It’s not just what parents say, she said, it’s what they do. Children are always watching how their parents use substances.

“Don’t glamorize it,” she advised. “It doesn’t mean you have to become a monk and never have a drop of alcohol, but please drink responsibly.” And, she said, don’t use it for stress control.

“This idea of coming home from the office and saying ‘I’ve got to have my glass of wine’ — if you want to have your glass of wine, have your glass of wine, but don’t announce it! That you’re just at wit’s end, and you have to have this drink.”

Grellman said the modeling part becomes tricky when kids ask parents about their past: Did you party? What drugs did you use?

When she led the Parents Night in March at Marin Primary and Secondary, she advised parents to get ready for that moment and have answers prepared.

If you did party in high school, don’t lie, she told them. If a kid senses dishonesty or hypocrisy, they’ll shut down. The most important thing is to keep the conversations going. If your child knows they can talk to you, no matter what, they will create a “safety plan” with you. They will reach out to you when trouble comes.

“You don’t have to tell the full story,” Grellman said. “You could say: ‘You know, I did smoke and I did drink when I was 13.’ And if you loved it, I don’t know if I would advertise that.

“You could say, ‘I did smoke, or I did drink, when I was 13. And you know, frankly? It was too early for me, man. I made some stupid decisions and I got in trouble.’ You can give them the consequences of it.”

After the presentation, parents said they felt relieved to have concrete suggestions about how to talk with their kids, and how much was OK to bring up.

“It’s much more prevalent than it was when I was growing up in the ’80s,” said Joseph Sullivan, a physician from Larkspur, Calif.

“This is a different time, and so it’s nice to hear that we’re almost given permission to be talking about these different aspects of drug experimentation at different ages,” he added.

His wife, Dr. Sara Sullivan, said she’s glad that the “Just Say No” paradigm is dead.

“Just to give the kids more information, I think, is such a different way to approach it, and I really appreciate that. And we’ve kind of started to have conversations in our family because of that,” she explained. “To really kind of take that approach and not be like ‘You’re kind of out there on your own.'”

This story is part of a partnership that includes , and Kaiser Health News.

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Listen: How A ‘Hippie Clinic’ In San Francisco Inspired A Medical Philosophy

Carrie Feibel, KQED — Wed, 10 Jan 2018 10:00:18 +0000

Fifty-one years ago in San Francisco, a small community clinic opened its doors. Its mission: to treat many of the young people who flocked to the city — who were often homeless, hungry and sick. The Haight Ashbury Free Clinic, now part of a larger network, still operates out of a second-floor office overlooking Haight Street in San Francisco, and it still helps people on the fringes of society.

Carrie Feibel of San Francisco’s KQED filed this radio story for NPR and KHN on the history of the clinic.

This story is part of a partnership that includes , and Kaiser Health News.

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Stoked! Weed May Light The Flame For A Roll In The Hay

Carrie Feibel, KQED — Tue, 31 Oct 2017 18:30:09 +0000

Many states permit the use of medical marijuana. Now there’s evidence that pot might work as “marital marijuana,” revving up sex drives in both men and women.

The exact nature of the cannabis-coitus connection remains unresolved, but researchers attempted to cut through the haze with a published in the November issue of the Journal of Sexual Medicine.

It showed that people who toke up are more likely to get down (and dirty).

It actually doesn’t matter who’s partaking — male or female, single or married, childless and carefree, or busy breeder. Among all demographic and ethnic groups, those who smoke weed reported having more sexual intercourse than those who don’t, the research shows.

“I was surprised,” said Dr. Michael Eisenberg, the study’s senior author and an assistant professor of urology at .

The study is based on surveys of more than 50,000 Americans ages 25-45, conducted over more than 10 years by the National Center for Health Statistics.

Before seeing the results, Eisenberg had been telling his patients that getting baked might be a drag on their sex drive or performance. But now he’s much more confident that marijuana isn’t interfering with sexual behavior. And that’s good information these days, especially in a state like California, which already allows medical marijuana and is preparing to go all the way with recreational sales next year.

Last November, California voters approved Proposition 64, , making California one of eight states — plus the District of Columbia — to legalize the drug for recreational use. The measure immediately made it legal for adults 21 and over to possess up to 1 ounce of cannabis, but delayed legal pot sales from licensed retailers until the beginning of 2018.

Eisenberg cautioned against drawing unwarranted conclusions from the study and cited the statistical adage that “correlation does not equal causation.”

“This doesn’t mean that if you want to have more sex, you should start smoking marijuana,” he said. “That’s definitely not what this data supports.”

But Eisenberg said the study could change how he counsels patients who already smoke marijuana. Previously, he’d advised them to quit smoking pot if they were having trouble with libido or sexual performance.

Now he thinks quitting might not be necessary, and that patients can focus on other lifestyle changes to increase libido.

“If somebody is using marijuana to help them for chronic back pain or something like that, there may be other interventions that we can think about targeting, rather than telling them they have to stop, otherwise their sex life is doomed,” he said.

Pot use and sexual activity appear to have a “dose-response relationship.” That means the more you smoke, the more likely you are to have had sex in the past month.

“The daily users, for example, compared to the never-users, reported about 20 more sexual encounters a year. So I think that is a significant difference,” Eisenberg said.

The survey respondents were not asked how much pot they smoked when they smoked. But it did ask about how much sex they had. According to the study, non-users said they had engaged in sexual intercourse between five and six times in the previous month.

But daily pot smokers reported having intercourse about seven times over that same period. The frequency was somewhere in between for people who smoked marijuana less often, on a weekly or monthly basis. They reported having sex more than abstainers, but less than daily users.

“For every group, the more marijuana use that they reported, the more sex they reported as well,” Eisenberg said. “So that … made me think that there could potentially be some biologic explanation here.”

Dr. Holly Richmond, a sex therapist who practices in Los Angeles and Portland, Ore., calls that finding “fantastic.”

“Obviously I’m not going to tell a couple that doesn’t use marijuana to use it,” she said. But “if they were interested, I would offer the information.”

Richmond said she has seen mixed results among her clients who use marijuana. Some couples tell her that they have more sex when they use pot; others have less.

She said those differences are probably attributable to how much pot someone smokes instead of how often they smoke.

“Too much can lead to lethargy and really checking out, which does not facilitate [emotional] connection at all, and definitely doesn’t encourage sexual activity,” she explained.

The results shed no light on what factors drive the association between pot use and sex, according to Dr. Igor Grant, chair of psychiatry and director of the at the University of California-San Diego.

The simplest explanation might be that the type of person who smokes pot — or is willing to admit it in a survey — also likes sex more. Grant called those people “risk-takers” or “sensation-seekers.”

“Drug use is one type of sensation-seeking behavior, and obviously sex is another,” he said.

Eisenberg said the study also controlled for other risk-taking behaviors, such as cocaine or alcohol.

He suspects marijuana may be stimulating arousal or other neural pathways in the brain. That’s different from Viagra, which works directly on the vascular system to improve blood flow to the penis.

But the study has some limitations. For instance, the study relies on self-reporting — and therefore imperfect memories — from participants who were asked to remember how many times they smoked pot in the past year and how many times they had sex in the past four weeks.

Also, the survey asked only about sex between men and women, so it’s unclear how marijuana affects same-sex encounters.

Still, the results fly in the face of some previous research, such as studies indicating that heavy marijuana use is associated with erectile dysfunction. Plus, research on cigarette smoking shows negative vascular effects that can interfere with male arousal, Eisenberg said.

The results also contradict stereotypes about stoners. Grant summed it up as “people just, you know, not feeling like having sex if they’re stoned all the time.”

Richmond, the sex therapist, agreed that those stereotypes exist, so this study could be reassuring to people who enjoy marijuana and also enjoy sex. At the very least, the study shows smoking weed doesn’t appear to decrease sexual activity.

“Individuals and couples look for additional ways to create novelty in the relationship and have fun, and [in some states] that’s now a legal and accessible way to do it,” she said.

This story is part of a partnership that includes , and Kaiser Health News.

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California Presses Forward In Fight To Regulate Pharma

Carrie Feibel, KQED — Wed, 12 Apr 2017 09:00:51 +0000

In November, California voters defeated a that would have given state government more control over drug prices. It was a for pharmaceutical companies, which spent more than $100 million campaigning against the measure.

Now the industry is fighting new efforts by state lawmakers to impose regulations. Drugmakers are watching in particular. Instead of direct price controls, it calls for price transparency. Drug companies would have to announce large price hikes and give detailed justifications to explain why the prices are going up.

“If you can’t understand what’s going on, how could you possibly make efforts to change that?” said Democratic Assemblyman , who chairs the Assembly Health Committee. Wood voted in favor of a similar drug price last year that stalled.

Both last year’s and this year’s drug transparency measures were authored by the Senate Health Committee Chair, Sen. Ed Hernandez (D-West Covina). SB 17 is scheduled for a hearing in the on April 19.

Pharmaceutical manufacturers frequently argue that drug prices are high because it’s expensive to conduct the scientific research and development necessary to bring a drug to market.

But Wood says we can’t simply take their word on that.

“I would personally love to know how much they spend on advertising and marketing, versus how much they spend on R&D,” he said.

Drug industry representatives and researchers visited the state Capitol last Wednesday to meet with lawmakers and underscore their contributions to the California economy. The pharmaceutical industry employs more people in California than in any other state, with 145,880 jobs, said Priscilla VanderVeer, a spokeswoman with

VanderVeer said SB 17 won’t do anything to help consumers.

“If the problem is that patients are having a hard time affording their medicines, which we know they are, then let’s come to the table and talk about solutions that can actually help them,” she said.

VanderVeer said one problem is that consumers often must pay the full list price of a drug, even if they are insured.

“Oftentimes when a patient goes to the pharmacy counter and they haven’t reached their deductible, or they have a coinsurance on their drugs, they’re paying that off the list price, not the negotiated rate their insurance has,” she said.

VanderVeer says that doesn’t happen to insured patients in other parts of the health care system.

“I give the example of the hospital. You know the $350 X-ray that your insurance brings down to $50, and then you pay your cost-sharing off the $50. That’s not happening with your drugs, that’s not happening at the pharmacy counter,” she said.

VanderVeer criticized the bill for ignoring other parts of the pharmaceutical supply chain that also affect prices.

“You’ve also got pharmacy benefit managers and insurers who negotiate the price significantly down … and then you also got wholesalers who purchase drugs directly and keep them in their warehouses and disseminate them to pharmacies. And then you’ve got pharmacies,” VanderVeer explained. She said those links in the supply chain account for one-third of the final price.

Assemblyman Wood agrees that California should pay more attention to . These companies act as middlemen, negotiating purchase contracts with drug manufacturers on behalf of health plans.

Wood has introduced a in the Assembly that would require pharmacy benefit managers to be licensed in California. The legislation would require the managers to disclose information about their business practices, including rebates and hidden arrangements that bring profit to them and force patients to unwittingly pay more for drugs.

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‘Right-To-Try’ Laws Expose Dying Patients To Exploitation, Ethicists Warn

Carrie Feibel, KQED — Mon, 06 Mar 2017 14:25:09 +0000

In the past three years, 33 U.S. states have passed laws aimed at helping dying people get easier access to experimental treatments. Supporters say these patients are just looking for the “right to try” these treatments.

Such laws may sound compassionate, but medical ethicists warn they pose worrisome risks to the health and finances of vulnerable patients.

California’s right-to-try law was enacted in January. It protects California doctors and hospitals who want to prescribe any medicine that has successfully made it through a Phase 1 drug trial. That’s the first stage of human testing required by the Food and Drug Administration — the sort of study that focuses merely on a drug’s safety, not its effectiveness.

Ian Calderon, a Democrat from Southern California and majority leader in the state’s Assembly, was one author of the law. He said that if he had just received a terrible diagnosis, he would want to try anything possible to live.

“My thought would be, ‘What do I have to lose?'” Calderon said. “I have an opportunity to potentially find a cure. Or at least find something that prolongs my life — find something that could help me.”

He said the law seemed to him the logical next step, after California passed a law in 2016 permitting physician-assisted death.

“It’s inhumane to have a law on the books that allows you to end your own life, but no law on the books that allows you to fight to extend it,” he argued. “That just seems counterintuitive.”

Proponents contend that some doctors have been hesitant to help dying patients, for fear of being penalized for using drugs or devices that don’t have FDA approval.

California’s law ensures that doctors can help patients petition to get an investigational medicine from drugmakers without fear of censure from the state’s medical board. It eliminates regulatory obstacles on the state level and creates processes for patient consent and data collection.

Lina Clark and her husband David Huntley on vacation in Croatia in 2014. Before he died of complications from ALS in 2015, Huntley’s illness prompted them both to become activists, lobbying for California’s right to try law. (Courtesy of Lina Clark)

, a San Diego State University professor who died from ALS, or Lou Gehrig’s disease, in 2015, was among the patients who fought for California’s law. Before he died, Huntley testified in favor of the bill from his wheelchair.

His widow, Lina Clark, founder of the patients’ advocacy group , said her husband completely understood what was at stake.

“The patient community is saying: We are smart, we’re informed, we feel it is our right to try some of these therapies, because we’re going to die anyway.”

It’s a compelling argument, but there are serious risks, according to doctors and medical ethicists.

“We know some people try to take advantage of our desperation when we’re ill,” said , director of the at University of California, San Francisco. “If we take the FDA out of it, how do we protect people from physicians or drug companies that will want to sell them things and will want to prey on their desperation?”

Dudley said the FDA and the clinical trial process were put in place for a reason — not just to shut out would-be snake oil salesmen, but to ensure that manufacturers are producing a safe product and not cutting corners.

“If you say there’s a path that’s not through the FDA,” he said, “then there are billions of dollars out there to be made by skipping the important steps that we’ve developed.”

The new state laws are called “right to try,” Dudley said, but all that patients can really do is ask for an experimental medicine. Drug companies don’t have to give them the medicine, and insurance companies don’t have to pay for it.

David Huntley testified in favor of California’s right to try bill in April 2015 in Sacramento. He died three months later. (Courtesy of Lina Clark)

Dudley said patients could spend huge amounts of money trying a drug that hasn’t been proven to work. And the patient may also be giving up their hopes for a controlled, peaceful death at home.

“Instead, you try a drug and you get very severe lung problems,” he said, “and you end up on a breathing machine in a hospital. That could cost hundreds of thousands of dollars.”

Although nearly three dozen right-to-try laws are now on the books, researchers at New York University who’ve been looking for evidence of the laws’ usefulness haven’t yet found a single substantiated case of a patient getting a drug using a state law.

That’s partly, perhaps, because the to help patients and their doctors apply for the use of experimental drugs (and such requests are nearly always approved). Still, Calderon and others point out that the process entailed in these “compassionate use requests” is much too slow and cumbersome for many patients who are dying.

A new federal research law might help change that. The requires drug companies to be more transparent about how they decide who gets experimental access to promising medications, and how long it will take.

This story is part of a partnership that includes , and Kaiser Health News.

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