A new study on psychiatric hospitalisations, out now in Drug and Alcohol Dependence, found that while most hospitalisations did not involve any substances, methamphetamine-related hospitalisations have increased even as the overall number of psychiatric hospitalisations remained stable.
Additionally, researchers detail that psychiatric hospitalisations caused by methamphetamine use was highest in a region which has higher reported methamphetamine use, but were also shifting geographically.
“Rates of methamphetamine-involved psychiatric hospitalisations were by far the highest in the Mountain West,” said Susan Calcaterra, MD, MPH, professor at the University of Colorado Anschutz Medical Campus and study lead author. “As expected, this mirrors rates of self-reported methamphetamine use and methamphetamine-related overdose deaths in the Mountain West,” Calcaterra said. “Psychiatric hospitalisations involving methamphetamine use is really taking off in the Midwest and Northeast, in particular.”
Study underscores need for clinic-based harm-reduction tactics
While rates of methamphetamine-related psychiatric hospitalisations increased 68% over the study period, opioid-related hospitalizations decreased by 22%. Methamphetamine rate increases may be attributed to methamphetamine’s ubiquity and affordability, as well as the lack of resources available to manage methamphetamine use. Why opioid-involved psychiatric hospitalizations declined is less clear but may be related to the lethality of fentanyl.
“An important takeaway from this study is the need for resources to address the mental and physical treatment of methamphetamine use,” Calcaterra said.
“While the vast majority of psychiatric hospitalisations in this timeframe did not involve substance use, the significant increase in methamphetamine use means we have to better consider harm reduction in clinical settings,” she said.
“Evidence-based interventions such as contingency management, which involves offering incentives for abstinence, harm reduction education, provision of naloxone for overdose reversal and access to expanded mental health treatments are proven to help mitigate dangerous effects from methamphetamine use, especially when contaminated with fentanyl much like the campaigns aimed at public awareness around opioid use.”
A good night’s sleep is essential for children’s health and development, but childhood sleep patterns may also be linked to future substance use. A new study, led by a team of Penn State researchers, found that adolescents were more likely to have consumed alcohol or tried marijuana by age 15 if they went to bed later and slept fewer hours during childhood and adolescence. The team published their findings in Annals of Epidemiology.
“The study suggests that there might be some critical ages when sleep can be a target for intervention,” said Anne-Marie Chang, associate professor of biobehavioural health at Penn State and senior author of the paper. “If we improve sleep in the school-age population, not only could that show improvements in sleep health but in other aspects like the decision to engage in risky behaviours like alcohol and other substance use.”
The research team explored childhood sleep at different developmental stages within the same sample of children to see if there’s an impact on later substance use, which few studies have investigated. They focused on two different facets of sleep health – total duration of sleep and time of sleep or bedtime. The researchers explained that if children, especially school-aged children, go to bed later, it could affect their ability to sleep well.
“Sleep is multifaceted. It’s important for children because it helps with growth and development. The brain is more plastic during younger ages and you want healthy sleep to support neural development,” said David Reichenberger, co-lead author and who earned his doctoral degree in biobehavioural health at Penn State during the time of the research. “Poor sleep health could have downstream effects on their physical health as well as decision making, which could in turn be related to their decision to engage in substance use.”
The study drew on data from 1514 children in the Future of Families and Child Wellbeing Study, a diverse longitudinal birth cohort of children from 20 cities across the United States. Parents reported their child’s regular weekday bedtime at ages three, five and nine. They also reported their child’s sleep duration at ages five and nine.
When the research team evaluated the relationship between childhood bedtime and sleep duration with future alcohol and marijuana use as teens, they found a longitudinal association. Teens were 45% more likely to try alcohol by age 15 if they had a later bedtime at age nine when compared to other children with earlier bedtimes at age nine. However, bedtime at age five wasn’t associated with future alcohol use, nor was sleep duration at ages five or nine. When it came to marijuana use, later bedtime at age five was associated with 26% increased odds of trying marijuana by age 15, while sleeping an hour less at age nine was associated with 19% increased odds of trying marijuana by age 15.
The research team also examined data from adolescents at age 15, who self-reported their bedtime, sleep duration and alcohol and marijuana use. They found that teens with a later bedtime had a 39% greater chance of drinking alcohol and a 34% greater chance of trying marijuana. Sleeping one hour less was associated with 28% increased odds of ever trying alcohol but wasn’t associated with marijuana use.
“Sleep at ages closer to adolescence is the most crucial in terms of future substance use risk. It’s that stage of development when children are rapidly changing and their brain is maturing,” Reichenberger said, noting that previous research by other groups suggests that shorter sleep duration and later bedtimes may increase impulsivity and impair decision making, which could influence substance use choices.
The findings highlight the critical role of sleep across multiple aspects of long-term health and wellbeing, researchers said. For school-age children, creating an environment that’s conducive for sleep and establishing an age-appropriate bedtime are key elements for cultivating good sleep.
“Exploring the connection between sleep and substance use is a critical area of research because we continue to struggle with an epidemic of opioid addiction and substance use,” Chang said. “It’s an important area to continue to research and to disseminate our research findings to the broader population, families and health care professionals.”
At the start of the COVID pandemic in 2020, scientists quickly recognised that a handful of characteristics, including age, smoking history, high body mass index (BMI) and the presence of other diseases such as diabetes, increased the risk of severe disease and death. But one suggested risk factor remains unconfirmed more than four years later: cannabis use. Evidence has emerged over time indicating both protective and harmful effects.
Now, a new study by researchers at Washington University School of Medicine in St. Louis points decisively to the latter: Cannabis is linked to an increased risk of serious illness for those with COVID.
The study, published in JAMA Network Open, analysed the health records of 72 501 people seen for COVID at Midwestern US health centres during the first two years of the pandemic. The researchers found that people who reported using any form of cannabis at least once in the year before developing COVID were significantly more likely to need hospitalisation and intensive care than were people with no such history. This elevated risk of severe illness was on par with that from smoking.
“There’s this sense among the public that cannabis is safe to use, that it’s not as bad for your health as smoking or drinking, that it may even be good for you,” said senior author Li-Shiun Chen, MD, DSc, a professor of psychiatry. “I think that’s because there hasn’t been as much research on the health effects of cannabis as compared to tobacco or alcohol. What we found is that cannabis use is not harmless in the context of COVID. People who reported yes to current cannabis use, at any frequency, were more likely to require hospitalisation and intensive care than those who did not use cannabis.”
Cannabis use was different than tobacco smoking in one key outcome measure: survival. While smokers were significantly more likely to die of COVID than nonsmokers, a finding that fits with numerous other studies, the same was not true of cannabis users, the study showed.
“The independent effect of cannabis is similar to the independent effect of tobacco regarding the risk of hospitalisation and intensive care,” Chen said. “For the risk of death, tobacco risk is clear but more evidence is needed for cannabis.”
The study analysed deidentified electronic health records of people who were seen for COVID at BJC HealthCare hospitals and clinics in Missouri and Illinois between Feb. 1, 2020, and Jan. 31, 2022. The records contained data on demographic characteristics such as sex, age and race; other medical conditions such as diabetes and heart disease; use of substances including tobacco, alcohol, cannabis and vaping; and outcomes of the illness: specifically, hospitalisation, intensive-care unit (ICU) admittance and survival.
COVID patients who reported that they had used cannabis in the previous year were 80% more likely to be hospitalised and 27% more likely to be admitted to the ICU than patients who had not used cannabis, after taking into account tobacco smoking, vaccination, other health conditions, date of diagnosis, and demographic factors. For comparison, tobacco smokers with COVID9 were 72% more likely to be hospitalized and 22% more likely to require intensive care than were nonsmokers, after adjusting for other factors.
These results contradict some other research suggesting that cannabis may help the body fight off viral diseases such as COVID.
“Most of the evidence suggesting that cannabis is good for you comes from studies in cells or animals,” Chen said. “The advantage of our study is that it is in people and uses real-world health-care data collected across multiple sites over an extended time period. All the outcomes were verified: hospitalisation, ICU stay, death. Using this data set, we were able to confirm the well-established effects of smoking, which suggests that the data are reliable.”
The study was not designed to answer the question of why cannabis use might make COVID worse. One possibility is that inhaling marijuana smoke injures delicate lung tissue and makes it more vulnerable to infection, in much the same way that tobacco smoke causes lung damage that puts people at risk of pneumonia, the researchers said. That isn’t to say that taking edibles would be safer than smoking joints. It is also possible that cannabis, which is known to suppress the immune system, undermines the body’s ability to fight off viral infections no matter how it is consumed, the researchers noted.
“We just don’t know whether edibles are safer,” said first author Nicholas Griffith, MD, a medical resident at Washington University. Griffith was a medical student at Washington University when he led the study. “People were asked a yes-or-no question: ‘Have you used cannabis in the past year?’ That gave us enough information to establish that if you use cannabis, your health-care journey will be different, but we can’t know how much cannabis you have to use, or whether it makes a difference whether you smoke it or eat edibles. Those are questions we’d really like the answers to. I hope this study opens the door to more research on the health effects of cannabis.”
More evidence shows potential connection between cannabis exposure in womb and adolescent behavioural problems
Photo by Thought Catalog on Unsplash
Scientists are trying to understand how cannabis may affect long-term neurodevelopment from in utero exposure. Previous work by Washington University in St. Louis researchers Sarah Paul and David Baranger in the Behavioral Research and Imaging Neurogenetics (BRAIN) lab led by Ryan Bogdan found associations between prenatal cannabis exposure and potential mental health conditions in childhood and adolescence, but potential biological mechanisms that could possibly explain this association were unclear.
In research published in Nature Mental Health this month, Bogdan, professor of psychological and brain sciences, and senior scientist Baranger outline some of those potential mechanisms, the intermediate biological steps that could play into how prenatal cannabis exposure leads to behavioural issues down the line.
“We see evidence that cannabis exposure may influence the developing brain, consistent with associations with mental health,” Baranger said.
Trying to draw out the long-term impacts of cannabis exposure during pregnancy is not a simple knot to untangle. There are many confounding factors that affect mental health and behavior.
For example, say someone was exposed in utero to cannabis and later develops attention deficit disorder as a teen – how do you differentiate that as an inherited trait or a trait influenced by environmental factors, versus a trait that cannabis exposure somehow contributed to early on in development? It is also possible that all three potentially could contribute to eventual psychopathology.
Another complication is the increasing prevalence of the drug, including among the pregnant population, where cannabis use has increased from 3% to 7% from 2002 to 2017.
Researchers have statistical methods to filter out some of those confounding factors that they used in the previous study, but now they can point to specific biological measurements that further signal a connection to cannabis exposure and adolescent behavioral problems.
Bogdan said that nothing can establish causation with certainty, “but we can look at the plausibility of causation and identifying biological correlates that are associated with exposure and these mental health outcomes suggests it’s plausible.”
Researchers have been using data on the children and their mothers from the Adolescent Brain and Cognitive Development (ABCD) Study, an ongoing research project that includes nearly 12 000 children across the country. As part of that study, they collected data about each mother’s substance use prior to the birth as well as the neuroimaging data of their offspring when they were between 9 and 10 and 11 and 12 years old. Some 370 children were exposed to cannabis prior to the mother’s knowledge of pregnancy, and 195 were exposed before and after learning of pregnancy.
The researchers looked at a variety of neuroimaging measurements that factor into brain development, including measures of brain thickness and surface area, as well as measures reflecting water diffusion in and outside of cells. The patterns found in the group exposed to cannabis are consistent with potential reductions in neuroinflammation.
“It’s possible what we’re seeing is an anti-inflammatory effect of cannabis, which is leading to differences in how the brain is being pruned during neurodevelopment,” Bogdan said.
Much has been touted about the anti-inflammatory effects of cannabis, but it’s not always good to reduce inflammation. It’s all about the timing: too much of a reduction of inflammation at the wrong time could affect how the brain is pruned and primed.
Another theory is that cannabis exposure leads to accelerated aging. But don’t expect to find the smoking gun of biological clues pinning mental health problems to early cannabis exposure.
It might not even be about cannabis effects on pruning but the post-combustion products from smoking cannabis that set off accelerated aging and the downstream cognitive effects, Bogdan said.
Or, it could all come down to sociological factors, he added.
Trying to find the one-to-one connection that proves that prenatal cannabis exposure has negative effects during the teenage years is a challenge and may not be possible with retrospective studies. Baranger notes that the major limitation of this data set is that it was retrospective; mothers reported what their cannabis use was 10 years ago, so he’s looking forward to new data from prospective, longitudinal studies that will offer more recent, accurate and detailed information about cannabis use in pregnancy.
“That will potentially give us more answers to these questions in the future,” Baranger said.
Baranger said these results reaffirm that if someone is thinking about using cannabis while pregnant, they should “talk to their doctor about their choices and what other options there might be.”
Rehab centres in South Africa have been admitting an increasing number of codeine users in recent years. Now, the country’s medicines regulator has published a draft guideline as part of a broader effort to track suspicious codeine sales.
South Africa’s medicines regulator – the South African Health Products Regulatory Authority (SAHPRA) – has released a new draft guideline which it says will help stem the misuse of codeine. The opioid, which is found in certain pain relief medicines and cough syrups, is used by some people in large doses to get high.
Under the new draft guideline, the regulator can request sales data (and other information) from manufacturers, suppliers or distributors of any scheduled medicines. This would allow them to track the flow of codeine all the way “from the manufacturer to the dispensary, be it a clinic, pharmacy, hospital, or doctor’s practice”, SAHPRA’s communications officer, Nthabi Moloi, told Spotlight.
Why is this important? Until now, health authorities have struggled to detect suspicious sales of codeine, which is found in both prescription and over-the-counter medicines. This problem manifests in two ways. For one, recreational users can often get a continuous supply of codeine directly from pharmacies. While people are only permitted to purchase a limited amount of the drug, many bypass this simply by buying from different pharmacies. It’s largely impossible to flag these individuals since there is no centralised data on what medicines people buy across vendors (though attempts have been made to address this).
The second issue relates to wholesale supply. Following a Carte Blanche investigation flighted last year, SAHPRA confirmed that a pharmacy group was making illicit bulk sales of codeine-based cough syrups. While patients are only allowed to get codeine from a licensed health worker or pharmacist, it’s thus no surprise that it can also be found on the black market.
The new draft guideline aims to tackle both of these problems by allowing SAHPRA to request information from companies and health workers about how much codeine they’re producing, selling or dispensing and who it is being provided to. This would “enable SAHPRA to detect anomalies in the distribution of medicines prone to abuse, such as abnormally large orders by dispensaries” Moloi explains.
It is the “first phase”, she says, of the codeine care initiative – which is an effort to centralise data on all codeine sales along the entire supply chain nationally. The plan is to ensure that the regulator can flag anything from an individual who is buying large amounts of codeine from multiple vendors to a wholesaler who is selling the drug to illicit dealers.
Codeine rehab admissions triple since 2019
The draft guideline, which is now available for public comment, comes at a time in which rates of codeine addiction are soaring throughout South Africa, according to admissions data from drug and alcohol treatment facilities. Most rehabilitation centres around the country are connected to a programme called the South African Community Epidemiology Network on Drug Use (SACENDU), which collects anonymised patient data from the different centres. Professor Nadine Harker, who oversees this project says “if you look at treatment admissions over time, there has been an increase [in codeine-related admissions] over the years – steadily but definitely”.
Indeed, SACENDU’s bi-annual reports show that in the first half of 2019, 277 people who went to SACENDU-linked rehab sites said they had been misusing codeine. This amounted to 3% of all admissions. But by the first half of 2023, this percentage had tripled to 9% – totalling 749 people. (In absolute terms the number slightly less than tripled).
Even before this uptick, health workers were concerned. In the mid-2010s, a survey of 238 (mostly private sector) doctors was conducted across South Africa. It found that 85% of these practitioners were worried about the easy availability of codeine in pharmacies.
Part of the concern is driven by the fact that people who use codeine-based medicines over a long time can develop a range of health complications, including stomach ulcers and liver damage (this is particularly when the medicines contain additional substances like paracetamol). And some people are more vulnerable than others, as genetic factors play a big role in how codeine affects a person.
Why is the problem getting worse?
Part of the spike in codeine use appears to be driven by a trend among young people, who sometimes mix codeine-based cough syrups with cooldrinks. The combination is often referred to as lean, and has become a popular party drug among high school students. Research shows that codeine’s low price and general accessibility is one reason for its popularity. Harker for instance notes that it’s often available at home, where kids “can pick it up out of their mom’s medicine cabinet”.
In other cases, people appear to be relying on the drug not for recreation but to cope with psychological distress. For instance, a 2022 study for which women were interviewed at rehab centres in the Western Cape and Eastern Cape found that many had turned to pharmaceutical products to deal with everything from trauma caused by physical abuse to grief over the loss of a child.
“I just wanted the pain to go away. I wanted my mind to switch off… [the tablets] actually made me dead inside if I can say that,” one woman explained.
A lack of awareness about the dangers of codeine also seems to play a role: 94% of doctors who were surveyed agreed that patients “do not fully understand the risk of dependence in taking over-the-counter medicines containing codeine”. The lack of regulatory control may contribute to this impression: one study at South African rehab centres found that “many participants were of the view that [over-the-counter] codeine-containing medicines were not drug[s] per se due to their free availability to purchase without any real regulations or protocols guiding their sale”.
Shouldn’t we just make codeine prescription-only?
Currently, the law states that codeine-based pills can be bought over the counter only under specific conditions. For one, they have to contain another active ingredient like paracetamol or ibuprofen, and each pill can contain a maximum of 10 milligrams of codeine. A person can only buy one pack and it must contain at most 5 days’ worth of medicine (with no more than 80 milligrams a day). Anything more and a script is needed.
Liquid codeine, like cough syrups, can be bought without a script if it contains no more than 10 milligrams of codeine per teaspoon (the maximum daily dose is 80 milligrams). The bottle itself may not contain more than 100 millilitres of syrup.
Products like Gen-payne, Myprodol, and Stopayne all contain small amounts of codeine – typically in combination with other painkillers such as paracetamol or ibuprofen. (Photo: Towfiqu Barbhuiya/Unsplash)
Some researchers that spoke to Spotlight argue these restrictions are too lenient, and that codeine should be ‘up-scheduled’, meaning that it would only be available if a patient has a script, regardless of the dose or combination. By doing this, children may find it harder to get a hold of cough syrups for lean, and people may generally become more aware of the addictiveness of the drug when used over the long-term.
Indeed, there are some studies which have found this approach to be effective in other countries. Research published in the journal Addiction found that when authorities in Australia made codeine prescription-only in 2018, a large poisoning information centre in the country began to receive significantly fewer calls about codeine-related incidents (both from health workers and members of the public).
But there are also potential downsides to this strategy. For one, as Spotlight has previously reported, increased regulation may make life harder for poorer patients seeking pain relief. This is given that they would have to spend more money for a consultation and prescription if they needed codeine-based painkillers.
Andy Gray, who chairs an advisory scheduling committee at SAHPRA, details a second issue: “I’m not convinced that up-scheduling would solve the issue if what we’re dealing with [in South Africa] is illegal behaviour… If [codeine] is being smuggled out of manufacturers or wholesalers, scheduling is not going to make a difference”.
Dr Andrew Scheibe, a harm reduction researcher at the University of Pretoria, notes a third related problem that may occur. “If people do have codeine-dependence and they’re unable to access the codeine, they might likely shift to accessing opioids… on the black market”.
Scheibe highlights the United States as an example, where prescription opioids like oxycodone and fentanyl have been at the centre of a major drug epidemic. “When they tried to increase restrictions on access to those opioids then people started using heroin,” he notes. A 2022 study found that this had taken place among opioid users interviewed in Connecticut, Kentucky and Wisconsin.
Whatever the answer, researchers agree that some basic steps need to be taken to educate the public. Harker says “a lot of awareness raising needs to happen at various levels, for instance at pharmacies”. She notes that “when someone purchases codeine over the counter, it’s important for a pharmacist to engage [with them and] make the consequences known to the individual if they use it outside of the dosages indicated… And we don’t do that enough from the medical or pharmacist’s side”.
Xylazine, only intended for animals, is being added to opioids and cocaine, with deadly effects. Photo by Colin Davis on Unsplash
Xylazine is an FDA-approved sedative and pain reliever for use in animals, but it has severe adverse effects when used in humans. Now, it is now being added illicitly to opioids, like fentanyl and heroin, as well as cocaine – leading to a sharp rise in overdose deaths.
Scripps Research chemical biologists have developed a vaccine to block the effects of xylazine’s toxicity. The vaccine works by training the immune system to attack the drug, which is described in a new paper published in Chemical Communications.
“We demonstrated that a vaccine can reverse the symptoms of a xylazine overdose in rodents,” says study senior author Kim D. Janda, PhD, professor of chemistry at Scripps Research. “There is currently no remedy for xylazine poisoning other than supportive care, thus, we believe our research efforts and the data we have provided will pave the way for an effective treatment in humans.”
The rapid increase in lethal drug overdoses attributed to xylazine combined with fentanyl prompted the White House Office of National Drug Control Policy to declare this combination an emerging threat to the United States. Xylazine intoxication presents similarly to opioid overdose, causing respiratory and central nervous system depression, and it can heighten the effects of opioids. However, naloxone – typically administered to reverse the effects of opioids – does not tackle the impact of xylazine, highlighting the need for effective measures to treat acute toxicity caused by xylazine.
Researchers suspect xylazine works by reducing blood flow to the brain, among other areas of the body. The drug also causes non-healing skin lesions and wounds, often located on the forearms and lower legs, that can require amputation in some cases – giving it the nickname “zombie drug.”
Although no treatment currently exists, targeted vaccines may offer a solution. Antibodies from vaccination can target toxins as well as viruses and bacteria. But sometimes molecules are too small to initiate an immune response, as is the case with xylazine. So, to circumvent this problem, the researchers created a vaccine using a design principle that Janda pioneered, which relies on pairing the drug molecule (called a hapten) with a larger carrier molecule (a protein) and an adjuvant.
In this study, the scientists combined a xylazine hapten with multiple different protein types, to see which combination would create a robust immune response against xylazine. The team tested three vaccine formulations (termed TT, KLH and CRM197, based on the protein involved) to see which vaccine cocktail could help rodents after being challenged with xylazine. One of the three vaccines (TT) significantly increased movement in mice given xylazine after 10 minutes, while two of the three vaccines (TT and KLH) led to an improvement in breathing.
The scientists also examined how these vaccines would limit xylazine blood brain barrier, (BBB) permeation, a filtering mechanism that scrutinizes drug penetration. When xylazine was injected, it immediately crossed into the brain to bind with receptors. Antibodies typically cannot navigate the BBB; however, two of the three vaccines (TT and KLH) showed a strong ability to stop xylazine from reaching its receptors in the brain, limiting its detrimental effects.
A provisional patent has been filed on the research. In the future, his team will build off this work to create a bifunctional antibody that will reverse both fentanyl and xylazine’s toxicity simultaneously, something that naloxone cannot do.
“A monoclonal antibody treatment could be given in tandem with the vaccine to provide both immediate and long-term protection from both opioid substance use disorders as well as opioid-xylazine overdoses,” says Janda. “This strategy could make a significant impact on the opioid epidemic.”
Smokers are on average more extraverted, but less conscientious and agreeable
Cigarette smokers, cigar smokers, and non-smokers each have distinct personality profiles, according to a study published July 3, 2024 in the open-access journal PLOS ONE by Dritjon Gruda from Universidade Catolica Portuguesa, Portugal, and Jim McCleskey from Western Governors University, USA.
Tobacco use remains a formidable global public health challenge, responsible for more than 8 million deaths annually, including those attributed to second-hand smoke exposure. Emerging research underscores the critical role of psychological factors, including personality traits, in shaping tobacco consumption patterns. To further explore this issue, Gruda and McCleskey examined the association between Big Five personality traits (openness, conscientiousness, extraversion, agreeableness, and neuroticism) and cigar or cigarette smoking in a sample of 9918 older adults across 11 European countries.
Photo by Sara Kurfess on Unsplash
The results showed that smoking is associated with lower scores in conscientiousness and agreeableness and higher extraversion scores than not smoking. The authors speculate that relatively low conscientiousness among smokers may reflect a lack of self-discipline and disregard for long-term health risks, characteristic of more impulsive behaviours, while reduced agreeableness could help explain why smokers often persist despite societal disapproval. They also suggest that the higher extraversion observed may suggest that these individuals enjoy the social nature of smoking.
The analysis also determined personality differences between types of smokers, finding that cigar smokers tend to exhibit lower neuroticism and higher openness compared to both cigarette smokers and non-smokers, underlining that the motivations and contexts of tobacco use are varied.
These findings suggest that personality traits are antecedents of smoking behaviour, with implications for targeted public health interventions and social policies aimed at combating the global tobacco epidemic. According to the authors, future research should explore these relationships in younger cohorts, potentially informing early intervention strategies that preempt the onset of smoking based on predisposition to certain personality types. Further studies could also expand the scope to include other forms of tobacco products such as chewing tobacco or more recent smoking trends such as e-cigarettes and vaping.
The authors add: “Basically what we found is: ‘tell me what you smoke, and I’ll tell you who you are.’”
The Gauteng Department of Social Development has decided to defund more than half of its existing capacity for inpatient drug rehabilitation in the province.
The department funded 571 beds in 13 non-profit organisations in the 2023/24 financial year, but at least five organisations, with 246 of these beds, will not be funded in the 2024/25 financial year.
The five organisations to be defunded – Westview Clinic Empilweni Treatment Centre, Golden Harvest Treatment Centre, Freedom Recovery Centre and Jamela Rehabilitation Centre – have been providing inpatient treatment for several years, but they have not received subsidies since the end of the last financial year.
Organisations GroundUp spoke to said they received letters from the department in the past few weeks informing them that they would not receive funding due to ongoing investigations. But they had not been told why they are under investigation, they said.
Representatives of FSG Africa, a forensic auditing firm appointed by the department, briefly visited some of the centres earlier this year, but the centres received no feedback on the progress or outcome of these investigations.
The auditors spent less than two hours at most of the facilities, asking only a few questions before leaving, the organisations said.
The organisations said they are yet to receive a report on the findings of the investigations. Queries they sent to the department have gone unanswered.
In previous years, the funding process was managed at a regional level, but this financial year it was centralised, cutting out the regional officials who would usually be in direct contact with the organisations. This has caused catastrophic delays.
Several of the organisations have been operating without departmental funding since March, depleting their savings and taking on debt, and having to short-pay staff salaries.
The department’s spokesperson Themba Gadebe confirmed to GroundUp that the organisations are under investigation, but did not provide details on the allegations.
In October 2022, Premier Panyaza Lesufi said treatment for substance abuse disorder was a priority. Yet the department has decided to defund beds in treatment centres without a clear plan to replace the lost capacity.
Gadebe said the department’s state-owned facility in Cullinan, near Pretoria, which has 288 beds, is undergoing renovation to increase its capacity. But he did not provide further details or timelines for completion.
Sedibeng’s only inpatient centres face closure
The only two drug rehabilitation centres with an inpatient programme in the Sedibeng region of Gauteng, with 116 funded beds between them, will be defunded this financial year.
One of these, Freedom Recovery Centre, was funded last year for 52 of its 94 beds (the remainder are for private patients). CEO Derick Matthews says when they received the department’s letter on 23 May “our world came crashing down”. What shocked him most was that there had been no warning that funding would stop.
Freedom Recovery Centre received a visit from the forensic auditors in March, who spent just two hours at the centre. They asked to see vehicles that the centre had supposedly received from the department.
“I was shocked by this request because we have never received vehicles from the department. But the auditor said that, according to their list, we had received vehicles from the department,” said Matthews.
“We are being punished for something. But we don’t even know what our transgression is,” he said.
On Monday, Freedom Recovery Centre began the process of discharging patients who were nearing the end of their treatment plans, as they can no longer afford to care for or feed them.
“We’ve had to take out loans for the past few months because of the delays in finalising service-level agreements and paying subsidies,” said Matthews. The centre has racked up more than R2-million in debt.
“Our staff are entering the third month of working without pay. Eskom is going to cut our electricity some time this week, because we are in arrears, and then we won’t even have water, because we rely on electricity to pump our boreholes. There are no funds left to keep the centre going,” said Matthews.
He said the centre will have no choice but to close completely in the coming weeks.
The other inpatient programme in the Sedibeng region, Jamela Recovery Centre, funded for 64 beds in 2023/24, faces a similar fate. CEO George Sibanda said they were relying on food donations from community members to feed their patients.
“We have been fully funded by the department since 2018 and our services are offered at no cost,” Sibanda said.
“We always had a backlog of patients. Our waiting list is sitting at 60 people so we were relieved when the department informed us that we would be getting additional beds in March this year. But what we don’t understand is how we must now provide a service to those patients if the department is not funding us this year?” said Sibanda.
Jamela also received a visit from the forensic auditors in March.
Despite not receiving any subsidies this financial year, Sibanda said the centre has been operating at full capacity.
“The department continued to refer people to us and we couldn’t turn them away,” he said.
Social workers at the centre have had to use their own money to pay for petrol for the centre’s car, which they use for outreach programmes.
Department spokesperson Themba Gadebe said that the closure of both centres in Sedibeng was not a concern as “the department prefers the placement of individuals within inpatient facilities far from where they reside, to limit the risk of them checking out or being contacted by those within their substance use networks.”
A clinical trial on a two-drug therapy for methamphetamine use disorder reduced use of the highly addictive drug for up to 12 weeks after initiation of treatment.
Participants in the ADAPT-2 clinical trial who received a combination of injectable naltrexone plus extended-release oral bupropion (NTX+BUPN) had a 27% increase in methamphetamine-negative urine tests, indicating reduced usage. By contrast, the placebo group had an 11% increase in negative tests.
“These findings have important implications for pharmacological treatment for methamphetamine use disorder. There is no FDA-approved medication for it, yet methamphetamine-involved overdoses have greatly increased over the past decade,” said Michael Li, assistant professor-in-residence of family medicine at UCLA and the study’s lead author.
Methamphetamine use has continued growing over the years around the world, increasing from 33 million people in 2010 to 34 million in 2020. Overdose deaths from the drug have jumped fivefold in the US from 2012 to 2018, and are followed by Canada and Australia in increases.
To curb the ongoing crisis, the National Institute on Drug Abuse (NIDA) Clinical Trials Network has supported various trials, including the ADAPT-2 trial, to test the effects of different pharmacological treatments for methamphetamine use disorder. ADAPT-2 was carried out from May 23, 2017 to July 25, 2019 across the eight trial sites that included UCLA. It included 403 participants, with 109 assigned to the drug combo group and the rest to the placebo group in the first stage.
The latest findings are the second stage of the multi-site trial. The earlier stage had demonstrated that the two-drug combination worked at six weeks, but the unanswered question was whether the intervention remained efficacious over a longer period.
In the second stage, the researchers conducted urine tests on the participants at weeks seven and 12, and again post-treatment at weeks 13 and 16 comparing the group on NTX+BUPN with the placebo group.
There is a need for further research to determine whether the drug treatment effect lasts longer than 12 weeks and yields further methamphetamine use reductions, the researchers write.
“Prior stimulant use disorder treatment trials suggest that change in use is gradual (consistent with our findings), unlikely to result in sustained abstinence in a typical 12-week trial, and dependent on treatment duration,” they write. “This warrants future clinical trials to quantify changes in MA use beyond 12 weeks and to identify the optimal duration of treatment with this medication.”
The psychoactive component THC of cannabis showed up in breastmilk in a study published in the journal Breastfeeding Medicine. Unlike alcohol, when THC was detected in milk there was no consistent time when its concentration peaked and started to decline.
Importantly, the researchers discovered that the amount of THC they detected in milk was low – they estimated that infants received an average of 0.07mg of THC per day. For comparison, a common low-dose edible contains 2mg of THC. The research team stressed that it is unknown whether this amount has any impact on the infant.
“Breastfeeding parents need to be aware that if they use cannabis, their infants are likely consuming cannabinoids via the milk they produce, and we do not know whether this has any effect on the developing infant,” said Courtney Meehan, a WSU biological anthropologist who led the project and is the study’s corresponding author.
Since other research has shown that cannabis is one of the most widely used drugs during breastfeeding, the researchers aimed to uncover how long cannabinoids, like THC, persisted in breastmilk.
For this Washington State University-led study, the researchers analysed milk donated by 20 breastfeeding mothers who used cannabis. The participants, who all had infants younger than six months, provided detailed reports on their cannabis use. They collected milk after abstaining from using cannabis for at least 12 hours and then at regular intervals after use. All of this was done in their own homes, at a time of their choosing and with cannabis they purchased themselves.
The researchers then analyzed the milk for cannabinoids. They found that the milk produced by these women always had detectable amounts of THC, even when the mothers had abstained for 12 hours.
“Human milk has compounds called lipids, and cannabinoids are lipophilic, meaning they dissolve in those lipids. This may mean that cannabinoids like THC tend to accumulate in milk – and potentially in infants who drink it,” said Meehan.
The research also revealed that people had different peak THC concentrations in their milk. For participants who used cannabis only one time during the study, cannabinoids peaked approximately 30 minutes to 2.5 hours after use and then started to decline. For participants who used multiple times during the study, the majority showed a continual increase in concentrations across the day.
“There was such a range. If you’re trying to avoid breastfeeding when the concentration of THC peaks, you’re not going to know when THC is at its peak in the milk,” said lead author Elizabeth Holdsworth, who worked on this study while a WSU post-doctoral researcher and is now on the faculty of The Ohio State University.
A related qualitative study by the research team revealed that many breastfeeding moms are using cannabis for therapeutic purposes: for the management of anxiety, other mental health issues or chronic pain. The mothers often chose cannabis over using other medications because they felt it was safer.
“Our results suggest that mothers who use cannabis are being thoughtful in their decisions,” said co-author Shelley McGuire, a University of Idaho professor who studies maternal-infant nutrition. “These women were mindful about their choices. This is far from a random lifestyle choice.”
While in most cases, the women were using cannabis as alternative treatment for a variety of conditions, McGuire pointed out that there is no evidence yet whether it is safer or more harmful. In fact, scientists know almost nothing about how many commonly used drugs may impact breastfeeding babies, partly because women, especially those who are breastfeeding, have historically been left out of clinical trials on medicines.
“This is an area that needs substantial, rigorous research for moms to know what’s best,” McGuire said.
Some research has been done regarding alcohol with guidelines for new mothers to wait at least two hours after consuming alcohol before breastfeeding. Nothing similar has been developed for cannabis, which has been growing in popularity.
The collaborative research team is currently working to address some of that knowledge gap with further research on cannabis use in breastfeeding moms, holistic composition of the milk they produce and its effects on infant development.
