Salvia divinorum is in the news again, and our study is being used within the discussion. The story seems to have started with an AP piece in Florida. Its not surprising that there would be a link here because a while back, a Florida legislator's office had asked me for a copy of my Dept of Ed poster. Perhaps they got the journal article too. Regardless, it didn't take long for reporters to start calling. First the Union Tribune, then NBC San Diego. I'll post other links as they come live. KFMB just called for an interview too, so I'll update this post with that story after it runs.

The published version of the Salvia Divinorum paper is now online. The paper will be in Drug and Alcohol Dependence, Vol 94, page 263-266. It can be downloaded in full if your institution has a subscription to that service.

It seemed so logical, restrict precursor chemicals necessary to make methamphetamines and supply of this dangerous drug of abuse would diminish. Oregon apparently went down that road more stringently than most states, but instead of seeing their problems shrink, news reports are telling us that the opposite is true. “There’s so much, it’s ridiculous” is how one cop described the current state of affairs. Apparently, while Oregon has successfully shut down most small-time meth labs, the void is being filled by drug cartels who are flooding the market. Violence may be increasing as well with the shift in suppliers.

From a prevention point of view, this would seem to be a failure. But the question we have to ask is, was this foreseeable? Was there research to guide the original policy shift, and if so, where did it go wrong? Or, indeed could research have predicted the failure.

According to the news accounts, Oregon made its policy changes in 2005, making products containing ephedrine and pseudoephedrine a schedule III medication. Thus, in Oregon such common cold and allergy medicines became a prescription only purchase. Restrictions on the quantity any one person could possess were enacted as well. Thus, a major aspect of the law was on the regulation of retail purchase of precursors, which are the source for small-scale meth labs. Given that the sentiment in Oregon was that small-time meth “cooks” were creating the problem, it makes sense that retail purchase was a concern. But what does the research say?

Research is scant
There are few studies reporting the results precursor restrictions on meth use and availability. One contemporaneous study (Cunningham and Liu, 2005) casts some doubts on such restrictions. Their report demonstrated marked reductions immediately following restrictions on bulk precursors was enacted either on the Federal or California State level. However, the authors found that “The regulation targeting precursors typically used by small-scale producers…had little or no effect on arrests” (p.485). Indeed even the effects of bulk sale restrictions that were observed were short-lived, with arrests rebounding within 2 to 3 years following the regulations. Of course, conclusions based upon this study are made problematic because the authors were studying arrests; changes in the laws of insterest may have affected arrest rates independently of actual use rates. So while this study appears to have predicted the Oregon failure, it must be acknowledged that it was not a definitive study. Another study conducted by the same researchers had previously demonstrated reductions in hospital admissions from the bulk precursor regulations (Cunningham and Liu, 2003). But some debate within the literature (e.g., Reuter and Caulkins, 2003) exists whether the supply-side intervention should have had such a dramatic result, given the somewhat modest effects on price and availability.

Environmental Prevention
A major tenet in environmental prevention is that with restrictions of access, abuse will be diminished. Oregon’s experience would appear to contradict that theory. However, it in fact could be argued that yet again the theory is left untested, for policy changes that were intended to limit availability have failed, perhaps predictably. But without the requisite reduction in availability, the environment did not actually alter in a preventive way, and thus use rates would not be expected to decline. A terrible example of what can happen when policy moves ahead of research.

I'm told that our paper College student use of Salvia divinorum will be published online by the journal Drug and Alcohol Dependence by about December 20th. Look for it then. The paper version will be out some months later.

I didn't really want the first entry to be negative, but in the field of AOD prevention, sometimes we need a reality check. So forgive me if I rant on what I perceive as a crazy recommendation to prevent prescription drug abuse.

According to a news report, a new trial is about to begin with folks being told that they should dispose of leftover medicines not only in the trash but mixed with pet feces. The idea is to (1) stop the flushing of medicines which causes a serious environmental problem, and (2) to make the medicines undesirable to those who may take them out of the trash. All well and good. Except they offer no evidence that abusers of prescription drugs get them by sifting through household trash. Indeed, it is bazaar to think that anyone would.

Think of the odds. How many times is your trash poked through? I have never had a sense that mine is, and if it has been, I doubt it has happened often. So that's a very rare event; let's be conservative and say once a year. Now, think of the number of days you'd be disposing leftover medication that's of any value to an abuser. Hopefully that is also an extremely rare event; let's again be conservative and say once a year. Now, we need both very rare events to happen at the same time; on any given year, that would be a probability of 0.00000075 that a trash picker would get your medicine on any given day. So a trash picker would need to hit about 67,000 homes each year to have a 50% chance of striking prescription paydirt once that year. And let's not forget he or she would actually have to find the pills within the trash too. All that seems so unlikely that it is not surprising that we don't hear any evidence that trash sifting is a common source of prescription drug abuse.

Now I don't want to understate the growing problem of prescription drug abuse. Indeed, my colleagues and I have published on the very topic (see Report Vault). The interviewed folks in the news story are probably right that a good chunk of medicines get in the wrong hands when leftovers are kept. But why not recommend a reasonable disposal protocol first, and then go to the extremes if that causes problems. Tell people to throw away your unused medicines. I'd bet the number of people who will actually comply will be much higher if they know that this is fine. Instead these folks are recommending something that many will find disgusting, and will turn them off to change. So they'll flush or just keep the old medicines and nothing will have been improved.

Better yet, how about a sensible prescription policy that limits the number of pills to the amount actually needed. We've all been handed 30 pills when maybe we're expecting a day or two of pain. Afterall its not just kids who get tempted by the leftovers. Perhaps the reason they're not being disposed is because they can be too tempting not to keep.