This Is Your Brain on Meth: A 'Forest Fire' of Damage
Sandra Blakeslee, New York Times- 7/20/2004

People who do not want to wait for old age to shrink their brains and bring on memory loss now have a quicker alternative -- abuse methamphetamine for a decade or so and watch the brain cells vanish into the night. The first high-resolution M.R.I. study of methamphetamine addicts shows "a forest fire of brain damage," said Dr. Paul Thompson, an expert on brain mapping at the University of California, Los Angeles. "We expected some brain changes but didn't expect so much tissue to be destroyed."
      The image, published in the June 30 issue of The Journal of Neuroscience, shows the brain's surface and deeper limbic system. Red areas show the greatest tissue loss. The limbic region, involved in drug craving, reward, mood and emotion, lost 11 percent of its tissue. "The cells are dead and gone," Dr. Thompson said. Addicts were depressed, anxious and unable to concentrate. The brain's center for making new memories, the hippocampus, lost 8 percent of its tissue, comparable to the brain deficits in early Alzheimer's. The methamphetamine addicts fared significantly worse on memory tests than healthy people the same age.
      The study examined 22 people in their 30's who had used methamphetamine for 10 years, mostly by smoking it, and 21 controls matched for age. On average, the addicts used an average of four grams a week and said they had been high on 19 of the 30 days before the study began. Methamphetamine is an addictive stimulant made in clandestine laboratories nationwide. When taken by mouth, snorted, injected or smoked, it produces intense pleasure by releasing the brain's reward chemical, dopamine. With chronic use, the brains that overstimulate dopamine and another brain chemical, serotonin, are permanently compromised.
      The study held one other surprise, Dr. Thompson said: white matter, composed of nerve fibers that connect different areas, was severely inflamed, making the addicts' brains 10 percent larger than normal. "This was shocking," he said. But there was one piece of good news: the white matter was not dead. With abstinence, it might recover.

Study Backs Antidepressant - Suicide Link
Associated Press, 7/20/2004

CHICAGO -- A study of nearly 2,800 British adults and children bolsters the evidence that patients are prone to suicidal impulses when they are first put on antidepressants. But it found no difference in risk between newer and older drugs. The study looked at four drugs and found that suicidal thoughts or attempts were four times more likely during the first 10 days of treatment than they were after three months. Suicide was almost 40 times more common early on than later in treatment, though there were only 17 suicides, all in patients older than 19.
      But the study is unlikely to resolve the debate over whether the drugs themselves increase the suicide risk. And it may not soothe skeptics who maintain that newer drugs such as Paxil and Prozac that increase brain activity of the mood-regulating chemical serotonin are particularly risky for children. The study found no clear-cut evidence to support that idea, and the researchers did not specifically compare children on antidepressants with those not taking medication.
      Some doctors argue that patients just starting on antidepressants are usually in the deepest throes of depression -- which itself can cause suicidal behavior -- and that the risks subside as the drugs take hold. Others say a medication-induced mood boost may give a profoundly depressed person just enough energy to act on suicidal thoughts. But some relatives of people who have committed suicide blame the drugs themselves, and British health authorities have said that most serotonin-affecting antidepressants are unsuitable for children. GlaxoSmithKline, the maker of Paxil, has been hit with a lawsuit accusing it of suppressing studies indicating the drug might increase suicidal tendencies in children.
      The U.S. Food and Drug Administration is investigating and earlier this year issued a public health advisory asking makers of 10 drugs to add or strengthen suicide-related warnings on their labels. Doctors were warned to watch patients on antidepressants carefully, especially when they first start taking the drugs. The FDA advisory includes Paxil and Prozac but not the two other drugs studied -- amitriptyline and dothiepin, older medications that work differently. The newer drugs have gained favor in part because they have fewer side effects.
      The study, by Drs. Herschel and Susan Jick and James Kaye at Boston University, appears in Wednesday's Journal of the American Medical Association. It was funded by the Boston Collaborative Drug Surveillance Program, which received consultation fees from Glaxo in connection with other research. The authors said Glaxo had no role in the current study's design. The data ``simply means that antidepressants are being prescribed for the right indication, and that they do not immediately eliminate suicide risk,'' Drs. Simon Wessely and Robert Kerwin of London's Institute of Psychiatry said in a JAMA editorial. Still, careful monitoring of youngsters is essential, they said. Wessely has received funding from pharmaceutical companies including Prozac maker Eli Lilly and Co.
      The researchers looked at 2,791 first-time users ages 10 to 69 of any of the four drugs from 1993 to 1999. Suicidal tendencies were 29 percent more common among Paxil users than among dothiepin users studied. Kaye said that finding was statistically insignificant and could reflect doctors' tendency to prescribe the newest drug for more serious cases. Still, he said it ``doesn't exclude the possibility'' that Paxil is more risky. Dr. David Fassler, a Vermont psychiatrist not involved in the research, said the study leaves key questions unresolved: ``This study isn't specific to children and adolescents, and that's been the area of most recent concern.''
      On the Net: JAMA, http://jama.ama-assn.org

U.S. Judge Again Hearing Case of Schizophrenic
Janet Elliott, Houston Chronicle- 7/20/2004

AUSTIN - Decrying the "abject irresponsibility" of the Texas Court of Criminal Appeals, U.S. District Judge Sam Sparks heard arguments Monday regarding whether he should order a new review into the competency of a schizophrenic murderer. Last February, Sparks granted an execution stay for Scott Panetti one day before Panetti was to be executed for the 1992 shooting deaths of his estranged wife's parents. The case came back before Sparks after Panetti exhausted his state court appeals.
      Panetti has a long history of mental illness and represented himself wearing a purple cowboy costume during a circuslike 1995 trial in Fredericksburg. His efforts to avoid execution have reopened a debate over how Texas treats mentally ill violent offenders.
      Lawyers for Panetti are trying to prove that he should not be executed because he believes he is on death row for "preaching the Gospel." Lawyers with the Texas Attorney General's Office argue that Panetti is competent, citing a review earlier this year by two mental health experts who said he is deliberately focusing on religious topics. The Court of Criminal Appeals refused to review an order by state District Judge Stephen Ables of Gillespie County that Panetti understands the reasons he is being executed, the key test for competency. The Court of Criminal Appeals did not say why it rejected Panetti's appeal, but merely issued what Sparks called a "penny postcard" denying relief.
      However, the court said in a previous case that the Legislature did not give it authority to review a trial court's finding that a death row inmate is competent to be executed; it said only findings of incompetency can be appealed. Sparks said it's ridiculous to think that the Texas Legislature would pass a law that cannot be appealed.
      That view was expressed by Court of Criminal Appeals Judge Cheryl Johnson, who wrote a dissent to the Aug. 28, 2000, ruling involving death row inmate Jeffery Henry Caldwell. Caldwell was executed two days after the court issued its opinion. "Surely the Legislature would not want its stated intention of not executing incompetent persons to be so easily overridden," wrote Johnson.
      Assistant Attorney General Tina Dettmer argued that Sparks should dismiss Panetti's case. But San Antonio lawyer Michael Gross, who represents Panetti, said the mental health examiners did not follow minimum standards and asked Sparks to authorize further investigation into Panetti's mental state.

Stronger Pot May Make Reefer Madness Real, US Fears
Reuters News Service, 7/20/2004

WASHINGTON - Alarmed by reports that marijuana is becoming more potent than ever and that children are trying it at younger and younger ages, U.S. officials are changing their drug policies. Pot is no longer the gentle weed of the 1960s and may pose a greater threat than cocaine or even heroin because so many more people use it. So officials at the National Institutes of Health and at the White House are hoping to shift some of the focus in research and enforcement from "hard" drugs such as cocaine and heroin to marijuana.
      While drug use overall is falling among children and teens, the officials worry that the children who are trying pot are doing so at ever-younger ages, when their brains and bodies are vulnerable to dangerous side effects. "Most people have been led to believe that marijuana is a soft drug, not a drug that causes serious problems," John Walters, head of the White House Office of National Drug Control Policy, said in an interview. "But marijuana today is a much more serious problem than the vast majority of Americans understand. If you told people that one in five of 12- to 17-year-olds who ever used marijuana in their lives need treatment, I don't think people would remotely understand it."

JUMP IN POT-RELATED DETOX
The number of children and teen-agers in treatment for marijuana dependence and abuse has jumped 142 percent since 1992, the National Center on Addiction and Substance Abuse at Columbia University reported in April. According to the report, children and teens are three times more likely to be in treatment for marijuana abuse than for alcohol, and six times likelier to be in treatment for marijuana than for all other illegal drugs combined. And it found the age of youths using marijuana is falling. The teens aged 12 to 17 said on average they started trying marijuana at 13-1/2. The same survey found that adults aged 18 to 25 had first tried it at 16.
      For National Institute on Drug Abuse director Dr. Nora Volkow the final straw was a report her institute published in May in the Journal of the American Medical Association showing the steady growth in the potency of cannabis seized in raids. According to the University of Mississippi's Marijuana Potency Project, average levels of THC, the active ingredient in marijuana, rose steadily from 3.5 percent in 1988 to more than 7 percent in 2003. Volkow said many studies have shown the brain has its own so-called endogenous cannabinoids. These molecules are similar in structure to the active ingredients in marijuana and are involved in a range of activities and emotions ranging from eye function to pain regulation and anxiety.

GETTING INTO THE BRAIN
Brain cells have receptors -- molecular doorways -- designed specifically to interact with these cannabinoids. The cannabinoids in marijuana may use these ready-made doorways into brain cells and this is why they cause a high and reduce pain sensations. But Volkow believes the effects may go beyond the general feeling of well-being that most marijuana users seek. "I would predict that stronger pot makes the brain less likely to respond to endogenous cannabinoids," Volkow said in an interview. The effects could be especially marked in young brains still growing and learning how to respond to stimuli, she said.
      While the research so far is inconclusive, Volkow believes that cannabinoids affect the developing brain and that stronger pot, combined with earlier use, could make children and teens anxious, unmotivated or perhaps even psychotic. As an analogy, Volkow said opiate addicts are more sensitive to pain, as their overuse of drugs have raised the threshold at which the body responds and their own bodies produce fewer natural opiates. NIDA is seeking proposals from researchers who want to investigate such possibilities for cannabis, she said.
      Proponents of legalizing marijuana disagree with the official line. Krissy Oechslin of the Marijuana Policy Project disputes the finding that cannabis products are stronger. "They make it sound like the THC levels in marijuana were almost nonexistent, but no one would have smoked it then if that was true," she said. "And there's evidence that the stronger the THC, the less of it a person smokes. I don't want to say it's good for you, but I'll say (more potent marijuana) is less bad for you."
      While Walters stresses that drug abusers are patients and not criminals, he hopes to crack down more on producers. And he says, there is a way to go in getting cooperation from local law enforcement officials. "For many in enforcement, marijuana is still 'kiddie dope'," Walters said. Walters is quick to stress he does not want to overreact. "We shouldn't be victims of reefer madness," he said, referring to the 1930s propaganda film "Reefer Madness" that became a 1970s cult classic for its over-the-top scenes of marijuana turning teens into homicidal maniacs.

Andrea Yates' Medical Condition Worsens
Steve McVicker, Houston Chronicle- 7/21/2004

The Clear Lake woman who was convicted of drowning her children in a bathtub has stopped eating and is being treated in a Galveston hospital, her attorney said Tuesday. Texas prison officials transferred Andrea Yates to John Sealy Hospital Monday because she has lost a significant amount of weight and her mental and physical condition has deteriorated, George Parnham said.
"There's just a blackness to her mental state right now," he said.
     Parnham, who represented Yates in her trial and is handling her appeal, said he hopes to meet with her as soon as Thursday at the hospital, part of the University of Texas Medical Branch.
He said, however, "she's in no shape to talk" at present and basically is "incoherent." Parnham said he did not know whether Yates, 40, was being fed intravenously or how much weight she has lost, but that it is a considerable amount. Hospital officials referred news media calls to a Texas Department of Criminal Justice spokesman, who would only confirm that Yates had been transferred to UTMB. The center provides medical care for the prison system.
     Yates' husband, Russell, said he had not known of her transfer to the hospital until being called by the Chronicle. He said this is the third time during his wife's prison stay that she has lapsed into what he called a "psychotic" state, adding that "this is the worst I've ever seen her, even before the tragedy." Yates, who described his wife as "fragile" and "precious," said he last visited her on Saturday, as he does about every two weeks. He said she was shaking and delusional. "She thinks the kids are still alive," he said. Her latest bout with depression, which started about two months ago, began with a change in her medication, Russell Yates said. He declined to specify the drugs she has taken or is taking now.
     Andrea Yates called Houston police to the family's Clear Lake-area home in June 2001 and admitted to drowning her five children - Noah, 7; John, 5; Paul, 3; Luke, 2; and Mary, 6 months. She was charged only with the slayings of Noah, John and Mary. But while she acknowledged killing her children, Yates, who had a history of mental illness, claimed innocence by reason of insanity. She was convicted of capital murder in March 2002 and sentenced to life in prison.
Yates' condition has fluctuated while at the prison system's Skyview Unit, a psychiatric facility near Rusk.
     In September 2003, as she gradually regained lucidity and became more involved in activities at the unit, she also became more aware of what she had done, according to Parnham and her husband. As a result, they said, she lapsed back into psychosis. In October 2003, Russell Yates told the Chronicle that prison officials had placed his wife on suicide watch. Parnham said then that prison officials had considered transferring her to UTMB, where she could be fed intravenously.
     Parnham said Tuesday that Yates' physical and mental condition has remained delicate. He said he visited her three weeks ago, but would not comment on what might have sent her into this latest tailspin. Parnham did say she is suffering from severe depression. "There are a number of issues that have led to (this)," he said. "She is just physically and mentally exhausted. And obviously, there is concern for her physical well-being, which prompted the transfer." Parnham praised the treatment Yates has received for her problems, both mental and physical, at the Skyview Unit. "But it's not a general hospital, and John Sealy is and has an excellent reputation," he said. "She's reached a point where, mentally and physically, she's having a very difficult time."



British Worry That Drinking Has Gotten Out of Hand
Sarah Lyall, New York Times- 7/22/2004

LONDON-- Britain has always been a place where people enjoy a drink or two (or more) at the local pub, and where football hooligans and so-called lager louts represent the public face of overconsumption. But lately the country's growing inability to hold its liquor has taken on the scope of a national crisis.
     Even Prime Minister Tony Blair is worried. "There is a clear and growing problem in our town and city centers up and down the country on Friday and Saturday nights," said Mr. Blair, whose son, then 16, was found vomiting and incoherent on a London street four years ago after an evening of drinking. "As a society we have to make sure that this form of what we often call binge drinking doesn't become the new British disease."
     By some measures it already has. Cheaper and more readily available alcohol, changing drinking patterns, a steep increase in drinking among young women and a decline in old standards of civility have turned what was once a manageable part of life into a problem that costs society, according to government estimates, $35 billion a year.
     The government, saying it wanted to make problem spots in city centers safe for the sober on weekends, recently presented an ambitious plan to tackle the violence and mayhem that follow when too many people drink too much too quickly in too small an area. Among its proposals are granting wider powers to the authorities to control hooliganism, imposing greater penalties for drunken behavior, and forcing pubs and clubs to help pay for extra police officers.
     But the most widely debated change is to allow some pubs to stay open past the current closing time of 11:20 p.m., starting in the autumn of next year. The change, allowing the pubs to set their own closing times, with approval, is meant to dissuade rushed binge drinking at "last orders."
Some have their doubts and worry that more time at the pub will, well, simply allow people to drink still more.
     "It's hard to see how it could help," said Michael Marmot, professor of epidemiology and public health at University College London. "The evidence suggests that the longer the opening hours and the easier it is to have access to alcohol, the higher the consumption." Professor Marmot presided over a recent report from the Academy of Medical Sciences that urged the government to work to reduce alcohol consumption in general. Britain has historically been a hard-drinking place, but the current trends are alarming.
     In contrast to many countries in Western Europe, where drinking has declined, in Britain, where the minimum legal drinking age is 18, people are starting younger and drinking more. Although some researchers say the figures are actually higher, government statistics show that Britons on average drank the equivalent of 8.6 liters of pure alcohol each in 2001, nearly double the rate of 1951. That translates into more than 86 bottles of wine, or 350 pints of beer. Young women on average now consume about 12.6 drinks a week, an increase of 66 percent since 1992.
     While people in a number of countries still drink more overall, Britons (and the Irish, as well) are likelier to go on drinking binges, consuming five, six, seven or more drinks in a single session. "Binge drinking is now so routine that young people find it difficult to explain why they do it," a recent Home Office report said.
     The related costs are ballooning. While crime overall has declined, alcohol-related crime is increasing: in 1999, half of the 2.4 million violent crimes reported were linked to alcohol misuse. On weekends, 70 percent of emergency-room patients are involved in drink-related incidents. Deaths from chronic liver disease in England, a crucial indicator of alcohol-related harm, have shot up more than fivefold since 1950.
     At Addenbrooke's Hospital in Cambridge, Dr. Paul Atkinson, a consultant in the emergency department, sees the effects of drinking when the late-night casualties roll in. Workers in the emergency room try fruitlessly to separate the drunks from the other patients. "There's no social group that's immune to binge drinking, except the elderly," Dr. Atkinson said, "although we recently had a 90-year-old who drank five pints and fell down as he tried to leave his local pub. It's very common to have head injuries- - dental injuries, facial injuries. I've had people who've inhaled their teeth into their lungs."
     Some 125,000 young people have suffered serious facial injury or disfigurement as a result of excessive drinking, either their own or someone else's, according to the Facial Surgery Research Foundation. Dr. Atkinson said he did not know why Britons tended toward violence and accidents after drinking. "I think it has a lot to do with social conditioning," he said. "Personally, too, I think it's because we've become a much more aggressive society. We are not at the top of the league in drinking, but what it brings out in us isn't always good."
     Indeed, why young Britons have trouble controlling themselves when drunk, while people in many European countries do not, is a complicated question. While southern wine-drinking countries like Italy and France favor convivial consumption with meals, the northern countries, including Britain, Ireland and Scandinavia, are more ambivalent about alcohol, relying on it as a crucial social lubricant while also treating it as something that needs to be tightly controlled lest it spin out of control.
     The result, in Britain, is a culture that celebrates drinking even as it condemns it. In June, in the midst of its own earnest anti-alcohol campaign, the government issued an advertisement urging apathetic young people to vote in the European elections by pointing out that the European regulations affect when and where they can drink. The Times of London published a front-page article about the problems of binge drinking, while its travel section offered tips on the best places in Eastern Europe for drink-fueled stag parties.
     Kate Fox, a social anthropologist who is co-director of the Social Issues Research Center at Oxford, said the British used alcohol to justify unacceptable behavior: they act like idiots and then blame the alcohol. "One thing that is common to ambivalent drinking cultures is the belief that alcohol is a disinhibitor and makes us violent," said Ms. Fox, the author of "Watching the English," a book exploring the nation's habits and quirks. The reality, she said, is more complicated: "It certainly interferes with your motor functions and your ability to speak rationally, but it doesn't cause you to go up to people, say 'Oy, what are looking at?' and start punching them."
     The effects of binge drinking are all too obvious to anyone brave enough to take certain trains late at night, or to stand outside certain pubs at closing time, or to venture into town and city centers across the country at midnight on a Saturday. Many older people simply stay away from "no go" areas so as not to be "the victim of a drunken yob beating them up, kicking them or headbutting them," as Ian McCartney, chairman of the Labor Party, said in a recent speech. Most such areas have had to hire extra police officers; some smaller communities have banned alcohol altogether. Even genteel Cambridge has had so many problems with street drunkenness that it is debating whether to forbid outdoor drinking.
     "Youth culture is just drink, drink, drink," said Eleanor Smith, a 57-year-old retired secretary who lives off Mill Road, one of the rowdiest drinking spots in Cambridge. Weekend nights find her firmly indoors. "I sleep at the front, so I hear them," Mrs. Smith said, meaning the drinkers who roll out of the pubs on Mill Road and start their merry journeys to the late-night clubs a few blocks away -- often, the police say, stopping on the way to smash a car mirror, urinate on a doorstep or provoke a fight.
     Writing in The Daily Telegraph, Dr. Theodore Dalrymple, a general practitioner, said the relative cheapness of alcohol, the introduction of fruity "alcopops" aimed at teenagers and the rise of happy hours and all-you-can-drink deals were partly to blame for the problem. "It seems that the acme of modern British experience is oblivion preceded by nastiness," he wrote.
     The overnight Saturday train from London to Aberdeen, a favorite for men on stag nights, was canceled recently because no guards would agree to work on it, The Guardian reported.
"It was like an alcoholic bullet flying through the night," one guard told the newspaper. "The buffet car was a cesspool. They were climbing into the berths with Christ knows who. It was madness. They'd pull the emergency cord. They'd vomit. Break guitars over each other's heads. You can't be having that on a nice train."
     Whether the relaxation in licensing laws and closing times will help is anyone's guess. The government, with one eye firmly on local economies and the $55-billion-a-year alcohol industry, says it will, taken in tandem with increased public awareness and the stricter anti-alcohol measures.
"We want to create some of our cities to be leading European cities of the future," Richard Caborn, the government minister for sport and tourism, said recently. "As tourism minister, I'm out there saying: 'Come and visit this great country of ours. Oh, by the way, you can't have a drink after 11 o'clock.' That's crazy."

Schizophrenic's Lawyers Will Get to Fight Execution
Jane Elliott, Houston Chronicle- 7/22/2004

AUSTIN -- Lawyers for schizophrenic murderer Scott Panetti will get a chance to argue in federal court that their client's mental illness makes him incompetent to be executed. U.S. District Judge Sam Sparks on Wednesday denied the state's motion to dismiss Panetti's claim of incompetency. Sparks authorized funds for experts and investigators, and set an Aug. 23 hearing.
     Last February, Sparks halted Panetti's execution one day before Panetti was to be put to death for the 1992 murders of his estranged wife's parents. The execution stay allowed Panetti's lawyers to ask the state trial court to determine whether he understands that he is to be executed and why. A psychiatrist and psychologist appointed by state District Judge Stephen Ables of Gillespie County determined that Panetti is competent after they jointly interviewed him for an hour. They described Panetti as uncooperative and interested only in "filibustering about the Bible and the Lord."
     But the two concluded that Panetti "deliberately and persistently chose to control and manipulate our interview situation by deflecting the interview into religious topics." They said although Panetti "chooses not to discuss the reason that he is to be executed, he has the ability to understand."
San Antonio lawyer Michael Gross said he will use the investigative authority Sparks allowed to have different mental health experts meet with Panetti. He said he also plans to interview inmates and nearby cells and prison workers familiar with Panetti.
     Panetti has a long history of mental illness and represented himself wearing a purple cowboy costume during a circus-like 1995 trial in Fredericksburg.

Meth Use Up, Testing Reveals
Adam Geller, Associated Press- 7/23/2004

NEW YORK - Often made on the cheap in simple home-based labs, methamphetamine is fast finding its way into the workplace, a new report indicates. Employers who screen job applicants and workers for drugs saw the number testing positive for methamphetamine surge 68 percent last year, according to Quest Diagnostics Inc., the country's largest testing company, and usage is likely to continue increasing as the potent stimulant spreads to the eastern U.S.
     The report - tallying the results of more than 7 million workplace drug tests performed last year by Teterboro, N.J.based Quest - shows the methamphetamine positive rate jumped, along with a smaller rise in positives for opiates like heroin, even as the overall number of workers failing tests stayed nearly unchanged at 4.5 percent. "These increases that we're seeing are the largest increases of any drug or drug class for as long as we've been tracking the individual categories" of drug tests, said Barry Sample, director of science and technology for Quest's workplace drug testing business.
     The surge in the use of amphetamines, a crystalline stimulant often called "meth" or "ice," has prompted some states to try to limit sales of the decongestant pseudoephedrine commonly used to make it. While big labs, most in California, continue to supply most of the illegal methamphetamine consumed in the U.S., much of the growth has been fed by small, home labs. Last year, the Drug Enforcement Administration shut down 10,061 small meth labs, up from 8,063 in 2002. "Clearly it's emerged and is still emerging as a serious problem," said Ed Childress, a DEA spokesman.
     The number of workers and job candidates testing positive for methamphetamine remains small compared to marijuana, by far the biggest reason that people fail employer drug screenings, the Quest figures show. About 3 of every 1,000 workers now test positive for meth, compared to about 3 of every 100 workers testing positive for marijuana.
     But while marijuana positives have stayed stable, amphetamine detection is soaring in the general work force. That contrasts with airline pilots, workers in nuclear plants and others whose tests are required by the government, for whom positive meth rates have increased only slightly. In the general work force, though, usage appears to be rising at an even faster rate than in the past few years, when annual increases in the number of positive drug tests ranged from 14 to 17 percent.
Employers who do screenings saw a 44 percent increase in positives for amphetamines, the category of drugs that includes methamphetamines. Amphetamines now account for about 9.3 percent of all positive tests, more than double the rate in 1999.
     Methamphetamine production and usage has its roots in southern California and was long most prevalent in western states. But DEA statistics and Quest testing data shows it has spread to the middle and eastern portions of the country. Quest found the number of workers testing positive for the drug has increased sharply in southeastern states like Georgia and Alabama. Of the small labs broken up by the DEA last year, the largest number were in Missouri, with states like Tennessee and Arkansas also hotbeds of production.
     In addition to the rise in meth usage, Quest found that positive tests for opiates -- including both heroin and the painkiller morphine, which is contained in many prescription drugs -- are also rising, up 25 percent in 2003 for the general work force. Overall, the share of workers testing positive for all types of drugs remained nearly unchanged -- rising to 4.5 percent from 4.4 percent. That is much lower than the 11 to almost 14 percent rate in the late 1980s, when employer drug tests were not as common. The number of workers testing positive has fluctuated below 5 percent for the last six years. Marijuana accounted for the largest share of the positive tests, with 2.96 percent of all workers testing positive for the drug. Cocaine was the next leading cause of positive tests, with 0.74 percent of workers testing positive, Quest figures showed. Both results varied little from 2002.

For Addicts at One Center, Severity Is Key to Success
Corey Kilgannon, New York Times- 7/24/2004

There are those who try to beat their drug and alcohol addictions with the help of fairly luxurious centers with gourmet meals and fancy amenities. But not Nelson Pavon, 43, who is kicking his heroin addiction at Grupo Jovenes New York, a rehabilitation center in Corona, Queens. Mr. Pavon lives in the center's cramped basement with 23 other men. They sleep in shifts on bunks, some of which are so close to the low ceiling that the men cannot sit up. But for Mr. Pavon, it is at least better than his first three days, which he was ordered to spend sitting on a chair without a shower or a pillow or a change of clothes.
      Like many rehabilitation centers, Grupo Jovenes, requires a mandatory stay in which clients both give and listen to personal testimonials and learn the 12-step approach to recovery from drug and alcohol addiction. But unlike rehabilitation centers with spas, massages, yoga and acupuncture, Grupo Jovenes has no such comforts to soften the bumpy ride to sobriety. There is no bucolic campus and no rich or famous clients, but rather 36 Spanish-speaking immigrants -- most of them undocumented and homeless -- crammed for three months at a time into a narrow, inconspicuous one-family house with faded yellow siding.
      But that severe setting, its administrator says, is the key to the center's success. Most clients are immigrants who come to New York looking for a better life, but wind up plagued by unemployment, discrimination and immigration snags, said Miguel Antonio Torres, the center's administrator. "They come looking for the American dream but get trapped in a vicious circle of alcohol and drugs," he said. "They lose everything and live in the streets as the scourge of society. Many come here because they're afraid if they go to a hospital or clinic they'll be deported. This is the last stop, because they have nowhere else to go."
      The center is on a residential street several blocks from Shea Stadium in a neighborhood populated with immigrants from Mexico and Central America. Its slogan is "terapia intensiva," or "intensive therapy," and its operating principle is that the spartan conditions are required to make a severe life change. The center is free, and no newcomer is turned away, day or night, Mr. Torres said. They are screened, however. New residents must spend three full days in a chair in the ground-floor meeting room. They sit through group discussions, slumping sometimes for sleep. Fellow residents bring them meals and take them to the bathroom, but make sure they do not shower or change clothing.
      After three days, it gets better, but not much. The newcomer, having proven he is committed to a painful struggle to change his life, is permitted a shower and change of clothes. He is given toiletries and a list of chores and must spend the balance of the day attending the group discussions that run around the clock in the meeting room. Then, except for the occasional trip to the park on a Sunday afternoon, the client must spend the next three months without leaving the property. Books and newspapers are forbidden, as are radio and television. This is called Phase One.
      For Phase Two, the client can begin looking for a job outside and move up to either of the two small bedrooms upstairs that have six bunk beds each and air conditioning and television. The conditions are dictated, in part, by the center's shoestring budget, financed by donations and by members who have returned to work, Mr. Torres said. He said the men ultimately band together and save each other. "Our success rate is higher than most fancy rehab programs because we're a family, and the guys stay members of our family even after they leave," he said. "Money makes it easier for an addict to relapse. Money and family can be a crutch. Here you don't have that crutch. You may do great on some farm in Princeton or some Malibu mansion where they pamper you, but you can always go back to your mansion. Our people have nothing but the street to go back to."
      The center, which opened in 1991 in a basement in Corona and has been at its current location for seven years, gets referrals from word of mouth, local health-care providers and community organizations like Bread and Life, a nonprofit organization whose mobile soup kitchen serves hot meals to the many day laborers who gather nearby along Roosevelt Avenue.
      On Wednesday in the stuffy, warm meeting room, two sleeping men, slumped in chairs, were awakened to listen to Mr. Pavon, 31, tell his story. Mr. Pavon described in Spanish how heroin had taken all he had and left only a swollen purple bruise in the crux of his right elbow. "When I first came here and heard I had to spend three days on the chair, I was ready to turn around and walk out," he said. "But I felt a certain warmth.'' Afterward, he walked down to the smallish basement, which was dimly lit, uncomfortably warm and smelling of mildew. Six two-bed bunks were squeezed in, so that one could barely squeeze through to the small bathroom in back. The residents sleep in shifts, sharing beds. A water pipe runs just over the sleeping men. "It's tight quarters," Mr. Pavon said.
      Out the center's back door, several men were smoking cigarettes in the narrow driveway. On an upended cinder block was an empty Café Bustelo coffee can with a young green plant growing straight out of it. Peter Roman, 45, an electrician whose hands now shake like leaves from drink, said his life had crumbled around him because he could not stop consuming rum. He sat smoking and said that he hardly minded the tough conditions, including sharing his bunk with two other men, if it could get him off "that bat juice" once and for all. "I spent 13 years in the Army,'' he said, "and this is worse than boot camp." Out on the small front stoop, Bert, 63, a retired building superintendent from Flushing who withheld his last name, stood smoking. He said he checked himself into Grupo Jovenes after his crack addiction nearly killed him. "One day I bought $3,000 in crack and went to a hotel room," he said. "I woke up in the hospital, and a doctor said: 'A.A. is not going to help you, you're too far gone. But I know a place in Corona that will teach you discipline.'" "He told me, 'You have insurance, you can go a lot of places,'' said Bert, who said he now he lives upstairs at the center, in a small room with five other men, and can leave to see friends. "But if you don't go here, you're going to die."

Drug Maker Acknowledges Misleading Claims
Associated Press, 7/24/2004

TRENTON, N.J. -- The maker of a popular medicine for schizophrenia has notified doctors that it minimized potentially fatal safety risks and made misleading claims about the drug in promotional materials. Janssen Pharmaceutica Products sent a two-page letter to the health care community this past week to clarify the risks of Risperdal, Carol Goodrich, a spokeswoman for the Johnson & Johnson subsidiary, said Saturday.
      The letter stems from a directive issued last year by the Food and Drug Administration, which told several makers of anti-psychotic drugs to update their product labels. Janssen complied in November 2003, but the FDA determined that the company's promotional materials still minimized the risk of strokes, diabetes and other potentially fatal complications. The agency also said Janssen made misleading claims that the medication was safer in treating mental illness than similar drugs.
      The Miami Herald reported Saturday that a handful of boys in Florida developed lactating breasts after taking Risperdal. The drug, which is prescribed to more than 10 million people worldwide, was cited in a federal lawsuit filed earlier this month by a doctor who claims children have been harmed and even killed by the misuse of drugs he blames on aggressive marketing by drug manufacturers. ``The FDA did not think we had (initially) provided enough information, so that is why further notification was done,'' Goodrich said.
     Risperdal is the leading drug used to combat schizophrenia and other types of psychotic disorders, earning Janssen about $2.1 billion in annual sales. The drug was first marketed about eight years ago.

For DUI, Personal Costs Are High
Lena Sun & Carol Morello, Washington Post- 7/25/2004

Cam Johnson and her husband had donated money to campaigns against drunken driving. They often talked to their three children about its dangers. And Johnson, 32, rarely drank alcohol other than a sip of champagne on New Year's Eve. But on a September night last year, the Herndon mother attended a birthday party at a D.C. restaurant. Prodded by her girlfriends, she said, she ordered a Remy Martin cognac and Coke. Her friends had drunk more, so she volunteered to drive them home. "I thought, I'm doing a good thing here," she said. "But then, it backfired on me." Johnson was arrested on the Reston Parkway when she drove her BMW through a yellow light at 4:30 a.m., she said. A petite woman, her blood alcohol level tested at 0.09 -- 0.01 above the state legal limit. She became one of the 27,000 Virginia drivers convicted last year of driving under the influence of alcohol or drugs.
      As Virginia and other states across the country tighten laws against DUI offenses, the legal ramifications of an arrest are becoming more serious and more predictable. But the personal fallout is harder to measure. A DUI arrest sent Dondi A. Randolph, an Alexandria man working to become a plumber, into a financial crisis. For State Department retiree Robert Alexander, it has meant depending on friends to drive him on every errand. One man said he agonized over how to explain to his children why he couldn't coach the Little League team after losing his driver's license.
      For some, it can bring public embarrassment and loss of livelihood. Rebecca L. Perry's job as Alexandria's school superintendent was jeopardized after her DUI arrest in April. And Dulles security chief Charles Brady resigned after admitting that he was driving drunk on New Year's Day while he was supposed to be overseeing airport security during a Code Orange terror alert.
      The hardships associated with a DUI conviction pale when compared with the loss suffered by the families of the 17,000 Americans killed every year in crashes involving drinking drivers. Drunk drivers don't get much sympathy. To gauge the effect of a DUI arrest on the lives of ordinary people, The Washington Post examined the court records of 92 drivers -- everyone arrested during a one-week period last September in Fairfax County, the region's largest jurisdiction. Their stories offer a look at the often painful consequences of an arrest, even before Virginia's stricter laws went into effect July 1.
      The majority of those arrested -- 74 of 92 -- were, like Johnson, charged as first-time offenders. And almost all the first-time offenders received the same sentence: losing their license for a year. Most were permitted to drive to such specified places as work, school and medical appointments. Most paid a few hundred dollars in fines. Eight of the first-time offenders spent time in jail.
      Many who received a DUI conviction said its huge financial costs and burdensome restrictions upended their lives. Johnson said she lives with the consequences of that one drink. She feels like an outcast in her own family. Her marriage has collapsed, in part because of arguments about the thousands of dollars her arrest has cost. She described the experience as the most wretched ordeal of her life. "I've been through hell these last seven months," said Johnson, who fled Vietnam at age 6 with her mother and sisters. Nearly a year after her arrest, she has admitted she made a mistake, yet she still can't believe her single drink was excessive.
      Charles Lieber, director of the Alcohol Research and Treatment Center at the Bronx Veterans Affairs Medical Center, said women and Asians have a limited ability to tolerate liquor. Compared with men, women produce less of a stomach enzyme that breaks down alcohol. Many Asians also lack a second enzyme that rids the body of alcohol toxin, meaning a single drink can cause flushed skin and elevated blood alcohol levels, he said.
      Johnson's difficulties were magnified when she missed a court date because of a misunderstanding with her attorney, she said. A bench warrant was issued for her arrest, and she wound up in jail. It was "the worst experience of my life," she said. In jail, she used her hands to drink water from a sink atop a steel toilet unit. Her bologna sandwich came with a thumbprint. She would call home to get the time because there was no clock in the cell. "I was there for two days. I cried for two days," she said recently, still stunned at the turn of events. "I'm a mother of three. I'm in the cell with people who did fraud, with people who steal cars, robbed a 7-Eleven. Everyone is together until their hearing. Here I am, I just missed my court date, but I'm in there with drug dealers."
      Eventually, Johnson pleaded guilty and paid $365 in fines and fees. Her license was suspended for a year, but she is allowed to drive to and from classes she is taking to become a nail technician, and to transport her children to school. Johnson also paid about $4,000 in attorneys' fees at a time when she and her husband had purchased a new house and had many bills. "My husband thinks I threw away $4,000," said Johnson, who believes her arrest contributed to arguments that ultimately led to their separation. Nobody in her family drinks alcohol, she said, adding to her feeling of estrangement. "They look at me like I'm an alcoholic," she said. "Everyone looks at me like I'm a criminal."
      Some first-time offenders said they drank too much because of an emotional crisis, then were caught driving while in that condition. Lawrence P. Robinson's girlfriend had just ended their 14-year relationship. Robinson, 53, was devastated and on antidepressant medication. He went to a bar and drank four small glasses of white wine, he said, then headed home in his Nissan Maxima. Robinson said he had his cell phone pressed to his ear, weeping as he begged his girlfriend to take him back. He was about two miles from his house in Herndon when police stopped him for driving erratically, according to court records. His blood alcohol level was 0.14. Robinson pleaded guilty and paid $465 in fines and fees. He is permitted to drive to jobs for the cleaning company he operates. But shortly after his conviction, he lost a secondary job. And his DUI made job interviews awkward. "It's embarrassing for someone my age to tell a prospective employer that I had a conviction," he said.
      For Burke resident Robert Alexander, 70, the crisis began last August when his doctor told him that he might have lung cancer, which turned out to be a false alarm. But that weekend, the retired State Department employee went to a Labor Day party, he said, where he drank some beers. Then he got behind the wheel of his GMC Yukon, and though another driver struck him, Alexander, with a blood alcohol level of 0.17, was charged with drunken driving, records show. Alexander pleaded guilty, paid $515 in fines and lost his license for a year. As a retiree, he can't get a restricted license, so he relies on friends to drive him everywhere, including the supermarket and church. He has given up competing in golf tournaments because he can never be assured of a ride. His car insurance premiums will triple. "It's really hard," he said. "My friends, thank God, they have taken care of me."
      Others struggle to recover from the financial burden. Dondi A. Randolph's downward spiral began the day he received DNA test results that showed that he was not the biological father of his 11-year-old son. That night, the plumber's apprentice went to a Ruby Tuesday restaurant and drank two strong mixed drinks -- Bombay Sapphire gin with a splash of grapefruit juice, he said. Police stopped him about 10:30 p.m. Sept. 2 on Richmond Highway, with a broken taillight and no headlights on. The police report described him as incoherent and confused. His blood alcohol level was 0.15, according to records. Randolph, 36, pleaded guilty. But he couldn't pay his $572 fine and court costs, even after the judge said he could make deferred payments. As a result, he couldn't get a restricted license to drive to work and school. Desperate not to miss plumbing classes that he had paid for, he got in his car and headed to school anyway. Police caught him behind the wheel twice, and the fines piled up to more than $2,500. He couldn't pay his attorney. He fell behind on his rent, triggering eviction notices. Eventually, he abandoned his 1980 Cadillac because the impoundment fees exceeded its value. It was particularly hard explaining the situation to his children. "Daddy made a mistake," he told his 11-year-old daughter. "Daddy can't drive." Yet Randolph has grown to consider his arrest a wake-up call. He said he has stopped drinking liquor. He continues to attend school. Some mornings, he rises as early as 3:30 to catch two buses and three trains to a job site 31 miles from his garden apartment in Alexandria. In all, Randolph has run up more than $4,400 in bills related to his arrest.
      The typical cost of drinking and driving in Virginia ranges from $5,000 to $20,000, according to a 2003 study by the Thomas Jefferson Community Criminal Justice Board in Charlottesville, a group of law enforcement officials. In addition to attorney and court fees, drunk drivers usually have to pay for car towing, restricted licenses and reinstatement of their regular licenses. Everyone is ordered into the alcohol education program that, in Fairfax County, costs at least $400. Repeat offenders and the "super-drunks" -- those with a blood alcohol level of 0.15 or more -- are required to install ignition interlock equipment on their steering wheels, at a cost of $450 for six months. Pat Bowman, a counselor at the Fairfax Alcohol Safety Action Program, often asks those in the program, most of them professionals, to list the time and the money they have spent since their arrest. It averages more than $10,000. "It's amazing," she said. "They could have taken a cab for $50."
      Juan Angel Melgar Urbina has not been able to accept overtime work since his arrest Sept. 4. Melgar is a bricklayer who came to the United States 10 years ago from Honduras, where he was a farmer harvesting corn and beans. He sets aside a portion of his income to send to Honduras for his two children and his parents. He lives in Herndon in a split-level frame house with his wife and young son. He described himself as "not much of a drinker," but after a long day's work in Manassas, he said, he went to a bar with co-workers and had three beers. When police pulled over his Nissan Pathfinder less than two miles from his home, Melgar's blood alcohol level was 0.12. He pleaded guilty, paid $475 and had his driver's license suspended for a year, though he is allowed to drive to work within a narrow time frame. His out-of-pocket costs exceeded $1,600 for an attorney, fines and fees. He said he knew it was illegal to drink and drive. But in Honduras, he said, drinking drivers could settle the matter on the spot by pressing some cash into the hands of the police officers who stop them. His co-workers shrugged it off. "They got you," said one, who himself had been arrested on another occasion. Since his arrest, Melgar said, he has consumed no alcohol. "One brings this upon oneself," he said, speaking in Spanish. "Who am I going to be angry at? If they caught me, it's because I did something and have to pay for it."
      For Muktar Ali Yahia, drinking had been a weekend activity since high school. The 27-year-old garbage collector comes from a Muslim family in which alcohol is considered a sin, but many of his friends were drinkers. He said he had consumed two or three beers Aug. 31 when he was arrested by police. His Nissan SUV was weaving between lanes, court records indicate. His blood alcohol level was recorded at 0.12, and he pleaded guilty. He paid the court $475, but he estimated that his DUI cost him about $4,000. Today, Yahia frequently takes public transportation. Instead of going to clubs, he goes to his mosque to pray, he said. And he has a new circle of friends. "I don't do what I used to do," he said. "I don't go out. I stay home on weekends and watch TV. Before, I'd hang out with friends. I don't know if they understand. I tell them I don't have a license, so I can't see them." He said he has abstained from drinking since his arrest. "It was an expensive night," he said. "And I never want to have a night like that again."

Shame Starts in the Drunk Tank
Lena Sun & Carol Morello, Washington Post- 7/25/2004

The drunk tank in Fairfax County is filled with sobering reminders of the perils of driving under the influence. A photograph of a woman whose face was horribly disfigured when she was struck by a drunk driver is taped to each of four tables where police officers interview drivers they have arrested. On each desk is a year-to-date tally of the number of people killed in car crashes in Virginia and Fairfax County. One wall holds unflattering mug shots of celebrities charged with drunken driving: Wynonna Judd, Nick Nolte, Bobby Brown and Glen Campbell.
      For the 92 drivers arrested in Fairfax one week last summer -- whose cases were examined by The Washington Post -- the first stop was the drunk tank, the Alcohol Testing Unit at the Fairfax County Adult Detention Center. On many summer and holiday weekends, a line of drunken driving suspects and police officers winds out the room and down the hall, waiting for the Breathalyzer machine, known as the "Intoxilyzer." Drivers have their mug shots taken, then appear before a magistrate sitting behind a thick glass window like a bank teller.
      Most defendants are released on their own recognizance, but they cannot leave until they sober up. They wait in "holding tanks": 18-by-18-foot rooms with three walls of concrete and one of plexiglass. Each room is equipped with a telephone, a few molded plastic chairs and a stainless-steel toilet. Televisions in the three men's holding tanks are turned to a sports channel; the set in the one women's room is usually a news program. Breakfast, lunch and dinner are turkey bologna or cheese sandwiches on white bread, with a small carton of milk.
      The week of Aug. 30 to Sept. 6 was fairly typical for Fairfax County, where law enforcement officials boast of being tough on drinking drivers. Seventeen of the 92 drivers arrested were women. The drivers were 19 to 70 years old, and half were 30 or older. Most were arrested between midnight and 4 a.m. Three arrests were on drug charges. Fifteen were repeat offenders.
      In a matter of weeks, the defendants appeared in Fairfax County District Court, their cases wedged among other offenses -- from speeding and cracked windshields to defective taillights. Most cases were dispatched within minutes. And the penalties were so uniform that even defense attorneys acknowledged that their representation in court made little difference. Of the 74 charged as first-time offenders, 11 were not prosecuted or charges were dismissed, and eight others pleaded down to reckless driving. Of the first-time offenders, only eight spent time in jail.
      A director of a consumer finance company was stopped after dinner and drinks with a new employee and refused to submit to a Breathalyzer test; he paid $415 in fees and fines, and lost his license for a year. After drinking hard liquor at a nightclub opening, a software engineer for a defense contractor was arrested with a blood alcohol level of 0.14; he paid $465 and had his license suspended for a year. A car dealership executive who drank wine on an empty stomach had a 0.13 blood alcohol content, paid $465 and lost her license for a year. All were given permission to drive to work.
      Of the first-time offenders, eight spent time in jail -- those whose blood alcohol levels were above 0.20. Most served two days, their sentences halved for good behavior. Some served only on weekends. Today, more than four times that number would spend time behind bars because of a new law, which took effect July 1, that redefines "super-drunks" as anyone with a level of 0.15 or more, an offense that now requires at least five days in jail.
      State officials are anticipating a shortage of cells and staff because they predict that thousands more drivers will be thrown behind bars, then put on probation for at least 12 months. Pat Bowman, a counselor at the county's Fairfax Alcohol Safety Action Program mandated for those convicted of driving under the influence, ticked off a long list of personal and professional humiliations that her clients have revealed. A sales representative wondered how to entertain business clients when drinking is part of the culture. An active church member was mortified that she could no longer drive to services. A man was chagrined that he couldn't help his wife with an eight-hour drive to North Carolina. "For some individuals, it's the absolute shame and embarrassment, that feeling of mortification, that they never dreamed of being arrested," Bowman said.