For the most part, there is not much healthcare information that does not have the potential to embarrass us or cause us problems in our personal or professional lives. Information related to alcoholism or drug addiction is an example of extremely sensitive information. Counselors, doctors and other addiction professionals are constantly vigilant about not revealing protected information as doing so could result in government fines, civil judgments or criminal prosecution.

However, what does an addition professional do when law enforcement demands that certain protected information be revealed during the course of a criminal investigation? For instance, when a heroin addict relapses and uses heroin in the facility can staffers call the police and have him arrested? What if another patient calls police to report a relapse? Are workers and patients required to cooperate with the investigation?

Workers at a Florida drug rehab treatment facility faced this dilemma when former Governor Jeb Bush’s daughter was a patient there. Bush had been ordered into drug rehab by a judge after being arrested for attempting to purchase anti-anxiety meds with a bogus prescription.

When employees refused to answer questions regarding whether Bush had been in possession of crack cocaine at the facility, the officers obtained a court order to compel them to answer. A judge ultimately determined that staffers at the center did not need to answer questions posed to them by law enforcement officers, finding that patient privacy trumped the public’s interest in a criminal proceeding. Had workers been compelled to answer the officer’s questions, the judge fear that anyone currently in rehab who had relapsed could be arrested and prosecuted.

Supporters of the decision claim that those seeking treatment for drug and alcohol addiction often relapse on the road to recovery and should not be penalized criminally for doing so. A policy of zero tolerance could have a chilling affect on the number of people willing to enter rehab, for fear that relapse could land them in jail. Further, knowing that your counselor could report you to police for using drugs would have a devastating affect on the therapeutic relationship that must be allowed develop between patient and counselor before recovery can be achieved.

In the event that a client is found with drugs or alcohol during treatment, most programs have a policy in place to confiscate and safely dispose of the drugs without intervention by law enforcement officials. In addition, the patient often undergoes intensive relapse intervention in order to get their recovery back on track.

A question that remains, however, is whether fellow patients in a rehabilitation facility have an obligation to keep confidential medical information disclosed during the course of group therapy sessions or learned due to the close proximity shared by patients.

Dr. Robert MacCoun, a professor at Berkeley’s Goldman School of Public Policy and the Berkeley School of Law, studied Dutch "cannabis coffee shops" and other aspects of the country’s marijuana experiment. He found that the Dutch actually use marijuana slightly less than many other Europeans, and that marijuana use among Dutch youth ages 15 to 24 actually dropped between 1997 and 2005.

However, Dutch marijuana users are more likely to be admitted for substance abuse treatment than other Europeans. Dr. MacCoun noted that the United States has four times the rate of treatment for marijuana than the Dutch, but about half of those admitted for treatment for marijuana addiction in the United States have come through criminal justice referrals, compared to only 10% in the Netherlands. Dutch children start to use marijuana before they turn 13 years old, but this is also true of American youth.

There are about 700 marijuana stores in the Netherlands, which adds up to one for every 29,000 citizens. Dr. MacCoun noted that the number of shops has dropped from a high of 1,179. Sales are heavier in the city of Amsterdam, where there is one shop for every 3,000 people. About four to five million tourists go to marijuana shops every year in Amsterdam, but the Dutch government has recently announced that the shops will be run as private clubs for Dutch citizens only, at the exclusion of foreign tourists.

Dr. MacCoun believes that marijuana policies in the United States could be more "nuanced." Writing in the journal Addiction, he noted, "There are daunting analytical challenges in making cross-national comparisons of drug policies and outcomes, but if we want to identify more effective policies, we need to make comparisons across jurisdictions, and it is surely better to make provisional judgments then provincial ones."

Sixteen states, including California, Michigan, New Jersey, and Washington, have legalized marijuana for medical uses. Nevertheless, the federal government has classified marijuana as a Schedule 1 substance under the Controlled Substances Act of 1970. Marijuana is classified as a drug that has no medical purposes, and a high potential for abuse, along with heroin and LSD. The penalties for selling, buying, or possessing marijuana are severe, especially if it is the second or third offense and if large amounts of the drug are involved.

People who are in favor of the federal legalization of marijuana often point out that many young people face prison time for using a common drug that is considered harmless and legal in other countries. Marijuana could be rescheduled through Congress or the executive branch, and the Obama administration is currently looking into the issue.

Between 1998 and 2008, there was a 30% increase in the number of people admitted to treatment for marijuana in the United States. In 2009 a government survey found that over 11% of American adults used marijuana in the past year, and over four million met the medical criteria for drug dependence. The percentage of young people who use marijuana is even higher — the same survey found that over 21% of high school seniors smoke marijuana.

The most recent studies of marijuana find that it causes brain damage, especially if it is used at young ages. Those who smoke the drug in large amounts perform below average on memory and other mental tests. Marijuana increases the risk for heart attacks and mental illnesses, including psychosis, in some individuals. One study found that smoking marijuana before driving a car doubles your chances of being in a fatal automobile crash.

Kalan LP, a small company in suburban Philadelphia, is manufacturing the candy that comes in the forms of "Pothead Ring Pops," "Pothead Lollipops," and "Pothead Sour Gummy Candy." The ring pops are yellow plastic rings worn around fingers like jewelry, except they feature large, protruding marijuana leaves made out of hard green candy. The lollipops look like marijuana leaves on a stick. Pothead Gummy Candy is soft and is sold in packages of 15 pieces, at two dollars a package. The lollipops cost a dollar each, and ring pops are three for $1.50. The products are also being sold online.

Some parents are expressing outrage because the candy is so similar to other products that children routinely consume, and city councils are taking notice, including the one in Buffalo, New York. City Council members are saying that the candy will just worsen drug use in impoverished neighborhoods.

The United States has been through similar controversies before. The Hershey Company voluntarily withdrew a product called "Ice Breakers Pacs" after police officers complained that the powdered mint candies and its packaging resembled illegal street drugs. Those candies came in tiny plastic bags kept in a tin box that looked very much like heat-sealed bags used in the sale of powdered street drugs.

There have also been many complaints against the sale of candy cigarettes to children.

Andrew Kalan, president of Kaplan LP, defended his product by saying that that so far the company has received only one formal complaint.

"We don’t advocate for a political position," he said. "We just look at what the marketplace wants and respond to it. It is just candy … it is sour apple flavor. It does not claim to be pot in disguise or anything like that."

If the results of the screening are positive, the applicants must pay for the drug test and would be prohibited from receiving public funds for the period of one year. If the screening results are negative for illegal drugs, then the state pays for the drug test. State officials believe that the population segment seeking financial subsidy are likely to be involved in illegal drug use and say it would be inappropriate for taxpayers to support the behavior. The law went into effect July 1, 2011.

According to one report, 1,000 applicants have been screened for illegal drugs since the law’s July start date. Of those, 2 percent tested positive for illegal substances. The state will save around $100,000 in welfare payments which would otherwise have been paid to those persons.

A 2008 survey which was conducted by the Office of National Drug Control Policy revealed that 8.1 percent of Floridians over the age of 12 use illegal drugs. It has become the publicly debated question as to whether or not the poor constitute a significant portion of that percentage. A 2 percent positive rate would not seem to indicate that is the case.

Supporters of the measure argue that the rate is low because people who are using illegal substances are not submitting to screenings, which is a savings to the state. Opponents argue that the poor can’t afford a drug habit. Current predictions say that the program to drug test welfare applicants will cost the state of Florida $178 million.

Unconstitutional Search or Necessary Measure?

Legal experts and addiction professionals are weighing in on the issue. The ACLU has announced its intention to file suit on the basis of constitutional rights, saying that the policy is discriminatory and unconstitutionally denies freedom from unreasonable searches. Legal pundits point out that while testing without suspicion can be unconstitutional, there is legal precedent for such testing when there exists a special need. High school athletes and people working in sensitive jobs, such as customs agents, are considered to fall within the purview of special need testing. The question remains whether applying for state financial assistance is a special need case.

A 1996 National Institute on Alcohol Abuse report, in which the organization says there exists no significant difference in rates of drug misuse between poor and rich, has been widely cited among reporters. Other sources say that the poor do experience increased rates of addiction along with higher rates of trauma, mental illness and unemployment – all considered to be risk factors for addiction.

Still further studies indicate that the poor account for perhaps 4 percent of all addicts while others say that 70 percent of those (age 18-49) involved in illegal use enjoy full-time employment. Evidently, no one can agree when it comes to the statistics.

Is Drug Testing the Answer?

What seems a bit more certain is that drug testing alone does not bring down rates of illegal drug addiction. When schools that conduct random drug testing on students are compared to schools that do not randomly test pupils, there is no discernible difference in the rates of drug use.

On the other hand, there are emotional ramifications involved with the testing. Evidence seems to indicate that schools involved with drug testing have student populations with lower emotional "connectedness." Lack of connectedness, similar to feelings of isolation and disengagement, is a contributor to drug misuse.

Addiction treatment professionals say that in order for drug screening to result in lowered rates of substance abuse, the screening needs to be connected to free or low-cost addiction treatment. When the two are joined, positive results have followed.

Florida is not alone in seeking to control welfare costs and to responsibly appropriate public funds. Idaho conducted a cost analysis for a plan similar to that currently in place in Florida and found that the cost of running such a program would exceed any savings the state might capture. When the cost of the program itself is added to potential legal expenses such as responding to the ACLU lawsuit, the price tag becomes hefty indeed.

At the end of the day, many feel that the Florida initiative may be well-intentioned and strike a sympathetic cord with taxpayers, but question whether it actually can deliver the goods of cost savings and reduced addiction.

The goals of incarceration in the U.S. have changed over the course of our history, and throughout various state and local jurisdictions. Although more than one goal can attach to any one particular incarceration, the goals of rehabilitation and retribution usually do coincide.

Incarceration goals can also depend largely on the type of crime a person has committed. For crimes with identifiable victims, such as murder, rape, or robbery, the goal of retribution is often a primary, if less advertised motivation. For crimes involving drug possession, however, retribution becomes nonsensical; however, rehabilitation is a goal most people who understand drug addiction can agree on. What remains to be seen is whether jail or prison is an appropriate venue for drug rehabilitation.

Over eighty thousand people are convicted of crimes in federal court yearly. It has been common practice for federal judges across the U.S. to sentence prisoners to extra time behind bars in order to participate in drug treatment. The problem, however, is that most defendants do not accept the extra sentence willingly, even though the judge is imposing the additional time for their “own good.”

The US Supreme Court recently ruled that federal judges cannot sentence criminals to longer prison terms so that they can participate in drug rehab. In other words, drug rehab is now simply a benefit of being behind bars, and no longer a primary motivator. With this ruling, the court has also made the idea of rehabilitation, in general, a less desirable justification for incarceration.

The issue came before the Court on behalf of a defendant in San Diego who was sentenced by a federal judge to more time in jail so that she could complete the corrections department’s drug rehab program. The defendant was arrested near the San Diego – Mexico border and charged with attempting to smuggle illegal aliens across the border. When she then failed to attend a court hearing on the charges, police showed up at her home and found illegal drugs.

In finding for the defendant, the Supreme Court declared that the federal sentencing act forbids judges from using prison for corrections or rehabilitation purposes.

In this defendant’s case, the maximum sentence that could have been imposed for both the alien smuggling and the methamphetamine possession was thirty-six months. However, the judge decided to extend the sentence to over forty-eight months so that she could enroll in and complete a 500-hour drug rehab program that had a long waiting list.

In defending the judge’s sentence, the prosecution reminded the justices that a sentencing judge could consider the need for educational or vocational training, medical care or other medical treatment. However, use of these justifications for enhanced sentences are usually not successful, given that a decision as to when someone has been sufficiently rehabilitated is too subjective for corrections officers to make when considering release dates.

Now that the Supreme Court has eliminated rehabilitation as a justification for incarceration, society is left with deterrence, incapacitation, and retribution as the only reasons to take away someone’s freedom. The need to complete drug rehab can no longer factor into a judge’s decision to impose a particular sentence.
 

Recent studies from Johns Hopkins University are also exploring the effects of Salvia as experts attempt to further clarify the dangers that can occur from smoking the plant, and to determine legal regulations to prevent recreational drug use. The drug is currently under consideration for bans in several states.

The key ingredient in Salvia – scientifically known as Salvia divinorum – is salvinorin A. The plant is part of the mint group of herbs, and has been used in ancient spiritual practices and in landscape settings. Recent emergence of numerous online videos showing people smoking Salvia and then acting in bizarre ways is helping spur the research into its effects and the exploration of laws surrounding its use.

Salvia is available at boutique drug shops or online, but is currently banned in at least 12 states, and has been listed among some of these states as a Schedule I hallucinogenic drug, similar to LSD. Several other states have enforced restrictions to keep Salvia out of the hands of minors. Symptoms for Salvia use include hallucinations, spells of dizziness and speech problems.

Researchers with the Johns Hopkins University team studied how smoking Salvia in 20 sessions, spread out over eight to 12 weeks, affected volunteer participants who had used hallucinogenic drugs before. Participants’ heart rates and blood pressure rates were evaluated for changes, and they were asked to rank the Salvia’s strength. Two participants said the Salvia produced a level “10,” or very high effect.

Johns Hopkins University School of Medicine assistant professor of psychiatry, and lead author on the Salvia study, Matthew Johnson, Ph.D., said that prior to this study, research for how Salvia impacts people has been unscientific and based on observation of online videos. Published in Drug and Alcohol Dependence, researchers said that while the study sample was not large, the research does suggest that use of Salvia could be deadly if the user tried to drive or engage in other activities.

Also of concern, say researchers, is the report by study participants that they experienced an intense sensation of not being present, almost like entering another dimension – which is different than reports of how people react to other hallucinogens. In some cases, the feeling of disconnect or anxiety may be so great that users will not desire to experiment with the drug again in the future.

Funded by the National Institute on Drug Abuse, the Johns Hopkins Study also revealed that Salvia seems to produce a very intense but not long-lasting effect on users, and that the effects of the drug become stronger as more of the plant is smoked or breathed in. Salvia can also be consumed by chewing the leaves.

Salvia is under consideration for national banning as a federal Schedule I controlled substance, although the drug has been placed behind other drugs like methamphetamines on some legislators’ agendas. Additional concern comes from studies showing that teens that experiment with herbal-based drugs like Salvia have a much higher likelihood of trying other drugs, such as cocaine.
 

Law enforcement officials, hospitals and even poison control centers have documented many reports of adverse reactions to the synthetic marijuana, including seizures and hallucinations. Evidence also exists that synthetic marijuana may actually be addictive. The American Association of Poison Control Centers claims to have received over fifteen hundred calls nationwide concerning use of fake pot. A seventeen year old boy recently smoke synthetic marijuana and had to be rushed to the emergency room for muscle contractions, low blood pressure (BP) and a racing heart.

The US Drug Enforcement Agency (DEA) recently initiated an emergency lockdown on fake pot, focusing on five chemicals use to create the substances. Over the next thirty days, the DEA will try to have the chemicals classified in the same category as illicit drugs such as heroin and cocaine. The emergency action is quickest way the DEA can legally get the products off the shelves. The federal government first became aware of the drugs in the fall of ’08, when a CBP (Customs & Border Protection) officer evaluated an incoming shipment of “Spice”. In early 2010, CBP took possession of over 100 pounds of two of the five target chemicals.

Although the DEA is just now taking action, over fifteen states have already taken steps to regulate the chemicals present in fake pot. In a perverse twist, it turns out that the man who invented three of the five chemicals did so as part of a government-sponsored research project two decades ago; even he admits the substances are dangerous and can result in overdose, addiction or suicide. More importantly, the effects of synthetic pot on the human body have never even been studied.

Real marijuana typically results in sleepiness and, occasionally, paranoia. Users of synthetic pot, however, report dizziness, nausea, agitation, fast heartbeat, and hallucinations. Other users have fallen into comas or have heart arrhythmias. One team reported having hallucinated that he was standing at the edge of a cliff, getting ready to jump. It turns out that he was actually standing at the edge of a curb and dove off it, injuring his mouth and chin. In addition, he experienced shortness of breath and seizure-like symptoms for about 6 hours.

After the thirty days is up, the DEA will likely ban fake pot for one year. A ban on fake pot means that anyone found to possess or to have sold the products or chemicals within the product will be guilty of a crime.

While medical personnel ultimately release the arrestee back into the custody of the police, it is a unique opportunity to gather information about the demographics and types of drugs involved when an emergency department visit results in jail time.

A report was issued by the Drug Abuse Warning Network for 2008 that details these types of emergency department visits. DAWN is a public health surveillance system that monitors drug-related emergency room visits in the United States. DAWN reports that in 2008 there were nearly 4.4 million drug-related emergency department visits, of which 1.8 percent were discharged into police custody.

The patients that were released into police custody were varied in age. About one-quarter were aged 18 to 24 and 25 to 34 each, and one-fifth were aged 35 to 44. Slightly less than ten percent of the visits were by patients aged 12 to 17. The patients discharged to police were 70.7 percent male.

Illicit drugs were involved in 61.6 percent of the emergency department visits resulting in a discharge to police custody. The three illicit drugs most commonly related to these incidents were cocaine, heroin, and marijuana.

Alcohol was also involved in 34.7 percent of the visits, though DAWN cautions that the number may not reflect the alcohol involved in some other cases. This number only reflects visits involving both drugs and alcohol or alcohol use by a minor. It does not account for those emergency department visits in which a person over 21 years of age was recorded as using alcohol only.

Nearly half of the emergency department visits involved pharmaceutical drugs, and pain relievers accounted for 21.1 percent of the visits. Narcotics accounted for 16.8 percent of the visits. Drugs that treat anxiety or insomnia were factors in 16.7 percent of the visits, while benzodiazepines accounted for 15.3 percent of visits.

The information gathered by DAWN in their reports about drug-related emergency department visits provides an opportunity to screen patients and recommend additional treatment. Though the patients involved in this report are discharged into police custody, it is important that they receive the care and treatment they need to overcome any possible struggles with alcohol or drugs.

These recent BUI stories remind us of the consequences of operating a boat while intoxicated.

Skipper Liable for Allowing Intoxicated Man to Pilot Boat

Percy Small and Matthew Reynolds are now well aware of what can happen when one mixes alcohol with boating. During an evening outing with 12 friends in Sydney Harbor, the boat that the men were piloting crashed, killing six of their friends. Each of the men faces a minimum of five years and maximum of seven and a half years in jail for their participation in the tragedy.
The group began the evening drinking at a local hotel and later moved the festivities to the house of one of the partygoers, where they continued to drink and take drugs. The manager of the hotel had too much to drink and asked Reynolds to take him by boat to drop off a set of hotel keys. Reynolds agreed and borrowed a boat large enough for twelve of his friends to join him on the errand.

While on board, the group continued drinking and doing drugs. On the way back from delivering the keys, the group stopped the boat at one of the light markers in the harbor and remained there for a period of time. At 2:30 in the morning, on the way back to shore, the group’s boat hit a fishing boat. Six of the group perished; the youngest was just 20 years old. Reynolds’ girlfriend was among the dead.

During a subsequent investigation, it was revealed that Reynolds was not piloting the boat at the time of the incident. Instead, he allowed Small to navigate even though Small was too intoxicated to drive. During the evening Small had been smoking pot, had snorted cocaine, and had a blood alcohol content (BAC) of .124.

Small was charged with dangerous navigation causing death and Reynolds was charged with manslaughter. During criminal proceedings, both Reynolds and Small appeared to be remorseful about what had transpired that fateful evening. However, Reynolds refused to take responsibility for taking the boat and Small claimed he was simply doing what Reynolds told him to do.

Reynolds blamed both the hotel manager for asking him to drive him and Small for claiming that he had a license to drive the boat. Further, the defendants attempted to blame the fishing boat pilot for failing to maintain a proper path and avoid colliding with the party boat.

BUI Tragedy in Nebraska

Todd Spangler of Omaha, Nebraska was recently convicted of manslaughter and sentenced to up to four years in prison in connection to the death of a family friend during a boating incident.

Spangler’s blood alcohol content was over twice the legal limit for driving an automobile while he was driving his boat on a lake in
Douglas County.

Spangler’s wife, Kimberly, and family friend Jennifer Finke-Dwyer were riding in an inner tube that was being towed by the boat that Todd was piloting. Unfortunately, Todd turned the boat too sharply and the women were slammed into the dock. Finke-Dwyer, aged 30, died from blunt force trauma to her liver. She had been working on her doctorate at the University of Nebraska.
Although he showed remorse for his actions, the judge refused Spangler’s request for probation and sentenced him to two to four years in prison; he’ll be eligible for parole in approximately one year. Spangler had faced up to 20 years in prison.

A 23-year-old man was sentenced to 20 years in prison recently by a judge in Georgia in connection with a fatal heroin overdose. Warren Ullom, singer with the Atlanta-based rock band “The Judies,” had pleaded guilty to voluntary manslaughter in the death of 32-year-old Rachel San Inocencio. Ullom was also convicted of possession and distribution of heroin and cocaine.

The circumstances surrounding the death take it out of the realm of mere “accidental” overdose and make it something entirely more sinister. Actions taken by Ullom that fateful day not only exacerbated San Inocencio’s already precarious position, but may also have prevented her from getting life-saving treatment.

On June 6, 2008, just days after the couple met, San Inocencio and Ullom shot heroin at Ullom’s apartment; San Inocenico became ill shortly thereafter and lost consciousness. Instead of calling 911, Ullom texted one of his friends and told him to bring over some cocaine to help revive San Inocencio. When his friend arrived with the drugs, Ullom proceeded to inject the fallen woman with two doses of cocaine. Upon leaving the apartment, Ullom’s friend called 911, but didn’t give the dispatcher the correct address. In the mean-time, Ullom sent the friend another text indicating that San Inocencio was feeling better and didn’t need an ambulance.

San Inocencio died thirty minutes later and was pronounced dead by emergency workers who responded to Ullom’s own belated 911 call. Ullom stashed the remaining coke in San Inocencio’s purse and told unsuspecting police officers to take it with them when they collected the body. To make matter’s worse, Ullom later pawned San Inocencio’s diamond earrings.

Ullom had originally been charged with felony murder, which carries with it a mandatory 30-year minimum sentence. However, he later pleaded guilty to a lesser offense. His lawyer claims that the heroin dealer who sold Ullom the drugs was the party responsible for the tragedy.

In anticipation of his incarceration, the singer and his band played farewell performances, made a DVD, and recorded some additional songs.

Ullom’s case, however, pales in comparison to the story of Carly and Andrea Townsend. In 2008, Carly’s mother, Andrea, was found guilty of manslaughter due to neglect in the death of her teenaged daughter after failing to call emergency personnel when Carly overdosed on heroin. Carly’s twenty-six year old sister, Gemma, was also charged in the crime.

During the trial, Andrea Townsend claimed that Carly’s lips briefly turned blue after taking the heroin, but that they eventually returned to normal color. Townsend also claimed that Carly was mumbling, and thus, not in any danger. Townsend was downstairs watching TV while her daughter was passed out upstairs, but insisted that she “listened” from the living room door a number of times and heard her snoring. Townsend refrained from calling an ambulance for fear that she or her daughter would get in trouble.

Sixteen-year-old Carly had been taking drugs for two years and had recently been released from a juvenile detention center into her mother’s care. It was revealed that 20 of Carly’s friends had recently died from heroin overdoses.

http://www.ajc.com/news/atlanta-rocker-convicted-in-544100.html?cxntlid=thbz_hm

http://www.walesonline.co.uk/news/wales-news/2008/04/18/mother-of-drug-overdose-girl-found-guilty-of-manslaughter-91466-20782361/