America’s New Tobacco Crisis: The Rich Stopped Smoking, The Poor Didn’t

Smoking is on the decline in the United States. In the 1960s, about 42 percent of American adults smoked; in 2015, the percentage had decreased significantly to about 15 percent were smokers. The reduction has saved millions of lives and led to a massive reduction in smoking-related cancer.

Public health campaigns emphasized education, highlighting the dangers of smoking to your lungs and the risks of developing cancers. The effects of secondhand smoke on others compelled smoking bans in restaurants, bars and public settings. Among high-income families, smoking use plummeted 62 percent in three and a half decades as campaigns and education efforts skyrocketed. In comparison, among low income families, there was only a 9 percent decrease. While the educated and wealthier Americans have left smoking behind for the most part, the poor and uneducated are still smoking.

While the nation’s smoking average is at historic lows, among the nation’s less-educated people, the smoking rate remains at 40 percent, according to the Centers for Disease Control and Prevention. Rural residents are diagnosed with cancer at rates 18 to 20 percent above those of city dwellers.

The gap between classes is shifting how healthcare and anti-smoking organizations shape their campaigns and outreach – not to mention tobacco companies. Cigarette companies are focusing their marketing on lower socioeconomic communities to retain their customer base. Advocacy groups say that funding for smoking cessation is dropping off, possibly due to the increase in e-cigarette use across the country. While America’s upper and middle class may see smoking as a problem solved, it is still common practice among thousands across the country.

 “There’s this tendency now to blame the ones still smoking,” said Robin Koval, president of the Truth Initiative, a leading tobacco-control nonprofit group. “The attitude is: ‘You’re doing it to yourself. If you were just strong enough, you’d be able to quit.’”

In states like Utah, current smoking is about 9 percent of adults; in Kentucky, it’s almost 26 percent. States like West Virginia, Arkansas, Ohio, and Tennessee project similar high percentages of smoking. Tobacco companies are taking advantage of their marketing, specifically in poorer, rural and often Southern states, where smoking remains the highest.

The Truth Initiative called out tobacco companies in a campaign launched earlier this year; through a series of ads, the campaign addressed tobacco companies’ targeting of black and low-income neighborhoods, “It’s no coincidence. It’s profiling.”

CADCA’s Geographic Health Equity Alliance (GHEA) strives to identify the gaps in information among socioeconomic groups, provide leadership and expertise and promote health interventions. Their mission is to raise awareness about geographic health disparities related to tobacco and cancer to ensure that the issue of

smoking isn’t considered “solved” until widespread education and effective public health practices can be in place. 

Each year, an estimated 480,000 people die prematurely from smoking or exposure to secondhand smoke.

Source: CADCA

Online Opioid Sales Contribute to National Tragedy


As the nation’s opioid crisis worsens, authorities are confronting a resurgent, unruly player in the illicit trade of the deadly drugs, one that threatens to be even more formidable than the cartels.

The internet.

In a growing number of arrests and overdoses, law enforcement officials say, the drugs are being bought online. Internet sales have allowed powerful synthetic opioids such as fentanyl — the fastest-growing cause of overdoses nationwide — to reach living rooms in nearly every region of the country, as they arrive in small packages in the mail.

Authorities have been frustrated in their efforts to crack down on the trade because these sites generally exist on the dark web, where buyers can visit anonymously using special browsers and make purchases with virtual currencies like bitcoin.

The problem of dark web sales appeared to have been stamped out in 2013, when authorities took down the most famous online marketplace for drugs, known as Silk Road. But since then, countless successors have popped up, making the drugs readily available to tens of thousands of customers who would not otherwise have had access to them.

Among the dead are two 13-year-olds, Grant Seaver and Ryan Ainsworth, who died last fall in the wealthy resort town of Park City, Utah, after taking a synthetic opioid known as U-47700, or Pinky.

The boys had received the powder from another local teenager, who bought the drugs on the dark web using bitcoin, according to the Park City police chief. “It’s unimaginable that Grant could gain access to a drug like Pinky so easily, and be gone so quickly, poof,” said Jim Seaver, Grant’s father. “The pain and brutality of this tragedy is crippling.”

Largely because of their potency, synthetic opioids have become the fastest-growing cause of the overdose epidemic, overtaking heroin in some areas. Just a few flakes of fentanyl can be fatal.

Their deadly efficiency also makes them ideal for sale online. Unlike heroin and prescription painkillers, which are relatively bulky, enough fentanyl to get nearly 50,000 people high can fit in a standard first-class envelope.

Darknet drug markets first gained attention six years ago with the rise of Silk Road, the online market created by Ross Ulbricht. He was arrested and the site taken down in 2013, but imitators quickly proliferated.

No federal agencies have released data on the prevalence of drugs ordered online. But the leading sites are doing far more business than the original Silk Road, according to findings by RAND Europe and researchers at Carnegie Mellon University.

Authorities say these markets account for a small proportion of the overall traffic in most drugs, including heroin and cocaine. But when it comes to synthetic opioids, many authorities tracking the traffic say that dark web markets have quickly assumed a more prominent and frightening role.

The dark web “has become such an important source of distribution for this sort of deadly drug,” said Kathryn Haun, who was a prosecutor in San Francisco until last month, and the Justice Department’s first digital currency coordinator. “It has enabled distribution channels that previously didn’t exist.”

As of Friday, the leading darknet market, AlphaBay, had more than 21,000 listings for opioids and more than 4,100 for fentanyl and similar drugs, from dozens of dealers large and small.

Many of those individual listings are like items in a catalog, representing an endless backroom supply of pills, powders and nasal sprays.

Just last month, federal authorities announced charges against a six-person operation in Utah that was purchasing fentanyl in bulk from China on the dark web and then pressing the powder into pills and selling the pills on the dark web to users in the United States.

Authorities said the group had sold hundreds of thousands of these pills, often marketed as less dangerous drugs like Xanax and Oxycodone.

The alleged ringleader of the operation, Aaron Shamo, was identified by many AlphaBay users as the vendor known as Pharma-Master, who had 8,332 verified sales on the site.

The social forums on AlphaBay and other sites are filled with conversations about how potent the drugs are, with frequent mentions of trips that ended up in emergency room visits or blackouts.

Court documents show that in the last year, there have been more than two dozen arrests of drug dealers who were operating significant operations buying or selling synthetic opioids online, most of which were tied to specific overdose deaths.

In late February, a man in South Carolina was accused of receiving more than 3 kilograms of fentanyl ordered on the darknet — or enough to kill 1.5 million adults, given that just 2 milligrams is a lethal dose.

A few weeks later in New Jersey, authorities arrested Chukwuemeka Okparaeke, who allegedly went by the screen name of Fentmaster on AlphaBay. He had received 2 kilograms of fentanyl from an address in Hong Kong, according to a criminal complaint.

Then in April, a Cleveland man, Alec Steinberger, 21, was arrested and accused of receiving a package of furanyl fentanyl that he was preparing to sell on the streets. He is said to have texted a 19-year-old who was helping him distribute the drugs to warn about their strength.

“Bro I did it last night any my pupils got so small they disappeared and then I was nodding for 18 hrs,” the text said, according to the indictment. When the 19-year-old tried the drugs, he overdosed and died.

Okparaeke, Steinberger and Shamo have all pleaded not guilty. Lawyers for the men had no comment on their cases.

Law enforcement officials investigating these cases say that public documents underrepresent the number of cases involving the dark web because many court documents don’t mention drug sources.

And many cases — including the death last year of musician Prince from a fentanyl overdose — are still being investigated because of the relatively recent advent of the phenomenon.

“It has come to play a key role in the overdose crisis,” said Tim Plancon, who oversees the Drug Enforcement Administration in Kentucky, Michigan and Ohio, states at the epicenter of the overdose crisis. “It’s expanded beyond just your traditional drug smuggling and trafficking. There is just a lot more involved with it when you are dealing with folks on the dark web with virtual currencies.”

Dark web technology was originally developed by U.S. intelligence agencies to allow for encrypted communication. News organizations use it to receive story tips from vulnerable sources.

But the illicit markets enabled by the dark web have made stopping the flow of deadly drugs much more complicated than it was when authorities were trying to stop earlier waves of overdoses.

“We could give you a pretty good idea of the drug traffickers in town who can order kilos from Mexico — that’s a known commodity,” said Joseph Pinjuh, chief of the organized crime task force in the U.S. attorney’s office in Cleveland. “What’s harder to track is the person ordering this from his grandmother’s basement.”

Source: Star Tribune


Apple takes on distracted driving wiht “do not disturb while driving” feature

Coalition Meeting Reminders

Friendly reminder that the SACK Coalition meetings for the month of June and July have been changed to accommodate for scheduling conflicts and the July 4th holiday.  

Meeting times will be:

Tuesday, June 13th, 8 a.m., Kanabec County Jail Training Room 
Tuesday, July 11th, 8 a.m., Kanabec County Jail Training Room

At the July meeting there will be a guest speaker from the Physicians Advocacy Network presenting information on e-cigarettes. Their mission is to help educate, engage and empower physicians and other leaders in the health care industry to reduce the use of tobacco in Minnesota.

You can expect to learn about current tobacco trends, health risks associated with e-cigarettes, target markets, appropriate language and strategies for asking others about nicotine use beyond conventional tobacco and tips for tobacco cessation. More information about the Physicians Advocacy Network can be found on their website. Please share with others and invite them to the presentation on Tuesday, July 11th. 


While Minnesota authorities focus on opioid abuse, meth is making a comeback

When it comes to drug abuse in Minnesota, opioids get all the attention.

But there’s another drug raising concerns among law enforcement and treatment professionals in the state: meth.

You might remember this drug from the early 2000s: it inspired anti-drug campaigns that were the stuff of nightmares, depicting methamphetamine users with deteriorated teeth and oozing scabs. Meth lab busts and sometimes meth lab explosions frequently made the news. But after measures were taken to restrict access to precursor chemicals required for manufacturing the drug, meth use seemed to taper off.

Now it’s back, in a big way.

More meth seized
For a little while, it looked like meth’s days might be numbered in Minnesota. In 2005 and 2006, new state and federal laws made it a lot harder to manufacture meth in large quantities by restricting the sale of cold medicines used to make it. Such products could no longer be sold over the counter, and the amount consumers may buy is now subject to daily and monthly restrictions.

In one way, the restriction seemed to have an effect. At the height of the wave of methamphetamine use, the Minnesota Department of Public Safety recorded 410 meth labs in 2003 — more than one for each day that year. In 2016, there were 13, said Brian Marquart, the department’s statewide gang and drug coordinator.

Seizures of methamphetamine by the state’s Violent Crime Enforcement Teams, 21 task forces that work across county lines in 70 Minnesota counties, saw a sharp decline, too.

But those seizures are going back up. Last year, Minnesota’s Violent Crime Enforcement Teams seized about 490 pounds of meth. That’s more than twice as much as the amount seized in 2015. And that’s just meth confiscated by VCETs; seizures made by other law enforcement agencies, which are not reported to the state’s Office of Justice Programs, could push that total even higher.

This year, between January and the end of March, VCETs already seized 188 pounds, Marquart said. If they continue at that rate for the rest of the year, they could beat last year’s record with more than 750 pounds of the stuff.

Methamphetamine seizures in Minnesota
The amount of methamphetamine seized by Violent Crime Enforcement Teams in Minnesota dropped off after new laws made it more difficult to obtain materials to make the drug, but has increased in recent years. Meth seizures, in pounds, doubled between 2015 and 2016 and are on track to increase again in 2017. Data are not available for 2001.

Busts of meth labs didn’t typically yield big seizures, but lately, the average size of seizures has increased dramatically, according to DPS. The Anoka-Hennepin Narcotics and Violent Crimes Task Force, for example, recorded one 140-pound seizure last year, said Lt. Wayne Heath. But even excluding that bust, total pounds seized were up significantly from the prior year, he said. Statewide, methamphetamine arrests have seen an increase too, Marquart said.

More seeking treatment
There are other signs there could be more meth on the streets, and more people using it.

Admissions to treatment programs for methamphetamine were second only to alcohol last year, numbering 12,050, up 76 percent over their previous peak in 2005, and accounting for about 23 percent of all substance abuse treatment admissions, data from the Minnesota Department of Human Services show. Methamphetamine was responsible for more admissions than the 10,404 primarily for heroin and prescription opioids combined last year.

Treatment admissions due primarily to methamphetamine abuse
The number of Minnesota residents admitted to treatment for methamphetamine abuse has steadily increased in Minnesota in recent years.

Admissions to treatment aren’t a perfect indicator of underlying usage, of course. Many people who are addicted do not enter treatment programs, Claire Wilson, assistant commissioner for community supports at the Minnesota Department of Human Services. More access to treatment due to the expansion of Medicaid, which made treatment accessible to some single adults, could also be a factor, she said.

But Dr. Joseph Lee, the medical director of the Hazelden Betty Ford Foundation Youth Continuum, who specializes in youth addiction, says he’s seen indications of more widespread use.

In particular, he’s seen an increasing number of young people come to Hazelden from all over the country for meth addiction for a few years now. But, he said, with the focus on opioids, his efforts to get the word out have been somewhat drowned out.

“It just didn’t take,” he said.

Treatment admissions data indicate the problem is statewide. Not a single one of Minnesota’s 87 counties was immune to sending residents to treatment for meth use last year. But Lee says he’s seeing new demographics involved, with more of it among urban and suburban young people than before.

More people are dying from meth, too, it seems.

According to data from the Minnesota Department of Health, 78 people in Minnesota died from overdoses of “psychostimulants with abuse potential,” a category of drugs that includes methamphetamine. Five years prior, in 2010, there were only 18 overdose deaths.

Overdose deaths due to ‘psycho-stimulants with abuse potential’
The number of overdose deaths due to psycho-stimulants with abuse potential, a class of drugs that includes methamphetamine, decreased after it became more difficult to obtain ingredients used to make meth. In recent years, they’ve increased dramatically.

That increase mirrors a national trend. According to Stateline, meth was involved in 3,700 deaths in 2014 — more than double the number associated with the drug in 2010. In 2015, meth was involved in 4,900 deaths, a 30 percent increase over the prior year. That number may be an under-count, as many people addicted to meth are longtime users and die of organ failure, which may not show up in overdose records.

New suppliers, new marketing
So what’s behind meth’s apparent resurgence?

Hazelden’s Lee attributes the increase in cases he’s seen to two things: new distributors and a new image.

Before the state cracked down on cold medicines used to make meth, it was a domestic cottage industry. Now, it’s global, mostly run by cartels that have sophisticated distribution networks in the state. Meth arrives in Minnesota by passenger car, commercial vehicle, mail, FedEx and planes, Marquart said.

And the product is much better. Mass manufacturers have figured out how to produce methamphetamine that’s purer at a much lower price.

Test results by state officials show wholesale methamphetamine seized recently coming back around 90 percent pure. Back when people made it at home, the purity was lower, Marquart said.

And it’s cheaper. Five or six years ago, a pound of methamphetamine would cost between $21,000 and $22,000 wholesale, Marquart said. Today, it’s going for about $5,000.

That’s because it’s coming from much bigger, more sophisticated manufacturers, Marquart said, and it’s now largely being distributed by the cartels.

The cartels’ takeover of the meth trade has resulted in a rebranding for the drug, Lee said.

“Historically, synthetic chemical drugs like methamphetamine have really been more popular in rural areas where they didn’t have access to higher-branded drugs like cocaine,” he said. “We’ve seen the quality of it and the branding of it change from a kind of backwoods, rural (drug) to kind of a poor man’s cocaine. We see kids who are high-performing and going to college who use meth. We see girls who have eating disorders who use meth.” Meth has also become popular in the LGBT community, particularly among gay men, he added.

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Tiger Woods and America’s Drugged Driving Problem

Shortly after being arrested for driving under the influence near his home in Florida Monday, golf legend Tiger Woods issued a statement saying the incident was the result of “an unexpected reaction to prescribed medications”—not alcohol. According to police documents, he blew a .000 breathalyzer and had fallen asleep in his car.

With that, Tiger Woods has become the most high-profile example of a worrisome nationwide trend: Drugged driving is on the rise, and for the first time ever, people involved in fatal crashes are more likely to have drugs than alcohol in their systems.

A report published this April by the Governors Highway Safety Association and the Foundation for Advancing Alcohol Responsibility found that both illegal and prescription drugs are found in the bodies of fatally-injured drivers—a good source of data, since they are tested more often than drivers in non-fatal crashes—about 43 percent of the time. Alcohol above the legal limit, meanwhile, was found in just 37 percent of the drivers.

That’s a stark turnaround from 2005, when alcohol was the bigger culprit, detected in 41 percent of traffic deaths, compared to just 28 percent for drugs, as Reuters reported.

The number of people driving under the influence of prescription drugs has increased in recent years. A just-released study found that 20 percent of drivers had used a prescription drug in the past two days—mostly sedatives, antidepressants, and painkillers.

But according to several surveys, the most common drug used by drivers is marijuana. In the Governors Highway Safety Association report, over one-third of the drugs found were some form of marijuana. The second-largest category was some sort of amphetamines, at 9.3 percent.

The most recent survey by the National Highway Traffic Safety Administration found that the percentage of weekend, night-time drivers using illegal drugs rose from 12.4 percent in 2007 to 15.1 percent in 2013, and those using prescription medications rose from 3.9 percent to 4.9 percent. The largest increase was in drivers’ use of THC: In the 2007 survey, “8.6 percent of weekend nighttime drivers tested positive for THC (based on the combined oral fluid and/or blood tests), whereas in the 2013–2014 [survey], 12.6 percent of weekend nighttime drivers tested positive for THC, a 48 percent increase.” In that survey, too, marijuana was a more prevalent drug than alcohol.

Jim Hedlund, the author of the GHSA report, told Reuters that the rise in drugged driving can’t be directly linked with the opioid epidemic, whose death toll has quadrupled since the late ’90s. However, marijuana-legalization advocates also cautioned news outlets covering the report last month that the high prevalence of cannabis in the drivers’ systems should be taken with a grain of salt: After all, marijuana can linger in the blood stream for weeks, long after the driver is no longer intoxicated.

The report lists marijuana as being associated with a “slightly increased” risk of crashing, followed by cocaine and opioids at a “medium increased risk,” amphetamines at a “highly increased risk,” and alcohol in combination with other drugs at the highest risk of all.

As more Americans rely on prescription painkillers, heavy-duty sedatives, and other pills to get through the day, cases like Woods’ have become increasingly common and frustrating for police. Prescription drugs act on the body differently than alcohol does. There’s little agreement among traffic authorities on how much is too much to have in one’s system, and the substances are harder to test for than booze.

Plus, the idea that it isn’t safe to drive on, say, Ambien or OxyContin hasn’t quite hit home with motorists, some officials say.

“We see that all the time with prescription drugs, and they think, ‘Oh, my doctor gave it to me, it’s okay to drive,’” as Pennsylvania State Police Cpl. Scott M. Davis told the Pittsburgh Post-Gazette. “When in reality they’re actually more of a danger than somebody under influence of alcohol.”

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