Drug Facts Week Interview: Bertha Madras

Next week is National Drug Facts Week (NDFW), sponsored by the National Institute on Drug Abuse. To help spread the word, the Dana Foundation is participating in today’s CyberShoutout for the second straight year.

In order to “learn the facts and shatter the myths about drug abuse,” who better to talk to than to than Dana Alliance for Brain Initiatives member Bertha K. Madras, Ph.D., professor of psychobiology at Harvard Medical School? Dr. Madras served as the Deputy Director for Demand Reduction for the White House Office of National Drug Control Policy from 2006-2008, and is an expert on drug addiction.

Since NDFW is geared toward teenagers, I asked Dr. Madras for a few facts about addiction that she thought teens might not be aware of. Here are three:

• Marijuana is addictive.
• There is growing concern that marijuana increases the risk for subsequent psychosis and schizophrenia, and the earlier the use the higher the risk.
• Even though a medication is prescribed, it is profoundly dangerous if used for non-medical purposes.

She also said that “there is good epidemiological data that indicate adolescents are at a higher risk than adults for addiction to nicotine, alcohol, inhalants, stimulants, cocaine, opioids, hallucinogens, and anxiolytic drugs.”

The rest of the interview follows.

What are you working on now?

I’m working on a public health problem reduced to basic research. The public health problem is that adolescents are far more vulnerable to drug addiction if they initiate drug use during early adolescence. The prevalence of addiction is five times higher for marijuana and for alcohol if they initiate use at the age of 14 or younger compared with initiation of use at the age of 18 or older. And that’s a very critical problem because it is obvious that we have to summon all our resources to prevent drug use amongst these younger people.

But equally important, it is necessary to understand why their addiction rate is higher. There are so many factors that could go into the reasons behind this. One of the areas I am exploring is whether or not the drug produces effects during neurodevelopment that are different in the adolescent than in the adult brain.

It’s clear from neuroscience research that the adolescent brain is not fully developed. It undergoes excessive changes. There are two global changes that it undergoes. There are anatomical changes, as the adolescent brain undergoes extensive pruning. The pruning does not finish and the final circuitry does not conclude until people are in their mid-20’s. The second change is that during adolescence the brain uses different regions to respond to external stimuli. It is clear that the adolescent brain has very significant differences, functionally and anatomically, compared with the adult brain. So the next question is, if that is the case, is it possible that drugs interfere with neurodevelopment in some way that heightens the risk for addiction and/or for drug-seeking and for a host of other issues that can occur as a result of early initiation of drug use?

What works as far as getting the message through to teens?

Based on the most recent data, if parents take strong stands against drugs and have unequivocal statements with regard to what their kids should be doing, marijuana use is five percent in those families. If parents do not take a strong stand or seem to approve of drug use, drug use is 35-37 percent. Drug use is reduced by half when parents spend time with their children and determine boundaries for their behavior. Close family dynamics—having dinner together, being fully aware of what your child is doing—are important. Another important factor is that young people who engage in extracurricular activities—in athletics, and all sorts of activities that are positive and character-building—have lower drug use.

So are we targeting the wrong group?

The big problem is that we have to be targeting parents and we’re not. The majority of drug prevention is targeted towards youth. Generally speaking, schools don’t hold forums for parents to help them understand the consequences of drug use for young people. The problem with government agencies is that they don’t have marketing people who really understand how to shape a message that is going to be widely disseminated.

We have to get to parents, that’s number one. Number two, I think the medical community has to get involved. At least 70-80 percent of people see a physician at least once a year. That is a remarkable opportunity for the medical community to engage in what is a very significant public health problem. The biggest problem is that they themselves are not educated in medical school on the adverse consequences of drugs and on the specific vulnerability of young people to addiction. We have a lot of work to do in that area.

What do you think about the current level of awareness among parents?

I think the majority of the parents in this country do not think or want to believe their kids use drugs. The majority of them are unaware of their own child’s drug use because they don’t engage in these crucial conversations with their kids. They assume their kids are going to make logical decisions without guidance. But there is a growing awareness of some of the problems. A lot of parents are beginning to realize that prescription drug abuse could be very hazardous. But there isn’t universal awareness of it. More than 60 percent of people who get opioids for non-medical use get them from friends and family. One of the sources is raiding medicine cabinets. This kind of awareness needs to be elevated so that adults know that if they have a prescription that involves opioids, such as for dental extractions, they should guard them like they are the ultimate poison.

Can you talk about your time in the White House?

My time in the White House was a very exhilarating experience. It was a combination of agony and ecstasy. The joy of being able to move mountains occasionally in order to improve public health and the achievements we managed delivered the most profound sense of personal and national satisfaction. The agony was that there wasn’t enough time to do everything that we wanted to accomplish. [Here is Dr. Madras’ essay on her time in the White House.]

Anything else?

I’d like to mention the approval of marijuana as medicine in ballot initiatives, which I think has had a very adverse effect on drug use in this country. Drug use has gone up in the past few years. Youth drug use went down by 25 percent from 2002-2008. What’s driving the increase is marijuana, and what’s driving that are these initiatives to offer marijuana as a medicine. It circumvents 100 years’ worth of legislation that has tried to make the drug approval process evidence-based and scientifically-based. All of this has been compromised by these ballot initiatives. I no longer feel our society is protected by this approval system. It has led to a lowering of risk perception among young adolescents that this is a potentially harmful drug. And it has led to increased use.

I do not think marijuana is an effective method of medicine, period. We have spent 50 years on a campaign to stop smoking because we know that smoking is harmful and now we are saying that smoking is a legitimate form of medication’s delivery of a complex mixture of over 400 chemicals. It just makes no sense. It’s an example of how propaganda can make people who normally wouldn’t touch a cigarette, vote ‘yes’ on a ballot.