8 Legendary Celebrities Who Died from Alcoholism

The disease of alcoholism does not discriminate. If you were born with a certain genetic makeup, if there is a history of alcoholism in your family, if you experience worsening consequences of your drinking and still can’t stop…you might be one of us. And alcohol use disorder is a progressive disease that only gets worse over time if left untreated.Since alcoholism is also a self-diagnosed and self-treated disease, you have to be willing to do the work necessary to recover. Regardless of external circumstances -- wealth, status, prestige, talent, access to the best resources -- if you are not willing to help yourself, nobody can. As evidence of this reality, here are eight legendary celebrities who tragically died from alcohol use disorder or alcohol-related causes.1) Richard Burton (1925-1984)The recipient of Golden Globes and Tony Awards for Best Actor, Richard Burton was one of the biggest celebrities of the second half of the 20th century. He was also known for his love affair with Elizabeth Taylor. Together, they starred as Mark Anthony and Cleopatra in the mega-bomb Cleopatra. At the time it was the most expensive film ever made, and its failure almost bankrupted 20th Century Fox. After playing Hamlet in a remarkable Broadway production in 1964, critics raved that Richard Burton was “the natural successor to Olivier.” Afterward, the expectations were overwhelming. Is that what drove him to embrace the bottle?According to biographer Robert Sellers, “At the height of his boozing in the mid-70s, he was knocking back three to four bottles of hard liquor a day." Even when drinking, Burton had an impressive career. From Look Back In Anger and Becket to Equus and Who’s Afraid Of Virginia Woolf?, he gave stirring performances time and time again. Still, his fans and critics felt there could have been so much more if not for the drinking.In his forties, Burton suffered from cirrhosis of the liver. His alcohol intake bloated his kidneys to abnormal proportions. During an operation to relieve back pain in the early 1980s, doctors discovered that his spine was covered with crystallized alcohol. Ignoring the pleas of his friends and family, Burton’s health issues continued to throttle him until his premature death at the age of 58 from a brain hemorrhage. Although alcoholism was not listed as a cause of death, the sharp downward trajectory of his health at such a young age is considered by doctors to be a direct result of his excessive drinking.2) Truman Capote (1924-1984)As the writer of the novella Breakfast at Tiffany’s and the true-crime novel In Cold Blood, Truman Capote proved that a writer could become an internationally-known celebrity. Published in 1966 by Random House, In Cold Blood broke new ground in non-fiction, and served as a beacon for the burgeoning and popular true crime genre. Speaking in 1974 at the San Francisco International Film Festival, Truman Capote described his extensive research for the book: “I spent four years on and off in that part of Western Kansas there during the research for that book and then the film. What was it like? It was very lonely. And difficult.” To console himself, Truman Capote drank and drank often, alone in Midwestern hotel bars.Returning to New York after publication, Capote became a celebrity, partying day in and day out with the richest wives of New York City’s power elite. He bragged about the brilliance of his forthcoming novel, Answered Prayers. But Capote never published another significant work in his lifetime. Instead, he drank and popped prescription pills. When an individual chapter from the now legendary unfinished book was published in Esquire magazine in 1975, it proved to be social suicide. Truman Capote was ostracized from high society for revealing the dirty laundry of the rich.Afterward, according to Vanity Fair, “Truman appeared in an inebriated state on … a local morning talk show in New York. Taking note of Truman’s incoherence during the interview … the host asked, ‘What’s going to happen unless you lick this problem of drugs and alcohol?’ Truman, through the fog of his own misery, replied, ‘The obvious answer is that eventually, I’ll kill myself.’” Fulfilling this prophecy, he spent his final years mostly alone in his New York high-rise apartment, drinking himself into sad oblivion. On August 25, 1984, Truman Capote died in Bel Air, Los Angeles, while visiting one of his last loyal friends. According to the Coroner's Report, the cause of death was "liver disease complicated by phlebitis and multiple drug intoxication.”3) F. Scott Fitzgerald (1896-1940)Like Ernest Hemingway, F.Scott Fitzgerald was a respected author and member of the "Lost Generation" of the 1920s. From The Great Gatsby to Tender Is The Night, Fitzgerald’s novels revealed the luxurious decadence of the Jazz Age. At the same time, he was one of the biggest drinkers during a notorious period of massive consumption. Later, during Prohibition, Fitzgerald’s extraordinarily heavy alcohol intake became the stuff of dark lore.Fitzgerald and his wife Zelda pushed the limits, leading to extreme health problems that he denied were caused by alcohol. According to Nancy Milford, Zelda’s biographer, Fitzgerald’s claim of contracting tuberculosis was a beard to cover health problems caused by excessive drinking. After Zelda was institutionalized for schizophrenia, his drinking worsened. Fitzgerald’s deterioration was finally publicly revealed in "The Other Side of Paradise, Scott Fitzgerald, 40, Engulfed in Despair,” an article published by the New York Post in 1936 that exposed his excesses and their devastating toll.Between 1933 and 1937, Scott was hospitalized for alcoholism on eight separate occasions. During this period, he also had two heart attacks. However, he would not stop drinking and even boasted of reducing his gin consumption by consuming 37 beers a day. At 44 years old, F. Scott Fitzgerald dropped dead of another massive heart attack brought on by chronic alcoholism. It’s not surprising that he’s known for saying, “First you take a drink, then the drink takes a drink, then the drink takes you.”4) Errol Flynn (1909-1959)The greatest action hero of his time with starring roles in Captain Blood (1935) and The Adventure of Robin Hood (1938), Errol Flynn was an Australian actor who achieved worldwide fame for his ability to play the dashingly handsome, romantic swashbuckler. In Hollywood, he had a reputation for womanizing, hard-drinking, and chain-smoking. A regular attendee of lavish parties at Hearst Castle, Errol Flynn once became so drunk that the newspaper baron had him escorted off the property. Flynn later shared a bachelor pad with actor David Niven in Malibu. The party pad became so notorious for extreme alcohol consumption that it was nicknamed “Cirrhosis-by-the-Sea.”Flynn would take weekend trips on his private yacht, hosting parties fueled by cocaine, alcohol, and sexual misadventures. In Errol Flynn: The Life and Career (McFarland, 2004), biographer Thomas McNulty describes Errol Flynn and Fidel Castro meeting in late 1958 and drinking hard together. The encounter inspired Boyd Anderson’s novel Errol, Fidel, and the Cuban Rebel Girls (University of Queensland Press 2010). In The Last of Robin Hood (Samuel Goldwyn Films, 2013), an independent movie about Flynn’s final days, the aging actor’s sexual misadventures with a 17-year-old girl and the resulting scandal are highlighted. His alcoholism led to a spectacular failure in judgment that nearly sent him to prison.In his thirties, Errol Flynn collapsed in an elevator and nearly died. A steady diet of alcohol had ravaged his heart, lungs, liver, and kidneys. Still, he continued drinking, injecting vodka into oranges when he was forbidden to drink on set. When he died of a heart attack at the age of 50, the medics who treated him told reporters they thought they were trying to save an eighty-year-old man.5) Billie Holiday (1915-1959)Born in Philadelphia to a teenage mother, Billie Holiday chose her eponymous stage name as a tribute to movie star Billie Dove and her father, jazz guitarist Clarence Holiday. Holiday suffered significant trauma as a child and later turned to prostitution, which led to an arrest for solicitation. After being released from prison, she landed her first paid performing gig, and her career took off. Unfortunately, she couldn’t stop drinking and drugging.She and Lester Young, the saxophone legend who bestowed upon her the nickname Lady Day, toured Europe with Count Basie's Orchestra to great acclaim. Coming back to the United States, she recorded the most haunting song in her repertoire. Based on a poem written by Abel Meeropol, a Jewish high school teacher in the Bronx sickened by a recent lynching of two black men, "Strange Fruit" is one of the most moving yet disturbing songs in American history. According to Frank Sinatra, “With few exceptions, every major pop singer in the US during her generation has been touched in some way by her genius. It is Billie Holiday who was, and still remains, the greatest single musical influence on me.”Already a heavy drinker, Billie Holiday was introduced to heroin by her first husband, trombonist Jimmy Monroe. She was arrested for drug possession in 1947 and ended up serving ten months in federal prison. Afterward, the constant drinking made her voice rougher and more vulnerable. Her exhaustion with life was palpable. By 1959, Lady Day has been diagnosed with cirrhosis. In failing health, she was admitted to a New York hospital. Days later, Billie Holiday died at 44 of chronic alcoholism.6) Jack Kerouac (1922 – 1969)With Allen Ginsberg and William S. Burroughs, Jack Kerouac is known for being the progenitor of “The Beat Generation” in the 1950s, an American literary movement that continues to exert a strong influence on each new generation. From On the Road (1957), his most iconic novel, and The Dharma Bums (1958) to Big Sur (1962) and Desolation Angels (1965), Jack Kerouac’s work is autobiographical with the names of the characters changed and the events intensified. All of these novels read like they were soaked in alcohol. Jack Kerouac drank as he typed, furiously writing first drafts that were rarely revised.When he moved with his mother in 1958 to Northport, a Long Island harbor town in New York, Jack Kerouac’s life revolved around alcohol. “The locals remember him mainly as a broke barfly who padded about barefoot or in bedroom slippers,” Corey Kilgannon wrote in The New York Times. “Emotionally fragile and beset by alcoholism, not to mention a complicated relationship with his mother, Kerouac was declining physically, disillusioned by his celebrity and growing apart from his radical friends and artistic colleagues.” In his last years, Jack Kerouac became a recluse, and his closest friend was a cheap half-pint of Schenley's whiskey.On the morning of October 20, 1969, in St. Petersburg, Florida, Jack Kerouac put down the breakfast of champions, stumbled into the bathroom, and began vomiting blood an esophageal hemorrhage. After several transfusions in an attempt to make up for the loss of blood, doctors subsequently attempted surgery. However, a damaged liver prevented his blood from clotting. His cause of death was an internal hemorrhage caused by cirrhosis.7) Mickey Mantle (1931 – 1995)A Hall of Fame professional baseball player for the New York Yankees, Mickey Mantle is considered to be the greatest switch-hitter in the history of the game. He is also remembered as one of the heaviest drinkers in the game. Despite winning three Most Valuable Player (MVP) awards and leading his team to seven World Series victories, the Mick was beset by alcoholism. Shortly after he began his Major League career, his beloved father, Mutt Mantle, died of Hodgkin's disease at age 39. Devastated by the loss, Mickey Mantle started to drink hard to escape the memories. As he later wrote, “After one drink, I was off and running… I'd often keep on drinking until I couldn't drink anymore.”Mickey Mantle was loved by his teammates. Hall of Fame Yankee pitcher Whitey Ford describes him as “a superstar who never acted like one. He was a humble man who was kind and friendly to all his teammates, even the rawest rookie.” Sadly, Mickey Mantle played with injuries throughout his career that would sideline a modern player, including a torn ACL. In high school, he had suffered chronic damage to the bones and cartilage in his legs. Wracked by injuries, Mickey Mantle also drank to find relief. By the end of his career, he couldn’t even swing a bat without collapsing in pain.When Mickey Mantle drank, he blacked out, often waking up in strange places with no idea of what had happened the night before. At the end of his career, he admitted he had a problem. After hitting rock bottom, diagnosed with hepatitis, cirrhosis of the liver, and liver cancer, the Mick checked into the Betty Ford Clinic in 1994. In a Sports Illustrated cover story later that year, he recounted the devastation that alcohol had caused in his life. After telling the same old stories about being drunk for years, Mickey Mantle realized they were not part of a comedy, but a tragedy. When he received a liver transplant, the doctors found the liver cancer had spread. A few months after receiving a new liver, Mickey Mantle, the golden boy of Major League Baseball, died on August 13, 1995, of this alcohol-related disease.8) Hank Williams (1923 – 1953)Considered one of the most influential singer-songwriters of the 20th century, Hank Williams is the archetype of the drunk country musician. A true hit-maker, Hank Williams recorded 35 singles (five charting after his death) that reached the Top 10 of the Billboard Country & Western Best Sellers chart. Impressively, 11 of those singles reached number one (three ranked after his death). He joined the Grand Old Opry in 1949 but his stay with the renowned Nashville country music broadcast was brief. In 1952, Williams was dismissed due to his unreliability and his alcohol abuse.The holy grail in country music is authenticity, and Hank Williams helped define the word. He inspired generations of artists with hits such as "I'm So Lonesome I Could Cry," "I Saw the Light," and the classic drinking song "There's a Tear in My Beer." As singer Bobby Bare recounts, “Everybody I know wanted to be like Hank Williams. And everyone I know bought into the drinking. You figure if Hank did it, it must be OK." Beyond his music, the lasting influence of Hank Williams is what the late Waylon Jennings described as the “Hank Williams syndrome.” To be authentic like Hank, you had to drink like Hank.While being driven across the country, Williams combined chloral hydrate, a sedative, with excessive drinking, and fell into a stupor. After being injected by a local doctor with a vitamin and morphine combination, the trip continued, but Hank’s conditioned did not improve. Realizing the singer was unresponsive, his driver pulled over and discovered the worst. On New Year's Day, 1953, at the young age of 29, Hank Williams died of alcoholism and drug intoxication while traveling to a concert in Canton, Ohio.***If only fame, talent, beauty, and wealth were effective armor against the onslaught of alcohol use disorder, imagine how many legendary celebrities would have had longer and more productive careers. Can you picture in your mind’s eye the Academy-Award acceptance speech of Richard Burton? Or F. Scott Fitzgerald accepting the Nobel Prize for his later work? How about Mickey Mantle breaking the record for the most home runs in a season? Unfortunately, none of those accomplishments ever materialized because alcoholism knocked each of these legendary celebrities down for the count.

How I Stayed Sober Through College

I was lucky to get accepted into one of the top colleges in the U.S., but I brought with me a serious drug habit and alcoholism. In my first semester, I would down 3 ½ - 4 ½ bottles of cheap red wine in a night, paired with a combination of cocaine, angel dust, weed, and benzodiazepines. Most nights, I passed out by 8 pm and my friends slipped out to clubs without me. Two months into college, I started collecting write-ups for violating the school’s drug and alcohol policies, which snowballed until I hit my bottom. The first sign that my style of “partying” was out of control was that three groups of friends each suddenly severed ties with me. I still don’t know what happened, but I can imagine, based on scenes I've snapped into from blackouts—my boyfriend trying to scream sense into me after I punched him in the face at a concert, rolling naked on the kitchen floor in a pile of broken glass while crying, friends dumping me on the doorsteps of psych wards. That’s how I partied.I somehow managed to squeak out mostly A's in my first semester, but I struggled to show up. I was constantly handing in assignments late, rescheduling exams, and conjuring doctors’ notes to excuse excessive absences. I was oversleeping for classes and therapy appointments in the late afternoon. At the end of my first semester, my school forcibly relocated me to a new dormitory for erratic behavior and chronic drug use. Friendless on campus, I turned to the local homeless population. That’s when I found heroin. It didn’t take long for consequences to reach a tipping point. Halfway through my second semester, I was arrested on two felonies and two misdemeanors after waking up next to my best friend’s lifeless body (she overdosed but was revived and survived). My school suspended me for a year, pending expulsion if I didn’t get sober. My probation officer pushed me into rehab and warned that if I left, he would send me to jail.I fought getting sober that entire year. But at the eleventh hour, something clicked and I suddenly wanted recovery. I abruptly left the dilapidated drug den I was living in and ran to AA meetings. I only had 30 days when a school psychiatrist evaluated if I could be readmitted. I think they saw that despite the little time I had, I was serious about sobriety. I was; I’m still sober 11 years later. And I only got through those first years of sobriety while in college because of the life I built and resolutely maintained.Solutions for SobrietyGetting suspended from student housing for two years was a blessing in disguise. I instead commuted from my family's home an hour from school, which made it easier to build a new life free of drugs and alcohol and kept me far from the parties that were definitely happening back in the dorms. I made friends with everyone in my local AA groups; fortunately, there was a community of sober young people in my area. Those friendships showed me that I could have more fun sober than I could while using, and I was never pressured or tempted to relapse. Between classes, I went to local meetings and established a second support system at school.The first two and a half years of sobriety were my most challenging. I struggled with cravings every day, so I kept recovery literature with me at all times. In the streets of New York City on any given night, I was confronted with scenes of the cunning fantasy of social drinking, passing by clusters of casual drinkers jovially sharing laughs over sparkling cocktails at posh outdoor lounges. I often walked past clouds of weed smoke and stepped over empty dime bags. Like so many of us reintegrating back into society in early sobriety, temptation was everywhere, despite my careful avoidance of people and places that I associated with using. But I always had silent support from a Grapevine or copy of Living Sober conveniently stashed among my schoolbooks for when I couldn’t call someone. I also developed the self-respect to walk away from situations when I was uncomfortable, like changing seats on the train when passengers were sipping liquor concealed in brown paper bags, or switching tables at a restaurant because nearby diners were drinking. For the first year, I took detours around the blocks where my homeless friends sat so I wouldn’t risk running into them. These extra buffers and barriers made it easier for me to keep my sobriety amidst incessant cravings.I shamelessly shared that I was sober with professors and classmates, so that when I had the opportunity to study abroad in Istanbul at two years sober, my professor helped make sure I got to and from AA meetings and fellowship in a city where I didn’t speak the language and didn’t have a cell phone. My study abroad classmates frequented clubs after class and drank during meals, so every effort helped since I had only e-mail contact with my sponsor and network. I would have similar conversations with classmates when we planned group work outside of class. They always agreed to meet during the day at school lounges, libraries, or cafés when I asked. Strategies that kept alcohol out of sight proved to be the safest for me in early sobriety. During my last semester, I got to help form a recovery group for students at my school. These organizations are common on campuses now, and some schools even offer sober housing. It took intense emotional, psychological, and physical energy to mourn my lifelong relationship with drugs and alcohol and process the trauma I had spent my life suppressing. After I got sober, I re-enrolled part-time in college and completed my bachelor’s degree over six years. My diligence paid off: I graduated Magna Cum Laude and immediately began a full-time position in my chosen field.Graduate SchoolFive years after receiving my bachelor’s, I realized my career didn’t match what I finally discovered was my purpose and calling in life. After six months of meditating, therapy, and weighing feedback from my sober network, I left my steady career job and started graduate school. Unexpectedly, my new school hosted a heavier drinking culture than my undergraduate campus. The omnipresent partying frequently left me in uncomfortable situations with my recovery feeling tenuous. Everything involved alcohol, including lab assignments and fieldwork excursions. The school even hosted weekly drinking socials, with most students slurring and stumbling by 8pm. When my cohort got together several times a week, the event always included hard drinking. I realized on the first night of orientation that I would need to double down on recovery again. Even though I entered graduate school with nine years of sobriety, I treated myself with the same care and caution as I did in undergrad as a newcomer. During graduate school, I felt I had no business in a place where the main activity focused on alcohol. When I’m tense or upset, the glamor of psychological escape can suddenly seem desirable. As an alcoholic, I know I have no defense against that first drink if my spiritual condition is anything less than fit that day. Adding to the constant stress of endless coursework, my career change challenged my self-esteem, confidence, and self-worth. I rarely felt grounded. As a result, I only saw my cohort outside of class when I felt absolutely secure in my sobriety. I didn’t form as close of bonds with them as they did with each other, but I made a concerted effort to be fully present when we were in class or working in our offices. Though I wish I could have gotten closer to them, I don’t regret honoring the boundaries I had set to care for my recovery.I didn’t have to entirely avoid being around drinking; I just had to distinguish the acceptable conditions. If an event would be beneficial to my studies or career, I only went at the beginning when attendees were adequately sober and constructive conversations were possible. Cocktail receptions and academic conferences felt safe because professional networking was the main purpose, and the pressure to perform distracted me from the drinking. I found comfort in idly sipping on water throughout the night as others do with their wine or cocktails. And as attendees became tipsy, I remained articulate, poised, and professional, and carried impressively intellectual conversations in the eyes of the inebriated. If the night turned into a party, my cue to leave was when people started talking loudly and laughing infectiously at nothing intelligible. At that point, I couldn’t connect with anyone and there was little left for me to do there. If the drinkers stayed only mildly tipsy, I ended up enjoying getting to know them because they were relaxed enough to reciprocate the deeper conversations I’m accustomed to in recovery.I was lucky that my school already had a strong student recovery group that held meetings several times a week and frequent sober outings. They became my friends because I didn't mesh with the local 12-step meetings. At this point in my recovery, AA had sadly become monotonous for me, but I was still committed to sobriety. I wanted to dive deeper into healing the trauma, childhood wounds, and character defects that continued to hamper effective relationships with myself and those around me. Over the years, I found guidance and wisdom in self-help books, A Course in Miracles, Refuge Recovery, Kundalini yoga, Western astrology, and Buddhist meditation. So in graduate school, I crafted a program of self-reflection and accountability around these practices, which doubled as solutions for stress management. I also stayed close to my networks where I got sober. Those women remain my dearest friends and strongest support. I worked closely with spiritual advisors until I found a local sponsor. Strengthening my program was critical because graduate school was emotionally demanding. It required at least twice the amount of work as my undergrad classes; it wasn’t even possible to complete all the assignments each week. The psychological strain combined with a busy schedule left little time for much else. I quickly recognized the need for self-care and balanced it with the coursework I would be graded on. I went to my favorite exercise classes at least twice a week, also setting aside time to rest and prioritizing a full night's sleep. At the end of the day, all the effort paid off. I recently received my Master’s degree at 11 years sober and it is one of my most proud accomplishments. I graduated with a higher quality of life, stronger sense of self, and more solid sobriety than I imagined were possible, thanks to the unique challenges I had to face in the process of obtaining each degree.

Listening to ketamine

At 32, Raquel Bennett was looking for a reason to live. She’d struggled with severe depression for more than a decade, trying multiple antidepressants and years of talk therapy. The treatment helped, but not enough to make it seem worth living with a debilitating mental illness, she says. “I was desperate.”In 2002, following a friend’s suggestion, Bennett received an injection of ketamine, an anesthetic and psychedelic party drug also known as Special K. During her first ketamine trip, Bennett hallucinated that God inserted a giant golden key into her ear, turning on her brain. “It was as if I was living in a dark house and suddenly the lights came on,” she says. “Suddenly everything seemed illuminated.”The drug lifted Bennett’s depression and dispelled her thoughts of suicide within minutes. The effect lasted for several months, and, she says, the respite saved her life. She was fascinated by the drug’s rapid effects and went on to earn a doctoral degree in psychology, writing her dissertation about ketamine. Today, she works at a clinic in Berkeley, California, that specializes in using ketamine to treat depression. “This medicine works differently and better than any other medication I’ve tried,” she says.When Bennett experimented with ketamine, the notion of using a psychedelic rave drug for depression was still decidedly fringe. Since the first clinical trials in the early 2000s, however, dozens of studies have shown that a low dose of ketamine delivered via IV can relieve the symptoms of depression, including thoughts of suicide, within hours.Even a low dose can have intense side effects, such as the sensation of being outside one’s body, vivid hallucinations, confusion and nausea. The antidepressant effects of ketamine typically don’t last more than a week or two. But the drug appears to work where no others have — in the roughly 30 percent of people with major depression who, like Bennett, don’t respond to other treatments. It also works fast, a major advantage for suicidal patients who can’t wait weeks for traditional antidepressants to kick in.“When you prescribe Prozac, you have to convince people that it’s worth taking a medication for several weeks,” says John Krystal, a psychiatrist and neuroscientist at Yale University in New Haven, Connecticut. “With ketamine, patients may feel better that day, or by the next morning.”The buzz around ketamine can drown out just how little is known about the drug. In the April 2017 JAMA Psychiatry, the American Psychiatric Association published an analysis of the evidence for ketamine treatment noting that there are few published data on the safety of repeated use, although studies of ketamine abusers — who typically use much higher doses — show that the drug can cause memory loss and bladder damage. Most clinical trials of the low dose used for depression have looked at only a single dose, following up on patients for just a week or two, so scientists don’t know if it’s safe to take the drug repeatedly over long periods. But that’s exactly what might be necessary to keep depression at bay.The analysis also warned about ketamine’s well-established potential for abuse. Used recreationally, large doses of the drug are known to be addictive — there’s some evidence that ketamine can bind to opioid receptors, raising alarms that even low doses could lead to dependence.Bennett has now been receiving regular ketamine injections for 17 years, with few negative side effects, she says. She doesn’t consider herself addicted to ketamine because she feels no desire to take it between scheduled appointments. But she does feel dependent on the drug, in the same way that a person with high blood pressure takes medication for hypertension, she says.Still, she acknowledges what most clinicians and researchers contend: There simply aren't enough data to know what the optimal dose for depression is, who is most likely to benefit from ketamine treatment and what long-term treatment should look like. “There’s a lot that we don’t know about how to use this tool,” Bennett says. “What’s the best dose? What’s the best route of administration? How frequently do you give ketamine treatment? What does maintenance look like? Is it OK to use this in an ongoing way?”Despite the unknowns, pharmaceutical companies have been racing to bring the first ketamine-based antidepressant to market. In March, the US Food and Drug Administration approved a ketamine-derived nasal spray, esketamine, developed by Janssen Pharmaceuticals, a subsidiary of Johnson & Johnson. Only two of Janssen’s five phase III trials had shown a benefit greater than taking a placebo. Still, in February an independent panel recommended FDA approval. That makes ketamine the first novel depression drug to hit the market in more than 50 years, notes Carlos Zarate Jr, a psychiatrist who studies mood disorder therapies at the National Institute of Mental Health.Thousands of people are already flocking to private clinics like Bennett’s, which provide intravenous ketamine infusions. Because the drug was approved in the 1970s as an anesthetic, physicians can legally provide the drug as an “off-label” depression treatment. Many ketamine clinics have long waiting lists or are so swamped that they aren’t accepting new patients, and Janssen’s nasal spray could rapidly expand access to treatment.But some researchers worry that the nasal spray won’t solve many of ketamine’s problems and could create new ones. Although the FDA is requiring that the nasal spray be administered only in a certified doctor’s office or clinic, esketamine is “every bit as habit forming as regular ketamine,” and will be difficult to keep out of the hands of abusers, says Scott Thompson, a neuroscientist at the University of Maryland and a coauthor with Zarate of a 2019 review on fast-acting antidepressants in the Annual Review of Pharmacology and Toxicology. A nasal spray can’t deliver as precise a dose as an IV infusion, Thompson notes. “If someone has got a cold, they’re not going to get the same dose.”In Thompson’s view, esketamine holds few advantages over generic ketamine, which costs less than a dollar per dose, although the IV infusions in private clinics often cost hundreds of dollars per visit. Janssen has indicated that each esketamine treatment will range from $590 to $885, not including the costs of administration and observation. Zarate and others are still thrilled to see big pharma investing in ketamine, after decades of stalled efforts to find new psychiatric drugs. “As esketamine hits the market, venture capitalists will come up with better versions and move the field forward,” Zarate says. Several drug companies are now testing other ketamine-like compounds in hopes of developing drugs that have its potent antidepressant potential without its psychedelic and dissociative side effects.Depression, fast and slowIn 2001, writer Andrew Solomon published a haunting description of the depression that derailed his early 30s: “If one imagines a soul of iron that weathers with grief and rusts with mild depression, then major depression is the startling collapse of a whole structure,” he wrote.When Solomon first fell ill, in the 1990s, many clinicians and researchers presumed that the pathological brain changes underlying depression were inherently slow to repair. This mind-set was rooted in the modest but controversial success of a class of slow-acting drugs that includes Prozac.Developed in the 1950s, the drugs were first inspired by the chance observation that a hypertension drug called reserpine – an extract of the plant Rauwolfia serpentina, or devil pepper — made people intensely depressed. After discovering that reserpine depletes monoamine neurotransmitters in the brain, including serotonin and norepinephrine, scientists hypothesized that low neurotransmitter levels cause depression. They went on to develop monoaminergic antidepressants, drugs designed to increase circulating levels of these chemicals in the brain.Today, monoaminergic antidepressants include selective serotonin reuptake inhibitors (SSRIs) such as Prozac, Lexapro and Zoloft, as well as the older and less commonly prescribed monoamine oxidase inhibitors (MAOIs) and tricyclic and tetracyclic antidepressants. Scientists have long debated whether the drugs work at all, but the most comprehensive study to date — published in The Lancet in 2018 — suggests that they do lower depression symptoms in about 60 percent of depressed people, albeit only modestly more than taking a placebo.The benefits start to show up only after several weeks of treatment, however, and roughly a third of people with major depression disorder – called treatment-resistant patients — don’t respond to at least two types of monoaminergic antidepressant.By the early 2000s, the monoamine hypothesis had unraveled. This was partly due to the antidepressants’ mediocre performance in patients, and partly to experiments which showed that depleting neurotransmitter levels in healthy people does not make people depressed. Scientists now believe that drugs like Prozac do not directly treat depression’s root cause. Instead, they think the drugs work via an indirect mechanism to subtly boost the growth of synapses and the birth of new neurons, and that this somehow relieves symptoms.Solomon’s bleak metaphor of corrosion was at least partly grounded in science. Many scientists now agree that depression slowly eats away at the neural pathways underlying our sense of worth and well-being, our desire to go to the movies or get out of bed. But research into ketamine holds out new hope that — unlike rusted iron — the depressed brain can be restored, by repairing and strengthening the neural circuits that regulate mood. —Emily UnderwoodSome researchers are also testing whether ketamine works for conditions beyond depression, such as obsessive-compulsive disorder, as well as in specific subsets of patients, such as severely depressed teenagers. Other scientists are using ketamine to help untangle one of the biggest mysteries in neuroscience: What causes depression? (See sidebar.)Seeking answers in neural wiringThirty years ago, the prevailing thought was that low levels of certain brain chemicals, such as serotonin, caused depression. Boosting those could remove symptoms.“I felt that depression needed months or weeks of treatment — that the plastic changes involved in the healing process would require weeks to reset themselves,” says Todd Gould, a neuropharmacologist at the University of Maryland and a coauthor of the recent review paper. But ketamine’s speed of action casts doubt on that idea.Newer evidence suggests that depression is caused by problems in the neural circuits that regulate mood, Gould notes. Much of the evidence for this faulty-wiring hypothesis comes from rodents. Starting in the 1990s, scientists began to discover intriguing abnormalities in the brains of mice and rats that had been exposed to certain stressors, such as bullying by a big, aggressive male.Stress and trauma are strong predictors of depression in people, but scientists can’t ask rats or mice if they are depressed. Instead, they use behavioral tests for classic depression symptoms such as anhedonia, the inability to take joy in pleasurable activities, Thompson says. Depressed animals “give up easily” in experiments that test their willingness to work for rewards like sugar water, or their interest in the intoxicating scent of a potential mate’s urine. “They can’t be bothered to cross the cage,” he says.Thompson and others have found that there are fewer connections, or synapses, between neurons that communicate reward signals in the brain in depressed animals. Other labs have found shriveled connections in neuronal circuits key to decision-making, attention and memory. Brain imaging studies in people with depression have also revealed abnormal activity in neural circuits that regulate emotion, suggesting that the findings in rodents may also apply to humans.If faulty neural connections are to blame for depression, the next question is, “How do we get atrophied neural pathways to regrow?” Krystal says.Circuit trainingThe answer, many scientists now believe, is the brain’s most abundant neurotransmitter, glutamate.Glutamate is the workhorse of the brain. It relays fleeting thoughts and feelings, and enables the formation of memories by strengthening synaptic connections. Glutamate is the reason you can still ride a bike years after you learned, even if you never practiced.Not all glutamate activity is good. Too much can cause the equivalent of an electrical storm in the brain — a seizure — and chronically high levels may lead to dementia. Abnormalities in glutamate receptors — specialized proteins on the surface of brain cells where glutamate can dock and bind — are linked to a wide array of psychiatric diseases, including depression and schizophrenia.To maintain balance, cells called inhibitory interneurons act like brakes, releasing a neurotransmitter called GABA that quiets brain activity. Most mind-altering drugs work by changing the balance between GABA and glutamate — amphetamines and PCP enhance glutamate signaling, for example, while alcohol inhibits glutamate and boosts GABA.By the 1990s, scientists had discovered that ketamine triggers a gush of glutamate in the brain’s prefrontal cortex. This region governs attention and plays an important role in emotional regulation. The out-of-body sensations that some people experience when they take ketamine may occur because this rapid release of glutamate “excites the heck out of a whole bunch of neurons” in the prefrontal cortex, says Bita Moghaddam, a neuroscientist at Oregon Health & Science University who discovered the drug’s glutamate-revving effect on rats while studying schizophrenia.Scientists aren’t sure yet how ketamine forms stronger neural circuits. But the hypothesis goes roughly like this: When ketamine enters the brain, it causes a short-term burst of neuronal activity that triggers a series of biochemical reactions that create stronger, more plentiful synaptic connections between brain cells.At first, many researchers thought ketamine’s antidepressant effects relied on a structure located on the surface of neurons, called the NMDA receptor. Like a key that fits into different locks, ketamine can bind to several types of NMDA receptor, making neurons release the excitatory glutamate neurotransmitter.This hypothesis suffered a blow, however, when several drugs designed to bind to the NMDA receptor (as ketamine does) failed in clinical trials for depression.Esketamine also complicates the story. Ketamine is made up of two molecules that form mirror images of each other, R- and S-ketamine. Esketamine is made up of just the S form and binds roughly four times as effectively as R-ketamine to the NMDA receptor. Despite acting much more powerfully on the NMDA receptor, studies in rodents suggest that S-ketamine is a less potent antidepressant than R-ketamine, although it’s not yet clear whether or not R-ketamine could work better in humans.Zarate and others now believe ketamine may work through a different receptor that binds glutamate, called AMPA. By pinpointing which receptor ketamine acts on, researchers hope to develop a similar drug with fewer side effects. One hot lead is a compound called hydroxynorketamine (HNK) — a metabolic byproduct of ketamine that does not affect NMDA receptors but still produces rapid antidepressant effects in rodents. The drug appears to lack ketamine’s disorienting side effects, and Zarate and Gould plan to launch the first small clinical trials to establish HNK’s safety in humans this year, likely in around 70 people. “I think we have a very good drug candidate,” Gould says. (Zarate and Gould, among others, have disclosed that they are listed on patents for HNK, so they stand to share in any future royalties received by their employers.)Plastic synaptic remodelersTo alter how the brain processes mood, scientists believe ketamine must ultimately change synapses. In experiments in rodents, Ron Duman of Yale University has shown that both ketamine and HNK can harness one of the brain’s most important tools for synaptic remodeling: brain-derived neurotrophic factor, or BDNF.BDNF is a protein intimately involved in shaping synapses during brain development and throughout the lifespan. Healthy brain function depends on having just the right amount of BDNF in the right place at the right time. Many mental illnesses, including depression, are associated with low or abnormal amounts of the protein. For example, samples of brain tissue from people who have died by suicide often contain abnormally low amounts of BDNF.Duman and colleagues have found that both ketamine and HNK cause a sharp uptick in the amount of BDNF that is released from neurons. This increase is required for the drugs’ antidepressant effects, and for the increase in dendritic spines — the stubby protrusions that form synaptic connections with other neurons. Both ketamine and HNK also seem to reduce inflammation, which has been linked repeatedly to the stress-induced loss of synapses.Ketamine is not the only compound that can induce rapid synaptic plasticity: Other psychedelics, such as ecstasy (MDMA), acid (LSD), and DMT also trigger similar structural changes in neurons and rapid antidepressant effects in rodents, researchers at the University of California at Davis recently found. The effects don’t hinge on getting high, the team reported in March in ACS Chemical Neuroscience. Even very small doses — too low to cause perceptual distortions — can increase synapse density and lift depression.Traditional antidepressants such as Prozac also increase BDNF levels in the brain, but not nearly as fast as ketamine does, Duman says. That is why most antidepressants take so long to remodel synapses and relieve depression symptoms, he says. Dissecting depressionBeyond promising new treatments, Zarate and other researchers see ketamine as a powerful tool for probing depression’s tangled neurobiology. Studies in mice and rats are a good start, but scientists need to study the drug in people to truly understand how ketamine affects the brain. Unlike traditional, slower-acting antidepressants, ketamine lends itself to short-term lab experiments.Zarate is using neuroimaging tools such as fMRI to study the human brain on ketamine. Past studies have shown that in people with depression, communication among several key brain networks is disrupted. One network, called the default-mode network (DMN), is involved in self-referential thoughts such as ruminating about one’s problems or flaws. This network tends to be hyperactive in people with depression, and less connected to more outwardly attuned brain networks such as the salience network, which helps the brain notice and respond to its surroundings.In one recent study, Zarate and his colleagues found that after receiving an IV dose of ketamine, people with depression had more normal activity in the default mode network, and that it was better connected to the salience network. At least temporarily, the drug seems to help people get unstuck from patterns of brain activity associated with repetitive, negative thoughts. Zarate does caution that the study results need to be replicated.The team has also used brain imaging to study how ketamine affects suicidal thoughts. About four hours after an infusion of ketamine, a chunk of the prefrontal cortex that is hyperactive in people with depression had calmed down, researchers found, which correlated with people reporting fewer thoughts of suicide.Ketamine also seems to tune other brain regions that are key to effective treatment. Last year, scientists published a study in mice showing that ketamine quiets abnormal activity in the lateral habenula, a small nodule wedged deep under the cortex. Some researchers have described the lateral habenula as the brain’s “disappointment center.” The region is responsible for learning from negative experiences, and is hyperactive in people with depression, as if “broadcasting negative feelings and thoughts,” Thompson says.Such studies remain exploratory. As to why ketamine works — and just as important, why its effects are transient — scientists are still speculating. “I think ketamine is resetting neural circuits in a way that improves the symptoms of depression, but the risk factors — whether genetic, environmental or other risk factors — are still present,” Gould says. “It seems to help reset things temporarily, but the underlying cause is not necessarily resolved.”Helen Mayberg, a neurologist at Mount Sinai Hospital in New York who specializes in using an experimental procedure called deep brain stimulation to treat depression, suggests that ketamine may be like using a defibrillator on someone experiencing cardiac arrhythmia. “I am not addressing the fact that you have underlying heart disease, but now that your arrhythmia is gone, I can concentrate on other treatments.”It’s important to put the potential risks of ketamine into perspective, particularly for people contemplating suicide, researchers emphasize. Most people are willing to tolerate severe side effects for other life-saving treatments, such as cancer drugs, Mayberg points out. “If you can interrupt an extreme suicidal plan and ideation, I’ll take that.”Ketamine in teens?For Krystal, weighing ketamine’s still largely uncharted risks and potential rewards ultimately comes down to a deeply personal question: “What would we want for ourselves? For our families? Do we want them to have to go through several failed trials over several months, or even a year, before taking a medication that might make their depression better in 24 hours?”Some of the hardest decisions are likely to involve children and adolescents. Hospitalization for youth suicide attempts and ideation nearly doubled between 2008 and 2015, leaving many clinicians — and parents — desperate for more effective and rapid treatments. Left untreated, depression is “really bad for the brain” and can cause serious, long-term cognitive and developmental problems when it starts young, Zarate says. “The question is, is that going to be better than the long-term side effects of ketamine?”Untreated depression is really bad for the brain, especially in the young. The question is, is that going to be better than the long-term side effects of ketamine?Scientists don’t yet know. Ketamine has been deemed safe to use as an anesthetic in children, but there aren't yet sufficient clinical data to show how low, repeated doses of ketamine used for depression could affect the developing brain.On a more fundamental level, scientists don’t fully understand the neurobiology of adolescent depression, notes psychiatrist Kathryn Cullen of the University of Minnesota. It may involve abnormalities in brain development, such as the way the prefrontal cortex connects to brain regions that process emotion, but “we don’t know if the brain connection abnormalities emerge because of toxic stress induced by depression, or if these abnormalities predispose people to develop depression, or if depression itself reflects abnormal development,” Cullen says. “It’s critical to figure out how to alleviate the biological changes that are associated with [teen] depression so that the brain can get back on a healthy trajectory.”Two recent clinical trials — one at Yale and another at Minnesota run by Cullen — have found that ketamine can lower symptoms in severely depressed teenagers, but neither study was set up to follow the teenagers long-term, says Cullen. Janssen is currently running a trial of its esketamine nasal spray with 145 youths who are suicidal, but the results of that study have not been published yet. Cullen thinks ketamine has potential for use in teens, particularly to avoid suicide, but “there are still a lot of unknowns.”Not just a quick fixWorldwide, depression afflicts more than 300 million people, making it the leading global cause of disability. When contemplating such overwhelming misery, the vision of a world in which depression can be cured with a single injection or squirt of nasal spray holds obvious appeal.But — despite the hype — that is not what ketamine offers, Bennett says. Based on her own experience as a patient, and her clinical work, she is troubled by the framing of ketamine as a “rapid” depression treatment if that precludes the slower, more effortful process of psychotherapy. Without psychotherapy, she says, “you’re not giving patients any tools to help themselves, just making them dependent on a molecule that has temporary effects. When the effect wears off, they have to go back for more medicine. This is going to be lucrative for the pharmaceutical company but probably not in the patient’s best interest.”In Bennett’s clinic, ketamine is administered only alongside talk therapy, which she uses to prepare patients before they take ketamine, and afterward to help them process the experience. “I think this is the only ethical way” to administer a drug that can trigger disorienting psychedelic experiences, she says. “This isn’t a ‘take two and call me in the morning’ situation.”There’s growing scientific interest in whether ketamine can enhance the effectiveness of therapy by increasing the brain’s ability to remodel circuits through experience, Krystal notes. And in 2017 a small Yale study found that providing cognitive behavioral therapy in tandem with ketamine can extend the drug’s antidepressant effects.Unlike some researchers and pharmaceutical companies, which consider ketamine’s and esketamine’s hallucinogenic side effects inherently negative, Bennett thinks that for some people the visions can be positive — particularly in the context of therapy. There’s scant scientific evidence to support the idea that such hallucinations are therapeutic, and they can be deeply disturbing for some people. (If people who experience hallucinations do better, it may simply be because they have received a higher dose of ketamine, Krystal points out.)Still, Bennett thinks researchers and clinicians need to stay open-minded about why ketamine is helping people — and be more attentive to the settings in which ketamine and esketamine are administered. “People consistently report that they experience the presence of God, or their own sacredness,” she says. “When someone comes to my office wanting to kill themselves, ready to die — and then they have a transformational moment where they believe their life is sacred — it’s indescribable how exciting that is as a clinician.”10.1146/knowable-032819-1 Emily Underwood is a freelance science writer and contributing correspondent for Science magazine. She is based in Coloma, California. Email: emily.l.underwood@gmail.com. Twitter: @em_underwood.This article originally appeared in Knowable Magazine, an independent journalistic endeavor from Annual Reviews. Sign up for the newsletter.

The 12 Steps of Christmas

How it Works - Yuletide EditionAdmitted we were powerless over the string of Christmas lights with three dead bulbs, mom’s green bean casserole and Aunt Barb’s warbling operatic rendition of O Holy Night.Came to believe that a power greater than us would deliver a brand new Toyota Tundra into the driveway in the morning.Made a decision to turn our will and our lives over to Amazon Prime next day delivery because we forgot that Uncle Dan was flying in on the Red Eye with his 5 kids.Made a searching and fearless inventory of our childhood bedrooms looking for proof that the 80’s really did happen even though we can’t remember.Admitted to anyone within earshot that we baked weed into the brownies we brought for Christmas dinner two years before.Were entirely ready to remove all the defects of character in every person seated at the table; by force if necessary.Humbly asked dad to remove the shortcomings in our bank account with a big fat Christmas check.Made a list of all the relatives who were going to ask “why aren’t you drinking?” and became willing to tell them to fuck off.Made direct deposits into the accounts of every family member from whom we had stolen money in the past; except when to do so would leave us short on rent.Continued to take inventory and when we found our hidden stash of coke from 12 years ago, promptly flushed it down the toilet.Sought through chocolate and the Hallmark Channel to improve our overall Christmas spirit as we understand it.Having survived the family Christmas still sober, we rushed home to our cats and our Darjeeling tea before remembering the world’s favorite drinking holiday is just seven days away.Happy holidays!

Stressed and Sober

“I could sure use a drink.”It’s a popular saying, an easy way to blow off steam after a stressful day or week. But for people in recovery, dealing with stress isn’t as simple as turning to alcohol (or drugs) for substance-infused relaxation. Once you’re living sober, there’s no easy way to mask your stress. Instead, you have to deal with it head-on. Unexpected emergencies or events, like the ongoing wildfires that are devastating California, can really challenge your recovery, no matter how long you’ve been sober. Personal tragedies or challenges can have the same affect. However, your recovery experience can also be a source of strength. The lessons you’ve learned in sobriety can help you get through other dire situations. With that, you can also help others. Here are some tips for staying sober, even when life is throwing curveballs. Be Honest About What’s in Your ControlMost people in recovery are familiar with the serenity prayer: “God grant me the serenity to accept the things I cannot change, Courage to change the things I can, And wisdom to know the difference.”No matter what your higher power, the lessons in this prayer are important throughout recovery, especially in time of stress. When you’re dealing with an unexpected event, take a moment to decide what’s in your control. You might feel better after packing an emergency bag if fires are near your area, for example. Exerting control where you can is empowering. However, what’s even more important is to remember what you cannot control. Trying to manage things that are uncontrollable, like hoping the fires do not come your way, can be exhausting and frustrating. It’s best to acknowledge where your limits are, and not waste time on things beyond your control. Lean Into Your Recovery CommunityIf you’re living sober, you can’t unwind with a drink at the end of the day. However, you can do something much healthier: go to a meeting, or go for a walk with someone who is also in recovery. Having open conversations about your fears and worries can help you process them, rather than just masking them with a chemical high. This can be especially helpful when you’re dealing with a local disaster. Most 12-step meeting are hyper local. That means that many people in your meeting are dealing with similar anxieties and fears, and can understand what you’re going through. Plus, they’ll understand navigating difficulties while dealing with the day-to-day of life in recovery. Watch for Relapse SignsAny time you’re dealing with increased stress, you are more at-risk for relapse. That’s why it’s important to be self-aware during times when you’re dealing with the unexpected. Be on the lookout for relapse warning signs that indicate that you’re struggling in recovery. For example, you might stop going to meetings, or start spending more time with the people who are unhealthy for you. If you notice that your recovery is faltering, reach out for help. Talking to a sponsor or trusted friend can help you get back on track before you really slip up. And, if you do end up using, remember that relapse is a normal part of recovery. The important part is getting help to get back on track as soon as possible. Remember, You Are ResilientIn recovery, we’re told to take things one day at a time. This is good advice for dealing with unexpected emergencies as well. Sometimes, when it seems like you can’t go on because of stress of uncertainty, remember that you just have to get through today. Everything is much more manageable when you’re only thinking about the next 24 hours. That’s one lesson that recovery has taught you, but the truth is that your whole recovery experience can fortify you in trying times. You’ve already overcome the odds and changed your life. You now know from experience that you can cope with whatever comes your way: even if it seems entirely overwhelming right now. Asana Recovery offers residential and outpatient treatment in Costa Mesa, California. Learn more by calling 949-438-4504.

The Pharmacy, the Pills and the Crisis

By Jenn Abelson, Aaron Williams, Andrew Ba Tran, Meryl Kornfield, Investigative Reporting WorkshopAt the height of the opioid epidemic, Walgreens handled nearly one out of every five oxycodone and hydrocodone pills shipped to pharmacies across America.Walgreens dominated the nation’s retail opioid market from 2006 through 2012, buying about 13 billion pills — 3 billion more than CVS, its closest competitor, according to a Drug Enforcement Administration database of opioid shipments. Over those years, Walgreens more than doubled its purchases of oxycodone.The company had “runaway growth” of oxycodone sales because it continued to send pills to stores “without limit or review,” Edward Bratton, Walgreens manager of pharmaceutical integrity, wrote to another employee in 2013. The email is among thousands of documents recently disclosed in a federal lawsuit that seeks to hold Walgreens and other businesses responsible for the nation’s opioid crisis.While most chain and independent pharmacies relied heavily on wholesalers to supply their prescription opioids, Walgreens obtained 97 percent of its pain pills directly from drug manufacturers, a Washington Post analysis of the data shows. This arrangement allowed Walgreens to have more control over how many pain pills it sent to its stores.By acting as its own distributor, Walgreens took on the responsibility of alerting the DEA to suspicious orders by its own pharmacies and stopping those shipments. Instead, about 2,400 cities and counties nationwide allege that Walgreens failed to report signs of diversion and incentivized pharmacists with bonuses to fill more prescriptions of highly addictive opioids.From 2006 through 2012, Walgreens ordered 31 percent more oxycodone and hydrocodone pills per store on average than CVS pharmacies, and 73 percent more than other pharmacies nationwide, according to The Post’s analysis of the DEA database, known as the Automation of Reports and Consolidated Orders System (ARCOS).When Walgreens considered surveying its pharmacies in Florida in 2011 to identify questionable pain pill customers, a company attorney advised caution: “If these are legitimate indicators of inappropriate prescriptions perhaps we should consider not documenting our own potential noncompliance,” according to an email disclosed in the case.In 2012, a drug distributor produced a report for Walgreens that flagged nearly half of the chain’s roughly 8,000 stores for dispensing high numbers of controlled substances, including oxycodone, court records show.After warnings from the DEA, Walgreens agreed in 2013 to pay $80 million — a record settlement for the agency at the time — to resolve allegations that the company failed to sufficiently report suspicious orders and negligently allowed controlled substances, such as oxycodone and other prescription pain medications, to be diverted for abuse and illegal black market sales.The large volume of pills flowing into Walgreens pharmacies made some stores targets for crime, including armed robberies and employee theft, according to police officials, board of pharmacy records and other published reports. In 2014, a pharmacy technician who stole about 25,000 pain pills from a Walgreens in Missouri told state investigators that another employee gave him instructions on how to pilfer the pills and sell them during breaks in the store bathroom and pharmacy parking lot.Now, Walgreens is one of the holdouts in the federal suit playing out in Cleveland after other major distributors and drug manufacturers reached a settlement with two Ohio counties on Oct. 21. The trial for Walgreens was postponed until next year. CVS and other major pharmacy chains are also defendants.“Because Walgreens had full visibility into all dispensing related information necessary to reveal red flags and criteria of suspicion, Walgreens might even be viewed as more culpable due to the wealth [of] data at its complete disposal,” the plaintiffs allege.“Walgreens might even be viewed as more culpable due to the wealth [of] data at its complete disposal.”The company denied that it incentivized pharmacists to inappropriately fill prescriptions and defended its practices in statements.“Walgreens is completely unlike the wholesalers involved in the national opioid litigation. We never sold opioid medications to pain clinics, internet pharmacies or the ‘pill mills’ that fueled the national opioid crisis,” the company said. “We never marketed or promoted opioid medications.”Walgreens also said the pain pill data is “misleading” because the records are seven years old and the chain stopped the internal distribution of controlled substances to its pharmacies in 2014.Employees were “incredibly diligent and careful” to ensure that pharmacies were not involved in diversion, the company said. “We proudly stand by our pharmacy professionals and their record of professional judgment and patient care.”A Directed Effort’ To Increase SalesWalgreens traces its roots to 1901, when Charles Walgreen Sr. pulled together enough money for a down payment on the pharmacy where he worked on Chicago’s South Side. He shook up the business by adding more merchandise and making some of the drugs himself to keep prices low.His model was successful, and over the next two decades he opened about 20 stores. Today, the company operates 9,277 pharmacies in all 50 states and the District of Columbia.As the demand for opioids increased in the early 2000s, Walgreens expanded its internal distribution network. The company added two facilities in Ohio and Florida that had special security to handle controlled substances, including oxycodone. It was an advantage over CVS, which relied entirely on outside suppliers for the medication.In 2006, though, regulators found problems with Walgreens’s distribution network. In May of that year, the DEA sent the company a letter detailing record-keeping and security deficiencies that the agency discovered during an investigation at the Walgreens facility in Perrysburg, Ohio, according to documents filed in the Cleveland court case.The DEA said Walgreens had an “insufficient” system for reporting suspicious orders of controlled substances. At the time, Walgreens identified questionable orders by analyzing the average daily prescriptions filled by stores in groups of 25, an internal memo shows. The DEA told the company that the size, pattern and frequency of orders should instead be used to flag suspicious ones.Two years later, Walgreens conducted an internal audit of its Perrysburg facility and discovered officials there had not properly overhauled the suspicious-order system to comply with the DEA. The audit, filed in court, noted this was an issue at all company distribution centers and “should be addressed to avoid potential DEA sanctions.”In 2009, Walgreens began testing a new method at several stores that identified suspicious orders based on order size and frequency. But an internal company document filed in court stated that Walgreens was “capturing data but not cutting orders.”As the opioid crisis deepened, the DEA stepped up enforcement against drug manufacturers, distributors and pharmacies. The agency again turned its attention to Walgreens and threatened in a 2009 letter to revoke the registration of a store in San Diego.A DEA investigation found that the San Diego store on Midway Drive had filled prescriptions issued by doctors who weren’t licensed in California. It also had dispensed prescriptions to people the pharmacy “knew or should have known were diverting the controlled substances,” agency enforcement records show. One customer over seven months obtained prescriptions for hydrocodone issued by four Florida physicians — an indication that she was “doctor-shopping” to procure pain pills, the DEA record shows.In April 2011, Walgreens entered into an agreement with the DEA to settle the case. The company promised to maintain a program to detect and prevent diversion of controlled substances from its stores across the country.The DEA would later discover that Walgreens had been engaged in “a directed effort to increase oxycodone sales,” agency records show. In a July 29, 2010, email, Walgreens sent out a spreadsheet to managers ranking all Florida pharmacies on their oxycodone dispensing with the instruction to “look at the stores on the bottom end . . . We need to make sure we aren’t turning legitimate scripts away.”Meanwhile, changes in the state’s laws over the years had shifted sales of prescription opioids from pain clinics to pharmacies. Soon the chain was grappling with a surge of pain pill customers in Florida.Kristine Atwell, who managed distribution of controlled substances at Walgreens’s Jupiter facility, had emailed corporate headquarters urging that stores justify their large volumes, including one pharmacy that ordered 3,271 bottles of oxycodone in a 40-day period.“I don’t know how they can even house this many bottle(s) to be honest,” Atwell wrote in early 2011 in an email previously reported on in The Post.A few months later, Walgreens decided to review the “significant increase” in controlled substance prescriptions in Florida, according to company emails filed in court.As part of its broader business initiative called “Florida Focus on Profit,” Walgreens officials discussed surveying some of its pharmacies. The proposed questions included, “Do pain management clinic patients come all at once or in a steady stream?” and “Do you see an increase in pain management prescriptions on the day the warehouse order is received?”But Dwayne Pinon, a Walgreens attorney, warned against “documenting our own potential noncompliance” and the questions were dropped from the survey, court records show. Pinon, through a company spokesman, declined to comment.Walgreens eventually renamed the survey effort “Focus on Compliance” after an employee in an email questioned the “Focus on Profit” title.For the first half of 2011, Walgreens accounted for 100 of the top 300 pharmacies in oxycodone purchases in Florida, and some of these company stores bought more than double the average amount of the opioid obtained by other pharmacies in the state, according to DEA enforcement records.For the first half of 2011, Walgreens accounted for 100 of the top 300 pharmacies in oxycodone purchases in Florida.Agency investigators met with Walgreens officials that August to express concerns about the high volume of pills. In advance of the meeting, Walgreens sent a disc to the DEA with a file labeled “suspicious drug” orders.“This gobbledygook is impossible to read and I stopped printing it when it reached 2” [inches] thick,” a DEA investigator wrote in an email to her colleagues after the meeting. “Obviously this is unacceptable.”Days after the DEA meeting, Walgreens devised a plan to restrict a store in Hudson, Fla., to a monthly 100 bottles of 30-milligram oxycodone, one of the most coveted pain pills on the black market because of its potency, according to DEA enforcement records. But the pharmacy routinely exceeded the limit, procuring 331 bottles in September 2011, 371 bottles in October, 200 bottles in November and 263 bottles in December, DEA enforcement records show.Some Walgreens stores attracted so many pain pill customers that the pharmacies had to hire security or call the police.In Oviedo, Fla., large crowds began waiting for the Walgreens on Lockwood Boulevard to open. Between August 2010 and November 2011, Oviedo police responded to 17 incidents at that location, arresting 35 people for charges related to controlled substances.Oviedo Police Chief Jeffrey Chudnow wrote dozens of letters and contacted Walgreens’s chairman and chief executive in March 2011 to plead for help and let them know the pharmacy parking lots at two company stores in the city had “become a bastion of illegal drug sales and drug use.”Chudnow, who has since retired, told The Post that he never received a response.The Lockwood Boulevard store doubled the number of 30-milligram oxycodone pills it ordered from 73,300 in March 2011 to 145,400 pills in July 2011, according to the DEA data. The Post and HD Media, which publishes the Charleston Gazette-Mail in West Virginia, fought a year-long legal battle for access to the DEA database.Nationwide, the explosion in pain pills helped fuel crime. Armed robberies spiked at independent and chain pharmacies. Some stores were repeatedly targeted.In Michigan, a Walgreens pharmacist purchased a gun to protect himself after the company refused to improve security following a 2007 robbery, the pharmacist alleged in a lawsuit. In 2011, the pharmacist shot at two masked gunmen during a robbery attempt on an overnight shift. No one was harmed, but the pharmacist was fired and sued Walgreens.Later that year, an armed gunman who fled after demanding painkillers at a Walgreens in Tennessee prompted a lockdown at nearby schools, according to police. In Colorado Springs, robbers hit multiple Walgreens pharmacies 14 times in 2011 and seven times in February 2012.Gaps in the SystemAs pharmacy robberies made headlines, the DEA escalated its investigation of Walgreens. The agency served warrants on six stores scattered across Florida and the Jupiter distribution center in spring 2012.Walgreens responded by slashing shipments of opioids to the six stores. In the event of the DEA shutting down the Jupiter location, the chain planned to shift distribution to outside suppliers and its Perrysburg, Ohio, facility, the same one the DEA had cited in 2006, according to company emails filed in the court case.During a meeting with the DEA, Walgreens told the agency it wanted to “cooperate and avoid litigation,” as stated in an internal company presentation from July 2012.Walgreens officials detailed steps the chain was taking to address the DEA’s concerns, including updated training for pharmacists to identify suspicious prescriptions. The company said while its suspicious-order monitoring program “did not automatically halt suspicious orders upon identifying them, it did systematically decrease [controlled substance] order quantities if the quantity ordered exceeded certain thresholds.”Later that summer, DEA investigators interviewed pharmacists at Walgreens stores in Fort Pierce, Fla.The DEA found that one of the pharmacists had filled at least seven oxycodone prescriptions issued by a Miami gynecologist, ignoring warnings other employees had left about the doctor in pharmacy records, including: “FAKE CII DO NOT FILL ANY CII CANDY DR.”The note referred to doctors who appeared to be writing bogus prescriptions for substances listed on Schedule II of the Controlled Substances Act.Questioned by the DEA about the prescriptions, the pharmacist said, “We should not have filled them,” according to agency enforcement records.In September 2012, the DEA employed its most severe enforcement action: Agents padlocked a vault containing oxycodone and other controlled substances at the Walgreens distribution center in Jupiter and later threatened to revoke the registrations of the six pharmacies.Walgreens responded by launching a task force and discussing ways to tighten up oversight of opioids distributed to its stores.When pharmacies hit limits imposed by Walgreens, they could still transfer pills from other stores or order from outside suppliers, court records show. Pharmacies could also find workarounds by placing special PDQ orders, meaning “pretty darn quick,” from Walgreens internal network.The company proposed eliminating PDQ orders for oxycodone, but Kermit Crawford, then a top executive at Walgreens who oversaw the pharmacy business, objected to the change.“I was not under the impression this was a done deal. Concerned we are ‘all or none,’ ” Crawford wrote in an Oct. 1, 2012, email disclosed in the case. “We have to do what’s right for patients also.”Crawford, who later became president and chief operating officer of the Rite Aid chain, declined to comment.At the same time, Walgreens wrestled with other gaps in the system.In October 2012, a Walgreens pharmacy in Modesto, Calif., came under scrutiny because it was purchasing about 17,500 pills containing hydrocodone per week, putting the drugstore “over the corporate limit” of the number of pills it was permitted to order, according to a company email cited in court records.To obtain more hydrocodone, the Modesto pharmacy, on McHenry Avenue, ordered pills from the distributor Cardinal Health, the document noted. When that set off red flags at Cardinal Health, the store transferred opioids from nearby Walgreens pharmacies, procuring so many pills that it led to shortages at the other stores.Walgreens conducted an investigation and discovered “employee pilferage” and fired an employee, company emails filed in court show. The Modesto pharmacy also stopped filling prescriptions from two local doctors.Cardinal Health, which had paid a $34 million fine in 2008 to settle allegations that it failed to report suspicious orders, declined to answer questions about the Modesto orders and said, “We are proud of our rigorous analytics system, including conservative, customer-specific thresholds, that we use to spot, stop, and report to our regulators any opioid order that is suspicious.”The McHenry Avenue Walgreens was the single largest purchaser of pain pills in the entire Walgreens chain from 2006 through 2012, and one out of every five oxycodone pills ordered was a 30-milligram tablet, The Post’s analysis found. Robbers targeted the store five times for prescription opioids from 2016 through 2018, police said.Walgreens said demand for opioids at the pharmacy was driven by hospitals, surgery centers and other pain treatment facilities in the area.“Walgreens thoroughly investigated concerns regarding this Modesto pharmacy after Cardinal raised them,” Walgreens said in its statement. “We found that the pharmacy was fully complying with all applicable internal policies and procedures for filling prescriptions for controlled substances.”A Dramatic StepIn November 2012, drug distributor Anda analyzed nearly 1.3 billion pills, including oxycodone, handled by Walgreens. The review “flagged” 3,768 of the chain’s pharmacies for dispensing high numbers of controlled substances in all 50 states, as well as Puerto Rico and Washington, D.C., court records show. The report, filed with redactions, identified 226 of 253 stores in Arizona, 64 of 69 pharmacies in Oregon and all 14 stores in Maine.Drug manufacturer Teva Pharmaceutical, which owns Anda, declined to comment.Soon after, Walgreens launched a new division called pharmacy integrity. Tasha Polster, who had served on the company’s task force, was tapped to lead that effort. (Polster is not related to Judge Dan Aaron Polster, who is presiding over the federal lawsuit).In December 2012, Polster emailed Dan Doyle, a Walgreens finance executive, and said without elaborating that the DEA was alleging the company’s suspicious-order monitoring program was “inadequate.” The DEA, she wrote in the email recently disclosed in court, was “demanding civil penalties, potentially totaling hundreds of millions of dollars.”Polster requested a team of a dozen people to review controlled substance orders before Walgreens shipped the drugs to its pharmacies.“The Company has enhanced its suspicious order monitoring program for controlled substances in an effort to convince DEA that the proposed penalty is excessive and that our new processes will ensure that similar incidents do not recur,” Polster wrote.A Walgreens spokesman said Polster and Doyle, who still work for the company, declined to comment.By the end of 2012, Walgreens’s orders of pain pills containing oxycodone and hydrocodone dipped to 2.2 billion from its peak of 2.4 billion the previous year, ARCOS data shows.But the DEA continued to investigate. In February 2013, the agency served a warrant and inspected the Perrysburg distribution center.In response, Walgreens halted shipments of controlled substances from Perrysburg. It was a dramatic move that Walgreens hoped would “eliminate any immediate need for further DEA administrative action,” three lawyers representing Walgreens wrote in a Feb. 20, 2013, letter to DEA officials that was filed in the court case.At first, Walgreens turned to Cardinal Health to distribute controlled substances to its pharmacies. But Cardinal Health had “red flagged” 367 Walgreens stores and would not ship to them because “they are considered suspicious,” according to internal emails between Walgreens employees.Cardinal Health, one of the defendants that recently reached a settlement in the national opioid litigation, did not respond to questions about its refusal to send pills to these Walgreens pharmacies.Walgreens soon found another distribution partner, AmerisourceBergen. In March 2013, Walgreens announced a deal that gave it an ownership stake in AmerisourceBergen in exchange for a distribution agreement.As the DEA investigations pressed on, Walgreens stopped filling pharmacy orders for opioids that exceeded certain limits, according to company documents filed in court.This prompted pill shortages and irate customers who complained to a corporate hotline.In June 2013, a pharmacy manager in Greenville, N.C., emailed the pharmacy integrity division that she had run out of oxycodone a week earlier and told customers the drugs would arrive that day. When the pills didn’t show up, she wrote that “luckily” she found bottles at another local Walgreens, court records show.“I placed a PDQ order for oxycodone . . . (one bottle will NOT be sufficient) – please send us this order ASAP! We are losing business over this!”The next day, Steven Mills, with the pharmacy integrity division, responded that PDQs should be used only in “an emergency situation.”“You have to realize the reason why we have issues with the DEA today, is due the high amounts of Oxycodone distributions over the past 3 years,” Mills wrote back in an email. “We had to create limits to all stores which protects the integrity of the Pharmacist, DEA license, and the Walgreen Company as a whole.”Half of the pain pills ordered by the Greenville store were oxycodone — nearly twice the average of all other pharmacies across the country, according to The Post’s analysis of DEA data from 2006 through 2012. Police said robbers targeted the store earlier this year and stole prescription pills, including opioids.The company said the Greenville pharmacy’s orders “were a legitimate reflection of the demands caused by its particular location and market, and Walgreens is unaware of any diversion of prescription pain medication at that pharmacy.” Mills, who still works at Walgreens, declined to comment through a company spokesman.On June 11, 2013, the DEA announced Walgreens had agreed to pay an $80 million civil penalty to resolve federal allegations that the pharmacy chain failed to sufficiently report suspicious orders and that the failure was a “systematic practice that resulted in at least tens of thousands of violations,” records show.In a statement at the time of the settlement, Crawford, of Walgreens’s pharmacy division, said, “As the largest pharmacy chain in the U.S., we are fully committed to doing our part to prevent prescription drug abuse.”Under the agreement, Walgreens admitted that it failed to uphold its obligations under the law and agreed to surrender its DEA registration for the Jupiter distribution center and six stores in Florida until 2014. The settlement addressed the claims in Florida and resolved open civil investigations into Walgreens by U.S. attorneys in Colorado, Michigan and New York, as well as other DEA field offices nationwide.In Colorado, federal investigators had identified over 1,600 violations of the Controlled Substances Act at Walgreens stores, including fraudulent prescriptions and the dispensing of controlled substances to customers without a prescription, according to the U.S. attorney’s office in Colorado.Employee TheftWalgreens eventually stopped the internal distribution of oxycodone and hydrocodone, although the company continued to purchase controlled substances from outside suppliers. The chain also removed sales of opioids from its bonus calculations for pharmacists, according to court records.The company declined to explain the change, but said dispensing volume was “one of many factors” used to determine bonuses. “The nominal compensation factor in question in no way incentivized pharmacists to inappropriately fill prescriptions for any medication,” Walgreens said.Although Walgreens had imposed limits on the number of opioid pills pharmacies could order, stores could submit override requests if they needed more.During 2014 and 2015, the company approved more than 95 percent of these override requests from stores for controlled substances — totaling thousands of orders — and boosted its overall sales of oxycodone, according to an internal presentation filed in court.As the pain pills kept flowing, so did problems with diversion. In 2015, Walgreens reported to the DEA that nearly 2 million doses of controlled substances were stolen or lost — a 16 percent increase from the previous year, documents filed in court show.Employee theft accounted for the largest share of missing pills, nearly one-third, followed by armed robberies and “unexplained loss,” the documents say. Pills containing oxycodone and hydrocodone topped the list.Walgreens’s business practices have drawn scrutiny from state regulators, as well. The boards that license the individual stores and pharmacists have documented problems at company stores such as inadequate security, delays in reporting thefts, inaccurate audits of controlled substances and insufficient vetting of employees.In Missouri, Walgreens employees allegedly have pilfered at least 138,000 pills containing hydrocodone and oxycodone from 19 stores since 2005, according to state board records. One of these cases involved a pharmacy technician at Walgreens who stole about 7,500 pain pills in summer 2016 and told investigators that she knew “how easy it would be” to take handfuls of pills and evade security cameras.The Post examined 67 investigations in 12 states in which pharmacy boards censured Walgreens or placed pharmacies on probation for violating state regulations, including inadequate security and theft of drugs. In some instances, the company had to pay fines.In July, Walgreens agreed to pay a $335,000 fine after the California State Board of Pharmacy discovered that the company had allowed a woman without a pharmacy degree or license to dispense prescriptions for over a decade.The employee, Kim Thien Le, had worked at Walgreens since 1999, rising from pharmacy cashier to pharmacy manager in 2016. She used the license numbers of other pharmacists to dispense 745,355 prescriptions at 395 pharmacies, including some remotely. In all, Le filled more than 100,000 prescriptions for controlled substances, such as oxycodone, hydrocodone and fentanyl, according to state records.Le, who was charged this summer with three felonies alleging she falsely impersonated licensed pharmacists, has a court date in January. An attorney representing Le declined to comment.The fine paid by Walgreens is one of the largest in the board’s history.Walgreens declined to answer questions about Le and other enforcement actions.“We take great pride in the judgment and patient care of our 28,000 pharmacists,” the company said. “In the event of a rare and isolated instance when we learn of an employee acting improperly, we act swiftly to address the matter and cooperate fully with law enforcement.”This story was originally published by the Investigative Reporting Workshop, a nonprofit,  nonpartisan newsroom at the American University School of Communication.

Andrew Yang Wants To Invest In Safe Consumption Sites

Democratic presidential candidate Andrew Yang discussed his plans to decriminalize opioids and the need for harm reduction sites during an interview featured on The Hill released this week. “I would not only decriminalize opiates for personal use but I would also invest in safe consumption sites around the country,” Yang told Krystal Ball in a recent interview. “You go home and you’re still addicted and you wind up in many cases overdosing again. We need to refer these people to counseling, treatment and safe consumption sites as needed.”Yang took Purdue Pharma and the government to task for their roles in the ongoing opioid epidemic.“At this point we have to say this was a systemic failure of capitalism run amok in the worst and most destructive way possible and that our government should come clean, claw back the resources from the drug companies and put them to work in communities to try to make people stronger and healthier—but also say to individuals who are struggling with addiction that this is not a crime of personal character, this is a systemic problem and if you’re using drugs and addicted, we should be referring you to counseling and treatment and not a prison cell,” he said.Julian Castro Is In Favor Of Safe Consumption Sites TooJulian Castro, another Democratic presidential candidate has made headlines recently for his statements on safe consumption sites. Castro discussed his views and policies while speaking at a forum hosted by the Iowa Harm Reduction Coalition. “I would like these communities to be able to pursue these safe consumption spaces and essentially pilot out how they work,” he said, according to Marijuana Moment. “I believe that we owe it to the effort to see how we can make sure that we avoid [overdose deaths].“We’ve been trying it one way for so long and I also believe, having been a mayor of a city, that one of the values of local communities is that they can try out policy in their own community and measure the results and see how it works. The system that we have in place right now doesn’t seem to be working very much at all. Whether it’s Philadelphia or its some of the other cities that have tried it, I believe that we should allow for the piloting of these programs and that that will help us come to a determination nationally about the approach.”Sanders & WarrenBernie Sanders and Elizabeth Warren have also expressed support for safe consumption sites in their platforms. 

Taraji P Henson Talks Therapy, Feeling Helpless

Academy Award winner Taraji P Henson has become a fierce mental health advocate in recent years. Since launching the Boris Lawrence Henson Foundation in honor of her late father who lived with mental illness, the Empire actress has shared her personal story in an effort to get people talking about mental health and hopefully inspiring members of the Black community to reach out for help.In an interview with Self magazine, the recently engaged actress got candid about mental health issues, having to be strong in the midst of helplessness and finding a good therapist with the help of a friend.“I hope that one day we can all be free to talk about mental health and be okay with seeking help,” she said.“There are some times where I feel absolutely helpless. That's human. Everybody feels like that. Just because I'm a black woman, don't put that strong-superhero thing on me.”Henson recognized that with a dayjob that consists of sometimes channeling negative emotions and invoking trauma, self-care is paramount so she found a productive way to recenter herself.Art As Therapy“Art is therapeutic for me,” she shared. “A lot of times when I have to reach these emotional places, I have to use things in my life, and a lot of times I've healed myself.”While art therapy has helped her deal with things, there were still other areas where Henson felt she had an opportunity to grow so she opted to enter talk therapy. “I had aligned all my chakras, and I still wanted to headbutt a bitch,” she joked. “The therapy came into play out of necessity. It was [a] time where I was like, ‘Oh, I'm just not feeling like myself anymore,’ and my son was going through his issues with becoming a young black male in America with no dad and no grandad." In 2003, Henson's son's father was murdered and three years later her own father passed away."It was like, ‘Okay, I'm not a professional. We both need help,’” she said.So Henson went in search of a therapist but like many, finding the right therapist for her needs was not as easy as she had hoped. But it would be her Empire co-star, Oscar-nominated actress Gabourey Sidibe who would recommend the perfect therapist for Henson - one that just so happened to be her own.Sidibe's TherapistSelf reached out to Sidibe about her decision to recommend and share her therapist with her co-star and friend.“It was extremely important for me to find a therapist who is a black woman, just because black women live in a different world than everyone else,” Sidibe wrote. “Our problems, daily interactions, and expectations are different than most other people, so I wanted a therapist who I could cut through the societal foundation of who I am with, so that we could get to my specific issues. There's a shorthand between us. We speak the same language because we're from the same world.”For Henson, finding care for herself was necessary but so is helping others in the community access help as well, something she is able to do with her foundation.“I think my mental health foundation picks up where my art leaves off,” Henson explained. “We have to deal with these traumatic situations [children experience], and these teachers and therapists and social workers need to be trained in cultural competency to be able to pinpoint [when a] child is having an issue that's deeper than just wanting to be bad in class.” 

Marijuana Vaping Busts Skyrocket

The recent wave of vaping illnesses and deaths has pushed authorities to crack down on illegal vaping cartridges, cranking the number of seizures of illegal marijuana vaping products through the roof in 2019.  According to the Associated Press, over the past two years more than 510,000 marijuana vaping cartridges have been seized by authorities across the nation. More than 120 people have been arrested in connection with the products. Big Busts In 2019In November a 30-year-old Minnesota man was caught speeding in Nebraska and police wound up searching his vehicle after "detecting the presence of a controlled substance." Inside the vehicle, they found 386 containers of THC wax, 144 packages of THC shatter, 62 THC vape cartridges, 39 containers of THC edibles and liquid products, and four pounds of marijuana. Nealry 1,000 pounds of marijuana and 2,000 vaping cartridges were seized during a routine traffic stop in North Texas in late November. The drugs were on their way to North Carolina. In October, a tip from a concerned anonymous source, led Wisconsin authorities seize more than 10,000 vaping cartridges, 18 pounds of marijuana and $950k. North Phoenix authorities had their own massive bust in September when they were able to seize $380,000 worth of drugs including THC vaping cartridges while serving a warrant. Daniel Ray Hawkins and Benjamin Blake Lumpkin were arrested in North Carolina. They stand accused of running a DMT lab (DMT AKA dimethyltryptamin is a powerful hallucinogenic drug) and putting DMT into marijuana vape pens. The DMT found inside the house was worth an estimated $4 million. “The solution to decreasing the risk associated with THC vapor products lies in continuing towards a legalized and regulated market, not increased criminalization and arrests,” said NORML Executive Director Erik Altieri.Vaping IllnessesWhile busts appear to be ramping up as vaping illnesses and deaths continue to rise on a daily basis. As of November 21, the CDC's Latest Outbreak Information for e-cigarette, or vaping, product use associated lung injuries (EVALI) reports that there are now 2,290 cases of EVALI and 47 deaths linked to the illness. Alaska, which was the only state unaffected by vaping illnesses, reported their first case on Tuesday. 

A Breathalyzer For Opioids Is In The Works

Researchers at UC Davis are working on a device that can detect the presence of opioids similar to the popular devices that detect alcohol on people's breath. "When we started this nobody knew you could measure drugs in breath," Professor Cristina Davis, the chair of the Mechanical & Aerospace Engineering Department at UC Davis, told CBS Sacramento.She along with her team of researchers helped develop the device, which they believe has the potential to save lives.How It WorksThe device in question is described as a "less invasive way to monitor a patient's drug use by collecting their breath in a small specialized machine. "Dr. Nicholas Kenyon, a member of the research team described the way the device works to CBS Sacramento. “We collect breath in a liquid format in this device and we chill it and then we collect it as a liquid and run it through a mass spectrometer to measure what’s in there.”The team believes that their device can help a multitude of professionals including doctors, firefighters, law enforcement and probation officers identify drug use. For doctors, the device could help them ensure patients aren't misusing their prescriptions. “A device like this could help tell if they’re taking the drugs like they’re supposed to,” Davis said.For police officers, the device can help identify drivers under the influence, while for probation officers could use the device to make sure that parolees remain sober.Davis has high hopes for the future of breath testing. “I would love to say in one to three years that we actually have people using this for one of the application areas and I think from there it will grow. I think over a five-to-10-year time frame, that breath testing won’t just be a story, it’ll actually be at your doctor’s office,” Davis said.Marijuana BreathalyzerAnother type of breathalyzer is being rolled out to combat driving under the influence of cannabis. Star Labs have created a device that uses nanotechnology to detect THC levels in breath. While breathalzyers for alcohol use have been in use for decades, similar tests for marijuana have been slow to develop due to the way THC works in the body.Determining the ratio of THC in someone's breath versus the amount of THC in their blood has left scientists scratching their heads. And federal prohibition makes researching the drug to come up with a proper way to measure it in the blood and breath particularly difficult. According to NPR, Star Lab's marijuana breathalyzer is "nearly ready for mass production" and could potentially be on the market soon.