TL neuro

June 30, 2015

The primary translational product of drug-abuse science is information

Filed under: CPDD, Op/Ed, Public Health — mtaffe @ 11:16 am

This is an excerpt of a CPDD News and Views piece* that has been accepted for publication in Drug & Alcohol Dependence. I’ve been working on this idea for several years now and it has gone through various iterations. The list of people I need to thank for shaping my thinking on this since discovering the “science blog” around 2006 or so is long and I will no doubt forget some of them. Nevertheless, I am particularly indebted to David Kroll, Janet Stemwedel, Peter Lipson, Jessica Palmer, Isis the Scientist, DrugMonkey, Bethany Brookshire, Zen Faulkes, Virginia Hughes, J. David Jentsch, Allyson Bennett and Carl Hart. I participated in a Media Forum at the 2014 CPDD annual meeting and made a presentation which touched on many of these themes.

Drug Abuse Scientists Should Use Social Media to Engage the Public Because Their Primary Translational Product is Information

Introduction

Increasing numbers of people are relying on the Internet to rapidly provide health information and preliminary medical diagnoses on the basis of key word searches (Jones and Fox 2009; Lagu et al. 2008; Moretti et al. 2012). In the most recent survey the Pew Internet & American Life project found that 59% of adults in the US had looked online for health information and 35% had gone online to gain information on a specific medical issue (Fox 2013; Fox and Duggan 2013). It is hardly news that exposure to high budget entertainment, informational and advertising media can influence the nonmedical use of psychotropic drugs (Brown and Witherspoon 2002; Nunez-Smith et al. 2010). However, current social media tools and the near universal use of Web searches to find information on health-related topics provide a new opportunity for individual scientists to communicate more directly with the lay public, health care providers and policy makers at the expense of minimal time and effort. This is of particular interest since so much of the most readily available information on psychotropic drugs is poorly informed by the existing scientific knowledge and may be substantially influenced by sociopolitical biases or agendas. Drug abuse scientists should therefore use social media to engage the public in a discussion of their ongoing scientific results.

Substance Abuse Information on the Internet

“When we confronted him, my teenage son assured me that he had done extensive research on the Internet which confirmed that pot is totally harmless”

-neighbor of Dr. Taffe, Aug 2011

Many individuals, from teens to adults, seek information about relative risks of cannabis and other recreational drugs so as to inform their day to day decision making. In the case of nonmedical drug use, the public faces an Internet dominated with inaccuracies and even pro-drug advocacy messaging in many cases. In one study of online information on the popular drug Ecstasy (3,4-methylenedioxymethamphetamine, MDMA) found that although half of Websites located by search engines were characterized as “anti-drug” (Deluca and Schifano 2007), 16% were harm-reduction and about 25% were pro-drug advocates. Perhaps of more functional significance, the pro-drug sites dominated the top ranks of Internet search returns. More anecdotally a simple perusal of comments in mainstream local newspapers whenever issues related to MDMA/Ecstasy (e.g., reports of Ecstasy-associated fatality) or cannabis (drug seizures, scientific findings of note) arise will illustrate a depth of scientific confusion and ignorance in the general public combined with a reflexive anti-science tone from drug advocates. Even more main-stream sources can be dangerously inaccurate. For example a recent public health advisory effort in California advised Ecstasy users to consume water (CBSLosAngeles 2011), a position that is not supported by deaths due to hyponatremia (Halpern et al. 2011; Rogers et al. 2009) and evidence that MDMA increases antidiuretic hormone production thereby causing the body to retain fluid (Wolff et al. 2006). Although ultimately not enshrined into law, the text of the 2010 California Ballot initiative to legalize recreational marijuana (Ballotpedia 2010) contained a Finding that “Cannabis is not physically addictive, does not have long term toxic effects on the body“ which is inconsistent with current scientific understanding (Allsop et al. 2012; Allsop et al. 2011; Budney et al. 2008).

…..

Information is Translational Science.

Problematic substance use continues to be, in many senses, a behavioral disorder over which individuals have some degree of conscious control. There are a number of complex, overt behavioral acts required for the individual to continue substance use. Drugs must be procured, often from illicit sources, oftentimes prepared in some way and taken into the body in acts as simple as swallowing a tablet and as complex as inhaling smoke/vapor or injecting intravenously. Evidence for a single use of a compound instantly addicting an individual is poor, thus it is also the case that these complex behaviors must be completed many times for the person to develop some of the more severe and distressing consequences. That is, compulsive use and the inability to cease taking a drug even in the face of palpable adverse effects on health, vocational success and family life, which may often include legal consequences.

Humans often use information about the potential consequences of actions to guide and shape their behaviors. This can be a decision to act or refrain from acting on the part of an individual, on the part of groups (via laws and regulations) and, perhaps most pertinently for substance abuse, on the part of parents guiding the development of their children. Drug abuse science has contributed immeasurably to a greater understanding of the harms posed by various psychoactive drugs and had consequent influence on behavior. Scientific information has contributed to a broader understanding that nicotine in cigarettes is an addicting substance, to the appreciation that cocaine can induce dependence (even if it doesn’t look like opiate dependence in the acute withdrawal/discontinuation epoch) and to a recognition that MDMA can cause lasting disruption of brain serotonergic function, as just a few examples. Greater knowledge about the health consequences of recreational drugs has been shown to decrease adolescent use (Brown et al. 2007; Martins et al. 2008; Morgenstern et al. 2009; Twombly and Holtz 2008).


Social Media Tools for Information Dissemination

Many scientists who focus on substance abuse issues are funded by the Public Health Service of the United States or similar bodies within their own respective countries. Yet because of the way we disseminate scientific research, most of the findings are inaccessible to the lay public for 6-12 months at a minimum. It is time to take a modest amount of our professional effort to return the information we generate to the taxpayers who have paid for it in advance. Second, scientists should use the tools of social media (blogs, Facebook, Twitter, etc) to share findings within their own fields of work, preferably using language that is accessible to nonspecialists. Official outlets such as the National Institute on Drug Abuse, ONDCP and even the CPDD websites have value but are often viewed, accurately or not, as driven more by a political agenda than by a sober assessment of the science. Individual scientists have the opportunity for generating greater trust by doing what scientists do best; weighing what are often conflicting sets of evidence to come up with a tentative conclusion, with skepticism ever held in reserve pending any additional new findings that might emerge. Individuals can generate a degree of trust with a social media audience by virtue of back-and-forth exchanges, by developing a distinct personal “voice” in their writing, and by explaining why and how they conduct the science in their own laboratory.

__

*News and Views are not peer-reviewed. They are considered for appropriateness by the CPDD Publications Committee on which Dr. Taffe has served in the past. Dr. Taffe currently serves on the CPDD Media committee which interacts in some degree with the Publications Committee.

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