Addiction Policy Forum Blog

Mark Gold, MD

Dr. Mark S. Gold is a teacher of the year, translational researcher, author, mentor and inventor best known for his work on the brain systems underlying the effects of opiate drugs, cocaine and food. Read more by Dr. Gold here.

Recent Posts

9 min read

Is our addiction crisis fueling the all-time high in reported STD cases?

By Mark Gold, MD on November 7, 2019

The French and Italians once blamed each other for the creation of syphilis, officials viewed it as a moral incentive to maintain sexual propriety, and California required cases to be reported by number rather than name to conceal the identities of “ sinful” sufferers.1 The infection often went undetected, causing neurological and psychiatric problems chronicled in the lives of the rich and famous: Eduard Manet, Paul Gauguin, Vincent van Gogh, Ludwig van Beethoven, Robert Schumann, Franz Schubert, Al Capone, Keats, Baudelaire, Dostoyevsky, and Oscar Wilde.2 Later, diagnosis and treatment changed. Advances in science and medicine, if not in the reduction of stigma, dramatically cut reported rates of syphilis,3 and public health authorities had major successes in curbing Sexually Transmitted Diseases (STDs) over the second half of the twentieth century. In 2018, 1,306 infants in the United States contracted syphilis, a 185 percent rise since 2014. 

The CDC, in a recent report, is now sounding the alarm over astonishingly large increases in the prevalence of STDs. Cases have now increased for the fifth straight year and reached another all-time high. One contributing factor is substance use and substance use disorders (SUDs), which are linked to unprotected sex, sex with multiple partners, and other behaviors increasing the risk of STDs. As the CDC predicted, needle use and substance-seeking sex have had major impacts on STD rates: a 2016 report spotlighted 220 counties at elevated risk of HIV from high levels of intravenous drug use. Drinking and use of other substances, which can alter judgment and risk calculations, are also associated with increased chances of contracting STDs. 

But in some STD cases, the problem is not a complex one linked to a variety of nuanced and complicatedly intertwined variables. It’s simply a function of not trying. As the CDC’s Director of STD Prevention Gail Bolan notes of infants with syphilis, “This goes beyond data and surveillance, beyond numbers and calculations—we lost 94 lives before they began to an entirely preventable infection.”4

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7 min read

The fentanyl crisis is only getting worse

By Mark Gold, MD on October 31, 2019

Synthetic opioids like fentanyl accounted for around 3,000 deaths in 2013—by 2018, they accounted for over 30,000.1 Fentanyl is approximately 100 times more potent than morphine, 50 times more potent than heroin. Breathing can stop after use of just two milligrams of fentanyl. That’s about as much as trace amounts of table salt. “Ten years ago,” write the authors of a recent RAND report on the future of fentanyl, “few would have predicted that illicitly manufactured synthetic opioids from overseas would sweep through parts of Appalachia, New England, and the Midwest.” Drug epidemics and outbreaks can be surprising, taking unexpected forms at unpredictable moments in uncharacteristic patterns. But the fentanyl crisis is different. It isn’t just distressingly surprising or one more deadly drug epidemic in a grueling, tragic history of new contagions. Its magnitude, intensity, and sharp variations dwarf previous epidemics with which experts and officials are familiar, and its challenges for public health are novel and, so far, unmanageable. The recent RAND report is a comprehensive overview of the fentanyl crisis’s origins, present status, and, most disturbingly, future.

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7 min read

How much social media is too much for teens?

By Mark Gold, MD on October 24, 2019

In August, the Substance Abuse and Mental Health Services Administration (SAMHSA) released results from the 2018 National Survey on Drug Use and Health. The release revealed that 14.4 percent of adolescents between the ages of 12 and 17 had a major depressive episode in the past year.1 Major depressive episodes are mental disorders characterized by two-week or longer periods of depressed mood or decreased enjoyment of usual activities, and associated behavioral problems. According to these released figures, 3.5 million, or one-in-seven adolescents had a major depressive episode in the past year. The numbers rose from 2017 when 13.3 percent of adolescents had experienced such an event and were up from 2004 when only 9 percent did. Added to rising suicide rates,2 these numbers raise the alarm of worsening mental health trends among adolescents. The internet and social media appear to play critical roles in spreading suicidal behavior: the effect of suicide clusters, for example, implicates social media.3  

While many young Americans face a dizzying array of challenges in their lives—from substance misuse to academic pressures to general fears about societal stability—adolescents in the past have also dealt with these concerns and did not experience a similar rate of depressive episodes. This leads journalists, educators, experts, and politicians looking for a root cause to understand these recent changes, and one major change stands apart from the rest: access to social media. In a recent study, researchers tried to determine whether frequent social media use contributes to negative mental health outcomes among adolescents.

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6 min read

Can CBD be used to treat Angelman syndrome? Here’s what new UNC research says

By Mark Gold, MD on October 17, 2019

Cannabidiol (CBD) is a “phytocannabinoid” part of cannabis, or an element created from the cannabis plant. According to a recent New York Times article, “The CBD industry is flourishing, conservatively projected to hit $16 billion in the United States by 2025. Already, the plant extract is being added to cheeseburgers, toothpicks and breath sprays."1 The FDA has approved Epidiolex, a CBD oral solution, for prescriptions to patients two years of age and older to treat certain intense forms of epilepsy, Lennox-Gastaut syndrome or Dravet syndrome, marking the first official go-ahead for a marijuana-derived substance.2 CBD, in short, makes headlines. Yet some consumers buying a CBD product sold over-the-counter have had difficulty finding a label and knowing what they’re actually getting.3 For other potential consumers, the biggest questions aren’t about a buzzy new wellness trend—they’re about failing a drug test after acquiring impure CBD or THC in a purchase.4 

Consumers try to balance these fears with the purported benefits CBD. It is true that Epidiolex has been life-changing for the seizures associated with Lennox-Gastaut syndrome and Dravet syndrome. For parents and children coping with these conditions, all other treatments have failed. CBD may have benefits for other patients with rare or difficult-to-treat neurological diseases. In a recent study, researchers at the University of North Carolina wondered if CBD might help treat individuals with another condition involving severe seizures, Angelman syndrome. 

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8 min read

Substance use disorders take a toll on more than just health

By Mark Gold, MD on October 10, 2019

Many Americans are aware of the United States’ current overdose and addiction epidemic. For patients, families, friends, and loved ones, the tragic health and behavioral effects of substance use disorders (SUDs) are readily recognizable at a level of intimate, granular detail. Among individuals who have used substances, not all have SUDS, but many have spent money on illicit substances. SUD-related discussions frequently focus on survival or addiction, sometimes looking past another elephant in the room: finance. A recent RAND report for the Office of National Drug Control Policy (ONDCP) sheds an important light on how much money we pay for illegal drugs by highlighting Americans’ expenditures on methamphetamine, marijuana, heroin, and cocaine.

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9 min read

The truth about MAT? Patients know the virtue

By Mark Gold, MD on October 3, 2019

47,600 people died from drug overdoses involving opioids in 2017. Between 2012 and 2018, the number of fentanyl-induced fatal overdoses rose dramatically, accounting for a majority of overdose deaths. While preliminary data from the Centers for Disease Control shows a marginal decline in fatal overdoses in 2018, from 70,237 to 68,557, it also reveals that fentanyl is still the primary cause of fatal overdoses.1 Naloxone is a non-opioid wonder drug that can reverse an opioid overdose. It is short-acting, and by temporarily reversing the effects of opioids, it gives a person with an opioid use disorder (OUD) a second chance—an opportunity to receive treatment. As a result of campaigns by, among others, the Surgeon General2 and the CDC to improve naloxone access, retail pharmacies increased naloxone dispensing from 2012 to 2018. Despite the increase in dispensation by pharmacies, only one naloxone prescription was dispensed for every 69 high-dose opioid prescriptions in 2018.3 In the old days, I remember patients saying that they felt stigmatized at the pharmacy when they heard, "Mr. Jones, your Elavil is ready." Stigma kept many depressed patients from filling prescriptions. But in this case, is the challenge both stigma and the lack of pharmacist or health care provider education?4 It is tough to pinpoint a cause explaining this data. 

The CDC and Surgeon General encourage us to improve naloxone access at the local level, including through prescribing and pharmacy dispensing. Widespread distribution of naloxone is an essential component of the public health response to the opioid overdose epidemic. Unfortunately, the lowest rates of naloxone dispensing are in the areas with the highest opioid overdose rates. We are in the third phase of the opioid epidemic, with pain clinics’ overprescribing practices overtaken first by heroin and, more recently, by fentanyl. Individuals who overdose often overdose again, and many patients treated in addiction programs or health providers' offices through MAT often relapse.

For the treatment community, adverse outcomes and continued overdose deaths are, naturally, extremely upsetting. OUD treatment program employees frequently complain of burnout. High turnover in many programs is a major problem. Some are frustrated by recidivism rates, others because some patients are not offered MAT. Some patients cease their MAT course, and others drop out of treatment altogether. Yet experts have consistently agreed that while MAT, due to a lack of options, has not helped us combat cocaine or methamphetamine use disorders, it can be enormously helpful in managing OUD. A recent review, written by James Bell and John Strang, looks at the overall evidence on MAT and compares the relative benefits of different medications, helping to shed light on this critical public health issue. It is important to keep in mind, however, how contentiously and frequently some of our evidence is debated. We lack, for example, prospective, long-term, oncology-like, 5-year studies on the subject. MAT is debated—and so are standards measuring patient "outcomes." For a physician with an OUD, the relevant outcome standards may include a return to practice, 5-year sobriety, urine testing, and fitness for duty. In other cases, outcome standards may include coming to a treatment program, or following an MAT course, or simply not overdosing or dying. 

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