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  • Fatal overdoses involving stimulants have spiked. Local health officials are responding.

    Researchers at the University of Pennsylvania have developed a way to help identify people at risk of overdosing on stimulants, including cocaine and methamphetamine.

    “We wanted a tool that would help us predict people at high risk in order to be able to provide them with the services and interventions and supports,” said Dr. Rebecca Arden Harris, who specializes in addiction medicine and research at Penn.

    MORE: Even smoking a few cigarettes a day drastically increases risk of heart disease

    Harris and colleagues used data from more than 70 million Medicaid recipients to track emergency department visits related to stimulant overdoses. Then the team identified key risk factors, including diagnosis of substance use disorders, prior overdoses, higher poverty rates, crowded housing and being male.

    The motivation for the research is a spike in overdose deaths involving stimulants, Harris said.

    Nationwide, fatal overdoses linked to stimulant use jumped from 4,681 in 2011 to 29,449 in 2023 nationwide. Nearly 60% of fatal overdoses between 2021 and 2024 involved stimulants, according to the Centers for Disease Control and Prevention.

    And while opioids, fentanyl in particular, remain the primary cause of fatal overdoses in Philadelphia, 70% of people who died from opioid overdoses in 2023 had cocaine, meth or other stimulants in their systems. About one-quarter of illicit opioid samples between January and June also contained cocaine or crack, according to the city’s drug-checking program.

    The findings reflect how the make up of Philly’s dope supply increasingly is becoming poly-chemical, and in addition to stimulants, drugs are heavy with animal sedatives, mainly medetomidine, that can reduce heart rate and cause severe withdrawal symptoms.

    People who think they are buying dope on the street may be getting bags with stimulants mixed in. Also, people who use opioids, which are sedatives, sometimes also use stimulants, or uppers, to combat the drowsiness, according to the Philadelphia Department of Public Health.

    City addressing cardiovascular dangers

    In reaction to the spike in overdose deaths involving cocaine and meth, Philadelphia recently started a campaign to educate people about the links among stimulant use, heart disease and overdose risk.

    Cocaine and other stimulants increase heart rate and blood pressure and cause vasoconstriction and vasospasm – so people who use them have heightened risks of stroke, heart failure, sudden cardiac death and other cardiovascular problems.

    Stimulant use poses other serious health problems, including the potential of meth-induced psychosis and permanent brain damage.

    Philadelphia’s outreach focuses on the heart health risks of stimulant use. It also aims to reduce barriers to primary care and help people learn how to talk to providers about stimulants, said Fatimah Maiga, a spokesperson for the health department’s Substance Use Prevention and Harm Reduction Division.

    “We really want people to be able to have an open conversation with their provider, make sure that they’re reporting their drug history, any symptoms and signs that they’ve experienced that might be related to heart disease, and then talk to their doctor about next steps, what they hope to accomplish from that visit, or continued visits with that provider,” Maiga said.

    The campaign’s website lists walk-in primary care clinics around the city. It also has a guide for how to talk to health care providers about substance use and tools for clinicians for assessing people who use stimulants.

    Limited of treatment options

    Part of the challenge of helping people who use stimulants is that no medication exists to reduce cravings or to help prevent and reverse overdoses.

    For people who use opioids, there are medications, like methadone and buprenorphine, which help reduce cravings and dependency. Narcan, the brand name for naloxone, reverses opioid overdoses by temporarily blocking their effects.

    Although research is ongoing, the U.S. Food and Drug Administration has not approved such medications for cocaine or meth addiction. In the meantime, contingency management – which offers monetary or other tangible rewards for people who reach specific goals for reducing or stopping cocaine or meth use – is considered the most effective treatment for people addicted to stimulants.

    The health department wants providers to consider a harm-reduction approach, advising that “reduction in stimulant use is often more achievable than total abstinence” and that “reduced use improves health outcomes” and “should be considered a valid, positive outcome for patients who use stimulants.”

    Prediction as means to help prevention

    Penn’s Dr. Harris hopes the stimulant overdose prediction model she and her colleagues developed will assist in efforts to address the dangers of using cocaine, meth and other stimulants.

    Limitations of the study include the fact that it was confined to people with Medicaid and only looked at overdoses that resulted in emergency department visits. While more research is needed, Harris said the tool has potential for integration into public health surveillance systems. It could help identify not just individuals at risk of stimulant overdoses, but also neighborhoods that could benefit from targeted interventions, she said.

    “Part of prevention is being able to match the intervention and resources to the individuals who would most benefit from it,” Harris said.

    Courtenay Harris Bond

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  • Homebuyers beware: How to avoid properties with high landslide risk

    Homebuyers beware: How to avoid properties with high landslide risk

    The landslides that have forced authorities to shut off power and gas to hundreds of homes in Rancho Palos Verdes over the last two months highlight the risk of living on land susceptible to shifting and eroding with little warning.

    Deep-seated landslides can occur weeks or months after heavy rainfall, when water has time to percolate down to weak zones of rock, creating a landslide plane under the weight of the overlying rock and soil, according to the California Geological Survey.

    These types of landslides generally occur on moderately steep slopes.

    If you are in the market to buy a home, experts say there are a few ways to determine whether you are buying a property with a high risk of landslides.

    What causes landslides

    Landslides are part of the natural process that erodes mountains and moves sediment to the ocean through river systems. “It’s important to the basic erosion process,” said Jonathan Godt, the landslide hazards program coordinator for the United States Geological Survey.

    “Over the human lifespan, we’re just a blink of an eye in geological time, so [landslide] issues or those processes don’t penetrate our consciousness until something like the unfortunate situation in Rancho Palos Verdes happens,” he said.

    In 2011 the California Geological Survey created a map that shows that a majority of the state’s coast is at risk of landslides.

    Homes built decades ago on ancient landslides that were at one time dormant are “fine for periods of time, [but] sometimes there are changes,” Godt said.

    Several factors can alter a landslide’s active status, such as rainfall and earthquakes, but the warning signs are hard to see because they are “well beneath our feet and kind of hidden,” he said.

    When properties in these areas are for sale, it’s up to buyers to gauge the land movement risk of the property they’re interested in.

    If the seller or their agent knows that the property is on a seismic hazard zone that is subject to strong ground shaking, soil liquefaction or landslide, the information must be disclosed, according to the state Department of Real Estate.

    But buyers are also responsible for conducting their own research.

    Online research into a property’s landslide risk

    At least two websites, Realtor.com and Redfin.com, provide information on the property’s natural disaster risk. Near the bottom of the listing there’s a section that breaks down the property’s risk of flooding, fires, heat, wind and air. Unfortunately, landslides and land movement are not factors that are disclosed.

    Instead, potential buyers should conduct a Google search of the neighborhood alongside the words “landslide” or “natural disaster.” If there has been previous landslide activity, news articles about those problems probably will surface, said Timothy D. Stark, professor of civil and environmental engineering at the University of Illinois.

    For more scientific data, buyers can turn to three landslide maps created by the California Geological Survey. The Reported Landslides Database has reports of landslides from local governments, the National Weather Service and citizen scientists. The Landslide Index allows users to request reports and other documentation of landslides in a specific area. The California Deep Landslide Susceptibility and Landslide Inventory includes a map of the state that marks areas of landslide susceptibility in dark red.

    The California Department of Conservation also published a 2023 California Landslide Response report that included a page showing where deep-seated landslide activity might occur after the 2023 storms.

    Stark also suggested using Google Earth Pro to look at aerial images over time to look for land movement.

    When you look up an address or a neighborhood on Google Earth Pro, it will automatically show you the current image. To view past images, click the View tab and then Historical Imagery or click on a small clock icon above the 3D Viewer. You can then zoom in or out to change the start and end dates.

    As you look at the surface of the area you’re researching, Stark said to look for ground surface features such as drops in nearby hillsides or reddish areas (that have exposed or no vegetation) that indicate steep slopes — all potential signs of prior slope movement.

    Looking for signs of past or potential landslide activity

    Other signs of landslide risks can be spotted with the naked eye when visiting a property you are looking to buy.

    When you’re visiting the neighborhood, take a look at the surrounding properties.

    If the house is near or around hills, check out the hill or slope itself. A sign of land movement is if the ridge at the top of the hill is flat and then has a steep curve, a drop or cracks, suggesting a previous landslide.

    Check the base of the hill; if the ground is heaved up, that’s a sign of movement.

    Consider how close the hill or slope is to the property you’re interested in. If there is sudden land movement or a landslide, the higher the nearby hillside, the farther a landslide can travel, Stark said.

    Other signs of past land movement in the area might include:

    • Misaligned fencing, pavement, guard rails, utility poles, trees or walls.
    • Visible cracks on the ground.
    • Water and sewer lines that are above ground.
    • A cracked or buckled roadway.
    • Offset yellow or white lines on the roadway.
    • Houses in the neighborhood that are supported by wooden boards or railroad ties.
    • Houses that have cracks or are leaning.

    You can also check whether land is moving by taking a photograph of the offset marked lines on the ground or a crack in the pavement and revisit the same site a week or two later to see if there’s any visible difference, Stark said.

    If you decide to make an offer for a home and start escrow, a home inspector can help you determine if past land movement has affected the property.

    Stark said home inspectors will complete a home assessment and look at the walls, drywall and foundation for any types of cracks that suggest land movement. Inspectors will also look at whether the walls are straight and the floor inside the home is level.

    Inspectors can also suggest if a geotechnical engineer is needed to conduct soil samples of the home. These tests can detect the behavior of the ground under varying conditions.

    Insurance coverage for landslides?

    Natural disasters such as earthquakes, flooding and landslides typically are not covered by a general homeowners insurance policy.

    However, homeowners can buy a non-standard policy, called a Difference in Condition policy, that’s often used to cover earthquake damage.

    Jerry Becerra, president of Heffernan Barbary Insurance Services, said it’s possible to find a DIC policy covering earthquakes where the definition of earth movement is broad enough to include landslides. But he said such a policy could be pricey.

    “Presuming you can find a DIC earthquake policy to cover a building located in an area prone to earth movement, the pricing would reflect the exposure,” Becerra said.

    Underwriters rely on maps that show soil conditions, proximity to earthquake faults and other factors to determine rates, he said.

    If the area is known to have a lot of earth movement, he said, it’s possible no company would be willing to provide coverage.

    “I would not take a guess on actual pricing, but I expect it to be more than 1% of the coverage value and subject to high deductibles,” Becerra said.

    Karen Garcia

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  • Study: Cannabis May Be Effective Harm Reduction Tool To Ease Stimulant Cravings | High Times

    Study: Cannabis May Be Effective Harm Reduction Tool To Ease Stimulant Cravings | High Times

    Despite the skewed messaging of the past suggesting that cannabis is a gateway drug or will lead to the use and abuse of more addictive and harmful substances, many today understand that cannabis may be utilized as a harm reduction tool. 

    Whether its individuals looking to reduce or eliminate their use of opioids for medical reasons or people who use drugs seeking relief from withdrawal symptoms and cravings, research is increasingly finding that cannabis may help.

    In one of the more recent studies on the topic, researchers at the University of British Columbia (UBC) took a closer look at cannabis use and managing cravings to stimulant drugs. Ultimately their findings, published in the journal Addictive Behaviors, indicated that cannabis is not only widely used to manage stimulant cravings but that it may be an effective strategy to reduce stimulant use.

    Cannabis as Harm Reduction for Other Drug Use

    Researchers note how medical and recreational cannabis reform has opened the door for other conversations, namely how cannabis use interacts with other higher risk substances and that cannabis substitution is a commonly utilized method of harm reduction. 

    Given today’s ongoing drug toxicity crisis and the prevalence of fentanyl contamination in a number of substances, researchers say that investigating cannabis as a substitute for stimulant use could have “important public health and harm reduction appliances among people who use drugs at a heightened risk of overdose and other drug-related harms.”

    To further analyze how cannabis use may affect people using stimulant drugs, researchers collected data from three cohorts in Vancouver, Canada: the At-Risk Youth Study (ARYS), the Vancouver Injection Drug Users Study (VIDUS) and the AIDS Care Cohort to Evaluate Exposure to Survival Services (ACCESS).

    Researchers used a cross-sectional questionnaire alongside logistic regression models to analyze the relationship between cannabis use to manage stimulant cravings as well as self-reported changes in the frequency of stimulant use. A total of 297 participants reported cannabis and stimulant use over the past six months and were included in the study. 

    Cannabis a Common Strategy to Reduce Stimulant Use

    Of the participants, 45.1% reported that they used cannabis to manage stimulant cravings and 77.6% of those participants said that cannabis use indeed decreased their use of stimulants, including powder cocaine, crack cocaine and methamphetamines. 

    Researchers noted that cannabis use to manage cravings was significantly associated with reduced stimulant use specifically among those who used crystal meth daily, though it was not significantly associated with reduced stimulant use among crack cocaine users.

    While the study doesn’t provide all the answers, lead author Dr. Hudson Reddon noted the importance of the results.

    “Our findings are not conclusive but do add to the growing scientific evidence that cannabis might be a beneficial tool for some people who want to better control their unregulated stimulant use, particularly for people who use crystal meth,” Dr. Reddon said. “This suggests a new direction for harm reduction strategies among people who use drugs.”

    Adjacent Research and the Push for Further Investigation

    While it’s surely an adjacent but far different issue, myriad research has explored the topic of cannabis as means to limit or replace opioids for medicinal use. 

    Recent studies have found that cannabis may be comparable to opioids in treating pain while providing more holistic relief and that patients largely reduce or fully replace opioid use after beginning a medicinal cannabis regimen. Another recent study also found that CBD curbed opioid cravings in rats.

    There is far less research available regarding the relationship between cannabis and recreational drug use and abuse, though the UBC study’s findings are still echoed in past studies. 

    A 2021 study similarly found that cannabis is commonly used as a harm reduction strategy to substitute for stimulants and opioids. Another 2023 study found that cannabis was often utilized as a harm reduction strategy for those who had difficulty accessing addiction treatment or those using substances where effective treatments are limited.

    Dr. Zach Walsh, a clinical psychologist and professor at the University of British Columbia Okanagan, called the findings of the UBC study “promising” while emphasizing the need for further research on the topic.

    “[The findings] underscore the need for more comprehensive studies to understand the full potential of cannabis in the context of the overdose crisis,” Dr. Walsh said.

    Keegan Williams

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