Chapter 4. The Chemistry of Behavior: Neurotransmitters and Neuropharmacology
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by Michael Slezak If you want to counteract the effects of getting drunk, a big dose of the so-called "cuddle-chemical" oxytocin might be the answer. Oxytocin has important roles in sexual behaviour and social bonding, and has previously been investigated as a way to help wean alcoholics off drink. While studying this effect in rats, Michael Bowen from the University of Sydney noticed something strange. Rats that had been given oxytocin didn't seem to get drunk. "Those that had the oxytocin were up and moving about as if they hadn't had any alcohol at all, whereas the ones that didn't have oxytocin were quite heavily sedated," Bowen says. This effect was confirmed in a second experiment, in which half the rats were given an injection of oxytocin straight into the brain, at a level about 150,000 times what would normally be found there. They were then given alcohol, after which researchers tested their motor control and reaction times. Oxytocin seemed to completely counteract the effects of the booze – even when a rat had consumed what would be equivalent to about one and a half bottles of wine in humans. "The rats that had received oxytocin, as well as the alcohol, were virtually indistinguishable from the rats that hadn't received any alcohol at all," says Bowen. This could be thanks to the brain's GABA receptors, where alcohol is thought to exert its intoxicating effects. Bowen's team found that oxytocin was binding to two parts of these receptors, blocking alcohol from getting there. "It was actually preventing alcohol affecting these sites in the brain that make you intoxicated." © Copyright Reed Business Information Ltd
Charles F. Zorumski It is indeed possible for a person to get intoxicated and not remember what she or he did. This state is called a “blackout” or, more precisely, a “memory blackout.” During a blackout a person is intoxicated but awake and interacting with the environment in seemingly meaningful ways, such as holding a conversation or driving a car. After the period of intoxication, usually the next day, the person has no or, at best, vague recall for events that occurred while inebriated. At times, being in this state can have disastrous consequences, such as waking up in an unknown or unsafe place, losing personal possessions or participating in risky behaviors. On the neural level, a blackout is a period of anterograde amnesia. That is, a person's ability to form new memories becomes impaired. Although a person does not lose previously learned information, he or she may also find it more difficult to recall certain facts while intoxicated. Yet once a person sobers up, his or her memory and ability to learn new information are not permanently affected. How alcohol, or ethanol, produces a memory blackout is not completely understood. It is clear, however, that alcohol can impair a process in brain cells called long-term potentiation (LTP), a cellular mechanism thought to underlie memory formation, particularly in the hippocampus. © 2015 Scientific American
A dozen university students have been treated at Connecticut hospitals after overdosing on "Molly" or MDMA, a popular synthetic party drug. Police are investigating after the overdoses were reported late Sunday on the campus of Wesleyan University in Middletown, Connecticut. By Monday, eight remained in hospital and two were in critical condition. It was unclear whether the students had been together or where the drugs had come from. Middletown Police Chief William McKenna said that their "first and foremost goal is to obtain information on the batch of Molly that was distributed to the students on the campus," adding, "this information is critical in ensuring the recovery of those students affected." A pure and more powerful form of MDMA often sold as "Molly" can cause liver, kidney, cardiovascular failure, or death. In a campus-wide statement, Wesleyan president Michael S Roth urged students to "please, please stay away from illegal substances, the use of which can put you in extreme danger. One mistake can change your life forever". Dean Michael Whaley, vice president of student affairs at Wesleyan University, sent a letter to the school body on Sunday recommending students to check on their friends. Ten of the 12 people were Wesleyan students. In 2013, Molly-related deaths and illnesses forced the Electric Zoo Festival in New York to shut down early after two young people died and four were confined to hospital.
Keyword: Drug Abuse
Link ID: 20602 - Posted: 02.24.2015
|By Roni Jacobson Several pharmaceutical drugs promise to help addicts quit, and many people embrace the ease of popping a pill. Yet research continues to show that although medication can help, support networks and therapy targeting the underlying behaviors are still the best available ways to kick addiction over the long term. In addition, some of these medications come with scary side effects—hundreds of people have reportedly committed suicide while on the smoking-cessation drug Chantix, for example. Read on for short profiles of the addiction drugs currently on the market, as well as a few compounds that may hit shelves soon. © 2015 Scientific American,
Keyword: Drug Abuse
Link ID: 20601 - Posted: 02.24.2015
Boer Deng Smoking marijuana may stoke a yearning for crisps, but understanding how it affects hunger is relevant not just to those who indulge in it. The drug has yielded a ripe target for scientists who seek to stimulate or suppress appetite: the receptor CB1, found in cells throughout the body. When activated by the anti-nausea drug dronabinol — which is also a component of marijuana (Cannabis sativa) — CB1 prompts the release of hunger-promoting hormones1. And suppressing its activity is thought to aid in weight loss2. But the mechanism by which the receptor kills or kindles appetite is not entirely understood. Now neuroscientist Tamas Horvath, of Yale University in New Haven, and colleagues report in Nature that nerve cells called pro-opiomelanocortin (POMC) neurons play a key role in this process3. POMC had generally been thought to promote satiation, but Horvath's team found that POMC neurons in the brain release not just a hunger-suppressing hormone, but also one that promotes appetite. Which hormone is secreted is regulated by a protein in the cells' mitochondria, structures that regulate energy levels. When the CB1 receptor is activated, this mitochondrial protein induces POMC to switch from secreting the substance that suppresses gorging to one that encourages it. The finding is intriguing, says Uberto Pagotto, a neuroscientist at the University of Bologna who has studied cannabinoids for many years. “It gives us a different starting point to look at CB1 receptors and the mitochondria,” he says. © 2015 Nature Publishing Group
By Abigail Zuger, M.D. I had intended to discuss President Obama’s plans for personalized precision medicine with my patient Barbara last week, but she missed her appointment. Or, more accurately, she arrived two hours late, made the usual giant fuss at the reception desk and had to be rescheduled. I was disappointed. Barbara has some insight into the vortex of her own complications, and I thought she might help organize my thoughts. Mr. Obama announced last month that his new budget included $215 million toward the creation of a national databank of medical information, intended to associate specific gene patterns with various diseases and to predict what genetic, lifestyle and environmental factors correlate with successful treatment. Once all those relationships are clarified, the path will open to drugs or other interventions that firm up the good links and interrupt the bad ones. This step up the scientific ladder of medicine has many advocates. Researchers who sequence the genome are enthusiastic, as are those with a financial interest in the technology. Also celebrating are doctors and patients in the cancer community, where genetic data already informs some treatment choices and where the initial thrust of the initiative and much of its funding will be directed. Skeptics point out that genetic medicine, for all its promise, has delivered relatively few clinical benefits. And straightforward analyses of lifestyle and environment effects on health may occasionally lead to clear-cut advice (don’t smoke), but more often sow confusion, as anyone curious about the best way to lose weight or the optimal quantity of dietary salt knows. Without Barbara’s presence, I was left to ponder her medical record, a 20-year saga that might be titled “Genes, Lifestyle and Environment.” and published as a cautionary tale. © 2015 The New York Times Company
By Lizzie Wade SAN JOSE, CALIFORNIA—Humans have been using cannabis for more than 5000 years. So why don’t scientists know more about it? Three experts gathered here at the annual meeting of AAAS (which publishes Science) to discuss what scientists and doctors know about the drug and what they still need to learn. “By the end of this session, you’ll know more about cannabis than your physician does,” said Mark Ware, a family physician at the McGill University Health Center in Montreal, Canada, who organized the talk. How does marijuana work? Our brains are primed to respond to marijuana, because “there are chemicals in our own bodies that act like THC [the psychoactive ingredient in pot]” and other compounds in cannabis called cannabinoids, explained Roger Pertwee, a neuropharmacologist at the University of Aberdeen in the United Kingdom who has studied cannabinoids since the 1960s. Cannabinoids produced by our bodies or ingested through marijuana use react with a series of receptors in our brains called the endocannabinoid system, which is involved in appetite, mood, memory, and pain sensation. Scientists have discovered 104 cannabinoids so far, but “the pharmacology of most of them has yet to be investigated,” Pertwee said. What are the known medical uses of marijuana? Marijuana has been used for decades to stimulate appetite and treat nausea and vomiting, especially in patients undergoing chemotherapy. Its success in easing the symptoms of multiple sclerosis patients led to the development of Sativex, a drug manufactured by GW Pharmaceuticals that includes THC and cannabidiol (CBD), a cannabinoid that isn’t psychoactive. © 2015 American Association for the Advancement of Science
Smoking potent cannabis was linked to 24% of new psychosis cases analysed in a study by King's College London. The research suggests the risk of psychosis is three times higher for users of potent "skunk-like" cannabis than for non-users. The study of 780 people was carried out by KCL's Institute of Psychiatry, Psychology and Neuroscience. A Home Office spokesman said the report underlines the reasons why cannabis is illegal. Scientists found the risk of psychosis was five times higher for those who use it every day compared with non-users. They also concluded the use of hash, a milder form of the drug, was not associated with increased risk of psychosis. Psychosis refers to delusions or hallucinations that can be present in certain psychiatric conditions such as schizophrenia and bipolar disorder. "Compared with those who had never tried cannabis, users of high potency skunk-like cannabis had a threefold increase in risk of psychosis,' said Dr Marta Di Forti, lead author on the research. She added: "The results show that psychosis risk in cannabis users depends on both the frequency of use and cannabis potency." Dr Di Forti told BBC Radio 4's Today programme that the availability of skunk-like cannabis was becoming more widespread. "In London, it's very difficult to find anything else," she said. "There were lots of reports from police across the UK saying we have become a great producer of skunk. And not only do we use it locally but we export, so this is a Made in England product." Someone suffering from psychosis would often be "extremely paranoid and become very suspicious" about the people around them, she added. She has called for "a clear public message" to cannabis users, comparable to medical advice on alcohol and tobacco. © 2015 BBC
By DENISE GRADY However bad you thought smoking was, it’s even worse. A new study adds at least five diseases and 60,000 deaths a year to the toll taken by tobacco in the United States. Before the study, smoking was already blamed for nearly half a million deaths a year in this country from 21 diseases, including 12 types of cancer. The new findings are based on health data from nearly a million people who were followed for 10 years. In addition to the well-known hazards of lung cancer, artery disease, heart attacks, chronic lung disease and stroke, the researchers found that smoking was linked to significantly increased risks of infection, kidney disease, intestinal disease caused by inadequate blood flow, and heart and lung ailments not previously attributed to tobacco. Even though people are already barraged with messages about the dangers of smoking, researchers say it is important to let the public know that there is yet more bad news. “The smoking epidemic is still ongoing, and there is a need to evaluate how smoking is hurting us as a society, to support clinicians and policy making in public health,” said Brian D. Carter, an epidemiologist at the American Cancer Society and the first author of an article about the study, which appears in The New England Journal of Medicine. “It’s not a done story.” In an editorial accompanying the article, Dr. Graham A. Colditz, from Washington University School of Medicine in St. Louis, said the new findings showed that officials in the United States had substantially underestimated the effect smoking has on public health. He said smokers, particularly those who depend on Medicaid, had not been receiving enough help to quit. © 2015 The New York Times Company
Keyword: Drug Abuse
Link ID: 20569 - Posted: 02.13.2015
By Michelle Roberts Health editor, BBC News online Women trying for a baby and those in the first three months of pregnancy should not drink any alcohol, updated UK guidelines say. The Royal College of Obstetricians and Gynaecologists (RCOG) had previously said a couple of glasses of wine a week was acceptable. It now says abstinence is the only way to be certain that the baby is not harmed. There is no proven safe amount that women can drink during pregnancy. The updated advice now chimes with guidelines from the National Institute for Health and Care Excellence (NICE). In the US, experts say there is no safe time to drink during pregnancy. But the RCOG highlights around the time of conception and the first three months of pregnancy as the most risky. Drinking alcohol may affect the unborn baby as some will pass through the placenta. Around conception and during the first three months, it may increase the chance of miscarriage, says the RCOG. After this time, women are advised to not drink more than one to two units, more than once or twice a week, it says. Drinking more than this could affect the development of the baby, in particular the way the baby's brain develops and the way the baby grows in the womb, which can lead to foetal growth restriction and increase the risk of stillbirth and premature labour, says the advice. © 2015 BBC
|By Stephani Sutherland More than half a billion people carry a genetic mutation that incapacitates the enzyme responsible for clearing alcohol from the body. The deficiency is responsible for an alcohol flush reaction, colloquially known as the “Asian glow” because the vast majority of carriers are descendants of the Han Chinese. Now research published last September in Science Translational Medicine suggests that the mutation might also compromise carriers' pain tolerance. The finding points to a new target for pharmaceutical pain relief and implies that drinking alcohol might exacerbate inflammatory conditions such as arthritis. When people consume alcohol, the body breaks it down into several by-products, including chemicals called aldehydes. These compounds are noxious if they remain in the system too long, causing flushing, nausea, dizziness and other symptoms of the alcohol flush reaction. In most people, aldehydes are immediately broken down by the enzyme aldehyde dehydrogenase (ALDH2), but in those with the genetic mutation, the enzyme is incapacitated. Researchers led by Daria Mochly-Rosen of Stanford University genetically modified some mice to carry the mutation seen in humans that disables ALDH2. When they injected those mice and normal mice in the paw with an inflammatory compound that turned it red and swollen, mice carrying the mutation showed increased sensitivity to a poke compared with those with functioning ALDH2. When the researchers treated all the rodents with a novel drug called Alda-1 that boosts ALDH2 activity, the pain symptoms were reduced regardless of whether they carried the gene mutation. © 2015 Scientific American
|By Erika Beras We know junk food can change the way bodies are shaped. Now, a study finds that those irresistible sweet and salty concoctions may also change the way brains are wired—at least in rats. Researchers divided rats into two groups—one labeled Cafeteria, the other called Chow. Both groups got a typical rat food diet, but the Cafeteria rats also got a bonus: meat pies, cakes and cookies. Both rat groups gained weight. But the Cafeteria rats gained significantly more than the Chows did—nearly half a pound more, which is a big body burden for a rat. But more important, over two weeks time the Cafeteria rats seemed to care less and less about even seeking out a balanced diet. This new behavior endured even after the rats were returned to their more healthy fare. The study is in the journal Frontiers in Psychology. [Amy C. Reichelt, Margaret J. Morris and R.F. Westbrook, Cafeteria diet impairs expression of sensory-specific satiety and stimulus-outcome learning] The researchers think junk-food diets cause lasting changes in the rewards circuits part of the brain—which plays a big role in decision-making. So if you’re a regular cookie eater and the next time you mindlessly reach for a cookie you wonder why you can’t help yourself—well, it could be because you’re not in charge, your rewired brain is. © 2015 Scientific American
By Gary Stix Everyone knows that ALS is a very bad disease, an awareness underscored by the recent Ice Bucket Challenge. The death of neurons that results in paralysis can be caused by specific genetic mutations. But in most cases, single genes are not the culprit. So researchers have looked for other risk factors that might play a role. Studies have tagged cigarette smoking as a definite danger. Alcohol, another plausible suspect, has yielded equivocal results in previous investigations. To get a better read on ethanol (some earlier studies were small), researchers from Sweden’s Lund University looked at giant medical registries from that country, compiled at various times between 1973 and 2010. They found that individuals who were classified as problem drinkers were a little more than half as likely to be diagnosed with ALS as those who didn’t have “alcohol use disorder.” More than 420,000 problem drinkers were registered during the period surveyed—and there were 7965 patients who received an ALS diagnosis. The study, just reported in The European Journal of Neurology, controlled for gender, education and place of birth, among other factors. But it was unable to tell why drinking might help. It did lead, though, to a number of intriguing speculations. The researchers cited studies in rats, done by other groups, that indicated that ingestion of alcohol decreased the number of brain cells called astrocytes that bore high levels of a certain protein linked to the pathology of ALS. © 2015 Scientific American
|By Simon Makin People with depression process emotional information more negatively than healthy people. They show increased sensitivity to sad faces, for instance, or a weaker response to happy faces. What has been missing is a biological explanation for these biases. Now a study reveals a mechanism: an unusual balance of chemicals in a brain area crucial for the feeling of disappointment. A team led by Roberto Malinow of the University of California, San Diego, studied the lateral habenula, a evolutionarily ancient region deep in the brain [see diagram on bottom]. Neurons in this region are activated by unexpected negative events, such as a punishment out of the blue or the absence of an anticipated reward. For example, studies have shown that primates trained to expect a reward, such as juice, after a visual cue show heightened activity in the lateral habenula if the reward is withheld. Such findings have led to the idea that this area is a key part of a “disappointment circuit.” Past studies have also shown that hyperactivity in the lateral habenula is linked with depressionlike behavior in rodents. In people with depression, low levels of serotonin, the brain chemical targeted by antidepressants, are linked with a rise in lateral habenula activity. The region is unusual because it lacks the standard equipment the brain uses to reduce overactivity: opposing sets of neurons that either increase activity by secreting the chemical glutamate or decrease activity by secreting the chemical GABA. The lateral habenula has very few neurons that decrease activity, so Malinow and his colleagues set out to discover how the brain tamps down activity there. © 2015 Scientific American
Link ID: 20508 - Posted: 01.22.2015
Research suggests that only 20–30% of drug users actually descend into addiction — defined as the persistent seeking and taking of drugs even in the face of dire personal consequences. Why are some people who use drugs able to do so without turning into addicts, while others continue to abuse, even when the repercussions range from jail time to serious health problems? In a comprehensive review in the European Journal of Neuroscience, Barry Everitt outlines the neural correlates and learning-based processes associated with the transition from drug use, to abuse, to addiction. Drug seeking begins as a goal-directed behavior, with an action (finding and taking drugs) leading to a particular outcome (the drug high). This type of associative learning is mediated by the dorsomedial region of the striatum, the area of the brain that is associated with reward processing, which functions primarily through the neurotransmitter dopamine. In this kind of learning, devaluing the outcome (by decreasing the potency of the drug, for example) tends to decrease the pursuit of the action. When the high is not what it used to be, the motivation to continue seeking it out decreases. However, in long-term abusers, this devalued outcome does not reduce the action — indeed, researchers have found that in cases of chronic drug use, a parallel associative learning process eventually comes to the fore. This process is one of stimulus–response; the conditioned stimuli in this case are the various environmental cues — the sight of the powdery white stuff, the smell of burning aluminum foil — that users associate with getting high and that compel them to seek out drugs. © Association for Psychological Science
It is now one hundred years since drugs were first banned - and all through this long century of waging war on drugs, we have been told a story about addiction, by our teachers, and by our governments. This story is so deeply ingrained in our minds that we take it for granted. It seems obvious. It seems manifestly true. Until I set off three and a half years ago on a 30,000-mile journey for my book 'Chasing The Scream - The First And Last Days of the War on Drugs' to figure out what is really driving the drug war, I believed it too. But what I learned on the road is that almost everything we have been told about addiction is wrong - and there is a very different story waiting for us, if only we are ready to hear it. If we truly absorb this new story, we will have to change a lot more than the drug war. We will have to change ourselves. I learned it from an extraordinary mixture of people I met on my travels. From the surviving friends of Billie Holiday, who helped me to learn how the founder of the war on drugs stalked and helped to kill her. From a Jewish doctor who was smuggled out of the Budapest ghetto as a baby, only to unlock the secrets of addiction as a grown man. From a transsexual crack dealer in Brooklyn who was conceived when his mother, a crack-addict, was raped by his father, an NYPD officer. From a man who was kept at the bottom of a well for two years by a torturing dictatorship, only to emerge to be elected President of Uruguay and to begin the last days of the war on drugs. ©2015 TheHuffingtonPost.com, Inc.
By David Shultz The most venomous animal on the planet isn’t a snake, a spider, or a scorpion; it’s a snail—a cone snail, to be precise. The Conus genus boasts a large variety of marine snails that have adopted an equally diverse assortment of venoms. Online today in the Proceedings of the National Academy of Sciences, researchers report an especially interesting addition to the animals’ arsenal: insulin. According to the paper, this marks the first time insulin has been discovered as a component of venom. Not all cone snails incorporate insulin into their venom cocktail, wonderfully known as nirvana cabal; the hormone was found only in a subset of the animals that hunt with a netting strategy that relies on snaring fish in their large, gaping mouthparts. Unlike the feeding tactics of some cone snails that hunt using speedy venom-tipped “harpoons,” the mouth-netting strategy is a rather slow process. For it to work, the fish either needs to be very unaware of its surroundings or chemically sedated. Scientists speculate that it’s the insulin that provides such sedation. Snails like Conus geographus (seen above) actually produce multiple variants of the hormone, some of which, like one called Con-Ins G1, are more similar to fish insulin than snail varieties. Con-Ins G1 isn’t an exact match of fish insulin though; it’s a stripped-down version that the team suspects may be missing bits that would let fish detect the overdose and respond. If they’re correct, the snail’s venom may yield insight into the nuances of how insulin is regulated that may extend to humans. © 2015 American Association for the Advancement of Science
By Consumer Reports The headlines about coffee’s impact on your health seem to change as quickly as the time it takes to drink a cup. Should you savor every drop or try to cut down? Here’s what we know right now: It may lengthen your life. True, coffee drinkers are more likely than nondrinkers to smoke, eat red meat, skimp on exercise and have other life-shortening habits, according to a large 2012 study published in the New England Journal of Medicine. But even after adjusting for such factors, they found that people age 50 to 71 who drank at least one cup of coffee per day had a lower risk than nondrinkers of dying from diabetes, heart disease or other health problems when followed for more than a decade. That may be due to beneficial compounds in coffee such as antioxidants — which might ward off disease — and not caffeine. Decaf drinkers had the same results. It may make you happier. Coffee is not just a pick-me-up; it also has been linked to a lower risk of depression. In a study led by the Harvard School of Public Health that tracked 50,000 women for 10 years, those who drank four or more cups of caffeinated coffee per day were 20 percent less likely to develop depression than nondrinkers. Another study found that adults who drank two to four cups of caffeinated coffee were about half as likely to attempt suicide as decaf drinkers or abstainers. The researchers speculated that long-term coffee drinking may boost the production of “feel good” hormones such as dopamine. It contains many good-for-you chemicals.
By Susan Svrluga Edwin Chapman’s secretary handed him a pile of prescription slips, and the doctor’s pen moved quickly across them: “Buprenorphine/naloxone.” “Buprenorphine/naloxone.” “Buprenorphine/naloxone.” His waiting room was full of heroin-addicted patients there to refill their generic prescriptions for Suboxone, a drug that helps keep their relentless cravings at bay and now outpaces methadone as a treatment. Chapman is an internist, a cardiologist. This drug has transformed his D.C. medical practice — now more than half of his patients are there to seek it, addicts edging out elderly ladies with arthritis and diabetes. And the drug, he believes, has transformed lives. He wishes more people could get it. Yet even as heroin use surges in the United States, destroying neighborhoods and families — drug overdoses kill more people than any other kind of accident — both addicts and doctors say there are barriers that keep some from the treatment they desperately need. “In the past we’ve kind of run away from these patients, put them in methadone clinics, places no one can see them,” said Chapman, who estimates that two-thirds of his heroin-addicted patients tested positive for hepatitis C and more than one in 10 for HIV. “We need to reverse that. Put them in primary care. We need to be taking care of sick folks, not running away from them.
Keyword: Drug Abuse
Link ID: 20480 - Posted: 01.14.2015
By KIRA PEIKOFF At a recent Seahawks football game in Seattle, Shy Sadis, 41, took a drag on a slim vapor pen that looked like a jet black Marlboro. The tip glowed red as he inhaled. But the pen contained no nicotine. Instead, it held 250 milligrams of cannabis oil loaded with THC, the psychoactive ingredient in marijuana. “Nobody noticed,” said Mr. Sadis, who owns several marijuana dispensaries in Washington State. “You pull it out of your pocket, take a hit like a cigarette, put it back, and you’re done. It’s so discreet.” The device, called a JuJu Joint, heralds a union that seems all but inevitable: marijuana and the e-cigarette, together at last in an e-joint. For years, people have been stuffing marijuana in various forms into portable vaporizers and into the cartridges of e-cigarettes. But the JuJu Joint is disposable, requires no charging of batteries or loading of cartridges, and comes filled with 150 hits. You take it out of the package and put it to your lips — that’s it. There is no smoke and no smell. Since their introduction in April, 75,000 JuJu Joints have been sold in Washington State, where marijuana is recreationally and medically legal. The maker says that 500,000 will be sold this year and that there are plans to expand to Colorado and Oregon, where recreational use is legal, and to Nevada, where it is decriminalized. “I wanted to eliminate every hassle that has to do with smoking marijuana,” said Rick Stevens, 62, the inventor and co-founder of JuJu Joints with Marcus Charles, a Seattle entrepreneur. “I wanted it to be discreet and easy for people to handle. There’s no odor, matches or mess.” © 2015 The New York Times Company
Keyword: Drug Abuse
Link ID: 20473 - Posted: 01.13.2015