“Medicating Normal,” a new documentary about the widespread use and resulting harms of anti-depressants, anti-anxiety medications, ADHD drugs and mood stabilizers, highlights research by Social Welfare Professor David Cohen, an authority on the benefits and risks of psychoactive drugs. The film notes that one in five Americans take these psychiatric medications daily but many are unaware of their potentially debilitating side effects. In the documentary and in online resources published by the filmmakers, Cohen weighs in on misconceptions about mental illness as brain damage; the challenges psychiatric patients face in providing fully informed consent; and the severe symptoms associated with withdrawal from benzodiazepines such as Xanax. He also spoke about the intense pressure on parents to medicalize their children’s problems, a break from previous generations. “You didn’t go to the doctor before if your kid misbehaved. You went to your sister-in-law or you went to your clergyman or you went to the Reader’s Digest,” Cohen said. “It’s hard right now in the contemporary world, in the 21st century, it’s hard for a parent to know, what should I do with my kid? … You get 20 different views on the internet, you are surrounded by opinions, and you’re supposed to do the right thing, the perfect thing.” Swayed by peer pressure, drug marketing and fear of making the wrong choice, many parents conclude that their children have a disorder and turn to medication, he said. “Medicating Normal,” which argues that profit-driven drug companies are concealing the harms caused by their products, was recently screened at the Santa Barbara International Film Festival.
The New York Times spoke to Public Policy Professor Mark Peterson for a story about House Democrats’ focus on rising prescription drug costs in their reelection campaigns. Democrats, particularly those in districts that flipped from red to blue in the 2018 midterm elections, are betting heavily that they have solidified an image as protectors of affordable health care, the story noted. “The Republican efforts at ‘repeal and replace’ ironically highlighted the protections in the [Affordable Care Act] that would be lost and generated more public support for the law than at any time since its passage,” Peterson said. “Now more attention has turned to the other live issue that remains, that has largely always been present and that the A.C.A. has done little to forestall, and in some cases is perceived to have made even worse: out-of-pocket healthcare costs for individuals and families.”
Mark A.R. Kleiman, emeritus professor of public policy at the UCLA Luskin School of Public Affairs and one the United States’ pre-eminent experts on drug and crime policy, died July 21 after a long illness. He was 68.
Kleiman’s long list of publications includes his most recent co-authored books, “Marijuana Legalization: What Everyone Needs to Know” (Oxford University Press, 2012) and “Drugs and Drug Policy: What Everyone Needs to Know” (Oxford, 2011), as well as “When Brute Force Fails: How to Have Less Crime and Less Punishment” (Princeton University Press, 2009).
He also worked at the United States Department of Justice, serving as director of the Office of Policy and Management Analysis, Criminal Division, and as the associate director for Drug Enforcement Programs. And he held posts as deputy director for management and director of program analysis for the city of Boston.
“Mark was a rare breed in academia, a truly Renaissance mind,” said Mark Peterson, professor of public policy in the UCLA Luskin School and one of Kleiman’s colleagues. “I quickly realized that he was both the smartest person in the building and among the funniest, with a quick wit that often required educational sophistication to fully grasp.”
Peterson added: “I can say that his network was simply enormous, encompassing friends, colleagues, mentees and protégés, graduate and undergraduate students, media figures, state and federal policymakers, all of whom he helped, he informed, he guided, and he just simply cared about.”
Kleiman also authored numerous journal articles, book chapters, technical reports and policy memos, as well providing articles and commentary for news media and book reviews and for professional publications. He served as editor of the Journal of Drug Policy Analysis and was a referee for numerous professional policy journals. He also was an active blogger on “The Reality-Based Community,” focusing on public policy analysis of the criminal justice system, substance abuse, and drug policy in the United States and abroad.
Kleiman, who was born in Phoenix and grew up in Baltimore, graduated magna cum laude in political science, philosophy and economics from Haverford College. He earned his master’s in public policy and doctorate in public policy at Harvard.
He came to UCLA in 1996 shortly after the founding of the graduate program in public policy in what was then known as the UCLA School of Public Policy and Social Research. He served on the faculty of the Luskin School until retiring in 2015. He later joined the faculty of New York University, where he was affiliated with NYU’s Wagner School and served as director of the crime and justice program at NYU’s Marron Institute of Urban Management.
Prior to UCLA, Kleiman held academic posts at Harvard University’s John F. Kennedy School of Government, and at the University of Rochester. He also served stints as a visiting professor at the Batten School of Leadership and Policy at the University of Virginia, Harvard Law School, and the University of Maryland’s School of Public Policy. He was a visiting fellow at the National Institute of Justice.
In addition, Kleiman served on the National Research Council as a member of the Committee on Law and Justice, and he was chairman of the board of the Los Angeles-based Botec Analysis Corporation, a research and consulting firm that develops solutions to issues in public policy in the areas of crime, justice and drug policy.
“Mark leaves behind a legacy — us,” said former student Brad Rowe, who earned his master’s in public policy in 2013, and who later worked closely with Kleiman. “He was a teacher first and foremost.”
Rowe said that Kleiman was a demanding instructor, but “he could always make you laugh with his ready-made arsenal of anecdotes.”
Rowe, who now teaches a public policy course at UCLA Luskin and serves as the school’s intellectual successor to Kleiman on drug policy, continued, “And, wow, I’ve rarely met someone who so loved seeing justice done.”
UCLA was the launching point and incubator for many of Kleiman’s ideas, Rowe recalled. “It was a safe haven where he valued the commitment this group has for thought and action rooted in truth, equality, dignity and public safety.”
Albert Carnesale, UCLA chancellor emeritus and professor emeritus of public policy and mechanical and aerospace engineering, first met his future colleague during Kleiman’s time as a doctoral student at Harvard.
“In addition to being an extraordinary fount of original ideas, deep insights, and rigorous and revealing analyses, he was a devoted mentor to generations of students, a valuable colleague, a caring friend, and a compassionate and effective advocate for fairness and justice,” Carnesale wrote in an email after learning of Kleiman’s death.
Former student Jaime Nack, the president of Three Squares Inc. and who graduated with a master’s in public policy in 2002, wrote: “Mark Kleiman was an amazing professor … He truly cared that we mastered the material. He knew it would serve us in life and in our careers.”
No services are planned. He is survived by a sister, Kelly Kleiman, who posted on social media: “If you are moved to honor him, please donate to the NYU Transplant Institute, the ACLU, or any Democratic candidate.”
Public Policy lecturer Brad Rowe discussed the future of cannabis regulation with other research and policy experts at the North American Cannabis Summit in Los Angeles, featured in an article and video broadcast on ABC 7. The decriminalization and legalization of cannabis in various states across the country has prompted public health and safety concerns. Rowe commented, “It is important for us to think about insecticides, pesticides, metals, molds, other things we don’t want in our products, and this new regulated regime will help get better quality to the consumers.” Despite efforts to establish a safer market and ensure higher quality, over-regulation of the cannabis market has resulted in a growing black market. Experts at the summit concluded that, while legalization should lower production and distribution costs, over-regulation serves as fuel to the black market.
The researchers report that the drug suicide rate in the United States rose nearly one-quarter (24 percent) between 2000 and 2016, and the accidental opioid and other drug intoxication death rate increased by 312 percent. iStock photo by Ismailciydem
By Stan Paul
The rate of suicides by drug intoxication in the United States may be vastly underreported and misclassified, according to a new study co-written by Mark S. Kaplan, professor of social welfare at the UCLA Luskin School of Public Affairs.
The study was published online Jan. 10 in the journal PLOS ONE. The researchers report that the drug suicide rate in the United States rose nearly one-quarter (24 percent) between 2000 and 2016, and the accidental opioid and other drug intoxication death rate increased by 312 percent. This rate gap suggests an increase in suicide undercounting, according to the multidisciplinary international team of researchers led by Ian Rockett of West Virginia University School of Public Health.
“Unfortunately, part of the problem is due to serious under-resourcing of state and local death investigation systems throughout most of the U.S.,” said Kaplan, whose research has focused on using population-wide data to understand suicide risk factors among veterans, seniors and other vulnerable populations. Kaplan added that the Centers for Disease Control and Prevention (CDC) recently reported more than 63,000 drug deaths in 2016, up from 52,000 in 2015.
“Many of these deaths were probably suicides, yet reported as accidental self-poisoning rather than intentional self-harm, particularly among the middle-aged,” Kaplan said.
The researchers report that suicide notes and psychiatric history, including a prior suicide attempt or diagnosed depression, are much more important in helping medical examiners and coroners identify drug suicides than suicides by more violent and obvious methods. The new research further shows this evidence is absent in a large majority of suicide and possible suicide cases.
“A suicide note, prior suicide attempt or affective disorder was documented in less than one-third of suicides and one-quarter of undetermined deaths,” the research team reported in the study. The researchers cited larger prevalence gaps among drug intoxication cases than gunshot or hanging cases.
“Our incorporation of undetermined deaths, as well as registered suicides, not only provided a window on the nature of suicide misclassification within the undetermined death category, but within the accident category — as a much larger reservoir for obscuring drug intoxication suicides,” the researchers wrote in the report.
The opioid epidemic in the United States is also exacerbating problems with suicide accounting, the researchers report. And that severely impedes the understanding and prevention of suicide and drug deaths nationally.
The team analyzed data from the Restricted Access Database in the National Violent Death Reporting System, which is administered by the CDC.
The majority of survey respondents cited the main reason they attempted to quit psychiatric medications centered on health risks of long-term use and side effects.
Despite numerous obstacles and severe withdrawal effects, long-term users of psychiatric drugs can stop taking them if they choose, and mental health care professionals could be more helpful to such individuals, according to a new study.
A new study shows that while long-term users of psychiatric drugs can stop taking them if they choose, mental health care professionals could be more helpful to such individuals dealing with problems like severe withdrawal effects.
While 1 in 6 Americans take a psychiatric medication for serious mental illness, there is little research on people’s experiences coming off the drugs. In the first large-scale study in the United States on this subject, Live & Learn, Inc., in partnership with researchers at the UCLA Luskin School of Public Affairs, UC San Francisco and New York University, began to fill this knowledge gap. Study findings are now available online in Psychiatric Services, a journal published by the American Psychiatric Association.
Surveying 250 long-term users of psychiatric medications who had a diagnosis of serious mental illness and chose to discontinue use, the study found that more than half succeeded in discontinuing usage, despite having little professional support while experiencing severe withdrawal symptoms including insomnia, crying and diarrhea. The majority of survey respondents cited the main reason they attempted to quit centered on health risks of long-term use and side effects.
Of the study’s respondents, 54 percent managed to stay off psychiatric medication for at least one year, with few reporting relapse or re-hospitalization. Eighty-two percent of those who discontinued use reported being “satisfied” with their choice.
“People stop taking their psychiatric medications whether or not they find the drugs helpful, and they do so at all stages of the medication experience — days, weeks, months, or years after taking them,” said David Cohen, professor in Social Welfare at UCLA Luskin and a co-author of the study. “This study is novel because it asks questions about stopping to take medications from the consumer’s point of view.”
Many industry-funded studies have asked patients why they stop taking their medications, but typically with a view to increase compliance, according to Cohen. By contrast, this study asks consumers what they experienced while coming off drugs, who helped them make and carry out their decision, and whether they were satisfied with their attempted or completed discontinuation.
“Over 70 percent of our study sample had taken medication for more than a decade; however, these individuals reported having little to rely on when discontinuing except the internet and social support in order to endure withdrawal. Limiting access to care through cuts to health and psychosocial services can only make that situation worse,” says principal investigator Laysha Ostrow, founder and CEO of Live & Learn, a California-based social enterprise that provides research, technical assistance and knowledge translation services to behavioral health systems. “Most were working with a provider at the time but did not find them helpful in the process. However, even though it was often complicated and difficult, the majority who were able to come off medication completely were satisfied with their decision to do so.”
Cohen said that there are still plenty of challenges for researchers who are examining this topic.
“There’s a lot of work to do to understand how people come off medications and how to help them do so safely, especially when they’re taking several psychiatric medications simultaneously,” he said. “This study didn’t use a probability sample. Though it very carefully selected the 250 respondents, most with over 10 years’ history of taking medications, it should be a priority to confirm or modify these findings with a probability sample.”
The study was funded through a grant by the Foundation for Excellence in Mental Health Care.