‘Truss’ worthy Biden: Prez’s economic mess could bring doom

 By 

Charles Gasparino

The bond market just carried out a hit on Liz Truss, so watch out, Sleepy Joe, you could be next. 

The implosion of the UK prime minister is certainly one for the ages. She came in with a burst of optimism that she would reverse the country’s economic malaise with Thatcherite tax cuts.

Unfortunately, Truss left out a few steps, including Thatcherite cuts to government spending. The bond market revolted. After less than two months in office, she’s now political roadkill. 

It’s a lesson of how markets ­impose their own discipline on undisciplined political leaders, like Truss or, possibly someday soon, the dude we have in the White House. 

Yes, real power lies with bond investors. They control things by setting interest rates on various government bonds that all other lending rates are pegged to and the economy responds to. If they think the value of their holdings will be eroded by inflation or deficits, they revolt by selling. Interest rates rise and the economic fallout could be devastating.

Recall then-President Bill Clinton’s famous surprise  during the first year of his presidency about how debt investors — or as he put it, “a bunch of f–king bond traders” — had a veto over his spending plans. After Clinton’s economic team convinced him the traders did, he used revenues from a tax increase mainly for deficit reduction, and the economy eventually recovered. 

New York Post photo composite

I give Truss some credit for at least considering the bond-market reaction to her tax and fiscal plan, even if it was a feeble one.  Last month, just after she officially took the job as prime minister, she appeared confident in looking to sell it to New York bond investors, sources tell me. The good times were about to roll, she assured one money manager I spoke to. 

The markets will love cutting corporate taxes and more. The burst of supply-side stimuli will allow her to fight what ailed the UK economy — slow growth and massive 10% inflation, aka the stagflation she was handed by her predecessor, the recently ousted Boris Johnson, whose tax-and-spend policies contributed mightily to the country’s economic ­anguish.

“She sounded like she was about to take over the world,” the money manager added. 

Reversing course

Fast forward a few days and Truss was quickly reversing course. Bond traders had enough of the unprecedented spending amid the pandemic and the recovery, coupled with super lower interest rates and money printing by the Bank of England. UK debt is now around 98% of the country’s gross domestic product of £2.4 trillion. You read that right: The amount of debt owed by UK taxpayers to investors is as large as the economy itself. 

In other words, it wasn’t such a good time to cut taxes without also cutting spending. Traders began selling the Gilt, the UK version of the US Treasury bond. Yields spiked widely; UK pension funds loaded with debt tied to risky derivatives took massive losses, and a meltdown of the UK financial system was looming as the market imposed its own discipline selling gilts and sending interest rates soaring. 

Truss inherited a stagflation economy from Boris Johnson.

Getty Images

The Bank of England soon became worried about a “Lehman” moment. Overnight, the BOE went from a seller of debt to stamp out inflation it helped create to printing money once again. This epic monetary policy reversal was followed by Truss’ own epic volte-face. 

Realizing that those damn bond traders hated her plan, she went from Thatcher back to the tax-hiking Boris Johnson. 

No more tax cuts or cuts of any kind, she announced. In fact, tax increases are on the table. None of this helped her standing in the cruel world of British politics, which is far more capricious than our own, even if bond traders backed off. 

Word spread Wednesday night she was out, I first reported. By Thursday, she announced her resignation after just 44 days in ­office. 

Sleepy Joe Biden should be taking notes on Truss’s trussing. Inflation is raging here as in the UK. Biden has kept spending, and until recently the Fed kept printing money. US debt is a staggering 125.9% of our GDP, or more than $31 trillion, according to ­USdebtclock.org. 

To fight the inflationary spiral created by Biden’s spending (and its own easy-money policy) the Fed (like the BOE initially) is raising interest rates. The bond market isn’t in meltdown but it is getting skittish. 

Recession soon

Yields on 10-year Treasuries have risen significantly over the past year, showing that those pesky bond traders think inflation and recession-inducing deficits are coming sooner or later. 

If inflation doesn’t peak and if the Fed keeps hiking, the bond market could sell off significantly, presenting one of those Lehman moments with mounting investor losses, and economic stagnation that the Brits just tried to avoid. Throw in massively higher US interest costs to service the enormous debt and you can see the pickle we’re in. 

There are key differences between the UK system and our own, of course. Our economy is much stronger thanks to American innovation in tech, etc. There will be no push to oust Sleepy Joe midterm, though he could be running for reelection in the middle of a financial storm. 

That means Biden should be very afraid. The bond market is starting to eye him as its next victim, and those “f–king bond traders” usually get their woman or man. 

https://nypost.com/2022/10/22/truss-worthy-biden-prezs-economic-mess-could-bring-doom/

COVID Lawsuits Have Arrived: Which Doctors Are at Risk?

 A pregnant patient who had COVID-19 showed up at a hospital with respiratory difficulty caused by her illness. Physicians had to perform an emergency delivery of her near-term baby.

The infant survived, but the woman lost oxygen during the ordeal and suffered hypoxic brain damage. She is now suing an obstetrician, a pulmonologist, and an intensive care unit (ICU) physician for medical malpractice.

The plaintiff contends there was a failure "to adequately recognize and treat her condition," said Peter Kolbert, senior vice president for claim and litigation services for Healthcare Risk Advisors, part of TDC Group, which includes national medical liability insurer, The Doctors Company.

"The physicians involved vehemently disagree and believe they treated her appropriately," Kolbert said. "In fact, we believe their actions were heroic."

In another case, a patient with COVID-19 and multiple comorbidities was admitted to a hospital. Physicians sedated and intubated the patient to maintain her airway. She recovered, but the patient now alleges doctors were negligent because she developed ulcers during her hospital stay. The case occurred during the height of the pandemic. In addition to the hospital, a pulmonologist, an ICU physician, and an acute care physician are named in the suit.

Both of these lawsuits are being defined as COVID claims because at the time, the plaintiffs either had COVID and needed care because of COVID in some way, or because the care that physicians provided was affected by COVID in some way.

In the second case, the patient had COVID and needed treatment. During her recovery, ulcers developed. A significant aspect of this caase is that it occurred during the height of the pandemic. Hospitals were overcrowded, the staff was swamped, and resources were limited. One factor may be that physicians were doing the best they could at the time but that the pandemic affected the extent of care they could provide.

Physicians have long worried about the legal consequences of COVID-19 and whether lawsuits might arise from the care that was provided or that was delayed by the pandemic. Now, new data reflect the grim news: COVID claims have arrived. These cases from the claims database of The Doctors Company, a national medical malpractice company, are just two examples of many COVID-related claims that have been levied since the pandemic started.

Currently, there are 162 open COVID-related claims in The Doctors Company database, according to Kolbert. A September 2022 benchmark report from Aon and the American Society for Health Care Risk Management indicates that 245 claims that pertain to patients with confirmed or suspected COVID-19 have been filed since the pandemic began. The findings in this report stem from an analysis of 95,600 hospital and physician liability claims that occurred between 2012 and 2021.

Of the 245 cases, 89 claims have been closed. The average cost was $43,000 per claim, said Kanika Vats, a director and actuary for Aon, a global firm that provides risk, reinsurance, and health solutions. Six of the claims cost $300,000 or more; the highest settlement was for $700,000.

"Most of the allegations in these claims revolve around delay in treatment or delay in diagnosis," Vats said.

Which Specialties Are Involved in Legal Actions?

Physicians working in acute care settings such as emergency departments and urgent care centers are the primary targets in COVID-related lawsuits involving doctors, say legal analysts. However, other specialties are also being affected. Physicians being sued include some who practiced telemedicine during the pandemic.

In one case, a primary care physician saw a patient via telemedicine because the physical medical office was closed. The patient was evaluated virtually and was sent for bloodwork and an x-ray.

The patient is now suing the primary care physician, alleging that failure to immediately send her to a hospital resulted in tuberculosis going untreated and that the failure led to a bad outcome. The allegation is that the physician underevaluated the case during the telemedicine visit, Kolbert said.

Drew Graham, an attorney at Hall Booth Smith PC, which is based New York, said that most of the COVID-related liability claims he has seen involve facilities that provide postacute care, such as nursing homes and assisted living facilities. His firm has also seen a small number COVID-related claims against physicians as well.

At least two of the claims involved allegations of improper treatment of COVID during hospitalizations, he said. Another involved a telehealth visit in which the patient claimed the virtual care that was provided was improper and that their condition required an in-person examination. Graham declined to specify the specialties of the physicians sued.

The Medical Professional Liability Association (MPL Association) reports similar trends in COVID-related claims. Long-term facilities and hospitals are the most common focus of COVID-19 claims, followed by emergency medicine, primary care, and ob/gyn medical specialties, according to Kwon Miller, manager of data and analytics for MPL Association, a national trade association for medical liability insurers that operates a large claims database.

Between January 2020 and June 2022, the MPL Association Data Sharing Project recorded 280 COVID-19 events. "Events" refers to notifications, licensing board inquiries, and claims involving COVID. Of these events, 180 were closed with no indemnity payment, and 13 were closed with an average indemnity payment of $3816, Miller said.

Complaints of delayed care associated with the pandemic are also on the rise. For example, one patient is suing a gastroenterologist for delaying his colonoscopy, alleging the postponement led to a delayed colon cancer diagnosis and worse prognosis, Kolbert said.

"It was delayed because all elective procedures at the time were being put off," he said. "The patient claims that had they received the scheduled screening, the cancer would have been diagnosed at stage I as opposed to stage III."

Why Isn't Federal Immunity Shielding Physicians?

A pressing question about the growing number of COVID claims is why state and federal immunity isn't preventing such lawsuits.

In 2020, the US Department of Health and Human Services published a declaration under the Public Readiness and Emergency Preparedness Act (PREP Act) that provided liability immunity to healthcare professionals for any activity related to medical countermeasures against COVID-19. The act allows an exception for negligence claims associated with death or serious injury caused by willful misconduct.

At the same time, most states implemented laws or executive orders shielding physicians from liability claims related to the prevention and treatment of COVID-19, unless gross negligence or willful misconduct is proven.

Graham said some COVID-related claims against physicians have included allegations of gross negligence to avoid the application of state immunity, while others combine allegations of deviations from standard of care unrelated to the pandemic.

Some plaintiffs are attempting to skirt the protections by making complaints sound as if they're not related to COVID-19, Kolbert said. That way, they don't have to prove gross negligence or willful misconduct at all.

"The filings at first blush may not tell you it's a COVID case, but it may be a COVID case," he said. "Plaintiffs' attorneys are trying to assert that COVID defenses do not apply and that these cases are 'traditional physician negligence' claims. They're trying to plead around the protections."

The federal and state immunities are likely keeping the volume of COVID claims down overall and are discouraging some complaints from moving forward, attorneys say.

But because some plaintiffs are downplaying or ignoring the COVID association, it's likely that more COVID lawsuits exist than anyone realizes, according to Kolbert.

"I expect there's an underestimation of how many COVID claims are really out there," he said.

What Does the Future Hold for COVID Claims?

Currently, the frequency and the severity of COVID claims are low, Vats said. She believes the cost of such claims will continue to remain at low levels.

"But again, there is a lot of uncertainty," she said. "This year, states have started to roll back their immunity protections, and in a lot of states, there is no cap in awarding [noneconomic] damages. There could well be a scenario where they allege wrongful death, and in a state with no cap on the pain and suffering component, if juries continue to behave the way they have been behaving, we could see aberration verdicts."

Another lingering issue concerns which court systems have jurisdiction in cases involving COVID-related claims. Because of the nationwide response to the pandemic, Graham thinks it makes sense that federal courts handle the cases, but the plaintiffs' bar has generally been opposed to federal jurisdiction.

"A second issue is the long-term impact of COVID litigation on our providers," he said. "If the protections in place to limit liability are determined to be ineffective, our state and federal leaders must act aggressively and in a bipartisan way to make sure our healthcare providers are protected when we face the next crisis."

https://www.medscape.com/viewarticle/982810

Latest Migraine Therapies -- Some You Might Not Know About

 Matthew F. Watto, MD Welcome back to The Curbsiders. I'm Dr Matthew Watto, here with my very good friend, Dr Paul Williams. It's time to talk about headaches. We did a great recent podcast on migraines, Headache Update: Making Migraines Less Painful with Dr. Kevin Weber. One of the quotes from that episode that stayed with me was when he said, "I tell my patients to think about migraine as an irritable old miser set in their ways, and your brain is set in its ways. It doesn't like changes in routine. It doesn't like lack of sleep, it doesn't like being hungry, it doesn't like being thirsty, and it doesn't like changes in the weather." That's a reminder of the good, old-fashioned primary care tips for taking care of headache.

Paul N. Williams, MD: That's right. Conservative supportive management goes by the wayside because we focus on the medications. But I thought that was a really nice way to start the episode.

Watto: I asked him about cervicogenic headaches, which I guess you have to diagnose by giving a cervical steroid injection and see if the patient feels better, but he said he doesn't do this. This is expert opinion territory. He asks his patients with chronic headache about cervical neck pain, because if they have it, he goes after it with physical therapy which can help with the headaches. I thought that was a great pearl that I hadn't heard before.

Give the audience a pearl from this great episode.

Williams: We talked about foundational treatments. We reviewed some of the abortive therapies and over-the-counter products. Some patients do quite well with acetaminophen or NSAIDs. We also talked about triptans, which are the standard medicines that we all know about. You can use those in combination, by the way. Patients can take their triptan with the NSAID that works best for them. They don't have to be used one at a time, trying one and then trying the other one if the first one doesn't help. Dr Weber gave us practical guides in terms of which triptans he favors. He mentioned rizatriptan and naratriptan, which is one that I had not used with any frequency. I've seen rizatriptan a fair amount and that one seems to be covered by most insurances. He favors those two triptans.

He also reminded us that even though there is theoretical concern for serotonin toxicity because these are serotonergic and you'll see these scary pop-ups in your electronic health record, that concern is almost purely theoretical. It hasn't been borne out. They are really safe medications to use. But do use caution if you have a patient with known cardiovascular disease or cerebrovascular disease. We spent a fair amount of time talking about chest pressure as a common side effect. We also talked about some of the newer agents.

Watto: I wanted to add something about the triptans. Part of the reason he favors rizatriptan and naratriptan is that they are newer. He thinks they tend to have fewer side effects. But he did mention sumatriptan because it comes in the most different formulations. If patients have severe nausea, there is a subcutaneous version of sumatriptan and also an intranasal version.

The new kids on the block are the CGRP receptor antagonists, and they are available for preventive and abortive therapy. The abortive therapies are probably what people will be seeing most often in primary care — ubrogepant and rimegepant. Patients can take ubrogepant for abortive therapy and then repeat it if necessary. That's similar to what patients are used to with the triptans. Rimegepant is taken once daily for abortive therapy or every other day as a preventive agent. Those are two of the agents that you might see patients taking. I've certainly started to see them.

There are also a whole bunch of monoclonal antibodies that affect the CGRP pathway. Those are given either once a month by subcutaneous injection or once every 3 months, and one is an infusion. They are pretty safe, and the big appeal is that they can be used in patients with cardiovascular disease. He also said that he has some patients who take them because triptans can cause the medication overuse side effect, but the CGRP receptor antagonists don't. It's an option for some patients to take the CGRP receptor antagonists on certain days for abortive therapy and then they can take the triptans the rest of the month.

Dr Weber said that in his practice, these new drugs have really been great, which I can imagine, if you're a specialist, patients have exhausted many of the typical therapies we offer in primary care.

Paul, bring us home here. What else should we tell the audience about? In primary care, what can we offer these patients?

Williams: A lot of the stuff we can offer works, by the way. It's exciting to have fancy new medications to use, but you don't even necessarily need to get to that point. We have a lot of medications that we can use for migraine prophylaxis, such as the beta-blockers and antihypertensives. Candesartan was a new one to me, an angiotensin receptor blocker that apparently has good evidence for migraine prophylaxis and Dr Weber swears by it. We talked about some of the antiseizure medications, such as topiramate, which is probably the one with the most comfort in primary care. Some older folks may be using valproic acid or the tricyclic antidepressants (amitriptyline and nortriptyline) because people with migraine often will have comorbid anxiety or trouble sleeping, so I find that can sometimes be an effective medication or if they have comorbid neuropathic pain.

Another one that was new to me was venlafaxine as migraine prophylaxis. It's not something I'd heard about before this episode. Certainly, for someone with chronic pain or a mood disorder that's comorbid with migraines, it may be worth a shot. So there are options that we can exhaust first, and we may actually be doing our specialist friends a favor by trying one or two of these in advance, because then by the time the patient gets to the neurologist, it makes the prior authorization process much easier for the newer, fancier-pants medications that we're all very excited about.

https://www.medscape.com/viewarticle/980657

Myocarditis After COVID Shot 'Rare and Mild' in Teens

 New data from Israel provide further evidence that myocarditis is a rare adverse event of vaccination with the Pfizer/BioNTech mRNA COVID-19 vaccine in adolescents — one that predominantly occurs in males and typically after the second dose.

The new data also indicate a "mild and benign" clinical course of myocarditis after vaccination, with "favorable" long-term prognosis based on cardiac imaging findings.

Guy Witberg, MD, MPH, Rabin Medical Center, Petah Tikva, Israel, and colleagues report their latest observations in correspondence in The New England Journal of Medicine, online Oct. 19.

The group previously reported in December 2021 that the incidence of myocarditis in Israel after receipt of the Pfizer/BioNTech BNT162b2 mRNA COVID-19 vaccine was highest among males between the ages of 16 and 29 (10.7 cases per 100,000).

The vaccine has since been approved for adolescents aged 12-15. Initial evidence for this age group reported by Witberg and colleagues in March 2022 suggests a similar low incidence and mild course of myocarditis, although follow-up was limited to 30 days.

In their latest report, with follow-up out to 6 months, Witberg and colleagues identified nine probable or definite cases of myocarditis among 182,605 Israeli adolescents aged 12-15 who received the Pfizer/BioNTech mRNA vaccine — an incidence of 4.8 cases per 100,000.

Eight cases occurred after the second vaccine dose. All nine cases were mild.

Cardiac and inflammatory markers were elevated in all adolescent patients and electrocardiographic results were abnormal in two thirds.

Eight patients had a normal ejection fraction, and four had a pericardial effusion. The patients spent 2-4 days hospitalized and the in-hospital course was uneventful.

Echocardiographic findings were available a median of 10 days after discharge for eight patients. All echocardiograms showed a normal ejection fraction and resolution of pericardial effusion.

Five patients underwent cardiac MRI, including three scans performed at a median of 104 days after discharge. The scans showed "minimal evidence" of myocardial scarring or fibrosis, with evidence of late gadolinium enhancement ranging from 0% to 2%.

At a median of 206 days following discharge, all of the patients were alive, and none had been readmitted to the hospital, Witberg and colleagues report.

This research had no specific funding. Five authors have received research grants from Pfizer.

N Engl J Med. Published online Oct. 19, 2022. Article.

https://www.medscape.com/viewarticle/982835

Bristol: FDA Accepts Application for Mavacamten in Symptomatic Obstructive Hypertrophic Cardiomyopathy

 The FDA has accepted a supplemental drug application (sNDA) for an expanded indication for mavacamten (Camzyos; Bristol Myers Squibb) to reduce the need for septal reduction therapy (SRT).

In April, the FDA approved mavacamten to treat adults with symptomatic New York Association (NYHA) class 2-3 obstructive hypertrophic cardiomyopathy (oHCM) to improve functional capacity and symptoms. The treatment modulates the number of myosin heads that can enter “on actin” states and lowers the probability of force-producing (systolic) and residual (diastolic) cross-bridge formation.

“Currently, it is recommended that many patients with severe symptomatic obstructive hypertrophic cardiomyopathy undergo SRT. This often requires either an open-heart surgical procedure or septal ablation procedure—both specialized care options,” said Roland Chen, MD, senior vice president and head of cardiovascular development, Global Drug Development at Bristol Myers Squibb, in a press release. “The approval of Camzyos earlier this year marked a significant milestone for patients. FDA acceptance of the filing for this expanded indication has the potential to strengthen the profile of Camzyos, while further reinforcing our commitment to delivering transformative cardiovascular therapies to patients.”

Mavacamten is a first-in-class, oral, allosteric modulator of cardiac myosin designed to decrease contractile function and improve VO2 in patients with oHCM, which often results in dynamic left ventricular outflow tract (LVOT) obstruction. oHCM thickens the heart walls and makes it more difficult for the heart to expand normally and fill with blood. Mavacamten aims to target the underlying pathophysiology of the condition.

Mavacamten has previously been found to reduce cardiac muscle contractility by inhibiting excessive myosin-actin cross-bridge formation that results in hypercontractility, left ventricular hypertrophy, and reduced compliance.

The sNDA submission was based on the results of VALOR-HCM, a phase 3 placebo-controlled study that evaluated mavacamten in patients with symptomatic, oHCM who met the 2011 ACC/AHA guideline criteria for SRT and who have not been referred for an invasive procedure.

VALOR-HCM randomized 112 patients 1:1 to receive mavacamten or placebo. The study includes 3 treatment periods over 128 weeks: a 16-week placebo-controlled period, a 16-week active treatment period in which all patients received mavacamten, and a 96-week long-term extension period in which all patients received mavacamten.

VALOR-HCM met its primary and all secondary endpoints with a high degree of statistical significance, with no new safety signals observed.

This safety finding is similar to what has been found in prior clinical studies of the drug. In the EXPLORER-CM clinical trial of mavacamten, adverse effects (AEs) were mild to moderate. Mavacamten was found to be generally well tolerated, with 97% of patients completing the trial with a total of 5 withdrawals.

Three patients withdrew from the trial due to AEs. Two patients administered mavacamten experienced atrial fibrillation and syncope, and 1 placebo patient suffered sudden death.

Eight percent of patients who finished mavacamten treatment experienced at least 1 serious AE, including atrial fibrillation, syncope, stress cardiomyopathy, diverticulitis, infection, contusion, or forearm fracture; 9% of patients in the placebo group also reported at least 1 serious AE.

https://www.pharmacytimes.com/view/fda-accepts-new-drug-application-for-mavacamten-in-symptomatic-obstructive-hypertrophic-cardiomyopathy

Enhanced recovery program enables same-day hip and knee replacement surgeries during pandemic

 Adaptations to a program that helps ensure the best possible outcomes from surgery allowed eligible patients to receive their hip and knee replacement surgeries during the COVID-19 pandemic without spending the night in the hospital. The changes were so successful that they have been implemented permanently at the institution, according to a quality improvement study being presented at the ANESTHESIOLOGY® 2022 annual meeting.

Championed by physician anesthesiologists, Enhanced Recovery After Surgery (ERAS) programs ease the effects of surgery and fast-track patient recovery.

In 2019, Stony Brook Medicine in New York implemented an ERAS program for elective hip and knee replacement surgeries, with all patients spending at least one night in the hospital after the procedure. However, during the pandemic the team revised the ERAS program so that selective patients could have an outpatient procedure, meaning they didn’t spend the night in the hospital.

The new ERAS protocol included:

• Developing a highly selective screening process to identify patients who would be good candidates for same-day surgery (i.e., relatively healthy, highly motivated with a good home-support system).
• Using a shorter-acting spinal anesthetic.
• Hydrating patients before the procedure and restricting the fluids used during surgery.
• Minimizing the use of urinary catheters to prevent infection.
• Improving pain management by sending patients home on a non-opioid pain pump.
• Providing home follow-up, including visits by nurses and physical therapists.

“We found for many patients, same-day surgeries are a safe alternative to an extended hospital stay,” said Sunitha Singh, M.D., lead author of the quality improvement project and coordinator for the ERAS program at Stony Brook Medicine. “Education, prehabilitation and patient engagement are critical to the recovery process. Patients often feel more rested recovering at home in familiar surroundings, and we have made the ERAS changes permanent due to the high success.”

Elective surgeries at Stony Brook Medicine were stopped during the peak of the pandemic (April-May 2020). The hospital implemented the new ERAS protocol beginning in June 2020 to provide continuity of care.

Over a one-year period, 152 patients had knee or hip replacement under the new program. Compared to patients who had the traditional ERAS protocol, patients in the new ERAS program stayed in the hospital an average of eight hours vs. an average of 1.7 days. No readmissions were reported. Currently, about 40% of the hospital’s hip and knee replacement patients participate in the same-day surgery ERAS program.

“Our findings demonstrate the adaptability of our health care system — including leveraging ERAS programs to respond to health care emergencies — while improving the quality of care,” Dr. Singh said.

https://www.eurekalert.org/news-releases/967704

San Diego ER seeing up to 37 marijuana cases a day — mostly psychosis

 Meg and Scott knew something was going on with their son Kyle when, during the pandemic, he began refusing to get out of bed to attend class online.

Up until then, Kyle had been like a dream son: tall, good-looking, strong, athletic, with a great sense of humor. He was such a good baseball player that talent scouts were checking him out, and had a decent chance of someday playing in the Major League.

“He had the world by the balls,” his dad said. (At the family’s request, The Post has used pseudonyms.)

Now, Kyle was constantly irritable and depressed and wanted to drop out of his New Jersey high school. Then, one night, he lost it completely, fantasizing that his parents wanted to kill him. 

“Zero touch with reality,” Scott recalled. The family checked Kyle into a psychiatric facility, where his delusions got worse. He thought his dad ran the mafia and had put Joe Biden in office. He demanded that his parents give him $10 million.

Meg and Scott were sure their son was messed up on some hardcore drug. But when the institution ran a drug test, Kyle came up positive only for his prescribed Attention Deficit Disorder medication and for THC — that is, marijuana.

With no regulations on THC, legalized marijuana products are reportedly leading to more medical emergencies.

REUTERS

Laura Stack’s son Johnny was driven into acute psychosis after years of high-concentrate THC usage. Believing his dorm room was bugged and that he was being followed, he jumped to his death at 19.

Matt Pangman

Kyle’s now in recovery, but his is a story that is becoming familiar to more and more American families. Someone begins showing classic signs of hardcore drug addiction. Eventually, they suffer a full psychotic break. But the only drug history is for cannabis.

“We’re now counting 37 cannabis-related diagnoses a day,” Dr. Roneet Lev, an addiction medicine doctor at Scripps Mercy Hospital in San Diego, said about her emergency department. “It’s been steadily increasing over the years. When I started in the 1990s, there was no such thing. Now I see 1 to 2 cases per shift. The most common symptom is psychosis.” 

“We probably see 20 THC-induced psychoses for every amphetamine-induced psychosis,” said Ben Cort, who runs a drug and alcohol treatment center in Colorado. One study showed an increase of 24% in cases of psychoses in emergency departments in Colorado in the five years following marijuana’s legalization in that state in 2012.

“We’re now counting 37 cannabis-related diagnoses a day … the most common symptom is psychosis,” said Dr. Roneet Lev of the ER at Scripps Mercy Hospital in San Diego.

Tom Russo for NY Post

Since then, legal marijuana has been transformed into a potent and unrecognizable product.

“When I speak at parent nights at schools, most adults still think it’s like the weed we smoked when we were teens in the ’80s, [which had] between 3 to 5% THC per gram of flower,” said Laura Stack, an advocate against cannabis abuse in Colorado. “We never had today’s high-potency concentrates, vapes or edibles.”

Laura’s son Johnny was driven into acute psychosis by years of high concentrate THC usage. He believed his dorm room was bugged and that the mob was after him.

The THC levels in legal edibles and vaping products are not regulated and often contain incredibly high amounts.

AFP via Getty Images

Johnny killed himself in 2019 at the age of 19 by jumping off a six-story building. “There are no caps on potency,” said Stack. “They’re cultivating higher and higher concentrates of THC. You literally can’t buy what you could get in the ’80s and ’90s; marijuana that mild isn’t around anymore.”

THC (Tetrahydrocannabinol) is the psychoactive chemical, or cannabinoid, that causes both the euphoria and the paranoia that tends to accompany marijuana highs. The strongest marijuana flower you can buy is in the range of 25% THC. 

The edibles that are sold in dispensaries are created by chemically stripping the THC from the marijuana plant and creating a concentrated THC “wax” that’s typically three times that level. These products also lack CBD, a chemical in natural marijuana that partially counteracts the THC. Even more potent than edibles are “dabs,” a form of THC that users smoke out of vape pens, which can be over 90% THC. At this level of potency, THC can trigger severe symptoms of psychosis in regular users, studies and addiction experts say.

Stack became an advocate against cannabis abuse in Colorado after her son’s death.

Matt Pangman

“Now that THC is a more readily available drug and the perception of harm is at the lowest point in recorded history, we treat more people for THC disorder than for opiate disorder right now,” said Cort. “I’d say about half of our census is THC. And the vast majority of them have THC-induced psychosis.”

“One clinical study showed that a moderate dose of pure THC causes psychotic symptoms in about 40% of people who lack a family history of psychosis. If you’re a casual user and your dosage is mild, that likely just means a touch of paranoia,” said neuroscientist Christine Miller, an expert on psychotic disorders.

Thirty-five percent of people who have experienced such symptoms, however, will go on to experience a full psychotic break, according to another study, if they continue their high risk environmental exposure by continuing to use cannabis.

Johnny killed himself in 2019 at the age of 19 by jumping off a six-story building.

Vision Photography

According to multiple studies, for those who have ever suffered a full cannabis-induced psychotic break, the chance that, if you still keep using, you’ll eventually develop permanent schizophrenia is almost 50 percent. That’s a higher conversion rate than amphetamines, opioids or LSD.

But what really makes THC more dangerous than those other drugs, experts say, is that so few people consider it dangerous at all. “We know fentanyl is bad. We know meth is bad,” said Dr. Libby Stuyt, a recently retired addiction psychiatrist in Colorado. “We don’t know that marijuana is bad.”

THC concentrates are highly physically addictive, experts add. “It is almost impossible for people to quit,” said Stuyt.

Dr. Lev says about daily cannabis-related diagnoses, “When I started in the 1990s, there was no such thing.”

Tom Russo for NY Post

But because they’re produced from marijuana, many users assume that they’re as non-addictive as an old-fashioned marijuana joint is. According to a Rasmussen Reports poll, 57% of Americans do not believe that marijuana is dangerous.

Often cannabis users believe the THC products they consume are cures for the very symptoms that are generated by their withdrawal from the drug, such as anxiety and insomnia. “People think, ‘Oh, it’s my symptoms. That’s why I need it. I’m anxious and it’s treating my anxiety,’” said Stuyt. “No: It’s the withdrawal that’s causing your anxiety.”

“Because it’s allowed to be heavily marketed and advertised as ‘medicine,’ people believe it’s safe,” Stuyt continued “It’s the industry, they keep saying it’s not addicting, it doesn’t cause psychosis. This is no different from the tobacco companies when they were saying it doesn’t cause cancer, it’s non-addicting.”

Stack became an advocate after her son’s death.

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Since marijuana has been legalized in 19 states and counting, a $13 billion industry has emerged around it that has marketed the drug as a remedy for everything from chronic pain to anxiety. The corporations that have invested most heavily in cannabis are the ones that know best how to market addictive products and manipulate public opinion into underestimating their risks: the tobacco, alcohol and pharmaceutical industries.

There are in fact only four cannabis-derived drugs that are FDA-approved: Epidiolex for seizures, Marinol and Syndros for nausea and anorexia, and Cesamet, also for nausea. They are available only by prescription, and none are sold over-the-counter at dispensaries. (Since marijuana is still a Schedule I drug, American scientists cannot legally research it. President Biden has announced plans to review that status; if the administration re-schedules it, researchers will be able to legally experiment with it and more medical applications could in time be revealed.)

Beyond those four prescription drugs, evidence for claims to the medicinal properties of marijuana are scientifically lacking. 

“This is not medicine,” Stuyt said. “This high-potency THC has not been studied as medicine.”

According to Cort, Americans underestimate the risks of THC because they conflate it with the much less harmful marijuana of the pre-legalization years. “They’re not smoking weed,” said Cort. “What’s being consumed in these concentrates is devastating for their mental health.”

“The whole world is telling them it’s safe,” said Dr. Lev of cannabis users. “People are in unbelievable denial.”

https://nypost.com/2022/10/22/san-diego-er-seeing-up-to-37-marijuana-cases-a-day/