It was Prozac. And let the drug-money-addled MSM’s defense begin before that word drops onto the page. Hey, do you think Jeremy Manier might drop in a quote next time from Elliot Valenstein or David Healy?
Doctors: Prozac, violence rarely linked
Experts doubtful that halting medication led directly to shooting at NIU
By Jeremy Manier | TRIBUNE REPORTER
February 19, 2008In the wake of Steven Kazmierczak’s murderous shooting spree at Northern Illinois University, law-enforcement officials noted he had begun to behave erratically after he recently stopped taking psychiatric medication.
That fact might seem to offer a tidy explanation for his rampage, or at least some insight into his troubled mind. But psychiatrists say suspending a patient’s use of antidepressants — Prozac, in Kazmierczak’s case — is rarely linked to violence toward others.
When used under a therapist’s supervision, they stress, such medication can help people overcome depression and other mental ailments. And while the source of Kazmierczak’s state of mind remains a mystery, experts said it’s unlikely that halting his Prozac therapy would have led directly to his shooting plot. [Weasel Words Alert 1: Well, how unlikely? Less than a .001% chance, or less than a 50% chance?]
At the same time, psychiatrists say, his case may help reinforce a key lesson: Stopping antidepressant therapy suddenly can be risky if patients do not follow a doctor’s instructions and don’t report any negative effects.
About one-fifth of people who halt a course of Prozac-like drugs report symptoms associated with a condition known as discontinuation syndrome [Weasel Words Alert 2: the syndrome is not known as “withdrawal symptoms” because drug PR muscle prevented describing accurately the Prozac realities of addiction and withdrawal], which can include abdominal pain, dizziness, crying spells, irritability and even a sensation similar to an electrical shock in the patient’s arms or legs. [That’s all? Nothing about wanting to kill others and yourself?]
Kazmierczak’s former girlfriend, Jessica Baty, told CNN on Sunday that he had stopped taking Prozac because “he said it made him feel like a zombie.” One crucial detail left unanswered is whether Kazmierczak stopped the medication under the advice of a doctor or if he did it on his own. . . .
“Your body has to adjust to being off the medication,” said Dr. Joan Anzia, an associate professor of psychiatry at Northwestern University’s Feinberg School of Medicine. “Some people are more sensitive to it than others.”
For some people, stopping antidepressants abruptly may leave them briefly [Weasel Words Alert 3: How briefly? A couple days, a couple months? Prozac in particular does not leave the system quickly after discontinued use.] worse off than they were before they took the medication. That’s because of the effect that Prozac and similar drugs have on serotonin, a chemical messenger in the brain that plays a key role in depression, obsessive-compulsive disorder and other psychological conditions.
. . . Although the biological roots of depression are a source of controversy, some research suggests it may stem in part from low levels of serotonin. [Weasel Words Alert 4: Weasel words needed cuz there’s no evidence depressed people share abnormal brain structure or chemistry that SSRIs can fix (See David Healy far below)]
. . . The added serotonin may also change how some brain cells function, by decreasing their normal response to the chemical. That may worsen the effects of low serotonin levels when patients abruptly stop taking antidepressants.
“The issue is how fast you reduce the serotonin activity,” said Dr. William Scheftner, chair of psychiatry at Rush University Medical Center. “If the drug dosage is lowered gradually you have the opportunity to make adjustments.” [Impressive how all these doctors are able to avoid saying the bad word ‘withdrawal’!]
It’s rare for patients who are stopping antidepressants to report severe psychological effects, [Weasel Words Alert 5: How fucking rare is rare? Is 200,000 cases a year (see SSRI stories reference below) still rare?] but such reports do exist. . . .
In one other case of multiple homicides, the Columbine school shootings, assailant Eric Harris had been taking the antidepressant Luvox before the murders. Harris claimed on a videotaped message that he stopped taking the pills in order to let his anger grow without the restraint of the medication. . . .
Patients who take Prozac in low doses — about 25 milligrams per day or less — tend to have the fewest side effects when stopping the drug, said Anzia of Northwestern. Kazmierczak’s dosage level is unclear.
http://www.chicagotribune.com/news/local/chi-prozac_19feb19,1,5479765.story
Reports of Gunman’s Use of Antidepressant Renew Debate Over Side Effects
By BENEDICT CAREY
February 19, 2008Sara Bostock, of Atherton, Calif., whose daughter committed suicide shortly after taking Paxil, acknowledged that the interaction between drug effects and underlying emotional distress was hard to untangle.
Ms. Bostock wrote in an e-mail message, “As an observer and suicide survivor, my main wish is that medical professionals, regulatory authorities and other scientists will examine closely the entire medical and treatment history of the perpetrators of these violent incidents in which innocent people are victims.”
She is a founder of ssristories.com, a Web site that has tallied 2,000 news reports of violent acts in which people were thought to be taking antidepressants or had recently stopped them.
http://www.nytimes.com/2008/02/19/us/19depress.html?_r=1&ref=us&oref=slogin
SSRI Stories is a great, tragically necessary website. It introduces itself with the following fact I bet the Chicago Tribune will never publish:
Preda and Bowers [Preda and Bowers. Antidepressant-Associated Mania and Psychosis Resulting in Psychiatric Admissions . Journal of Clinical Psychiatry 2001: 62: 30-33] reported that over 200,000 people a year enter a hospital with antidepressant-associated mania and/or psychosis. The subsequent harm from this prescribing can be seen in these 2100+ stories.
These stories have been collected over a period of years by two directors of the International Coalition for Drug Awareness (ICFDA). Their focus has been on Selective Serotonin Reuptake Inhibitors (SSRIs), of which Prozac was the first. Other SSRIs are Zoloft, Paxil (Seroxat), Celexa, Sarafem (Prozac in a pink pill), Lexapro, and Luvox. Other newer antidepressants included in this list are Remeron, Anafranil and the SNRIs Effexor, Serzone and Cymbalta as well as the dopamine reuptake inhibitor antidepressant Wellbutrin (also marketed as Zyban).
By the way, the following is all that Lilly wants you to know about possible problems with Prozac. Note the non-mention of withdrawal — oops, I mean discontinuation syndrome — or homicidal tendencies in Lilly’s description of potential problems:
Lilly Launches Public Outreach Initiative to Correct Allegations About Company and Prozac
January 17, 2005
. . . In addition, you, your family and other caregivers should be aware of the following information: Depression, as a disease, can be associated with periods when the symptoms can worsen and thoughts of suicide can emerge. Patients and their families should watch for these as well as for anxiety, agitation, panic, difficulty sleeping, irritability, hostility, aggressiveness, impulsivity, restlessness, or over excitement and hyperactivity. Call the doctor if any of these are severe or occur suddenly. Be especially observant at the initiation of antidepressant drug therapy and when there is a change in dose.
http://www.medicalnewstoday.com/articles/18960.php
FDA’s VOLUNTARY REPORTING SYSTEM
A huge problem with SSRIs is the libertarian, sucking up to the drug companies, voluntary approach the FDA has taken to problems with all drugs on the market, including antidepressants. This is means it is impossible to know how large-scale the antidepressant problem is. For example, notice the standard FDA reaction to a health care crisis involving a drug that was legally on the U.S. market:
FDA urges consumers, health care providers, and caregivers to cease using and dispose of these products and report any adverse events related to these products to MedWatch, the FDA’s voluntary reporting program at 1-800-FDA-1088; by FAX at 1-800-FDA-0178; by mail to MedWatch, Food and Drug Administration, 5600 Fishers Lane, Rockville, MD, 20857-9787; or online at www.fda.gov/medwatch/report.htm.
And note also that the FDA’s voluntary reporting program is only for ‘serious’ adverse events, and is urged on doctors primarily for drugs out in the market 3 or less years (i.e., not Prozac, Zoloft, or Paxil). For confirmation and further details, read the following:
Learning from Prozac: A Case Study on Reforming the FDA Drug Approval Process
Maria Wood
April 11, 1997The FDA encourages only the reporting of serious adverse effects, which it defines as “those cases in which the physician suspects that an FDA-regulated product was associated with a serious outcome — death, a life-threatening condition, initial or prolonged hospitalization, disability, or congenital anomaly, or when intervention was required to prevent permanent impairment or damage.” The FDA also emphasizes reporting events that occur with drugs that have been on the market for less than three years, because this appears to be the critical time period in which most serious problems are discovered.
Here’s Peter Breggin further describing and noting the obvious problems with the voluntary reporting system:
To detect postmarketing risks, the FDA relies upon a spontaneous report system based on voluntary reports from physicians who take the time to send a report to the drug company or the FDA. This process is informal and voluntary. Up to 40 percent of physicians do not even realize that the FDA reporting system exists. . . .
Critics of the FDA, as well as FDA officials I have interviewed, agree that the postmarketing surveillance for adverse drug effects is very inadequate. . . .
Only a small fraction of serious drug side effects ever get reported to the manufacturer or the FDA, yet in the case of Prozac, the FDA has now received more than 28,000 adverse reaction reports of all kinds since the drug became available in January 1988. This is far more than for any other drug in FDA history.
Peter R. Breggin, M.D., Talking Back to Prozac, 1995, pp. 185-186.
DR. DAVID HEALY
March 20, 2002
Prozac, Suicide and Dr. Healy
By Rick Giombetti
http://www.counterpunch.org/prozacsuicide.htmlDr. David Healy, professor in Psychological Medicine at Cardiff University College of Medicine, Wales, is hardly a household name in the United States and that is a shame.
One of the world’s leading research psychopharmacologists, Healy’s expert testimony in last year’s Paxil civil trial was one of the deciding factors in the plaintiff’s jury victory in that case. Wyoming resident Donald Schell, 60, killed his wife, daughter and granddaughter and then himself with a gun in 1998 after only two days on Paxil. Schell’s surviving family members sued Paxil manufacturer UK-based Glaxo-Smith-Kline (GSK), the world’s largest pharmaceutical manufacturer, and won. The decisive factor in the case was the company’s own internal data demonstrating that they knew Paxil could cause agitation and suicidal ideation in research subjects. . . .
. . . Two weeks after the verdict in the Paxil trial, Houston area mother and convicted murderer Andrea Yates drowned her five children while she was on not one, but two antidepressant drugs with strong stimulant profiles. What could have been an opportunity for the mass media to educate the public about the dangers of antidepressant drugs, instead has been a non-stop awareness campaign for the mental health industry about the need for more psychiatric “treatment.” The real story that has been missed in the Yates case is the fact that it is a story about psychiatric treatment failure. Yates had been getting psychiatric drugs for her post partum depression for years. She was on high doses of two antidepressants drugs at the time she drowned her children but went ahead and did what these drugs are supposed to prevent anyway.
Meanwhile, Dr. Healy hasn’t shied away from linking Prozac, Paxil and the other SSRI’s to suicide. He figures at least 250,000 people have attempted suicide worldwide because of Prozac alone and that at least 25,000 have succeeded. . . .
RG: How do Prozac and the other SSRIs like Paxil cause suicidal ideation (“We can make healthy volunteers belligerent, fearful, suicidal and even pose a risk to others,” you wrote in the June 2000 Primary Care Psychiatry. “People don’t care about the normal consequences as you might expect. They’re not bothered about contemplating something they would usually be scared of.”)?
DH: There is a greater difference between Prozac and other SSRIs on the one side and placebo on the other side in the rate in which they cause agitation, than there is between Prozac and the other SSRIs and placebo and the rate at which they get people who are depressed better (i.e., the SSRIs cause more agitation in testing subjects than sugar pills, but they also tend to outperform sugar pills at getting depressed people better). The fact that companies have chosen to market them as antidepressants rather than agents that cause agitation is a business decision rather than a scientific matter. It is certainly not one that was “ordained by God.” You could say that the fact that some people who are depressed get better is a side effect.
These drugs are drugs that primarily work on the serotonin system. There is no evidence for any abnormality in the serotonin system in people who are depressed. There are however variations in the serotonin system in people who are depressed. There are however variations in the serotonin system in all of us so that some of us will have quite different effects from these drugs than others. It would have been a relatively simple matter to do work on this 10 years ago to find out which of us were more likely to have problems with the drug than which of us were more likely to do well on them. [I wish RG had asked a follow-up question here, that is, “Why isn’t such research being conducted now?”]
RG: You testified in the Paxil trial in Wyoming on behalf of the plaintiffs. The plaintiff’s position . . . was that Paxil was the primarily responsible for Donald Schell shooting his wife, daughter and granddaughter to death before killing himself with a gun in 1998. Schell had been taking the drug for two days. Based on internal Glaxo-Smith-Kline(Paxil’s UK-based manufacturer and world’s largest pharmaceutical company) documentation you reviewed as an expert witness in that case, what would you have to say about Paxil and suicide to an individual contemplating a prescription for the drug?
DH: The evidence across the board from all of the companies producing SSRIs is that their drugs can make 1 in 20 of us agitated to the extent that we drop out of trials. This agitation in some cases will include thoughts of suicide, self-harm or strange, out-of-character thoughts. The agitation may even develop to psychotic proportions.
Part of the problem with SSRIs is that they have been prescribed to many people by a doctor who may not be aware of these side effects and may not have warned you about the side effects. If you then develop problems on the drugs you may not link the drug to the problem or you may feel now that you have a very severe nervous problem and that your physician is the only way out of the problem. A hostage dynamic can develop.
There is a particularly difficult scenario where a patient is faced with a physician who tells them that any increased nervousness they now have is not being cause by their pills and that the answer to this is to continue with the pills. In this case many people may not even let the physician know how serious this increased nervousness is – as they feel they are not being listened to. This situation can arise in part because physicians are dependent on companies for information about any problems that can be caused by the drugs and are informed that there is no problem of this kind that stems from the drugs, that any problem of this kind stems from the illness. In such circumstances where a physician is relying on what they have been told by the company and is not listening to their patient, there is a real risk of things going badly wrong. Some people will only escape disaster if they halt their pills.
RG: The story of Houston area mother Andrea Yates drowning her five children has led to quite a campaign of awareness about mental illness in the mass media during the past several months. . . . What hasn’t happened with the Yates case has been an honest accounting of what it really is about: Another case of psychiatric treatment failure. Andrea Yates’ post-partum depression had been getting treated with drugs for years and she was on two antidepressants at the time she drowned her five children. I’m not asking for much from the mass media on the reporting of this case, just the barest mention of two words with this case would be helpful: Effexor and Remeron.
At the time of the drownings Yates was on 450 mg/day of Effexor, or 75 mg above the maximum recommended dosage, and 45 mg/day of Remeron, or the maximum recommended dosage. Yates had been taken off 4 mg/day of the tranquilizer Haldol two weeks before she drowned the children and the Remeron was added to her prescription, which continued to include the Effexor. Now there is a wealth of clinical date out there about these two drugs but the media has to look at it instead of helping the mental health industry promote mental health awareness. [RG describes research pertinent to the two drugs’ potential for harm and the Yates case] . . .
Well, am I on to something here? Is it unreasonable to suggest that Yates was suffering from extreme agitation and/or insomnia, given that she was taking high doses of both Effexor and Remeron, and that this might have been a factor in her actions the day she drowned her children? What do you know about Effexor and Remeron? (Effexor is known as a “Serotonin and Norepinephrine Reuptake Inhibitor” or “SNRI” and Remeron is known as a “Noradrenergic and Specific Serotonergic Antidepressant,” “NaSSA”)
DH: The European tradition had been that all antidepressants could cause a problem. This included the tricyclic antidepressants which like Venlafaxine (Effexor) inhibited both serotonin and norepinephrine reuptake. The clinical trials of Mirtazapine (Remeron) submitted to the FDA that got it a license contain an excess of suicides and suicide attempts in those trials compared to placebo. I don’t know the details for Venlafaxine (Effexor).
Your point about it not being unreasonable to suggest that Yates was suffering from extreme agitation and/or insomnia on the combination of Effexor and Remeron is a reasonable one.
. . .RG: “No Such Thing As An Antidepressant” is the title of one of the chapters of Peter Breggin‘s book The Antidepressant Factbook. Breggin writes, “Is it possible that there is no such thing as a genuine antidepressant? Before the scientific data had confirmed my suspicions, I doubted that a drug could actually ‘treat’ depression. After all, if depression is a product of our conflicts, stressful life experiences, and stifled choices, a drug would have no direct effect on treating it. Meanwhile, study after study has confirmed that antidepressants typically perform only a little better than sugar pills. In some studies, antidepressants actually turn out to be less effective than the lowly sugar pill.” Breggin then goes on to cite the clinical data in a review of the performance of seven antidepressants in 45 clinical trials. Is there such a thing as an antidepressant drug and is controlled clinical testing anyway for us to answer this question?
DH: The Breggin line that there is no such thing as an antidepressant because depression arises from conflicts and you couldn’t expect a drug to treat that does not follow a coherent medical logic. The problem with a wide variety of nervous states we are faced with is that we don’t know the origins of these. To say that they arise from conflicts is too simplistic.
But even if they did arise from conflicts it is not clear that an entirely artificial solution that had little to do with conflicts wouldn’t be a way of treating the problem. In many medical states from broken legs through to cardiac problems the answer may be to insert something artificial like a metal plate or a plastic valve in order to produce a new modus vivendi(manner of living). The origins of these problems are not a deficiency of metal in the leg or plastic in the heart but the metal in one case and the plastic in another may provide a workable solution. However, having said this antidepressants are not a cure in the sense that they do not correct either the biological abnormality that may be involved in depression or event the biological predisposition to depression. Some antidepressants are energy enhancing. Others like Zoloft, Prozac and Paxil are more anxiolytic(anxiety relieving). This may or may not be helpful thing to do in the case of someone who is depressed.
Controlled clinical testing doesn’t answer the question of whether there is such a thing as an antidepressant or not. What trials do is to show whether a drug can do something or not. Whether it is wise to then do that something or not is an entirely separate question and it is probably the case that many clinicians don’t take the time to make a clear decision as to the wisdom of using an antidepressant in the case of each of the patients that they ultimately go on to prescribe for. The overwhelming majority of those who are prescribed antidepressants are at little or no risk for suicide or other adverse outcomes from their nervous state. Treatment runs the risk of stigmatizing the person as well as giving them problems that they didn’t have to being with. . . .
[The discussion moves on to Thomas Szasz, prominent in the ‘antipsychiatry’ movement and Professor Emeritus of Psychiatry at the State University of New York Health Science Center in Syracuse, New York] In the case of Thomas Szasz, he was arguing that it was unreasonable to say that psychoneuroses were diseases. I agree with him. However I have not been a psychotherapist earning my living out of treating minor mental disorders. I’m at the coalface in a District General Hospital setting managing psychoses. Many of these patients can end up in states of rigid immobility that we know can last for months or years if left untreated. Others are consumed by nihilistic delusions of various sorts. Yet others have thought disorder of a kind that most clinical observers looking at it have said indicates frontal lobe dysfunction. It is these states that I am happy to say look like real diseases.
Saying that these look like real diseases does not mean that they have to be treated with physical means. I am happy to respect a person or their families wish to leave the state untreated. I also believe that when we finally understand the biological underpinnings of things this will put us in a better position to know how to handle many of these states by non-physical means. Genetic testing for disorders like phenylketonuria makes it possible to avoid the damage that this illness causes by simply managing your diet properly.
I believe the real concern the antipsychiatrists had was not so much whether mental illness was real or not, but rather a concern at the extension of the psychiatric reach out into the community that took place in the 1960s. Who were these guys who were telling us how to live our lives – what training do they have in how to live life. . . .
More on Healy here: http://en.wikipedia.org/wiki/David_Healy_(psychiatrist)
More on Szasz here: http://en.wikipedia.org/wiki/Thomas_Szasz
In light of everything Healy writes, it’s interesting that one problem the psychological establishemt will find with Kazmierczak is that he very much did not want to identify as mentally ill. Note in the following, by the way, how many years ago his parents placed him in a ‘psych’ house, when he was 17 or 18, and that probably means he’d been on or been urged to be on antidepressants roughly ten years:
Kazmierczak spent more than a year at the Thresholds-Mary Hill House in the late 1990s, former house manager Louise Gbadamashi told The Associated Press. His parents placed him there after high school because he had become “unruly” at home, she said.
Gbadamashi said she couldn’t remember any instances of him being violent.
“He never wanted to identify with being mentally ill,” she said. “That was part of the problem.”
http://www.mercurynews.com/ci_8282001?source=most_viewed
FINAL THOUGHTS AND STUFF
Semi-finally, and a little ominous in that it gives a powerful impression of how widespreaded antidepressants are among the middle and upper-middle social classes, here’s an op-ed from the Stanford Daily:
Anti-anti-anti-antidepressants
August 25, 2005
By Andrea RunyanA column opposed to the antagonizing of people who would prefer not to take antidepressants for their whole lives.
From the way people talk about it, you’d think the decision to stop taking antidepressants or to refuse to start taking them was like shunning power steering out of mere stubbornness. “It can help so much,” people say. “Why struggle when things can be so easy?” . . .
Much of this ease with which people are buying into antidepressants could be attributed to the bioamine hypothesis of depression, a theory supported much less by research than by drug companies. The eminent neurosientist Elliott Valenstein challenged this theory in his book, “Blaming the Brain,” writing that no biochemical or anatomical traits have been found to reliably distinguish the brains of the depressed, and attempts to prove the chemical deficiency hypothesis of depression have been in vain. Contrary to predictions, depressed people don’t have less serotonin, and they don’t seem to have predictable imbalances of other neurotransmitters, either.
Valenstein’s conclusion about why the chemical imbalance theory persists despite decades of failures to validate it is similar to that which David Healy voices in “The Antidepressant Era,” — “It can reasonably be asked whether biological language offers more in the line of marketing copy than it offers in terms of clinical meaning.”
Dr. Jonathan Metzl writes that when a patient asks how his or her psychiatric medication is thought to work, “[t]he question, amazingly enough, often results in a disquieting pause. Sometimes, the physician will take the scientific approach. `What we know about their in vivo action is simply theory. There are many, many neurotransmitters in the brain. We know medications such as Prozac work on the serotonin system, thought to be involved in the mechanism of depression…’
“Sometimes, the response can sound a bit defensive. `Well, let’s just say they work.’ And sometimes, one can just change the subject. `Well, how about this weather, huh?’ But beneath these responses, or lack thereof, lies a discomforting truth: We are not entirely sure of the mechanism of action, broadly speaking, of many psychotropic medications. Moreover, while we have ample evidence attesting to these medications’ effect on brain chemistry, much remains to be said about the connection of brain chemistry and emotional well being.”
I also found the following an excellent survey of the complex choices each individual deals with, somewhat alone, when faced with depression and how to emerge from it or deal with it. The author notes that her family history of alcoholism made her reluctant to accept as a cure doctors’ offers of addictive substances:
Emotional choices: what story you choose to believe about antidepressants reveals a deeper truth about who you are.
Joli Jensen (2004)Critics of modernity, from the Frankfurt School to the post-structuralists, point out that we can be convinced to become willing participants in our own oppression. They argue that capitalism, patriarchy, and modernity convince us to become what these systems need us to be. Even though I’m less worried about these systems than they are, I think there is at least some value in constant skepticism about the importance of being “normal” if “normal” means being docile and tractable.
In fact, I’ve long been drawn to the grouchy and the eccentric. There is something enlivening about being a crank, and something scary about how easily difference is labeled pathology these days. The relentless emphasis on “adjustment” that sociologists criticized in the 1950s is now so commonplace as to be almost invisible. But what’s so great about being adjusted to systems I don’t always believe in or support?
So here’s where I end up: Mood medication is too risky for me to take or want to give to my kids, although I’m happy to let other people take whatever legal or illegal drugs they want as long as they realize what they are doing. I don’t want my friends, family, of fellow citizens to get sucked into believing they are treating a chemical imbalance with medicine when what they are actually doing is taking drugs to feel better.
I think we make too much of being “normal.” Variety and difference are good things. I want people to stop falling for stories about diseases and imbalances that make them eager consumers of expensive, possibly dangerous, and possibly ineffective drugs. Taking drugs to feel better may be just fine for you, but I am betting that the option is particularly dangerous for me. So far, living without most drugs (I’m keeping the caffeine) has worked out pretty well.
Joli Jensen (joli-jensen@utulsa.edu), a professor of communication at the University of Tulsa, is the author, most recently, of Is Art Good for Us? Beliefs About High Culture in American Life (Rowman & Littlefield).
JOLI JENSEN’S interest in mood-altering pharmaceuticals, the focus of “Emotional Choices” (page 28), is not merely academic. As someone who has wrestled with depression, Jensen says she has been “amazed by the number of different health care professionals who have offered to write me prescriptions, and by how baffled they are by my refusal to give these drugs a try.” Jensen says she was reticent about offering such a personal take on the issue, but it is “only fair to illustrate–using my personal experience–the kinds of quandaries all of us face.” Jensen teaches communications at the University of Tulsa.
Last but not least, there’s this from Prescription Drugs, Not Illegal Ones, Killed Heath Ledger, by Scott Thill, posted February 14, 2008:
“This would have never happened with weed.”
