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On the Fringe of Society with Christopher Occhicone

Christopher Occhicone was the recipient of the TIME award at the 2014 Eddie Adams Workshop

Photographer Christopher Occhicone spent months following a group of addicts who live on the outskirts of Lakewood, N.J., in a tent city in the forest. The result is his long-term project titled Fringe. “They live outside the boundaries of social norms,” he writes in his introduction to the series. “Their food and clothing needs are satisfied through donations. Their drug and alcohol needs are met by cash gotten from odd jobs, petty crime, sympathetic relatives, and social security and disability payments.”

Today, the camp is gone. Promoters acquired the land it used to sit on, buying out its former occupants. But, in 2013, when a group of 15 to 20 people still lived in tents and makeshift home, Occhicone documented their everyday lives.

“It took time to get the access,” he says. “In the eight months I spent there, I really shot a lot for four months. The first two months, I was just hanging around, talking to people and not taking any pictures. I wanted to get to know the guys.” That also meant eating and drinking with them. “They invite you to eat, you eat. They offer you a beer, you have a beer,” he says. “Obviously, there are certain lines you don’t cross, certain things you get offered that you don’t accept.”

Quickly, two main characters appeared in Occhicone’s work: Chris and Eve. The married couple, featured in many of the New Jersey-based photographer’s work, had a turbulent relationship. “She was a 30-year-old alcoholic, and he was only 19,” he says. “And it felt like he thought he was in a summer camp. I don’t think he realized what he was doing. They would call the cops on each other all the time.”

Now, with the camp dismantled, Occhicone’s work is done. “I think I said what I wanted to say,” he tells TIME.

Christopher Occhicone is a New Jersey-based freelance photographer.

TIME Addiction

Your Fingerprint Can Reveal Cocaine Use

A new way to accurately test for drugs may be through your fingerprint

Scientists can already tell from people’s fingerprints if they’ve touched cocaine, but a new study goes one step further, showing that fingerprints can now also reveal whether a person has ingested the drug. The study, published in Analyst, may pave the way for simpler drug testing that doesn’t require urine or blood.

In a small study, a team of researchers analyzed the fingerprints of a handful of patients in drug treatment centers using a process called mass spectrometry. Someone who uses cocaine excretes components of metabolized cocaine called benzoylecgonine and methylecgonine. The study authors showed they were able to detect the cocaine components in the residue left by the patients’ fingerprints on glass through the mass spectormetry chemical analysis technique.

“These results provide exciting opportunities for the use of fingerprints as a new sampling medium for secure, non-invasive drug detection,” the researchers write in their study. “The mass spectrometry techniques used here offer a high level of selectivity and consume only a small area of a single fingerprint, allowing repeat and high throughput analyses of a single sample.”

If such a technique could be made portable, the researchers believe it could possibly provide a simpler and less invasive alternative to current drug testing.

TIME Addiction

Health Experts Angry FDA Still Doesn’t Regulate E-Cigarettes

TIME.com stock photos E-Cig Electronic Cigarette Smoke
Elizabeth Renstrom for TIME

Prominent medical groups are asking the government to hurry up

A year has passed since the U.S. Food and Drug Administration (FDA) proposed new regulations for e-cigarettes, cigars and waterpipe tobacco, to prevent them from being sold to minors and to require manufacturers to add health warnings to labels—but the new rules still haven’t gone into effect.

Now, public health experts are urging action, arguing it’s unacceptable that it’s taken so long given data shows use of these products among minors has spiked.

Earlier this week, 31 health and medical groups including the American Academy of Pediatrics, the American Academy of Family Physicians and the American Heart Association wrote a letter to President Obama asking for the federal government to finalize the “long-overdue” regulation. The medical groups say cigar and e-cigarette brands are using marketing tactics that they feel appeal directly to young people, like promoting candy and fruit-flavored products, and they want regulations to put an end to it.

“It’s no wonder use of e-cigarettes by youth has skyrocketed,” the letter reads. “This process has already taken far too long. We cannot afford more delays that allow tobacco companies to target our kids with a new generation of tobacco products.”

Health experts are concerned over a recent U.S. Centers of Disease Control and Prevention (CDC) report that showed e-cigarette use among middle school and high school students tripled between 2013 to 2014 and hookah use doubled. The report showed that e-cigarette use among high schoolers increased from 4.5% in 2013 to 13.4% in 2014, which is a rise from approximately 660,000 students to 2 million.

“My concern is always the first-time users,” says Shyam Biswal, a professor in the department of Environmental Health Sciences at the Johns Hopkins Bloomberg School of Public Health. “It’s bad it took so long to make a dent in [conventional] tobacco users, and we are now starting something else, and we are just waiting and waiting and waiting. We don’t have the data that e-cigarettes are a gateway [to other tobacco products], so we just wait. It should not be like that.”

In a statement sent to TIME, the FDA said it “remains concerned about the significant increase in e-cigarette and hookah usage among youth.” The agency wrote:

These staggering increases in such a short time underscore why FDA intends to regulate these additional products to protect public health. Rulemaking is a complex process, and this particular proposed rule resulted in more than 135,000 public comments for the agency to review and consider. FDA is committed to moving forward expeditiously to finalize the rule that will extend its authority to additional tobacco products such as e-cigarettes, cigars, pipe tobacco, and other currently unregulated tobacco products.

Stanton Glantz, a professor of medicine at the University of California, San Francisco Center for Tobacco Control Research & Education, said he hopes that when the regulation is finalized there are no loopholes. “Given that the White House has blocked eliminating menthol from cigarettes for years despite strong evidence—including from the FDA’s own analysis that doing so would protect public health—I am not holding my breath,” he said.

Several states and local governments have regulated items like e-cigarettes on their own. Data shows at least 42 states and 1 territory currently prohibit the sale of e-cigarettes or vaping/alternative tobacco products to minors.

“I just hope that the final FDA rule does not do anything to make that process more difficult,” said Glantz.

The medical groups concluded in their letter that “further delay will only serve the interests of the tobacco companies, which have a long history of using product design and marketing tactics to attract children to harmful and addictive products.”

When asked for a comment about the letter, the White House’s Office of Management and Budget referred TIME to the FDA.

TIME Addiction

Habitual Gamblers See Patterns Where There Are None, Study Says

Las Vegas Sands deceived a Nevada court in an attempt to stall a lawsuit by the former head of its Macau operations, a state judge ruled on Friday, fining the casino operator and abridging its right to object in a fight over key evidence. REUTERS/Tyrone Siu (CHINA - Tags: BUSINESS CRIME LAW SOCIETY) - RTR386IJ
Siu Chiu—Reuters A croupier sits in front of a gaming table inside a casino on the opening day of Sheraton Macao hotel at Sands Cotai Central in Macau September 20, 2012

"Gamblers are more willing to bet impulsively on perceived illusory patterns," researcher says

Researchers have found gamblers are more prone to find non-existent patterns in completely random sequences — and are more likely to bet on those erroneous perceptions — adding to a large amount of research that suggests pathological gambling is the result of cognitive distortions.

The study, published Wednesday in Springer’s Journal of Gambling Studies, says that all humans fall victim to illusory patterns — if a roulette ball lands on black five turns in a row, for example, it is normal to think that it must surely land on red next. But compulsive gamblers see more such imaginary patterns and are different to recreational gamblers by their increased likelihood to bet on the false trends.

“Our results suggest that gamblers are more willing to bet impulsively on perceived illusory patterns,” stated co-lead author Wolgang Gaissmaier in a press release.

In a laboratory, the team compared the betting habits of 91 habitual gamblers versus 70 people who were not. Participants were shown pictures of two slot machines and had to predict the winner, but the catch was one had a 67% chance of producing a win while the other machine produced a win only 33% of the time. Participants were not explicitly told of the probability difference but the study said it “could be learned from experience via feedback.”

The results showed that gamblers were more likely than non-gamblers to use ‘probability matching’ — or making predictions based on past results.

“They are overly prone to accept random series of events as, in fact, non-random — and non-random enough to be worth betting on,” said Gaissmaier.

TIME Addiction

Hawaii Set to Become First State to Raise Smoking Age to 21

TIME.com stock photos E-Cig Electronic Cigarette Smoke
Elizabeth Renstrom for TIME

The bill covers both cigarette and e-cigarette use

Hawaii is set to become the first state to pass a law banning the sale, use and possession of cigarettes and e-cigarettes to people under the age of 21.

If a bill approved by Hawaii lawmakers on Friday is signed into law by Governor David Ige, adolescents will be prohibited from smoking, buying and possessing both conventional cigarettes and e-cigarettes. First-time offenders will be fined $10, and after that they can be charged a $50 fine or be required to complete community service, the Associated Press reports.

Some local governments have raised the smoking age to 21 in certain counties and cities — New York City among them — but if the bill becomes law, Hawaii will be the first state to do so.

Though the rates of high-school-age smokers have dropped in recent years, some 2.3 million children and young adults started smoking in 2012. In addition, a recent report from the U.S. Centers for Disease Control and Prevention revealed that e-cigarette use among middle-school and high school students tripled in one year.

If the Hawaii bill passes, it will go into effect Jan. 1, 2016.

[AP]

TIME Addiction

Health Officials Worry as HIV Cases in Indiana Grow

TIME.com stock photos Health Syringe Needle
Elizabeth Renstrom for TIME

Health officials say families are using drugs together

The number of new HIV infections in Scott County, Indiana, has risen to 142, prompting local and state officials to call it a public-health emergency.

A new report released by the federal and state health officials on Friday reveals disturbing trends in injection drug use in a county of only 4,200 people. Scott County has historically reported less than five new cases of HIV each year, making the new tally of 142 all the more alarming. Health experts say the recent outbreak is reflective of a growing drug epidemic nationwide.

“There are children, and parents and grandparents who live in the same house who are injecting drugs together sort of as a community activity,” said Dr. Joan Duwve, the chief medical consultant for the Indiana State Department of Health, at a press briefing. “This community, like many rural communities, especially those along the Ohio River and Kentucky and West Virginia, has really seen a lot of prescription opioids flooding the market. With few resources [and] not a lot to do, the use and abuse has been occurring for at least a decade and probably longer.”

Health officials note that like many other rural counties in the U.S., Scott County has high unemployment, high rates of adults who have not completed high school and a large proportion of residents living in poverty with limited health care access. The report underlines the fact that the county consistently ranks among the lowest in Indiana for health and life expectancy.

“The outbreak highlights the vulnerability of many rural, resource-poor populations to drug use, misuse and addiction,” said Duwve.

The ages of the men and women diagnosed with HIV in Scott County range between ages 18 and 57. The health officials report that no infants have tested positive, though a small number of pregnant women have. Ten women in the cluster were identified to be sex workers. Around 84% of the patients have also been infected with hepatitis C. Eighty percent of the patients with HIV have reported injection drug use and among those people, all of them have reported dissolving and injecting tablets of oxymorphone. Some also reported using methamphetamine and heroin.

Dr. Jonathan Mermin, who runs the CDC’s National Center for HIV/AIDS, reminded reporters that the United States is facing an epidemic of prescription opioid abuse. “An estimated two million people are dependent on or abuse prescription opioids nationally. So while opioid pain relievers can play an important role in the management of some types of pain, the overprescribing of these powerful drugs has created a national epidemic of drug abuse and overdose,” he said.

The CDC estimates that nationwide about 3,900 new HIV infections each year are attributable to injection-drug use, which is down nearly 90% from a peak of about 35,000 in the late 1980s, says Mermin. He adds that opioid poisoning deaths in the United States have nearly quadrupled from 1999 to 2011. This epidemic has already played a major role in a growing epidemic of viral hepatitis among people who inject drugs with a 150% increase in reports of acute hepatitis C nationwide between 2010 and 2013.

State health officials and the CDC are working together to control the outbreaks of HIV and hepatitis C. The state has launched a public health campaign to notify residents of the support available to them: lab testing and treatment, referrals to addiction services and employment, and help with insurance registration. The state initially declared a 30-day public health emergency for Scott County on March 26, but expanded the executive order another 30 days. “I want to assure everyone [that] the state of Indiana will not abandon this community once the executive order is over,” said Dr. Jerome M. Adams, the Indiana State Health Commissioner.

The CDC also released a health advisory on Friday, and is asking states to look closely at their most recent data on HIV and hepatitis C diagnoses, overdose deaths, admissions for drug treatments, and drug arrests in order to help identify communities that could be at high risk for unrecognized clusters of the infections.

“We must act now to reverse this trend and to prevent this from undoing progress in HIV prevention to date,” said Mermin.

TIME Addiction

Here’s Where Americans Binge-Drink the Most

A new study breaks down the numbers by county

Heavy drinking and binge drinking are on the rise in the U.S., but the average amount Americans drink varies greatly by region, according to a new study.

Ten years of research, published in the American Journal of Public Health, breaks down the data by county, observing adults 21 and over who binge-drink — imbibing at least five drinks in one sitting for a man; four for a woman — and those who drink heavily, defined as more than two drinks a day for a man; and more than one for a woman.

Binge-drinking is highest in Menominee County, Wisc., the least populated in the state. Heavy drinking is highest in Esmeralda County, Nev, likewise the least populous in that state. Madison County, Idaho has the lowest levels of binge-drinking, and Hancock County, Tenn.—one of the state’s ‘dry counties’ where the sale of alcohol is prohibited—has the lowest levels of heavy drinking.

Members of affluent communities are the most likely to have at least one drink per month, the study found, while members of poor communities are most likely to binge or drink heavily.

[USA Today]

TIME Addiction

E-Cig Use Triples Among Middle and High Schoolers in One Year

TIME.com stock photos E-Cig Electronic Cigarette Smoke
Elizabeth Renstrom for TIME

More students use e-cigarettes than the conventional kind

E-cigarette use among middle school and high school students tripled in one year, reported the U.S. Centers for Disease Control and Prevention on Thursday. The new data shows that e-cigarette use has surpassed the use of all tobacco products, including regular cigarettes, among young people.

The data, published in the CDC’s Morbidity and Mortality Weekly Report, shows that e-cigarette use among high schoolers increased from 4.5% in 2013 to 13.4% in 2014. That’s a rise from about 660,000 students to 2 million, the CDC says. Use among middle schoolers rose from 1.1% to 3.9% in the same time period.

MORE: E-Cig Flavors May Be Dangerous, Study Says

The study looked at all forms of tobacco use and found that hookah use doubled for middle and high schoolers, and other smoking methods like cigarettes and cigars declined.

“We want parents to know that nicotine is dangerous for kids at any age, whether it’s an e-cigarette, hookah, cigarette or cigar,” said CDC director Dr. Tom Frieden in a statement. “Adolescence is a critical time for brain development. Nicotine exposure at a young age may cause lasting harm to brain development, promote addiction and lead to sustained tobacco use.”

Tobacco sources like cigarettes and smokeless tobacco are regulated by the FDA, and the agency is currently in the process of finalizing rules that would give it jurisdiction over other products including e-cigarettes. In hopes of discouraging use among kids and teens, several states have passed laws that enlist a minimum age for purchasing e-cigarettes, and many states have extended traditional cigarette bans to include e-cigarettes.

TIME Addiction

E-Cig Flavors May Be Dangerous, Study Says

TIME.com stock photos E-Cig Electronic Cigarette Smoke
Elizabeth Renstrom for TIME

Why you might want to reconsider that cotton candy e-cig

The chemicals used to flavor e-cigarettes may surpass safe levels, a new study says.

The study, which is published in the journal Tobacco Control, reveals that high exposure levels of these chemicals could spur respiratory irritation. The chemicals used to flavor e-cigarettes are the same flavors often added to foods, so the FDA has determined them to be generally recognized as safe in food. However, the authors of the new study say the high levels raise concern for safety and need for regulation and that these chemicals may be more dangerous when inhaled than when they are ingested in food.

“Chronic inhalation of these ingredients has not really been studied much at all,” says study author James F. Pankow, a professor of chemistry and civil & environmental engineering at Portland State University.

In the study, Pankow and his colleagues assessed the levels and types of flavor chemicals used in 30 different e-cigarette refill bottles, including a wide variety of flavors like tobacco, menthol, vanilla, cherry, coffee, chocolate, grape, apple, cotton candy and bubble gum. In 13 of the 30 products, the flavor chemicals made up more than 1% of the refill liquid volume, the researchers found, and the chemical levels were higher than 2% in seven of the liquids. Two of the liquids had levels of flavor chemicals higher than 3%.

The researchers found that some of the flavor chemicals used were benzaldehyde and vanillin, which are known to be respiratory irritants and have exposure limits for the workplace. However, when Pankow and his colleagues estimated consumption rates, they found that an e-cigarette liquid consumption rate of about 5 ml per day puts users at an exposure of twice the recommended occupational limits. “That’s probably not a good thing,” says Pankow.

The study authors point out several concerns about flavoring, including the fear that flavored e-cigarettes might attract young people and the fact that flavored e-cigarettes don’t usually list the levels of specific chemicals that are present in the liquids.

“The point is that when e-cigarettes manufacturers talk about these things as being food grade or food-like, they are sort of suggesting that use of flavors is equivalent to using them in foods,” says Pankow. “Never mind the fact that these things have not really been tested for safety, but in food FDA requires labeling ingredients. If they are going to say these are food-like, then why don’t they list the ingredients? It’s also not food-like product because you are inhaling it not ingesting.”

The researchers note that the small sample size doesn’t necessarily represent the entirety of the growing e-cigarette market. But they conclude that the results are likely what a broad survey would have revealed and that their findings suggest high levels of certain chemicals are likely present in many products.

TIME Addiction

FDA Panel Votes Against Smokeless Tobacco Safety Claims

Swedish Match Targets Wall Street Smokers With Snus Tobacco
Getty Images

The panel's vote was split on some important points

An FDA advisory panel voted on Friday that it does not agree with the evidence and claims put forward by smokeless tobacco manufacturer Swedish Match regarding its application to change warning labels on its tobacco product, called snus.

Snus, pronounced snoose, is a cloth baggie with moist tobacco powder which users stick under their upper lip for a nicotine buzz. As TIME reported on Thursday, Swedish Match wants to remove the required warnings that say snus causes mouth cancer, gum disease and tooth loss, arguing that there isn’t sufficient scientific evidence to support them. The company also wants to change the warning to read: “No tobacco product is safe, but this product presents substantially lower risks to health than cigarettes.”

On Thursday and Friday an advisory committee to the FDA met about the company’s application and voted on a series of questions related to the application. The FDA will use the committee vote as a recommendation that it may or may not adopt. On Friday, the committee largely voted against many of Swedish Match’s claims, with some exceptions.

On certain claims, the panel’s vote was clear cut. The committee unanimously voted that there was not evidence to suggest that snus products do not pose risks to gum disease or tooth loss. The committee was, however, split on the question of whether snus products do not pose risks for oral cancer. Three members voted yes, three members voted no, and two abstained from the vote.

The committee was split on the question of whether there’s evidence to support the statement that the health risks for people who exclusively use snus products are “substantially lower” than the health risks from smoking cigarettes. Four members voted yes and four voted no.

The vote suggests the committee is still unconvinced that solely using the smokeless tobacco product is indeed safer than using cigarettes. A large part of Swedish Match’s argument is that snus has contributed to what’s called the “Swedish experience.” Sweden has similar tobacco consumption rates as other European countries but has the lowest smoking-related mortality rate. Many say that’s because Swedish men tend to choose snus over cigarettes (the product is less popular among women). Members of the public health community watching the vote have been largely divided on whether harm reduction has a place in tobacco control and whether pushing people toward products with lower levels of nicotine is good for public health.

The committee also voted that the proposed warning statement from Swedish Match does not adequately communicate the potential health risks from using snus.

“I am very happy with the vote,” says Shyam Biswal, a professor in the department of Environmental Health Sciences at the Johns Hopkins Bloomberg School of Public Health. “My main concern is [snus attracting] new users who would otherwise not smoke. Saying snus is significantly less harmful [than cigarettes] is a very broad claim.” Biswal adds that he thought the evidence presented by Swedish Match was weak, including studies with small sample sizes. Biswal was not involved in the vote, but has studied modified risk tobacco products.

Swedish Match did not respond to requests for comment by time of publication.

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