Notes On Substance Abuse
Notes On Substance Abuse
Notes On Substance Abuse
Drug abuse and drug dependence represent different ends of the same
disease process.
Myth: Marijuana Is More Potent Today Than In The Past. Adults who
used marijuana in the 1960s and 1970s fail to realize that when
today's youth use marijuana they are using a much more dangerous
drug.
Fact: When today's youth use marijuana, they are using the same drug used
by youth in the 1960s and 1970s. A small number of low-THC samples seized
by the Drug Enforcement Administration are used to calculate a dramatic
increase in potency. However, these samples were not representative of the
marijuana generally available to users during this era. Potency data from the
early 1980s to the present are more reliable, and they show no increase in
the average THC content of marijuana. Even if marijuana potency were to
increase, it would not necessarily make the drug more dangerous. Marijuana
that varies quite substantially in potency produces similar psychoactive
effects.
Fact: Marijuana arrests in the United States doubled between 1991 and
1995. In 1995, more than one-half-million people were arrested for marijuana
offenses. Eighty-six percent of them were arrested for marijuana possession.
Tens of thousands of people are now in prison or marijuana offenses. An even
greater number are punished with probation, fines, and civil sanctions,
including having their property seized, their driver's license revoked, and
their employment terminated. Despite these civil and criminal sanctions,
marijuana continues to be readily available and widely used.
Fact: Marijuana does not cause people to use hard drugs. What the gateway
theory presents as a causal explanation is a statistic association between
common and uncommon drugs, an association that changes over time as
different drugs increase and decrease in prevalence. Marijuana is the most
popular illegal drug in the United States today. Therefore, people who have
used less popular drugs such as heroin, cocaine, and LSD, are likely to have
also used marijuana. Most marijuana users never use any other illegal drug.
Indeed, for the large majority of people, marijuana is a terminus rather than
a gateway drug.
Fact: The Netherlands' drug policy is the most nonpunitive in Europe. For
more than twenty years, Dutch citizens over age eighteen have been
permitted to buy and use cannabis (marijuana and hashish) in government-
regulated coffee shops. This policy has not resulted in dramatically
escalating cannabis use. For most age groups, rates of marijuana use in the
Netherlands are similar to those in the United States. However, for young
adolescents, rates of marijuana use are lower in the Netherlands than in the
United States. The Dutch people overwhelmingly approve of current cannabis
policy which seeks to normalize rather than dramatize cannabis use. The
Dutch government occasionally revises existing policy, but it remains
committed to decriminalization.
Myth: Marijuana Kills Brain Cells. Used over time, marijuana permanently
alters brain structure and function, causing memory loss, cognitive
impairment, personality deterioration, and reduced productivity.
Fact: None of the medical tests currently used to detect brain damage in
humans have found harm from marijuana, even from long term high-dose
use. An early study reported brain damage in rhesus monkeys after six
months exposure to high concentrations of marijuana smoke. In a recent,
more carefully conducted study, researchers found no evidence of brain
abnormality in monkeys that were forced to inhale the equivalent of four to
five marijuana cigarettes every day for a year. The claim that marijuana kills
brain cells is based on a speculative report dating back a quarter of a
century that has never been supported by any scientific study.
Myth: Marijuana Use Impairs the Immune System. Marijuana users are
at increased risk of infection, including HIV. AIDS patients are particularly
vulnerable to marijuana's immunopathic effects because their immune
systems are already suppressed.
Fact: Many active drugs enter the body's fat cells. What is different (but not
unique) about THC is that it exits fat cells slowly. As a result, traces of
marijuana can be found in the body for days or weeks following ingestion.
However, within a few hours of smoking marijuana, the amount of THC in the
brain falls below the concentration required for detectable psychoactivity.
The fat cells in which THC lingers are not harmed by the drug's presence, nor
is the brain or other organs. The most important consequence of marijuana's
slow excretion is that it can be detected in blood, urine, and tissue long after
it is used, and long after its psychoactivity has ended.
Myth: Marijuana Use is a Major Cause Of Highway Accidents. Like
alcohol, marijuana impairs psychomotor function and decreases driving
ability. If marijuana use increases, an increase in of traffic fatalities is
inevitable.
Fact: Marijuana does not cause overdose deaths. The number of people in
hospital emergency rooms who say they have used marijuana has increased.
On this basis, the visit may be recorded as marijuana-related even if
marijuana had nothing to do with the medical condition preceding the
hospital visit. Many more teenagers use marijuana than use drugs such as
heroin and cocaine. As a result, when teenagers visit hospital emergency
rooms, they report marijuana much more frequently than they report heroin
and cocaine. In the large majority of cases when marijuana is mentioned,
other drugs are mentioned as well. In 1994, fewer than 2% of drug related
emergency room visits involved the use of marijuana.
Alcohol
Worldwide alcohol causes 1.8 million deaths (3.2% of total) and 58.3 million
(4% of total) of Disability-Adjusted Life Years (DALYs). Unintentional injuries
alone account for about one third of the 1.8 million deaths, while neuro-
psychiatric conditions account for close to 40% of the 58.3 million DALYs. The
burden is not equally distributed among the countries, as is shown on the
map below.
Amphetamine-type stimulants
The use of ATS is a global and growing phenomenon and in recent years,
there has been a pronounced increase in the production and use of ATS
worldwide. Over the past decade, abuse of amphetamine-type stimulants
(ATS) has infiltrated its way into the mainstream culture in certain countries.
Younger people in particular seem to possess a skewed sense of safety about
the substances believing rather erroneously that the substances are safe and
benign. Meanwhile, ATS are posing a serious threat to the health, social and
economic fabric of families, communities and nations.
For many countries, the problem of ATS is relatively new, growing quickly
and unlikely to go away. The geographical spread is widening, but awareness
of it is limited and responses are neither integrated nor consistent. Recent
data has shown a decline in ATS use in the regions of the Americas and
Europe, while the highest levels of abuse worldwide have emerged in East
Asia and Oceania. According to a review of ATS by UNDCP in 1996, there are
about 20 countries in which the abuse of ATS is more widespread than that of
heroin and cocaine combined. Japan, Korea and the Philippines all register 5-
7 times the rate of ATS use compared with heroin and cocaine use.
Smoking, sniffing and inhaling are the most popular methods of ATS use, but
ways to take the drug vary widely across the region. In countries like
Australia, where over 90 per cent of those who report using ATS (mostly
methamphetamine) inject, the drug represents a significant risk factor in the
transmission of blood-borne viruses. The Philippines and Viet Nam are also
reporting signs that injecting methamphetamine is increasing while in
Thailand, the number of methamphetamine users now represents the
majority of all new drug treatment cases. There are currently very limited
data to indicate what proportion of current users are dependent. Researchers
have pointed out that it is likely that dependence and chronic usage is
associated with methamphetamine psychosis and related adverse
consequences and that the high rates of usage are dramatically escalating
levels of presentation of methamphetamine psychosis to mental health
services.
Cocaine
Cocaine and its derivative ‘crack’ cocaine provide an example of both the
globalization of substance use and the cyclical nature of drug epidemics.
Traditionally coca leaves have been chewed by people in the Andean
countries of South America for thousands of years. The main alkaloid of the
coca leave, cocaine, was isolated relatively recently in about 1860. Cocaine
was then used in patent medicines, beverages and ‘tonics’ in developed
countries in Europe, North American and in Australia until the early 1900s.
Laws restricting the availability of cocaine saw a decrease in consumption in
these countries until the 1960s. From that time cocaine use became popular
among certain groups of young people in some developed countries and in
the producer countries of South America. Cocaine became widely available in
North America in the 1970s and Europe in the 1980s.
Prevalence rates for lifetime use of cocaine are typically 1-3% in developed
countries, with higher rates in the United States and in the producer
countries. Cocaine dependence has become a substantial public health
problem, resulting in a significant number of medical, psychological and
social problems, including the spread of infectious diseases (e.g. AIDS,
hepatitis and tuberculosis), crime, violence and neonatal drug exposure.
Opiates
Reports by the UNDCP have shown that there has been a global increase in
the production, transportation and consumption of opioids, mainly heroin.
Heroin use has become increasingly common in North America and Europe
since the 1960s. The worldwide production of heroin has more than doubled
or even tripled since 1985. Evidence from national surveys and other data
sources suggests that the prevalence of heroin use in general populations is
relatively low. Globally, it is estimated that 13.5 million people take opioids,
including 9.2 million who use heroin. However, in many countries (notably
those from Europe), the majority of heavy drug users seeking treatment are
primarily addicted to opiates.
Volatile solvents
The illicit use of drugs has taken on global dimensions. New patterns of drug
abuse can easily develop as a result of excessive availability and inadequate
regulatory controls. There is sufficient reason to believe that unregulated,
excessive drug supply and consumption trends in certain countries may be
continuing and that new problems may be developing. Pain and other forms
of suffering may result from disease or from a state of dependence on
otherwise beneficial psychoactive drugs following prolonged, excessive use.