Drugs and Drug Policy book notesIntroduction:• ¼ of 14-15 year olds in the US have already tried an illegal drug• Half a million people are behind bars for dealing • Half of all criminal violence and automobile fatalities are caused by drunkenness • 1 in 12 adults suffer from a substance abuse disorder and 8 million children are living with an addicted parent. • Cigarette smoking kills more people than alcohol and all illegal drugs combined• Now there are more psychoactive drugs than in ancient times and the availability of multiple drugs raises the possibility of drug combinations, which can be more deadly than any drug alone.• The 19th century gave us both organic chemistry, to produce refined products from plant materials (including morphine and cocaine) and potent synthetic molecules (such as amphetamines and heroin), and the hypodermic syringe as an especially efficient means of getting them to the brain. • Our current drug policies allow avoidable harm by their ineffectiveness and create needless suffering by their excesses. Chapter 1• What is a drug?o A chemical that influences biological function (other by providing nutrition or hydration)o Drugs can come from plants, laboratories, be benign or harmful depending or both depending on the dosage, or can be traditional or novel.o A psychoactive drug – is a drug whose influence is in part on mental functions: on mood, perception, cognition, and behavior. Penicillin is a drug but not a psychoactive drugo Abusable drug – A drug whose mental effects are sufficiently pleasant or interesting or helpful that some people chose to take it for some reason other than to relieve a specific malady. Antipsychotics are psychoactive, but not abusable drugso By this definition cannabis is not technically a drug; it is plant material containing many different psychoactive drugs, most notably THC and cannabidiol. • Why is drug use a problem?o Often it isn’t a problem since most people use drugs in reasonably controlled fashion and without much harm to themselves or others. o Most drugs have the many occasional users, fewer heavy users, and fewer still who remain heavy users for years on end.• If adbusable psychoactives can be used safely, where does the problem come in?o They can be used safely, doesn’t mean that they will be used safelyo They can cause three distinct types of problems: psychological toxicity, behavioral toxicity, and addiction. • What does it mean for a drug to be toxic?o “The dose makes the poison” o A standard measure of toxicity is the median lethal dose – the quantity of some drug that will take to kill half of the people exposed to it. Therapeutic index or ratio = LD50/ED50 • The higher the index the smaller the risk of therapeutic disastero Mixing drugs and quantities increase risks of overdose – form of toxicityo Sometimes it takes time for a substance to be toxic Tobacco can be profoundly toxic if chronically used o Not all toxic risks come from the drugs themselves i.e. other chemicals in smoking, not nicotine, causes cancer and the chronic health risks of heroin users come from sharing needles not from the heroin• What is behavioral toxicity? Is it the same as intoxication?o “Behavioral toxicity” – The way one acts under drugs (i.e. foolish, violent, etc)o A true intoxicant – alcohol, cannabis, methamphetamine, cocaine, heroin – can (depending on dose) generate a state of mind in which the ordinary constraints of prudence and conscience are so blunted as to enable extreme behavior, atypical of the actions of the same person when not under the influence. o By contrast, drugs such as caffeine in coffee and nicotine in cigarettes (or even small amounts of cocaine in coca tea or coca cola) are psychoactive, but not intoxicating.o We could distinguish intoxicants from other drugs based on whether the drug-induced state is a plausible explanation for the person’s actions. i.e. I was drunk is a valid excused, I smoked a cigarette is not• What is addiction?o Bad drug habit = “substance abuse or dependent disorder” = addiction when it reaches a more severe chronic form Bad habit – A hard to break habit even after the problem is identified when the drug stars being consumed more often and in larger amounts Most people who try drugs never develop any substance-abuse disorder.o Trying without ever using consistently is by far the most common pattern for the most expensive illegal drugso Most people who develop a bad habit recover fairly rapidly, usually without professional help, and with varying rates of residual damage, only minorities don’t.• What is dependency?o Two different kinds:o “Physical Dependency” – Defined by the presence of a withdrawal syndrome Withdrawal syndrome – If a person experiences discomfort or other worse experiences once he stops taking the drug.• Can be sometimes fatal, but managed with “detoxification” Alcohol and opiates can generate powerful physical dependency Cocaine’s withdrawal symptoms are not as dramatic with the most important symptom being “anhedonia” – inability to experience pleasure o “Chemical Dependency” – The aggravated form of the substance-abuse disorder Continued drug taking in the face of adverse consequences, diminished voluntary control over the frequency and quantity of drug taking, “craving” – persistent, intrusive thoughts about drug use that complicate efforts to abstain – time spend using them, and the crowding out of other activities.• Is addiction a disease? Is it a “chronic, relapsing brain disorder?”o Since disease is an abnormal, unwanted, involuntary physical or mental condition, then it is reasonable to label substance abuse disorders diseaseso Someone with a problematic drug habit can choose from day to day whether to use the drug, but can’t choose from day to day not to have the habit or craving that help maintain it (most people don’t have such habits).o The persistent craving, even after years of abstinence, can lead to relapse• Does that mean that drug addicts are not personally responsible for their drug taking?o No, taking drugs is always voluntary, not like the “gag reflex”o However, for persistent drug cravers, the decision to not use requires effort and induces suffering.• Is the risk of addiction limited to those with an “addictive personality” or those who are genetically predisposed? o
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