Drugs and Drug Policy Introduction A quarter of 14 15 year olds in the US have already tried an illegal drug Injection drugs use fuels epidemics of HIV and Hepatitis 1 in 12 adults suffer a substance abuse disorder 8 million children live with an addicted parent important to know that alcohol abuse drives those numbers to a much greater extent than does dependence on illegal drugs Cigarette smoking kills more people than alcohol and all illegal drugs combined The Odyssey depicts what may be the first recorded drug intervention danger of losing oneself to a drug must then have been familiar to Homer some three millennia ago Industrialization and urbanization has increased the amount of damage an intoxicated person can do to self and others car accidents availability of multiple drugs increases combination of drugs that could be deadly Policies to control drugs create harms and hazards of their own o Highly desired commodity illegal creates an opportunity that some illicit entrepreneur is certain to seize on Turns out that the laws cannot be enforced strictly enough to abolish entirely the use and sale of illegal drugs If drug abuse and drug abuse control alike create predictable harms then figuring out what to do is a hard problem Drugs and Drug Policy What Everyone Needs to Know includes o Facts about drugs and drug related behavior o Pharmacology o Prohibitions o Regulation o Taxes o How drug enforcement drug prevention and drug treatment work o Along with characteristics problems and limitations Chapter 1 Why is Drug the Name of a Problem What is a drug o A drug is a chemical that influences biological function other than by providing nutrition or hydration From plants or labs Effects can be benign or harmful or both o A psychoactive drug is a drug whose influence is in part on mental functions on mood perception cognition and behavior An abusable psychoactive drug the topic of this book is a drug whose mental effects are sufficiently pleasant or interesting or helpful that some people choose to take it for a reason other than to relieve a specific malady Scientifically cannabis is not technically a drug Abusable psychoactive drugs include o Caffeine o Nicotine o Alcohol o Nitrous oxide o Cocaine o The opiates and opioids heroin morphine codeiene ocycodone etc o Stimulants methamphetamine sedative hypnotics and central nervous system depressants such as benzodiazepines Valium Xanax and their ilk o Barbiturates o Hallucinogens psychedelics entheogenes such as LSD psilocybin mescaline o Entactogen MDMA ecstasy Why is drug use a problem often is not a problem most drugs resemble alcohol many occasional users fewer heaving users and fewer still who remain heavy users for years on end If abusable psychoactives can be used safely where does the problem come in abusable drugs can cause 3 distinct problems o physiological toxicity o behavioral toxicity o addiction What does it mean for a drug to be toxic most dramatic toxic risk is sudden death from overdose o mixing drugs together a standard measure of toxicity is the median lethal dose the quantity of some drug that will kill half of the people exposed to it o LD50 lethal dose 50 percent o Median effect does ED50 Generates the therapeutic index or therapeutic ratio LD50 divided by ED50 Higher the index the smaller the risk of overdose Tobacco no overdose but toxic with chronic use Heroin large overdose risk due to small index plus uncertain purity o But biggest risk comes from shared injection equipment Toxic risk makes drugs a subclass of the category potentially unsafe consumer product What is behavior toxicity Is it the same as intoxication behavioral toxicity can mean that drug taking imposes risks on those who don t engage in it drunken driving drunken domestic abuse An intoxicant can 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 IN SLIDE FROM POWERPOINT pg 4 Form of behavior toxicity is loss of self control over dosage example binge drinking o first the man takes the drink then the drink takes a drink then the drink takes the man What is addiction is a problem A behavior pattern that is difficult to break even once the person figures out the behavior o Called substance abuse or dependency disorder Most people who try drugs never develop an substance disorder Minority that develops a bad habit develops the sort of persistent bad habit called to mine Pattern for more expensive illicit drugs trying without consistency even most people who develop a bad habit around some drug recover fairly rapidly the word addiction or by the description of drug abuse as a chronic relapsing disorder What is dependency Two different senses o physical dependency by the presence of a withdrawal syndrome a drug is said to generate physical dependency if a user who stops taking the drug after a period of using it experiences discomfort or worse Medical process of managing withdrawal is called detoxification Alcohol opiates powerful physical dependency o chemical dependency the aggravated form of substance abuse disorder Defined by continued drug taking in the face of adverse consequences diminished voluntary control over the frequency and quantity of drugs taken craving persistent intrusive thoughts about drug use that complicate efforts to abstain and the crowding out of other activities as the effort to obtain drugs and the time spent using them absorbs more and more of the dependent user s life Is addiction a disease Is it a chronic relapsing brain disorder if disease is an abnormal unwanted involuntary physical or mental condition then it s reasonable to call substance abuse disorder diseases Problem drug users people who consistently use drugs that they would prefer not to use or who use drugs in greater quantity or with greater frequency than intended disease fits because nobody wants to have a drug habit and it can t be wished away Addiction is a burden because the persistent cravings that can lead to relapse even after years of abstinence Relapsing group is a minority among all the people who develop a drug habit Does that mean that drug addicts are not personally responsible for their drug taking No Taking drugs is voluntary Persistent drug cravings and decision not to use causes suffering Is the risk of addiction limited to those with an addictive personality or to those genetically
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