You can get garden variety health advice from the daily newspaper, the "health" section of most book stores, and of course thousands of web sites. I'm hoping to present thought provoking and maybe change provoking thoughts about individual and community health. This blog is not just what to do about health, but how to think about it. I'm looking forward to an exchange of ideas with readers. July, 2010


Friday, September 17, 2010

Drug Use Trends and Smokescreens

People who are old enough will remember the fever pitch of anxiety about illegal drug use in the 1960s.  The nature and extent of illegal drug use was undoubtedly greater than in earlier decades, though there were no systematic data systems available to profile or depict the number of users and the types of drugs they were using.  All we had were anecdotal accounts of people participating in drug use, accounts from treatment providers, and police accounts of arrests and drug confiscation.  All of those were indicators, but had limited value in really capturing representative statistics on drug use in the over-all population. 

Starting in 1975, we had a national survey of drug use by high school seniors.  Called Monitoring the Future, this survey was a representative sample of seniors across the country.  The survey was done every year; starting in the early 90s, grades 8 and 10 were also surveyed and included in the data reports.  This national survey gave a picture of school drug use, and served as a valid benchmark with which to compare states, local communities, and schools when comparable data at those levels were available.

In later years the U.S. government initiated a national household survey of drug use by persons 12 years and older.  This then complemented the school survey, so that we had valid statistics on drug use across the population.  Both of these surveys continue to the present.

From year to year, we have seen fluctuations.  One year some drugs are up, other drugs are down.  The only time there has been a truly consistent trend was in the 1980s.  During the late 1970s, drug use reached higher and higher levels, but then began about an eight year consistent decline for all drugs included in the surveys: marijuana and other illicit drugs, alcohol, and tobacco.  Prevention methods and tools at the time were still primitive and not evidence based, so it is not possible to attribute the positive change to anything being done by schools and other agencies working on drug abuse prevention.  Perhaps it boiled down to a "Hawthorne Effect," meaning adolescents responded because of the magnitude of attention to drugs being giving across society in schools, mass media, law enforcement, faith communities, position statements by political and community leaders, and so forth, but not because of any single intervention.  Nothing explicitly tested was shown to be effective, but the bulk of all the effort was accompanied by encouraging declines in drug use.

Since the late 1980s, drug use has fluctuated up and down, with no real trend or pattern.  We have seen specific drugs become insurgent with new popularity (e.g. methamphetamines, Oxycontin) while others declined (e.g. Rohypnol, LSD).  There is a whack-a-mole quality to these changes: if we succeed in reducing consumption of one drug, another comes along to take its place.  American drug use will respond to strategic efforts by the various players, but deep seated social change is probably much more powerful.  This happened at the turn of the 19th century.  People were tired of the consequences of widespread community drug abuse, and this laid the groundwork for a set of drug control legislation passed in the first 30 years of the 1900s.

Recently, there has  been a transition from heroin and cocaine toward abuse of prescription psychotherapeutic drugs, including synthetic opiate pain relievers, like Oxycontin, anti-anxiety sedatives such as Valium and Xanax, and stimulants such as Ritalin.  Evidence is that the frequency of people visiting hospitals for overdoses of these drugs has risen dramatically.  It is too early to tell whether this is like the ebbs and lows common during the last 20 years, or really the beginning of a significant epidemic.

Another new development in recent years is the use of synthetic marijuana.  Chemists have designed a synthetic version of the active ingredient of marijuana (tetrahydrocannabinol).  The chemical is then infused into a mixture of herbs, which are then smoked.  There have been anecdotal reports of serious reactions and side effects, but it is really too early to definitively say that this drug is greatly increasing in usage or that it poses a major health threat.  There are no systematic data yet to provide answers.  News reports are not a reliable indicator of a real trend or a genuine threat.

Historian J.M Scott (1969) has said that "We animals appear set upon destroying ourselves by nuclear or germ warfare and by drugs in war and peace.  Someday by some such means-unless informed interest and public opinion gets busy-we shall possibly succeed.  Then the symbol of eternal sleep (opium) will bloom on year by year, more appropriate than ever, and utterly indifferent."  Progressive public opinion can be powerful in changing the trajectory of drug use, and health promotion workers can strengthen the speed and vigor of the process.  However, at no time are we likely to see a triumphal end to the war on drugs.

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