Drug Abuse

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Awareness kit helps parents fight drug abuse

Tragic memories brought tears to Pat Tyrell's eyes this week as she watched local school board officials unveil their latest drug-prevention strategy -- an awareness kit for parents.

''There was nothing like this when my son got involved in drugs,'' she said softly during a break in the presentation. ''There were no support groups, nothing available in the schools, and very little from the police. We were totally alone, and we had no idea what to do.''

Tyrell's son Micheal died in Ottawa almost 12 years ago of a heroin overdose. He was 19 and had been using drugs for about five years.

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About the Author
Charles Gant, M.D., Ph.D., is a member of the American Academy of Psychiatrists in Addiction and Alcoholism and lives in Syracuse, New York.

It is tragedies like the Tyrells' that the region's Inter-board Substance Abuse Committee hopes to prevent with its new parent awareness kit.

''Most parents are at a loss when it comes to figuring out what to do about the possibility that one of their children has a substance abuse problem,'' explained Josephine McFadden, an addiction activist who helped the committee develop the kit.

Starting in September, the region's four English-language school boards will encourage parents' organizations to offer information sessions on drug abuse, using the kit as a guide and trained volunteers as leaders.

While the kits are available to all groups, they are most appropriate for parents with children at the middle school or high school level. They offer advice on preventing children from becoming involved in drug use, on identifying abuse and on appropriate ways of handling the situation if drug use is suspected. There is also an outline of community resources and treatment.

Although substance abuse is declining among Ontario students, McFadden estimated that between five and 10 per cent of teenagers will become dependent upon alcohol, marijuana or another drug if they do not get professional help. Alcohol-related accidents are still the leading killer of young people between 16 and 25.

Early identification of a drug problem is crucial, added McFadden. Many drug users begin experimenting as early as Grade 6 or 7, and the highest-risk period is in grades 8 and 9, when they are making the difficult transition to high school.

That's when parent involvement becomes crucial.

While many teachers have been trained to watch for the symptoms of drug use among their students, early identification and action by parents can prevent an experiment from becoming a cruel way of life.

Pat Tyrell knows the signs of drug abuse only too well, after seeing them in her son when he was just 14. A decade after his death, she and Micheal's father have published a family booklet, What You Should Know About Drugs & Alcohol, which is featured as part of the inter-board parent kit.

Among the physical and behavioral symptoms it lists are:

Slurred speech, dilated pupils and slow reactions.

Irritability, headaches, tiredness and shakiness.

Difficulty getting up in the morning, missing meals.

Broken curfews, unplanned sleepovers, lying about whereabouts.

Family property missing, personal articles sold.

Phone calls from strangers, dropping old friends.

Dropping of subjects at school, failing grades.

To discourage kids from experimenting with drugs, the kit advises parents to talk openly and honestly with their children about alcohol and other chemical substances, remembering that listening is better than lecturing. They should set limits together, with well-defined consequences.

And they should make an effort to spend more time with their children on healthy activities, such as biking or other sports, and be aware that their own drug consumption may be affecting their children's choices.

Parents' groups interested in organizing information sessions using the new kit should contact their principals or trustees when school resumes in September.

Laws can't stop drug abuse: Hnatyshyn

Laws are not enough to combat drug abuse in Canada, Justice Minister Ray Hnatyshyn told an Ottawa conference on drug abuse Saturday.

''Too many Canadians have unrealistic expectations about what our drug laws and programs can accomplish. And all too often these laws and programs are expected to eliminate the drug problem,'' he told a national conference on youth and drugs organized by PRIDE Canada. The organization's goal is to prevent adolescent drug abuse.

Laws can limit the supply of drugs into the country by enforcing stiff penalties on people who import and sell drugs, but the community must get involved in educating people against drug use, he said in a speech at the Congress Centre.

In the past, people have blamed the countries that supply drugs for problem in Canada, but Canadians have to stop the demand and the supply, he said.

Ethnic & multicultural drug abuse: perspectives on current research

Knowledge about ethnicminority drug use is thin, uneven in its explanations, almost devoid of theory, and all too often lacking sufficient data from which to generalize.

It is with these concerns that the editors of Ethnic and Multicultural Drug Abuse undertook this newest contribution to an obviously under - researched area in the psychoactive drug field.

Although a 1990 U.S. survey showed that drug use among America's youth is slowly declining after reaching a crisis level in the late 1980s, ethnic minorities are not a part of that decline. They continue to be over - represented in drug abuse reports and data - tracking systems. No one is quite certain why.

While this volume doesn't attempt to answer that question, it does offer some plausible ways of conducting research with ethnic populations. It also suggests guidelines for preparing competitive research proposals -- albeit from an American perspective, but general enough to help Canadians looking for grants as well. Useful, too, is an annotated review evaluating strengths and weaknesses of some of the existing literature.

Most of the contributors to this collection are themselves of ethnic minority background -- African - American, American Indian, Asian - American, or Hispanic. Several were trained through a special office set up between 1985 and 1991 by the U.S. National Institute on Drug Abuse (NIDA).

While the papers have a distinctly American slant, Canadian researchers and clinicians will likely find enough common ground to make this book worthwhile reading. Some areas of particular interest will probably be:

substance abuse predictors among high - risk urban black youth -- with recommendations for possible interventions

a treatment model for black cocaine abusers (according to NIDA, cocaine - related deaths in the U.S. jumped 450 per cent between 1985 and 1989)

evidence disproving the myth that America's Oriental populations don't have drug abuse problems

the causal effects of life stress, social support, and depression on the drug use patterns among American Indian boarding - school youth

results from an extensive study of Alaskan youth, including an explanation of why drug use is higher there than in other parts of the country.

Teens 'next endangered species': Worldwide drug abuse blamed

Teenagers may well be the next endangered species in a worldwide drug abuse crisis "of epidemic proportions," psychologist Dr. Peter Vamos said Monday at the 14th World Conference of Therapeutic Communities.

"It is impossible to overstate the danger drug abuse poses to society and the future," Vamos, chairman of the conference and general manager of Montreal's Portage rehabilitation program for drug addicts, told some 2,500 people attending the week-long gathering's opening session.

While so-called "incidental drug use" is declining, experts agree "serious, chronic drug abuse is on the rise," Vamos said later in an interview.

And law enforcement has failed to solve the problem.

"There are more drugs now entering the States from Panama than when (former leader Manuel) Noriega was in power," Vamos said, citing a recent article in the New York Times.

Adult drug addicts have resources and options, Vamos said. But a dearth of treatment programs for teenagers - especially poor and homeless teenagers - forces them to go it alone.

"The Ontario government spent $47 million last year sending teens to expensive (hospital-based) treatment centres of dubious efficacy in the United States" because it lacks its own treatment centres, Vamos said.

And the minority of adolescents so accommodated were "middle-class kids."

"The street kids, the ones who really need help the most, were left to rot on the streets of Toronto. It's enraging."

Since the 1960s the Canadian government has tried to combat drug abuse, Vamos said, "but it was a politicians' war rather than society's war.

"The answer lies with us - not only those of us working in the field but all of us."

Vamos said an absence of "real information" along with a lack of vision and leadership has created "a state of affairs that must be changed if the war on drugs is to succeed."

He said authorities have minimized the extent and severity of the problem for years and conflicting information has "mystified the situation."

"We are paying a terrible price for our failure to control the drug problem," he said, pointing to rising rates of violence and teen suicide.

"It's time to face the facts," he said citing the following: In Canada, purchases of illegal drugs total $10 billion. Worldwide, the figure is $300 billion.

Countrywide, 80 per cent of imprisonments for serious crimes are directly or indirectly related to drug abuse.

In Montreal, the number of heroin users has grown to 20,000 from 5,000 in 1985. The city counts more than 500 "shooting galleries" where addicts buy, sell and inject cocaine and heroin.

There are more than 60,000 cocaine addicts on Montreal Island - and the number is growing.

"We're responsible for the problems in our own society," Vamos said. "It's not 'those bad guys' in Southeast Asia or Panama or Colombia that are to blame."

Small towns hotbed for drug abuse, therapist says

ELMIRA - Randy Smith points to his telephone and boldly states that he could call someone up right now and buy drugs.

"I know a user right here in Elmira who could get us some," he says, bringing home the point that many people here and elsewhere in small-town Ontario aren't willing to admit.

Drugs are available everywhere, no matter how small a community may be or isolated its residents believe it is from the evils of the big cities, says Smith, a Elmira native.

He's also a front-line fighter in the war on substance abuse in his work as a therapist with the Stonehenge Therapeutic Community in Guelph.

In fact, the country may provide an ideal setting for large drug- distribution centres that close-quartered, carefully watched neighborhoods of cities like Toronto may not be able to fulfil.

It's a bit of shock therapy that Smith has been delivering to many small Ontario communities for eight years now. It provides the opportunity "to mobilize communities so they take their heads out of the sand" when it comes to drugs, he said. The word he carries is blunt, but Smith doesn't want the subject of drug abuse to be taken lightly either.

"International drug cartels can deliver the drugs anywhere in the world. They come in here, steal our kids and murder them. People are shocked that there is really a problem," explains Smith, who will continue his message in Elmira tonight at 8 p.m. He'll speak at a substance-abuse seminar at The Steddick Hotel, sponsored by the local Jaycees.

Smith compares the problem of drug abuse to the burning of the Brazilian rain forest. How long will it take before the problem gets so big that nothing can be done to stop it from destroying the younger generation, he asks.

Smith may sound all doom and gloom, but admits he tries leaving his audiences some sense of hope.

The fight to educate high school students about the dangers of drugs is going well, particularly in Waterloo Region, Smith says. He praises community intervention - areas that become pro-active in the war on drugs and recognize that drug users are lost kids and "not two-headed baby-eating monsters."

The third hope of drug rehabilitation - his own area of expertise - must be one of long-term therapy, which most rehab centres are moving towards, not fast fixes. But here, Smith is not all positive, criticizing governments for not setting up enough centres in Canada and forcing drug users to seek help south of the border.

"There are parents, from Elmira too, looking to send their kids anywhere for rehabilitation."

He says the worst situation that could happen in the war on drugs is for paranoia to set in, particularly among parents.

So often, they may read about the signs of drug abuse and notice their own children exhibiting the behaviors that go along with it. Smith remembers one mother who came to him and said her 14-year-old son was eating more and appearing very tired, two of the warning signs she had read about that pointed to drug use. She was concerned he was doing drugs.

Smith suggested she ask him why he was eating more and going to sleep so early in the evenings. "It turned out he was trying out for the high school football team.

"If she had accused him of doing drugs, then she would have been violating the valuable trust of the family. That would've been great damage to the kid. Parents must realize the great majority of kids don't do drugs."

United Nations says drug abuse on decline in U.S.

Drug abuse is on the decline in the United States, but its effects remain grim worldwide, with heroin and cocaine addiction a growing problem in several regions, a UN panel said today.

The International Narcotics Control Board, in its annual report, also noted wide differences in the number of intravenous drug users testing positive for the AIDS virus across Europe, according to country.

A breakdown, by region, of the 13-member panel's report:

Drug abuse in the United States continued to decline. From 1988 to 1991, the number of abusers dropped from an estimated 14.5 million to 12.6 million. Yet cocaine use rose. In 1991, abusers were estimated at 1.9 million, compared to 1.6 million a year earlier. The abuse of crack, which had fallen as much as 50 per cent since 1989, levelled off.

Canadian authorities seized increased amounts of heroin and cocaine in 1991. At 1.2 tons, cocaine confiscations were double that of the previous year.

The report noted wide disparities in the percentage of intravenous drug users testing positive for the HIV virus in Europe. For Britain, it was up to five per cent; Germany, 20 per cent; Netherlands 30 per cent; Spain 40-60 per cent; France 58 per cent, and Italy 30-80 per cent.

LSD abuse seemed to be on the rise, judging from a four-fold increase in seizures across the continent.

In Africa, drug abuse and trafficking continued to increase in 1992, and "if effective steps are not take soon, illicit trafficking and drug abuse will (further) escalate."

In East and Southeast Asia, heroin traffickers are making inroads north into China, which in turn is a transit country for shipments to Hong Kong and Macao. Heroin addiction has grown as a result.

Burma remained the world's largest producer of opium and heroin, while the Philippines cntinued to be an important transit point for foreign syndicates smuggling heroin from Thailand to Australia, the United States and Europe.

A growth of cocaine abuse was reported for all of Latin America, with Caribbean authorities noting a general rise in drug-related crime.

In contrast to the board's previous reports which devoted only a paragraph to the notion of legalizing some drugs for "recreational use," the 1992 report attacked the idea head-on in a special sub-chapter.

Apart from undermining legal conventions which form the cornerstone of the international drug control system, decriminalizing soft drugs would be an invitation to more crime, steeper health bills and legislative chaos, it said.

Prescription Drug Abuse and the Diversion of Prescription Drugs into the Illicit Drug Market

Prescription drug abuse has received considerable attention in media reports in recent years. The purpose of this article is to describe the Canadian situation and context with regards to prescription drug abuse and the diversion of psychotropic prescription drugs into the illicit drug market, with a focus on the need for more data and interventions. Canada ranks within the top 10% of countries in the use of benzodiazepines, opioid prescriptions and stimulants. There are many ways that prescription drugs are diverted into the illicit market and varied reasons for use and abuse. Prescription drug abuse is further related to a number of negative consequences, including overdose. While seniors and women have been the primary focus for research in Canada on prescription drug abuse, adolescents and young adults have received less attention. Systematic epidemiological data specifically on prescription drug abuse in the Canada context are lacking and are needed in order to more clearly understand the reasons for the phenomenon and to develop and implement appropriate interventions.

Examinations of 'illicit drug use' typically focus on illegally produced substances like heroin and cocaine; however, a closer look suggests that the abuse of prescribed drugs plays a major role. The existence of the problem of prescription drug abuse in Canada is not new. In 1979, Wilson and Geekie1 called for more knowledge and better control of abuse of narcotic pharmaceuticals. Their call seems even more relevant today in light of media reports that have pointed to the continued high prevalence of the diversion and illicit use of specific prescription drugs.2,3 The purpose of this paper is to describe the available Canadian data, with a discussion of the implications for interventions.

Prescription drug abuse will be defined in this paper as use that occurs without a physician's prescription, in greater amounts than prescribed, more often than prescribed, and/or for other reasons than indicated by the prescribing physician.4 Further, this article will focus on particular groupings of psychotropic drugs: stimulants, benzodiazepines (sedativehypnotics), and opioids (narcotics).

Epidemiology of prescription drug use

The data on the extent of psychotropic prescription drug abuse in Canada are vague at best. Thus, quite often indirect indicators are used, such as internationally comparable figures on use. In such global statistics, Canada maintains a very high position for use (and possible abuse) of the psychotropic drugs of concern discussed in this paper: it is second highest in the list of all countries in the world for benzodiazepine use, fifth highest for prescription narcotics use, and within the top 15 countries for stimulant use.5,6 While we acknowledge these statistics to be only indirect indicators of abuse, the consistent high ranking of Canada is reason for concern. Benzodiazepine use seems to be of particular concern in the Canadian context: the use of this group of drugs is about 4 times the use documented for Australia, and about 15 times the use documented for the United States.6

The lack of large-scale surveys into the abuse of prescription drugs in Canada makes it difficult to more accurately gauge rates and the extent of the behaviour. Of the many large-scale population surveys in Canada (e.g., Canada's Alcohol and Other Drugs Survey, the CAMH Monitor), some do collect information on prescription drug use, but not data on prescription drug abuse or non-medical use of prescriptions.7

Even documentation of specific prescription drugs in the Canadian context does not provide much information on abuse. For instance, the final report of the OxyContin Task Force in Newfoundland and Labrador8 documented the increases in OxyContin (an opioid narcotic) prescriptions in recent years and the trends in the related abuse consequences, including overdose deaths. Although this report indicated a rise in OxyContin prescriptions and the number of pills distributed in the region (similar to the per capita dose rates in the International Narcotics Control Board report), there is no information presented on rates of abuse.

The majority of attention in Canada with regards to prescription drug abuse has tended to be on women9 and elder populations;10,11 these populations have also been the focus in the research on medical use of prescription drugs.12,13 Adolescents and young adults have, conversely, received relatively little attention. The most recent Ontario Student Drug Use Survey (OSDUS)14 collected data on non-medical prescription drug use among 6,616 students in grades 7-12 in the province of Ontario. In the previous year, 5.8% of students had used stimulants and 2.2% had used tranquilizers; rates were stable during the 1990s. Data from Nova Scotia found that 4.7% of students in grades 7, 9, 10, and 12 reported non-medical use of tranquilizers in the 12 months prior to the survey.15 Poulin et al.16 found that 8.5% of New Brunswick, PEI and Newfoundland students in grades 7-12 reported nonmedical stimulant use in the year prior to the survey. Ever use of prescription pills without a doctor's consent in the Adolescent Health Survey III (BC students) in the year 2003 was at the rate of 9%.17

Prescription drug abuse in the illicit drug market

Drugs intended to be used by prescription only are able to make their way into the illicit drug market in a number of ways. Sajan et al.18 conducted a study of 32 users and dealers of prescription sedative/hypnotic and narcotic drugs in Vancouver's Downtown Eastside to explore the street values of prescription drugs. The three 'index' drugs (i.e., most in demand) Valium, Tylenol 3 and MS Contin - were sold for street prices 15 to 50 times the pharmacy prices. Prices were fluid and depended on the inexperience of the buyer, availability of illicit drugs, current street supply of prescription drugs and the time of the month (in reference to social assistance cheques). Sajan et al.18 went on to describe the ways in which prescription drugs made their way into the illicit drug market, with their results indicating either robbery or fraudulent prescription as primary methods.

In a current cohort of illicit opioid users in five cities across Canada (OPICAN cohort), benzodiazepines were the most common prescription drugs used, with 36.2% of the sample reporting last 30 days usage (which could entail legitimate usage, but also non-prescription usage, as can be seen by drawing upon the data indicating source of drug acquisition). About a third of participants also reported Tylenol 3/4 use (32.5%) and Dilaudid (hydromorphone) use (33.1%). Percocet/Percodan (oxycodone plus acetominophen or ASA, respectively) were used by 16.2% in the last 30 days; other opioid prescription drugs (including MS Contin, Tylenol 1, others) were used by 28.5%. Table I provides information on the sources for selected prescription drugs in the OPICAN cohort, calling attention to the varied ways in which prescriptions may be diverted into the illicit drug market.18,19 Source of prescription drug acquisition may be useful as an indicator of possible medical use (i.e., prescribed by a doctor - although there could be drug abuse in this situation) as opposed to non-medical use with drugs accessed via the illicit drug market (i.e., dealers, friends).

Prescription drug use risks

The abuse of prescription drugs entails a number of risks for users, with dependence or harmful use according to ICD criteria20 being one of the most important. Dependence on prescription drugs requires that the user seek ways to access and pay for drugs; if the money required exceeds the individual's income, criminal and semi-legal activities (e.g., property crimes, hustling, panhandling) may be engaged in to pay for drugs.21 In populations of illicit opioid users, benzodiazepine use and abuse has been evidenced as an important risk factor for overdose with morbidity and mortality consequences, particularly in conjunction with alcohol use.22-24

DISCUSSION

The exact extent of prescription drug abuse in the Canadian context remains elusive at present because of the lack of systematic data with regards to this phenomenon. Prescription drug abuse should be a category that is utilized in national surveys of health and drug use, similarly to information collected on illicit drug use. The reasons for the very high use of benzodiazepines, and prescription drugs in general, in Canada need to be established and explored further.

The Canadian situation appears to be one of contradiction: on the one hand, benzodiazepines appear to be overprescribed, thus placing Canada very high on the list of defined daily doses of these drugs.6 On the other hand, fears among Canadian physicians of causing addiction and attracting addicts to their practices"28 may be involved in the underprescription of certain drugs and the undermedication of patients, particularly for those with chronic pain.

The key challenge is to identify appropriate and effective interventions to reduce abuse and its adverse consequences, targeting all involved: pharmaceutical industry, physicians, pharmacists, and patients.29 Further, calls have been made to establish communication between law enforcement and the Department of Health in such a way that information on individuals suspected of engaging in criminal activities to access prescriptions would be provided to law enforcement authorities.8 This is particularly important given the globalization of trade with internet pharmacies offering potentially abusable prescription drugs.30,31 These are but a few of the suggestions for interventions to address prescription drug abuse in Canada. More information is required in order to fully detail and develop appropriate and effective interventions at all levels.

CONCLUSION

The phenomenon of prescription drug abuse needs to be addressed within the research community in order to develop appropriate, feasible and helpful interventions. Evidence-based interventions will be difficult if not impossible to establish without more precise epidemiological data on the extent of prescription drug abuse in general and for specific groups (including adolescents and young adults) and the factors related to the diversion of prescriptions into the illicit drug market.

Our drug abuse fight 'superior'

The U.S. government's preoccupation with cutting off the supply of drugs is "out of sync" with the Canadian and European approach to fighting drug abuse, a federal Health and Welfare Department official said Thursday.

Canada's emphasis on reducing demand for drugs and alcohol will be much more effective in the long run, Peter Conley, head of the department's alcohol and drugs division, said in an interview during a national conference on drug abuse.

"The Americans seem to be extremely hung up with the illicit drug issue, and their program is primarily federal," Conley said. "They didn't find out what people across the country want.

"Ours is a more balanced response. We have a much bigger educational component and we are also looking at alcohol abuse. You have to build a generation on people who just won't accept it."

Conley pointed to the dramatic reduction in tobacco consumption over the last 25 years and said the federal government's strategy is to achieve a similar decrease in the social acceptibility of drugs and alcohol.

He said the federal government is focusing about 60 per cent of its efforts on decreasing demand and 40 per cent on controlling supply.

The National Action Conference on Drug Abuse, which ends Saturday, was organized as part of the federal government's Action on Drug Abuse program, a five-year, $210-million campaign launched by Health and Welfare Minister Jake Epp in May 1987.

For the first time, more than 700 politicians, community workers, experts and young people from across the country are meeting to share information on alcohol and drug abuse.

Epp told the conference Thursday that his department's strategy has led to two major initiatives in its first 18 months: the conference and the establishment of a Canadian Centre on Substance Abuse.