Policy Implications of Multiple Drug Use

Public policies that deal with the use and abuse of alcohol and drugs are very fragmented, reflecting in many ways the history of various substances as well as the role played by the substances in this society. Alcohol is a good example. Because the impact of alcohol on traffic fatalities is so painfully obvious, public interest in the control of alcohol has increased in the recent past. There have been a number of initiatives at Federal, state, and local levels concerning enforcement of minimum age drinking and dram shop liability laws and a push in some areas for raising the driving age. However, very little public policy attention has been directed toward the other control strategies that might have a larger impact on alcohol consumption and its relationship to traffic accidents and fatalities (i.e., changes in laws that would eliminate tax deductions for advertising, restriction of advertising of various types of alcoholic beverages, or substantial increases in the tax placed on alcoholic beverages and thus on the price). After all, when the economics of alcohol is examined it is easy to see how thoroughly interwoven alcohol is in society. The value of alcohol in the advertising, trucking, and agricultural sectors Read more […]

Consequences of Multiple Drug Use: Specifying the Causes

In order to illustrate these points, three specific consequences of drug use will be discussed in some detail below. These three consequences are traffic accidents, involvement in delinquent/criminal acts by youth and young adults, and emergency room visits related to drug abuse. Traffic Accidents The Monitoring-the-Future surveys contain several questions concerning traffic accidents. The seniors are first asked how many accidents (i.e., a collision involving property damage or personal injury — not bumps or scratches in parking lots) they had while they were driving in the past 12 months. If the answer is one or more, the senior is asked how many occurred after he/she was drinking alcoholic beverages and then how many occurred after he/she was smoking marijuana or hashish. By piecing together the information from these separate questions, it is possible to estimate the proportion that would be due to alcohol, to marijuana, and to alcohol and marijuana. The data in Table “Motor Vehicle Accidents and Their Connection to Use of Alcohol, Use of Marijuana, and Use of Both Alcohol and Marijuana” are for seniors in the class of 1980 classified according to the extent of alcohol and marijuana use reported during the Read more […]

The Epidemiology of Multiple Drug Use

How much multiple drug use is there? What proportion of the population at any one point in time is using/abusing multiple substances? Has use of multiple substances become more normative in the recent past as opposed to exclusive use of a favorite drug? What are the principal consequences of multiple drug use? Do these consequences differ according to pharmacological parameters for interactive potential or are there other parameters of almost equal predictive value? To what extent are the consequences attributed to single drugs (traffic accidents labeled as alcohol related) really the result of impaired judgment and performance from ingestion of multiple substances? These are just a few of the questions that need to be addressed within the scientific and public policy communities. In the following section some epidemiological data pertinent to understanding the “extent” of multiple drug use are presented. Monitoring-the-Future Studies Each year since 1975, researchers at the Institute for Social Research at the University of Michigan have administered questionnaires to about 17,000 high school seniors attending schools randomly chosen to be representative of all high schools in the continental United States. These Read more […]

Measuring the Developmental Nature of Multiple Drug Use

There have been a number of studies in which attempts have been made to measure or assess multiple drug use. Some of these are from general populations while others are focused on specific subpopulations of users. The studies are grouped more on the basis of the approach taken to assessing multiple drug use than on the patterns uncovered. There are at least four different groupings of studies and some studies fit into more than one grouping. Developmental Patterns of Onset of Use One of the most influential attempts to describe patterns of multiple drug use is the “stages of drug use” model developed by Kandel. Kandel posited that persons proceed from licit to illicit drugs and from use of less to more serious drugs. The stages of drug use involvement that she identified were: (1) no use of any drugs; (2) use of beer or wine; (3) use of cigarettes and/or hard liquor; (4) use of marijuana; and (5) use of illicit drugs other than marijuana. Although it is not made explicit by Kandel, there is an implication that the drugs from the earlier stages of development are “carried forward” into the later stages of drug involvement. Thus, a marijuana user is likely to continue his or her use of cigarettes/hard liquor and beer Read more […]

Drug Impairment Reviews: Opiates and Minor Tranquilizers

STUDY: Gordon, N.B. Reaction Times of Methadone-Treated Heroin Addicts. Psychopharmacologia, 16:337-344. 1970. Site: Rockefeller University and Yeshiva University, New York City, New York. Subjects: The subjects were divided into six groups. Groups 1 and 3 both had been maintained for at least 1 year on methadone for the treatment of heroin addiction. Group 1 had 18 males whose average age was 32.5 years; group 3 had 9 females whose average age was 33.5 years. Group 2 consisted of 20 unpaid male volunteers who did not use drugs; they averaged 32.5 years. The participants in groups 4 and 5 had recently withdrawn from narcotic drugs. The 20 males in group 4 averaged 31.5 years and had withdrawn 14 days earlier. The 19 males in group 5 averaged 30 years and had withdrawn 4 days earlier. Group 6 consisted of 9 females whose average age was 23 years. They were paid volunteers from the nonprofessional hospital staff, and did not use drugs. Method: Measurements were taken under controlled laboratory conditions; urines were tested (details were not given) for drugs to assure conformity to group. Variations of reaction time were tested in a button-pressing situation: (a) simple reaction time (one of six stimuli); (b) Read more […]

Buprenorphine, Heroin, and Methadone: Comparison of Relative’ Reinforcing Properties

Buprenorphine is a partial agonist of the morphine type. It is both a long-acting opiate antagonist, like naltrexone, and a potent opiate agonist with respect to analgesia, physiological and subjective reactions in man (). However, buprenorphine does not induce physical dependence in several species and appears to produce only minimal physical dependence in man (). Buprenorphine’s positive morphine-like agonist effects combined with its antagonist potency, low toxicity, and minimal capacity for producing physical dependence, suggested that it should be valuable for the treatment of opiate addiction (). Clinical studies have shown that buprenorphine maintenance (8 mg/ day s.c.) significantly suppressed self-administration of heroin (21 to 40.5 mg/day) by male heroin addicts over 10 days of heroin availability in comparison to buprenorphine placebo (). Buprenorphine (0.282 to 0.789 mg/kg/day i.v.) also significantly suppressed opiate self-administration in the rhesus monkey drug self-administration model (). Recent clinical studies have shown that sublingual administration of buprenorphine (1-2 mg) should be suitable for daily maintenance for the treatment of narcotic addiction (). The opiate agonist effects of Read more […]

Criminality During the Life Course of Heroin Addiction

Statement of the research problem It has been established that opiate addiction in the contemporary United States is associated with exceedingly high crime rates (). Indeed, recent studies have reported () that heroin addicts are frequently involved in criminal behavior on a daily basis and that, consequently, they comnithundreds and thousands of offenses per individual during their addiction careers. Furthermore, it is becoming apparent that the scope and magnitude of the crime problem associated with opiate addiction is not only due to the frequency with which addicts commit “victimless” and lesser offenses, but that many of their offenses are serious and destructive (). But further questions about the association of crime and addiction remain to be answered. One of the most crucial of these involves the continuity of crime among heroin addicts. What are the long-term consequences of this crime-drug relationship? Do active addicts become more, or less, enmeshed in criminal behavior over their adult years? Do the types of crimes they commit change? Or do they reach a high crime plateau which remains stable? What is the effect of successive abstinence periods upon criminality? In order to investigate the life Read more […]

Cocaine abuse treatment strategies

Strategies devised to treat cocaine abuse have existed since its intractable lure for some first became obvious almost a century ago. During this period no generally accepted or successful treatment has emerged. Chronic cocaine abuse has been assumed to cause no physiologic withdrawal state on discontinuation because of insufficient evidence for an abstinence syndrome of major physiological changes like the classic sort characterizing sedative or opiate withdrawal (). Cocaine abuse has thus been assumed to be a “psychological dependence” rather than one involving neurophysiological adaptations, and currently used treatments consist of psychological strategies aimed at modifying addictive behaviors. Issues related to current psychological strategies will be discussed first, followed by a summary of evidence indicating cocaine abuse may cause neuroadaptation. The latter includes a review of pharmacological strategies, aimed at reversal of such adaptation, which may hold future potential as adjuncts in cocaine abuse treatment. Cocaine abuse treatment strategies: Current treatments Potential New Directions in Treatment Despite the past assumption that cocaine abuse is a “psychological addiction,” it is plausible Read more […]

Narcotic Addiction: A Changing Scene?

The purpose of this paper is to explore changes in the narcotic addiction [Narcotic addicts are defined in this study as persons who have used opium, its derivatives, or synthetics for non-medical reasons four or more days a week for at least a month. Onset of addiction was defined in terms of the first occurrence of such a period] scene in an era of rapid social change. The quarter of a century covered by this study embraces an era in which major significant changes have occurred in this society. The Sample and Data A sample of 499 subjects was selected from a roster of male narcotic abusers first known to the Baltimore City Police Department Narcotic Squad between the years 1952-1976, inclusive. From each year’s contribution to the roster, ten whites [Only nine whites were available in 1956] and ten blacks were selected in a random, stratified manner, and 402 were interviewed. The data to be analyzed were drawn from a structured interview schedule devised by the project staff; each interview took approximately three hours and was administered by a staff member especially trained for this purpose. In this report, the data [All appropriate tables have been deleted from this abbreviated presentation and appear in Read more […]

The Effects of Law Enforcement Activity on a Population of Opiate Abusers

This study examined the effect of police action against heroin pushers on clients of methadone programs in metropolitan Denver. On November 10, 1979, twenty suspected drug dealers and buyers were arrested and another twenty were under investigation in a vice squad operation in metropolitan Denver. The operation involved an undercover agent who mingled with addicts and bought opiates over an extended period from dealers, who were later arrested within a 48-hour period. Newspaper reports indicated that most of those arrested had been selling heroin in the vicinity of the outpatient clinic operated by Addiction Research and Treatment Services (ARTS) of the University of Colorado School of Medicine. Although linked to the clinic by the press, only two of those arrested were known to clinic personnel. In this study we examined the patterns of opiate use of the clients enrolled in that clinic as reflected by the presence of opiate metabolites in their urine samples collected before and after the drug bust. The clinical course of a sample of clients who abused opiates before, but not after the bust was examined. In addition, urine data from the other two methadone programs in the city were examined. Metropolitan Denver Read more […]