Multiple Drug Use Epidemiology, Correlates, and Consequences

The initial focus is on the conceptual issues essential to the understanding of multiple drug use. This is followed by a discussion of the developmental nature of multiple drug use and the various strategies that have been designed to measure multiple use. The third section of the paper contains a review of the extent of multiple drug use in various segments of society with data from the Monitoring-the-Future surveys of high school seniors, the National Survey on Drug Abuse, and the Treatment Outcome Prospective Study of drug abuse treatment clients. The conclusion is that multiple drug use is pervasive. The next section deals with several consequences associated with multiple drug use: automobile accidents, delinquency, and emergency room visits. The final section outlines some of the prevention and treatment implications of multiple drug use from a public policy perspective. In a study of the effects of a single drug upon behavior, the implications are manifold. Dosage levels, modes of administration, baseline states, the expectations of the subjects and of the investigators, the environment in which the drug is taken — all these variables, and others as well, make human psychochemical studies difficult and complex. 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 […]

A Review of Drug Abuse Data Bases: the National Survey

The data base which appears to provide the most consistent source of drug use data on youth and young adults is the National Survey co2nducted between 1971 and 1977. There are five studies in this series. The first two surveys were conducted for the National Commission on Marihuana and Drug Abuse. The most recent three were conducted for the National Institute on Drug Abuse. The five studies are entitled: 1) 1971 study: Public Attitudes Toward Marihuana. 2) 1972 study: Drug Experience, Attitudes and Related Behavior Among Adolescents and Adults. 3) 1974 study: Public Experience with Psychoactive Substances. 4) 1976 study: Nonmedical Use of Psychoactive Substances. () 5) 1977 study: National Survey on Drug Abuse. () These surveys share several critical characteristics which contribute to their utility for estimating drug use: Data collection on the “at risk” 18-25 year age bracket; Adequate and consistent sampling methodology; Comparability of drugs investigated; Comparability of question formats; and Accessibility of detailed tabular data. Each of the five studies is discussed below to demonstrate its adequacy as a data base for projecting the number of drug users in the United States Read more […]

A Review of Drug Abuse Data Bases: Treatment-Oriented Data Systems

Six treatment-oriented data systems were studied: 1. Drug Abuse Warning Network (DAWN) Purpose. Project DAWN is a Federal program jointly funded by the Drug Enforcement Administration (DEA) and the National Institute on Drug Abuse (NIDA). DAWN has been in existence since 1972 and was established to monitor the consequences of drug abuse using two indicators, emergency room visits and deaths. Respondents and Sampling. DAWN collects its information through episode reports provided by selected hospital emergency rooms, crisis centers, and medical examiners. In order to be eligible, emergency rooms must: Be open 24 hours per day; Be located in non-Federal short-term general hospitals (specialty hospitals, hospital units of institutions, and pediatric hospitals are excluded); and Have at least 1,000 patient visits to the emergency room per year. At the end of 1978, over 900 facilities were supplying data to the program. Reporting facilities are concentrated in 24 Standard Metropolitan Statistical Areas (SMSA’S) which are not randomly selected but are chosen to account for approximately 30 percent of the population of the U.S. in geographically diverse locations. Drugs Investigated. DAWN distinguishes Read more […]

WHO’s Response to International Drug Control Treaties

I should like to review briefly the activities undertaken by WHO since I last reported to you in Philadelphia June 1979: Scheduling Activities WHO’s recommendations to the Secretary-General of the UN regarding the control status of eight substances were reviewed by the 6th Special Session of the UN Commission on Narcotic Drugs in February 1980 in Vienna. Tilidine and Sufentanil were placed in schedule I of the 1961 Convention while Dextropropoxyphene was placed in schedule II of the same Convention. The Commission agreed with the recommendations of WHO that Phencyclidine continue to be controlled under schedule II of the 1971 Convention as it is needed in veterinary practices. It was also decided that three analogues of PCP (TEP, PHP or PCPY and PCE) be controlled under schedule I and Mecloqualone under schedule II of the 1971 Convention. In September 1980, WHO plans to review the status of a group of 9 substances (anorectics). These are: Phentermine Chlorphentermine Chlortermine Benzphetamine Mazindol Fenfluramine Amfepramone Phenmetrazine Phendimetrazine Phenmetrazine and Amfepramone are already controlled under schedule II and IV respectively of the 1971 Convention. Technical Cooperation Read more […]

Epidemiology of Drug Use Among Adolescents

This review of the epidemiology of adolescent drug use focuses on typical stages of the drug use career and assesses the diversity of experience that my characterize special subgroups of youth. As shown by earlier longitudinal studies (), drug use during the adolescent years is a dynamic, multistage phenomenon which my best be understood by a conceptualization of progressive stages of involvement. The most recent data on dominant patterns of drug use in the 12 to 21 age group are provided by two series of nationwide surveys: the national survey of high school seniors () and the national survey of household population aged 12 and older (). Both of these surveys are cross-sectional, but because many of the data consist of retrospective drug use histories, nationwide patterns of use in 1979 can be described in terms of sequential stages of drug experience. As Kandel has noted, the study of stages of adolescent drug use does not imply “that the use of a drug causes the progression to the next level. Nor can we assume that once started adolescents will progress through the entire sequence” (). Rather, during the adolescent years, each stage of the drug use career represents a risk factor with regard to more serious stages Read more […]

Adolescence and Drug Abuse: Biomedical Consequences

Many facets of the biomedical aspects of substance abuse in adolescents have not yet been adequately researched. Little is known about the biological elements, if any, that contribute to the genesis of substance abuse. In the instance of alcoholism a genetic vulnerability appears to be established from the studies of identical twins, one raised by the natural parent and the other placed at an early age in the home of nonalcoholic foster parents. In the studies conducted both in this country () and in Denmark () the incidence of problem drinking of both groups of twins was similar. It is well established that among people of Mongolian descent, a widespread sensitivity to alcohol, based upon the rapid accumulation of acetaldehyde, is observed (). Facial flushing and more upsetting symptoms, including asthma and hypotension, can be present. In those with marked discomfort after drinking small amounts of ethanol, a certain preventive role is probably played by this inborn racial change in the ability to metabolize alcohol. Such genetic factors have not yet been uncovered for other psychoactive drugs. With the recent identification of opiate () and benzodiazepine () receptor sites, and the hint that other drug-specific Read more […]

The Diagnosis and Treatment of the Phencyclidine Abuse Syndrome

David E. Smith, M.D., Donald R. Wesson, M.D., Millicent E. Buxton, Richard Seymour, M.A., and Honey M. Kramer Our first exposure to Phencyclidine occurred during the summer of 1967 in the Haight-Ashbury District of San Francisco in which the drug was first introduced as the “PeaCe Pill” during a rock concert. We saw that day between twenty-five and thirty acute Phencyclidine toxic reactions. In some respects, these reactions were like the bad LSD trips we were used to treating, but in other respects quite different, with greater physical toxicity and paranoid thinking. We had samples of the “PeaCe Pill” analyzed through a local Bay Area toxicology laboratory and found that the psychoactive drug was PCP. The “PeaCe Pill” was not well received by the majority of individuals in Haight-Ashbury at that time, although Phencyclidine became the drug of choice for a small number of users who continued to use it on a chronic basis. For them most part, Phencyclidine was a drug of deception, usually marketed as “THC” or as one of the psychedelics which were more in demand. Within the past five years, however, Phencyclidine has become increasingly visible as a primary drug of abuse under a variety of street names, including “hog,” Read more […]

Stage I. Acute Phencyclidine Toxicity

In acute Phencyclidine toxicity there are four “C’s”: combativeness, catatonia, convulsions and coma. These effects are dose-related. Combativeness and catatonia are frequently observed together at the lower dosages, while convulsions and coma are related to higher dosage effects. During this stage, one also sees hypertensive crisis sufficiently severe to be fatal, although such crises are relatively rare in our experience. Illusions can dominate: space walking, the detachment of sounds, objects changing in size, shape, and distance. Visual illusions rather than true hallucinations are common, but occasionally auditory hallucinations occur. If the dose of Phencyclidine is high enough, the patient may have many grand mal seizures and coma which require hospitalization and supportive care to stabilize and maintain the respiratory and cardiovascular function. With proper management, most patients who go into a PCP-induced coma survive, although the period of coma may be quite prolonged. Our experience indicates that the usual duration of acute Phencyclidine toxicity is 0 to 72 hours. Lab results indicate that blood is almost always positive and urine is positive. A large number of people clear after stage I, Phencyclidine Read more […]