Legal Instrumental Use

Besides accepted medical use, instrumental use of other legal drugs: Nicotine==> Stay awake while studying.

OTC (Over-The Counter)

• Proprietary drugs
• $28.8 billion in sales for 2002 (http://www.euromonitor.com/OTC_Healthcare_in_United_States) ($15 billion in 1995)
  • Current OTC sales
• Not strongly psychoactive (in USA)
• Rarely used for high (last resort, Look Alikes)
• Fairly Safe: Tylenol 35,000 non-lethal ER and 367 deaths (1995) vs. Millions of doses

Prescription

• Ethical/Legend (establish in 1938)
• Advertised only to doctors until 1997 when congress approved direct to consumer advertising.
  • 2009: FDA and Congress cutting back on drug advertising
  • "In a recent IMS survey on direct-to-consumer advertising, 29% of physicians said they received specific requests from patients for Claritin, making it by far the most frequently requested brand-name product," noted Paul Allen, Vice President, Product Management at IMS. "Overall, Schering spent $18.5 million in the first half of 1997 alone on TV ads. However, they were outspent by Merck, Novartis, Glaxo Wellcome, and Pfizer. Now that companies can communicate brand and indication in the same TV ad, we expect the industry's investment in this type of marketing to double."  (Pharmacy Times, 1999)

    "Advertisements on TV or in magazines have made some people aware of conditions they didn’t realize they had, or of new treatments for conditions that they were aware of. In certain cases, DTC ads have made patients aware that they are not alone in suffering from various conditions, and that help is available." (Pharmacy Times, 2001)

Shopping for Drugs: http://www.ncpa.org/pub/st/st262/
• Prescription Status set by Pharmaceutical Industry until 1951.
• Legitimate for medical purposes
• Prescribed by licensed Physician (300,000)
• Sold by licensed Pharmacy (150,000 pharmacists; 60,000 pharmacies)
• MAJOR SOURCE OF PSYCHOACTIVE DRUG USE
1. Over $145,092,763,000 per year in sales (2000); $124,835,595,000 (1999) (Pharmacy Times) (around $95 Billion in 1997)
2. 1,563,974,000 New Prescriptions in 2000.
3. 2.98 billion total prescriptions in 2000, 2.8 billion in 1999, 2.5 billion in 1997, 2.4 billion in 1996, 1.5 billion in 1990 (Pharmacy Times, 1999 and Pharmacy Times, 2001)
4. 1 in 7 are psychoactive (approximately).
5. 2007: Spending on Psychotherapeutic Drugs Soars

Use and Distribution of Prescription Drugs

• Main Point: Following the Dramatic Decline in psychoactive drugs being prescribed through the late 1980s, there has been a notable increase in prescriptions (including psychoactive drugs) during the past decade.
• Prozac
may be the drug that ignited this turn-around?
• Top 200 Drugs by prescriptions dispensed (scroll to bottom of list for previous years' data) (see also: Mosby for 2002)
• Top 200 Drugs by sales

Researching, Developing, Testing, and Marketing a new drug

• Costs==> $800 million to $2 billion (for 2008: see, "The Cost of Developing a New Drug: New wonder medicines come from years of research, high costs," US Department of State)
• Patent lasts==> around 20 years
• Then==> Generics

Valium

• Mid 1960's==> #1: $250 million/year
• 1975 was its best year==> 61.3 million prescriptions
• 1980 only 33.6, yet still best seller
• Patent expired 1980, falls to #3, then #4 in 1983
• 1984 three companies market generic diazepam
• 1986-- Valium is #11; 1990 #47
• Now, sales of generic versions of diazepam in top 200, now Alprazolam.

As of 1990 sales of all generics account for one-third of the market

We're talking BIG BUCKS here!

• The role of advertising in the health industry has been critiqued by a number of commentators
• $1000's are spent per physician, millions more on direct-to-consumer ads today: "As DTC ads become more and more common, we may see future increases in prescriptions for products for depression, allergies, arthritis, and gastrointestinal problems. (Pharmacy Times, 2001)
  
• Concern is that the drive for profits by pharmaceutical companies, leads to the over prescribing of psychoactive medicine as doctors are inundated with information on the "wonders" of these drugs (and demands for certain drugs by their patients).

Interestingly, from the early 1970's through the mid 1980's, prescriptions for:

• Barbiturates dropped by 90%
• Amphetamines dropped by 60%
• Methaqualone (which skyrocketed from 1976-1986) fell to NO prescriptions

What's Going on Here??

"Pharmacological Revolutions"

(Oakley Ray, Erich Goode, and Keel)

1. Vaccines: Polio, Smallpox==> Medicines as powerful and beneficial
2. Antibiotics (1940's)==> Faith in drugs as cures
3. Anti-psychotics==> Acceptance of drug's impact on the mind
4. Oral Contraceptives==> Use drugs on healthy body in order to gain control
5. Decline in the use of psychoactive drugs, overall, by a factor of 50%==> "We can get along without them." (Goode)

One notable exception to overall trend in Psycho-Pharmaceuticals during the 1980s: Prozac. (And, perhaps, the herald of a "new age")

• Hit the market in 1987
• Quickly takes #1 spot: 1 million prescriptions/month
• 1988-89 prescribing up X3
• 1989-1990 up another 60%
• Now??? Horror Stories, but major legal struggle by Eli Lilly to defend the drug. Current status: warnings but no official action.
• Currently (2001) 23rd drug in sales (beat by both Zoloft and Paxil) and SSRIs rank 3rd for number of prescriptions written, and 2nd for sales.

But, this (#5) appears to have been a short-lived revolution. Now maybe beginning of #6- "Better Living Through Chemistry: Part 2"

(BTW: These revolutions are significantly related to illicit use, too.)

Problem: As we enforce tighter controls on one drug, others, sometimes older and more problematic drugs, other times new "replacements" drugs, increase in use and problems increase. 1989 NY law on benzodiazepines (which were created to replace the more problematic barbiturates) and other similar "minor" depressants, led to significant increases in the use of more problematic depressants, including barbiturates. And, Prozac, created to (at least partially) replace the benzodiazepines, seems to have its own problems.

INTEREST: If a drug is psychoactive, it rarely remains purely instrumental

• Heroin, Cocaine all original used medically, even OTC
• Heroin: Pain==> Britain
• Amphetamines: Inhalers
• Marijuana: Glaucoma, AIDS, Chemotherapy
• U.S. stopped marijuana use for medical purposes: 1985 (Marinol), supported by DEA in 1992
1. Cited immune system problems
2. AIDS patient: "Decision made by a bunch of Bozos"
3. Now: Legal for medicinal use in 14 states 01/2010. Federal: illegal--Schedule I. (16 states/districts with some type of program)
• U.S. view==> if we allow these drugs to be used legitimately, there would be more abuse
• Physicians often hesitate to use even strong doses of morphine to relieve the pain of terminally ill cancer patients: "Problem of addiction"

Important: Definition of legal/illegal; instrumental/recreational SHIFTS (Relativity)

• Tremendous marketing/advertising activity
• Huge profits: Tobacco and Kids ("Who Profits From Tobacco Sales to Children?")

1. $1.23 billion in sales to children
2. $52 million in Federal taxes
3. Office of Smoking and Health Budget: $3.5 million
4. Children cultivated as lifelong/permanent market
5. But: Now Federal Government is debating defining nicotine as addictive and is seeking to regulate advertising, promotions, and sales.
6. 2006 Update on tobacco sales to youth

• Not identical to illegal recreational, but close
• Pleasure is not an either/or proposition, but a continuum
• Recent Alcohol Industry Statistics
• Tobacco:

  $80.3 Billion in sales for 2002, Globally: http://www.princeton.edu/~ina/infographics/smoking.html

• 1994: Smoking: Stable. 1995=>1999 significant increases for Teenagers. 2002-2007, overall decline led by decline in teen use:

Past Month Tobacco Use among Persons Aged 12 or Older: 2002-2007 (2007 NSDUH) (2008 NSDUH)

Past Month Tobacco Use among Youths Aged 12 to 17: 2002-2007 (2007 NHSDUH)

• Smokers 4 times more likely to be heavy users of ETOH and illicit drugs
• Rate of use of alcohol and nicotine (except among the young) is declining, except for Caffeine (most popular)
• Nicotine alone is used by more people than all illicit drugs combined
• Nicotine is used most frequently by those who use drug
• Current MTF Data
• Current National Survey on Drug Use & Health

Correlates of Use of Legal Drugs
(from Mosher and Akins, Drugs and Drug Policy: The Control of Consciousness Alteration, Sage Publications, 2007, pages 171-200.

Age

• Typically highest during late adolescence
• Drinking peaks: 21 (also binge and heavy use)
  • Alcohol used for ASC (not simple sociability)
• Performance-enhancing drug
• "Pharming"
  • Rapid increase in recent years
  • Ritalin, Adderall, DXM, prescription pain pills
• Perception of "difference" from illegal drugs, "safer,"
• Parallels high levels of prescription use--including to adolescents

  The Elderly

  • Perhaps 17% of those over 60 "addicted" to alcohol and prescription psychoactives
  • 2-3 times more likely to be prescribed drugs
  • Frequent dosing--added problems
  • Leads to: confusion, falls, toxicity
  • Alcohol use difficult to chart, yet rates of problem use appear high.
  • Minimization--other problems
  • Factors--similar to adolescents, and stressors associated with aging.

Gender

• Use (and problematic use) more likely among males
• Gap varies by drug and age
  • Adolescents: drinking versus binge/heavy drinking--true for adults, too
  • Performance-enhancing drug (males)
  • Diet-pills and "fat-burners (females)
  • Cultural factors
• Tobacco--similar use patterns, especially recently
• Females--more likely to use/over-use prescription medication (gender norms--women/mothers not "on the streets")
  • Women more likely to seek treatment, especially for mood disorders
  • Men, self-medicate

Race/Ethnicity

• Similar to illegal drugs--misperception of overuse by minorities
• Alcohol: Whites and Native Americans--high levels of use throughout the life-course
  • White adults higher rates, NA adolescents higher.
  • NA adults high levels of binge/heavy drinking, but also abstinence
• Tobacco: far higher among Native American youth (almost twice), also high for adults (nearly 50%)

Within and Between Group Patterns

• Most focus on alcohol
• Acculturation, SES stress, and minority status
• See, illegal use patterns

African-Americans

• Youth--low levels
• Adults--similar to whites. As age increases, problematic drinking for African-Americans increases
• High levels of abstinence, yet consequences of drinking more severe--issues:
  • SES
  • Family disruption
  • Social isolation
  • Unemployment
  • Limited access to health care
  • Hyperavailability
  • Segregation and concentrated poverty
  • Alcohol outlets and advertising
• Yet, parental vigilance over youth and negative attitudes towards drinking and drunkenness

Hispanics

• Moderate levels of use throughout the life-course
• variation across groups
• Disproportionate exposure (similar to blacks)--leads to higher rates of problems
• Protective factors (compared to blacks)
  • employment
  • marriage
  • less isolation
• Females drink less
• Mexican-Americans males binge/heavy drinking rates high
  • High rates of problems
  • "Fiesta Drinking" (high rates of abstaining, yet high binging)
• Acculturation: most recent groups (South Americans, Cubans)--more likely to drink and smoke
  • Traditional norms discourage heavy use, but "machismo" may encourage binge drinking, i.e. drink less frequently, but when drinking they consume a lot.

Native Americans

• Display highest patterns of legal drug use
  • Genetics? (alcohol)
  • Social/economic disadvantage
  • Culture (destruction of traditional culture--issue of drunken comportment)

Asians and Pacific Islanders

• Lowest levels of use
• Importance of family
• Focus on education
• Affluent and employed
• Yet--diverse
  • pacific Islanders and Native Hawaiians: similar to american Indians
  • Asians--recent immigrants--heavy use. Increased availability? Also, high rates of tobacco use

Social Class

• Rates of use of many legal drugs highest in middle to upper class
• Race/ethnic differences (SES little impact on whites, minorities more adverse effects due to poverty)
• Tobacco use higher in lower/working class youth
• Prescription pharmaceuticals--varies by type
• Alcohol use and education--varies by age--high among young student, lower among older graduates (employment?)
  • "Hyperavailability" on college campuses
  • Yet, availability of resources to mediate effects of consumption (compare to poor neighborhoods, consequences limited for college youth)
• Hagan's "party subculture."
  • Participation results in lower educational attainment
  • Controlling for educational attainment, party subculture results in positive occupational outcomes for middle/upper class and lower outcomes for working class youth. Issue: consequences of heavy use varies by class.

Urban/Rural

• Small cities and rural areas--higher rates of binge drinking, heavy alcohol use, tobacco use, inhalants,and illicit pharmaceutical use
• Boredom and recreational opportunities
• Although legal/illegal drug use patterns are similar across other correlates, urban rural correlate displays dissimilarity
  • Limited interest in illegal drugs (no "critical mass")
  • negative attitudes
  • Disapproval of use of illegal drugs, yet less likely to disapprove of problematic use of legal drugs: type of drug rather than level of use as key factor.

• Socially Approved Purpose
• User's self-image==> NOT "drug" user; Don't seek "High," "technically illegal- but not criminal or deviant"
• Viewed similar to OTC use
• Public Opinion: Goal is OK, means--problematic, but not "as" deviant as illegal recreational

Sources

• Diversion of legally manufactured pharmaceuticals
• "Script" doctors
• Illicit manufacture
• Smuggling

• Element of and often focal point of subculture
• Link to roles and status and expectations from dominant culture
  • Masculinity
  • Perfect Body
  • Sex appeal
  • Success
  • Winning is everything

• Big Bucks here: U.S.- consume 60% of world's output
• Internationally, spend more on illicit drugs than any other product or service ($1/2 trillion) (accuracy?)
• U.S. sales (DEA est.) $80 billion in 1980; $30-130 billion is the typical range
• U.S. News and World Report-- $100 billion
• Whatever: HUGE DEMAND
• Statistics are difficult, no records kept of the sales
• Drug Use in Europe: The European Monitoring Centre for Drugs and Drug Addiction

• World Drug Report Archive
• News Flash (June 2002):

Newsbrief: UN Reports Drug Use on the Rise Worldwide
http://www.stopthedrugwar.org/chronicle/243/worldofdrugs.shtml

"The United Nations Drug Control Programme has released its annual report, showing an increase in global drug consumption. According to the report, 185 million people now use illicit drugs. 147 million of these are cannabis (marijuana) users, but the increase of global consumption is primarily due to increased use of ecstasy and amphetamines.

Worldwide, cannabis use is most popular among individuals ages 18 to 20, and other drugs are most popular among those aged 18 to 25. Almost half of all 10th graders in the United States have used drugs, the report says, though the rate has fallen somewhat since last year. No other country in the world was reported to have a rate nearly that high, despite the massive US drug war effort."

2005 World Drug Report (from the executive summary):

"Some 200 million people, or 5% of the world’s population age 15-64, have used drugs at least once in the last 12 months. This is 15 million people higher than last year’s estimate but remains significantly lower than the number of persons using licit psychoactive substances (about 30% of the general adult population use tobacco and about half use alcohol). The number of cannabis users worldwide is now close to 160 million people or 4% of the population age 15-64. Estimates of the number of ATS users - 26 million people using amphetamines and 8 million using ecstasy - are slightly lower than those of last year’s World Drug Report (WDR), reflecting declines of methamphetamine use in South-East Asia (notably Thailand) and of ecstasy use in North America (notably in the USA). The number of opiate users is estimated to have risen slightly to around 16 million people (11 million of which abuse heroin), mainly reflecting increasing levels of opiate abuse in Asia. No significant changes were observed in most other parts of the world. The number of cocaine users – close to 14 million people – rose slightly.

Unsurprisingly, the main problem drugs at the global level continue to be the opiates (notably heroin) followed by cocaine. For most of Europe and Asia, opiates continued to be the main problem drug, accounting for 62% of all treatment demand in 2003. In South-America, drug related treatment demand continued to be mainly linked to the abuse of cocaine (59% of all treatment demand). In Africa, the bulk of all treatment demand – as in the past – is linked to cannabis (64%)."

World Drug Report: 2008 (Transnational Institute Response)

1. NIDA supported Institute for Social Research, "Monitoring the Future survey of High School Students and Young Adults (since 1975)
2. SAMHSA supported "National Survey on Drug Use & Health " (NSDUH) (Formerly called the National Household Survey) (since early 1970's) 
3. DAWN Report (since mid 1970's) (see below)
4. ADAM: Arrestee Drug Abuse Monitoring Program (press release, fact sheet)
5. Pulse Check: January 2004 (local copy) St. Louis 2004 (local copy) January 2002 Report (local copy) seems to have lost funding. 2004 was last year available)
6. Complete listing of federal data sources

Other sources

• Erowid's Statistics Vault
• Erowid's Statistics Chart

• Use: Lifetime, Annual, 30 day, Daily (20/30)
• Attitudes
• Follow-up: Young Adults
• Good on trends: How extensive, Use increasing or decreasing

• Pre 1990: 12-17, 18-25, over 26 years of age
• Now 26-34, and over 35 years of age
• No figures of daily use
• No military, prisons, or homeless

• ETOH and Nicotine extensively used-- Legal, Available, long cultural history
• About 47% (over 100 million people) have tried illicit drugs
  • 14.2% used past year (12.6% 2001 NHS)
  • 8.0% past month (7.1% 2001)
  • ~3-4% are "frequent users (51 or more days over past year)
• Over two-thirds of illicit use is Marijuana (used by 75% of past month illicit users, 57% only use marijuana): 40.1% lifetime use, 10.3% past year, 6% past month.
• Current NHDUH
• 2006 Press Release: teen use down (for third year, baby-boomer use up)
• Cocaine, Hallucinogens, and non-medical use of pain relievers "tie" for the #2 spot.
  1. Cocaine: 14.7%, Hallucinogens: 14.4% and pain relievers: 13.3% lifetime (cocaine up compared to 2007)
  2. Cocaine
     1. 2.1% past year (2% occassional 1997 NHS)
     2. .7% past month (.9% 1998 NHS) this is also the same as for frequent use,
     3. .1% are past month crack users (.7% 1997--ongoing decline over past couple of years)
  3. Hallucinogen use is "high" too--14.4% report lifetime use, 1.5% past year, and .4% past month
  4. 4% have used other drugs illicitly in the past year. 1% in past month
  5. Figures on heroin too small for accuracy

Lifetime Use 2002-2008 for various illicit drugs.

2007 NHSDUH General Findings: (2008 NSDUH)

Past Month Use of Selected Illicit Drugs among Persons Aged 12 or Older: 2002-2007 (2007 NHSDUH)

Past Month Illicit Drug Use among Persons Aged 12 or Older, by Age: 2007 (2007 NHSDUH)

Past Month Illicit Drug Use among Adults Aged 50 to 59: 2002-2007 (2007 NHSDUH)

Current MTF Data (MTF 2008 Overview)

• 1990 lifetime- 18%, 30 day-4%
• 1992 lifetime- 14%, 30 day- 2.8%
• 1993 lifetime- 15%, 30 day- 3.7%
• 1998 lifetime- 16.4%, 30 day-4.6%
• 2001 lifetime-16.2%, 30 day-5.6%
• 2002 lifetime- 16.8%, 30 day-5.5%
• 2003 lifetime-14.4%,30 day-5.0%
• Current MTF Data

• 1990 lifetime- 9%, 30 day- 2%
• 1992 lifetime- 6.1%, 30 day-1.3%
• 1993 lifetime- 6.1%, 30 day- 1.3% (low point--since 1975)
• 1994/95: 1.2% (Crack used by 0.2% of total population)
• 1998 lifetime- 9.8% (use still down in general population), 30 day- 2.4
• 2001 lifetime-8.2%, 30 day-2.1%
• 2002 lifetime-7.8% , 30 day 2.3%
• 2003 lifetime-7.7% , 30 day-2.1%
• Current MTF Data

• Some try, then stop
• Some use infrequently

• Others: Loyalty

  • Highest in user loyalty: Alcohol and Cigarettes
    1. 60% of those who have ever used ETOH, used in past 30 days
    2. 40% of those who have ever used Nicotine, used in past 30 days
  • Crack was at about 25% of ever used, used past 30 days(1990)-- but this ratio has fallen in recent years.  Today Cocaine: 8% "loyalty rate," and Stimulants: 9%
  • 15% of population who have ever used and 34% of HS Seniors who have tried Marijuana, still using--Marijuana ranks highest in contnuance of all illicit drugs.
  • 2001: 53.9% of HS Seniors have used Marijuana

Drugs most likely to be given up:

1. Heroin
2. LSD/Hallucinogens

Higher rate of "user loyalty" for high school students has to do with their age and the recency of initial use: We tend to see that as a population ages, many "mature out" of their drug use.

Overall Trends

• No surveys pre- 1970
• "Retrospective estimates" indicate Marijuana, Cocaine and Hallucinogens were the most popular drugs.
• 1960 estimate: 6% had ever used marijuana (18-25 year olds)
• Use rose gradually throughout the 1960's
• 1967: 15% had tried marijuana
• 1967-1972: Dramatic increase, by 1972 (1st household survey) 48% had tried marijuana
• Same pattern holds for other drugs (at correspondingly lower levels)
• "Summer of Love"-- 1967/68 largely a localized phenomenon
• Peak of use: 1979-1982(some disagreement here based on sampling differences of surveys and specific drug in question.
• 1980-early 1990's: Steady and dramatic decline for just about all drugs (some exceptions and irregularities)
• Even Alcohol and Nicotine use was down (contrary to belief that their use would increase as illicit use declined)
• At worse use of Alcohol has been stable, but with decline in many age groups
• Illicit use: Way down until 1990/91 (except for stability of "lifetime use")
• Exception: Interesting Stability of LSD Use, also increases
• 1998-2002: RISE IN REPORTED USE, growth in regular, frequent use of cocaine (peaks in 1999), perceived rise in binge drinking among young adults (40-45% of college population)
• 1997-1998:  Stabilizing? Downward trend beginning?  Or, Lull before the storm?
• 1998-2001: Modest increases in many drug categories
• 2001-2002: Slight decreases in most use--especially alchol and tobacco. Even ecstasy use is down slightly from peak in 2001 (9.2% seniors/lifetime). Also, modest increases in stimulant use (cocaine and methamphetamine). Also, slight increases in heroin use--yet these findings could be insignificant year-to-year variations.
• 2002-2006: Stabilization and or significant decrease in use--especially cigarettes.
• 2008: Tobacco use stabilizing

Correlates of Use of Illicit Recreational Drugs
(from Mosher and Akins, Drugs and Drug Policy: The Control of Consciousness Alteration, Sage Publications, 2007, pages 147-169.

Age

• Use increases rapidly during adolescence
  • Independence
  • Lack of responsibility
  • Boredom
• Peaks--18-21
• Same issues for young adults
• Positive functions of limited experimentation
  • Peer bonding
  • Independence
  • Identity experimentation
• Young less likely to experience serious health problems compared to older adult users
• Resurgence of use among older adults
  • Mainly alcohol and prescription drugs
  • Retirement, free-time, and lack of commitments
  • Issue--aging baby-boomers: 65 million

Gender

• Boys experiment early
• Late adolescence--similar rates
• Adulthood--males higher rates
  • Social stigma for female users
  • Women view use as more risky and are less tolerant
  • Societal institutions reinforce norms of gender difference
  • "Traditional female role" and motherhood
• Males use in more problematic ways
• Women more likely to use prescription drugs: more likely to visit physicians

Race/Ethnicity

• Low levels of use among minorities--especially African-Americans. "Asians" lowest levels.
• Issue of under-reporting: drop-outs and school-based surveys, yet differences apparent at 8th grade prior to drop-outs
• Though overall use low in comparison to Whites, problems in minority communities are higher
  • "Two worlds," large population practicing temperance and small, heavy using
  • Hyperavailability: legal and illegal
    • Easy to obtain
    • Visible sales
    • Visible users (drunk and high)
    • Negative and positive effects
      • deterrent
• African-American adolescents and parental influence (vs. peer): another deterrent
• African-American Adults--use rates similar too Whites
  • SES: $25,000 and above--similarities; $7,500: 5 times
  • Educational levels same relationship
  • "Truly Disadvantaged"
    • Inner-city isolation
    • Under-class
    • Lack of supporting institutions
• Hispanics
  • Similar to Whites, but...
  • Diversity
  • Residence: exposure factor--even rural area Rio Arriba County (NM)--highest drug mortality rates
  • Puerto Ricans versus other groups: Acculturation
    • Traditional norms--protect against illegal (even legal, re: Mexico)
• American Indians
  • Again diversity, highest levels of use
  • Extreme social and economic disadvantage
  • Unemployment
  • Limited health care access--self-medication, no rehab
    
• Asian and Pacific Islanders
  • Diversity
  • Model Minority Myth
  • Overall, lowest rates of use
    • Income
    • Education
  • Acculturation factor: Pacific Islanders--most likely to use
  • Others--illiterate and poor (South East Asia)
    • Linguistic (and social) isolation
    • Traditional value system--traditional norms of use

Social Class

• Important, but not "determining
• Lower class NOt more likely to use
• Adults: high levels of education--high levels of use
• Poverty (poor similar to wealthy, BUT "Extreme Poverty" (200% below poverty line)
  • Relevant for minorities versus whites
  • Exposure to numerous sources of disadvantage

Urban/Rural

• Urban: access, exposure.
• Rural: high levels of legal drug use (alcohol and tobacco)
  • Prominent role of family and church
  • Yet, Arriba County and Methamphetamine in midwest
    • Fewer resources
    • Cultural traditions resist seeking help
      

Attitudes toward Drug Use

Three General Areas of Concern

1. Considered Harmful
2. Disapproval of Use
3. Availability
4. Support Criminalization

Between 1979 and 1990 the rate of disapproval on all three of these items DOUBLED for Marijuana and Cocaine, and increased or remained stable for other drugs. Since 1992, disapproval rankings dropped and have leveled off since 2003.

	Disapprove of use (12th)	Support Criminalization
1979	34%	28%
1990	68%	52%
2001	49%	?

Long-term Patterns through 2003

Generally, Throughout the period 1979-1990:

• Opposition towards "Hard" drugs remained strong
• Opposition towards legal drugs remained weak, with a growing awareness of their risks.
• Opposition to Marijuana grew dramatically

As of 1990 most High School Seniors disapproved of illicit drug use, view it as harmful and feel the use of such substances should be criminalized.

BUT, most still felt that experimentation is OK and relatively safe

1991-1996: Strong reversal taking place

Generational Forgetting??

• No experience
• No subculture to inform
• Problems of use vague: not only are the use of drugs such as marijuana increasing; but LSD, Inhalants, and heroin use are remaining stable, perhaps even increasing (sampling problems)

1996 Analysis: Link to Control/Social Bonding Theory

• "Drug Use in Young Adulthood"

The Next Millenium??

DAWN Reports

• Drug Abuse Warning Network
• Charting medical problems associated with drugs
• Emergency room episodes (ER) (drug-related reactions, including OD's) (As reported by PATIENT)
• Medical Examiner Reports (ME) (If drugs are thought by examiner to have been a factor in the patients death)
• Alcohol only included when in combination with other, illegal drugs for adults 21 years of age and older.
• Pre 1990, survey of 27 metro areas, now complex nation wide sample
• Influences and distortions:

1. changing purity: # of users constant, but OD's increase
2. variations in availability: dosage and frequency of use
3. drug mixing and adulterants (is all that matters known to or reported by patient?)
4. Route of administration
5. no reporting of Chronic complications, only Acute
6. one person, multiple admissions
7. problem of drugs as an indirect cause of death- not included
8. Some drugs show up, esp. In suicides, not because the are dangerous or unsafe, but because they are available
9. Aging user population: older, chronic users, tend to die more, have more problems (the Graying of the Flower Children)
10. Illegality and unstandardized doses: more problems

Laboratory Analysis of DAWN Reports:

1. Only 20% of cases were the drugs reported actually ingested
2. 10% significant differences
3. 70% incomplete listing
4. Lots of multiple drug use

Abuse potential==> Number of problems/number of total users. Dawn is risky, but drugs that show up frequently and consistently==> probably a problem.

SO:

1. Cocaine is a big problem: 20-25% ER; 40% ME (slight drop in '89-'90, but holding as 1 of top 2 illegal drugs now)
2. 1995 27% of all admissions were related to cocaine (little change in 1996 report)
3. Heroin/narcotics: continuing to increase. 1 of 6 ER; 60% ME. This is significant since less than 1% of population has ever used vs. 10% for cocaine.
4. 1993: Highest level ever for Heroin. Upswing continuing
5. 1990-1995: Mentions for Heroin doubled
6. 1994-1995: Admissions for Heroin up 19%
7. Alcohol, although only reported with other drugs: 30% ER; 33% ME. Signs of a drop in 1990, but for 1995 still frequently mentioned.
8. Decline that Goode notes for 1989-1990 (12% drop in ER, 20% drop in ME) appears to have been non-significant.
9. 1991-2001 continual yearly increases.
10. DEA Statistics on ER admissions, http://www.usdoj.gov/dea/statistics.html#cocaine

• Perhaps drug marketing wars-- purity levels of heroin going up.
• Perhaps aging cocaine population: frequent, heavy users experiencing more problems.
• Trend of increased use

1. Cigarettes: Use has been down, but trend flattened in early 90's and rose through the latter 1990s, now very siginificant declines from peak in 1999.
2. General use of Alcohol fluctuated throughout the 1990s, and daily use and "Binge" drinking (5 or more drinks in a row within the past two weeks) increased (40% of college age youth). However, this trend appears to have plateaued, too. Significant declines (2001-2002) for high school students.
3. LSD use has been relatively stable. Recent (1995) surveys showing significant increases at younger age levels. Annual and lifetime prevalence was up, but now appears to be declining, too. Surge in MDMA use seems to have peaked and shows decline (2003).
4. Heroin use, although difficult to chart, is apparently on the upswing (increasing purity and availability). Also, frequent, regular use of cocaine appears to stabilized- perhaps increasing at younger age levels
5. Marijuana use increased rather dramatically among the younger age levels (49% HS Seniors report lifetime use, 37% past year, 22.4% past month, 5.8% daily), now stablizing in 2002-2007?

URL: http://www.umsl.edu/~keelr/180/trends.html
Owner: Robert O. Keel rok@umsl.edu
References and Credits for this Page of Notes
Last Updated: Thursday, February 25, 2010 2:28 PM