medical use, instrumental use of other legal drugs: Nicotine==> Stay
awake while studying.
OTC (Over-The Counter)
billion in sales for all, $11.6 billion psychoactive, for 2012
($15 billion total sales in 1995)
strongly psychoactive (in USA)
used for high (last resort, Look Alikes)
Safe: Acetaminophen 20,543 non-lethal ER and 150 deaths (2011) vs.
Millions of doses
(established in 1938)
only to doctors until 1997 when congress approved direct to consumer
FDA and Congress cutting back on drug advertising
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)
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,
Status set by Pharmaceutical Industry until 1951.
for medical purposes
by licensed Physician (300,000)
by licensed Pharmacy (150,000 pharmacists; 60,000 pharmacies)
$145,092,763,000 per year in sales
(2000); $124,835,595,000 (1999)
(Pharmacy Times) (around $95 Billion in 1997)
New Prescriptions in 2000.
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
in 7 are psychoactive
on Psychotherapeutic Drugs Soars
billion in 2010 (local
- Therapeutic Drug Use (CDC)
and Distribution of Prescription Drugs
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.
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
200 Drugs by sales (historical data)
Testing, and Marketing a new drug
1960's==> #1: $250 million/year
was its best year==> 61.3 million prescriptions
only 33.6, yet still best seller
expired 1980, falls to #3, then #4 in 1983
three companies market generic diazepam
Valium is #11; 1990 #47
sales of generic versions of diazepam no longer in top 200 in sales but 109 by prescriptions dispensed, and
even Alprazolam (Xanax) appears to be slipping.
1990 sales of all generics account for one-third of the market
We're talking BIG BUCKS here!
role of advertising in the health industry has been critiqued by a
number of commentators
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)
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).
from the early 1970's through the mid 1980's, prescriptions for:
dropped by 90%
dropped by 60%
(which skyrocketed from 1976-1986) fell to NO
What's Going on
(Oakley Ray, Erich
Goode, and Keel)
Polio, Smallpox==> Medicines as powerful and beneficial
(1940's)==> Faith in drugs as cures
Acceptance of drug's impact on the mind
Contraceptives==> Use drugs on healthy body in order to
in the use of psychoactive drugs, overall, by a factor of 50%==>
"We can get along without them." (Goode)
notable exception to overall trend in Psycho-Pharmaceuticals during
the 1980s: Prozac. (And, perhaps, the herald of a "new age")
the market in 1987
takes #1 spot: 1 million prescriptions/month
prescribing up X3
up another 60%
Horror Stories, but major legal struggle by Eli Lilly to defend
the drug. Current status: warnings but no official action.
(2012) no longer on top 200 list (beat by both Cymbalta and Lexapro) and
SSRIs rank 23rd for number of prescriptions written, and 5th for
over the last two decades: Ambien, Lunestra, Strattera, Viagra....SO:
This (#5) appears
to have been a short-lived revolution. Now maybe beginning of #6- "Better
Living Through Chemistry: Part 2"
only one antidepressant (Zoloft) made it to the top 10 of total prescriptions,
on the money side, manufacturers of such medications had nothing to be
depressed about. Two of the top grossing drugs in 2000 were antidepressants—Lilly’s
Prozac and Pfizer’s Zoloft. Also among the top 10 earners was the antipsychotic
drug Zyprexa. And coming in at number eleven was the antianxiety agent,
Paxil. The SSRI category ranked third in the top 20 categories ranked
by total prescriptions dispensed, third in new prescriptions dispensed,
and second in total dollar sales. Dollar sales for the SSRI/SNRI category
rose 19% from 1999 to reach a huge $8.33 billion."
(Pharmacy Times, 2001)
These revolutions are significantly related to illicit use, too.)
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.
If a drug is psychoactive, it rarely remains purely instrumental
Cocaine all original used medically, even OTC
Glaucoma, AIDS, Chemotherapy
stopped marijuana use for medical purposes: 1985 (Marinol), supported
by DEA in 1992
view==> if we allow these drugs to be used legitimately, there
would be more abuse
often hesitate to use even strong doses of morphine to relieve the
pain of terminally ill cancer patients: "Problem of addiction"
- Cited immune
- AIDS patient:
"Decision made by a bunch of Bozos"
Legal for medicinal use in 21
states and the District of Columbia 10/2013.
Federal: illegal--Schedule I.
Definition of legal/illegal; instrumental/recreational SHIFTS (Relativity)
billion in sales to children
million in Federal taxes
of Smoking and Health Budget: $3.5 million
cultivated as lifelong/permanent market
Now Federal Government is debating defining nicotine as addictive
and is seeking to regulate advertising,
promotions, and sales.
Update on tobacco sales to youth
identical to illegal recreational, but close
is not an either/or proposition, but a continuum
- Cigarette smoking and health events, Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, CDC. "Achievements in Public Health, 1900-1999: Tobacco Use -- United States, 1900-1999." 1999.
Smoking: Stable. 1995=>1999 significant increases for Teenagers. 2002-2012,
overall decline led by decline in teen use.
12 and up
tobacco (past month)
Month Tobacco Use among Persons Aged 12 or Older: 2002-2012 (Latest
Past Month Tobacco
Use among Youths Aged 12 to 17: 2002-2012 (Latest
- Smokers 4 times more likely to be heavy users
of ETOH and illicit drugs
of use of alcohol and nicotine (except among the young) is
declining, except for Caffeine (most popular)
alone is used by more people than all illicit drugs combined
is used most frequently by those who use drug
MTF Data (MTF: Cigarettes: Trends in 30-Day Use, Risk, Disapproval, and Availability in Grades 8, 10, and 12
National Survey on Drug Use & Health
Alcohol Industry Statistics
12 and up
ETOH past month
Drinkers (binge 5x/month)
Binge, and Heavy Alcohol Use among Persons Aged 12 or Older, by Age:
of Use of Legal Drugs
(from Mosher and Akins, Drugs and Drug Policy:
The Control of Consciousness Alteration, Sage Publications, 2007,
highest during late adolescence
peaks: 21 (also binge and heavy use)
used for ASC (not simple sociability)
increase in recent years
Adderall, DXM, prescription pain pills
of "difference" from illegal drugs, "safer,"
high levels of prescription use--including to adolescents
17% of those over 60 "addicted" to alcohol and prescription
times more likely to be prescribed drugs
to: confusion, falls, toxicity
use difficult to chart, yet rates of problem use appear high.
to adolescents, and stressors associated with aging.
(and problematic use) more likely among males
varies by drug and age
drinking versus binge/heavy drinking--true for adults, too
and "fat-burners" (females)
use patterns, especially recently
likely to use/over-use prescription medication (gender norms--women/mothers
not "on the streets")
more likely to seek treatment, especially for mood disorders
to illegal drugs--misperception of overuse by minorities
Whites and Native Americans--high levels of use throughout the life-course
adults higher rates, NA adolescents higher.
adults high levels of binge/heavy drinking, but also abstinence
far higher among Native American youth (almost twice), also high for
adults (nearly 50%)
and Between Group Patterns
to whites. As age increases, problematic drinking for African-Americans
levels of abstinence, yet consequences of drinking more severe--issues:
access to health care
and concentrated poverty
outlets and advertising
parental vigilance over youth and negative attitudes towards drinking
levels of use throughout the life-course
exposure (similar to blacks)--leads to higher rates of problems
factors (compared to blacks)
males binge/heavy drinking rates high
rates of problems
Drinking" (high rates of abstaining, yet high binging)
most recent groups (South Americans, Cubans)--more likely to drink
norms discourage heavy use, but "machismo" may encourage
binge drinking, i.e. drink less frequently, but when drinking
they consume a lot.
highest patterns of legal drug use
(destruction of traditional culture--issue of drunken comportment)
and Pacific Islanders
levels of use
Islanders and Native Hawaiians: similar to american Indians
immigrants--heavy use. Increased availability? Also, high rates
of tobacco use
of use of many legal drugs highest in middle to upper class
differences (SES little impact on whites, minorities more adverse
effects due to poverty)
use higher in lower/working class youth
pharmaceuticals--varies by type
use and education--varies by age--high among young student, lower
among older graduates (employment?)
on college campuses
availability of resources to mediate effects of consumption (compare
to poor neighborhoods, consequences limited for college youth)
results in lower educational attainment
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
cities and rural areas--higher rates of binge drinking, heavy alcohol
use, tobacco use, inhalants,and illicit pharmaceutical use
and recreational opportunities
legal/illegal drug use patterns are similar across other correlates,
urban rural correlate displays dissimilarity
interest in illegal drugs (no "critical mass")
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
self-image==> NOT "drug" user; Don't seek "High,"
"technically illegal- but not criminal or deviant"
similar to OTC use
Opinion: Goal is OK, means--problematic, but not "as" deviant
as illegal recreational
of legally manufactured pharmaceuticals
of and often focal point of subculture
to roles and status and expectations from dominant culture
Bucks here: U.S.- consume 60% of world's output
spend more on illicit drugs than any other product or service ($1/2
sales (DEA est.) $80 billion in 1980; $30-130 billion is the typical
News and World Report-- $100 billion
are difficult, no records kept of the sales
Use in Europe: The
European Monitoring Centre for Drugs and Drug Addiction
Drug Report Archive
UN Reports Drug Use on the Rise Worldwide
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.
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
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.
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%)."
supported Institute for Social Research, "Monitoring the Future
survey of High School Students and Young Adults (since 1975)
supported "National Survey on Drug Use & Health "
(NSDUH) (Formerly called the National Household Survey) (since early
Report (since mid 1970's) (see below)
Drug Abuse Monitoring Program. Now, ADAM II since 2007 (2010 Report)
copy) St. Louis 2004 (local
2002 Report (local
copy) seems to have lost funding. 2004 was last year available)
listing of federal data sources
Lifetime, Annual, 30 day, Daily (20/30)
on trends: How extensive, Use increasing or decreasing
National Survey on Drug Use & Health
1990: 12-17, 18-25, over 26 years of age
26-34, and over 35 years of age
figures of daily use
military, prisons, or homeless
and Nicotine extensively used-- Legal, Available, long cultural history
48% (over 100 million people) have tried illicit drugs
used past year (12.6% 2001 NHS)
past month (7.1% 2001)
are "frequent users (51 or more days over past year)
two-thirds of illicit use is Marijuana (used by 79% of past month
illicit users, 62.8% only use marijuana): 42.8% lifetime use, 12.1%
past year, 7.3% past month.
Press Release: teen use down (for third year, baby-boomer use
Hallucinogens, and non-medical use of pain relievers "tie"
for the #2 spot in lifetime use.
14.5%, Hallucinogens: 14.6% and pain relievers: 14.2% lifetime
(cocaine up compared to 2007, pain relievers up over 1% from 2010)
past year (2% occassional 1997 NHS)
- .5% past
month (.9% 1998 NHS) this is also the same as for frequent
- .2% are
past month crack users (.7% 1997)
use is "high" too--14.6% report lifetime use, 1.7% past
year, and .4% past month
- 3.6% have used
other psychotherapeutic drugs illicitly in the past year. 1.3% in past month
- Methamphetamie: 4.7% lifetime, .4% past year, .2% past month
- Figures on
heroin too small for accuracy
Use 2002-2012 for various illicit drugs.
2012 NHSDUH General
Month Use of Selected Illicit Drugs among Persons Aged 12 or Older:
Month Illicit Drug Use among Persons Aged 12 or Older, by Age: 2011-2012
Past Month Illicit Drug Use among Persons Aged 12 or Older, by Age: 2002-2012 (Latest
Month Illicit Drug Use among Adults Aged 50 to 59: 2002-2012 (Latest
Past Month Nonmedical Use of Types of Psychotherapeutic Drugs among Persons Aged 12 or Older: 2002-2012 (Latest
Past Month and Past Year Heroin Use among Persons Aged 12 or Older: 2002-2012 (Latest
Seniors (3/4 of users of illicit drugs)
MTF Data (MTF
(8th-12th) #3 (down from #2 in 2009)
Cough Syrup, and Oxycotin--#4-#6 (2012)
Cocaine (all forms) (8th-12th)
other Illicit drugs, Marijuana Use is in a class by itself!
And, Alcohol, of course:
try, then stop
- Highest in
user loyalty: Alcohol and Cigarettes
- 63% of
those who have ever used ETOH, used in past 30 days
- 40% of
those who have ever used Nicotine, used in past 30 days
was at about 25% of ever used, used past 30 days(1990), in 2012 it's at 6%-- but this
ratio has fallen in recent years. Today Cocaine: 4% "loyalty
rate," and Stimulants: 9%
of population who have ever used and 50% of HS Seniors who have
tried Marijuana, still using--Marijuana ranks highest in contnuance
of all illicit drugs.
most likely to be given up:
- LSD/Hallucinogens (2.7% loyalty rate)
- Cocaine (4% loyalty rate)
- Methamphetamine (4% loyalty rate)
(5% loyalty rate)
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.
surveys pre- 1970
estimates" indicate Marijuana, Cocaine and Hallucinogens were
the most popular drugs.
estimate: 6% had ever used marijuana (18-25 year olds)
rose gradually throughout the 1960's
15% had tried marijuana
Dramatic increase, by 1972 (1st household survey) 48% had tried
pattern holds for other drugs (at correspondingly lower levels)
of Love"-- 1967/68 largely a localized phenomenon
of use: 1979-1982(some disagreement here based on sampling
differences of surveys and specific drug in question.
1990's: Steady and dramatic decline for just about all drugs (some
exceptions and irregularities)
Alcohol and Nicotine use was down (contrary to belief that their
use would increase as illicit use declined)
worse use of Alcohol has been stable, but with decline in many age
use: Way down until 1990/91 (except for stability of "lifetime
Interesting Stability of LSD Use, also increases
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)
Stabilizing? Downward trend beginning? Or, Lull before the
Modest increases in many drug categories
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.
Stabilization and or significant decrease in use--especially cigarettes.
Tobacco use stabilizing
Illicit use up, concern over prescription pain relievers, tobacco
- 2012: Tobacco use down, especially among the young. 2011-2012 declines in illicit use, especially among the young (Latest
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.
increases rapidly during adolescence
issues for young adults
functions of limited experimentation
less likely to experience serious health problems compared to older
of use among older adults
alcohol and prescription drugs
free-time, and lack of commitments
baby-boomers: 65 million
stigma for female users
view use as more risky and are less tolerant
institutions reinforce norms of gender difference
female role" and motherhood
use in more problematic ways
more likely to use prescription drugs: more likely to visit physicians
Past Month Illicit Drug Use among Persons Aged 12 or Older, by Race/Ethnicity: 2002-2012 (Latest
levels of use among minorities. "Asians"
of under-reporting: drop-outs and school-based surveys, yet differences
apparent at 8th grade prior to drop-outs
overall use low in comparison to Whites, problems in minority communities
worlds," large population practicing temperance and small,
legal and illegal
users (drunk and high)
and positive effects
adolescents and parental influence (vs. peer): another deterrent
Adults--use rates similar too Whites
$25,000 and above--similarities; $7,500: 5 times
levels same relationship
of supporting institutions
to Whites, but...
exposure factor--even rural area Rio Arriba County (NM)--highest
drug mortality rates
Ricans versus other groups: Acculturation
norms--protect against illegal (even legal, re: Mexico)
diversity, highest levels of use
social and economic disadvantage
health care access--self-medication, no rehab
and Pacific Islanders
lowest rates of use
factor: Pacific Islanders--most likely to use
and poor (South East Asia)
(and social) isolation
value system--traditional norms of use
but not "determining
class NOT more likely to use
high levels of education--high levels of use
(poor similar to wealthy, BUT "Extreme Poverty" (200% below
for minorities versus whites
to numerous sources of disadvantage
high levels of legal drug use (alcohol and tobacco)
role of family and church
Arriba County and Methamphetamine in midwest
traditions resist seeking help
Areas of Concern
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 then rose slightly for cannabis, leveled off 2005-2008 and have dropped since 2009. Disapproval of cocaine use has been rather stable throughout the past decade.
Patterns through 2012
the period 1979-1990:
towards "Hard" drugs remained strong
towards legal drugs remained weak, with a growing awareness of their
to Marijuana grew dramatically
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.
most still felt that experimentation is OK and relatively safe
Strong reversal taking place
Generational Forgetting (1991-1996)?
subculture to inform
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)
Analysis: Link to Control/Social Bonding Theory
This Millenium--Ups and downs--overall consistency in use.
Abuse Warning Network
medical problems associated with drugs
room episodes (ER) (drug-related reactions, including OD's) (As
reported by PATIENT)
Examiner Reports (ME) (If drugs are thought by examiner to have
been a factor in the patients death)
only included when in combination with other, illegal drugs for
adults 21 years of age and older.
1990, survey of 27 metro areas, now complex nation wide sample
- changing purity:
# of users constant, but OD's increase
in availability: dosage and frequency of use
- drug mixing
and adulterants (is all that matters known to or reported by patient?)
- Route of administration
- no reporting
of Chronic complications, only Acute
- one person,
- problem of
drugs as an indirect cause of death- not included
- Some drugs
show up, esp. In suicides, not because the are dangerous or unsafe,
but because they are available
- Aging user
population: older, chronic users, tend to die more, have more problems
(the Graying of the Flower Children)
and unstandardized doses: more problems
Analysis of DAWN Reports:
20% of cases were the drugs reported actually ingested
of multiple drug use
potential==> Number of problems/number of total users. Dawn is
risky, but drugs that show up frequently and consistently==> probably
Rates of ED visits per 100,000 population involving illicit drugs, 2011
is a big problem: 40% ER; 40% ME (slight drop in '89-'90, but
holding as 1 of top 2 illegal drugs now)
27% of all admissions were related to cocaine (little change in
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.
Highest level ever for Heroin. Upswing continuing
Mentions for Heroin doubled
Admissions for Heroin up 19%
although only reported with other drugs: 30% ER; 33% ME. Signs of
a drop in 1990, but for 1995 still frequently mentioned.
that Goode notes for 1989-1990 (12% drop in ER, 20% drop in ME)
appears to have been non-significant.
continual yearly increases.
drug marketing wars-- purity levels of heroin going up.
aging cocaine population: frequent, heavy users experiencing more
of increased use
Trends and Patterns
Use has been down, but trend flattened in early 90's and rose through
the latter 1990s, now declines from peak in 1999.
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.
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).
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
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), stablizing in 2002-2007, but trending upward 2008-2012.
Owner: Robert O. Keel firstname.lastname@example.org
and Credits for this Page of Notes
Friday, October 4, 2013 1:52 PM