Drugs and Society: Legal Drugs

CJ Trowbridge

Drugs and Society

2020-06-09

Section 3 Reading Response

• treat drug users as you would want to be treated
  • We are all drug users. Coffee, alcohol, cigarettes, weed, Viagra, ecstasy, antidepressants, anti-anxiety pills and more: people are using these drugs on a weekly or even daily basis.
    • Coffee helps me start my day and gives me a little boost in the afternoon. While I know how harmful my cigarette habit is, it also gives me pleasure.
  • It’s clear to me that some of my drug use is because of stress and an attempt to push down some anxiety and difficult feelings. Life can be hard.
  • While most people use drugs, not everyone has the same relationship with these different drugs and some of us have different experiences with drugs depending on the night or what is going on in our life at that time.
  • While it is counterintuitive, it is worth pointing out that the overwhelming majority of people who use drugs don’t become addicted.
    • Carl Hart, a neuroscientist and professor at Columbia University has done groundbreaking work around drug use and addiction and notes that, “80 to 90 percent of people who use illegal drugs are not addicts. They don’t have a drug problem. Most are responsible members of our society. They are employed. They pay their taxes. They take care of their families. And in some cases they even become president of the United States.”
  • While drug use and abuse don’t discriminate, our drug policies do. The war on drugs is a vicious war on people and African Americans and people of color feel the brunt of this war. Despite similar rates of use and sales, African Americans go to prison at 13 times the rates of whites for drugs.
  • So if we can agree that the majority of people in society are using drugs, and if most people who use drugs don’t have a problem, what should be done about it?
    • 1) Offer treatment and compassion to people who want help for their drug problems;
    • 2) leave people alone who don’t want or need treatment;
      • the vast majority of people who use drugs don’t have problems from their use.
    • 3) continue to hold people responsible for crimes that harm others;
    • 4) fight like hell to end the war on drugs and stop locking up our brothers and sisters.
  • Deadly Persuasion
    • Alcohol and nicotine are by far the most widely used drugs, and they do by far the most damage.
    • These are also some of our most heavily advertised products
    • Nicotine kills more people than all other drugs plus car deaths, homicides, suicides, and aids combined.
    • Over $9b/year spent on cigarette advertising in the us
    • $3b/year spent on alcohol advertising in the us
    • Advertising for smoking and drinking are a public health issue.
  • Tobacco Education and Media
    • The video argues that kids take queues from celebrities on how to behave
      • These celebrities are often used as advertising tools for cigarettes and alcohol.
    • Kids say they are not affected by media
    • The fact that kids can recognize logos and brands is seen as evidence that they will start smoking and drinking if actors smoke and drink.
    • Literacy education should include critical thinking and skepticism of advertising
  • Ban on former legal highs has driven trade underground
    • The government’s blanket ban on novel psychoactive substances, formerly legal highs, has succeeded in shutting down high street trade in the substances but has led to products such as Spice being added to the regular menu of illicit street dealers, according to an authoritative report.
    • Gangs from inner-city drug hubs in London, Liverpool and Birmingham are moving into more rural areas and using higher-quality drugs to take over local dealing networks.
    • One police officer told researchers that 14 out of the 24 shops in his area had closed in the week before the law came into force, before the police had a chance to deliver a warning letter. The north-east area ambulance service reported a significant reduction in NPS-related callouts after May. However, the report says that as a result of the ban, Spice and other NPSs have become just another street drug being sold by illicit dealers.
  • how big tobacco got a new generation hooked
    • While teenage cigarette smoking rates have recently fallen below 5 percent, America is now contending with an epidemic of young people using e-cigs, vapes and other nicotine delivery devices,” as the tobacco industry christened them years ago in secret memos, searching for an official alternative to describing their products as cigarettes.
    • If Juul were serious about marketing to adults, it could use pinpointed digital marketing to make sure that those seeing its ads are over 21. Stanford researchers found the company’s launch marketing “was patently youth-oriented.”
    • Traditional tobacco products have strict regulations. But since Juul is a nicotine delivery device with no tobacco leaf, it is largely free to market as aggressively as possible. You won’t hear cigarette ads on the radio. You could hear from Juul. You can’t see cigarette ads on your televison. But you might see one for Juul, or any of the others.
  • The World Pushes Back Against E Cigs and Juul
    • “in five years, 50 percent of Juul’s revenue will be international “ -CEO
    • The company has been met with ferocious anti-vaping sentiment and a barrage of newly enacted e-cigarette restrictions, or outright bans, in country after country. As a result, its ambitious overseas plans have collapsed.
      • The company has been met with ferocious anti-vaping sentiment and a barrage of newly enacted e-cigarette restrictions, or outright bans, in country after country. As a result, its ambitious overseas plans have collapsed.
      • Juul was kicked off the market in China last fall after just four days. The company has had to abandon plans for India after the government there banned all electronic cigarettes. Thailand, Singapore, Cambodia and Laos have also closed the door to ecigarettes. In the Philippines, President Rodrigo Duterte ordered the arrest of anyone caught vaping outside designated smoking areas.
      • Juul has postponed its launch in the Netherlands and has pulled out of Israel. In South Korea, the number of Juul customers has plummeted after the government issued dire health warnings about e-cigarettes, and the company has scaled back its distribution there.
      • “It has been an extraordinarily quick backlash,” said Kathleen Hoke, director of the Network for Public Health Law at the University of Maryland. “Countries that you wouldn’t necessarily describe as progressive public health nations are attacking this new product so that it doesn’t become embedded in their culture as cigarettes have.”
    • Public health officials abroad fear the same youth vaping epidemic that has been declared in the United States. Although Juul stopped selling its fruit- and dessert-flavored nicotine pods in the United States ahead of the national ban, it has not done so overseas, where it is offering glacier mint, mango nectar, royal crème, alpine berry, and until recently, apple orchard.
    • South Korean health officials, prompted by the outbreak of lung ailments in the U.S., issued a stark warning about e-liquids, saying they posed the risk of “serious lung damage and even death.” A month later, the South Korean Army banned e-liquids on all military installations. In December, South Korean health authorities announced the results of testing on a number of vaping products, including the apple orchard flavor formerly made by Juul, and said that in some products they had detected trace amounts of vitamin E acetate, the adulterant U.S. health authorities have linked to most of the lung injury cases.
    • “Juul has been very aggressive in India, and they hired well-known lobbyists,” said Ms. Shah. The end came swiftly. In November, around the time Juul had planned to launch, Prime Minister Narendra Modi signed a law banning the manufacture and sale of any e-cigarettes.
    • Philippine president Duterte banned most e-cigarette products including potential arrest for using them.
    • While Juul often labels itself as a harm reduction product, the fact that they deliberately market dessert flavors to children disproves any claim that they are good people trying to improve conditions for smokers.
  • The opioid crisis changed how doctors think about pain
    • WILLIAMSON, West Virginia — This town on the eastern border of Kentucky has 3,150 residents, one hotel, one gas station, one fire station — and about 50 opiate overdoses each month.
    • On the first weekend of each month, when public benefits like disability get paid out, the local fire chief estimates the city sees about half a million dollars in drug sales.
    • “Elderly folks who depend on blood pressure medications, who can’t afford them, they’re selling their [painkillers] to get money to buy their blood pressure drug
    • The underlying drugs are often being prescribed for real reasons.
    • where drug companies pushed too-good-to-be-true statistics that promised opioids to be safe and effective, when they were in fact addictive and deadly.
    • Pharmaceutical companies sent 780 million opioid pills to West Virginia — a state with fewer than 2 million residents — over six years
    • In the 1990s, a new movement swept through professional medicine that urged providers to not just reduce pain but cure it entirely.
      • pain scales with smiley faces and scowls suddenly appeared in doctors’ offices
      • big hospital systems, including the Veterans Health Administration, dubbed pain the “fifth vital sign,” just as important as blood pressure and temperature
      • opioid painkillers, meanwhile, had just begun to roll onto the market. They promised the pain relief that doctors now believed they needed to deliver
      • “There was a push that we had to get pain to zero,”
    • The ensuing opioid addiction crisis has now forced doctors to rethink some very fundamental pillars of how they practice medicine: How much can they do to treat pain? Were they right to consider it a vital sign? How much should they do? Is it more ethical to ask patients to live with pain when they know relieving pain can have horrific side effects?
    • Doctor groups have recently begun pushing for a new practice of medicine that deemphasizes the role of pain. Accordingly, the federal government announced in 2016 that it would not pay out financial rewards to the hospitals that have the biggest reductions in patients’ pain.
    • “Most of us went into medicine to alleviate suffering,” says Andrew Gurman, president of the American Medical Association. “One of the expectations our patients have is that pain can be completely eliminated. We as a medical community are coming to an understanding that this is not realistic.”
    • In November 1998, the Veterans Health Administration sent a memo to its 1,200 clinics requiring clinicians to ask patients’ about their pain level at each visit. The initiative was called “Pain as the 5th Vital Sign.” A pain score above 4 was meant to trigger “a comprehensive pain assessment and prompt intervention.”
    • “I could hear my nurses taking the history of patients, taking the vital signs, and then asking, ‘Do you have any pain today?’” Young says. “It’s not what the patient is there for, but then it’s like, well, now that you mention it, my left toe has been hurting me. It felt like patients got more demanding that they get medication.”
      • “People thought their pain should be a zero,” he says of his patients. “If you injure yourself or have a chronic injury, your pain is never going to be zero. But there was this expectation of getting there, and the goal of acquiring the smile face instead of the scowl.”
    • over time, patients develop a tolerance to opioids and require higher and higher doses to achieve pain relief
    • articles have found that long-term opioid users do no better at regaining quality of life than those who don’t use the prescriptions
    • “The intensity level of pain is not a good outcome to measure,” Ballantyne says. “If you focus just on pain intensity, the tendency is just to use opioids, because opioids are the only thing that will reduce pain so immediately.”
    • “We have felt trapped now, for years, between patients wanting their pain adequately treated and the safety of the products we have available for treating their pain,”
    • “The goal of pain relief should be 30% to 55% improvement, and therefore the patient should be expecting tolerable pain levels, not 0 pain levels,” Harvard surgeon Haytham Kaafarani and his co-authors argued.
    • “Assessing and understanding the impact of pain doesn’t mean we write a prescription for an opioid,”
    • “The problem of persistent pain is widespread,” said Kevin Vowles, a health psychologist at the University of New Mexico. “The evidence base for interventions like surgery or medications has never been super strong for getting people back to participating more fully in life.”
  • alcohol and harm reduction
    • In the late nineteenth and early twentieth centuries, a commitment to alcohol prohibition became the leading force in alcohol temperance movements in the USA, Britain and its English-speaking colonies and dominions, and in most of the Nordic countries. In the context of the First World War, these movements succeeded in their goals in the USA, Canada, Finland and Russia, and came close to success in Norway, Sweden, Iceland and New Zealand. In all of these countries, alcohol prohibition proved to be controversial, however, and was sooner or later abandoned.
    • In the language of the time, this alternative was known as ‘liquor control’. In current language, we might think of it as a harm-reduction movement. That is, it started from an acceptance of the use of alcohol, but sought to structure and influence the use so as to limit the social and health harm from drinking
    • Most alcohol prohibitionists, therefore, had an abiding dislike for the liquor control alternative, and were willing to see things get worse, from their perspective, rather than accept its solutions.
    • reducing ‘public nuisance’ has often been a source of political support for harm-reduction programmes, factored into such specifics as the location of programmes.
    • The alternative framing is to define harm reduction in terms of the goal—a goal of reduction of harm from alcohol or drug use, as opposed to a goal of elimination or prevention of the use. In this framing, a wide variety of strategies can be counted as harm reduction, including even the prevention of use.
    • The aims of liquor control
      • Focus on the harms
      • Pragmatism in policy
      • Liquor control and the inveterate drinker
    • One striking commonality between the modern drug harm-reduction movement and the liquor control approach of the early twentieth century is the positioning of both as the alternative to and antagonist of prohibitory approaches. In both cases, the political weight tended to lie with the prohibitory approach (at least through the early 1920s in the case of liquor control), while both drug harm reduction and liquor control commanded strong intellectual resources as well as practitioners with much practical experience.
  • toxic and untaxed
    • half of all alcoholic drinks consumed in countries across Africa and Latin America are illicit
      • Methanol, mortuary formaldehyde and battery acid were among a cocktail of toxic ingredients found in unregulated drinks
    • In Kenya, one of the most common varieties of home-produced alcohol is called “chang’aa”, or “kill me quick” . The spirit is widely available in poor townships and is often made with contaminated water and potentially lethal methanol. One variant, “jet-five”, is spiked with jet fuel, while another contains embalming fluid.
    • The production of illegal alcohol, which is cheaper and often more readily available than regulated alcohol, is largely driven by poverty, the report found
    • In five of the seven African countries examined – Uganda, Tanzania, Cameroon, Malawi and Mozambique – at least 61% of the alcohol consumed is illicit. Unrecorded alcohol is also widespread across Asia and in parts of Europe, the report said, but comparable data was not available. In Russia, bootleg accounts for 38% of all alcohol consumed.
  • Reducing Harm from Youth Drinking
    • Alcohol is the psychoactive substance used the most often by adolescents and college students and is associated with more youthful dysfunction and morbidity than any other drug.
    • The thrust in the public health field has been towards labeling alcohol an addictive drug and towards reducing and even eliminating youthful drinking.
    • Differences in drinking have frequently been noted among religious groups in the U.S. and elsewhere, including among youth and college students. Drinking by Jews has been one special object of attention due to their apparently low level of drinking problems. Weiss indicated that, although drinking problems in Israel have increased in recent decades, absolute rates of problem drinking and alcoholism in Israel remain low compared with Western and Eastern European countries, North America, and Australia.
    • The nonproscriptive approach to alcohol characterizes not only Jewish drinking. Some American Protestant sects are highly proscriptive towards alcohol (e.g., Baptists); others (e.g., Unitarians) not at all. Kutter and McDermott studied drinking by adolescents of various Protestant affiliations. More proscriptive denominations were more likely to produce abstinent youth, but at the same time to produce youth who binged, and who binged frequently. That is, while 90 percent of youth in nonproscriptive sects had consumed alcohol, only 7 percent overall (or 8% of drinkers) had binged 5 or more times in their lives, compared with 66 percent of those in proscriptive sects who had ever consumed alcohol, while 22 percent overall in these sects (33% of drinkers) had binged 5 or more times.
    • These European data show regular drinking is inversely related to binge drinking. Countries in which people are unlikely to drink daily (Ireland, UK, Sweden, and Finland) have high binge drinking rates, while countries with higher rates of daily drinking (e.g., France, Italy) have lower levels of binge drinking.
    • At this point, it is obviously easier to point to failures in alcohol education and prevention programs for youths than to identify successes.