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THE USE AND ABUSE OF DRUGS
A HANDBOOK FOR HEALTH EDUCATORS
The Board of Health Committee on Drug Dependency and Drug Abuse recommended
in its First Report "that a comprehensive education programme on the proper and improper use of drugs be instituted".
The Handbook has been prepared to assist all community educators in presenting factual information to the population at risk. It is not intended that this Handbook be used
in isolation and it will be necessary to refer to other resource material.
The Department of Health acknowledges with appreciation the assistance and cooperation of the Division of Health Education, Department of Public Health, New South
Wales, and the advice and suggestions of the Board of Health Committee on Drug Dependency and Drug Abuse, New Zealand.
CONTENTS
Page
Drugs - their origins and use
The problem of drug abuse 10
Type of drugs - use and misuse
18
Signs and symptoms of drug abuse 29
Control of drugs and treatment of drug abuse 34
Drug abuse slang
42
Tabulated drug information chart 46
DRUGS - THEIR ORIGINS AND USE
1. An introduction to drug education
It is the nature of Man to be curious, to explore new ideas and territories in the world
around him. How and why he behaves as he does is the particular concern of sociological
and psychological studies. However, actions that may result in damage to the body
through careless behaviour or misinformation are of concern to all as others are often involved or harmed in the process.
In his investigations into his own surroundings, Man has made remarkable use of the
products of Nature in providing for his own basic needs and comforts. Food, clothing,
and hundreds of other products have been produced from these natural sources for better
living.
Early in his search for useful materials in Nature, Man discovered certain products that
eased pain and infection when taken internally or applied to his wounds. Continued study
and refinement of these products have made available to medical science the great variety
of drugs and medicines we have today. Unfortunately, many of these substances have
dangerous and damaging effects on the body if used indiscriminately. But in spite of their
drawbacks modern medicine could not function without the help of potentially dangerous drugs, and their use by the medical profession is increasing, particularly in the developed countries. Accompanying the increased use of such substances by the medical profession, is a growing tendency for the ordinary citizens to use drugs obtained without
medical prescription or expert advice as well as abusing those prescribed legitimately.
A substance may not be dangerous of itself; but the improper use of nearly any substance can be dangerous. Unfortunately the search for drugs has, in the past, often been
a search for "magic" and, except in scientific evaluation, this is still substantially the case.
Society has two means by which it can prevent individuals from using potentially harmful
substances for other than socially approved purposes.
The first of these is through legislation. This may place the manufacturer and distributor under strict control, or make the manufacture or distribution illegal, or permit forceful restraint to be employed whenever an individual makes other than approved use of
potentially harmful substances. A shortcoming of legal restrictions which applies particularly to drugs, is that the reasonably successful control of one substance often leads to the
emergence of another as a substitute. There are other shortcomings too - such as the
arousing of acute resentment; and making it difficult for offenders to seek treatment.
The second means at society's disposal is the provision of educational programmes that
provide opportunity for every individual to acquire adequate knowledge about potentially harmful substances, and to develop attitudes that will lead him to make correct decisions about the use of the variety of substances available.
Neither of these means is likely to be effective alone, but it is apparent that education
offers society the greatest opportunities to prevent the misuse or abuse of potentially
harmful substances.
2. The nature and origin of drugs
(a) What isadrug?
There is no precise definition of the term "drug" which will convey adequately
the complex range and functions of therapeutic substances available to modern
man. The origin of the word itself is unknown although variations of it appear in
many modern languages.
Generally speaking, any chemical substance, natural or synthetic, which alters
or is claimed to alter the structure or function of the body, may be labelled a drug.
Some drugs exert their effects on every cell in the body but most have selective
effects on certain kinds of cell, or on particular organs. The drugs with which we
are principally concerned generally affect the nervous system. They are used both
for medical treatment and for modifying man's perception of the real world or his
subjective sensations.
Substances of this kind have been in use since the dawn of history for producing
three kinds of effect; stimulation, sedation, and hallucinatory perceptual changes.
(b) Types of drugs
Drugs range widely in their nature, and just as widely in their application. Some
people think only of narcotic drugs like opium and heroin when the word "drug"
is used, but this is a very narrow idea of what drugs really are. There is, for instance, the very wide range of medicines prescribed by the family doctor, which
contain such drugs as the antibiotics, anaesthetics, sedatives, hormones such as insulin and thyroid extract, tranquillizers, pain relievers, and so on. To this we must
add an equally wide range of proprietary medicines and household and industrial
chemicals which can be bought without the need for a prescription. These can
include laxatives, mild pain relievers such as APC powders, corn cures, preparations
to prevent or treat sunburn, and medicated creams and lotions. All of these preparations and many more besides, contain drugs. Vitamins may be used to treat
specific deficiency diseases, and to this extent they may be considered as drugs. We
sometimes include drugs in such everyday toiletries as soaps, toothpastes, haircreams, and deodorants.
3. Origins of drugs
Drugs have been used by man from the beginning of recorded civilization and possibly
before.
The use of narcotic drugs extends so far back in time that they appear to have been
known to Stone Age Man. The seeds and capsules of the opium poppy have been found in
the pile works of the Swiss lake dwellers of 4,000 years ago, and evidence suggests that
the plant was deliberately cultivated. The drug was used medicinally by the Ancient
Egyptians, Persians and Greeks. Homer describes the affects of a "sorrow easing" opium,
and the cultivation and preparation of drugs described on clay tablets by the Sumerians
about 700 B.C. are substantially the same as the methods used today.
Marijuana was known to the Assyrians as early as the seventh or eighth century B.C.
They used it as incense under the name of "Qunnabu", a term apparently derived from an
old East-Iranian word "Konabu", the same as the Scythian name KavvaBis (cannabis).
Herodotus, writing in 500 B.C., speaks of the use of hemp as a narcotic by the Scythians
of Asia Minor.
There has always been a close connection between drug cures and faith healing.
Through the ages an immense number of substances has been used to treat disease, but
only a few of these substances have had any direct influence on the symptoms of a
disease, and some are actually harmful in their effects. Most of the substances that have
been used as remedies depend upon their appeal to the imagination for the healing virtues
they are believed to possess. Curative properties have been attributed to nearly every substance when it was new, unusual or difficult to obtain and which could be forced into the
human system.
The use of naturally available materials for medicinal purposes became the prerogative
of special persons; the priests, the medicine men or the witch doctors - and to make their
effects more dramatic, ritual ceremonies were developed. Thus, drugs have been used by
primitive peoples in tribal rituals such as puberty rites, and to combat and neutralise
various taboos. The American Indians extracted from desert plants the drugs mescaline
and peyote, in belief that it would enable them to communicate with their dead ancestors.
Similarly warriors sometimes smoked hashish to endow them with superhuman strength
before battle, and the Indians of the Andes chewed coca leaves, so extracting the cocaine,
for energy and virility.
The Maoris had many plant materials which they used as drugs but scarcely any so far
have been found to have any notable value. The tohungas, wise men learned in philosophy
and traditional knowledge and in the ways of their fellow men, used these drugs only as
an adjunct to their teaching of what they had evolved as healthy living habits.
In our own society the fallacious belief is still widely held that drugs in some mysterious way are a necessary part of the treatment of all diseases. Folk-lore, word of mouth,
and the pecuniary interests of advertisers and proprietors perpetuate excessive belief in
what drugs can do. As a result, much self-applied drug treatment is really of little value,
often unnecessary, and of little more than palliative or psychological effect, while a selflimiting illness abates as it would without any treatment.
4. The development of modern drugs
There are two main fields of development of modem drugs. The first is the extraction
of active principles from plants which have been known for centuries to possess healing
properties. The second is the testing of entirely new substances, some produced by
moulds, yeasts, and other simple living organisms, and others produced by chemists in the
laboratory. Thus, from living organisms we obtain the range of antibiotics now available,
while the list of synthetic drugs is enormous.
(a) Drug extraction from plants
There are many examples of modern drugs that are extracted from plants which
have been used for hundreds or thousands of years to treat illness. For instance,
there is the heart drug digitalis and its derivatives which come from the Foxglove,
a plant commonly grown in England and Northern Europe. The Autumn Crocus is
the source of colchicine, a drug used in the treatment of gout. Leaves of the Belladonna (Italian for "Beautiful Lady") were crushed and an extract used by women
of fashion to dilate the pupils and so give the eyes a sparkling appearance, hence
the plant's name. From this we now obtain atropine, a drug with wide medical
application. And of course there is the opium poppy, from the unripe seed capsules
of which opium is obtained. From this we extract morphine, used for the relief of
severe pain. A large part of the morphine extracted commercially from opium is
converted chemically to codeine. Although it is not as potent a pain reliever as
morphine, codeine is less addictive but it may also have harmful effects if used to
excess.
(b) Synthetic drugs
The pattern of development of synthetic drugs varies widely, for as yet we do
not have a sufficient knowledge of the mechanism of body processes to be able to
predict what a particular substance will do, simply by looking at its chemical structure. Neither can we predict accurately what chemical structures will be required
in a group of substances so they will exert a desired effect. In some instances we
do know what chemical characteristics are responsible for the activity of a particular group of compounds, but often we do not.
Discovery of useful drugs is therefore still very much dependent upon chance.
The usual process begins when a research chemist makes a series of new compounds. He may be experimenting with an entirely new chemical, quite unrelated
to any drug already in use, but he is more likely to be preparing a range of compounds, which differ in some small way from a compound which has already been
found to have useful properties. In this way the research chemist may prepare
small quantities of dozens of closely related substances, but at this stage he will
have no idea of whether or not they have any of the properties he is looking for.
The next step, then, must be a series of "screening" tests to see whether any of
the substances may-be useful. More than 150,000 substances are tested every year
in the pharmacological laboratories of Western European countries, but only approximately 50 new drugs - excluding combinations of already known products are actually introduced each year; this is equivalent to one new pharmaceutical
product for every 3,000 chemical substances investigated.
If he is wise, the person conducting these tests will be looking for a wide range
of possible effects, as small variations in chemical substances can quite markedly
affect their biological properties. If the person doing the screening only looks for
the one effect he is trying to achieve, he may cast aside a new compound with very
useful properties in another direction. There are many instances where useful
effects have been found in substances being prepared in search of quite different
properties. For example, a substance useful for treating ringworm was found while
looking for a more effective chemical to relax muscles during operations.
5. Use of drugs
(a) Medicinal
The most familiar use to which drugs are put is, of course, the treatment of illness. Where the illness is something easily recognised and of a minor nature, we
will often purchase something and treat ourselves. This is quite satisfactory in the
case of such simple conditions as the occasional headache or the pain of a bruise,
which are relieved with aspirin or other simple analgesics (pain relievers). If we get
carsick or have a stuffy nose due to a cold, other drugs give relief. Even in conditions like these it is advisable to seek advice on the first occasion on which the
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drug is used, as some can cause unpleasant reactions in some people. In some instances they may cause drowsiness so that driving a car can be dangerous. Where a
condition persists for a long period, such as continuous or repeated headache or a
cold that does not get better, a doctor should always be consulted. Continuing to
use drugs without medical advice can have serious consequences because taking
analgesics could mask the symptoms and in so doing prevent a correct diagnosis
and treatment.
Many illnesses and symptoms are self limiting. The use of drugs as palliatives for
these mean that excessive virtue has been ascribed to palliatives - but these merely alleviate pain or discomfort without curing.
(b) Experimental
Some drugs can also be extremely useful in helping to explain living processes.
If a drug is known to enhance or suppress a normal body process, the working of
the body under the influence of that drug can often tell us something about the
process itself, or the way it influences other body functions; it may even help us to
learn something about diseases which affect that particular body function. Thus,
drugs are not only useful for treating disease, but may assist us to learn something
about the nature of the disease itself.
These experiments must be carried out under carefully controlled conditions by
qualified personnel.
(c) Cultural
A number of drugs have at various times been associated with the customs of a
particular race or society of people. Betel nut chewing is prevalent among native
inhabitants of New Guinea, India and other similar countries. Tobacco smoking
was a custom developed by the North American Indians and brought to Britain
and Europe in the sixteenth century. Alcoholic drinks produced by fermentation
of various fruit juices have been consumed for many centuries, the main variation
being due to the natural material available to produce the sweet juices upon which
yeasts can act. These are all examples of the cultural use of drugs, and, as is shown
elsewhere, this form of drug use can often cause serious illness itself. In fact, these
are frequent forms of drug abuse, a subject which is referred to in more detail
later.
6. Faulty use and abuse
Much unwise use of drugs, some of which leads to abuse or to actual illness arises from
the persuasiveness of tradition or of advertisements. This should be critically examined.
First the cause of illness needs to be determined and the causes corrected or removed.
Then understanding care of the person is the most important need.
Use of drugs should only follow an objective assessment by a person appropriately
trained. The drugs then used may be palliative only, to suppress some of the transient discomfort while the patient recovers, or have some fundamental effect. Departure from this
procedure leads to faulty use or abuse.
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Sig 2
THE PROBLEM OF DRUG ABUSE
Cultural and social factors are important in understanding the use of drugs, for drug
abuse is largely a problem related to the community attitudes toward drugs. Every culture permits certain methods of tension reduction, e.g., alcohol is to many an approved
way of reducing tension in our society.
The permitted social uses of drugs may be implied from the traditional mores or rules
that form part of the culture of each society. An almost invariable tradition is that drugs
are used in group situations; e.g., some primitive cultures restrict drug use to religious
occasions. Commonly drugs are used to promote gregarious social functions, which may
be contrasted with another traditional valued social function - to assist in inflaming
hatreds against an external enemy of the group. On different occasions the same drug may
be used for a variety of purposes consistent with the aims of the society of the users;
marijuana is used by some societies to promote a pleasant happy state, but it has been
claimed that it was used deliberately to promote homicidal impulses in members of a
political group of professional murderers in Persia. The group was active for centuries in
medieval times and their use of hashish (marijuana) is reflected in the term "assassin".
Most cultures also embody rules that attempt to control drug abuse. In contrast to
drug use in a social setting, solitary. use of,a drug is usually censured. European Jewish
culture resulted in a society that achieved satisfactory drug use with practically no abuse
in the case of alcohol: a very low rate of alcoholism exists in spite of a high degree of
acceptance of alcohol. Clearly many other factors are involved but it is probably
significant that the use of alcohol is mandatory in Jewish religious ceremonies of special
social consequence, such as the wedding ceremony and the family service during the
Passover. Even in the case of opium, before the Opium Wars disrupted the traditional
social and administrative controls there was comparatively little abuse of opium in China
where it had been known and used since the ninth century.
Regardless of the widely disparate types of drugs adopted by different societies, they
are used for identical social purposes. In the Pacific area, societies using khava, an
intoxicating beverage and also a sedative, are distinctly separate from those using
betelnut, a stimulant. Other societies that use stimulants are found in South America
(cocaleaf, containing cocaine), around the Red Sea (khat), and in Asia (betel nut).
Marijuana has effects broadly similar to alcohol andis used extensively in Asia, Arabia,
and Africa. Opium and its derivatives have an extensive use, as distinct from abuse, and it
may not be too much to claim that abuse of drugs in these societies is a problem of the
same order of magnitude as abuse of alcohol in alcohol-using societies.
The reason for the current trend towards drug abuse is often presented as aconsequence of modern life: the soul-destroying pace of the competitive world, the disruption
of traditional standards, and the elevation of materialistic and hedonistic drives. In fact,
the use and abuse of drugs has been a general trend over the span of recorded history and
the influence of urbanisation on drug abuse is not yet clear.
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Epidemics of drug abuse usually erupt when a population is exposed to a new drug,
the use and control of which is not incorporated in its culture. The destructive effects of
alcohol on native populations exposed to European colonisers is only one special
example. The European population was also exposed to new drugs when the returning
colonisers brought back tobacco and a variety of other drugs. The widespread abuse of
opium in Europe followed its importation on a large scale by the East India Company.
Alternatively, a population may be exposed to a drug already known and incorporated
in its culture when the usual controls are disrupted by a conquering civilisation: the
extensive use of the coca leaf in South America as a drug of addiction followed the
disruption of the Inca civilisation by the Spaniards. Before this, its use was restricted to
the aristocracy, who in turn were restricted to enjoying its effects only in the course of
religious ceremonies. Today, the number of addicts in South America is variously estimated to be from 8 to 15 millions, which is not remarkable considering that in Bolivia
and Peru alone the estimated coca leaf production is 10,000 tons a year.
The international drug problem
The increase in the abuse of drugs in recent years is world-wide. At the 20th World
Health Assembly held in mid-1967, a resolution sponsored by ten countries noted "with
great concern" the increasing abuse of certain classes of drugs and called for immediate
co-ordination of national control measures against this threat.
Drugs about which the Assembly expressed particular concern were LSD and related
hallucinogenic substances, and drugs of the sedative and stimulant types. Measures were
proposed for greater control of the manufacture and supply of drugs and WHO undertook to carry out a pilot project over 3 years with the aim of establishing an international
system of monitoring adverse reactions to drugs. Later the United Nations Economic and
Social Council sponsored a conference at which a treaty, the Convention on Psychotropic
Substances, was written in 1971.
The most widely abused drug under international control is Marijuana (cannabis). In
1968, 1,440 tons (1,440,000 kilograms) of cannabis and 9 tons (9,000 kilograms) of
cannabis resin were confiscated compared with 34 tons (34,000 kilograms) of opium,
205 kilograms of morphine, 258 kilograms of heroin, 20 tons (20,000 kilograms) of coca
leaves, and 109 kilograms of cocaine. (Annual Report of U.N. Commission on Narcotic
Drugs, 1968).
A World Health Organisation Expert Committee has reported that 200 tons of opium is
diverted from legal production annually and only one-tenth is recovered by seizures.
As well as the opiates, cannabis and cocaine, there has been a rise in the world
consumption of the synthetic drugs like "Pethidine". This drug has proved to be just as
dependence producing as the natural opiates.
The following figures indicate the number of therapeutic doses of analgesic and cough
depressant narcotic drugs consumed annually per 1,000 inhabitants over the period
11
2'
1964-69:
Denmark
Finland
Atistralia
United Kingdom
New Zealand
Canada
United States
Japan
18,046
14,225
12,443
11,582
9,038
8,003
5,736
2,556
Of all psychiatric admissions in New Zealand, one patient in 62 is rated as drug
dependent. The chief problem has so far been with barbiturates and the amphetamine
group rather than with the narcotic drugs or LSD.
What is drug abuse?
The Committee of Experts on Drugs Liable to Produce Addiction, World Health
Organisation, defined addiction as:
"A state of periodic or chronic intoxication detrimental to the individual and to
society, produced by the repeated consumption of a drug. Its characteristics include:
(1) an overwhelming desire or need (compulsion) to continue taking the drug and
to obtain it by any means;
(2) tendency to increase the dose;
(3) a psychic (psychological) and sometimes a physical dependence on the drug".
Drug dependence
Recently, the term drug dependence has come into general use to replace "addiction"
and "habituation", because it has become scientifically unsound to maintain a single
definition for all forms of drug addiction and/or habituation. A feature common to these
conditions as well as to drug abuse in general is dependence, psychic or physical or both,
of the individual on a chemical agent.
The new term "drug dependence" is thus defined as a general term applicable to all
types of repeated or continuous drug abuse. It is a state of psychic or physical
dependence, or both, which may arise after repeated or long-term administration of a
drug. Describing the type of dependence is an integral part of the new terminology (i.e.,
morphine-type, cannabis-type, amphetamine-type).
People can become dependent on a wide variety of chemical substances that produce
central nervous system effects varying from stimulation to depression. When psychic
dependence develops there is a feeling of satisfaction and a drive that requires periodic or
continuous use of the drug to produce pleasure or avoid discomfort ("craving"). Some
drugs also produce physical dependence, i.e., an adaptive state that shows itself by intense
physical disturbances when the drug is stopped. These disturbances are known as withdrawal or abstinence syndromes.
Some drugs such as marijuana have now no medical purpose. If a drug were quite
harmless, no objection could be raised against its indiscriminate use, other than the waste
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of money and effort involved. However, no drug is without some toxicity, whether
physical, behavioural, or both. Where a drug is being used to cure or relieve an illness,
some degree of hazard, related to the seriousness of the illness, can be permitted. Drugs
that are being used to fulfil a medical need cannot be said to be subject to abuse while
they are being used to satisfy that need. But once the necessity for medical use is over,
any further use, whether out of habit or desire, must constitute abuse.
This brings us back to consider the purposes for which a definition of dependence is
necessary. The purposes are (1) scientific and medical and (2) social and legal.
For scientific and medical purposes the main feature is the overpowering desire or need
for the agent; the loss of power of self-control; the abuse of the drug on which the drug
taker is dependent.
For social and legal purposes the main feature is that the dependent himself and the
community to which he belongs are harmed by his dependence.
Factors concerned in drug dependence
Three main factors operate in the occurrence of drug dependence:
(a) the pharmacological and physiological properties of the drug;
(b) the personality, stability and attitudes of the individual;
(c) environmental and socio-cultural influences.
(a) Pharmacological and physiological factors
Dependence inducing drugs are usually those which produce some noticeable
subjective effect within a short time of their administration. These effects are
desired by the individual either to escape from problems or be relieved of anxiety
or to capture new experiences. These drugs, if taken over a sufficiently long period
of time and in sufficient doses, may produce physical dependence and this is
enhanced by the tolerance for the drug which develops with the consequent need
to increase the dose to produce the desired effects. The person then becomes
enslaved because he is unable to withstand or cope with the withdrawal effects of
the drug, i.e., he needs to continue the drug to feel reasonably normal.
The most recent work based on investigations in monkeys and human beings
has established that there are minimum requirements regarding daily dosage,
interval of administration, and total duration for the establishment of dependence.
The figures for opium derivatives have not yet been finally worked out but those
for barbiturates are now well-established. The daily intake needs to be 0.5 of a
gramme, which is five times the normal medical dose, at intervals of 6 to 8 hours
for 4 to 6 months.
(b) Personality of the drug dependent person
• There is little which persons who abuse drugs appear to have in common. They
can be found among young and old, rich and poor, and every social class.
The crucial questions: what are the attributes, psychological, physiological, or
biochemical which render certain individuals exposed to drugs, more likely to
13
become dependent or conversely, what are the attributes which militate against
the development of dependence in those similarly exposed?
It is now clear from animal and human experiments that anyone can become
physically dependent on some drugs if the dose is high enough, given sufficiently
frequently for a sufficiently long period of time. Despite this, some persons may
recover from their dependence whereas others remain dependent for the rest of
their lives.
Various surveys of dependents reveal that they show the whole range of
personality characteristics, from the normal to the neurotic, psychotic, psychopathic, and sexually deviant.
Certain traits of personality would appear to be conducive to the development
of drug dependence, for example, low tolerance for anxiety, distress, discomfort,
pain, or frustration of the person's needs. This may be relevant in the inability to
cope with the distress of the withdrawal state. Although many dependents show
marked personality disorders, with emotional instability, immaturity, impulsiveness and although these undoubtedly increase vulnerability to dependence these
traits are also quite common in non-dependents. It is also clear that a number of
drug dependents were previously stable, well adjusted persons and it is important
to bear in mind the harmful habitual effects of dependence, particularly on the
person's interpersonal and social relationships. The behaviour changes, the falling
off in reliability and efficiency, the need for deception, the measures needed to
obtain drugs to counteract abstinence syndromes can all exert adverse effects on
the person's disposition and personality, but these are not necessarily permanent
as follow-up studies of addicts have shown.
(c) Environment,
social and cultural factors
(i) latrogenic
A certain proportion of dependence arises from the unwise and prolonged
use of drugs, prescribed originally for quite valid medical reasons.
(ii) Profession
Doctors and nurses; because of the availability of drugs, constitute a wellknown proportion of dependents.
(iii) Socio-cultural aspects
Dependents can come from all social classes and from all races and countries
but there tends to be a difference in prevalence which is related to cost,
availability, degree of social acceptability, religion, economics, class consciousness, ethics, group mores, and many other factors which influence the
acceptance of certain drugs. Moslems, in general, reject alcohol but accept the
consumption of hashish, although both are officially banned by the Moslem
religion. Oriental opium-producing countries show a much higher rate of
dependence than do other countries such as Scandinavia. But many observers
have noted that Orientals keep their opium habits under much closer control
than do non-Orientals.
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It may also be said that the use of drugs creates a fraternal spirit among
users which may lead to the formation of their own particular kind of social
organisation, which in turn is reinforced by their rejection by society and
through economic and psychological factors: In our society the prohibitions
placed on the use of drugs may make their consumption-more attractive to
some adolescents.
A classification of major causes of drug dependence
(i) Teaching or example
We all have some figures whom we idealise, whether they be parents, older
brothers or sisters, friends, people with whom we come in contact such as the
family doctor or people who have acquired a following such as "pop" singers. The
less mature we are, the more likely we are to accept everything they do as correct
or acceptable behaviour. The key here is emotional maturity. The mature person
can make his own assessment of what is right and wrong, and act accordingly,
without unquestioningly accepting what he sees others doing.
(ii) Medical induction
Most drugs have a legitimate medical purpose, and their use for this purpose is
part of sound medical treatment. When the need for continued treatment no
longer exists, any further use constitutes abuse, whether the reason for continuing
to take the drug is due to liking for its effects or simply due to habit. It is
important that no drug should be taken for a prolonged period except on the
advice of an expert, in this case the doctor.
Many persons are introduced to the use of drugs by their physician as relief for
pain in long periods of severe illness. Constant effort is maintained by doctors and
hospitals to avoid drug dependence; however, experience with drugs and their
effect in relieving tension and pain leads many people to ignore the warnings of
professional advisors on the dangers of uncontrolled and habitual use, and they
try to obtain drugs from other sources.
(iii) Escape
There are probably occasions when each of us feels overwhelmed by problems
which beset us and often there is a desire to seek some way of removing those
problems. The obvious and sensible method isto tackle the problem itself, but
many people seek ways of escape. Drugs which can produce a feeling of detachment or oblivion are sometimes resorted to. Of course this does nothing to settle
the difficulty, but simply makes it seem less urgent or pressing. If possible, the
problem itself should be faced and solved, or if this is not possible, ways of escape
less harmful than self-medication should be found to relieve tension.
(iv) Experimentation
It is natural for all people to experiment. Unless we accept without question
what we read or are told, this is themain way we learn. So it is natural that
people will wish to experiment with drugs, to try and discover by personal
experience the effects of different drugs, particularly those which have some
stimulant or depressant effect. Because of the possibility of harm which can
come from such drugs, and the dangers of becoming dependent upon some of
them, experimentation must be strongly discouraged except by persons with
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expert knowledge in the handling of drugs. Thrillseekers, looking for new
experiences, investigating all sorts of novel or different situations or substances,
are especially susceptible to the ill effects of drugs. Their emotional immaturity
which makes them dissatisfied with normal relationships with other people and
with everyday experience also makes them particularly liable to become dependent upon drugs with which they might experiment while seeking "something
different"
(v) Boredom
Boredom can be a very real problem for some people, particularly if they are
required to do tedious, repetitive jobs or jobs which do not sufficiently occupy
their minds. Housewives can very easily drift into this sort of situation. The
obvious way out is to seek interests outside the home or hobbies or crafts which
can help fill their spare time. Unfortunately it is common for people in this sort
of situation to turn to drugs to try and overcome the depression caused by
tedium or to relieve the minor aches and pains which are magnified when they
have too much time to pass.
(vi) Persuasion
A major proportion of known drug dependents are introduced to the habit by
peddlers, confirmed dependents, or other drug abusers. Through ignorance of the
damaging effect on the body and mind produced by narcotics or because
"a friend" or "the gang" uses a drug many individuals are persuaded to undergo
their first experience in self-administration of drugs in one form or another. The
first few doses or shots seem perfectly safe. The clever peddler or firm addict
often supplies the novice free of charge, knowing that once he is dependent he
will pay almost any price to satisfy his craving.
(vii) Easy availability
Especially when they are under extreme stress, as in wartime and periods of
intense and exhausting hospital training, professional medical personnel sometimes turn to drugs for relief and come to depend on them, because the supply is
so readily available.
Younger age groups
The problem of drug dependence in our society tends to, be centred mainly on the
younger age groups, although a considerable problem exists with the middle-aged group.
The rebellious non-conformist is likely to resort to drugs as well as to other means of
demonstrating his independence of the moral codes of society. Adolescence is a period of
experimentation and rebellion, and the real problem is the possible - though not yet
existent - large-scale use of drugs by normal young people in an attempt to follow
seemingly modern trends and to express the normal adolescent' desire for independence.
Being curious about the affect of drugs often leads young people to accept invitations
to parties in the hope of seeing how others are affected by certain drugs. This can result
in conflict with the law and being identified with a group "known to the police."
It is among young people, therefore, that our main educational programmes need to
be developed.
16
Some results of drug abuse
Physical harm
The type of ill-effect will vary according to the particular drug involved. Aspirin causes
irritation to the lining of the stomach, and minute capillary bleeding into the stomach
may occur when aspirin is taken. If it is taken to excess over a long period of time,
sufficient irritation can occur to produce a stomach ulcer. Phenacetin has been shown,
particularly in some susceptible persons, to cause serious harm to the kidneys if it is
taken in large amounts over a period of time. People who habitually consume APC
powders or tablets are therefore quite likely to develop gastric ulcer, or kidney disease.
Stimulants are used to combat fatigue. The first few doses will also raise blood
pressure. The prolonged continuous use of stimulants, however, is likely to produce
hallucinations which are particularly dangerous when operating machinery or driving a
car. Drivers have crashed trying to avoid imaginary objects. Another possibility is a feeling
of over-confidence, resulting in risks being taken which are unnecessary and dangerous,
with occasional fatal consequences.
With sedatives, the opposite occurs. Abuse of sedatives can result in a perpetual state
of stupor, with a lack of awareness of all that is going on, a slowed reaction time which
can result in the affected persons being unable to get out of a dangerous situation in time,
whether as a pedestrian, a car driver, or an operator of any other mechanical device.
Continued abuse of bromide-containing sedatives leads to a condition known as bromism,
in which bromide replaces chloride in the body tissues, resulting in impairment of nerve
impulse transmission. Excessive use of some sedatives has been reported to result in a
state of forgetfulness. Some apparent suicides have been thought to be possibly due to
this condition, the person concerned forgetting that a dose has already been taken and
swallowing a further dose, then another, and so on until a coma results.
The dangers to a person under the influence of hallucinogens, where they are in a
dream world largely divorced from reality, are obvious. The possibility that this condition
may recur without further drug use makes these drugs potentially highly dangerous, and
until we know much more about their effects they must be treated with extreme caution.
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TYPES OF DRUGS - USE AND MISUSE
TYPES OF DRUGS LIABLE TO ABUSE
The chemical agents which, Man may abuse are remarkably diverse in chemical composition, pharmacological action, and subjective effects. They can be conveniently
classified into the following groups:
(a) Analgesics.
(b) Tranquillisers.
(c) Depressants.
(d) Stimulants.
(e) Opiates and opioids.
(f) Hallucinogens.
GENERAL EFFECTS
All dependence-producing drugs have powerful actions on the central nervous system.
Their harmful and adverse effects are related to neurological and behavioural changes.
It will be' seen that the nature of the effects varies according to the groups of drugs.
Dependence may be psychological or physiological or both. All drugs can create
psychological dependence, that is to say that the drug is taken as a means of coping with
life's stresses and to produce various effects, desired by the person, on his emotions,
drives, perceptual powers, conflicts and problems.
Physical dependence varies in its intensity. This is very marked with the opiate drugs
and less marked or absent with other drugs such as amphetamine and marijuana.
The abstinence syndrome varies in form according to the choice of dependent drug.
TYPES OF DRUGS ABUSED
Drugs subject to abuse appear invariably to be those drugs which affect the central
nervous system. They may vary from solvents contained in such common household and
industrial preparations as paints, thinners, glues, petrol, and thy cleaning fluids, through
familiar medicines like headache powders, sedatives, and cough mixtures to the more
potent and dangerous hallucinatory drugs, sleeping capsules and tablets, stimulants, and
opiates. Decongestants, drugs which contract blood vessels and appear to relieve blocked
nose and throat, often have a "rebound" effect, the symptoms being worse when use of
the drug has ceased, even though the cause has gone. This can lead to continued use and
habituation.
Drugs particularly likely to be the subject of abuse fall into the following categories:
(a) Analgesics
Analgesics, or pain relievers, are used for the relief of mild to moderate pain. Some
analgesic preparations, such as APC powders and tablets, also contain caffeine, a mild
stimulant.
(i) Aspirin (Acetyl Salicylic Acid). This drug is widely used for relief of pain but may
cause irritation of the gastric mucous membrane and even bleeding from the
stomach. For children, in particular, it is generally safer to use soluble aspirin (e.g.,
18
the calcium salts of acetyl salicylic acid). Excessive use of aspirin over a long
period may result in ringing in the ears, giddiness, nausea, and mental aberration.
(ii) APC. These initials stand for - Aspirin, Phenacetin, and Caffeine.
Phenacetin has three adverse effects on the body:
(a) It can cause cyanosis (blueness) by oxidising in the iron in the haemoglobin molecule in the red blood cells so that oxygen cannot be effectively transported. This
occurs in people who take the drug frequently.
(b) It can cause kidney damage (a form of chronic nephritis) when used over a long
period.
(c) It can cause headaches and result in the repeated use of phenacetin ostensibly to
relieve the headaches the drug has caused.
Caffeine is usually well tolerated in small amounts. It may, however, cause insomnia,
rapid pulse, and increased excretion of urine. It can be dangerous to people with heart
damage. The initials APC sometimes are used to mean Aspirin, Phenacetin, and Codeine
(e.g., in "Veganin", "Codis", "Codaphos", "Codiphen", etc.).
Codeine is generally given to people suffering from pain, diarrhoea, or severe cough. It
may, however, cause nausea, vomiting, drowsiness, or constipation. Taken in excessive
amounts over a prolonged period Codeine may also cause mild morphine type
dependence - or support already developed dependence.
WI Tranquillisers
Unlike barbiturate-type sedatives, tranquillisers can be used to counteract tension and
anxiety without producing sleep or significantly impairing mental and physical function.
The more potent tranquillisers have been used with great success in treating mental
disturbances. However, they are not a general panacea, and even the mildest tranquilliser
may produce dependence in the regular user.
Tranquillisers may be divided into two groups - "major" or "minor" - based on their
usefulness in severe mental disorders (psychoses).
"Major" tranquillisers are those prescribed for the treatment of psychoses and include
primarily the phenothiazine and reserpine-type drugs. The antipsychotic tranquillisers are
not known to produce physical dependence, and abuse of this type of drug is almost nonexistent.
"Minor" tranquillisers include a number of chemically quite different drugs. For the
most part they are not effective in psychotic conditions, but are widely used in the treatment of emotional disorders characterised by anxiety and tension. Members of this group
are abused by some patients or others who have access to them, the two most common
being merprobomate and chlordiazepoxide.
Chronic abuse involving increasingly larger daily doses, may result in the development
of physical and/or psychological dependence symptoms during misuse and following
abrupt withdrawal which closely resemble those seen with barbiturates.
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(c) Depressants, or sedative drugs
This group includes a variety of old and new drugs which have a depressant effect on
the nervous system. They may be prescribed in small doses to achieve a general feeling
of calmness, relaxation, drowsiness, or stupor, or in larger doses to produce a condition
of deep sleep or narcosis.
The most widely used drugs in this class are the barbiturates, which are used for
epilepsy, high blood pressure, insomnia, in the treatment and diagnosis of mental disorders, and before and during surgery. Alone or in combination with other drugs, they
are prescribed for almost every kind of illness or special situation requiring sedation.
Under medical supervision, barbiturates are safe and effective. When self-administered
or taken in excessive amounts, they are dangerous as their depressant effect on the
central nervous system may result in mental disorientation and physical incapacity.
A person under the influence may appear to be intoxicated - judgment and muscular
co-ordination are impaired. Reaction time, visual perception, and attention are affected
by even small doses.
Often, these drugs are taken to counteract the effects of stimulants. However, when
combined, amphetamines and barbiturates do not counteract each other completely; the
one may even exaggerate the euphoriant effects of the other. "Purple Heart" pills
("Drinamyl" tablets) are deliberately abused for this effect.
BARBITURATE ABUSE
Barbiturates can be taken orally, intravenously, or rectally.
Although barbiturate intoxication closely resembles alcoholic intoxication, barbiturate
abuse can be far more dangerous than alcohol abuse or even opiate abuse. Unintentional
overdosage can easily occur. Convulsions, which may follow withdrawal, can be fatal.
Over-indulgence in alcohol before barbiturate ingestion may result in fatal depression of
respiratory and cardio-vascular systems.
The barbiturate abuser exhibits slurred speech and staggering gait. His reactions are
sluggish. He is emotionally erratic and may be easily moved to tears or laughter.
Frequently, he is irritable and antagonistic. Sometimes, he has feelings of euphoria.
Because he is prone to stumble or drop objects, he often is bruised and has cigarette
burns.
Chronic misuse of barbiturates is accompanied by the development of tolerance and
both psychological and physical dependence. Physical dependence appears to develop
only with continued use of doses much greater than those customarily used in the practice of medicine. In a physically dependent barbiturate abuser, abrupt withdrawal is
extremely dangerous because of convulsions, which can be fatal.
Whether or not convulsions occur, there may be a period of mental confusion.
Delirium and hallucinations similar to the delirium tremens (DT's) of alcoholism may
develop. Delirium may be accompanied by an extreme agitation that contributes to
exhaustion.
20
Bromides are a traditional sedative which, because of their ill effects, are not much
use today. In some countries where, unlike New Zealand, they continue to be available
without a doctor's prescription, the use of the organic bromides, carbromal, and brom.
valetone is increasingly being found to have a cumulative action resulting in depression,
sometimes of a severe degree and requiring psychiatric treatment.
Alcohol increases the rate of absorption of bromide. Bromides accumulate slowly in
the body and produce insidious symptoms among those who continue to take the many
proprietary medicines containing them for years. Constant headache, irritability,
emotional lability, and confusion may cause them to be labelled as neurotic. Hallucinations, amnesia, and speech disorders lead many into psychiatric institutions. Skin
rashes of many types, which resist treatment, occur in a proportion of cases.
(d) Stimulants
This group includes drugs which directly stimulate the central nervous system and
therefore induce wakefulness. However, although such drugs may keep a person awake,
they do not help him to concentrate. Likewise, although they stimulate physical activity,
they do so at the expense of fatigue - causing the body to ignore its natural warning to
rest. Thus, when artificially stimulated activity is indulged in, the body adds a second
fatigue burden to the first. Obviously the body cannot continue to ignore fatigue in this
way indefinitely without suffering some ill-effects. Nervousness is a direct result and
severe depression frequently follows as the effect of the stimulant wears off.
Stimulants also have some effect on the appetite, and are sometimes used for slimming,
although their activity is limited in this direction and no great benefit has been demonstrated beyond the early period of treatment for excessive weight. Stimulants related to
amphetamine and ephedrine can be of value in treating hay fever and colds because they
shrink the nasal membrane and ease stuffiness. They also have a stimulating effect on the
heart and cause constriction of blood vessels which may result in acute or permanent
damage.
Mild and relatively harmless stimulation can be obtained from "stay-awake" tablets
containing caffeine, but the same stimulating effects can be obtained from drinking tea
or coffee - both of which in normal strength contain roughly similar amounts of caffeine.
Cola drinks, too, are refreshing as a result of their caffeine content, but they contain
quite a high percentage of sugar which may be to the detriment of good nutrition. So far
as the drug effects of these drinks are concerned, the average healthy adult can drink
them in moderation without fear of serious consequences. Nevertheless, caffeine can have
a definite habit-forming effect, although not nearly as serious as the dependence which
can be developed to the stronger stimulants.
Continued use of stimulants may lead to a psychosis indistinguishable from schizophrenia, with delusions of persecution, hallucinations, etc.
The more tolerance to the drug that occurs in stimulant dependents, the greater the
risk of psychosis. There is no appreciable withdrawal physical syndrome with stimulants.
Stimulant abuse is an increasing problem among social rebels, delinquents, and adolescents seeking excitement. It may also be a larger problem than is generally realised among
women who have been taking slimming pills containing amphetamines for long periods.
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At least one reason why stimulants present such a danger is that the intoxicated individual is not rendered incompetent, as with alcohol or barbiturates, and is not peacefully
content, as with marijuana or opiates. Even when suffering from a drug-induced paranoid
psychosis, he has no clouding of consciousness and is able to act on his delusions of persecution. The danger has been recognised with cocaine, but it would appear to be equally
relevant to other stimulants in direct proportion to their relative potency.
Cocaine
Cocaine was formerly used extensively to produce local anaesthesia particularly for
dental surgical procedures. In this field newer synthetic compounds are being used. It is
an uncommon drug of abuse in New Zealand. Cocaine is generally taken intravenously,
although it is still occasionally taken as a snuff. Dependents will inject 2-3 grains of
cocaine every 10-15 minutes and may take 20-60 grains of the drug in 24 hours.
Cocaine is extracted from the leaf of the coca plant, native of South America. It was
used by the Inca civilisation, which was fully developed before the tenth century, but
limited to the aristocracy. When the Spaniards disrupted the Inca civilisation the habit
spread and was encouraged as a means of enslaving the native populations. There is still
an enormous trade in it in South America.
Towards the end of the last century cocaine was used extensively in Europe before its
dangers were recognised. Conan Doyle portrayed his own cocaine habit in Sherlock
Holmes.
There is no physical dependence on this drug, but the main dangers lie in the violent
stimulation it causes and in the subsequent paranoid feelings. The paranoid may try to
counter-attack the supposed enemy. The less serious physical effects of cocaine are
digestive upsets, sleeplessness, excitability and an increased heart rate.
Amphetamines ("Pep Pills")
The amphetamine group of stimulant drugs is widely used for purposes such as slimming, keeping awake for study, or for long journeys, increasing athletic performance, or
simply for "kicks".
Amphetamine was first synthesised in 1887 but it was not until 1932 that it was used
therapeutically (as an inhalant for head colds). In World War II it was used extensively in
Britain to counter fatigue and was sold in the form of "energy tablets". Stimulation has
been shown to lead to depression and in turn to suicide in severe cases.
Common amphetamines are:
Amphetamine (Benzedrine) (Durophet)
Dexamphetamine Sulphate (Dexedrine)
Methylamphetamine (Methedrine)
and mixture of amphetamines with other drugs such as Drinamyl (Purple Hearts).
These products are generally manufactured as 5 mgm white, yellow, blue, or purple
tablets.
Some people obtain these drugs fraudulently by visiting numerous doctors and having
the prescriptions made up at a variety of pharmacies, thus avoiding detection. Many of
these drugs are also purchased on the black market.
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About one-third of amphetamine dependents report increased sexuality, often with the
appearance or exaggeration of perverse activities. Increased promiscuity, homosexuality,
transvestism, exhibitionism, and seduction of children have occurred under the influence
ofthe drug.
The outstanding physiological change that accompanies dependence is an extraordinary
tolerance to the drug. Doses as high as 1,700 mg have been tolerated by them whereas a
number of deaths have been reported from less than 150 mg taken by non-tolerant adults.
Physical dependence is practically non-existent for stimulants.
Drinamyl (purple hearts) is a most serious drug of dependence. The psychological
reason for danger is that it has the qualities of immediate sensory gratification. The self
regulation of pleasure-seeking demands is corrupted and the adult returns to infantile
responses demanding immediate relief. It is the craving for pleasure which encourages its
use.
A close relationship has also been found between dependence on stimulants,
particularly amphetamine, and crime. In one study petty crime, such as shoplifting,
thieving, breaking and entering, and false pretences, has been found to be common in
the case histories of stimulant dependents. It is usually related to the need to replenish
supplies and the reluctance or inability to obtain gainful employment.
(e) Opiates and Opioids
This term usually refers to opium and its derivatives and includes the most dependent
drug of all - viz., heroin.
The classical narcotic is opium, although its main active constituent, morphine, is now
more commonly used. From morphine chemists have manufactured a number of other
drugs, some extremely potent like heroin, and others much less dangerous like codeine.
A number of synthetic compounds with morphine-like effects have also been made during
the past 30 years. These include pethidine, methadone (Physeptone), normethadone
(Ticarda), dextromoramide (Palfium), and levorphan (Dromoran).
Natural and synthetic morphine-like drugs are the most effective pain-relievers in
existence and are among the most valuable drugs available to the physician. They. are
widely used for short-term acute pain resulting from surgery, burns, etc., and in the
latter stages of terminal illnesses such as cancer.
The depressant effect of opiates produces drowsiness, sleep, and reduction in physical
activity. Side effects may include nausea and vomiting, constipation, itching, flushing,
constriction of pupils, and respiratory depression.
Their appeal lies in their ability to reduce sensitivity to both psychological and physical
stimuli and to produce a sense of euphoria since they dull fear, tension, and anxiety.
Under the influence of morphine-like narcotics, the drug dependent is usually lethargic
and indifferent to his environment and personal situation. If a woman is dependent on
drugs and continues to use opiates during pregnancy, her baby will be born physically
dependent.
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The price tag on the abuse of these drugs is high since chronic use may lead to both
physical and psychological dependence. Psychological dependence is the more serious of
the two, since it is still operative after drug use has been discontinued. As the need for
the drug increases, the dependent's activities become increasingly drug-centred.
The most commonly abused narcotic drugs include:
Opium is the less refined product obtained from the opium poppy. It takes up to 1 lb
of opium to produce 1 oz of morphine, therefOre opium itself, being more bulky and
therefore more difficult to smuggle, Is less common than its derivatives such as morphine.
Morphine and other opium derivatives are available legally on a doctor's prescription
for the alleviation of pain or for cough suppression. Morphine is marketed for legitimate
use as white tablets and in ampoule form. Sources of unlawful morphine circulated by
drug peddlers are by theft from pharmacists or doctors' surgeries or from warehouses,
or are obtained through the use of a forged prescription on forms stolen from doctors.
Codeine is derived from morphine. It has a milder pain killing action than morphine;
it is used as a white tablet, either alone or in combination with aspirin and sometimes
caffeine as well for the relief of pain, or in a syrupy combination as Linctus Codeine for
the suppression of a cough. Codeine tablets and codeine linctus are a source for illegal
preparation of morphine for illicit use.
Heroin is a white or off-white powder at least four times more toxic than morphine
and has a far greater dependence producing potential. The importation of heroin into
New Zealand was forbidden in 1952.
(f) Hallucinogens
Distortions of perception, dream images, and hallucinations are characteristic effects of
a group of drugs variously called hallucinogens, psychotomimetics, dysleptics, or psychedelics. They include mescaline, d-lysergic acid diethylamide (LSD), psilocybin, and
dimethyltryptamine (D.M.T.). At present they have no general clinical medical use except
in research. However they are being encountered with increasing frequency as drugs of
abuse.
There is much we do not yet know about these drugs, as their action is to modify the
processes which are taking place within the brain, the part of the body which is least
understood. We do know that it is the mid-brain, in the part which modulates emotional
responsibility and regulates awareness, where the drugs produce their unique effects.
Because people differ so much from one another in their emotions, their fears, beliefs,
affections and reactions, their reaction to the use of hallucinogenic drugs is unpredictable.
For some it is pleasant, for others a nightmare. A common feature is detachment from
reality and an inability to react normally. There is a danger that a depressed person may
be driven to suicide, or that the mind may in some cases be permanently affected,
although this is an occasional observation which has yet to be adequately investigated.
Marijuana (Cannabis)
Although chemically distinct from the hallucinogens just named, marijuana is also
considered an hallucinogen because its effects are similar.
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The intoxicating substance which gives marijuana its activity is found primarily in a
resin from the flowering tops and leaves of the female plant. The potency of marijuana
varies with the geographical location in which the plant grows, time of harvest, and the
plant parts used.
Unlike other drugs which are abused, marijuana has no present day therapeutic use.
Marijuana may be smoked, sniffed, or ingested, but effects are experienced most quickly
with smoking.
When marijuana is smoked there is initially apparent stimulation and exhilaration, followed by sedation, depression, drowsiness, and sleep. The effects, however, are variable
and unpredictable. Few herbs show such variations in their content of active alkaloid
ingredients. Even in the individual, the response to marijuana varies from time to time.
The neurophysiological effect is muscular inco-ordination, but this is not often obvious
by clumsiness or unsteady gait. Other effects include dizziness, dry mouth, dilated pupils,
and red and burning eyes, urinary frequency, diarrhoea, nausea and vomiting, hunger,
particularly for sweets, and a rise in pulse rate and blood pressure.
The effects on mood vary from extreme elation and exhilaration to depression, panic,
and severe anxiety. In general marijuana promotes a sense of well-being and relaxation,
and an alteration in consciousness and an altered way of feeling and reacting to sensory
stimuli.
Anxiety and emotional tension may be reduced and critical faculties inhibited. It may
induce striking illusions and hallucinations.
The ditortion of time perception is especially marked, and time appears to pass more
slowly. Fantasy and imagination may be stimulated. Ideas may be plentiful but disconnected and disorganised with forgetfulness of recent events. There may be increased
auditory perception and sensitivity to rhythm. Listening to music after taking the drug
may produce unusual aesthetic responses.
In terms of some effects on behaviour, moderate use of marijuana is roughly comparable to moderate abuse of alcohol (also a drug). Like alcohol, it tends to loosen inhibitions and increase suggestibility, which explains why an individual under the influence of
marijuana may engage in activities he would not ordinarily consider. Although the marijuana smoker sometimes feels himself capable of extraordinary physical and mental feats,
he seldom acts to accomplish them for fear of disrupting his "euphoric" state. Marijuana
does not produce physical dependence or an abstinence syndrome. Once the user has
established the amount of marijuana needed to achieve his particular "high", there is
little tendency to increase the dose, indicating that tolerance doesn't develop. Moderate
to strong psychic dependence can develop in accordance with the user's appreciation of
the drug's effects. However the drug can have unpredictable effects even on people
accustomed to its use.
To date, available information indicates that marijuana has few detrimental effects on
an individual's physical health. When it is used frequently enough to produce psychic
dependence it may lead to extreme lethargy, self-neglect, and preoccupation with use of
marijuana to a degree that precludes constructive activity. Additionally, the use of marijuana may preciptitate psychotic episodes or cause impulsive behaviour in reaction to fear
25
or panic. According to a 1965 report on drug dependence in the Bulletin of the World
Health Organization: "Abuse of cannabis (Marijuana) facilitates the association with
social groups and sub-cultures involved with more dangerous drugs, such as opiates or
barbiturates. Transition to the use of such drugs would be a consequence of this association rather than an inherent effect of cannabis. The harm to society derived from abuse
of cannabis rests in the economic consequences of the impairment of the individual's
social functions and his enhanced proneness to asocial and antisocial behaviour".
Thus while the use of marijuana does not usually cause mental or physical ill-health,
it may lead to social and legal problems. For example, it can be dangerous to drive a car
under the influence of marijuana, owing to altered perception and lack of co-ordination.
There are, therefore, two principal arguments against the widespread use of marijuana;
one is individual and the other social.
From the individual point of view, marijuana smoking is most dangerous to those with
the greatest unfulfilled needs and those seeking escape from reality. The effects on such
people, particularly the immature, are not predictable. At the very least, they become
irresponsible and silly, and if in charge of a vehicle or in a position of personal risk of
injury, they are likely to make grave errors or judgment. Sometimes violent behaviour
results from marijuana intoxication, more often it induces inward looking detachment.
The social risks of "legalising" marijuana are even more serious than the individual, in
that its widespread use may encourage too ready withdrawal from social responsibility.
No urban society can tolerate a threat to the social organisation of this nature, particularly in view of the indeterminate dosage margins which divide euphoria from anti-social
behaviour.
There are other hazards which could follow in the train of "legalised" marijuana usage,
one of which is multiple habituation to drugs, common in the young experimenter, and
extremely rapid in development and difficult to treat effectively. One should not forget
the highly vulnerable state which marijuana may induce in those with personality disorders or social or intellectual maladjustment.
It is illegal for the young to consume alcohol yet all to easy for them to obtain it. It
would be a dereliction of social duty to make yet another potent intoxicant available
which can and does lead to continued heavy indulgence in some cases with consequent
physical and mental disturbance, and in other cases introduces the young and immature
Person to undesirable elements of society from which he may find it difficult to
withdraw.
A cheap, easy, and also a common way of drifting into drug habituation is to begin by
smoking marijuana. Most heroin addicts come through a series of preceding drug misuse.
Marijuana is for many the most enjoyable substance (until they find others). But there is
no reason to believe that marijuana use inevitably leads to the use of other drugs. It may
indeed follow other drug misuse in some instances.
LSD
d—Lysergic acid diethylamide, one of the most potent of the hallucinogens, is derived
from an alkaloid found in the fungus ergot.
26
The importation, manufacture, and use of this substance, except for restricted medical
research use is illegal under the Poisons Act. On the illicit market, the drug may be
obtained as tablets, gelatine flakes, a small white pill, as a crystalline powder in capsules,
absorbed on paper, or as a tasteless, colourless, or odourless liquid in ampoules.
Frequently, it is offered in the form of impregnated sugar cubes, or biscuits. LSD is
usually taken orally, but may be injected.
LSD primarily affects the central nervous system, producing changes in mood or
behaviour. Very small amounts of the drug produce hallucinations, intensification and
distortion of sensory perception and may lead to panic, impulses toward violence, suicidal
acts, and loss of sanity.
A millionth part of a gramme per kilogramme of body weight is enough to produce
hallucinations. The effect depends to some extent on the environment and the expectation which the subject brings to the experience. LSD may cause synaesthesia wherein
colours produce sounds and where music is seen as well as heard. The subject may then
feel himself "slipping out of his body" like an egg eased from its shell. This is followed by
the "trip", i.e., the feeling of taking a journey. The subject feels himself to be "flowing on
a cosmic wave", or "flowing with the universe".
During "trips" LSD users experience hallucinations and heightened powers of perception. In general, the LSD experience consists of changes in perception, thought, mood,
and activity.
Perceptual changes involve senses of sight, hearing, touch, body image, and time.
Colours seem to intensify or change, shape and spatial relation appear distorted, objects
seem to pulsate, two-dimensional objects appear to become three-dimensional, and inanimate objects seem to assume emotional import. Sensitivity to sound increases but the
source of the sound is elusive. Conversations can be heard but may not be comprehended.
There may be auditory hallucinations of music and voices. There may be changes in taste
and food may feel gritty. Cloth seems to change texture, becoming coarse and dry or fine
and velvety. The subject may feel cold or sweaty.
There are sensations of light-headedness, emptiness, shaking, vibrations, fogginess.
Subjects lose awareness of their bodies with a resultant floating feeling. Arms or legs
may be held in one position for extended periods of time. Time seems to race, stop, slow
down, or even go backwards. Changes in thought include a free flow of bizarre ideas
including notions of persecution. Trivial events assume unusual significance and importance. An inspiration or insight phenomenon is claimed by some LSD adherents.
The mood effects of LSD run the gamut. There may be bursts of tears, laughter, or the
subject may feel no emotion at all. A state of complete relaxation and happiness, not
apparent to an observer, may be experienced. A feeling of being alone and cut off from
the world may lead to anxiety, fear, and panic. Accordingly the LSD session is frequently
monitored by an abstaining LSD-experienced friend to prevent flight, suicidal attempts,
dangerous reaction to panic states, and impulsive behaviour, such as disrobing. There may
be a feeling of enhanced creativity, but this subjective feeling rarely seems to produce
objective results.
Experiences under the drug are related to the previous personality of the person. Some
describe the experience as frightening and feel they have passed through a living hell,
27
others delight in the experience. Others experience severe panic, and also prolonged
psychotic episodes (even in experimental subjects when the personality of the volunteers
is carefully selected). "Freak outs" occur, i.e., bad trips after pleasant ones.
The physical effects of LSD are; increase in blood pressure and heart rate; the blood
sugar goes up; there may be nausea, chills, flushes irregular breathing, sweating of the
hands, and trembling of the extremities. Sleep is virtually impossible until at least 8-10
hours after the LSD episode is over. The pupils of the eyes are widely dilated, so that dark
glasses are often worn, even at night for protection against the light.
The view that LSD is harmless and safe is not supported by the figures of untoward
reactions. Common complications are psychotic reaction with hallucinations, anxiety which can amount to severe panic - depression, and confusional episodes with disorientation. These may occur at the time the drug is taken, and may sometimes recur, particularly under stress, for several weeks after. Judgment may be so disordered that a person
may believe that it is possible and safe to float down from a height.
Medically unsupervised use of LSD has been described as analogous to playing "chemical Russian Roulette". Although the drug is still largely an unknown quantity there are
well documented instances of LSD induced psychosis and well documented instances of
panic states under the influence of the drug.
The "LSD state" may recur months later, e.g., with disturbances of reality while
driving a car or while on a high building ("Flash-back phenomenon").
LSD has been reported to be a "chromosomal toxin"; fragmenting and re-arranging
chromosomes which determine a person's appearance, sex, and other characteristics. If
the reports are confirmed this makes the drug potentially dangerous to the user and to
his or her descendants over several generations.
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SIGNS AND SYMPTOMS OF DRUG ABUSE*
It is often difficult to detect persons misusing drugs simply by observation, as many of
the observable effects of drugs are similar to the signs of other quite unrelated conditions.
A student may be sleepy simply because of one or more late nights, he may be feverish
due to an infection, or he may be irritable through worry or domestic tensions. Symptoms of central nervous disorder may be due to organic disease.
Although it is difficult to recognise drug abusers, many potential "hard-core" addicts
can be rehabilitated if their involvement in drug abuse is spotted in its early stages when
professional help can be brought to bear on the problem effectively.
THE KEYNOTE IS PERSISTENT CHANGE IN APPEARANCE OR BEHAVIOUR
Common symptoms of drug abuse
Not all drug abuse-related character changes appear detrimental, at least in the initial
stages. For example, a usually bored, sleepy student may - while using amphetamine be more alert and thereby improve performance. A nervous, highstrung individual may,
on barbiturates, be more co-operative.
What we must look for, consequently, are not simply changes for the worse, but any
sudden changes in behaviour out of character with a person's previous conduct. When
such behavioural expressions become usual for an individual, there is a causal factor. That
factor may be drug abuse.
Signs which may suggest drug abuse include sudden and dramatic changes in school
attendance, discipline, and academic performance. With the latter, significant changes in
legibility, neatness, and calibre of homework may be observed. Drug abusers may also
display unusual degrees of activity or inactivity, as well as sudden and irrational flare-ups
involving strong emotion or temper. Significant changes for the worse in personal appearance may be cause for concern, for very often a drug abuser becomes indifferent to his
appearance and health habits. He is also likely to be disinterested in school and social
activities, but may become interested in new and older companions or acquaintances.
There are other, more specific signs which should arouse suspicions, especially if more
than one is exhibited by a single person. Among them are furtive behaviour regarding
actions and possessions (fear of discovery), sunglasses worn at inappropriate times and
places (to hide dilated or constricted pupils), and longsleeved garments worn constantly,
even on hot days (to hide needle marks). Of course, association with known drug abusers
is a sign of potential trouble.
Because of the expense of supporting a drug habit, the abuser may be observed trying
to borrow money from a number of individuals. If this fails, he will not be reluctant to
steal items easily converted to cash, such as cameras, radios, jewellery, etc. And if his
habit is severe enough to force him to use drugs during the school day he may be found,
at odd times, in places such as storage rooms, cupboards, toilets, and parked cars.
*NOTE - This section is written with particular reference to the school situation.
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In addition to these general behavioural clues which are common to most drug abusers,
each form of abuse generally has specific manifestations that help identify those engaged
in it.
They are as follow:
The stimulant abuser
The behaviour of the abuser of stimulants, such as amphetamine and related drugs, is
characterised by excessive activity. The stimulant abuser is irritable, argumentative,
appears extremely nervous, and has difficulty sitting still. In some cases, the pupils of his
eyes will be dilated even in a brightly lit place.
Amphetamine has a drying effect on the mucous membranes of the mouth and nose
with resultant bad breath. Because of the dryness of mouth, the amphetamine abuser
frequently licks his lips to keep them moist. This often results in chapped and reddened
lips, which, in severe cases, may be cracked and raw. Dryness of the mucous membrane
in the nose, cause the abuser to rub and scratch his nose vigorously and frequently to
relieve the itching sensation. Incessant talking about any subject at hand, and often chain
smoking, may also be signs of amphetamine abuse.
Finally, the individual who is abusing stimulant drugs often goes for long periods of
time without sleeping or eating and usually cannot resist letting others know about it.
The depressant abuser
The abuser of a depressant drug, such as the barbiturates and certain tranquillisers,
exhibits most of the symptoms of alcohol intoxication with one important exception:
there is no odour of alcohol on his breath. Students taking depressants may stagger or
stumble in classrooms or halls. The depressant abuser may fall into a deep sleep in
the classroom. In general, he lacks interest in activity, is drowsy, and may appear to be
disoriented.
The hallucinogen abuser
It is highly unlikely that students who use hallucinogenic drugs (such as LSD) will do
so in a school setting. Such drugs are usually used in a group situation under special conditions designed to enhance their effect. Persons under the influence of hallucinogens
usually sit or recline quietly in a dream or trance-like state. However, the effect of such
drugs is not always euphoric. On occasion, users become fearful and experience a degree
of terror which may cause them to attempt to escape from the group.
Other signs include decreased sensitivity to pain (comparable with effect of opiates),
loss of apprehension, impaired intellectual functioning, loss of contact with reality.
LSD users often experience dramatic shifts in values. A pupil who has been doing well
in school and has established goals for himself may suddenly lose interest and decide to
drop out of school. And the pupil who is an LSD user may think he is achieving at a
higher level when his performance has actually decreased. In contrast to the users of other
drugs, who attempt to conceal their actions, the LSD user frequently talks about using
the drug and encourages friends to use it. Speaking the jargon associated with LSD may
be indicative of association with LSD users.
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The marijuana user:
While marijuana is pharmacologically an hallucinogen its widespread use warrants
separate discussion. The user of marijuana ("pot", "grass") is unlikely to be recognised
unless he is heavily under the influence at that time.
Pupils will probably never come to school while they are in the early stage of marijuana
use - characterised by hilarity, talkativeness, and generalanimation - or even when they
are in the later stage - one which is characterised by depression, drowsiness, and incoordination. However, they may come to school wearing clothes that carry the odour of
marijuana smoke, and this can be identified because it is similar to the odour of burning
hay or rope. The eyes - depending on the recency of use - may be reddened, and the
pupils of the eyes may appear frozen and dilated. To conceal this tell tale sign, the smoker
will often wear dark glasses.
The marijuana smoker is also likely to have badly stained fingers for two reasons:
(a) the practice of holding the cigarette until it is almost consumed:
(b) the way the "reefer" is smoked. Because of the rapid burning and harshness of the
marijuana cigarette, it is generally passed rapidly, after one or two puffs, to another
person. The smoke is deeply inhaled and held in the lungs as long as possible. The
cigarette is often cupped in the palms of both hands when inhaling to save all the
smoke possible.
If a person is indulging in more than occasional marijuana smoking, he may appear
sleepy, perspire freely, and show marked pallor. A teacher should be alert to identify
these signs, even though they may indicate health abnormalities; and when they are noted
the teacher should refer the pupil to the school health service, for, regardless of what
causes the conditions, an investigation is imperative.
The glue sniffer
The glue or solvent sniffer usually retains the odour of the substance he is inhaling on
his breath and clothes. Irritation of the mucous membrances in the mouth and nose may
result in excessive nasal secretions. Redness and watering of the eyes are commonly observed. The user may appear intoxicated or lack muscular control, and may complain of
double vision, ringing in the ears, vivid dreams, and even hallucinations. Drowsiness,
stupor, and unconsciousness may follow excessive use of the substances.
Discovery of plastic or paper bags and rags or handkerchiefs containing dried plastic
cement is a telltale sign that glue sniffing is being practised.
The opiate abuser
Few opiate abusers are seen in school, situations; they usually cannot function within
the ordered confines of such institutions. However, a rare individual may begin narcotic
abuse while still attending school. Such individuals are likely to be drinking paregoric or
cough medicines containing small quantities of opiates. The presence of such bottles in
waste baskets or around school grounds is a clue to this form of abuse. The medicinal
odour of these preparations is often detectable on the breath.
/
31
Other "beginner" opiate abusers inhale drugs such as heroin in powder form. Sometimes, traces of this white powder can be seen around the nostrils. Constant inhaling of
narcotic drugs makes nostrils red and raw.
The opiate user is sometimes peevish, irritable, and restless and at other times drowsy
and apathetic. In either case he is uncommunicative and disinterested. He shuns his
former friends and classmates, shows lack of interest in others, and is generally antisocial.
In order to secure money to support his habit he may find it necessary to steal from his
mates.
He is likely to show little or no interest in physical activities and to exhibit poor capacity for muscular exertion.For maximal effect, opiates usually are injected directly into a vein. The most common
site of the injections is the inner surface of the arm at the elbow. After repeated injections, scar issue ("tracks") develops along the course of such veins. Because of the
easy identification of these marks, such drug abusers usually wear long sleeves at odd
times. Females sometimes use make-up to cover marks. Some males are tattooed at injection sites.
The presence of equipment ("works" or "outfit") used in injecting is another way to
spot the abuser. Since anyone injecting drugs must keep his equipment handy, it may be
found on his person or hidden nearby in a locker, washroom, or some place where temporary privacy may be found where the user disappears from group activities for prolonged
periods while preparing a "fix".
The characteristic instruments and accessories are a bent spoon or bottle cap, small ball
of cotton, syringe or eyedropper, and a hypodermic needle. All are used in the injection
process: the spoon or cap holds the drug in a little water for heating over a match or
lighter, the cotton acts as a filter as the drug is drawn through the needle into the syringe
or eyedropper.
The small ball of cotton ("satch cotton") is usually kept after use because it retains a
small amount of drug that can be extracted if the abuser is unable to obtain additional
drugs. The bent spoon or bottle cap used to heat the injection is easily identifiable because it becomes blackened by the heating process.
In time the opiate user is likely to lose weight and appear emaciated. This is because in
his preoccupation with drugs and the means of securing them he is prone to neglect his
physical wellbeing.
Identification of drugs
No one can effectively identify a drug by sight, taste, or smell for one reason - all the
drugs discussed, except for marijuana, can be found in tablet, capsule, powder, and liquid
form - and in varying colours and shapes. Even marijuana, which is usually smoked, can
be found as a sweet. Marijuana biscuits and marijuana tea also exist. The original "Turkish Delight" contained marijuana in resin form.
The only way, therefore, that most drugs can be correctly identified is through a series
of complicated laboratory procedures performed by trained technicians. The best a
person can do is to suspect the possibility of abuse when drugs are found under peculiar
circumstances or in the possession of someone exhibiting unsual behaviour.
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What to do
Obviously no young person attending school should be summarily labelled as a user
of drugs because one or more of the indications described in the foregoing are present. It
is possible that he could be suffering from some problem, defect, or disease quite unrelated to drug abuse.
In either case an appropriate investigation should be instituted in an endeavour to
secure any medical help and treatment that might be needed.
Most unusual, but highly critical, is the emergency situation. In a case of unconsciousness which may be drug-induced, rapid action is vitally important. If there is not a standing procedure for emergencies a doctor should be called immediately, or the victim taken
to a hospital. If breathing fails, some form of artificial respiration should be administered
until medical help arrives. Parents should be advised of the situation as soon as possible.
Because of the contagious nature of drug abuse every effort should be made to determine sources of supply and names of other persons who may be abusing drugs. Experience has shown that drug abusers attempt to pass their habit to friends and associates in
order to raise money. The drug abuser, therefore, must be identified to help prevent the
spread of drug abuse.
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CONTROL OF DRUGS AND TREATMENT OF DRUG ABUSE
Legislation controlling the distribution and use of drugs of dependence takes into
account a number of factors. The first is the nature of the drug itself, for obviously a drug
that quickly produces dependence in any person taking it must be more rigidly controlled
than one which must be taken to excess over a period of time. The second factor is the
usefulness of the drug. Where a drug has no recognised medical or other useful property,
prohibition of its use may be possible, whereas this may not be applied to a useful and
perhaps, even irreplaceable drug. A third factor is what we intend legislation to achieve, in
relation to those who may promote the misuse of drugs (peddlers) and those who may be
the victims of misuse (dependents and their associates).
Considerable confusion has been created in the use of words. In some contexts the
terms "addiction" and "dependence" have been used interchangeably. W.H.O. Expert
Committees and other United Nations Organisations have for many years recommended
replacement of the word "addiction" by the word "dependence", supplemented where it
is necessary by a brief, usually one word, description of the type of dependence. Originally used in pharmacology as an adjective and adverb, to describe an effect which is dose
related, increasingly in law (New Zealand followed suit in the Narcotics Act 1965) the
word "narcotic" has been used as a noun. Not every substance that can have narcotic
effect (e.g, alcohol, petrol, barbiturates) is stated by the law to be a narcotic (noun).
Some drugs of abuse which have little or no narcotic effect (e.g., hallucinogens) have been
named in the law as "narcotics". Use Of the word as a noun should be restricted to the
legal meaning.
International control of drugs liable to misuse
Drug dependence is a world health problem, and a problem that must be tackled internationally.
As early as 1909 it was realised that action on an international scale was imperative in
order to combat successfully the growing opium traffic. The question of limitation of
production of opium in China was made the subject of international study by the International Opium Commission which met at Shanghai during that year.
Three years later came the Hague Convention which was aimed at limiting the use of
opium and its derivatives and cocaine to medical and scientific purposes. The Hague
Convention was wide in scope but confined itself to general principles leaving signatory
nations free to adopt differing methods of putting them into practice. This Convention
was signed by the United Kingdom on behalf of the British Empire.
The inadequacy of the Hague Convention of 1912 was felt when the League of
Nations endeavoured to co-ordinate the activities of nations into a more effective campaign against the illicit traffic in narcotic drugs. In 1925 the First Opium Conference was
held and it resulted in an Agreement, limited to countries having Far Eastern territories and dependencies, and a Protocol to the Agreement, relating to the gradual suppression and eventual elimination of use of opium prepared for smoking.
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The Second Opium Conference was held in the same year, resulting in the conclusion
of the Geneva Convention of 1925. This convention replaced certain sections of the
Hague Convention and made more detailed the obligations of signatory nations, particularly in regard to national controls, international trade and the furnishing of statistical
information to the Permanent Central Opium Board set up under the terms of the Convention.
The Gevena Convention of 1925 produced a much more effective control over the use
of narcotic drugs but there still remained one big weakness, namely that existing conventions placed a limitation only on use of drugs and as a result there was production of raw
materials and manufactured drugs far in excess of the world's requirements for legitimate
use. It was realised that the continued existence of these surplus substances increased the
danger of diversion of narcotic drugs into illicit channels. Limitation of production,
manufacture, importation, and exportation of such substances to medical and scientific
requirements was considered to be the most effective answer to this problem. The Limitation Convention of 1931 resulted from international action to attain this objective,
although less emphasis was placed on limitation of production of raw materials than on
limitation of manufacture and sale of refined drugs.
The first pästwar achievement of note was the Protocol of 1948 which brought under
the Limitation Convention of 1931 drugs of a type formerly outside its scope. Medical
advances prior to and during the war resulted in a number of synthetic narcotic drugs
being developed. The Protocol of 1948 enabled international control of such substances
to be exercised in the same manner as for "natural" narcotic drugs.
The postwar years showed a rapid increase in the production of raw opium, until the
estimated stocks were sufficient to supply legitimate world demands for many years and
annual production was far in excess of requirements. Such overproduction was reflected
in increased illicit trafficking of raw opium. It became clear that the Limitation Convention of 1931 did not place sufficient emphasis on the limitation of cultivation of opium
poppies and production of opium. In an endeavour to overcome this weakness an international opium conference was held in 1953. The Conference concluded the Opium
Protocol of 1953, the object of which was to place the cultivation and production of
Opium under a regime of control as stringent as that applying to the manufacture of refined narcotics.
Single Convention on Narcotic Drugs, 1961
With the coming into force of the Opium Protocol of 1953, the total number of
associated conventions and protocols reached nine. It has long been realised by parties to
these agreements that they should be codified into a single document setting out the obligations more clearly and eliminating anomalies caused by some of the treaties not being
complementary in all respects.
In 1961, after more than 10 years of preparation, such a document was signed by representatives from 61 countries throughout the world. This agreement, known as the
Single Convention on Narcotic Drugs, '1961, sometimes referred to simply as The Single
Convention, replaces all previous treaties.
35
Being a codification of the previous agreements the Single Convention covers all
aspects of the control of narcotics. For the first time it provides for the names of all
drugs brought under this international control to be listed in or, by simple amendment
procedures, added to the one document,
Parties are obliged to keep their imports and manufacture within the limits of their
estimates and may not export to another party, quantities in excess of the estimates of
that country.
Parties to the Single Convention are required to furnish information to the Narcotics
Commission including an annual report of the operation of the Convention. The annual
report must include detailed statistics of drug dependence. Details of narcotics legislation
passed and reports of cases of illicit trafficking must also be supplied.
The basic requirements of domestic control of the illicit trade as contained in the
Single Convention are that:
(a) manufacture, trade, and distribution of narcotics shall be permitted only under
licence, issued to properly qualified persons;
(b) supply of specified narcotic drugs to the public, shall be on prescription only;
(c) detailed records of all processes and transactions involving narcotic drugs must be
kept by licensees and all commercial operations subject to regular government
inspection;
(d) action must be taken against illicit trafficking, with national authorities coordinating their preventive and repressive measures and co-operating with other
countries;
(e) serious offences involving narcotics are required to be punishable by adequate
• penalties, particularly imprisonment; and
(0 parties are required to give special attention to the provision of facilities for the
medical treatment, care, and rehabilitation of drug dependents.
Further International Control
Almost immediately after the Single Convention came into effect it was clear that the
problems of drug dependence and drug abuse were expanding explosively and that the
drugs involved extended far beyond those which were under international control. Most
of these are synthetics - some known for many years, but the majority of quite recent
origin.
The Commission on Narcotic Drugs of the Economic and Social Council of the United
Nations, together with the World Health Organisation, asked for an evaluation of this
newer type of drug abuse and co-ordinated a search for methods of control. From this
study the community of nations has enacted a new treaty, the Convention on Psychotropic Substances 1971. Psychotropic substances are drugs which have an effect on the
mind and are liable to be abused or to induce dependence. By this convention, signatory
countries undertake and bind themselves:
(a) To strengthen (or, in a few countries where it has not already been instituted, to
put into effect) internal controls on psychotropic substances;
(b) To institute a licensing system for manufacture, trade, import, export, and distribution;
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(c) To give special attention to the provision of facilities for medical treatment, care,
rehabilitation, and social reintegration of dependents on psychotropic drugs;
on much the same lines as provided for narcotics.
Control of Narcotics and Psychotropic Drugs
As a party to the Single Convention on Narcotic Drugs, New Zealand already has obligations, and is likely to have more, which require control of the legal trade, distribution
and possession of a wide range of drugs, and suppression of illicit trafficking in them.
The "competent authority" to do this is the Director-General of Health, but the responsibility for all aspects of suppressing illicit activity, and for some aspects of legitimate
distribution and use is given by Parliament to the Customs Department and the Police.
The Health Department is responsible for legitimate distribution and medical use within
the country and is the co-ordinating body for the purposes of the Single Convention and
any Protocols that may be added to it.
New Zealand's performance in controlling drugs is under the constant surveillance of
the international controlling bodies - the Commission on Narcotic Drugs of the Economic and Social Council ("ECOSOC") of the United Nations, the International Narcotics
Control Board, and the International Criminal Police Organisation (ICPO or Interpol). An
annual report on the operation of the Single Convention is required to be furnished by
the Director-General of Health to the Secretary-General of the United Nations Organisation, and the Commissioner of Police reports to Interpol. There is a continued exchange
of information, in their appropriate responsibilities, between these people and bodies.
Types of Control of Drugs
Every country develops its own system of control of drugs. Superficially these systems
may appear dissimilar because they operate under different types of constitutional or
legal framework and in countries of varied economic and social development. Function ally they all embody application of the same principles and aim at similar end results. But
drugs affect people, so some of the law appears to be directed to people rather than to
drugs. A number of laws are involved in New Zealand and these divide drugs into several
categories to which different conditions apply.
Prohibited Substances
This is a misnomer, for there are no drugs which are absolutely prohibited in New
Zealand. What happens is that possession, distribution, and use is illegal outside a specific
or general authority which can be given sometimes by the Minister of Health and sometimes by the Director-General of Health. It is in this way possible to "tailor" an authority
which is appropriate to the particular drug and the purpose of use. These restrictions can
arise partly under the Narcotics Act, but principally under the Poisons Act with drugs
such as cantharidin, LSD, thalidomide, mescaline, and D.M.T. or under the Food and
Drug Act with new drugs about which not enough is known and research is necessary.
Narcotics
The classification in law is not to be confused with the pharmacological (effect on the
body) meaning. Many drugs having pharmacological narcotic effect are not legal
RIVA
Narcotics: a few legal Nacotics do not have narcotic effect. They are the drugs recognised
as having the greatest potential for causing or supporting dependence. There are various
types of dependence - the morphine type, the cannabis type, the cocaine type. All have
elements of compulsive use.
Only persons licensed or authorised to do so may import, export, manufacture, distribute in any way, or be in possession of any of these drugs. Most of these are required
to keep balanced accounts of their receipts, disposals, and stock. A patient may receive
the drugs only on a medical prescription.
Prescription Poisons and Restricted Drugs
These are drugs which should, for a wide variety of reasons, be supplied and used only
upon the written prescription of a medical practitioner. Some are anti-infective agents
like antibiotics, sulphonamides, and drugs used for the control of tuberculosis, the indiscriminate use of which may decrease their effectiveness through the appearance of drug
resistant organisms. Some alter the hormonal balance of the body. Some can, as "side
effects", cause serious damage to various functions or organs of the body - blood cells,
kidneys, thyroid function. Some have not been used long enough for their probable
dangers to be known. An evaluation of the benefit which the drug may bring compared
with the unwanted effects must be made in individual cases.
Some of the prescription poisons have a profound stimulant or depressant effect upon
the brain, and have been used to excess for their ability to delay fatigue, as an escape
from the problems of daily living, or simply for "kicks". Most of this group can produce
dependence, often physical, always psychological. It is probable that most of this group
will be controlled more closely in a somewhat similar manner to the Narcotics under the
Convention on Psychotropic Substances.
Only persons licensed or authorised to do so may import, export, manufacture, distribute in any way, or be in possession of, any prescription poison or restricted drug. A
patient may receive them only on a medical prescription. Traders are required to keep
records of all disposals and be able to produce evidence of receipts.
Medicinal Poisons
These fall into two groups, and may be sold only in pharmacies; the first by a pharmacist, personally; the second by an assistant with the pharmacist's agreement. In many
cases (particularly when there is a doctor's prescription) a record of the supply must be
kept. The pharmacist has the responsibility of pointing out to a person being supplied,
any danger in the use of the drug and has the right (indeed the duty if he thinks there is
likely to be misuse) to refuse any sale.
Some drugs in these groups can be abused and can cause some dependence. But their
potential is not as great as is that of the narcotics or the prescription poisons.
Open Selling Drugs
There is a limited number of drugs which may be sold by anyone. This does not mean
that their use is altogether free from the risk of causing harm. They can be misused or
overused and cause mild types of dependence or, in a few cases, iatrogenic illness.
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Advertising of Drugs
The Food and Drug Act sets out some requirements and some prohibitions in advertisements for drugs. As instances; the name and address of the advertiser must appear; claims
must not be false or misleading; testimonials or claims that any person uses the drug are
prohibited; references to many illnesses are prohibited or restricted; statemenst must not
qualify or be contrary to, any that are specifically required by regulations; The Poisons
Regulations prohibit claims that any drug is safe or non poisonous or non habit forming
and require a few statements like "Poison" or "Caution: It is dangerous to exceed the
stated dose" to appear in advertisements.The legal principle of Caveat Emptor - let the buyer beware - still applies. There is
nothing to insist that the advertisement be "balanced" in setting out advantages and disadvantages of the drug. The prominence to be given to required statements is not specified, so a reader- may miss them. There is nothing to prevent advertising puffery; the
promotion of imaginary needs which the product advertised can claim to satisfy; or the
making of the "open ended comparison" which cannot be tested; or the use of other such
promotion techniques.
Labelling and Storage
Good labelling is designed to encourage users to read warnings before opening containers. As -a minimum labels are required to show:
(a) The name or identity of the drug. In some cases this may require reference to
the prescription records of a pharmacy, hospital, or doctor to establish clear
identity.
(b) If for internal use, the recommended dose and frequency of dose;
(c) The name and address of the supplier - either the immediate supplier or wholesaler or manufacturer. -
In some cases additional information or warning may be required. Labels are also often
advertisements and should be subjected to the same critical view.
It is usually difficult, if not impossible, by looking at drugs to identify them or to tell
their strength or whether they have deteriorated. Deterioration may take place by access
of moisture, air, light, or chemical interaction with some other substance (perhaps another drug).
It is of considerable importance, then, to keep drugs and medicines in their closed
original containers with the original label, protected from light and moisture and, because
many can be poisonous if improperly used, to ensure that children cannot gain access to
them. It is also important to destroy drugs and medicines when the purpose and time for
which they were obtained is past. (The best method of destruction is probably the simple
one of putting them down a drain.) Availability
Under the groupings of general classes of drugs given above, brief reference is made to
the circumstances and conditions under which they may be sold. But it must be remembered that in the majority of cases the word "sold" has the extended meanings of
"give", or "bartered", or "lent", or "supplied as part of a service". It follows that
except for the small group of open selling drugs, their supply must be by a doctor, dentist (or veterinary surgeon - for animals), hospital, or pharmacy, on the conditions which
apply to these licensees or authorised persons, or the supply is illegal.
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Possession
The possession of narcotics, prescription poisons, and restricted drugs is illegal unless
the person who has them is licensed or authorised - much in the way that the driving of a
motor vehicle is illegal unless the driver is licensed. And in the manner that the onus of
producing his licence is on the driver, the responsibility of showing that he has authority
or reasonable excuse for having them rests with any person found to be in possession of
any of these drugs, often whether he knows what they are or not. This is an added reason
for never removing drugs from the labelled container in which they were received, because the label often has the information of the name of the supplier, the patient's name,
and a prescription number which will enable proof of the authority to be traced.
Dealing with offenders
New Zealand Narcotics Law clearly distinguishes between trafficking and possession,
the penalties for which are light by overseas standards.
In fact the Courts may, and generally do, impose far lesser penalties than the maxima
set out in the relevant Acts having regard to the person involved as well as to the seriousness of the offence. Often rehabilitation of the offender is the immediate aim, and the
Court may order and arrange for this in lieu of other penalty, or as a condition of probation.
Procuring, receiving, storing, using or otherwise having in possession, and without reasonable excuse, any prescription poison or restricted drug renders the person liable to up
to 3 months' imprisonment or to a fine of up to $400 or to both.
For illegal importing, exporting (including smuggling), cultivation, production, selling,
supplying, administering drugs classed as narcotics under the Narcotics Act sometimes
even for offering to do these things, or possession for the purpose of trafficking, a Court
is empowered to impose up to 14 years' imprisonment or, in special cases, a fine of up to
$2,000. For mere possession of narcotics and for some other offences, the maximum
penalty is 3 months' imprisonment and/or a fine of $400. For theft or "receiving" of
narcotics or false pretences or fraud to obtain a narcotic, the maximum penalty is imprisonment for 7 years.
Prescribing of drugs
In New Zealand the legislation makes provision for the prescribing of narcotics, prescription poisons, and restricted drugs only for medical treatment. What medical treatment is has not been defined; it depends on the professional judgment of medical
practitioners individually and collectively, and in realtion to the particular person who is
being treated. It may in some cases where there is also psychiatric or medical illness,
extend to the continuing prescribing of drugs for a person who is dependent on them.
But a drug dependent will sometimes not submit to the regiment of medical treatment.
He may seek illicit suppliers, or attempt forging prescriptions or taking other fraudulent
action, or seek attendance by more than one doctor. Because of the system of records,
inspections, and reporting, this soon becomes apparent if the drugs are narcotics. It is less
conspicuous if they are psychotropic substances.
A Medical Officer of Health may invoke the appropriate restricting provisions of the
Narcotics Regulations or of the Poisons Regulations. If he is satisfied that the person is
40
dependent or likely to become dependent on the drug, he may issue a notice restricting
the person to seeking the drug, or prescription for the drug, from one named medical
practitioner (or hospital). He may restrict the dispensing of prescriptions to a named
pharmacy, and may either prohibit the seeking and obtaining of any supplies of the drug
or drugs, or name and limit the maximum quantities of drugs that may be sought or obtained. If the person oncerned departs from the terms of such a notice the seeking,
obtaining, or possession of the drugs is illicit and the person becomes liable to the penalties set out above.
The ultimate sanction is an order for detention and treatment under the Alcoholism
and Drug Addiction Act.
Treatment of dependence
Persons dependent on alcohol, narcotics, psychotropic stimulants or sedatives should
be treated with a combination of the psychological, medical, and social methods best
suited to their individual needs, and then rehabilitated. Not all hospitals can provide satisfactory treatment programmes for such patients as yet.
Treatment services should be so planned as to provide support and supervision right up
to final rehabilitation. The problem has so many facets - medical, psychological, social,
and economic - that a wide range of services must be employed, closely linked with the
health services. In addition, any country with a problem of alcoholism or drug dependence needs to establish at least one specialised research and teaching hospital (or hospital
unit), associated with a university, to provide facilities for investigating every phase of
dependence from withdrawal to rehabilitation and to train medical and auxiliary staff.
Doctors, dentists, pharmacists, nurses, and social workers should receive instruction on
the subject of dependence.
The range of personnel, who should ideally be involved in clinical programmes on drug
dependence is wide; it includes physicians, psychiatrists, social workers, psychologists,
nurses, occupational therapists, and religious or lay counsellors. In some cases, good work
can be done by unqualified persons, particularly those who have themselves recovered
from dependence on drugs.
Treatment has to be preceded by diagnosis; so health workers, police, and magistrates
should be trained to recognise dependence.
High success rates have been recorded with special groups of narcotic addicts, but the
relapse rate is also very high. Even the most active treatment programmes reach only a
small proportion of those affected and are, at best, effective with only 50 percent of
those they reach. It is probable that more new drug abusers appear annually in any
country than are reached by treatment services. Hence the importance of prevention.
In short, drug dependence is an illness which needs treatment. A patient may never be
completely cured, but by gradual withdrawal of the drug, a return to comfortable, drugfree life is possible. Psychiatrists and social workers can help to abolish psychological
dependence upon the drug in time. The personal problems which first led to drug taking
can be understood and dealt with. Above all the sober fact that a return to drug dependence is very easy can be faced up to.
41
DRUG ABUSE SLANG
Some drug abusers have a language of their own which covers almost every aspect of
the abuser's life as affected by his habit.
There are variations in this vocabulary from one locality to another and there are
periodic changes, even in the same area such change may occur rapidly.
The following list contains formal terms and the equivalent jargon that is spoken by
persons who are using drugs or associating with drug abusers. Although this jargon originated with persons using drugs and their associates, it should be remembered that these
terms are often picked up as slang by non-abusers, particularly teenagers, and therefore
use of many of these terms cannot be considered evidence of drug abuse. However,
persistent use of these terms by pupils should alert teachers to the fact that pupils are at
least interested in drugs and to the desirability of discovering the reasons for this.
Expressions Associated With General Use of Drugs
Formal Usage
Drug supplier
To purchase drugs
To attempt to purchase drugs
Container of drugs
To have drugs
Prescription for drugs
Effect of a drug
Under the influence of drugs
To inject drugs
Equipment for injection drugs
Needle for injecting drugs
To take small amount of, on an irregular
basis
To be dependent on drugs
A fatal dosage of drugs
To abandon a drug habit
Withdrawn from drugs
42
Slang
Connection, peddler, pusher, the man,
dealer, friend
To connect, to make a meet, to hit, to
cop, to score, to make a buy
To buzz, to hit, to make it
Bag, cap (usually a capsule), a can
To be holding, to have gear
Reader, ticker, script
Bang, Loot, buzz, jolt, kick, coasting, let
down, flash, nod (i.e., on opiates), high
High, turned on, on the nod, hopped up,
charged up, blasted, coasting, floating,
lit up, wasted.
Taste, hit up, to drop, bang, mainline
(i.e., directly into a vein), pop, shoot
up, job, skin pop, joy pop (small
amounts irregularly)
Fit, spike, biz, factory, layout, machinery,
works, outfit
Spike, needle, gun, hypo
Dabble, week-end habit
Hooked, hung up, habit (i.e., to have one)
Hot shot, overdose, OD
Kick
Turned off, washed up, off
Formal Usage
Sudden drug withdrawal
Non-user of drugs
A personal problem
Party
Money
To have money
Arrested
Police
Wanted by police
Out of jail
To alibi or confess
To understand
Slang
Cold turkey, come down
Cube, square
Hang up
Ball, blast, scene
Bread, lace
To be flush, heeled
Been had, busted, hit
Man, bull, heat, fuzz, pigs
Hot
On the street
Cop-out
To be hep, to he hip, to have savvy
Expressions Associated with Dangerous Drugs
Formal Usage
Amphetamines
Methamphetamine
Benzedrine
Dexedrine
Barbiturates
Barbiturates mixed with amphetamines,
and the like
One who uses (prescription poisons)
Under the influence of barbiturates
Amphetamine intoxication
Slang
Speed, beans, yippee beans
Crystals
Bennies
Dexies
Barbs, candy
Goof balls
Pill freak, pill head, pilly
Goofed up
High
Expressions Associated with Marijuana
Formal Usage
Slang
Marijuana
Marijuana user
Grass, hay, weed, hemp, tea, T, pot, shit
Weed head, hay head, pot head, tea head,
head
Under the influence of marijuana
Flying high, high, on the beam, out of this
world, way out
Marijuana cigarette
Joint, reefer, stick, pot, weed
Roach
Butt of a marijuana cigarette
Light a marijuana cigarette
Torch up
43
To smoke a marijuana cigarette
Slang
Turn on, to blow a stick, blast, blast a
joint, blow, blow hay, blow jive, blow
pot, blow tea, get high
Stack
A quantity of marijuana cigarettes
Blasting party, tea party, pot party
Marijuana smoking party
Formal Usage
Expressions Associated with LSD
Formal Usage
LSD
Sugar cube or water impregnated with
LSD
One who takes LSD
Under the influence of LSD
An LSD "trip"
The act of taking LSD
Feeling the effects of LSD
The feelings a person experiences while
under the influence of LSD
To have unpleasant experiences
while on a "trip"
Vicarious experience that occurs by being
with someone who is on a "trip"
An experienced LSD user who helps or
guides a new user
Parties or sessions where LSD is used
A pseudo experience obtained through the
use of lights and sound; to have the
same type of experience that one has
with a drug
A deprecative term applied by LSD users
to social conformity and to the normal
activities, occupations and responsibilities of the majority of people
Emerging from an LSD experience
Slang
Acid
Cube or wafer
Acid head
On a trip, on a rip, on a voyage, bent out
of shape
Experience
Turning on
Tuning in
Out of the body, outside of myself
Freak out, bum trip
Contact high
Sitter, tour guide, guru, travel agent
Kick parties
Happening
Ego games
Coming down
Expressions Associated With Narcotics
Formal Usage
Slang
Any narcotics
Dope, goods, junk, shit, stuff, gear
Powdered narotics
Sugar
44
Formal Usage
Slang
Morphine
Dope, junk, M, stuff, white stuff, hard
stuff
Cocaine
Heroin
Hard stuff, flake, star dust, dust, coke
Hard stuff, Harry, joy powder, scat, dope,
junk, sugar, white stuff
Speedball
Fix, shot, jolt
Morphine or heroin mixed with cocaine
Dose of a narcotic
Poor quality narcotics
Various amounts of a narcotic
Small packet of narcotics
To adulterate narcotics
A narcotic addict
Occasional user of narcotics
In possession of narcotics
Opium addict
Under the influences of narcotics
Narcotic habit
Attempt to break the habit
Method of curing addiction without
tapering off
Nervous or jittery because of need or
desire for narcotic injection
Paraphernalia for injecting narcotics
An injection of narcotics
To sniff powdered narcotics into nostrils
One who injects narcotics into veins
Place where narcotic addicts inject drugs
Prescription or packet of narcotics
A capsule purported to be narcotic but
filled with a non-narcotic substance
To inject narcotics
Blanks, Lipton tea, flea powder
Bag, bird's eye (extremely small amount),
cap, paper, piece (1 oz, a large amount
usually heroin), taste, things, deck
Bag, balloon, bindle, deck, foil, paper
To cut, to sugar down
Hop head, hype, junkie, hooked, on the
stuff, strung out
Joy popper, skin popper, chippy
Dirty, holding, straight
Gow head
High, litup, goofed up, knocked out, on
the nod, stoned, wired
Habit
Kick, kick the habit, sneeze it out
Cold turkey, cold
Frantic, sick
Biz, business, dripper, dropper, factory,
fit, gun, joint, kit, lay-out, machinery,
outfit, point, spike, works
Shot, fix, bang, hit, jolt, pop
Snort, sniff, horn, smack
Hype, junkie, mainliner
Shooting gallery
Paper
Turkey
Shoot up, mainline
45
Appendix - TABULATED DRUG INFORMATION CHART
.rotenuai sor uepl
Pharmacologic
ClassificationControlsMedical Use
Physical Psyc
Drugs
1. Morphine (an opium
derivative)
Central nervousNarcotic
system depressant (Narcotics Act 1965)
To relieve painYesYes
2. Heroin (a morphine
derivative)
DepressantNarcotic
(Narcotics Act 1965)
To relieve painYesYes
3. Codeine (an opium
derivative)
DepressantNarcotic To relieve painYesYes
(Narcotics Act 1965) and coughing
For sedation and YesYes
4. Paregoric (preparationDepressantPoison
(Poisons Act 1960)to counteract
containing opium)I
diarrhoea
DepressantNarcotic
5. Pethidine (synthetic
morphine-like drug)
(Narcotics Act 1965)
To relieve painYesYes
6. Methadone (syntheticDepressantNarcotic
(Narcotics Act 1965)
morphine-like drug)
To relieve painYes
7. Cocaine
Local anaesthetic No
8. Marijuana
Central nervousNarcotic
system stimulant (Narcotics Act 1965)
I Hallucinogen
9. Barbiturates (e.g., amylo- Depressant
barbitone, pentobarbitone
quinalbarbitone)
Narcotic
(Narcotics Act 1965)
Yes
Yes
None NoYes
Prescription PoisonFor sedation, sleep YesYes
(Poisons Act 1960)producing, epilepsy, high blood
pressure
10. Amphetamine drugs (e.g., Stimulant
amphetamine, dextroamphetamine, methamphetamine - also known as
desoxyephedrine)
Prescription PoisonFor mild depres- -NoYes
(Poisons Act 1960)sion, anti-appetite,
narcolepsy
11. LSD (also mescaline,Hallucinogen
peyote, psilocybin, DMT)
Narcotic (Medical research NoYes
(Narcotics Act 1965) only)
Prohibited Substance
(Poisons Act 1960)
12. Glue (also paint thinner, I Depressant
None
46
None Unknown Yes
/
V)M
27041329
N.Z. Dept of Health.
The use and abuse of drugs.
S1AC
342
WM
270 NEW
41329
LIBRARY,
DEPARTMENT OF HEALTH.
P.O. BOX 5013,
WELLINGTON.
25,000 Bks/2/71-4494D
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