Special of the week; Issue 29-70 "Drug Dependence"

The world today pauses in its rush consoles its despair and summons up its energy by using drugs in a hundred forms. A typical businessman for example goggles and fetching means to get a boost tranquillizers to ease his anxiety and barbiturates to summon sleep. He has probably never been a time when man has not sought and found a shortcut to happiness through drinking smoking or swallowing some form of drug. What is a drug. Well a drug is any substance that causes a change in man's body or way of thinking and feeling. The danger of drugs is abuse or addiction with. The growing use of some of them emphasis was recently put on marijuana and LSD. The World Health Organization called for greater control of the approximately 100 so-called narcotic drugs which represent a danger to public health in connection with a recent meeting of the WHL expert committee on drug dependence. A press conference was held on the subject with Dr. Dale C. Cameron chief who drug dependence unit

in the course of this press conference many questions were raised to which Dr Cameron who is also a psychiatrist gave comprehensive answers. First of all Dr Cameron gives a short history of W H O's interest in drug control. He then proceeds to give definitions of the different forms of drug dependence culminating. Definition of drug abuse or addiction doctor. In the earlier days the WHL the primary interest. Relative to addiction producing drugs as they were then called. Was with the control of the drug itself. To try to control its circulation and distribution. As time has progressed it became increasingly apparent not only to whl but to the United Nations which were going in this field. That man takes these drugs and that he also makes

them and therefore it was necessary to be concerned about the drug dependent person or the drug taker and the environment in which he lived as well as with the substance. He took now. Narcotics such as opium and its derivatives. Coca leaf and cocaine and cannabis have been under international control kind of Us or marijuana have been under international control for some time. But new drugs are tending to come to the fore and be abused drugs such as hep pills the amphetamines certain hallucinogens such as LSD and barbiturates sedative use and certain governments are already beginning to place some of these substances under control. Let me just say parent Thetic play here something about the nature of

dependence that may help your understanding of what I have to say in a moment. In general there are three things to think about. When one talks about drug dependence psychic dependence that is a compulsive desire to take the drug for the psychic effect that it produces is the only common denominator in all of these drugs. It is the most important factor in the initiation of maturation of drug dependence and lapse into drug dependence. If withdrawn from drugs it's common to all of them. And there are dependences of the morphine type of cocaine type of the cannabis type. Of the barbiturate of the amphetamine type. Type and the hallucinogenic type in a. They have different manifestations and psychic dependence is common to them all. Second there may or may not be physical dependence that is by physical

dependence. If you become physically dependent It means that if the drug is taken away from you. You will become sick. Your body has just had to have a drug that you will become physically ill if it's taken away. Physical dependency exists with the opiates and the barbiturates and with alcohol but not. With them. Setting means not with cannabis and not with some of the other drugs. This has resulted in a lot of argument as to whether or not certain drugs are quote addicting because they may or may not produce physical dependence. But the fact is that it's the psychic dependence that's a important consideration. The third thing that usually thought of in this connection is tolerance that is if a person becomes tolerant it takes an increasing dose to produce the same effect and you have to keep raising the dose. Cannabis does not produce tolerance. Opium does and that means produce a remarkable tolerance it is possible for a person to

take several hundred times the usual dose of amphetamines by building up over time a dose which if taken at the outset would kill them. He has become tolerant to it. All right. Now back to these drugs and the criteria for their control. There are the drugs. Which are being produced for use in medicine. And here one would look at. Scientific evidence from the laboratory as to whether or not the drug will produce psychic dependence or physical dependence and may have therefore a capacity. To produce drug dependence and the effort would be to bring this drug under control before it ever gets to the market. This is what's been going on in relation to certain synthetic opiates over the years. There is the second situation a drug is already on the market either as a medicine or on the illicit market as hallucinogens are

when and how does one decide that this drug is being abused because of its psychic defense characteristics abuse to the extent that it should be brought under control and the expert committee said that when it exists in more than a particular local area. Where its effects are quite serious. When there is communication or a spread of the dependence from persons already dependent to those who are not communicability. And when there is beginning to develop and illicit traffic that is the availability of the substance outside of the usual medical channels. When this happens then you probably have a public health problem in relation to drug dependence and the drug should be brought under control.

Cannabis is the scientific name for what is also called Indian hemp hash pot. We need grass. True on the question of what sort of dependence cannabis produces and whether or not it is necessary to control it. Dr Cameron has this decision. Cannabis produces psychic dependence or simply can be no question about this. It does not produce physical dependence. It simply doesn't do it and it doesn't produce much of any tolerance in other words you don't have to keep increasing the dose to get the same Okay. These are the facts whether or not you want to call that an addicting drug or a dangerous drug is something else again. But we do know that some person because of the psychic effect use it repeatedly. Almost to the exclusion of any other kind of activity. It now depends on your moral values as to whether or not you want to call that harmful. It would become illegal. Health problem if it involves many

persons in the community and in some communities some countries it does not involve many persons or there are a good many persons who appear to be debilitated. As a consequence of its continued use of it let me hasten to add that the committee in reviewing this point noted that there was really insufficient scientific evidence about the long term effects of cannabis use and urged further study in this field. The question is is it of sufficient import to make it important to control the substance which produces the psychic dependence. But with the case of cannabis and with the other drugs under control it is concluded that the repeated using of these drugs a complete preoccupation. With their acquisition and use. Does not only harm the individual. But the society of which he is a part. It's therefore a public health

problem. Young people have often protested that cannabis is no more dangerous than alcohol. On the question of the comparative hazards of alcohol and cannabis you may have noticed this a spoke of different classes of drugs that I included. Alcohol is a dependence producing drug and it is as society has chosen for one reason or another in most countries not to control it. I can speak of the United States because I am relatively more familiar with their data. There are approximately. 80 to 90 million persons who drink. Out of roughly 200 million persons of all ages of those who drink. About six million or roughly. Six percent. Of drinkers. Drink to the point.

That it interferes with their life or their relations with other persons and that might be some kind of a criterion for saying they have a problem with alcohol or that they may be chronic alcoholics. Roughly six percent of drinkers I think the figure in the UK is not too different. As a percentage of those who drink a figure 6 percent of persons who drink a very high price to pay for the privilege of the other 94 percent. Certainly it's a public health problem. Now. It is not for health agencies alone to decide unilaterally. Just how certain health problems will be dealt with. There are social problems here as well. No question but what alcohol is a public health problem. The next question is whether that society wishes to control it. This is not alone a medical decision a medical decision can be taken that it's a public health problem no question about that. But whether you want to deal with it by controlling the drug or in

other ways is a question for decision. Beyond medicine but one in which medicine may play a part. Point two you observe that this apparently is greater in extent in some populations than cannabis use. I suspect that's probably true in most western countries. However the fact that cannabis remains illegal may be one reason that it is less of a problem. I don't know what the controls on it may have been very important in maintaining this situation. We do know that if you take cannabis in intoxicating amounts it distorts your perception your sense of time and would probably result in the same kind of road accidents that alcohol does because when you take alcohol it distorts your judgment and your sense of time and your ability to respond. I am not much impressed frankly by the argument of that quote cannabis is no worse than alcohol and

therefore it should be legalized because alcohol is legalized. I simply am not much impressed by this one might if one wanted to simplify I'd say that this is the two wrongs makes a right argument and I think it's quite clear that the number of persons who become billeted through dependence on cannabis is relatively small as compared with the number who have tried it. Time for another. The same is also true of alcohol. Relatively small 6 percent. All I can tell you is that there are many many people who've used it who did not become debilitated. There are also quite a number who have become dependent but the ratio is I simply am not prepared to say why have they become debilitated. I suppose because of the psychic attractiveness of the drug they like the way it makes them feel and they return to its use so frequently that they get essentially nothing else done. I'm not talking about the kid who occasionally smokes one stick.

If you subscribe to a set of values which call for persons to be as productive as possible then in supporting themselves and so on. If you subscribe to such a set of values then the person. Likes cannabis so much that he never gets anything done of that kind. You could say that that is not a very useful thing. If on the other hand you subscribe to a set of values which say that to experience the usual. Psychic feelings and to ruminate over them is a perfectly acceptable way to spend your life. Others should support you. Why do you do this that you can say that this is not very high on the question of the physical and psychic effects of cannabis. Dr Cameron says this trying to be factual. First of all I wouldn't start out by saying this is dangerous. I would say these are the things that cannabis will do. If you take enough cannabis to intoxicate you

first things that will happen is that there will probably be some distortion in your sense of time. It may well be that it will seem as though Time passes very slowly. Or it may seem that it passes very quickly. If a fly lights on the end of your nose it may seem an eternity before he flies away. But there is this kind of time distortion that may occur. I don't particularly care kid that that's bad or good. I just want to tell him that that's what'll happen. And then I would like to tell him also that if he takes continues to take more he may begin to see colored lights and colored visions of one sort or another. If you continue to take heavy doses of it a certain proportion of persons become panicky or a certain small proportion become psychotic. And have to be taken to a mental hospital. A temporary kind of psychotic episode may occur.

It may also produce respiratory irritation. And difficulty in the lungs because it's an irritant it produces errors in judgment. It tends to give one a feeling of a sense of accomplishment when indeed he has done relatively little or relatively nothing. Let me give you an example. Years ago I took care of some musicians some of these were very excellent musicians from back and they say use marijuana because at that time jazz was popular and they thought it was possible because of the slowing up of time. Play more notes and therefore get in more hot licks and to play better. And they were convinced. That this was happening and they felt very good about the way they played. I resorted to the very simple expedient of recording them while they were intoxicated and playing the record back to them when they were

sober and they said was that me. That's terrible but at least it demonstrated to them. That their sense of accomplishment. And their judgment about it was distorted while under the influence of cannabis and that it had really interfered with their ability rather than answering it. And all studies using cannabis or LSD and things of this kind that have tried this kind of approach have turned up to show that rather than enhanced in creativity it tends to degrade. Dr Cameron was asked whether the use of marijuana or alcohol led to the abuse of heroin in the United States 75 percent of heroin users indicate that they used marijuana. First there are four. The conclusion is drawn that marijuana leads to peril. Of course that's why they spurious reasoning.

One would need to know how many persons used marijuana and never progressed to heroin. And obviously the number is very great indeed. Even though we don't have a good count because the number of heroin users is somewhere in the States somewhere around 100000 I would guess that the number of people who've tried marijuana exceeds that by several for. So I can accept that it inevitably leads to heroin. Some persons just because they are both illicit illegal drugs they are sometimes to be found in the same channels. And if. You because of some. Peculiarity or difficulty of personality you're looking for some kind of thrill. Or satisfaction. And cannabis doesn't give it to you and you've made contact with a man who has cannabis you probably have make contact with them and with them give you

something stronger if you want it. In that sense they run in the same trade channels and for the person who is susceptible. To abuse of drugs it makes it easier for him to get a hold of her. That's because these ladies contact first on another. I think these may be the associations rather that there's no chemical reason to believe that one would leap to the other. Indeed the kind of psychic feeling that the cannabis user usually seeks is not the kind of feeling you ordinarily get from here since I can't really believe that there is any chemical reason why marijuana would lead to heroin. I wouldn't have any. Thing to say on that point. But some persons apparently have a greater need for crutches of this kind. Than others. And if you try cannabis and it isn't a sufficient crutch for you having broken the ice it is entirely possible that it will be easier for you to seek a stronger crutch.

Thirty years ago in the United States to have been an alcoholic first and to progress to heroin was a rather common story to be heard from heroin users. It's a rarely heard story today. I don't know why this is true. The heroin user of 30 years ago in the states was for the most part middle aged Caucasian. The heroin user of today in the States. Is apt to be Puerto Rican or Puerto Rican as Caucasian. And he is much younger. And if you wanted to be rather cynical you could say he has not had time to become an alcoholic. On the problem of pills such as LSD and barbiturates are useful in the abuse they control. Dr. Cameron comment. Well some of the drugs causing more serious problems in some countries at the moment are certain types of central nervous system stimulants such as the

amphetamine methamphetamine meth Adrain things of this kind. These drugs have relatively little usefulness in medicine and therefore there I should have mentioned earlier that in deciding on levels of control expert committee said that you should take account of two things the extent of the public health problem and the usefulness of the drug in medicine. If it's a very useful drug you want to control research that it can be readily available for use in this way without escaping to illicit channels. And I'm saying now that most of them. Aren't all that useful in medicine. They do have some specific indications but putting them under reasonably strict control would not embarrass the practice of medicine to loose an agenda such as Ellis. Have essentially no use in medicine except on an experimental basis. And. The dangers inherent in intoxication from

LSD are fairly substantial. And therefore some reasonably strict controls of this substance would be in order. You get to a more difficult problem when you talk about barbiturates because they are abuse no question about it very widely and yet they're very useful and effective medications and widely used and this will present a very special problem of how the rise of appropriate controls are there to be done. If they are to be made internationally many national governments have already put them under control. On the question of the possible. Effects of LSD Dr. Cameron say they're still kind of an open question. The original reports which indicated that it would produce great chromosome so it will. The way they did it first to put white blood cells in the test tube and introduce LSD in my blood cells to their broken chromosomes All right. So I asked for the question then arises as to whether or not this

particular rating is significant whether or not it can be passed on genetically to your offspring. That isn't nearly so clear. I think it's still an open question as to whether or not there is any significant genetic effect of LSD. How should young people be informed about drugs. What attitude should be adopted towards delinquent it's due heavy penalties deter addicts. Taking drugs Dr. Cameron has this to say I think it's quite important. Where there is. The possibility of getting ahold of drugs of various types. That young person has to be given factual information. About the effects of the drugs. And has not moralistic away as one possibly can you're saying if you tell. College students. That anyone who ever smokes a reefer will inevitably become

dependent on marijuana. He will not believe one further thing you say because he knows what you have just said is absolute nonsense. And if you start out on that kind of a tack then. You've lost your audience. I think it's important therefore that information be given factually as one knows how and not moralistic told him if this is done and I'm convinced that most young persons have the capacity to make sound judgments for themselves. If a person. Is apprehended. Carrying out an illegal act. Then I think it's not. Speaking now is it. It's an individual not as a physician I think it's not appropriate to ignore. This illegal act. To do so I believe. Would help him gain a disrespect. For the

laws and rules of society. So as long as it's illegal I think you can exactly Nora. But at the same time I think it's utter nonsense. To talk about penalties of years and years in prison. For such an act. I'm sure that heavy penalties probably has some deterrent effect. On how heavy the penalties need to be in order to have as much deterrent effect as they're going to have. I don't know. I would suggest that certain types of unlawful activity. Made tend to be deterred by penalties of imprisonment. Others might tend to be deterred by other kinds of penalties for example. When it was a capital offense. In Great Britain to steal Brit. People still stole bread. I suppose one could reason that if you're starving to death and you don't get some bread the penalty

of threat of capital punishment isn't very meaningful because you're dead anyway. There is a substantial hunger in connection with drug dependence. There is a psychic drive to have the drug. There is a psychic hunger. I therefore am not convinced that heavy penalties are likely to have a powerful deterrent effect on the person who is already dependent. They may have a substantial bitter enough effect on the person who is not yet dependent. You have this kind of argument. Then you also have the possibility that the fact that a thing is frowned upon by society may make it attractive to some people. I don't know whether this is. True or not but you hear this kind of argument. I can only say that from myself. First of all as far as I know w h o is taken no position on the question of penalties but for myself there would seem to be some

need to keep penalties reasonably commensurate with the hazard or nature of the Act to be deterred. Finally on the question why are most people not taking drugs. And how is it possible to. Event drug dependence Dr. Cameron concludes by saying why are there so many persons who do appear to have some personality difficulties or who live in very strange social circumstances and where drugs are available. Why do they not use drugs. And it's just as important for us to learn why people don't use them. As it is to learn why people do use them and this is a line of research which is very important to follow because by doing this we may learn something about how to help prevent the drug dependence. Astonishingly there has been relatively little study of the why not.

Oh I can do is read to you but colleagues from some of the countries have said to me I understand from colleagues from the Soviet Union that there is relatively little dependence on anything aside from alcohol alcohol problems they have and how great a degree and I can't say. But they seem not to have as major problems as some of the others and some of the other eastern countries there is an increasing problem according to persons from those countries with some drugs in general. But I can speculate as to why this might be so. But these are what some colleagues from these countries tell me. This is the national educational radio network.