CHOOSE YOUR POISON

Who Uses Drugs, And Why

Most drug users live in the poor world, not the rich. Countries such as
China and Pakistan in the case of heroin, and Colombia (South America's
second most populous country) in the case of cocaine, have local traditions
of drug use and vast uprooted urban populations to provide expanding
markets. In future, growth will be concentrated in developing countries and
the former Soviet Union.

At present, the markets with the big money are in the rich world, where the
markups between import and sales prices are highest.

Here, not surprisingly, most people buy the drugs that have the fewest side
effects and are least likely to cause addiction.

In that respect, drug users seem to behave as rationally as other consumers.

Everywhere, the most widely used drug by far is cannabis.

At some point or another, about half the people under 40 in America have
probably tried it. In time, as many adults in the rich world may have
sampled cannabis as have tried alcohol.

In many social groupings, especially in large cities, using cannabis has
already become more or less normal behaviour. "The last time anyone offered
it to me," recalls Paul Hayes, a senior British probation officer who has
just become head of a new drug treatment agency, "was after a primary
school parent teacher association disco, in the home of a Rotary Club
member, and the person was a detective sergeant in the Metropolitan Police.
If that's not normalisation, I don't know what is." Prudently, Mr Hayes
refused.

Other drugs are becoming part of the normal weekly pattern of life in some
social circles.

Amphetamines and cocaine, like cannabis, are mostly taken sporadically, and
are used far more heavily by the young than by the middleaged. Simon
Jenkins, a former editor of the Times and member of an inquiry into drugs
and the law under Lady Runciman, argues that London's vibrant clubbing
scene is clear testament to the profusion of drugs available there: how
else would people have the energy to dance all night? Most drug users, like
those clubbers, are occasional dabblers.

A 1997 survey of western German drug users sets the tone: just under 80% of
cannabis users take the drug no more than once a week, and almost half take
it fewer than ten times a year With ecstasy and cocaine, users
indulge even less often.

With drugs, as with alcohol, a minority of users tends to account for the
bulk of consumption. In America, for instance, 22% of users account for 70%
of use. Heroin use is probably even more dominated by frequent or dependent
users. Most drug users, it seems, understand the risks they are taking, and
approach them rationally. Of Europe's adults, at most 3% are likely to have
tried cocaine; fewer than 1% have ever sampled heroin.

Most drugs do not appear to be physically addictive.

Views on this may eventually change: in laboratories all over the United
States, unfortunate rats are being put into drug-induced hazes as the
National Institute on Drug Abuse (NIDA) spends its hefty budget on a mass
of research on the impact of drugs on the brain.

Recent work on people who give up a heavy marijuana habit seems to show
that they suffer anxiety and loss of appetite.

However, for the moment, the evidence suggests that neither marijuana nor
amphetamines are physiologically addictive.

Many people find it hard to abandon crack cocaine once they have tried it a
few times, but when they do, they do not appear to become physically ill,
as they would with heroin--or indeed nicotine or caffeine. "Heroin is a
true addiction, with a recovery rate of 40 - 50%," explains Giel van Brussel,
who has been head of Amsterdam's addiction care department for many years.
"With cocaine, the recovery rate is around 90%, so we don't see it as such
an enormous problem." That is rare sanity from a policy-maker, but then
Dutch policy-makers are saner than most.

Even with the most addictive illegal drugs, only a minority of users seems
to get hooked.

With heroin, according to figures from America's National Household Survey
on Drug Abuse, one user in three is dependent. Alarming--but not compared
with nicotine, which appears to be the most addictive drug of all: one
study quoted by America's Food and Drug Administration found that 80% of
cigarette smokers were addicted. David Lewis,
professor of alcohol and addiction studies at Brown University in Rhode
Island, reckons that the relapse rates for those who try to give up are
higher than those for heroin or crack cocaine. If the aim of drugs policy
were to prevent harmful addiction, the main target of drugs enforcement
agents would clearly be tobacco smokers and their dealers.

Studies of the routes by which people come to take up drugs have had a huge
impact on policy.

Most influential has been the "gateway" theory, suggesting that soft drugs
lead on to hard drugs: if cannabis is the path to crack cocaine, then
clearly the sooner that path is blocked, the better.

Guesswork About Gateways

In fact, this turns out to be nonsense.

Certainly, most people who take "hard" drugs have usually first smoked
marijuana.

But, as Lady Runciman's excellent report on the misuse of drugs in Britain
argued last year, for the "gateway" theory to be proved correct requires
not just that cocaine and heroin users are highly likely to have taken
cannabis; it also requires that cannabis users are highly likely to move on
to cocaine or heroin.

Yet the vast majority of cannabis users do not graduate to these more
dangerous drugs.

Moreover, there is no reliable evidence indicating that taking marijuana
pharmacologically disposes people to later use of heroin.

But work at Johns Hopkins University shows that children who drink and
smoke in their early teens are disproportionately likely to progress later
to marijuana.

And a study in Britain found that the probability of 11-to-15-year-olds using
an illicit drug is strongly related to underage smoking and drinking.

Beer and cigarettes seem to be gateways to marijuana, but marijuana does
not seem to be a gateway to other drugs.

Whether somebody becomes a heavy drug user seems to depend on other
factors. Heredity may play some part, and so may social conditions: recent
American research has found that drug use is 50% more common in households
that are welfare recipients than in those that are not. And family
circumstances may interact with personality. Mr Hayes, after a long career
in the London probation service, sees a typical user as "someone who is a
risk taker--whose lifestyle involves bending rules." Part of the lure of
drug taking seems to be the sense of danger.

The question is how far people should decide for themselves whether to take
such risks, and how far the government should make that decision for them.

Next article: http://www.mapinc.org/drugnews/v01.n1362.a06.html