Social Aspects of Drug Misuse

Substance Misuse - NICE Definition



  • Substance misuse is defined as intoxication by, or regular excessive consumption of and/or dependence on substances that have an effect on the brain, which leads to social, psychological, physical or legal problems 
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Legal Drugs

Some examples of legal but restricted drugs:

  • Caffeine
  • Tobacco
  • Alcohol
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Caffeine

  • Sales of energy drinks to children under 16 have been banned in most major UK supermarkets, amid concerns about high levels of sugar and caffeine.
  • Boots is also joining supermarkets such as Asda, Waitrose, Tesco and the Co-op in introducing the rule.
  • Retailers will limit sale of energy drinks containing more than 150mg of caffeine per litre to under 16s

(2015)

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Alcohol Around the World

  • Saudi Arabia completely bans the production, importation or consumption of alcohol and imposes strict penalities on those violating the ban, including weeks to months of imprisonment, and possible lashes.
  • Kuwait also bans the importation or consumption of alcohol, but does not impose corporal punishment for violations.
  • Libya bans the import, sale and consumption of alcohol, with heavy penalties for offenders.
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Illegal Drugs

Examples of illegal drugs include:

  • Cannabis
  • Heroin
  • Spice
  • LSD
  • Khat
  • Cocaine
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Cannabis Around the World

  • Cannabis is legal in Chine (except for recreational drug use). Cannabis is cultivated for its seeds and for fibre, and has a long medicinal history.
  • Cannabis is legal in Peru under certain conditions. Possession of up to 8 grams of marijuana is legal as long as one is not in possession of another drug.
  • In Uruguay, possession of up to 20 grams is not punished, but users must go through a drug treatment program.
  • While technically illegal, the use of cannabis is widespread among the Khmer people and foreigners visiting this country. Marijuane can easily be purchased and smoked in public areas without the threat of arrest. Certain restaurants offer food cooked with marijuana or as a side garnish.
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Khat

  • Made illegal and a class C drug in June 2014
  • Before that it was legal to import, export and deal in Khat
  • Common in Somali communities - large population in Cardiff
  • When chewed its effects were like a mild stimulant
  • Active ingredient of Khat is Cathinone which is illegal anyway and a class B drug
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Spice

  • Former 'legal high'
  • Synthetic Cannabinoid
  • Use the same receptors that tetrahydrocannabinol (THC) use, but bind much more strongly
  • Highly addictive and unpredictable
  • Estimated that between 75-85% of prisoners have used Spice
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Decriminalisation - The Case of Portugal

  • July 2001 - Portugal decriminalised all illegal drugs
  • Dealing with possession and use of drugs has moved away from criminal court
  • Manufacture, distribution and trafficking are all criminal offences with heavy sanctions
  • They noticed a significant drop in rate of continuation of drug use and drug-induced deaths
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Misuse in the UK

  • Recent research has suggested that 1/5 of the UK adult population have misused a non-prescription product during their lifetime
  • Misuse related to, for example, taking a product for longer than recommended, taking a product at a higher dose than recommended, or using a product more often than recommended
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ACMD: Advisory Council on the Misuse of Drugs

  • Independent to the Government
  • Expert body that advises on drug related issues in the UK
  • Established under the Misuse of Drugs Act 1971
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Responsibilities of the ACMD

  • Make recommendations to government on the control of dangerous of otherwise harmful drugs, including classification and scheduling under the Misuse of Drugs Act 1971 and its regulations
  • Consider any substances which are being, or appears to be, misused and of which is having, or appears to be capable of having, harmful effects sufficient to cause a social problem
  • Carry out in-depth inquiries into aspects of drug use that are causing particular concern in the UK, with the aim of producing considered reports that will be helpful to policy makers and practitioners
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Role of ACMD

Recommendations to the government on the control of dangerous or harmful drugs

  • Classification (A, B or C)
  • Scheduling under the Misuse of Drugs Act 1971
  • Substances which are/appear to be misused or having harmful effects sufficient to cause a social problem
  • In-depth enquiries in aspects of drugs use that are causing concern in UK --> reports that are helpful to policy makers
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ACMD Decisions

  • A multidisciplinary approach is needed
  • Look into types of harm that drugs can do to an indivual user, and to others
  • Examples of harm: physical, social, physiological
  • Assigns a harm score between 0 and 100
  • Examples: alcohol 72/100, mushrooms 6/100
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Alcohol Misuse

  • In 2009/10 there were around 1,057,000 admissions related to alcohol consumption where an alcohol-related disease, injury or condition was the primary reason for hospital admission or a secondary diagnosis. This is a 12% increase on the 2008/09 figure, and over double the number in 2002/03.
  • Alcoholic liver disease accounted for 82% of 5,507 alcohol-specific deaths. A further 8% were from mental and behavioural disorders due to the use of alcohol.
  • A further 1,686 deaths were due to unspecified hepatitis and fibrosis and cirrhosis of the liver. These deaths are not defined as alcohol-specific deaths. 
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ACMD - Notable Involvements

  • 1988/89 - AIDS and Drug Misuse 1 & 2
  • 1993 - AIDS and Drug Misuse Update
  • 2000 - Reducing Drug Related Deaths
  • 2010 - Consideration of the Cathinones: Khat rescheduling to schedule 1 controlled drug in June 2014
  • 2013 - Consideration of Tramadol: from schedule 4 to schedule 3 controlled drug. Became law in 2014.
  • 2013 - Rescheduling of Ketamine (schedule 2 controlled drug).
  • 2016 - Psychoactive Substances Act
  • 2018 - Consideration on medical Cannabis - from schedule 1 to schedule 2 controlled drug
  • 2019 - Pregabalin and gabapentin - schedule 3 controlled drugs
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UK Government Drug Policy 2016 Update

'

Drug misuse harms the health and wellbeing of too many people. We want to reduce the number misusing illegal and other harmful drugs and increase the number who successfully recover from drug dependence. We want to restrict the supply of drugs by identifying and prosecuting those involved in the drug trade, and confiscating the proceeds of crime.'

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Drug Misuse in Wales

Working Together to Reduce Harm: The Substance Misuse Strategy for Wales 2008-2018

Includes alcohol and volatile solvents as well as drugs, but not tobacco.

Four different action areas:

  • Preventing harm
  • Support for substance misusers to improve health
  • Supporting and protecring families
  • Tackling availability via enforcement activity
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