Just lucky!

Hanif casts a glazed, vacant look. He is groggy and sick. But at least he can remember his name. Today is day four of his detoxification and he can’t think straight enough to lie. Ask any "dry" heroin addict when they felt at their lowest ebb and they will tell you between day three and day five. This is when the vomiting, diarrhea, hallucinations and shivers are at their worst. It will take another ten days before the process is over, and even then Hanif will be far from cured. Leave him alone and he is certain to wind up back in the embrace of the heroin he has been smoking for 10 years. But this time he has a chance. His mother, who works as a nurse overseas, has sent money to pay for his detoxification at this centre called "new life". It is one of fewer than 200 treatment and rehabilitation centres in his country.

What is drug abuse?

Hanif is indeed lucky. There are over 21 million victims around the world who abuse cocaine and heroin, most of them are without any real opportunity for cure. And this number is part of a larger group of people who have taken psychoactive drugs for curative, religious and recreational purposes since time immemorial.

People take drugs to change the way they feel, think, or behave. These kinds of substances are called psychoactive and cover alcohol and tobacco as well as natural and manufactured drugs. In the past, most of the drugs that were used were made from plants, such as the coca bush for cocaine, opium poppies for heroin and cannabis for hashish or marijuana. More recently, drugs such as ecstasy or LSD are produced by synthesizing various chemicals.

Drug abuse affects most countries in the world, both rich and poor. The problem now crosses national, ethnic, religious and gender lines. Addicts range from the homeless, to white-collar professionals, college students to rural farmers, street children to suburban teenagers.

What kind of drugs are being abused?

Drugs of abuse fall into three categories: depressants (e.g. heroin, barbiturates), stimulants (e.g. cocaine, crack, amphetamines) and hallucinogens (e.g. marijuana, ecstasy, LSD), and are either ingested, inhaled, smoked, injected or snorted.

Depressants are sedatives which act on the nervous system. Artificial relaxation and relief from anxiety and mental stress tend to produce psychological dependence and withdrawal from heavy use is severe. 

Stimulants are agents that activate, enhance, or increase neural activity. They include amphetamines and synthetic appetite suppressants such as phenmetrazine or methylphenidate. They can give rise to symptoms suggestive of intoxication, including tachycardia, pupillary dilation, elevated blood pressure, nausea or vomiting and abnormal behaviour such as fighting. agitation and impaired judgement. A full-blown delusional psychosis may occur. 

Hallucinogens are a chemically divers group which produce profound mental changes such as euphoria, anxiety, sensory distortion, vivid hallucination, delusion, paranoia and depression. They include mescaline and LSD.

How prevalent is the abuse? 

Prevalence of abuse of different drugs varies considerably by region and even country throughout the world. 

Marijuana and Hashish: Estimates show that cannabis is the most widely abused drug in all parts of the world, with an estimated 141 million people (or 2.4 per cent of the world's population) consuming it. In particular, large numbers of young people experiment with cannabis: as high as 37 per cent (one time use over the past year) of school children and young adults in some countries and 10-25 per cent for past month use. Overall, cannabis abuse is increasing in many countries while stabilizing in countries where it has reached high levels. 

Estimates show that cannabis is the most widely abused drug in all parts of the world, with an estimated 141 million people (or 2.4 per cent of the world's population) consuming it.

Synthetic Drugs: Globally, UN estimates show that the abuse of synthetic drugs, particularly of amphetamine-type stimulants (such as speed and ecstasy) is widespread and increasing rapidly. Some 30 million people abuse such synthetic stimulants. 

Having spread relatively slowly in the 1980s, abuse of amphetamine-type stimulants increased rapidly in Europe, Australia, North America and South-East Asia in the 1990s. While the abuse has stabilized in some of these areas, there is still a continuous growth in global demand particularly in East and South-East Asia. Increasingly, synthetic drugs have gained in significance, particularly among young people as their recreational drug of choice, often in combination with cannabis. MDMA (ecstasy) is popular in the industrialized world, especially in Europe. 

Other Drugs from Plants: In general, cocaine together with various other coca-derived substances like "bazuco" (coca paste), is the second most widely abused drug in the Americas after cannabis, and coca-derived substances dominate the demand for treatment. UNDCP estimates that some 13 million people abuse cocaine worldwide: highest in the United States. Despite recent declines in the last decade and in a large number of Latin American countries. 

Compared to other drugs, the abuse of heroin and other opiates is less prevalent. UN estimates show that around 8 million people abuse opiates, mostly in Europe, South-East and South-West Asia. In general, consumption affects less than 2 per cent of the population in these regions but can be more widespread in some of the opium-cultivating areas. Rising levels of abuse are reported in Eastern Europe and Central Asia.

In general, cocaine together with various other coca-derived substances like "bazuco" (coca paste), is the second most widely abused drug in the Americas after cannabis.

Who are the abusers? 

People who abuse drugs come from all walks of life, although statistics show that some are more likely to take drugs than others. For instance, men are more likely to abuse drugs than women, single more than married, city-dwellers more than rural residents, younger more than older. Prisoners and street children also show a high incidence of drug abuse. 

Recent data raise concern over the increased use of drugs among the young people worldwide. The data available show the prevalence among young people tends to be three or four times higher than among the general population. Their drug of first choice is cannabis and its abuse is spreading. 

Abuse of synthetic stimulants is widespread and ecstasy abuse, while stabilizing at a high level in some western European countries, is increasing in others and is also spreading to other regions. The average for ecstasy is 2.6 per cent. 

Inhalants (such as glue and solvents) abuse is common (average 7.8 per cent) and remains a serious problem for many young people.

Cocaine does not seem to be the drug of first choice among young people. However, recent trends indicate some increase in its abuse in Europe (notably London and Amsterdam). In the United States cocaine abuse among youth has been falling during the last 15 years but there are some recent indications of a slight increase. 

Injection of heroin is increasing among youth in Eastern Europe, while there are signs of a rise in abuse of heroin by smoking (United States and Western Europe). 

However, cocaine and heroin, with averages of 1.9 per cent and 1.0 per cent respectively, are not the main drugs of choice of youth. 

Inhalants (such as glue and solvents) abuse is common (average 7.8 per cent) and remains a serious problem for many young people.

 How big is the supply? 

BIG! In 1999, worldwide production of opium reached a record of 5,794 metric tons derived from 219,000 hectares of poppy. More than 75 per cent of the opium was from Afghanistan. Global production of coca-leaf rose to 317,926 tonnes from 183,000 hectares of coca. Almost 60 per cent of all coca leaf came from Colombia. How do we know? Integrating efforts in aerial surveillance, on-the-ground assessment and satellite sensing has enabled countries to gain a wide-ranging map of illicit growing areas and pinpoint areas of decreased or increased cultivation so as to provide a reliable assessment of crop yield. 

Who Benefits? 

Between the illicit production of drugs and the demand for them there has arisen a flourishing illegal business - a non-business that can undermine economies and cripple States. Drug trafficking is in the hands of transnational organized crime syndicates which have taken advantage of globalization while countermeasures have lagged behind.

The opening up of borders and the explosion of electronic communication technology have aided organized crime groups to traffic drugs and launder the proceeds.

What are the effects? 

Drugs can be harmful in a number of ways, through both immediate effects and damage to health over time. Even occasional use of marijuana affects cognitive development and short-term memory. In addition, the effects of marijuana on perception, reaction and coordination of movements can result in accidents.

Cocaine and amphetamines first cause tremors, headaches, hypertension and increased heart-rate. Long-term effects are nausea, insomnia, loss of weight, convulsions and depression.

Hallucinogens (such as LSD) distort perceptions, alter heart-rate and blood pressure and, in the long term, cause neurological disorders, depressions, anxiety, visual hallucinations and flashbacks. 

Cocaine and amphetamines first cause tremors, headaches, hypertension and increased heart-rate. Long-term effects are nausea, insomnia, loss of weight, convulsions and depression. 

Heroin use initially results in nausea, slow respiration, dry skin, itching, slow speech and reflexes but, over a long period, there is the serious risk of developing physical and psychological dependence which in the end can lead to acute overdose which can lead to death due to respiratory depression. 

There is some tendency towards presenting some drugs (such as cannabis and ecstasy) as less harmful than they actually are, without taking into consideration their long-term effects and the effects they have on adolescent development, especially of certain critical cognitive functions like the capacity to memorize. While ecstasy is said to have little or no side effects, studies show that its use alters, perhaps permanently, certain brain functions and damages the liver and other body organs. 

There is no illicit drug that can be considered safe.

Although not listed as illicit, inhalants are widely abused, especially by disadvantaged youth. Some of these volatile substances, which are present in many products such as glue, paint, gasoline and cleaning fluids, are directly toxic to the liver, kidney or heart, and some produce progressive brain degeneration. 

The major problem with psychoactive drugs is that when people take them, they focus on the desired mental and emotional effects and ignore the potentially damaging physical and mental side effects that can occur. There is no illicit drug that can be considered safe. In one way or another, the use of psychoactive substances alters the normal functioning of the human body, and in the long run, can cause serious damage.

What about the HIV/AIDS connection? 

By June 2000, there were more than 34 million people with HIV/AIDS.

Perhaps the most evident problem caused by drug abuse is the role of drug injecting in the spread of HIV/AIDS. Sharing injecting equipment, whether the injection method be intravenous, intramuscular or beneath the skin, carries a very high risk of transmission of HIV as well as other blood-borne infectious diseases such as hepatitis B and C. 

By June 2000, there were more than 34 million people with HIV/AIDS. The majority of them live in sub-Saharan Africa. The most common way of transmitting the virus is sex between men and women but a second epidemic - drug injecting – propel the virus in many, if not most countries outside Africa. 

Over half of all AIDS cases in Bahrain, Georgia, Italy, Kazakhstan, Portugal, Spain and Yugoslavia are attributed to injecting drug use. In the Russian Federation between 1998 and 1999 over 90 per cent of all new HIV infections were found among injecting drug users. In 1999, the number of countries reporting injecting drug use was 136, up from 80 in 1992. Of these 136 countries, 93 also identified HIV among drug injectors.

It is often overlooked that non-injecting drug abuse can also result in HIV infection. Once intoxicated, the users often let down their guard, engage in risky sexual behaviour and thus contract the virus. 

Apart from personal physical effects on the individual, drug abuse has far-reaching social and economic effects.

What has been the United Nations response? 

The United Nations has addressed the drug abuse phenomena since the Organization's inception. 

The Commission on Narcotic Drugs was established in 1946 and now comprises 53 Member States serving on a rotational basis. The UN office dealing with drug control were unified in 1990 as the United Nations International Drug Control Programme (UNDCP). In 1999, this Programme linked with the Centre for International Crime Prevention (CICP) to form the Office for Drug Control and Crime Prevention. The Office is based in Vienna.

The reality that drug abuse was a problem that needed serious attention and control first emerged from the Opium Commission in Shanghai in 1909 when the first international controls were instituted. Over the years, various international agreements were negotiated restricting the sale and use of different substances to medical purposes. However, it was only through the United Nations that countries of the world were able to develop a coordinated response. 

The Single Convention on Narcotic Drugs (1961) joined together various existing treaties restricting the sale and use of different substances to medical purposes. This was supplemented in 1972 by a Protocol stressing the need for treatment and rehabilitation services. The Convention on Psychotropic Substances (1971) established an international control system for a list of pharmaceutical drugs and other substances that affect the mind. The United Nations Convention against Illicit Traffic in Narcotic Drugs and Psychotropic Substances (1988) addressed drug trafficking and included provisions against money laundering and the diversion of chemicals used in the manufacture of illicit drugs.

For many years the drug problem was perceived by the international community to lie on the "supply side." It was thought that the drugs of abuse originated in the developing world and were consumed in the industrialized world. Little attention was given to demand reduction. However, the situation has now changed dramatically, with some of the highest consumption rates being found in developing countries and cannabis and synthetic drugs being produced in the North as well as the South. 

As a result, the United Nations has adopted a balanced approach to reduce both supply and demand simultaneously. In 1998, the General Assembly, in a special session on the world drug problem, adopted a Political Declaration containing a number of time-bound goals for each side of the equation, including: 

The role of UNDCP 

UNDCP, which is responsible for coordinating all United Nations drug control activities, pursues three goals: reducing demand for illicit drugs, reducing production of illicit drugs and reducing trafficking of drugs. In order to help Governments develop national programmes and policies, UNDCP collects and disseminates information on drug abusers. It coordinates projects to eradicate illicit drug crops and to assist farmers with finding alternatives. And to reduce drug trafficking, UNDCP gathers information, provides expert advice on law enforcement methods and coordinates international drug control activities. 

By promoting alternative development, UNDCP helps reduce or eliminate the economic dependence of farmers on illicit crops. In some countries, such as Mexico, UNDCP has demonstrated that growing rubber and other valuable trees can be a reliable and long-term source of income (see box). There has been some success in eradicating illicit crops. For example, in 1979, 800 tonnes of illicit opium were produced in Pakistan whereas the figure had dropped to less than 15 tonnes in 1999. UNDCP’s Global Programme against Money Laundering provides training to business, law enforcement and judicial professionals, including groundwork for the creation of Financial Intelligence Units by sponsoring financial investigation workshops. Working with six other UN agencies and programmes in the fight against HIV/AIDS, UNDCP has been implementing a comprehensive anti-drugs programme in Brazil. It includes community outreach projects, condom distribution, research on HIV and training of community promoters. Similar activities are being carried out in Eastern Europe, the Russian Federation and some states of Central Asia, where there are potentially explosive situations regarding drug injecting and HIV infections.