Discrimination against drug addicts

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Discrimination against people with substance use disorders is a form of discrimination against people with this disease. In the United States, people with substance use disorders are often blamed for their disease, which is often seen as a moral failing, due to a lack of public understanding about substance use disorders being diseases of the brain with 40-60% heritability. People with substance use disorders are likely to be stigmatized, whether in society or healthcare.

Contents

In the process of stigmatization, people with substance use disorders are stereotyped as having a particular set of undesirable traits, in turn causing other individuals to act in a fearful or prejudicial manner toward them. [1] [2] [3]

Background

Global Marijuana March, Paris. JP Galland 492937382 4a0afd096d o d.jpg
Global Marijuana March, Paris.

Drug use discrimination is the unequal treatment people experience because of the drugs they use. [4] People who use or have used illicit drugs may face discrimination in employment, welfare, housing, child custody, and travel, [5] [6] [7] [8] in addition to imprisonment, asset forfeiture, and in some cases forced labor, torture, and execution. [9] [10] Though often prejudicially stereotyped as deviants and misfits, most drug users are well-adjusted and productive members of society. [11] [12] Drug prohibitions may have been partly motivated by racism and other prejudice against minorities, [13] [14] [15] and racial disparities have been found to exist in the enforcement and prosecution of drug laws. [16] [17] [18] Discrimination due to illicit drug use was the most commonly reported type of discrimination among Blacks and Latinos in a 2003 study of minority drug users in New York City, double to triple that due to race. [19] People who use legal drugs such as tobacco and prescription medications may also face discrimination. [20] [21] [22]

Individual factors

Clinicians use DSM-V-TR criteria to establish whether a person has a Substance Use Disorder, which may be classified as mild, moderate, or severe. It may also be ruled out, as some people may use substances or may be prescribed controlled substances that have the potential for addiction, but never go on to develop a substance use disorder. Addictive substances include stimulants, (caffeine, cocaine, amphetamine, methamphetamine, ephedra, etc.), sedatives/anxiolytics (benzodiazepines, barbiturates, quaaludes, etc.), opioids (oxycodone, fentanyl, etc.), alcohol, nicotine/tobacco, cannabis, dissociatives (ketamine, nitrous oxide, etc.), certain hallucinogens (especially MDMA), hormones (testosterone), GHB, Kratom, gabenergic agents (such as gabapentin), and more. The term addiction usually correlates with a severe substance use disorder. Addiction is characterized by behavior that is originally voluntary and reward-seeking that over time, becomes compulsive, with a desire to avoid dysphoria or withdrawal rather than to experience the original positive effects associated. A person may become physiologically dependent, experience withdrawal, and experience significant cravings. It does not degrade their personality, but people may engage in illicit behaviors such as buying drugs that are controlled substances, or engaging in prostitution to fund their addiction. Since these behaviors are illegal and they may face legal issues as a result, people who use drugs may not be forthcoming about these practices and may also delay seeking medical treatment for sequelae related to substance use out of fear of stigma or legal consequences.

Institutional basis

Stigma by health care professionals has many contributing factors. The first is a well-documented, decades-long lack of education on substance use disorders in many healthcare professions, such as medicine, nursing, and pharmacy. Due to this gap in educational curricula, and competency, healthcare professionals may be unaware of how much of what they assume to be true about treatment and people with substance use disorders is neither evidence-based nor factual. Very few providers are certified in addiction treatment; addiction is often thought of as a subspecialty with providers having an initial certification in another specialty area, such as psychiatry. Healthcare professionals may hold biases similar to those of the general US population, who often see substance use disorders as a moral failure rather than a chronic brain disease that has significant contributory racial and psychosocial factors, with 40-60% heritability. Unfortunately, healthcare providers may perpetuate stigma when they use language that is stigmatizing/non-factual or refuse to provide care that is evidence-based or person-centered as a result of their lack of competency or biases which may be subconscious. Unfortunately, they may also believe stereotypes about people with substance use disorders or drugs, that the general population holds. These include people with SUDs not being able to get better when they have similar relapse rates to people with diabetes or hypertension, and most people with SUDs recovering without treatment. What is more, medications for opioid use disorder are highly effective at preventing relapse; methadone and buprenorphine specifically also prevent all-cause mortality by more than 70% in patients with OUD. However, medical providers may hold the false belief that in being prescribed these, patients are "substituting one drug for another". Medications for Opioid Use Disorder (MOUD), Medications for Alcohol Use Disorder (MAUD), and medications for Tobacco Use Disorder, are widely used in the United States Healthcare System. However, regulatory and legal barriers to methadone and buprenorphine prescription have inhibited their utility. Under current law, people on methadone have to go to SAMHSA-approved OTPs (special facilities) to receive this medication, on a nearly daily basis. Although now removed, until recently providers who wanted to prescribe buprenorphine had to be x-waivered, receiving addition education to prescribe, and were limited in the number of patients they could prescribe for. SAMHSA and ASAM have clinical guidelines for things such as medications for addiction treatment, withdrawal management, and non-pharmacological therapeutic interventions as well.

There are several terms related to addiction that are not stages of addiction per se. Tolerance means the need to take more of a substance to achieve the desired effect when compared to before--it does not matter what the desired effect is (pain control/focus/euphoria/etc.). Tolerance to opioids can develop rapidly. Tolerance may occur in addiction but also occurs in those who are prescribed certain medications who may not meet DSM-V-TR criteria for a Substance Use Disorder. Tolerance quickly develops to the effects of hallucinogens after a few administrations, which is part of the reason why addiction to this class of substances is rare. When people describe dependence in addiction treatment, they often mean physiological rather than psychological dependence. If someone is physiologically dependent, they are likely to experience withdrawal once the substance is removed, as their body has become accustomed to the substance's presence and its presence has affected their body's homeostasis. Withdrawal symptoms are often unpleasant and are typically the opposite of those experienced during intoxication. Rarely, withdrawal can be life-threatening; this may occur in patients with benzodiazepine, alcohol, or barbiturate dependence for example. Withdrawal is not a stage of addiction but is often a symptom, although a few drugs do not have withdrawal as part of their DSM-V-TR criteria (hallucinogens and cannabis).


People with substance use disorders may have co-occurring mental health disorders, substance-induced mental disorders, both, or not have mental health disorders. Substance-use disorders are not thought of as mental health disorders, but can induce acute symptoms such as mood alterations or psychosis, depending on the drug and whether a person is intoxicated, experiencing withdrawal. In some cases, a person can be in active recovery (methamphetamine-induced psychosis specifically can last up to 2 years following discontinuation of methamphetamine, and hallucinogen persistent perception disorder can last several months following discontinuation). Generally, however, substance induced mental health symptoms are time-limited, clearing up within one month or less based on DSM-V-TR criteria. If symptoms persist for longer following discontinuation, providers may consider a mental health disorder as primary, or as stemming from a different etiology, rather than as substance-induced. Thus the person's diagnosis may change based on the timeframe and symptoms following discontinuation. People with substance use disorders still have agency, but it may be very difficult to control cravings and urges in early recovery. Therefore, people who use drugs win early recovery may avoid people, places, or things, that serve as triggers for these. If unavoidable, they may urge surf, call a friend or sponsor, or use other coping mechanisms to distract themselves or ride the cravings and urges out. While much substance use is initially voluntary, this is not always the case. People may be exposed to substances in utero, or involuntarily initially in childhood (especially if parents use or manufacture drugs) or in adulthood (e.g. GHB, rophynol, etc.). Some people who use may use substances that do not know are contaminated (laced) with other substances, such as fentanyl, nitrazine, or xylazine. This is a significant problem, with the DEA reporting fentanyl-related overdoses are the #1 cause of death in people 18-45.

Although 1 in 10 people in the United States will meet criteria for a substance use disorder in their lifetime, few will receive treatment.


With the increasing number of adults that suffer from an addiction, only a few will receive treatment due to the complexity of health care systems. [23] Most health care systems do not have insurance coverage for addiction recovery and many health care providers have little to no training in treating addiction. [24] Some doctors do not feel comfortable treating addictions, due to their lack of knowledge and training of the topic. [25] The American Society of Addiction Medicine reports that there are only 3,000 board-certified addiction specialist physicians in the United States while there are nearly 2 million people experiencing opioid addiction. [26] The limited presence and access to comprehensive care for addiction poses a barrier for recovery for many, particularly those hailing from lower socioeconomic backgrounds. [27]

Role of language

Stigma founded in societal preconceptions about substance dependence often perpetuates discrimination against those with Substance use disorder (SUD). [28] How language regarding SUD is framed plays an important role in mediating stigma experienced by those with the condition, which can consequently shape critical outcomes for this population such as treatment contact, social isolation, and attitudes towards healthcare providers. [28] Shifting towards person-first language has been emphasized in healthcare provider circles to mitigate such stigma. For instance, as opposed to saying "former addict" or "reformed addict", the National Institute on Drug Abuse (NIDA) recommends language such as "person in recovery" or "person who previously used drugs" to separate the problem from the individual. [29] [30] [31] The NIDA additionally applies a similar framework to terminology such as "clean" or "dirty" to denote whether or not someone is actively using as they cite the former vocabulary holds punitive connotations. [31] [32] Moreover, SUD policy reform advocates report language adjacent to SUD can misconstrue associated medical treatment practices which in turn poses barriers to expanded harm reduction efforts from being adopted. [32] An example of this provided in a 2017 executive memorandum from The National Prevention Council was a recommendation to wean usage of "opioid substitution replacement therapy" which many believe falsely alludes that an individual is substituting their addiction for another (i.e. from heroin to methadone) to "opioid agonist therapy". [29] [32] Another term that is losing favor is "abuse", due to its negative connotations and its impact on patient care. Instead, the terms "misuse" for prescribed medications or "use" for illicit substances are used. Similarly, "user" is not used in favor of person-first language, such as "person with a substance use disorder", or "person who uses intraveneously"

Drugs and HIV infection

Among people who use drugs intravenously, the incidence of HIV and Hepatitis C infection is higher than among those who administer drugs through other routes. However punitive and discriminatory measures against people who use drugs are not able to eliminate either the spread of drug addiction or HIV. Researchers say that around 90% of people who choose to inject drugs have missed prior opportunities for HIV testing that were provided. [33] . This is why annual screening for Hep C and HIV is recommended for patients who use drugs. Also, in states where it is legal, people may use syringe service programs, or use at safe consumption sites. Also, patients may employ other harm reduction measures, such as employing aseptic technique, to reduce their risk of exposure to infectious disease. The website NextDistro has harm reduction resources for people who use drugs to minimize the risk associated with intravenous use.

Regional patterns

Africa

In Africa, approximately 28 million people use substances. [34] This number is impacted by the rising availability of drugs that can be administered intraveneously such as heroin, cocaine, and methamphetamine. [34] Socio-demographic factors are often primary determinants of the health status of people who use drugs. [34] These factors contribute to an individual's drug use behaviors such as the sharing of needles and the solicitation of sex in exchange for police protection or more drugs. [34] Nutritional status, family support, stigma/discrimination, adherence to medication, and recovery from addiction are also impacted by these socio-demographic factors. [34] Research shows that the majority of people who use drugs transition from the use of non-soluble substances s to substances that can be used intravenously or end up using both simultaneously. [34]

Kenya

In Kenya there is a link between injection-related discrimination, mental health, physical health, and the quality of life for those who inject drugs. [35] The rates of discrimination are linked to higher levels of psychological distress and risky behaviors. [35] Women in Kenya account for 10% of people who use drugs. [35] These women tend to experience typical discrimination faced by people who use drugs in addition to gender-related discrimination. [35] Levels of discrimination are often higher for those that are also HIV positive. [35]

Tanzania

The Tanzanian government initiated support for substance-dependence treatment rehabilitation in the latter 20th century, with the Ministry of Health administering the Treatment II center network to oversee this care. [36] Treatment centers and harm reduction efforts in Tanzania have come into conflict with recent discourse from politicians, such as President John Magufuli, who established the nation's war on drugs in early 2017. [37] Calling for the arrest of anyone involved in narcotics, Magufuli's stance is distinct from growing harm reduction pathways established in sub-Saharan Africa in the early decades of 2000. [37] This wave of criminalization policy aims to redress the issue of those who use being primarily being targeted by law enforcement, rather than other individuals involved in the trafficking schema. [38] Tanzania's policing of injection drug use has encouraged both consumers and traffickers to further ingratiate themselves in the nation's black market, with injection drug users consequently being more likely to be involved in sex work and other illicit trafficking, rather than engage in traditional employment opportunities which risk greater exposure. [39] Populations that exist at this intersection, for instance, Tanzanian women sex workers who engage in injection drug use, are alienated from utilizing risk reduction interventions due to fear of arrest. [40]

Low-income, urban, young men which are the most likely populace to be recruited to illicit substance trafficking due to lack of economic opportunity otherwise, have been highly scrutinized under recent waves of drug criminalization. [41] Substance use ranging from marijuana to heroin is prohibited and a record denoting arrest for such use highly influences subsequent employment outcomes after time served for these individuals, which can ultimately be deleterious to expanding economic mobility within the communities they hail from. [42]

A study published in the Review of African Political Economy notes that commerce and political corruption in Tanzania have promulgated crack cocaine consumption and flash-blood practices, or blood sharing between substance users after recent injections, specifically among poor youth in urban centers. [43]

Asia

India

Narcotic substance consumption is prohibited in India by the Narcotic Drugs and Psychotropic Substances Bill inducted in 1985, which also levies punitive measures on adjacent activities such as production or vending of such substances. [44] Possession of a controlled substance can result in punishment ranging from a $136.21 USD fine and half a year imprisonment to $121,261 USD and twenty years imprisonment, depending on whether the amount identified is considered small or commercial. Certain crimes outlined by the Narcotic Drugs and Psychotropic Substances Bill are also eligible for the death penalty, and while cases involving marijuana have been charged with capital punishment in the past, they tend to be successfully appealed in higher courts. [45] This legislation is heavily influenced by a coordinated United Nations effort throughout the latter twentieth century to stymie international drug trafficking. [46]

According to the International Drug Policy Consortium, India's Narcotics Control Bureau, which executes the various facets of the Narcotic Drugs and Psychotropic Substances Bill, has encountered criticism for the legislation's stringent measures which have limited access to pain-relief medication, specifically the prescription of opiates for post-operative patients. [47] Bill revisions in response have expanded access to such substances, like methadone, to be distributed through recognized care providers, and members of parliaments have subsequently pushed for expanded bill protections for marijuana use, which has not gained traction. [48] Language cited as demeaning within the 2012 National Policy on Drugs and Psychotropic Substances regarding harm reduction pipelines such as clean needle programs, referring to such as "shooting galleries," have posed barriers to preventing comorbidities such as HIV which are prevalent among people who inject drugs in India. [49] This poses an issue in states such as Punjab where over 20% of people who inject drugs are also infected with HIV. [50]

Philippines

In the Philippines, the government's war on drugs has led to allegations of killings and other human rights violations by the Philippine National Police against drug suspects. [51]

This has led the United Nations Human Rights Council to adopt a resolution urging the Philippine government to set up an investigation into mass killings during the war on drugs. [52]

Vietnam

Drug control strategy in modern Vietnam was first formally introduced in 1990 around the cause of eradicating "social evils," in reference to substance use. [53] Such policies were inspired by the UN, and specifically, its International Drug Conventions which took placed from the latter 1960s to 1997. [54] Ordinances and violation measures were propositioned by the Vietnamese National Assembly in this legislation to mandate compulsory treatment for substance users, rather than subject them to prison. [55] High input in mandatory treatment centers has resulted in a tendency for there to be more patients at treatment centers than can be handled, thus limiting access to rehabilitation for these individuals. [56] Harm reduction measures such as clean needles and condom access have been introduced throughout the 2000s at a national level to address the prevalence of HIV and HCV among drug users. [56] Inconsistencies between the Ordinance on HIVAIDS which outlines such harm reduction practices, and the Drug Law of 2000, which prohibits the distribution of materials like needles, has made provincial adoption of harm reduction institutions, like syringe exchanges, challenging. [57]

While Vietnamese policy leaders generally veer towards addressing substance use as a medical issue, rather than criminal activity, having decriminalized many substances since 2009, the Ordinance of Administrative Violation continues to classify illicit substance consumption as a crime. [55] Consequently, at a local level, substance users remain eligible to be charged by law enforcement and subjected to forced labor treatment centers that are comparable to detention. [58] Thus, many substance users do not access harm reduction institutions out of fear of being identified by law enforcement and placed in these conditions. [58]

Europe

Sweden

Narcotic substance use is criminalized in Sweden, with drug offenses holding punishments ranging from fines to six months imprisonment. [59] To apprehend people who use, law enforcement is permitted to conduct urine testing based on suspicion, rather than wholly requiring a public disturbance. [60] Such protocol is justified by lawmakers as a way to expand early intervention for people who use substances to be referred to rehabilitation channels, but legal advocates have challenged such practices for infringing upon personal freedoms. [60] [61] Diversion to court-ordered treatment programs rather than criminalization has been expanded in response during the early 21st century. However, there are disparities in representation in such programs. [61] For example, people who use drugs found in violation who belong to the top third Swedish wealth bracket are twice as likely to be admitted into a treatment program rather than imprisoned compared to people who committed a similar offense but belong to the bottom two-thirds of the wealth bracket. [61] Moreover, while those who use drugs can apply to their local welfare administrator for rehabilitative services, this process is selective despite being less costly than long-term imprisonment for an associated drug-related crime. [62]

Sweden has faced criticism for having harsher drug policies and less accessible rehabilitative programs for people who use drugs than peer Nordic nations which are moving towards drug liberalization. [61] Many cite this for why Sweden has rising substance-related mortality in the 21st century, for instance, having 157 overdose deaths in 2006 compared to the Netherlands which had a little over a hundred despite having a population close to double the size. [63] Zero-tolerance policies are also in place for those who drive under the influence of an illicit substance. [64]

North America

Canada

In Vancouver, Canada, there have been efforts to reduce opioid-related deaths. An article published by the Canadian Medical Association Journal discusses new efforts to create safe injection sites for people struggling with opioid addiction. Vancouver politicians created these sites for people to safely use drugs that they are addicted to without the risk of infection or prosecution by the police. These safe injection sites provide sterilized needles to limit the reuse of needles that lead to the spread of AIDS and other diseases. [65] Drug addicts in Vancouver have been discriminated against on numerous occasions. Mothers who are said to be drug addicts have had their children taken away, as they are thought to be unfit mothers. These women have a hard time getting jobs because employers might not want to hire someone who they believe are drug addicts. Women have started a union for drug users in Vancouver to aid them with housing and education to help them get back on their feet.

United States

The Prison Policy Initiative cites that the criminalization of drug use in the United States can limit personal daily activities for those who may use substances, even if it is done in a safe, recreational manner. States that suspend driver's licenses for drug offenses.svg
The Prison Policy Initiative cites that the criminalization of drug use in the United States can limit personal daily activities for those who may use substances, even if it is done in a safe, recreational manner.

The War on Drugs, which formalized in the 1970s with the Nixon administration, has disparately affected communities of color in the United States. [67] Substantial punitive measures exist for illicit possession, whether that be in the context of use, trafficking, or selling, with length of incarceration scaling up with repeat offenses. [68] [69] Charges can go up to life without parole for third-time offenses related to opioids such as fentanyl. [69] Three-quarters of those imprisoned for fentanyl today are people of color, which directly corresponds to Black and Latin populations being disproportionately policed for drug-related crimes. [70] This additionally infringes upon voting eligibility among people who use drugs, as more extreme drug charges hold felony status which revokes voting rights in a majority of states. [71] Drug criminalization moreover operates within the deportation pipeline in the US, with drug charges making all individuals without citizenship eligible for deportation. [72] This includes marijuana-related charges which have constituted over ten thousand deportations from 2012 to 2013, often severing families and communities. [72] While statewide measures to legalize marijuana have gained traction throughout 2010, individuals of color have been less likely to receive post-carceral clemency for these charges due to barriers to legal advocacy. [73]

Human rights advocates have criticized the use of demeaning language regarding the condition in criminal litigation to leverage character assault against defendants or victims who have or are presumed to have the condition. [74] A prominent example of this is the trial of Derek Chauvin, the former Minneapolis police officer convicted of murdering George Floyd, whose legal defense asserted substance use as a potential cause of death, rather than the asphyxiation which incurred from Chauvin. [75]

In the US, employers and educational institutions may legally discriminate against people who are currently using based on the results of their drug screens. Otherwise, the ADA protects people with a prior history of substance use or who are receiving treatment. Employers may elect to administer drug screens at random, upon suspicion, on a routine basis, and before employment as a prerequisite as part of a zero-tolerance policy. [76] However, according to the Rehabilitation Act of 1973, employers are supposed to ensure that people with alcohol use disorder and substance use disorders receive needed treatment and accommodations. The lack of job opportunities and treatment for people with substance use disorders may result in relapses or jail time . [77] Nathan Kim and his associates once conducted a study on the HIV status of people who inject drugs and found that the HIV rate in those individuals in San Francisco increased by 16.1% from the year 2009 when the HIV rate was 64.4%, to 80.5% in 2015. [78]

See also

Related Research Articles

<span class="mw-page-title-main">Recreational drug use</span> Use of drugs with the primary intention to alter the state of consciousness

Recreational drug use is the use of one or more psychoactive drugs to induce an altered state of consciousness, either for pleasure or for some other casual purpose or pastime. When a psychoactive drug enters the user's body, it induces an intoxicating effect. Recreational drugs are commonly divided into three categories: depressants, stimulants, and hallucinogens.

<span class="mw-page-title-main">Harm reduction</span> Public health policies which lessen negative aspects of problematic activities

Harm reduction, or harm minimization, refers to a range of intentional practices and public health policies designed to lessen the negative social and/or physical consequences associated with various human behaviors, both legal and illegal. Harm reduction is used to decrease negative consequences of recreational drug use and sexual activity without requiring abstinence, recognizing that those unable or unwilling to stop can still make positive change to protect themselves and others.

Self-medication, sometime called do-it-yourself (DIY) medicine, is a human behavior in which an individual uses a substance or any exogenous influence to self-administer treatment for physical or psychological conditions, for example headaches or fatigue.

<span class="mw-page-title-main">Opioid use disorder</span> Medical condition

Opioid use disorder (OUD) is a substance use disorder characterized by cravings for opioids, continued use despite physical and/or psychological deterioration, increased tolerance with use, and withdrawal symptoms after discontinuing opioids. Opioid withdrawal symptoms include nausea, muscle aches, diarrhea, trouble sleeping, agitation, and a low mood. Addiction and dependence are important components of opioid use disorder.

<span class="mw-page-title-main">Buprenorphine</span> Opioid used to treat pain & opioid use disorder

Buprenorphine, sold under the brand name Subutex among others, is an opioid used to treat opioid use disorder, acute pain, and chronic pain. It can be used under the tongue (sublingual), in the cheek (buccal), by injection, as a skin patch (transdermal), or as an implant. For opioid use disorder, the patient must have moderate opioid withdrawal symptoms before buprenorphine can be administered under direct observation of a health-care provider.

Substance dependence, also known as drug dependence, is a biopsychological situation whereby an individual's functionality is dependent on the necessitated re-consumption of a psychoactive substance because of an adaptive state that has developed within the individual from psychoactive substance consumption that results in the experience of withdrawal and that necessitates the re-consumption of the drug. A drug addiction, a distinct concept from substance dependence, is defined as compulsive, out-of-control drug use, despite negative consequences. An addictive drug is a drug which is both rewarding and reinforcing. ΔFosB, a gene transcription factor, is now known to be a critical component and common factor in the development of virtually all forms of behavioral and drug addictions, but not dependence.

A methadone clinic is a medical facility where medications for opioid use disorder (MOUD) are dispensed-—historically and most commonly methadone, although buprenorphine is also increasingly prescribed. Medically assisted drug therapy treatment is indicated in patients who are opioid-dependent or have a history of opioid dependence. Methadone is a schedule II (USA) opioid analgesic, that is also prescribed for pain management. It is a long-acting opioid that can delay the opioid withdrawal symptoms that patients experience from taking short-acting opioids, like heroin, and allow time for withdrawal management. In the United States, by law, patients must receive methadone under the supervision of a physician, and dispensed through the Opioid Treatment Program (OTP) certified by the Substance Abuse and Mental Health Services Administration and registered with the Drug Enforcement Administration.

<span class="mw-page-title-main">Drug injection</span> Method of introducing a drug

Drug injection is a method of introducing a drug into the bloodstream via a hollow hypodermic needle, which is pierced through the skin into the body. Intravenous therapy, a form of drug injection, is universally practiced in modernized medical care. As of 2004, there were 13.2 million people worldwide who self-administered injection drugs outside of medical supervision, of which 22% are from developed countries.

<span class="mw-page-title-main">Substance abuse prevention</span> Measures to prevent the consumption of licit and illicit drugs

Substance abuse prevention, also known as drug abuse prevention, is a process that attempts to prevent the onset of substance use or limit the development of problems associated with using psychoactive substances. Prevention efforts may focus on the individual or their surroundings. A concept that is known as "environmental prevention" focuses on changing community conditions or policies so that the availability of substances is reduced as well as the demand. Individual Substance Abuse Prevention, also known as drug abuse prevention involves numerous different sessions depending on the individual to help cease or reduce the use of substances. The time period to help a specific individual can vary based upon many aspects of an individual. The type of Prevention efforts should be based upon the individual's necessities which can also vary. Substance use prevention efforts typically focus on minors and young adults – especially between 12–35 years of age. Substances typically targeted by preventive efforts include alcohol, tobacco, marijuana, inhalants, coke, methamphetamine, steroids, club drugs, and opioids. Community advocacy against substance use is imperative due to the significant increase in opioid overdoses in the United States alone. It has been estimated that about one hundred and thirty individuals continue to lose their lives daily due to opioid overdoses alone.

<span class="mw-page-title-main">Opioid overdose</span> Toxicity due to excessive consumption of opioids

An opioid overdose is toxicity due to excessive consumption of opioids, such as morphine, codeine, heroin, fentanyl, tramadol, and methadone. This preventable pathology can be fatal if it leads to respiratory depression, a lethal condition that can cause hypoxia from slow and shallow breathing. Other symptoms include small pupils and unconsciousness; however, its onset can depend on the method of ingestion, the dosage and individual risk factors. Although there were over 110,000 deaths in 2017 due to opioids, individuals who survived also faced adverse complications, including permanent brain damage.

Heroin-assisted treatment (HAT), or diamorphine-assisted treatment, refers to a type of Medication-Assisted Treatment (MAT) where semi-synthetic heroin is prescribed to opiate addicts who do not benefit from, or cannot tolerate, treatment with one of the established drugs used in opiate replacement therapy such as methadone or buprenorphine. For this group of patients, heroin-assisted treatment has proven superior in improving their social and health situation. Heroin-assisted treatment is fully a part of the national health system in Switzerland, Germany, the Netherlands, Canada, and Denmark. Additional trials are being carried out in the United Kingdom, Norway, and Belgium.

<span class="mw-page-title-main">Substance use disorder</span> Continual use of drugs (including alcohol) despite detrimental consequences

Substance use disorder (SUD) is the persistent use of drugs despite the substantial harm and adverse consequences to one's own self and others, as a result of their use. In perspective, the effects of the wrong use of substances that are capable of causing harm to the user or others, have been extensively described in different studies using a variety of terms such as substance use problems, problematic drugs or alcohol use, and substance use disorder.The National Institute of Mental Health (NIMH) states that "Substance use disorder (SUD) is a treatable mental disorder that affects a person's brain and behavior, leading to their inability to control their use of substances like legal or illegal drugs, alcohol, or medications. Symptoms can be moderate to severe, with addiction being the most severe form of SUD".Substance use disorders (SUD) are considered to be a serious mental illness that fluctuates with the age that symptoms first start appearing in an individual, the time during which it exists and the type of substance that is used. It is not uncommon for those who have SUD to also have other mental health disorders. Substance use disorders are characterized by an array of mental/emotional, physical, and behavioral problems such as chronic guilt; an inability to reduce or stop consuming the substance(s) despite repeated attempts; operating vehicles while intoxicated; and physiological withdrawal symptoms. Drug classes that are commonly involved in SUD include: alcohol (alcoholism); cannabis; opioids; stimulants such as nicotine (including tobacco), cocaine and amphetamines; benzodiazepines; barbiturates; and other substances.

<span class="mw-page-title-main">Addiction</span> Disorder resulting in compulsive behaviours

Addiction is a neuropsychological disorder characterized by a persistent and intense urge to use a drug or engage in a behavior that produces natural reward, despite substantial harm and other negative consequences. Repetitive drug use often alters brain function in ways that perpetuate craving, and weakens self-control. This phenomenon – drugs reshaping brain function – has led to an understanding of addiction as a brain disorder with a complex variety of psychosocial as well as neurobiological factors that are implicated in addiction's development.

<span class="mw-page-title-main">Psychoactive drug</span> Chemical substance that alters nervous system function

A psychoactive drug, mind-altering drug, or consciousness-altering drug is a chemical substance that changes brain function and results in alterations in perception, mood, consciousness, cognition, or behavior. The term psychotropic drug is often used interchangeably, while some sources present narrower definitions. These substances may be used medically; recreationally; to purposefully improve performance or alter one's consciousness; as entheogens for ritual, spiritual, or shamanic purposes; or for research, including psychedelic therapy. Some categories of psychoactive drugs, which have therapeutic value, are prescribed by physicians and other healthcare practitioners. Examples include anesthetics, analgesics, anticonvulsant and antiparkinsonian drugs as well as medications used to treat neuropsychiatric disorders, such as antidepressants, anxiolytics, antipsychotics, and stimulant medications. Some psychoactive substances may be used in the detoxification and rehabilitation programs for persons dependent on or addicted to other psychoactive drugs.

<span class="mw-page-title-main">Mark S. Gold</span>

Mark S. Gold is an American physician, professor, author, and researcher on the effects of opioids, cocaine, tobacco, and other drugs as well as food on the brain and behavior. He is married to Janice Finn Gold.

<span class="mw-page-title-main">Opioid epidemic in the United States</span> Ongoing overuse of opioid medication in the US

There is an ongoing opioid epidemic in the United States, originating out of both medical prescriptions and illegal sources. The epidemic began in the United States in the late 1990s, according to the Centers for Disease Control and Prevention (CDC), when opioids were increasingly prescribed for pain management, resulting in a rise in overall opioid use throughout subsequent years.

<span class="mw-page-title-main">Opioid epidemic</span> Deaths due to abuse of opioid drugs

The opioid epidemic, also referred to as the opioid crisis, is the rapid increase in the overuse, misuse/abuse, and overdose deaths attributed either in part or in whole to the class of drugs called opiates/opioids since the 1990s. It includes the significant medical, social, psychological, demographic and economic consequences of the medical, non-medical, and recreational abuse of these medications.

Opioid agonist therapy (OAT) is a treatment in which prescribed opioid agonists are given to patients who live with Opioid use disorder (OUD). In the case of methadone maintenance treatment (MMT), methadone is used to treat dependence on heroin or other opioids, and is administered on an ongoing basis.

<span class="mw-page-title-main">Prescription drug addiction</span> Medical condition

Prescription drug addiction is the chronic, repeated use of a prescription drug in ways other than prescribed for, including using someone else’s prescription. A prescription drug is a pharmaceutical drug that may not be dispensed without a legal medical prescription. Drugs in this category are supervised due to their potential for misuse and substance use disorder. The classes of medications most commonly abused are opioids, central nervous system (CNS) depressants and central nervous stimulants. In particular, prescription opioid is most commonly abused in the form of prescription analgesics.

Harm reduction consists of a series of strategies aimed at reducing the negative impacts of drug use on users. It has been described as an alternative to the U.S.'s moral model and disease model of drug use and addiction. While the moral model treats drug use as a morally wrong action and the disease model treats it as a biological or genetic disease needing medical intervention, harm reduction takes a public health approach with a basis in pragmatism. Harm reduction provides an alternative to complete abstinence as a method for preventing and mitigating the negative consequences of drug use and addiction.

References

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