Snapshots from a not-so-happy globe

Global Spread of Injecting Drug Use

Injecting drug use has been spreading internationally in both developed and developing countries due to political, economic, and social conditions and changes, drug control strategies, law enforcement, and local culture and tradition (Stimson, 1993, 1996; Des Jarlais, 1992). In the 1970s and 1980s, injection of illicit drugs began to increase in countries in Asia and South America. As yet there is no definitive explanation for the increase in injecting drug use in these countries, but three hypotheses have been suggested as important components. (Des Jarlais, et al. 1992; Stimson 1993; Inciardi, 1992).

First, illicit drug use occurs along drug production and drug trafficking routes (Des Jarlais, et al. 1992; Stimson, 1993; Inciardi, 1992; Sarkar, et al 1993). Particularly relevant are the areas referred to as the "Golden Triangle" and the "Golden Crescent." The Golden Triangle is a major heroin producing region which comprises the area in Southeast Asia where the Lao People’s Democratic Republic, Myanmar, and Thailand meet. (Inciardi, 1992; McCoy and Inciardi, 1995). The Golden Crescent is the second major heroin producing region, and includes districts in the Northwest Frontier Province of Pakistan, the adjacent Badakhshan area of Afghanistan and the Baluchistan area of Iran. (Poshyachinda, 1993; Inciardi, 1992).

Drug InjectionThe increase of injecting drug use in some countries in Asia, including Thailand, Myanmar, the Lao People’s Democratic Republic, Yunnan Province in China, Viet Nam, and also the northeastern states of India (including Manipur, Mizoram and Nagaland) has been attributed to the availability of inexpensive heroin, grown (from poppies) and produced in the Golden Triangle and distributed along drug trafficking routes in these countries (Stimson 1993, 1994). For example, until the 1960s, opium was produced in the Golden Triangle region for export for refining in the Mediterranean basin. As heroin was refined elsewhere, it was not available for local consumption, and opium was the drug most commonly used in Southeast Asia. However, from the late 1960s onward, the Golden Triangle region experienced an expansion of the refining of opium into heroin. The development of heroin refining was influenced by successful law enforcement against production in the Mediterranean countries and later in Mexico, as well as lower production costs and the growth of the world market (Stimson 1996). Markets for heroin emerged due to the refining and distribution of heroin in the Golden Triangle region, and resulted in availability of the drug at low cost. In addition, enforcement and government activity against dissident groups in Myanmar and the development of new transport networks caused drug trade routes to shift from Myanmar to a route that went through Shan State to Yunnan Province, China and on to Hong Kong (Stimson 1996). Yunnan Province has experienced a corresponding increase in heroin abuse.

Availability of inexpensive heroin is not relegated to countries surrounding the drug producing regions. Countries in Africa, particularly Nigeria, Cote d’Ivoire and South Africa, have become part of the international heroin and cocaine trafficking route, and have experienced increases in injecting drug use in the last 5-10 years. (Stimson, 1993; Mann, et al. 1992; Adelekan, 1995; Adelekan and Stimson 1996).

It is also important to note that there are temporal and regional variations in patterns of heroin use that seem to be influenced by drug production and trafficking routes. Many countries have experienced a shift from predominantly opium smoking, to smoking of heroin ("chasing the dragon"), to injection of heroin, and these shifts correspond with availability of injectable grade heroin (Stimson and Choopanya 1996). For instance, in Madras, India, injection as a route of administration of heroin was uncommon, with most drug users smoking brown sugar heroin (unrefined heroin) until the mid-to late-1980s. Injecting was not reported until 1987. Several factors seem to be related to the shift to injection, including the increased availability of injectable-quality heroin from young people who migrated from Manipur and brought in heroin from South-east Asia. By 1990, injecting was increasingly found in many areas of Madras (Stimson and Choopanya 1996).

Similarly, Thailand experienced a shift in the pattern of drug administration which coincided with increased drug production and trade in the Golden Triangle. Within a period of 25 years many drug users Thailand switched from smoking to injecting heroin (Stimson and Choopanya 1996). Other countries, including China (Yunnan Province), Myanmar and Viet Nam have had similar experiences. While the mechanisms of this transition are somewhat unclear, it is accurate to state that where injectable-quality drugs are available, injecting drug use occurs.

Regional variations in the prevalence of smoking versus injecting heroin also exist, and these again correspond to drug production and trade routes. For example, in Myanmar, the areas close to the heart of the poppy growing regions tend to have higher prevalence rates of opium smoking than heroin injecting. However, in areas further from the growing regions and closer to the heroin distribution routes, injecting is more common than smoking (Stimson and Choopanya 1996). Similarly, in certain regions in China along the drug trade route (Yunnan, Guangxi, Guangdong and Sichuan provinces), heroin injecting is common. Drug users in provinces remote from the drug trade routes tend to use less injectable drugs such as "yellow crust" (heroin and opium) and opium (Zheng et al. 1995).

The spread of drug use and injecting can also be examined in terms of innovation and diffusion from upper and middle-classes to poorer classes. In Western Europe, heroin injecting was initially adopted by small groups of individuals, such as jazz musicians, bohemians, and students (Stimson and Choopanya 1996). However, with the increase in heroin produced in South-east Asia in the 1970s and distributed in Europe, injecting spread rapidly to new groups, and subsequently became associated with poor and disadvantaged social groups. The same pattern can be seen in Nigeria. Over the past 15 years there as been an increase in the use of heroin and cocaine as a result of increased trafficking through this area. While consumption of these drugs initially occurred among middle class elites, heroin and cocaine are now used by all classes (Adelekan 1995). Increased availability and decreased prices afford poor individuals greater access to drugs previously limited to wealthier groups.

At the individual level, there are differences in the timing of transition from snorting or inhaling ("chasing the dragon") to injecting, and whether that transition is made at all. Some drug users move from snorting or sniffing to injecting within 6 to 12 months, while others remain dependent on inhaling for over a decade (Strang, et al. 1992). There are several explanations and theoretical perspectives that contribute to understanding this shift in behavior; however, no one model of transition can be specified. Transition at the individual level depends both on contextual factors, including economic, political, and normative influences, as well as individual behavioral factors and individual relationships (see Strang, et al. 1992 for a review of relevant perspectives). Understanding changes in route of drug administration is important for considering HIV prevention programs. Interventions may need to be tailored to specific types of drug users in different stages of their drug careers.

Global Spread of Injecting Drug Use and the Nature of Heroine

The second hypothesis explaining increased prevalence of injecting drug use is related to law enforcement and drug-related policies. Efforts by law enforcement to control drug use have the effect of increasing drug prices and decreasing availability, thereby creating a need for efficient distribution and consumption of drugs (Des Jarlais, et al. 1992; Inciardi, 1992; Stimson, 1993). Highly processed drugs, such as heroin and cocaine, are more compact and, therefore, more easily transported and distributed than other forms of drugs, such as opium. In addition, injection is a more efficient route of drug administration because none of the drug is lost as it is when smoked. Injection provides a rapid delivery of drug to the brain and a reportedly more intense drug effect (Des Jarlais et al, 1992; Inciardi, 1992, McCoy and Inciardi, 1995; Auerbach 1994). These factors become important to the drug user when drugs are expensive and not readily available. A pilot study of IDUs in Malaysia found that one of the primary reasons cited for administering the drug by injection was to economize on expenses of drugs (Kin 1995). There is also evidence of a temporal relationship between law enforcement efforts to control opium smoking in cities such as Bangkok, Calcutta, and other areas in India, and a subsequent increase in heroin injection (Des Jarlais, et al. 1992; Sarkar, 1995).

In addition, the experience of Southeast Asia discussed above indicates that national drug enforcement policies can result in re-routing of drug transportation, which in turn influences drug consumption patterns. Successful law enforcement efforts against heroin refining in the Mediterranean were partly responsible for the expansion of heroin refining in the Golden Triangle, resulting in increased availability and use of heroin in this area (Stimson, 1996). Also, in the mid- to late 1980s, Thailand began to vigorously pursue law enforcement efforts against opium and heroin production, and implemented crop-replacement programs in opium growing regions in the northern hill areas (Tullis 1995; Stares 1996). These policies have resulted in decreased production of heroin in this country (though not decreased trafficking), with cultivated hectares of opium poppy cut in half (United States, Department of State 1993). However, these drug control efforts also resulted in the displacement of production of opium and heroin into the neighboring country of Laos (Stares 1996; Tullis 1995). Since then, illicit heroin production and trafficking have increased in this country.

Third, increased injecting drug use can be seen as part of modernization of some developing countries (Des Jarlais, et al. 1992; Inciardi, 1992). Improved transportation routes and infrastructure and the availability of industrial chemicals facilitate processing and transportation of illicit drugs (Inciardi, 1992). For example, in India, the prevalence of IDUs corresponds with the path of national highway 39, which originates from a town bordering Myanmar, and cuts across urban areas of Manipur state to reach Nagaland (Sarkar, et al. 1993). IDU prevalence is lower in areas further from this highway.

Source: World Bank

Nature of Heroine

Heroin is a half-synthetic drug that is derived from morphine.

It was first produced in 1874.

It was used in medicine as strong painkiller, but then forbiddendue to its high addictive potential.

The quality of heroin sold on the illegal market is varies a lot.

The gramof “heroin” normally contains 25–50% pure heroin. The percentage is much higher in the so-called “heroin no. 4”.

Injected undiluted it is absolutely lethal.

The heroin is mostly available on the street market as a brown powder and is referred to “Brown Sugar” or “Sugar”.

Heroin no. 4 is also called “ChinaWhite”.

Heroine is mostly injected intravenous, but it can also be smoked or sniffed.

Recently, smoking heroin has become popular with younger drug users, making it a gateway drug.

This is fatal because of the extreme addictive potential of heroin. The amount of heroin needed for inhalation is generally greater than for injecting.

Source: Editorial at The Toronto Star

About Drug Use by Children

Drug UseThere is no single cause, no one reason why children, teenagers and adults use drugs. From studies of young people who use drugs we know that certain factors shape children’s attitudes about drugs and their decisions whether or not to use them.

Some of these factors are more important than others, and not all apply in each case. In most cases it is probably a combination of these factors that makes the crucial difference.

The single greatest influence in the lives of most children is their parents. The word ‘parent’ here applies not only to biological parents but also to stepparents, foster parents, relatives and others who serve as guardians. The examples they set and the values they communicate greatly determine children’s susceptibility to drug use.

Children are more likely to abuse drugs if their parents:

- Abuse alcohol or are alcoholics.
- Use alcohol or prescription medications to cope with stress.
- Tolerate or encourage heavy drinking or allow them to serve, pour, or purchase alcoholic beverages.
- Smoke tobacco.
- Use illicit drugs.
- Convey an ambivalent or positive attitude towards drugs and drug use.

Young drug abusers tend to have a number of characteristics in common.

These include:

- Isolation and alienation from family and friends.
- Little or no value for personal achievement.
- Little or no sense of personal and social responsibility.
- Poor grades and little commitment to doing well in school.
- Difficulty getting along with others (communicating their thoughts and feelings,
resolving differences).
- Inability to deal positively with stress, make rational decisions, approach problems
- Families that have a history of criminality, alcoholism or other anti-social behavior.
- Parents who are either too lenient or too strict, or who do not clearly define and consistently enforce rules.

It is generally assumed that the more of these “risk factors” there are in a child’s life, the more likely he or she is to develop serious drug problems.

Global Spread of Injecting Drug Use. (Reuters/Adeel Halim)

An Indian boy smokes brown sugar heroin, a crude form of the opiate, at a slum in Bombay, India on May 22, 2005.Drug addiction is rampant among the poor in India with a majority of street children in Bombay and other urban areas falling prey to drug abuse.

During the primary school years, most young people do not use drugs. Not using drugs is the “norm” at this age. However, as children approach and enter adolescence they are exposed to information and drugs. During this stage of exploration and discovery, pressure from peers to use drugs intensifies, especially by the time they enter secondary schools.

Young people respond to a kind of natural “herd instinct.” As long as they believe and see most of their peers using drugs and/or approving drug use, they will be more likely to use drugs themselves.

But if they know that most of their peers do not use drugs, and that they disapprove of drug use, peer pressure will work in favor of stimulating the non-use norm.

Source: The Kenya Scouts Association

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