Epidemics Of Drug Abuse Hearing

the word epidemic, one often thinks first of the flu, measles, the ACQUIRED IMMUNODEFICIENCY SYNDROME (AIDS), or some other contagious disease spreading through a community. In epidemics with person-to-person spread of infection and disease, people become infected and fall victim to the disease, and in the process they come into contact with other people, who in turn get the infection and disease. Often, what is being spread from person to person is not the disease itself, but rather an agent of the disease—for example, one of the viruses that accounts for influenza, the measles virus, or the human immunodeficiency virus (HIV) that causes

AIDS.

In Epidemiology (the study of epidemics), it is not the agent, the person-to-person spread of a disease, or the intentional or unintentional nature of acquiring the infection or disease that defines an epidemic. Instead, an epidemic is defined as an unusual occurrence of an infection, disease, or other health hazard in a population. The contrast between ''usual'' and ''unusual'' most often is determined by looking at the number of cases that have been occurring within the population over time. If the number of cases occurring in the population this month (or year) is notably greater than the number of cases that occurred in the population during each of the prior months (or years), then it is legitimate to talk of a growing epidemic.

An epidemic may be most obvious when the number of cases goes from zero to a much greater number in a relatively short span of time. For example, before the middle 1970s, the U.S. population apparently had no cases of HIV infection or AIDS. For those years, the usual number of cases per year was zero. Since then, the country has seen a mounting number of HIV infections and AIDS cases each year, and it has become a raging epidemic. Compared to the previous usual number of cases per year, the United States faces an unusual occurrence of disease in the form of thousands of cases per year.

The same concept can be applied on a smaller scale. In the mid-1990s there still are small cities and communities where apparently no one in the population has yet acquired the HIV infection. Health officers who watch over these populations may speak legitimately of an HIV epidemic once the number of cases occurring in the population begins to mount, and there is no need to wait until there are hundreds or thousands of cases before describing the epidemic situation. This is because epidemics are not defined by the absolute number of cases that are occurring. In the early 1990s, there was an epidemic outbreak of hantavirus infection and hantavirus-related deaths in the southwest United States. Because the usual number of hantavirus-related deaths in this region was zero, the situation was declared to be an epidemic well before 100 cases had occurred. Sometimes an epidemic that is limited to a certain place or time will be called an outbreak, but this distinction is not a technical one.

There are also epidemics even when no person-to-person spread is involved. For example, in the middle of the twentieth century, there was an epidemic of infant blindness due to retrolental fibroplasia, induced when premature infants were kept in incubators with excessively high concentrations of oxygen. These very high concentrations of oxygen were not a result of machine failure. Instead, the number of cases of retrolental fibroplasia and associated blindness kept growing as ever more hospitals raised the oxygen concentration within incubators in a misguided effort to increase survival of the infants by enriching their oxygen supply. Later, clinical and epidemiologic studies showed that this effort to save lives actually led to the increased occurrence of blindness.

Sometimes people object to the usage of the term epidemic as applied to drug dependence because it is believed that people bring drug problems down upon themselves by their careless behavior. Epidemiologists, however, typically do not recognize the distinction between ''careless'' and ''careful'' behavior when it comes to epidemics. For this reason, they have no trouble speaking about epidemics of syphilis and AIDS, which in some degree are linked to unprotected sexual behavior, something that many would regard as careless behavior.

In summary, the evenhanded application of the concept of epidemic makes it clearly legitimate to speak of an epidemic of smoking-related lung cancer or emphysema, an epidemic of liver cirrhosis due to drinking of alcoholic beverages, an epidemic of leukemia induced by ionizing radiation, an epidemic of mental retardation due to rubella (German measles) infection during gestation, an epidemic of motor vehicle crashes, and an epidemic of deaths by homicide, as well as epidemics of drug use and drug abuse. In order to use the term epidemic to describe the health-related experience of a nation, state, or community, it is necessary to demonstrate an unusual occurrence of the condition in the population during some specified span of time, relative to the number or rate of cases that occurred in the population during the immediately prior time spans. There is no need to limit usage of the term to infectious diseases with known agents such as rubella or HIV: nor is there a need to limit its usage to diseases spread by person-to-person contact or to be concerned whether the spread of the disease involves careful or careless behavior.

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