Unintended And Negative Consequences

Data do not exist to document in a comprehensive or detailed manner the extent to which the negative consequences of substance abuse exist worldwide, for specific nations (including the

United States), or for given states or cities. Consequently, I have chosen to present mainly summary information that is based on the best evidence available rather than partial statistical data of questionable accuracy, which would soon be out of date.

The following discussion is divided into four categories of drug problems; acute, chronic, drug-caused, and drug-related. Acute problems are defined as those which usually occur suddenly and often can be remedied in a relatively short time. Chronic problems typically have a relatively gradual onset and tend to persist, sometimes indefinitely. Drug-caused problems, for the purposes of this discussion, are defined as those which have an obvious and/or demonstrated direct causal connection between the use of a substance and a negative effect. In drug-related problems, negative outcomes result from drug-diminished capacities and their effects on user behaviors.

Acute Drug-Caused Problems. The National Institute on Drug Abuse's DRUG ABUSE WARNING Network (DAWN) estimates that alcohol-in-com-bination (alcohol used with another drug, the criterion for reporting this substance to DAWN) represents the most frequently reported category in drug-related hospital emergency department visits.

''Other drugs'' (illicit drugs, accidentally misused, and intentionally abused legal medications) collectively represent an acute drug-caused problem that may equal or surpass ALCOHOL in this category. The DAWN system is the best source of documentation of these problems, capturing data on substance abusers who come or are brought to hospital emergency departments, particularly for negative and/or unexpected reactions. These cases are usually thought of as overdoses, attributable to (a) tolerance effects (the need to use increasingly larger doses to achieve the same PSYCHOACTIVE effects). (b) inexperienced users with panic reactions, or (c) the use of a substance of greater strength than intended or expected. There also is increasing evidence that users of some drugs, such as COCAINE, can experience medical emergencies and deaths from seizure disorders and allergic reactions. This is true not only for first-time users but also experienced users at their regular (and sometimes low) dosage levels. Other frequently noted hospital emergency department (and medical examiner) cases involve SUICIDE ATTEMPTS (and suc cesses) where medications and/or drugs are the means chosen.

Chronic Drug-Caused Problems. Intravenous drug users can suffer from chronic cardiovascular problems that may be primarily attributable to infections and damage from ''fillers''—talcum powder, cornstarch, or baking soda added to drugs to increase volume, unit sales, and profits—that have been injected. Some drugs—especially the DESIGNER DRUGS, where an easily added molecule can produce a deadly variant of the intended substance—are neurotropic/neuro-pathic (have an affinity for and do damage to nerve endings and tissue). Researchers and clinicians are studying and treating individuals who are afflicted with Parkinson's disease caused by such ''party'' drugs.

One chronic drug-caused problem is particularly tragic because the individuals most damaged are totally innocent and defenseless against the substances that can cause them permanent disabilities or even death. I refer here to teratogenic drug use (use by pregnant women that causes abnormal fetal development).

When the use of CRACK-cocaine exploded in the mid-1980s, fetal developmental damage resembling Fetal Alcohol Syndrome began to be noted among infants born to women who had used this drug during the pregnancy. Although accurate counts are difficult to obtain, estimates cited in a 1990 government report—which are not based on representative national samples—range from 100,000 infants annually exposed to cocaine alone to as many as 375,000 annually exposed to drugs in general; more recent research, however, produced much lower estimates.

Acute Drug-Related Problems. Acute drug-related problems are typified by physical trauma; because of inebriation- or intoxication-impaired judgment or motor control/coordination, substance-abusing individuals can and do accidentally injure themselves.

Common examples in this category are accidental weapon discharges and motor vehicle and boating accidents; drownings, falls, and electrocutions are less common but not rare.

Even more unfortunate are instances where others—clean and sober—are injured or killed by the impaired substance abuser. (These cases often go unnoted; for example, DAWN records only cases where the injured or deceased had drugs ''on board.'') In addition to the types of accidental injuries noted immediately above, there are anecdotal (verbally reported but not documented) accounts which suggest that spouses, children, other relatives, and friends often are the victims of drug-impaired individuals. With diminished emotional control, inhibitions, and judgment, substance abusers often inflict physical trauma (e.g., gunshot, blunt force, or penetrating injuries) in chance encounters with strangers (other drivers, business-people), in disputes with coworkers or friends, in domestic disputes, or in physical abuse of their children. Moreover, analysis by Brookoff and his colleagues (1993) conclude that DAWN reporting procedures seriously underreport drug-involved emergency department cases, especially those with serious trauma.

Chronic Drug-Related Problems. Some of the most common chronic drug-related problems are similar to those resulting from in utero exposure of fetuses to cocaine and other development-impairing substances, in that severe illness and death are frequently involved and individuals other than the users themselves are victims. This class of drug-related problems is most closely associated with injecting drug use because the category is defined by infectious diseases that can be transmitted via sharing of unsanitized hypodermic needles. The most deadly infectious agent spread in this manner is the Human Immunodeficiency Virus (HIV), which causes ACQUIRED IMMUNODEFICIENCY SYNDROME (AIDS). Another potentially deadly infection spread in this manner is the liver disease hepatitis B. Various sexually transmitted diseases (including AIDS, syphilis, and gonorrhea), as well as tuberculosis, are among the other debilitating and often fatal diseases that are chronic problems related to substance abuse.

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