Pubdate: Sat, 20 May 2017
Source: Journal-Pioneer, The (CN PI)
Copyright: 2017 Journal-Pioneer
Author: Desmond Colohan
Page: A6


In a recent Canadian Public Health Association discussion paper, "A
New Approach to Managing Illegal Psychoactive Substances in Canada,"
the point was made emphatically that our current approach to managing
risk is not working.

Here are some of its highlights:

- - A psychoactive substance is a chemical that changes brain function
and results in alterations in perception, mood, consciousness or
behaviour. Societies mitigate the health, social, and economic
consequences of the use and misuse of psychoactive substances such as
alcohol, tobacco, cannabis, opioids, amphetamines, cocaine,
tranquillizers and sleeping pills in a variety of ways with varying
degrees of success. Their effects on population health, however, are
often overshadowed by our fascination with the direct effects of
substance misuse on individuals [e.g. recent rise in the opioid death
rate due to adulteration of the drug supply with fentanyl and its
analogues]. Currently, western societies manage illegal psychoactive
substances largely through prohibition and criminalization and legal
drugs, like tobacco and alcohol, through regulation, restricted
availability and price control. The laws and systems initially
introduced to control these substances reflected the times ! and
prevalent issues of the day, but no longer reflect current scientific
knowledge concerning substance-related harms to individuals, families,
or communities.

- - There is growing evidence, awareness, and acceptance that
prohibition and criminalization are not reducing drug use and
associated harms. The war on drugs has been lost. Furthermore, it is
clear that drug prohibition engenders an environment that fuels the
growth of illegal markets, organized crime, violent injuries, and the
deaths of users, dealers, and police. It also has unintended public
health consequences such as accelerating the spread of HIV and
hepatitis C, and increasing overdose deaths from black market sales of
extremely potent and contaminated products. An alternative to
prohibition and criminalization does exist in a public health approach
that is based on the principles of social justice, attention to human
rights and equity, evidence-informed policy and practice, and
addressing and improving the underlying determinants of health. Such
an approach espouses health promotion and the prevention of death,
disease, injury, and disability as its central tenet. It bases its
initiatives on evidence of what has worked or shows promise of

- - Worldwide psychoactive substance use is estimated at 2 billion alcohol 
users, 1.3 billion smokers and 185 million illicit drug users, including 
147 million cannabis users. Amongst the many preventable factors 
responsible for the global burden of disease, tobacco, alcohol and 
illicit drugs comprised 12.9 per cent of all deaths worldwide in 2010. 
Looking at the percentage of preventable years of life lost, it has been 
estimated that they account for 9.1 per cent.

- - Tobacco is responsible for 8.7 per cent of all deaths worldwide and
3.7 per cent of total preventable years of life lost [Disability
Adjusted Life Years]. Alcohol causes 3.8 per cent of all deaths and
4.5 per cent of preventable years of life lost. You might be surprised
to learn that all the illicit psychoactive drugs combined [cannabis,
opioids, cocaine, amphetamines, prescription medications misused,
others] only result in 0.4 per cent of worldwide deaths and 0.9 per
cent of preventable years of life lost. The health burden from
psychoactive substance use is higher in the developed world. Deaths
from psychoactive drug use are predominantly male, ranging from 80 per
cent for tobacco and illicit drug use to 90 per cent for alcohol. As
more men quit smoking tobacco, the female death rate from smoking is
expected to surpass that of males in the near future. One of the
differences amongst these substances is that they tend to affect
different age groups. Illicit drug use cau! ses harm earliest in life,
alcohol in middle age, while 70 per cent of tobacco deaths occur after
the age of 60.

It is time for us to focus our public health attention on the more
common preventable causes of disease such as alcohol, tobacco and
obesity. As Pogo once so wisely said "We have met the enemy and he is

Desmond Colohan, MD is a semi-retired island physician with a keen 
interest in responsible public policy.
- ---
MAP posted-by: Matt