The War on Drugs
The Ethics & Rationale Behind the
Federal Government’s ‘Other’ War
The War on Drugs
Robert Portley
Isuru Kumarasinghe
Brooke LaFlamme
John Widen
Arvind Vijayasarathi
Scientific and Ethical Aspects of Behavior Modification
Dr. Victor Hruby
18 April 2006
Presentation Overview
Introduction: History and Controversial
Features
The Chemistry of Illicit Drugs: Physiological
Effects/Mechanisms
Treatment Options: The Anti Drug
The Global Drug Trade: Supply Issues
Conclusion: Summary & Ethical Aspects
Introduction
The History and Controversy
War on Drugs Policy
The Modern War on Drugs began in 1971 when
Nixon identified abuse of illicit substances as
"America's public enemy number one."
In 1988 the Anti-Drug Abuse Act created the
Office of National Drug Control Policy (ONDCP)
This branch of the executive office was created
to centrally coordinate the political aspects of
the war on drugs under direction of the Drug
Czar.
Objectives of the War on Drugs
Reducing drug related crime and drug caused
health problems by reducing drug use
Drug addiction was moved from being a personal
problem to a public problem
“It is the declared policy of the United States
Government to create a Drug-Free America by
1995” – Anti-Drug Abuse Act 1988
What constitutes abuse?
A drug is a substance to affect mood or
behavior
For U.S. public policy purposes, drug
abuse is any personal use of a drug
contrary to law.
ONDCP
John P. Walters current
Drug Czar since 2001
2006 National Drug
Control Strategy
Goals:
Stopping drug use before
it starts
Healing drug users
Disrupting the market for
illicit drugs.
Drug War Expenditures
FY 2002 funding
for the war on
drugs was 18.8
billion according to
ONDCP
http://www.drugse
nse.org/wodclock.h
tm
History
Harrison Narcotics Tax Act 1914
Tax on opium and cocaine
Marihuana (sic) Tax Act 1937
Imposed a tax on commercial distribution and
lead to eventual ban
Controlled Substance Act 1970
5 Schedules (classes) determined by DEA and
HHS
History (Cont.)
Drug Prohibitions targeted
racial groups:
Opium as a way to target
Chinese Immigration
Cocaine due to racist fears
about African Americans
Marijuana during the
depression targeted Mexicans
Despite popular belief to the
contrary, there was never
evidence that the laws were
necessary, or even beneficial,
to public health and safety
Constitutionality
The Controlled Substances Act stresses the
impact of intrastate drug offences on "interstate
commerce" and the "general welfare" of the
American people.
Therefore circumventing any constitutional
objections regarding states rights
Medicinal Marijuana usage was initially approved
by the ninth circuit but lost in the Supreme Court
in 2005
Schedule 1 Drugs
(A) The drug or other substance has a high
potential for abuse.
(B) The drug or other substance has no currently
accepted medical use in treatment in the United
States.
(C) There is a lack of accepted safety for use of
the drug or other substance under medical
supervision.
These include:
GHB, LSD, Marijuana, Heroin, Ecstasy, Peyote
Schedule 2 Drugs
A) The drug or other substance has a high potential for
abuse.
(B) The drug or other substance has a currently accepted
medical use in treatment in the United States or a currently
accepted medical use with severe restrictions.
(C) Abuse of the drug or other substances may lead to
severe psychological or physical dependence.
These include:
Cocaine
Ritalin
Opium, morphine, oxycodon
Amphetamines
Schedule 3 Drugs
(A) The drug or other substance has a potential
for abuse less than the drugs or other
substances in schedules I and II.
(B) The drug or other substance has a currently
accepted medical use in treatment in the United
States.
(C) Abuse of the drug or other substance may
lead to moderate or low physical dependence or
high psychological dependence.
Includes Anabolic Steroids
Schedule 4 Drugs
(A) The drug or other substance has a low
potential for abuse relative to the drugs or other
substances in schedule III.
(B) The drug or other substance has a currently
accepted medical use in treatment in the United
States.
(C) Abuse of the drug or other substance may lead
to limited physical dependence or psychological
dependence relative to the drugs or other
substances in schedule III.
Includes Xanax and Valium
Schedule 5 Drugs
(A) The drug or other substance has a low potential
for abuse relative to the drugs or other substances
in schedule IV.
(B) The drug or other substance has a currently
accepted medical use in treatment in the United
States.
(C) Abuse of the drug or other substance may lead
to limited physical dependence or psychological
dependence relative to the drugs or other
substances in schedule IV.
Includes codeine containing cough suppressants
How big is the drug problem?
We don’t know
Unable to accurately determine number of
drug users or money spent on illegal drugs
due to the nature of the subject
34.8 million Americans ages 12 or over (14.5%
of the US population ages 12 and over) used
an illicit drug during the previous year.
Drug Mortality Statistics (per year)
Tobacco kills about 390,000.
Alcohol kills about 80,000.
Second hand smoke from tobacco kills about
50,000.
Cocaine kills about 2,200.
Heroin kills about 2,000.
Aspirin kills about 2,000.
Drug Mortality Statistics (cont’d)
Marijuana kills 0.
There has never been a recorded death due to
marijuana at any time in US history.
All illegal drugs combined kill about 4,500 people
per year, or about one percent of the number killed
by alcohol and tobacco. Tobacco kills more people
each year than all of the people killed by all of the
illegal drugs in the last century.
Non-Drug Related Deaths in U.S.
Air pollution - 50,000 - 100,000
Diabetes - 73,000
Alzheimer’s - 60,000
Automobile - 30,000
HIV – 23,000
Suicide – 13,000
Still almost 100,000 less than tobacco related
deaths
Health Impact
Rockefeller University concluded that "Tobacco
is unquestionably more hazardous to the health
than heroin."
Forty percent of all hospital care in the United
States is for conditions related to alcohol.
As a medical hazard, few drugs can compete
with alcohol or tobacco on any scale.
Do Drugs Cause Crime?
Alcohol is the only drug
whose consumption
has been shown to
increase aggression
Alcohol Prohibition gave rise to a violent
criminal organization. Violent crime
dropped 65 percent in the year
Prohibition was repealed.
Policy Causes Crime
Policy Causes Crime (cont’d)
In 1933 the homicide rate peaked at 9.7 per
100,000 people, which was the year that
alcohol prohibition was finally repealed.
In 1980, the homicide rate peaked again at 10
per 100,000, coinciding with the escalation of
the “War on Drugs.”
Crime & Societal Impact
The vast majority of drug-related violent
crime is caused by the prohibition against
drugs, rather than the drugs themselves
Illegal drugs and violence are linked
primarily through drug marketing
“Drug-related” crime is a
direct result of drug prohibition's
distortion of immutable laws of
supply and demand.
Mandatory Minimum Sentencing
Low level drug offenders are often imprisoned
longer than rapists, child molesters, bank
robbers, and those convicted of manslaughter
Since the enactment of mandatory minimum
sentencing for drug users, the Federal Bureau
of Prisons budget has increased by 1,954%.
Its budget has jumped from $220 million in
1986 to more than $4.3 billion in 2001
Drug courts and drug treatment programs are
seen as money saving alternatives to
imprisonment
Average Federal Sentences
Drug offenses-6.5 years
Sex offenses-5.8 years
Manslaughter-3.6 years
Assault-3.2 years
Racketeering-5 years
Extortion-5 years
Costs to Society
The cost to put the average drug offender in jail is about
$450,000
1.5 million people in prisons across the United States
Drug Offenses 59.6%
Of the 1,745,712 arrests for drug law violations in 2004,
81.7% (1,426,247) were for possession of a controlled
substance. Only 18.3% (319,465) were for the sale or
manufacture of a drug.
Federal Prisoners (By Offense)
Common Myths Influencing Drug Policy
Myth #1: Experimentation with drugs is not a common
part of teenage culture
Myth #2: Drug use is the same as drug abuse
Myth #3: Marijuana is the gateway to drugs such as
heroin and cocaine
Myth #4: Exaggerating risks
will deter young people from
experimentation.
Drug War Programs
National Youth Anti Drug Media Campaign
DARE
The High-Intensity Drug Trafficking Area
Program
Drug Endangered Children
Inefficacy of Anti-Drug Campaigns
The National Youth Anti-Drug Media
Campaign is a multi-dimensional effort to
educate and empower youth to reject illicit
drugs.
Congressional Appropriations committee
“deeply disturbed by the lack of evidence that
the National Youth Anti-Drug Media Campaign
has had any appreciable impact on youth drug
use” in 2002.
DARE
Drug Abuse Resistance Education (K-12)
National Youth Program that teaches kids to
“just say no” to drugs
Zero Tolerance - one of the creators at a 1990
testimony before the U.S. Senate said that the
“casual user ought to be taken out and shot,
because he or she has no reason for using
drugs.” When asked about this outrageous
testimony, he stressed that he was not “being
facetious” and asserted that marijuana users
were guilty of treason.
DARE Ineffectiveness
Glamorizes drugs
Mixed message
Self fulfilling
prophecy
Hidden agenda
The High-Intensity Drug Trafficking Area
Program
Areas within the United States which exhibit serious
drug trafficking problems and harmfully impact other
areas of the country
Provides additional federal resources to those areas to
help eliminate or reduce drug trafficking and its
harmful consequences. Law enforcement
organizations within HIDTAs assess drug trafficking
problems and design specific initiatives
HIDTA-designated counties comprise approximately
13 percent of U.S. counties, they are present in 43
states, Puerto Rico, the U.S. Virgin Islands and the
District of Columbia.
Drug Endangered Children
Programs have been developed
to coordinate the efforts of law
enforcement, medical services,
and child welfare workers to
ensure that children found in
environment where illegal
substances are produced receive
appropriate attention and care.
Risks children face in these
environments include: inhalation
or ingestion of chemicals, fires,
neglect, and generally hazardous
living conditions.
There were 1,660 children
affected by or injured or killed at
methamphetamine labs during
calendar year 2005.
2002
2003
2004
2005
Child injured
11
25
13
11
Child killed
2
1
3
2
Children affected
3,660
3,682
3,088
1,647
Total injured/killed/
affected
3,673
3,708
3,104
1,660
Possible Solution
The overwhelming weight of the scholarly
evidence on drug policy supports
decriminalization. Every major study of drug
policy in history has recommended a noncriminal approach.
The best analysis done to date by any Federal
official shows that "legalization" of the now
illegal drugs would result in a net $37 Billion
annual savings. This estimate is considered
conservative.
Alternative Policies
Harm reduction: diminishing individual and
social risks associated with potentially
dangerous behaviors.
Decriminalization: without legalizing the
currently banned substances decriminalizing
them would relieve the burden from law
enforcement and society
Non incarceration: deterring offenders to
treatment and rehabilitation rather than
imprisonment
Benefits of Decriminalization
Decriminalization would increase the use of
the previously criminalized drug, but would
decrease violence associated with attempts to
control illicit markets and as resolutions to
disputes between buyers and sellers.
Moreover, because the perception of violence
associated with the drug market can lead
people who are not directly involved to be
prepared for violent self-defense, there could
be additional reductions in peripheral settings
when disputes arise.
Non-Incarceration
Drug courts and local policies which favor
treatment:
In 1996, Arizona Proposition 200, the Drug
Medicalization Prevention and Control Act which
sends first and second time non-violent drug
offenders to treatment rather than incarceration.
Saved Arizona taxpayers $6.7 million in 1999.
In addition, 62% of probationers successfully
completed the drug treatment ordered by the
court.
California Non-incarceration
In November 2000, 61 percent of California voters passed
Proposition 36, the Substance Abuse and Crime Prevention Act
(SACPA), an initiative aimed at rehabilitating rather than
incarcerating non-violent drug possession offenders. Under
SACPA, certain persons convicted of non-violent drug possession
offenses are given an opportunity to receive community-based
drug treatment in lieu of incarceration.
By treating rather than incarcerating low level drug offenders,
SACPA would save California taxpayers approximately $1.5
billion over the next five years and prevent the need for a new
prison slated for construction, avoiding an expenditure of
approximately $500 million.
36,000 would be diverted to alternative treatment programs
Admission of Defeat
A report released in December 2005 by
the Government Accountability Office
showed that, despite U.S. law to the
contrary, the more than 50 plus agencies
working on the National Drug problem
have little effect on the overall
production and consumption of illegal
drugs
The War on Drugs Could be Won If…
We could stop drug production in other
countries.
We could stop drugs at the border.
We could stop the sale of drugs within
the United States.
However, these are unattainable goals,
so why do we continue?
References
Eddy, Mark. War on Drugs: Legislation in the 108th Congress and Related Developments. 4 April 2003.
Rosenbaum, Marsha. Safety First A reality based approach to teens drugs and drug education. Drug Policy Alliance
2004.
US Department of Justice, Bureau of Justice Statistics, Sourcebook of Criminal Justice Statistics 1996 (Washington
DC: US Dept. of Justice,1997), p.20;
Executive Office of the President, Budget of the United States Government, FY 2002 (Washington DC: US
Government Printing Office,2001), p.134.
U.S. National Center for Health Statistics, Health, United States, 2004.
Negro Cocaine Fiends: New Southern Menace, New York Times, February 8, 1914
Controlled Substances Act - U.S. Drug Enforcement Administration 1970
www.druglibrary.org
www.drugwarfacts.org
www.drugpolicy.org
www.Dea.gov
http://www.whitehousedrugpolicy.gov/
The Chemistry of Illicit Drugs
Physiological Effects and Mechanisms
Section Overview
Drugs classification
Drugs mechanism of action
Illegal drugs and their mechanism of action
Receptors, Agonists & Antagonists
Receptor
Any target molecule with which a drug molecule has to
combine in order to elicit its specific effect.
When drug molecule binds to receptor molecule, there will
be cascade of reactions– adrenaline
Agonist and Antagonist
Agonist binds to the receptor and activates the receptor,
but antagonist binds to the receptor and does not activate
the receptor and it prevents binding agonist to the receptor.
Drug Specificity
Drugs specificity
Drug must act selectively on particular cells or tissue. It must show
high degree of binding specificity. Remove or substitute an amino
acid from a peptide drug lose it selectivity for the target molecule. No
drug acts complete specificity. Side effects are due to non specificity.
Lower the potency of the drug, higher the dose needed. Binding and
activation are two distinct steps
Tendency of drug molecule to bind to the receptor called affinity and
tendency for it once bound activate the receptor is denoted by its
efficacy.
Drug with high potency generally have high affinity for the receptor
thus occupy significant proportion of receptor even at low
concentrations.
Agonists & Antagonists
K1
Drug ( agonist)
(A)
+
Receptor
(R)
Β
AR
+
Receptor
(R)
AR*
Response
K-1
K1
Drug ( agonist)
(A)
α
AR
No
Response
K-1
Agonist has high efficacy
Antagonist has zero efficacy
Drug with intermediate levels of efficacy such that even when 100
% of the receptor are occupied the tissue response is sub maximal
are called partial agonist.
Receptor Binding
The binding of a drug to a receptor can often
be measured directly by the use of radio active
drug molecule. Radio active ligand should bind
with high affinity and high specificity.
Method is incubate the sample of tissue with
various concentrations of radio active drug
until equilibrium is reached. Tissue is then
removed or isolate and radio activity amount
will be quantitated.
Specifically bound (Fmol /mg)
Binding curves
This is the relationship between
concentration and amount of drug bound
Concentration (nmol /l)
Dose response curve
Biological response
(%max)
Biological response
Rise in blood pressure
Activation of enzyme
Contraction or relaxation of strip of
smooth muscle
[E max] maximal response that the drug
can produce [Emax]
[EC50] or [ED50] Concentration or dose
needed to produce a 50% maximal
response
[EC50]
E max
Concentration (mol /l)
10-11 10 -10 10-9 10-8 10-7 10-6 10-5 10-4
[EC50] or [ED50] values used to comparison of potencies of different drugs
that produce qualitatively the similar effect
Dose response curve can not be used to measure the affinity of agonist
drugs for their receptor
Agonist occupancy decreases in the
presence of antagonist in competitive
antagonism
Biological response
(%max)
10
[EC50]
20
30
In the presence of
antagonist
E max
Concentration (mol /l)
10-11 10 -10 10-9 10-8 10-7 10-6 10-5 10-4
Biological response
(%max)
In the presence of agonist (100%
efficacy)
100%
Partial
agonist
50%
(Sub maximal
response)
occupancy
50%
100%
Inverse
agonist
(Negative
efficacy)
Inverse agonist - Ligand that reduces level of constitutive activation
Targets for the drug action
Enzymes
Carrier molecules
Ion channels ( voltage sensitive sodium channel for local
anesthetics)
Receptors
Exceptions some drugs binds to plasma protein, site of
action of some drugs is still unknown. Antimicrobial
drug and antitumor drugs, mutagenic and carcinogenic
agents interact directly with DNA
Receptor
•
•
Receptors are the sensing elements in the system of chemical
communication that coordinates the function of all the different cells in the
body
Drugs act as agonist or antagonist on receptor
Agonist
molcule
Direct
Ion channel
opening and
closing
Enzyme activation
and inhibition
Receptor
Transduction
mechanism
Ion channel
modulation
DNA transcription
Antagonist
molcule
Receptor
No effect
endogenous
mediators blocked
Types of receptors
Binding domain
N
N
C
N
C
C
Channel
Ligand gated ion
channel
Fast response (milliseconds).These are for
neurotransmitter
E.G.Nicotonic acetylcholine receptor,
GABA receptor, gluatmate receptor
G protein
coupling
domain
G protein coupled
receptor
Response in seconds.
These are for hormones
and slow
neurotransmitter
E.g Adrenoreceptor,
acetylcholine, dopamine
and opiate receptors.
Catalytic
domain
Kinase linked
receptor
Response in hours.
Features
Receptors for insulin,
cytokines and growth
factors
N
C
DNA
Binding
domain
Nuclear
receptor
Response in hours
regulate the gene
expression.
Receptors for steroid
hormones or thyroid
hormones.
G protein coupled receptor families
Family
Receptors
Structural features
Rhodopsin family
The largest group. Receptors for most
amine neurotransmitters, purines,
prostanoids, cannabinoids
Short extra cellular ( N terminal) tail
ligand binds to transmembrane
helices or to extra celllar loops
Secretin / glucogen receptor
family
Receptor for peptide hormones,
including secretin, glucogon, calcitonin
Intermediate extra cellular tail,
incorporating ligand binding tail
Metabotropic glutamate
receptor/ calcium sensor family
Small group, metabotropic glutamate
receptor, GABA receptor, calcium
sensing receptor
Long extra celluar tail including ligand
binding domain
Shares same heptahelical structure but differ in length of N terminus and location of
agonist binding domain.
What is importance of having cytoplasmic loop? How it relates to response?
Mechanism of receptor activation
Rhodopsin is activated by light induced cis-trans isomerization
For thrombin, protease activate the receptor by cutting first N terimnal tail (41 residue), then the
liberated N terminal binds to the receptor domains in the extra cellular loops and function as
agonist (tethered)
Inactivation is by phosphorylation.
Due to the mutation in the receptor, it can be constitutively active. Several human diseases
associate with this.
Signal transduction is by GPCR
First stage of signal transduction is through G proteins
Resting state
1
2
Receptor
Target
1
Receptor
α
GDP
Target
2
βγ
Target
1
Target
2
βγ
α
GDP
3
Target proteins
activated
Target
1
α
GDP
GTP
Target proteins
activated
Receptor
βγ
Target
2
Target
1
4
Receptor
α
GTP
βγ
Target
2
G proteins is made of 3 subunits α,β, γ. There three types Gi, Gs, or Gq
G proteins are able to diffuse in plane of membrane
Agonist binds to the receptor. GDP/GTP exchange happens. Dissociation of complex
occurs. α-GTP and βγ are active form of G protein. They can activate/or inactivate
enzymes and ion channels (effectors). Process is terminated when GTP hydrolyze to
GDP. Then α subunit dissociate from the effector and reforms complex with β and γ
These enzymes produce products and they act as second messengers
Second messenger
AC
α
Protein kinase(inactive)
Increased
lipolysis
Lipase
active
Glycogen
synthase
(active)
cAMP
GDP
βγ
ATP
Lipase
inactive
Protein kinase (active)
Glycogen
synthase
(inactive)
80 % of Drugs in the market target for G proteins. Since GPCR controls different
cell function through followings
1.
2.
3.
Adenylate cyclase – enzyme responsible for cAMP formation (it regulates
magnitude of cAMP Formation) cAMP controls energy metabolism, cell
division, ion transport, ion channels and contractile protein in smooth
muscle. cAMP ultimately activates of protein kinase in turn activate or
deactivate enzymes or ion channels
Phospholipase C – The enzyme responsible for inositol phosphate and
diacylglycerol formation
Ion channels – Calcium and pottasium channels
Phosphorylase
kinase
(inactive)
Reduced
glycogen
synthesis
lipolysis
Increased
glycogen
synthesis
Phosphorylase b
inactive
Phosphorylase
kinase (active)
Phosphorylase b
active
Hydrolysed
products of cAMP
cAMP
Methylxanthine,
Theophylline, Caffeine
Slidenfil(viagra)
phosphodiesterase
Ion channels
Blockers
E.g. voltage gated
sodium channel
modulators
Permeation
blocked
Increased or
decreased opening
probability
Ion channels known as ligand gated ion channels. These open only
when agonist molecule occupies the receptor. Other has different
mechanism.
Interaction of the agonist molecule is direct or indirect. Direct is drug
binds to it and change is fuction. Indirect mechanism happens through
G protein coupled receptor
Enzymes
Normal reaction
inhibited
inhibitor
False
substrate
Abnormal metabolite
produced
prodrug
Active drug produced
Agonist /normal substrate
Many drugs target the enzymes. Often the drug molecule is substrate analogue that
act as competitive inhibitor of the enzyme reversibly or irrevesibly.
Drugs also act as false substrate, where drug molecule undergoes chemical
transformation to form an abnormal product that subverts from normal metabolic
pathway e.g. Flourouracil
Drug toxicity can happen when enzymes converts the drug molecules to reactive
intermediates
Drugs require the enzymetic degradatation activty converts from inactive prodrug to
active drug molecule
Biosynthesis of PGs
Phospholipids
Phospholipase A2
Arachidonic acid
Cyclooxygenease reaction
Block by NSAIDS
e.g. naproxen,
ketoprofen, ibuprofen
Lipoxygenase pathway
Leukotriene
PGG2
Cyclcoxygenase peroxidase reaction
PGH2
TXA2
Promotes
plattlet
aggregation
Thromboxan synthase
PGD2
Cytoprotective
propoeties in GI track
Control the renal
function since PGs act
as a vasodilator
Plattlet aggregation
(TXA2)
Bronchodialation (PGE2)
Prostacyclinsynthease
Isomerase
PGE2
PGI2
Develops inflammation
reductase
Dialate small blood
vessel
PGF2a
Vascular permeability
(causes swelling)
Sensitize the peripheral
nerve ending
nociceptors to transmit
pain signal to brain
Transporters
Normal transport
inhibitor
Agonist /normal
substrate
False
substrate
Abnormal
compound
accumulated
Transport of ions or organic molecule through the lipid membrane requires the
carrier protein because permeating molecules are always too polar. (glucose ,
amino acids, Na, K , Cl
Carrier protein molcules or transport molecules always has a special site for
recognize the permeating ions. These recognition sites are always targets for
drugs that block the transport system
Cannabis
It is extracted from cannabis sativa
In 300, AD people found that the cannabis
increases hunger and appetite particularly for
sweet and palatable food
OH
∆9 Tetrahydrocannabinol (THC) is the active
component
C5H11
O
∆9 Tetrahydrocannabinol
Active component
C5H11
Cannabinol
inactive
Marijuvana is name given to dried leaves and
flower heads prepared as smoking mixture.
Until 20 th century due to antimarijuana
attitude research in this area was neglected
OH
O
∆9 Tetrahydrocannabinol (THC) contains 1-10
% of weight of marijuvana and hashish.
Receptor for Cannabis
Cannabis interacts with two types of receptors CB1 and CB2
Cannabinoid receptor belongs to G protein coupled receptor
superfamily
Cannabis activates the receptor by modulating adenylate cyclase,
activating potassium and inhibition of calcium channels.
CB1 mainly found in CNS. So we called this one as brain type
cannabinoid receptor where as CB2 mainly expressed in immune
cells it considered as peripheral part.
This classification is wrong since some CB1 express in periphery
and someCB2 express in brain
In brain, CB1 modulates the release of neurotransmitter including
gaba aminobutyric acid, dopamine, noradrenaline, glutamate and
serotonin
Pharmacological Effect
•This acts mainly on CNS and producing the mixture of
psychotomimetic and depressant effect
•Gives a feeling of relaxation and well being similar to the effect of
ethanol.
•Gives feeling of sharpened sensory awareness
•Central effect that can be directly measured by human and animal
studies. Those are impairment of motor coordination and increased
appetite and analgesia
•Regulates the feeding behavior
•Peripheral effect
•Vasodilatation, reduction of intraocular pressure, bronchodilation
Dronabinol – treat
for chemotherapy
induced nausea
1 These are substance extract from plants and
several synthetic compound. (3 ring)
2 Analogues of ∆9 Tetrahydrocannabinol (THC)
3 Third is used for experimental models
4 Mimic the effects of plant derived ∆9
Tetrahydrocannabinol (THC). But structure is not
similar.
Antagonist this use for therapy
for obesity and eating disorders
Tolerance of Marijuana
Tolerance
Tolerance to cannabis occurs in minor degree and mainly in
heavy users. Withdrawal effect is as same as withdrawal effect
of opiate and ethanol e.g. nausea, agitation, irritability,
confusion.
Overall it can not be classified as addictive
Smoking marijuana is better tolerated than the oral
administration of the principle component
Adverse Effects of Marijuana
THC is relatively safe in overdose proving drowsiness and
confusion.
It is safer than most abused substance e.g. opiate and ethanol.
Cannabis lowers the plasma testosterone and a reduction of
sperm count
Smoking cannabis may be officious in no of conditions. It
provide relief of pain relief of other types of chronic neuropathic
pain.
Improvement of appetite
Also gives relief from chemotherapy induced nausea
Heroin
Heroin (Cont’d)
Diamorphine- is the diacetyl derivative of morphine.
This rapidly deacyletate to morphine in the body
Because of the lipophilicity, it will pass blood barrier
more rapidly than morphine
It can be used as an analgesic
Half life is 2 hours because its very rapid action,
Causes dependence
Agent produces euphoria, analgesia, respiratory
depression and sleep. Nausea and vomitting,
constipation. Overdose causes the coma
Heroin (Cont’d)
Mechanism of action is through G protein coupled
receptors. It inhibit the adenylate cyclase. So it reduces the
intracellular cAMP amount. Also it effect to the ion
channel. It opens k channel.(causes the hypoploarization)
and closes the Ca channel (inhibiting transmitter release).
Three different receptors. Alpha, beta and mu( mostly
reside in brain). Analgesia effect is from mu receptor
For heroin abuse, patients are treated with naloxone.
Cocaine
Cocaine (Cont’d)
This is potent stimulant of the central nervous
system. Exact mechanism of action is unclear
Cocaine acts by inhibiting catecholamine
uptake (especially dopamine) by nerve
terminals. It blocks the noradrenaline and
dopamine transporters. This causes
dopamine overaccumilation in certain regions
of brain.
Cocaine also interact with GABA and opioid
receptor
Cocaine (Cont’d)
Produces euphoria, increases motor activity
Duration of action is shorter
Behavioral effects of cocaine are similar to
those of amphetamines
Causes the strong psychological dependence
Still this uses as a local anesthetics
Treatment for the cocaine abuse has to be
multitarget.
Amphetamines and Methamphetamines
H
N
Methamphetamine
Pharmacological
effect
Locomotor stimulation
NH2
Amphetamine
Euphoria and
excitement
Stereotyped behavior
anorexia
Releases the monoamines from nerve terminals in the brain
Effects mainly from release of catecholamines such as noradrenaline and
dopamine.
5 Hydroxytryptamine (5-HT) release also occurs
Stimulant effect lasts for few hours, after then depression and anxiety
Amphetamine psychosis can develop due to prolong use
References
Endogenous cannabinoid system as a
modulator of food intake, International journal
of obesity (2003),27,289-301
Molecular approaches to treatment for cocaine
abuse, Journal of molecular structure (2003),
259-267
Pharmacology, fifth edition, H.P Rang, M. M
Dale, J.M Ritter, P.K Moore, 2003,pp 7-45
Treatment Options
The Anti-Drugs
National Policy on Drug use—3 parts
Stopping Drug use before it starts through
education
Healing America’s drug users through
treatment and intervention
Disrupting the market
Chapter 2:
Healing America’s Drug Users
Even though drug use is ‘down’, because of increased
education, “the Administration has made intervention and
treatment a top priority”
The ONDCP states that 19.1 million Americans have used
an illicit substance in the ‘past month’.
The government’s goal is to decrease the use of illegal
drugs while providing help to addicts
Healing America’s Drug Users--Strategies
Support: Many non-medical support systems
exist for recovering addicts. Examples include
AA, Oxford House, and other faith-based groups.
Medical treatment: Using drugs to combat drug
use
The Anti-Drugs: Marijuana
Marijuana is the most commonly
used illicit substance (ONDCP)
In 2001, 14.7% (about 255,394) of
drug treatment admissions in the
U.S. were for marijuana use
~56.8% of those were referred
through the criminal justice
system
We may have a drug to cure your
marijuana addiction!
Marijuana is a schedule 1
substance in the U.S. (eg: heroin,
LSD) There are NO legal uses of
marijuana under federal law
Rimonabant (SR141716A)
SR141716A was first introduced in
1994 as an antagonist of the brain
cannabinoid receptor, CB1
(Rinaldi-Carmona, et al. 1994)
The drug will be sold by SanofiAventis as “Acompila” for the
treatment of obesity starting this
year. The FDA is requiring further
information before it can be sold
in the U.S.
Studies are being conducted on
the effectiveness of Rimonabant in
treating addiction to tobacco,
alcohol, and marijuana
Rimonabant—What does it do?
SR141716A binds to the central
cannabinoid receptor (CB1), but not to
the peripheral receptor CB2, with
nanomolar affinity
CB1 is a G-protein coupled receptor
found in the brain and some peripheral
tissues. Natural ligands include
anandamide and 2-AG. This receptor
system is thought to play a role in
regulating blood pressure, etc.
Acute administration of SR141716A
decreased glucose intake of rats,
especially in those tolerant to THC
(Freedland, et al. 2002)
A study in humans showed this drug
prevents symptomatic hypotension
in marijuana smokers (dizziness,
lightheadedness
Rimonabant produces withdrawal
symptoms in lab animals addicted to
cannibinoids (eg: Beardsley & Martin,
2000)
The highest density of CB1 receptors is in the basal ganglia
Other anti-marijuana drugs
Rimonabant blocks the receptor for Δ9-THC, but it does not help
withdrawal symptoms.
The following drugs have been tested in animals for their use in
treating withdrawal symptoms associated with cannabinoid
abstinence (reviewed in Hart, 2005):
Clonidine (Lichtman, et al. 2001): reversed some withdrawalrelated symptoms (paw tremors, head shakes) in mice
Prostoglandin E2 (Anggadiredja, et al. 2003): alleviated
withdrawal symptoms
Lithium (Cui, et al. 2001): blocked withdrawal symptoms
If you want to learn more…
Rinaldi-Carmoni, M., et al. (1994) “SR141716A, a potent and selective
antagonist of the brain cannabinoid receptor.” FEBS Letters 350: 240-244.
Marx, J. (20 Jan 2006) “Drugs Inspired by a Drug.” Science 311: 322-325.
Gorelick, D.A., et al. (2006) “The Cannabinoid CB1 Receptor Antagonist
Rimonabant Attenuates the Hypotensive Effect of Smoked Marijuana in
Male Smokers.” Am Heart J 151: 754e1-e5.
Cohen, C., et al. (2005) “CB1 Receptor Antagonists for the treatment of
Nicotine Addiction.” Pham Biochem Beh 81: 387-395.
Hart, C. (2005) “Increasing Treatment Options for Cannabis Dependence: A
Review of Potential Pharmacotherapies.” Drug and Alcohol Dependence 80:
147-159
The Anti-Drugs: Opiates
ONDCP: heroin is highly addictive and considered one of the
most abused opiates. It is a Schedule I drug.
“A rough estimate of the hardcore addict population in the
United States…between 750,000 and 1,000,000”
Many drugs exist to treat heroin addiction
The anti-drugs: Opiates
Buprenorphine
Methadone
Naltrexone
RF9
Opioid Agonists
buprenorphine
Heroin (diamorphine)
Buprenorphine: μ agonist/κ
antagonist
Also shown to be an effective
antidepressant (Bodkin, et al.
1995)
May be more effective at
reducing heroin use in
depressed addicts (Gerra, et
al. 2005)
methadone
Methadone: Chemically, the simplest
opiate. Methadone is a Schedule II
drug (eg: cocaine, Ritalin)
Can be administered orally or by
injection
Almost always, methadone must be
taken indefinitely
Opioid Antagonists
Naltrexone: Competitive antagonist
at opioid receptors, completely
blocks action of opioid agonists
(Comer, et al. 2006), except
buprenorphine
Used in “rapid detox” regimens
Can cause increased sensitivity
to opioids after use.
naltrexone
Shown to be more effective at
treating cravings than
methadone (Grusser, et al.
2006)
Opioid Antagonists
RF-9: Antagonist of a different
receptor (NPFF receptor) involved
in pain modulation and tolerance
to opiates (Simonin, et al. 2006)
Prevents tolerance to opiates
by decreasing hyper-analgesic
effects
Only tested so far in rats; not
currently under consideration
for treatiment of heroin
addiction
If you want to learn more…
Comer, S.D., et al. (2006) “Injectable, Sustained-Release Naltrexone for
the Treatment of Opioid Dependence.” Arch Gen Psychiatry 63: 210-217
Coffin, P.O., et al. (2006) “Support for Buprenorphine and Methadone
Prescription to Heroin-Dependent Patients among New York City
Physicians.” The American Journal of Drug and Alcohol Abuse 32: 1-6
Grussser, S.M., et al. (2005) “A New Approach to Preventing Relapse in
Opiate Addicts: A Psychometric Evaluation.” Biological Psychology 71:
231-235
Gerra, G., et al. (2005) “Buprenorphine Treatment Outcome in Dually
Diagnosed Heroin Dependent Patients: A Retrospective Study.” PNPBP
30: 265-272
Simonin, F., et al. (2006) “RF9, a Potent and Selective Neuropeptide FF
Receptor Antagonist, Prevents Opioid-Induced Tolerance Associated
with Hyperalgesia.” PNAS 103(2): 466-471
The Anti-Drugs: Cocaine
In 2000, chronic users were estimated at 2,707,000
(ONDCP)
Occasional users were estimated at 3,035,000
No drugs are currently approved to treat cocaine
dependence, but many are being tested
Drugs for Cocaine Dependence
Disulfiram: Currently prescribed for
alcohol dependence. Studies suggest
effectiveness against cocaine dependence
 This drug acts by inhibiting
sulfylhydryl-containing enzymes (eg:
acetylaldehyde dehydrogenase)


Baclofen: GABA agonist. Reduced cravings
for cocaine in studies with humans
Modafinil: Subjects reported reduced
cravings for cocaine and amphetamines.
Increases alertness in narcoleptic patients
and has been tested for treatment of
ADHD.
For a review, see: Vocci, F.J.,
et al. (2005) “Medication
Development for Addictive
Disorders: The State of the
Science.” Am J Psychiatry
162: 1432-1440
The Anti-Drugs: Methamphetamine
Available in pure form as a
prescription (Desoxyn) for
ADHD, obesity, and narcolepsy
It is a Class II substance
Social stigma attached
Can be made from household
products (don’t try this at
home!)
597,000 people in U.S. over 12
report “past month usage”
(ONDCP)
Combat Methamphetamine
Epidemic Act of 2005 passed
this March
The anti-drugs - Methamphetamine
Selegiline: Used in the treatment
of Parkinson’s and Alzheimer’s
diseases
Potential in treating ADHD, cocaine, and
methamphetamine abuse
Studies on the safety of selegiline in
combination with methamphetamine
have been conducted (eg: Schindler, et
al. 2003)
Selegiline
Prometa: Clinical trials (phase II
and III) have been registered, but
not yet started as of Dec. 2005
Preliminary studies show decrease in
cravings and minimal withdrawal
symptoms (Alcoholism and Drug Abuse
Weekly 24 Oct 2005)
Also being marketed for alcohol and
cocaine dependence (Hythiam, Inc.)
Meth
Does Treatment Work?
For marijuana:

“To date, no medication has been
shown to alter cannibis selfadministration by humans” (Hart,
2005)
Side effects of Rimonabant include
depression and anxiety
We don’t know the effects of
messing with the endocannabinoid
pathway
For heroin:
Methadone treatment works
for certain individuals, but
almost no one ever gets off
methadone completely
In one study, 2/3 of
participants could not
complete a methadone taper.
13% successfully switched to
bupe/naltrex (Calsyn, et al
2005)
Does Treatment Work?
Gerra, et al. 2006
•MD: major depression
•GAD: generalized
anxiety disorder
•PD: personality
disorder
•SC: schizophrenia
•SUD: substance
abuse disorder
Buprenorphine works for some people, best for those with major
depression
Does Treatment Work?
Treatment for heroin, continued
Naltrexone completely blocks the
effects of opiates. It would work
great, except that people generally
just stop taking it
Sustained release injectable
naltrexone as well as implants may
help compliance, but not entirely
fix the problem
Naltrexone can cause rapid and
severe withdrawal symptoms
Comer, et al 2006
Does Treatment Work?
Treatment for cocaine dependence:
Disulfiram

SIDE EFFECTS

(See CONTRAINDICATIONS, WARNINGS, and PRECAUTIONS.) O.T.(C)
NEURITIS, PERIPHERAL NEURITIS, POLYNEURITIS, AND PERIPHERAL
NEUROPATHY MAY OCCUR FOLLOWING ADMINISTRATION OF
DISULFIRAM.

Multiple cases of hepatitis, including both cholestatic and fulminant
hepatitis, have been reported to be associated with administration of
disulfiram.

Occasional skin eruptions are, as a rule, readily controlled by
concomitant administration of an antihistaminic drug.
Disulfiram (cont’d)
In a small number of patients, a transient mild drowsiness,
fatigability, impotence, headache, acneform eruptions, allergic
dermatitis, or a metallic or garlic-like aftertaste may be
experienced during the first two weeks of therapy. These
complaints usually disappear spontaneously with the
continuation of therapy, or with reduced dosage.
Psychotic reactions have been noted, attributable in most cases
to high dosage, combined toxicity (with metronidazole or
isoniazid), or to the unmasking of underlying psychoses in
patients stressed by the withdrawal of alcohol.
http://www.rxlist.com/cgi/generic/disulfiram_ad.htm
Does Treatment Work?
Baclofen – side effects
an allergic reaction (difficulty breathing; closing of your throat; swelling of
your lips, tongue, or face; or hives);
Seizure
an irregular heartbeat.
Other, less serious side effects are more likely to occur:
drowsiness, dizziness, weakness, or unusual fatigue;
a headache;
·
constipation;
·
stuffy nose;
·
blurred vision;
Rash
frequent urination.
For more information see  http://baclofen.drugs.com/
Does Treatment Work?
Modafinil
Side effects: headache, nausea, nervousness, rhinitis, diarrhea, back pain, anxiety,
insomnia, dizziness, and dyspepsia
http://www.rxlist.com/cgi/generic2/modafinil_ad.htm
For methamphetamine dependence:
Selegiline
Side effects: This medication may cause stomach upset, loss of appetite, nausea,
heartburn or dry mouth.
http://www.medicinenet.com/selegiline-oral/article.htm
may increase dopaminergic activity by interfering with dopamine re-uptake at the
synapse (http://www.rxcarecanada.com/Eldepryl.asp?prodid=662)
Selegiline irreversibly inhibits the enzyme MAO-B. The mechanism of action is
uknknown
Law of Unintended Consequences?
General points of interest
The mechanisms of action of many of these drugs are unknown for
any of their uses
In some cases, such as methadone, treatment may lead to
addiction to the medication, though it may be safer than addiction
to the illicit substance
The biggest concern is noncompliance. Doctors are therefore
interested in taking the decision-making out of the patients hands.
An example is naltrexone implants (not yet proven 100% effective).
What might be some of the unintended consequences of taking the
problem of addiction out of the addicts’ hands?
The Drug Trade
Where Drugs are Being Produced,
and How Much are Coming into
the United States
Global Economics of the Drug Trade
Total trade in illicit drugs is $400
billion annually
The Drug Trade accounts for Slightly
more commerce than the textile
industry
US Drug Policy – Foreign Focus
US drug policy emphasizes source control,
including interdiction and eradication
Targeting the source of drugs is often
ineffective as new suppliers fill the demand
A new set of suppliers quickly emerged
after the fall of the Medellin Drug Cartel in
Columbia
Cocaine Supply
75 - 90% of cocaine comes form Columbia
50% world wide and 60% in US is controlled
by FARC (Revolutionary Armed Forces of Colombia)
FARC has used the money to wage a 41year war
Is Interdiction the Answer?
Successful interdiction can lead to a
decentralization of the illicit industry
On the other hand, it could also lead to an
increase in the concentration of the product
Examples of the latter include the
concentration of alcohol during Prohibition,
and the concentration of Marijuana in the
1960’s
International Implications of the US Drug War
When considering the ethics of legalized
drugs should we be concerned with its
effect on foreign society?
It is important to keep in mind that the US
War on Drugs is part of a larger
international effort, and thus has a number
of wide-ranging international implications
Conclusion
Connecting the Issues & Ethical Analysis
Connecting the Issues
Historical & Statistical Analysis of the War on
Drugs and the surrounding controversy.
Physiological and neurobiological effects of
drug abuse: Marijuana, Cocaine,
Methamphetamines, & Heroin.
Treating Drug abusers: the Anti Drug
Global Implications of the War on Drugs –
Combating the Supply
Case Studies
Analysis of the Drug War
The War on Drugs, in its modern form, began in 1971.
Overarching Goal of the War on Drugs: To create a Drug free
America
Method of choice: Arrest & Incarceration of drug users/sellers
Implications of the War on Drugs:
Financial - $ 18.8 Billion per yr. of taxpayers’ money
Workforce – Over 50 government agencies involved with the
War on Drugs
Prison system – Drug related criminals account for the largest
demographic of prisoners in the United States
Criticisms of the Drug War
Drug laws have been oftentimes selectively enforced, arguably
as a way to target racial minorities.
Tobacco & Alcohol account for 100 times more deaths than
illicit drugs.
The majority of drug-related crime stems from the laws that
prohibit drug use/possession, not the effects of the drugs
themselves.
Imprisonment of drug-offenders is a severe drain on the
nation’s economy.
Some minor drug offenders face sterner punishment than
rapists, child molesters, and bank robbers.
Failed Federal Initiatives & Policies
The National Youth Anti-Drug Media Campaign has
produced no observable results, despite receiving
millions of dollars in federal funding.
Drug Abuse Resistance Education (DARE) has been
found to send mixed messages and may actually
serve to glamorize drugs
The plethora of government agencies that aim to
combat drugs have been for the most part
ineffective.
Is it time for a national overhaul on drug policy?
The Chemistry of Illicit Drugs
Marijuana – Schedule 1 Drug – CNS Depressant
Heroin – Schedule 1 Drug – Analgesic that
causes Euphoria
Cocaine – Schedule 2 Drug – CNS Stimulant
Methamphetamine – Schedule 2 Drug –
Stimulant & Depressant
Treatment Options
Are non-invasive measures such as drug treatment and
rehabilitation therapy effective?
Is it safe to use ethical drugs to treat illicit drug addiction?
In the case of heroin, methadone is used as a way to treat
addicts. However, methadone treatment leads to
methadone addiction, rather than Heroin addiction,
because methadone stops your body from going through
Heroin withdrawal symptoms.
Essentially, methadone treatment requires lifelong use to
be effective, at what point does the treatment become
worse than the problem?
The Global Drug Trade
The Illicit Drug Business is responsible for upwards of 400 billion
US dollars in trade annually.
Though international interdiction efforts stop about 10-15 % of
illicit drugs, UN estimates show that at least 75 % of the
international drug shipments would need to be intercepted in
order to have any major effect on the industry.
It is very difficult to reduce drug supply because suppliers produce
excess amounts in anticipation of government seizures
According to Rydell & Everingham, in order to reduce US cocaine
consumption by 1 %...
34 million dollars is needed in drug treatment programs
(or)
783 million dollars towards supply reduction
Case Study # 1
O’Shea Jackson, a young African-American man is
pulled over on a routine traffic stop. The police
officers conduct a basic search of his car and uncover
a minimal amount of marijuana in the ash tray. Mr.
Jackson is immediately arrested for Marijuana
possession, and is subsequently taken to the local jail.
After about 5 hours, Mr. Jackson is brought in front of
a local night court judge. He and his public defender
are presented with two basic options. The first option
is to plead not guilty to felony possession of
marijuana (perhaps the Marijuana was not his, but was
left by another driver). By pleading not guilty, Mr.
Jackson would spend upwards of 4 months in jail while
awaiting trial…
Case Study # 1 (Cont’d)
On the other hand, Mr. Jackson’s second option is to
simply to plead guilty, and go home in a day or two
on Probation. Option two seems to be a lot more
practical and preferable, as no one wants to spend 4
months in jail. However, by pleading guilty, Mr.
Jackson now has a criminal record, and if he
subsequently commits even the most minor of
infractions he can be imprisoned for a number of
years without a trial, for violating his Probation. In a
three strikes state, Mr. Jackson is now only two minor
felonies away from a life sentence.
Ethical Issues
Mr. Jackson’s situation is all too common given the
current legal policy on Drug possession
The people most likely to be suspected of and searched
for illegal drugs are racial minorities with low
socioeconomic status.
Examples like Mr. Jackson’s situation illustrate the way in
which anti drug laws can be selectively used by law
enforcement to target groups that they want to
incarcerate.
Ethical Issues (Cont’d)
This was especially prominent in the 1960’s and 70’s as
Black Panthers, War Protestors, and revolutionary students
were the target of intense anti-drug law enforcement.
How would Mr. Jackson’s situation be different if he was an
elite Hollywood celebrity, or an upper middle class white
male?
Do Drug Laws & Law Enforcement that discount equity in
favor of selective implementation constitute a just/ethical
response to the nation’s drug problem?
Case Study # 2
Gross disparities in resource allocation exist between the
ever growing US Prison Budget and the majority of other
government expenditures. In 1998, the US Prison system
warehoused over 1 million non-violent / low risk prisoners,
the vast majority of whom were incarcerated due to drug
related offenses. The taxpayer cost necessary to house
these 1 million inmates was approximately 24 billion US
dollars. When compared with the 16.6 Billion dollars the
government spent on Welfare for 8.5 million people, and the
4 billion dollars the government spent on childcare for 1.25
million children, these drug related criminals are
disproportionately draining our economy & tax revenue.
Case Study # 2 (Cont’d)
Meanwhile, as the US Prison Budget balloons to
never before seen heights, states are cutting
funding for universities and K-12 programs
nationwide. In addition, since these non-violent
offenders (mostly drug offenders) are being housed
with the worst that society has to offer, the majority
of them will leave the prison system in worse shape
than they entered. Unable to get back on their feet
and with the added burden of a prior prison stint
on their record, almost all undoubtedly be back.
Ethical Issues
Why do the Federal and State governments essentially have carte
blanche in regards to drug-related spending?
The 24 Billion Dollars per year (1998) spent on imprisoning the more
than one million non-violent criminals in the US represents only a
moderate portion of the entire expenditure related to the War on
Drugs.
The money spent on the Drug War each year could easily serve to
insure the nearly 50 million Americans who lack basic healthcare.
If even 10 % of the money allocated to the War on Drugs was redirected
to K-12 education, the public school system could enjoy vast
improvements, perhaps truly leaving NO child behind.
Are we essentially tossing billions of dollars at an unsolvable problem,
in hopes of winning an impossible war?
Overarching Ethical Questions
Are the motives behind the War on Drugs just?
Does the War on Drugs constitute a necessary
and effective use of public/federal resources?
Can a clear line be drawn between legal drugs
and illicit drugs?
By what criteria does the government (FDA)
decide which drugs are legal or illegal?
Is there a better approach?
Motives behind the War on Drugs
From the ONDCP standpoint, the War on Drugs aims to reduce drug
related crime and drug related health complications by eradicating illegal
drug use.
From the research that we have presented/reviewed, the War on Drugs in
its current form has clearly failed in its aim to eradicate illegal drug use.
Has the War on Drugs reduced drug related crime, or simply made
thousands of criminals out of drug users?
Despite all of the negativity surrounding the War on Drugs, it is important
to keep in mind that drugs like heroin, cocaine, and methamphetamines,
are clearly unsafe and detrimental to health.
However, since the methods of the current War on Drugs are clearly not
optimal, perhaps a new outlook and new tools are necessary.
Resource Allocation
How much time, effort, and money is being investing into this war?
Is this an effective use of taxpayers’ money?
Intense Anti-drug advertising
Police-work, prosecution, and court-related issues regarding drug
users
Imprisoning Drug-users (rather than treating them)
Do other causes deserve more federal resources?
Could this be accomplished by decreasing drug-related expenditures,
and diverting the saved resources to other causes?
Why isn’t there a “War on Poverty” or a push for national Health
Insurance?
Drawing the Line
Can a clear line be drawn between legal and illegal
drugs?
Why are Alcohol & Tobacco legal, while marijuana and
steroids are illegal?
As can be seen from our previous slides, illicit drugs
account for less than 1 % of the deaths that alcohol and
tobacco cause.
By what criteria does the government (FDA) decide which
drugs are legal or illegal?
Does alcohol and tobacco lobbying have anything to
do with the FDA’s stance?
Is there a better solution?
Decriminalization would certainly save billions of dollars in taxpayer
money.
At the same time, Non-incarceration (drug treatment therapy) would
certainly be more beneficial to the drug addicts/users than prison
sentences.
However, if decriminalization, which amounts to the partial legalization
of illicit drugs, was enacted, drug use would rise.
This rise in drug use would undoubtedly lead to more health problems.
On the other hand, by staying on the current course, it is clear that
billions of taxpayers’ dollars will be wasted in vain
Perhaps the solution lies in the proverbial grey area of moderation,
ultimately leading to a de-emphasis of the War on Drugs in its
current form.
References
Associated Press, "U.N. Estimates Drug Business Equal to 8
Percent of World Trade," (1997, June 26).
Baum, D. (1997). Smoke and mirrors: The war on drugs and the
politics of failure. Boston: Little, Brown/Back Bay.
Coffin, P.O., et al. (2006) “Support for Buprenorphine and
Methadone Prescription to Heroin-Dependent Patients among
New York City Physicians.” The American Journal of Drug and
Alcohol Abuse 32: 1-6
Caulkins, Jonathan P. & Peter Reuter. “Setting goals for drug
policy: harm reduction or use reduction?” Journal of Addiction
(1997) 92 (9), 1143± 1150.
References (Cont’d)
Cohen, C., et al. (2005) “CB1 Receptor Antagonists for the
treatment of Nicotine Addiction.” Pham Biochem Beh 81: 387-395
Comer, S.D., et al. (2006) “Injectable, Sustained-Release
Naltrexone for the Treatment of Opioid Dependence.” Arch Gen
Psychiatry 63: 210-217
Drugs.com “Balcofen.” http://baclofen.drugs.com/ Accessed on
April 3rd, 2006.
Drug War Facts. www.drugwarfacts.org. Accessed on March 11th,
2006.
Dupont, R & Voth, E. “Drug Legalization, Harm Reduction, & Drug
Policy.” Annals of Internal Medicine. 12.3, 1995; 461-465
References (Cont’d)

Eddy, Mark. War on Drugs: Legislation in the 108th Congress and
Related Developments. 4 April 2003.

Endogenous cannabinoid system as a modulator of food intake,
International journal of obesity (2003),27,289-301

Executive Office of the President, Budget of the United States
Government, FY 2002 (Washington DC: US Government Printing
Office,2001), p.134.

Gerra, G., et al. (2005) “Buprenorphine Treatment Outcome in
Dually Diagnosed Heroin Dependent Patients: A Retrospective
Study.” PNPBP 30: 265-272
References (Cont’d)
Gorelick, D.A., et al. (2006) “The Cannabinoid CB1 Receptor
Antagonist Rimonabant Attenuates the Hypotensive Effect of
Smoked Marijuana in Male Smokers.” Am Heart J 151: 754e1-e5.
Grussser, S.M., et al. (2005) “A New Approach to Preventing
Relapse in Opiate Addicts: A Psychometric Evaluation.” Biological
Psychology 71: 231-235.
Hart, C. (2005) “Increasing Treatment Options for Cannabis
Dependence: A Review of Potential Pharmacotherapies.
Irwin, John, Vincent Schiraldi, & Jason Ziedenberg. America's One
Million Nonviolent Prisoners. Social Justice Summer 2000 v27 i2
p135.
References (Cont’d)
Marx, J. (20 Jan 2006) “Drugs Inspired by a Drug.” Science 311: 322325.
Molecular approaches to treatment for cocaine abuse, Journal of
molecular structure (2003), 259-267
Musings About the War on Drugs George Melloan. Wall Street Journal.
(Eastern edition). New York, N.Y.: Feb 21, 2006. pg. A.19
Pharmacology, fifth edition, H.P Rang, M. M Dale, J.M Ritter, P.K
Moore, 2003,pp 7-45
Prescription List.
http://www.rxlist.com/cgi/generic/disulfiram_ad.htm. Accessed on
April 2nd, 2006.
Prescription List.
http://www.rxlist.com/cgi/generic2/modafinil_ad.htm Accessed on
April 2nd, 2006.
References (Cont’d)
Rinaldi-Carmoni, M., et al. (1994) “SR141716A, a potent and
selective antagonist of the brain cannabinoid receptor.” FEBS
Letters 350: 240-244.
Rosenbaum, Marsha. Safety First A reality based approach to
teens drugs and drug education. Drug Policy Alliance 2004.
Rydell, C.P. & Everingham, S.S., Controlling Cocaine, Prepared for
the Office of National Drug Control Policy and the United States
Army (Santa Monica, CA: Drug Policy Research Center, RAND,
1994), p. 6.
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