ABSTRACT
Introduction
Summary of the drug abuse situation in the world
Review of drug abuse: extent, pattern and trends by region
Summary of measures to reduce the illicit demand for drugs
Review of measures to reduce the illicit demand for drugs by region
Pages: 3 to 30
Creation Date: 1987/01/01
This article, which was prepared on the basis of two documents (E/CN.7/1987/9 and E/1987/17-E/CN.7/1987/18) of the Commission on Narcotic Drugs, summarizes information on drug abuse and measures to reduce the illicit demand for drugs at the global level and by region. The Commission on Narcotic Drugs noted at its February 1987 session that the drug abuse situation continued to deteriorate in most parts of the world. The most striking feature of the problem was the escalation of heroin and cocaine abuse, but the abuse of other substances also continued to spread.
The injection of drugs had contributed significantly to the increasing spread of acquired immunodeficiency syndrome (AIDS) and hepatitis B. The age of first users was falling from adolescence to preadolescence and even earlier. Young users were experimenting with a variety of substances, most often with those that were easy to obtain. In most countries, drug abuse had spread to all social strata. The majority of abusers were males, but the proportion of female abusers was growing.
This article was prepared on the basis of information contained in relevant sections of two documents of the Commission on Narcotic Drugs ( [ 1] , [ 2] ). One of the documents, a report of the Secretary-General [ 1] , summarizes information received from 105 countries and territories on drug abuse and measures to reduce the illicit demand for drugs. The information was submitted to the Secretary-General in government reports on the working of the international drug control treaties in 1984 and 1985. The other document is the report of the Commission on Narcotic Drugs at its thirty-second session [ 2] , held at Vienna from 2 to 11 February 1987. The report of the Commission includes a section on drug abuse and measures to reduce the illicit demand for drugs, which was considered in the preparation of this article.
*The designations employed and the presentation of material in this article do not imply the expression of any opinion whatsoever on the part of the Secretariat of the United Nations concerning the legal status of any country, territory, city or area, or any authority, or concerning the delimitation of any frontiers or boundaries.
This summary is based on the assessment of the drug abuse situation by the Commission on Narcotic Drugs at its thirty-second session [ 2] . The Commission noted that the drug abuse situation continued to deteriorate in most parts of the world. Most representatives and observers expressed grave concern at the extent to which drug abuse and associated problems were spreading in their countries. In a number of them it had reached epidemic proportions. The most striking feature of the problem was the escalation of heroin and cocaine abuse, but the abuse of cannabis and various types of psychotropic substances also continued to spread. In some countries and territories in which abuse had been a long-standing problem, the number of new cases was stable, or even decreasing, but the total number of abusers still remained unacceptably high.
A new cause for concern was the appearance of "designer drugs" - analogues of controlled drugs whose structures had been changed to circumvent their control but whose effects were similar to, or even stronger than, those of the original. The use of such substances was associated with increased morbidity and mortality.
Personal and social dysfunction, crime, accidents, impairment of health and death (predominantly among young people) were often associated with drug abuse. The injection of drugs through the use of unsterilized needles had contributed significantly to the increasing spread of acquired immunodeficiency syndrome (AIDS) and hepatitis B. One representative informed the Commission that the provision of clean needles had resulted in a remarkably low occurrence of AIDS among addicts in his country.
Patterns of abuse were becoming increasingly complex: abuse involving two or more substances was generally widespread and had become the predominant pattern in certain countries. The age of first drug use was falling from adolescence to preadolescence and even earlier. Young users were experimenting with a variety of substances - most often with those that were easy to obtain, such as volatile solvents, but also with heroin and cocaine. In most countries, drug abuse had spread to all social strata and affected most age groups, but predominantly the younger one. While the majority of abusers were males, the proportion of female abusers was growing.
Heroin abuse had spread to a number of countries with little or no previous experience of the problem, and had begun to be abused in certain African countries. It continued to be a serious problem in North America, in a number of countries and territories of Asia and the Far East, in most countries of Western Europe, in certain countries of the Near and Middle East and in Oceania. The abuse of other opiates remained on a much smaller scale than that of heroin. In certain countries of Eastern Europe, there was an increasing abuse of other opiates, particularly the decoction of poppy straw and codeine. Opium consumption had generally remained stable, or had even declined slightly, in some of those countries of Asia and the Far East and the Near and Middle East in which it had traditionally been abused.
Cocaine abuse had escalated in most regions of the world, mainly in the Americas, Europe and Oceania. The smoking of coca paste had increased in a number of South American countries, as had the smoking of cocaine base ("crack") in North America and, to a lesser extent, in other parts of the world. Cannabis continued to be the most widely abused illicit drug in most regions. More potent forms of cannabis plant and its preparations, such as cannabis resin and liquid cannabis, were increasingly abused.
Abuse of amphetamine-type stimulants was reported from all regions. Such abuse had increased in a number of countries. Benzodiazepines, minor tranquillizers, barbiturates and non-barbiturate sedative-hypnotics were abused world-wide. The abuse of lysergic acid diethylamide (LSD) appeared to be declining, but it was still a problem in some countries. Phencyclidine (PCP) continued to be abused in North America, but only sporadically elsewhere. Natural hallucinogens, particularly mushrooms, were increasingly abused in several countries. An increasing abuse of volatile solvents, such as glue and petrol, by young adolescents and children was becoming a difficult problem in all regions, particularly from the point of view of control, since solvents were readily available in most countries.
This section is based on information contained in the above-mentioned report of the Secretary-General [ 1] , which was considered by the Commission on Narcotic Drugs at its thirty-second session in February 1987. The information is summarized by region.
Government reports showed deterioration in the drug abuse situation in the region. Cannabis remained the most widely abused drug, but the problem had escalated from the abuse of cannabis to that of more dangerous drugs, and from the involvement of limited groups of users to a wider range of users. The trend towards multiple drug abuse, and especially towards combinations of drugs and alcohol, continued. Heroin and, to a lesser extent, cocaine, had begun to be abused in some African countries with no previous experience of these drugs. Amphetamine-type stimulants and sedative-hypnotics were also increasingly abused. Sometimes these substances were imported illegally into African countries; the lack of funds and shortage of trained personnel made it difficult to implement control measures. Several countries reported the abuse of volatile solvents or other non-controlled substances.
Abuse of narcotic drugs
Several countries reported opiate abuse. In Chad, opium and morphine were abused. In Mauritius, there had been a large increase in heroin abuse (by injection) predominantly by males in the 17-30 age group. In 1985, an estimated 10,000 to 15,000 persons abused heroin, 400 to 500 opium, and a small number synthetic narcotics. The abuse often involved combinations of heroin, benzodiazepines, alcohol and cannabis. Among the reasons for the increase in heroin abuse were the massive amounts of the drug illicitly entering the country, easy access to it and the refined illegal marketing system existing in the country. Abuse, which had spread through all social strata, was frequently associated with family and social problems and delinquent behaviour, including armed robbery. Nigeria also reported increasing heroin abuse, mainly by males in the 18-35 age group. It was often abused in combination with cannabis and cocaine. All social groups were affected. Tunisia reported heroin abuse (by inhalation), mainly by males in the 20-30 age group. South Africa reported a small number of opiate abusers.
Cocaine abuse had appeared for the first time in some African countries. Nigeria reported increasing abuse (by smoking or sniffing), mainly by males in the 18-35 age group; the cocaine was often used in combination with cannabis or heroin. Abuse was also reported from Chad and South Africa, but on a relatively small scale.
Almost all countries that provided information reported problems of cannabis abuse. These included: Benin, Burkina Faso, Burundi, Central African Republic, Cameroon, Chad, Côte d'Ivoire, Djibouti, Gambia, Ghana, Kenya, Madagascar, Mali, Mauritius, Mozambique, Morocco, Nigeria, Rwanda, Senegal, South Africa, Togo, Tunisia and Zimbabwe. The drug was abused (by smoking or eating it), in both urban and rural areas, but its abuse was higher among the urban young. The abuse affected all social strata and age groups, commencing with preadolescence. The abusers were predominantly male, with the percentage of female abusers ranging from 0.2 in Mali to 12 in Zimbabwe. Cannabis appeared to be abused less commonly in those African countries where the abuse of khat was prevalent; in Djibouti it was used in combination with khat (mainly by youth in the 16-22 age group). The abuse of cannabis, particularly in combination with alcohol and other drugs, was often associated with severe psychotic or behavioural disorders, family disruptions, delinquency and traffic accidents.
In Mali, cannabis was often abused in combination with stimulants, sedatives and hallucinogens, mainly by persons in the 15-29 age group. In Madagascar, cannabis was increasingly abused by urban dwellers in the 15-30 age group, but abuse had spread also among young and older people in the rural areas. It was often abused in combination with alcohol. In Mauritius, in 1985, an estimated 4,000 to 5,000 persons, mainly in the 17-30 age group, and in all social strata, were abusing cannabis. In Morocco, cannabis was increasingly being abused in the 20-25 age group, and in Mozambique in the 15-45 age group. In Nigeria, cannabis abuse (often in combination with alcohol, cocaine or heroin) had spread across all social strata, both urban and rural. In Senegal, it had also spread to all social strata; in Togo, it had spread mainly in the urban areas. In these two countries, however, it had shown a tendency to decrease. Zimbabwe reported increased cannabis smoking, mainly by persons in the 20-24 age group, and 12 per cent of them women.
Abuse of psychotropic substances
A number of countries (Benin, Burkina Faso, Cameroon, Chad, Côte d'Ivoire, Madagascar, Mali, Nigeria, Senegal, South Africa and Togo) reported the abuse of amphetamine-type stimulants, in combination with cannabis, alcohol or sedative-hypnotics. In Mali, most abusers were in the 15-29 age group. In Togo, they were in the 18-25 age group. In Nigeria, ephedrine was abused in combination with caffeine. The abuse of amphetamine-type stimulants was frequently associated with violence and psychological disorders.
Most countries that provided information reported abuse of tranquillizers, barbiturates or non-barbiturate sedative-hypnotics. Benzodiazepines and minor tranquillizers were abused in the Central African Republic, Madagascar, Mauritius and Mozambique. Benzodiazepines abuse had increased in Mauritius. In 1985, an estimated 15,000 to 20,000 persons, principally males in the 17-30 age group, abused them, often in combination with opiates, alcohol and cannabis. The abuse of barbiturates or non-barbiturate sedative-hypnotics was reported from Burkina Faso, Central African Republic, Côte d'Ivoire, Kenya, Mali, Morocco, Nigeria, Senegal, South Africa, Togo and Tunisia. Seco-barbital was abused in Côte d'Ivoire, often in combination with amphetamines. Kenya, Senegal and South Africa reported methaqualone abuse.
Mali and South Africa reported small-scale abuse of hallucinogens.
Cocaine and cannabis were the major drugs of abuse, and combinations of two or more drugs, often involving alcohol, continued to be the growing pattern throughout the region.
Abuse of narcotic drugs
The abuse of heroin by injection remained a serious problem in Canada and the United States of America, although the available data indicated a declining trend in such abuse. In Canada, 3,275 persons were known to be abusing heroin in 1985, compared with 5,478 in 1984 and 5,813 in 1983. Most of the heroin abusers were in the 30-39 age group, and approximately 32 per cent were female. In Canada, 4,028 persons were also known to be abusing synthetic narcotics and opiates other than heroin in 1985, compared with 3,420 such cases reported for the previous year. In the United States of America, it was estimated that in 1984 492,000 persons abused heroin; 97,500 persons were registered for heroin abuse, and 10,300 for abuse of opiates other than heroin. The average age of heroin abusers is higher today (30 years or more) than it was in the early 1970s. Moreover, heroin abuse remained a significant cause of drug-related injuries and deaths. A number of other countries and territories, including Argentina, Bolivia, Ecuador, Guatemala, Honduras, Mexico and Netherlands Antilles, reported opiate abuse, but on a relatively limited scale, Ecuador reported increasing abuse (by injection) of morphine derivativesamong the adult population. In the Netherlands Antilles, heroin was abused, often in combination with cocaine, by immigrants or people temporarily staying on the islands.
Cocaine abuse had become the major drug problem in the region. Sniffing or injection of cocaine hydrochloride and smoking of cocaine base or coca paste had increased rapidly in many countries and territories. Coca paste, an intermediate product of cocaine extraction from coca-leaves, was increasingly being abused (by smoking) in the countries that produced it, including Bolivia, Colombia and Peru. Coca paste and/or cocaine were abused in Argentina, Barbados, Belize, Canada, Cayman Islands, Colombia, Ecuador, Guyana, Haiti, Jamaica, Mexico, Netherlands Antilles, Panama, Trinidad and Tobago, Uruguay, United States and Venezuela. The smoking of cocaine base or coca paste was a particularly dangerous pattern of abuse, since it rapidly produced a high level of cocaine in the blood. Coca-leaf chewing continued where it was traditionally rooted in certain population groups in the Andean countries.
Bolivia reported a large increase in coca-paste smoking. In 1985, some 11,000 abusers were registered, but it was estimated that 40,000 persons abused the product. The authorities considered that the reasons for the increase were easy access to and low cost of the paste, associated with family disintegration and ignorance of the hazards of abuse. Coca paste was often used in combination with cannabis or alcohol; over the past five years, this combination had accounted for 10 deaths. The paste was mainly abused by urban males in the 15-25 age group. The abusers usually started with cannabis or volatile solvents and progressed to multiple drug abuse involving coca paste, cocaine and alcohol. Cocaine hydrochloride was also abused, often in combination with volatile solvents, but the number of abusers was much lower. In Colombia, coca paste and cocaine abuse were most common in the 12-24 age group. Ecuador reported increasing abuse of coca paste and cocaine base, often in combination with cannabis and alcohol, and mainly in the 18-20 age group.
Canada reported increasing abuse of cocaine, mainly in the 25-29 age group. Approximately 20 per cent of abusers were female. The Cayman Islands reported an increase in psychological and social problems associated with cocaine abuse. Abusers were mainly in the 19-25 age group; 33 per cent were female. The Netherlands Antilles reported a large increase in cocaine-base smoking and cocaine sniffing. Abusers cut across all social strata and were most often in the 15-50 age group, approximately 40-50 per cent of them being female. Abusers often resorted to crime to obtain money to purchase drugs. Trinidad and Tobago reported a large increase in cocaine-base smoking. The abuse affected all social strata, but mainly urban residents in the 20-35 age group. Here again it was associated with crime and vagrancy, and the cocaine was often used in combination with cannabis. In the United States, cocaine abuse had remained a serious problem. In Uruguay, abuse of cocaine hydrochloride, mainly by people in the 22-27 age group, was growing.
Cannabis remained the most widely abused illicit drug in the region, affecting almost all countries and territories. Bolivia, Dominica, Guyana, Panama, Saint Vincent and the Grenadines and Uruguay reported a large increase in abuse. In Jamaica, cannabis, including its oil, was smoked, most abusers being males. The growth in the tetrahydrocannabinol content of the cannabis plant over the years and the developing tendency to use cannabis in combination with other psycho-active substances had led to an increase in the number of injuries and other health, psychological and social problems resulting from cannabis abuse in Jamaica.
In Bolivia, the smoking of cannabis, usually in combination with coca paste, volatile solvents or alcohol, had escalated among the youth population, the male-female ratio being 6 : 1. In the British Virgin Islands, cannabis abuse was most prevalent among low-income groups, the unemployed and school drop-outs. In the Cayman Islands, increased psychological and social problems were associated with cannabis abuse. In Chile, cannabis was abused by youth, often in combination with alcohol, stimulants or inhalants. In Dominica, cannabis abuse was rising, mainly among males in the 18-30 age group, both urban and rural. In Ecuador, cannabis was abused mainly by adolescents, often in combination with coca paste or alcohol. Guyana reported a large increase in cannabis abuse in all social strata, but particularly among low-income 17-35-year-old urban dwellers.
In the Netherlands Antilles, cannabis abuse was widespread, cutting across all social strata, and with approximately equal male-female involvement. It was increasingly being replaced by cocaine abuse, however. Nicaragua reported that several hundred persons abused cannabis. Panama reported increased abuse, mainly by the unemployed and students in the 16-35 age group. This was often associated with crime, traffic accidents, loss of jobs and family abandonment. Trinidad and Tobago reported cannabis smoking, mainly by persons in the 15-30 age group. Saint Vincent and the Grenadines reported a large increase in cannabis smoking among people in the 12-40 age group. In Uruguay, the same was true of the 16-25 age group, the male-female ratio being 5 : 1. In the United States, surveys showed a substantial decrease in cannabis use among young people, but the level remained, nevertheless, very high. Cannabis abuse was also reported from Argentina, Canada, Colombia, Haiti, Honduras, Mexico, Peru and Venezuela.
Abuse of psychotropic substances
Countries reporting the abuse of amphetamine-type stimulants included Argentina, Chile, Colombia, Ecuador, Honduras, Mexico, United States and Uruguay. In Uruguay, amphetamines were increasingly being abused by young people, by injection or orally, and often in combination with alcohol. In the United States, the illicit manufacture, use of and trafficking in methamphetamine continued to increase during 1985. Some 266 illicit methamphetamine and 70 illicit amphetamine laboratories were uncovered.
The abuse of benzodiazepines, minor tranquillizers, barbiturates or non-barbiturate sedative-hypnotics was reported by Argentina, Bolivia, Colombia, Ecuador, Honduras, Mexico, United States and Venezuela. In Ecuador, the abuse of benzodiazepines had increased, mainly among young adults. Trinidad and Tobago reported that approximately 20 per cent of drug abusers used benzodiazepines and minor tranquillizers.
The abuse of hallucinogens was reported as a problem in Canada, Ecuador, Mexico and the United States. In Canada, 4,072 persons were known to be abusing hallucinogens, mainly LSD, in 1985, compared with 4,595 in 1984; some 1,987 persons were abusing PCP, compared with 2,552 in 1984. Ecuador reported increasing abuse of naturally occurring hallucinogens, such as "magic" mushrooms. Secondary school students and foreign tourists visiting rural areas were the most prevalent abusers of naturally occurring hallucinogens, which were often used in combination with alcohol. In the United States, PCP continued to dominate the illicit hallucinogenic market. It was increasingly used by intravenous injection, often in combination with heroin or cocaine. The availability and abuse of LSD decreased in 1984, but LSD-related hospital emergencies showed a 24 per cent increase in 1985.
Abuse of volatile solvents
Argentina, Bolivia, Chile, Ecuador, Mexico, Panama, Peru, United States and Uruguay reported the abuse of volatile solvents. Bolivia and Ecuador were experiencing increasing abuse of these solvents, often in combination with cannabis, cocaine, coca paste or alcohol. The abusers were most often in the 10-16 age group.
Abuse of narcotic drugs
In Asia and the Far East, the drug abuse situation continued to deteriorate. Heroin abuse had reached epidemic proportions in a number of countries and areas, including several not previously affected. Bangladesh reported a heroin-abuse problem for the first time, with an estimated 10,000 heroin abusers in 1985. While India had no records of heroin abuse prior to 1981, recent information available from treatment facilities indicated a rapid spread of heroin abuse among urban populations. In Sri Lanka, where heroin abuse had not been a problem prior to 1982, there were an estimated 24,000 abusers in 1985.
Heroin abuse remained a serious problem in Burma, Hong Kong, Macao, Malaysia, Singapore and Thailand. In Burma, where it continued to increase, 8,830 abusers were registered in 1985, but it was estimated that approximately 17,600 persons were addicted. Increased heroin abuse was also reported from Thailand, where 43,914 opiate addicts, mainly heroin abusers, were admitted for treatment in 1985. Heroin abuse trends in Hong Kong, Malaysia and Singapore showed a tendency to stabilize, but the magnitude of the problem remained great. In Hong Kong, 33,448 heroin abusers were registered in 1985 and 12 heroin-related deaths were recorded. In Malaysia, of 14,101 opiate abusers treated in 1985, some 10,110 were seeking treatment for the first time. In Singapore, in 1985, an estimated 6,500 persons were addicted to heroin and 12 heroin-related deaths were recorded.
Heroin was predominantly abused by smoking in Malaysia and Singapore, by inhalation in Sri Lanka, by injection in Bangladesh, Macao and Thailand, and by either injection or inhalation in Hong Kong. When heroin was difficult to obtain, addicts turned to opium, cannabis or psychotropic substances. Most heroin abusers in 1985 were young, single males. The percentage of women addicts ranged from 0.4 in Sri Lanka to 6 in Singapore. The youngest addicts, by age group, were in Sri Lanka (16-30) and the oldest in Singapore (25-39).
In Sri Lanka, heroin abuse was confined mainly to big cities, but in Thailand it had spread to both urban and rural areas. Malaysia reported that heroin abuse had spread to almost all states of the country, and that abusers were predominantly from the lower- and middle-income groups, generally unskilled and semi-skilled workers. In Singapore, abuse was also most prevalent among unskilled workers. Approximately two thirds of the heroin abusers in Hong Kong and Singapore held jobs at the time their addiction was detected. In Singapore, most young heroin addicts were school drop-outs. Hong Kong reported that 80 per cent of its heroin abusers had had previous convictions. In Malaysia, a variety of criminal activities were associated with heroin abuse. In Sri Lanka, too, crime was associated with it, as were family breakdown, unemployment and male prostitution.
The smoking or eating of opium was traditionally rooted in certain parts of the region. In most cases, opium abusers were older than heroin abusers. In Burma, 31,956 opium addicts were registered in 1985, but it was estimated that approximately 159,700 persons were addicted and that 79,800 of these were daily users. It was estimated that 30,000 persons used opium in Bangladesh in 1985. In the same year, India had 31,714 registered opium addicts (mainly older people), a figure slightly lower than that of the previous year. Opiate addiction was also reported from Hong Kong, Malaysia, Philippines, the Republic of Korea, Singapore and Sri Lanka, but the numbers of abusers were lower. Thailand estimated that the number of its opium addicts had increased.
Opiates other than heroin and opium were abused in many countries and territories, but the numbers of abusers were relatively small. In 1985, Malaysia registered 534 such cases and Hong Kong 1,087. In the Philippines, 1,156 cough-syrup abusers were registered.
Bangladesh reported a cocaine abuse problem, but its magnitude was not known. The Philippines reported several dozen registered abusers and Japan a small number.
Cannabis was widely abused in many countries by smoking or eating it. Most abusers were males in the 15-29 age group. The percentages of female abusers ranged from 0.5 in Malaysia to 16 in Japan. Bangladesh reported that an estimated 2.5 million persons used it, often in combination with opium. Singapore and Thailand reported increasing abuse, mainly among young males. In 1985, 1,584 cases of cannabis abuse were registered in Malaysia, and 1,906 cases in the Philippines. In India, cannabis was abused mainly by low-income industrial and plantation workers, but also, to a small extent, by students and educated youth in the upper-income groups. Japan estimated that 7,000 to 30,000 persons abused cannabis in 1985. Burma, Hong Kong, Maldives and the Republic of Korea also reported cannabis abuse, but the numbers of abusers were relatively low.
Abuse of psychotropic substances
In Japan, methamphetamine abuse (by injection) continued to be a serious problem. In 1985, 23,344 methamphetamine abusers were registered, but it was estimated that up to 500,000 persons might be abusing stimulants. The abuse was country-wide and approximately 18 per cent of the abusers were female. Amphetamine-type stimulants were also abused in Hong Kong, Malaysia, the Philippines and the Republic of Korea, but the numbers of reported cases were much lower. Bangladesh also reported stimulant abuse, but the extent was not known.
Reporting the abuse of benzodiazepines, Bangladesh estimated that approximately 1 million persons abused sedative-hypnotics, 700,000 on a daily basis. In 1985, registered abusers of tranquillizers and sedative-hypnotics numbered 3,193 in Burma, 1,029 in the Philippines and a few hundred in Hong Kong. In Thailand, the abuse of these substances, mainly by persons in the 20-24 age group, was a cause of concern. Bangladesh reported hallucinogen abuse, but the extent of the problem was not known. Some cases were reported from Hong Kong, Malaysia and the Philippines.
Abuse of volatile solvents
Japan estimated that up to 1 million of its adolescents sniffed volatile solvents. This abuse pattern was country-wide. In 1985, 47 deaths were attributed to the practice. Bangladesh and Thailand also reported solvent abuse. In the same year, Singapore registered approximately 1,000 cases of such abuse and the Philippines over 100.
Multiple drug abuse
Multiple drug abuse was the most prevalent pattern in Indonesia and the Philippines. Other countries reported the problem, but to a lesser extent. Most often heroin addicts, when they could not obtain a sufficient supply of heroin, resorted to opium, benzodiazepines or cannabis.
Abuse of narcotic drugs
Of 32 reporting countries, 22 stressed problems of heroin abuse. In Austria, heroin was the second (after cannabis) most frequently abused drug; of 16,349 known drug abusers, 20 per cent abused heroin. In Finland, heroin abuse (by injection) was increasing; when heroin was difficult to obtain, other narcotics were used. In France, heroin abuse (generally by injection) had also increased. Most abusers were in the 21-25 age group, and approximately 18 per cent of them were female. In 1985, 129 deaths were caused by heroin overdose. An estimated 75,000 persons abused the drug in 1984, often in combination with cocaine. In Italy, heroin abuse (by injection) remained a serious problem. In 1985, 20,000 abusers received treatment. Most of them were in the 18-29 age group, 20 per cent being female. There were 237 deaths from overdose. Heroin was often used in combination with benzodiazepines and minor tranquillizers. In Monaco, heroin was increasingly being abused (by injection), often in combination with alcohol.
In the Netherlands, an estimated 15,000 to 20,000 persons abused heroin (by smoking or injection) in 1985. They were mainly in the 20-35 age group, came from large urban areas, and were in the lower-income group or unemployed. The heroin was often used in combination with methadone, cocaine, amphetamines or benzodiazepines. In 1985, there were up to 150 heroin-related deaths. Portugal reported an escalation in heroin abuse (by injection). This was attributed mainly to increased supplies of the drug and the underlying psychological problems of its users. The heroin was commonly used in combination with cannabis. Most abusers were young people, but over 21. Some 20 per cent were female. In Spain, in 1985, an estimated 80,000-120,000 people abused heroin (by injection), often in combination with benzodiazepines or alcohol; 142 deaths were caused by overdose. Most abusers were in the 15-29 age group.
Heroin abuse in the United Kingdom of Great Britain and Northern Ireland in 1985 was approximately 25 per cent higher than in 1984. Most abusers were in the 21-25 age group; 29 per cent were female. Most new users inhaled the drug. The shift from injection to inhalation had reduced heroin-related morbidity and mortality, but had led to an increase in overall use. The heroin was often used in combination with cocaine, methadone, dipipanone or morphine. In Denmark, heroin abuse (by injection) had decreased slightly. Most abusers were in the 20-30 age group; 30 per cent of them were female. The heroin was often abused in combination with sedatives or alcohol. In 1985, there were 158 heroin-related deaths. In the Federal Republic of Germany; heroin abuse had decreased slightly, but an estimated 12,300 persons (mainly in the 25-30 age group) abused the drug by injection. In 1985, 151 deaths were caused by heroin overdose.
In Liechtenstein, heroin abuse (by injection), often combined with alcohol, had been observed mainly among persons in the 20-25 age group. The abusers were becoming involved with the drug at a much earlier age than in the past, however. In Luxembourg, heroin abuse (by injection) remained a problem, mainly among youth in the 20-24 age group. The heroin was often abused in combination with alcohol or psychotropic substances. Norway and Sweden reported heroin abuse (by injection), but it appeared to be levelling off. In Turkey and Yugoslavia, the numbers of heroin abusers were relatively small, but increasing. In Yugoslavia, heroin was usually abused in combination with cannabis or morphine.
Switzerland reported that an estimated 10,000 persons were heavy abusers of heroin in 1984. Belgium, Greece, Ireland and San Marino also reported heroin abuse in 1984.
Abuse of opiates other than heroin was reported from Austria, Bulgaria, Cyprus, Czechoslovakia, Denmark, German Democratic Republic, Germany, Federal Republic of, Greece, Hungary, Portugal, Switzerland, Turkey, the Union of Soviet Socialist Republics and Yugoslavia. Hungary reported a large increase in dihydrocodeine abuse (orally or by injection), and an increase in codeine abuse. The abusers were mainly in the 18-30 age group. Hungary also reported the abuse of a decoction of poppy straw (to which one death had been attributed). In Czechoslovakia, codeine abuse (by injection), sometimes in combination with methamphetamines, had increased among youth. In 1985, the number of persons prosecuted for drug offences was nearly three times that of the preceding year.
Poland reported increasing abuse of opiates, mainly a decoction of poppy straw, sometimes in combination with benzodiazepines. Abuse was most prevalent among unemployed urban dwellers in the 18-24 age group; 25 per cent of the abusers were female. Opiates were taken orally or by injection. In 1985, 109 opiate-related deaths were recorded. Opiate injection had caused an increase in the incidence of hepatitis and syphilis. In the Union of Soviet Socialist Republics, of 8,999 drug abusers admitted for treatment in 1985, most had used preparations derived from opium, including morphine and codeine. A small percentage had used synthetic narcotics.
Cocaine had emerged as one of the major drugs of abuse in Europe. In the Federal Republic of Germany, cocaine abuse had increased, mainly in the 25-30 age group. There were five deaths from overdose in 1985. Luxembourg reported a large increase in abuse (by injection), mainly among the 20-24 age group. The cocaine was often abused in combination with alcohol and psychotropic substances. In the Netherlands, cocaine abuse had also increased, mainly in the high-income group, but the trend was towards more middle-income involvement. A 1984 survey showed that 75,000 persons in the 15-24 age group had used cocaine at some time in their lives. Norway reported increasing cocaine abuse (by sniffing), mainly by 20-30-year-old people in the worlds of business, fashion and music. The problem had not yet reached the street level. Spain reported increasing abuse of cocaine (by inhalation), often in combination with alcohol. In 1985, the number of abusers was estimated at 70,000, mainly in the 20-39 age group.
In the United Kingdom, the evidence suggested that while cocaine abuse had increased, it had not yet reached the street level to any significant extent. The drug was mainly abused during weekends, the predominant methods of consumption being smoking the pure cocaine base and combining it with heroin. In France, cocaine abuse had decreased slightly, but it remained a significant problem. Abusers were mainly in the 20-24 age group. In 1985, four deaths were caused by overdose. Other countries reporting cocaine abuse included Belgium, Greece, Iceland, Ireland, Poland, Portugal, Sweden, Switzerland and Yugoslavia.
Cannabis continued to be the most widely abused drug in Europe. In Austria, of 16,349 known drug abusers, 62 per cent abused cannabis. Denmark reported that approximately 25 per cent of persons in the 14-18 age group had used cannabis and that there had been an increase in the overall number of abusers. Finland and Monaco also reported increased cannabis abuse. In Italy, an estimated 500,000 people abused cannabis in 1985. In the Netherlands, a 1984 survey showed that 300,000 persons in the 15-24 age group had used cannabis at some time in their lives. In the Federal Republic of Germany, cannabis abuse was levelling off. An estimated 20,100 persons abused cannabis herb, resin or concentrate. The abusers were mainly in the 18-21 age group. In Sweden, an estimated 12,500 persons in the 15-35 age group were abusing cannabis in 1984. Of those, 6,300 smoked cannabis exclusively, 4,400 combined it with amphetamines, 500 with opiates and 1,300 combined it with both amphetamines and opiates. In Switzerland, an estimated 10,000 persons abused cannabis resin in 1984. France reported some decrease in cannabis abuse. Cannabis abuse was also reported from Belgium, Bulgaria, Liechtenstein, Luxembourg, Norway, Poland, San Marino, Turkey, the Union of Soviet Socialist Republics, the United Kingdom and Yugoslavia. In most countries, the abuse affected all social strata, but it was most prevalent among urban dwellers in the 18-29 age group.
Abuse of psychotropic substances
The Federal Republic of Germany reported a large increase in amphetamine abuse. Increased abuse of amphetamine-type stimulants (by injection) was also reported from Finland and Norway. In Finland, amphetamines were often used in combination with other psycho-active substances. In Spain, an estimated 350,000-400,000 persons abused amphetamines in 1985. In Sweden, approximately 1,400 persons abused amphetamine-type stimulants in the same year. In the Netherlands, a 1984 survey showed that 37,000 persons in the 15-24 age group had used amphetamines at some time in their lives. In the United Kingdom, amphetamines were often abused in combination with opiates. Other countries reporting the abuse of amphetamine-type stimulants included Belgium, Bulgaria, France, Iceland, Luxembourg and Portugal.
The Federal Republic of Germany reported 5,900 abusers of benzodiazepines and minor tranquillizers and 2,000 abusers of other depressants in 1985. In the Netherlands, the 1984 survey showed that, at some time in their lives, 1.6 million persons in the 15-24 age group had used benzodiazepines and minor tranquillizers, and 1.75 million had used other depressants and sedatives. Cyprus reported the abuse of diazepam, lorazepam and clorazepate, mainly by persons in the 30-50 age group, 60 per cent being female. In Denmark, 70 per cent of those abusing benzodiazepines and tranquillizers were women between the ages of 25 and 80. Poland in 1985 had 7,594 registered abusers of benzodiazepines and minor tranquillizers and 1,429 abusers of other depressants and sedatives. The German Democratic Republic and Iceland reported that hundreds of persons abused benzodiazepines. In Italy, benzodiazepines were frequently abused in combination with heroin, and in Spain with alcohol or heroin. Yugoslavia reported 1,269 abusers of tranquillizers or sedative-hypnotics for 1985.
In Hungary, the abuse of glutethimide, often in combination with dihydrocodeine, was increasing. The abusers were mainly in the 18-30 age group. Iceland, Ireland, Luxembourg, Malta, Portugal, Sweden and Turkey also reported abuse of tranquillizers or sedative-hypnotics.
The Federal Republic of Germany reported that 1,500 persons abused hallucinogens in 1985. In the Netherlands, the 1984 survey showed that 25,000 persons in the 15-24 age group had used hullucinogens at some time in their lives. Poland, Portugal and Yugoslavia also reported relatively small numbers of hallucinogen abusers.
Abuse of volatile solvents
Czechoslovakia, Norway, Poland, Portugal, Spain and Turkey reported the abuse of volatile solvents, mainly by younger adolescents. In Spain, the number of abusers in 1985 was estimated at 20,000.
Multiple drug abuse
Multiple drug abuse, involving two or more substances in various combinations, was widespread and attended by serious medical and psychological problems.
The continuing spread of heroin abuse in the region, and an outbreak of cocaine abuse in Egypt, were the most striking features of the drug abuse situation. Abuse of benzodiazepines, methaqualone, amphetamines and, in particular, combinations of drugs, also continued to spread, often with considerable rapidity. Cannabis was still the most common drug of abuse. Opium addiction, which was well established in the region, showed a tendency to stabilize, or even to decrease.
Abuse of narcotic drugs
Egypt reported a large increase in heroin abuse (by injection and inhalation). The drug was often used in combination with cocaine, Mandrax (a preparation containing methaqualone and diphenhydramine) or methaqualone. It was mainly abused by urban males in the 20-40 age group. The abuse of opium had decreased slightly. In Kuwait, heroin continued to be abused (by injection), mainly among middle-income urban males in the 20-30 age group. It was often used in combination with cannabis, tranquillizers and alcohol. Opium was also abused in Kuwait, but it caused fewer problems. Qatar reported increased heroin abuse, mainly by males in the 17-25 age group; opium abuse had decreased. In Pakistan, heroin abuse (by smoking) had increased. In 1985, an estimated 300,000 persons abused the drug, often in combination with cannabis. Most abusers were urban dwellers in the 15-45 age group. In Pakistan also, some 377,000 persons abused opium (by smoking), in 1985, often in combination with cannabis or Mandrax. Opium abusers tended to be older people from both urban and rural areas. Iraq reported some opium abuse, but the extent was not considered to represent a major problem.
Egypt reported a large increase in cocaine abuse, often in combination with heroin. Abusers were mainly in the higher-income groups. Kuwait reported a small number of cases of cocaine abuse.
In Egypt, abuse of cannabis resin (hashish) was showing signs of decreasing, but it remained widespread among all social strata, urban and rural alike. Most abusers were in the 20-40 age group. Jordan reported increased cannabis abuse, mainly by males in the 17-40 age group. In Kuwait, cannabis was abused mainly in combination with heroin, tranquillizers or alcohol. In Qatar, cannabis smoking was tending to fall off, but there was a trend towards combining benzodiazepines with cannabis. In Pakistan, an estimated 595,000 persons abused cannabis resin in 1985. Abusers, whose numbers appeared to be growing, ranged in age from 15 to 60 and were found in urban and rural areas, particularly in the lower-income groups. Mandrax was often abused in combination with cannabis. Iraq, again, reported hashish abuse, but not to any grave extent.
Abuse of psychotropic substances
Egypt reported a large increase in methamphetamine abuse (by injection). Abusers were mainly in the 20-50 age group. Some deaths had occurred. Amphetamine abuse was also reported from Kuwait, but the incidence was relatively small.
Methaqualone abuse had also increased in Egypt. The abusers, who often combined it with heroin, were mainly males in the 20-40 age group coming from both urban and rural areas. Some deaths had occurred. In Kuwait, tranquillizers and sedative-hypnotics were often abused in combination with other substances, such as heroin, alcohol and cannabis. Most abusers were middle-class urban dwellers in the 25-35 age group. Qatar reported abuse of diazepam and flunitrazepam, often in combination with heroin or cannabis, and mainly in the urban areas. Abuse of the former drug tended to be stable, but that of the latter was increasing. In Pakistan, in 1985, an estimated 51,000 persons abused benzodiazepines and minor tranquillizers, and 85,000 other depressants; Mandrax was often abused in combination with opium and cannabis.
Abuse of volatile solvents
Kuwait, Qatar and Pakistan reported the abuse of volatile solvents, such as benzine and glue. Pakistan alone had an estimated 289,000 abusers in 1985.
Multiple drug abuse was widespread and had contributed significantly to the incidence of drug-related deaths.
Abuse of narcotic drugs
The abuse of opiates remained a serious problem in the region. In Australia and the Cocos (Keeling) Islands, the abuse of heroin (by injection) showed a tendency to increase, predominantly among unemployed persons in the 18-30 age group in major urban centres. Of 229 heroin-related deaths in 1985, 181 were caused by overdose. The most frequent problems associated with abuse were theft, prostitution (to pay for the drug), unemployment, health impairment and family disruption. In New Zealand, heroin was abused mainly by persons in the 15-24 age group. The level of heroin abuse was medium, compared with that for opium (low) and synthetic narcotics and opiates other than heroin and opium (high). Synthetic narcotics (such as buprenorphine, pethidine, methadone, dextromoramide and dextropropoxyphene) and opiates other than heroin and opium (such as codeine and morphine and home-manufactured morphine) were abused (injected or eaten) mainly by 15-19-year-olds. In 1985, of 20 deaths caused by the abuse of these substances, 17 had involved the use of synthetic narcotics and 3 opiates other than heroin and opium; 12 of the deaths were the result of multiple drug abuse, sometimes involving additional substances. Papua New Guinea reported a small number of cases of opium and heroin abuse.
Australia reported an increase in cocaine abuse (by sniffing), mainly in the larger urban centres. Abuse was most prevalent among 20-40-year-olds in the middle- and upper-income groups. Some cocaine abuse was also reported from New Zealand.
In Australia, cannabis smoking, often in combination with alcohol, continued to be relatively widespread, affecting most sections of the population, especially in the 15-30 age group. Some 40 per cent of the abusers were female. Abuse was often associated with behavioural disorders and traffic accidents. In New Zealand, marijuana, cannabis resin and cannabis oil were increasingly being abused, mainly by persons in the 15-19 age group; one cannabis-related death was reported in 1985. In Papua New Guinea, cannabis herb, hashish and cannabis oil were readily available and there was a high and growing illicit demand for them. In 1985, there were 5,000 registered abusers, but it was estimated that 10,000 persons abused cannabis-type substances. Abusers tended to be in the 20-40 age group and 30 per cent were female. Fiji also reported some cannabis abuse.
Abuse of psychotropic substances
In New Zealand, the abuse (by eating) of anorexiants (such as diethyl-propion hydrochloride and phentermine resinate), anti-depressants and amphetamines continued to be a problem. The abuse of amphetamine-type stimulants, mainly by 15-19-year-olds, was reckoned to be at the medium level, compared with levels for other forms of drug abuse. In 1985, 20 deaths were caused by the abuse of these stimulants; in 9 cases, other substances were also involved.
In Australia, the abuse (by eating) of benzodiazepines and minor tranquillizers was relatively widespread and increasing among all levels of the population, mainly in the 30-50 age group. Most abusers were female. In 1985, 116 deaths were attributed to the use of benzodiazepines and tranquillizers (both minor and major). A high level of abuse of benzodiazepines and minor tranquillizers, as well as sedative-hypnotics, including barbiturates, was also reported from New Zealand. Abuse of benzodiazepines was most prevalent in the 15-19 age group, and of barbiturates and other depressants in the 19-24 age group. In 1985, 19 deaths were related to the abuse of those substances, often in combination with other substances.
LSD and hallucinogenic mushrooms were being abused (by eating) in New Zealand, mainly by 15-19-year-olds. The prevalence of the abuse was at the medium level, compared with levels for other forms of drug abuse.
Abuse of volatile solvents
Australia and New Zealand reported the abuse of volatile solvents such as petrol, glue and aerosols. In the latter country, it caused seven deaths in 1985. In Australia, petrol sniffing was a problem among some aboriginal children and young adults, mainly males, in rural areas. Sniffing glue and aerosols was relatively widespread among urban youth. In general, the abusers were in the 10-14 age group. In urban areas, they were predominantly female, and in rural areas, male. In New Zealand, the abuse of solvents had increased, especially among 10-14-year-old Maori children in urban areas. The increase was associated with a growth in social problems, as many abusers were "street kids" who had turned to shoplifting and other forms of theft to support themselves.
This summary is based on the assessment of measures to reduce the illicit demand for drugs by the Commission on Narcotic Drugs at its February session 1987 [ 2] .
Regarding such measures, many representatives and observers of the Commission described programmes for prevention, treatment, rehabilitation, after-care and social reintegration in their countries and territories. Some stated that the levelling-off or decrease in abuse was attributable to drug information and education programmes. The family, school, community and work-place were the usual settings for such programmes. Specific prevention curricula and related educational activities were most successful when they were selected in response to the perceived needs of target groups, such as parents, schoolchildren, students, teachers, religious groups, workers and individuals dealing with youth problems.
In a number of States, education designed to support a healthy, drug-free existence had been included in the curricula of schools and other educational institutions. The school was also a setting for the development of a variety of other preventive programmes. The most effective were those that involved schoolchildren or students, teachers, parents and the community in mutuallysupportive drug abuse prevention efforts. Support of such programmes by the mass media had proven useful.
With respect to drug information, some representatives drew attention to the wide range of experience, publications, documentation and guidelines already available, which could be useful in developing abuse prevention programmes. Good information programmes were those that provided accurate and up-to-date information and emphasized the advantages of a drug-free life-style, rather than merely concentrating on the hazards and futility of drug use. Information was the basis of any preventive programme, but information could be ineffective or even counter-productive if it was not designed to meet the needs of a target group. Inappropriate information could arouse curiosity, which in turn might lead to experimentation with drugs. In that connection, individuals in the entertainment industry who were also drug users should not be portrayed in the media as having glamorous and enviable life-styles.
Some representatives and observers stated that drug education in their countries and territories had been placed in a broader social perspective to include not only knowledge related to specific drugs, but also the development of self-respect and respect for others, as well as skills for living (such as decision-making, coping with stress, awareness of values, problem-solving and interpersonal communication) which, in turn, could help the individual to develop the ability to resist the temptation to use drugs. People often resorted to drugs in order to compensate for their failure to cope with life's difficulties.
Some representatives drew attention to the need to provide opportunities for young people to become involved in stimulating and creative activities and to encourage them to use the resources readily available. Various youth groups, communities, religious institutions and non-governmental organizations were increasingly involved in developing and carrying out programmes for the prevention of drug abuse. It was important to make more use of low-cost programmes for the prevention and reduction of drug abuse which could be developed by utilizing local community resources. Such programmes focused on encouraging government institutions, youth, civic groups and others to co-operate closely and to help in coping with drug abuse problems.
Several representatives stressed the need for accurate assessment of both drug problems and the resources to cope with them. This was essential to the development of successful prevention, treatment and rehabilitation programmes. It helped to determine the objectives, tasks and activities of programmes and to evaluate their effectiveness.
A number of representatives and observers said that their Governments were paying considerable attention to increasing public awareness of drug problems. This was considered a prerequisite for successful drug abuse control.
A number of intergovernmental regional organizations and non-governmental organizations were becoming increasingly involved in developing programmes for the reduction of the illicit demand for drugs. Most representatives and observers considered that a drug control programme must have a balanced approach to measures for reducing the illicit supply of, and demand for, drugs. It was important to ensure a reduction not only in the illicit demand, but also in demand for legally available medicines and other dependency-producing substances.
Many representatives and observers described the way in which Governments, private organizations and non-governmental organizations were implementing treatment, rehabilitation, after-care and social reintegration programmes. In some countries, training courses were conducted for professionals in those fields. The effectiveness of the programmes depended to a large extent on the initiative and dedication of the personnel involved. The unstable life-style of former addicts, their difficulty in getting a job, and the reluctance of neighbourhoods, employers and schools to accept them were factors that often adversely affected the success rate of treatment, rehabilitation and social reintegration programmes. The reported success rates one year after leaving treatment varied between 40 and 80 per cent in different countries.
A number of representatives and observers drew attention to the need to ensure international co-operation in the exchange of experience on drug demand reduction programmes which had proven most useful. Such experience should be made more widely available. Attention was also drawn to the need to promote co-operation among various government departments and sectors of society involved in demand reduction programmes at the national level, in order to make optimal use of the available facilities and human resources.
This section is based on information contained in the report of the Secretary-General [ 1] , which summarized by region information received on this subject from Governments.
Drug abuse assessment
Few of the reporting countries were implementing programmes to assess drug abuse. Côte d'Ivoire, Madagascar and Mauritius collected relevant data mainly on the basis of medical and police records.
Prevention
In Ghana, a pharmaceutical society organized lectures, symposia and films on drug-related topics. In Côte d'Ivoire, informational and educational programmes aimed at increasing public awareness of drug abuse problems and preventing such problems. In Madagascar, drug abuse had been incorporated into the programme of medical studies. In Morocco, a drug information programme was provided for medical and secondary school students. In Nigeria, law enforcement personnel were briefed on drug abuse prevention. Lectures on prevention were also delivered to students and other youth. In Togo, the national health education service provided periodic courses on drug abuse prevention for university and secondary school students. In Zimbabwe, a group of pharmacists was preparing a drug education programme.
Treatment, rehabilitation and social reintegration
In Ghana, treatment for drug abuse was available from three psychiatric hospitals. In Côte d'Ivoire, a social reintegration centre, currently at the experimental phase of development, provided services for persons with behavioural difficulties, including drug abusers. In Madagascar, ex-addicts received agricultural ergotherapy; a long-term social reintegration programme was also available. In Mauritius, treatment was available for abusers of opiates, cannabis and psychotropic substances.
Drug abuse assessment
Of the 23 reporting countries and territories, 12 conducted drug abuse surveys or maintained statistics of drug-related treatment or medical emergencies. Central registers of known drug abusers were maintained in five countries and territories.
Prevention
In Argentina, the National Centre for Social Re-education provided training in drug abuse prevention for various professional groups. It also organized conferences for students, parents, and teachers to promote prevention. In addition, it provided drug-related educational programmes for young people. In Bolivia, pamphlets were disseminated which provided information on drug abuse problems. In Canada, drug education and information programmes, aimed at specific groups, were carried out by the Government, education boards, private organizations, and the police. In the Cayman Islands, the Public Health Service co-operated with school authorities in educating school children with regard to drug problems. In Colombia, the Ministry of Communication had organized a campaign on drug abuse prevention; the Ministry of Education provided training for teachers and educators on the use of free time as a strategy for drug abuse prevention among youth; the national family welfare system trained educators in strategies of drug abuse prevention in the family; and the Ministry of Agriculture supported a crop-replacement programme for coca-growing areas. In Dominica, the police provided information for different target groups.
In Ecuador, national prevention programmes included: specialized training for personnel from institutions concerned with children, youth and the family; early-stage intervention activities; and special programmes for students and for persons from urban and rural communities. In Guyana, the accent was on the use of mass media and the presentation of lectures and on audio-visual slide programmes in schools and clubs. In Mexico, a drug educational programme for schools, launched by the office of the Attorney General, dealt, inter alia, with problems of drug-related delinquency. In Netherlands Antilles, lectures on prevention were delivered to various population groups.
In Panama, prevention was promoted through the mass media and an educational programme designed for teachers and parents. In Trinidad and Tobago, an extensive prevention campaign was supported by the mass media, primary health care personnel, religious organizations and youth groups. In the United States, prevention included providing drug information, educating specific population groups, suggesting alternatives to drug use, and helping to solve the psychological, social and other drug-related problems of youth. An important recent development was the "parent movement for drug-free youth" in which government institutions, civic groups and individual citizens co-operated closely to design and implement preventive programmes.
Treatment, rehabilitation and social reintegration
In Argentina, the National Centre for Social Re-education provided treatment and social reintegration programmes for addicts, as well as training for professionals in the field of drug abuse. In Canada, treatment and rehabilitation programmes were carried out in centres operated by provincial governments, municipalities and private organizations. Methadone treatment was available from physicians specially authorized by the Government. Supportive counselling and social services normally formed part of the treatment. Agencies at the municipal level provided vocational training programmes. In Chile, treatment for drug abusers was available mainly in psychiatric hospitals. In 1985, 11,059 persons with drug abuse problems in Colombia received help from special assistance centres, health centres and hospitals. Vocational training, group therapy, family treatment and social reintegration programmes were also provided. In Ecuador, treatment was available to abusers in general hospitals, psychiatric hospitals and rehabilitation centres.
In Mexico, treatment programmes for drug abusers, which included family therapy, were carried out by "centres for youth integration". In the Netherlands Antilles, treatment and social reintegration programmes were provided by social workers, psychologists and psychiatrists who used various methods, including family therapy. In Panama, treatment and rehabilitation were the responsibility of psychiatric hospitals and other health centres. Voluntary groups also endeavoured to facilitate social reintegration for former drug abusers. In Trinidad and Tobago, a "drop-in' centre and religious organizations assisted in the work of social reintegration.
In the United States, 272,042 drug abusers were admitted in 1984 to state-supported, drug-abuse treatment units. The units provided detoxification, maintenance and drug-free therapy in out-patient, residential and hospital facilities. Social reintegration was assisted by a wide range of federal, state, private and religious organizations. Emphasis was placed on vocationalrehabilitation to enable the patient to become self-supporting and more self-reliant. In Venezuela, treatment and rehabilitation programmes were provided by a psychiatric hospital and private institutions.
Drug abuse assessment
Of the 10 countries and territories that provided information for 1985, eight maintained national-level registers of known abusers as well as statistics on drug abuse treatment. Five carried out sample surveys of abuse. Four collected statistics on drug-related medical emergencies and deaths.
Prevention
Most reporting countries and territories carried out prevention programmes aimed at risk groups as well as the general public. Such programmes in Bangladesh, India, Japan, Maldives, the Republic of Korea and Sri Lanka relied mainly on the use of the mass media and the dissemination of printed material. Some of the programmes were combined with ongoing anti-narcotic campaigns. In India, a campaign had been organized for university students. In the Republic of Korea, one had been organized for school counsellors and inspectors. In Sri Lanka, lectures and seminars were arranged for parents, community leaders and risk groups.
In Burma, school-level prevention programmes included regular instruction in drug education; exhibitions, essays and other forms of competition; special training for teachers; and alternatives to drug use. A compulsory drug education programme had been launched in former opium-growing areas in support of crop-replacement programmes. Prevention programmes for parents focused on meetings, talks and discussions. Moreover, specific programmes had been arranged for parents (including illiterate ones) in former poppy-growing areas.
In the territory of Hong Kong, prevention activities included the use of a mobile unit to present audio-visual anti-narcotics programmes to various population groups; school-level programmes and talks; community involvement projects; anti-narcotics campaigns; and a "youth against drugs scheme" which encouraged youth groups to design and implement prevention projects.
In Malaysia, drug-abuse prevention was focused on the schools and on community action programmes. In the schools, prevention activities included the establishment of counselling and guidance clubs, parent-teacher associations, youth clubs, self-help camps and anti-drug committees. Drug-related topics were included in school curricula and special training courses were introduced for teachers. Community action programmes included group discussions; sermons; stage shows; an abuse and trafficking telephone service; the development of community self-help groups and rehabilitation committees; and the training of ex-addicts to instruct community groups in the problems of drug abuse.
In the Philippines, an intensive prevention programme had achieved considerable success. In schools, special abuse-related programmes had been designed for administrators, teachers, students and parents. Moreover, drug abuse prevention had been incorporated into school study programmes. Greater involvement of young people in community-level prevention activities had also been generated. Prevention-related seminars, workshops and training courses were conducted for various professional and voluntary organizations.
In Singapore, drug education was a regular component of school instruction. Student welfare committees developed prevention programmes and assisted other students in need of help. Training courses for teachers were conducted. Guidelines on how to identify and deal with students involved in drug abuse had been issued to schools. The Singapore Anti-Narcotics Association, a voluntary group, organized prevention programmes for parents, students, servicemen and workers.
In Thailand, prevention programmes included an anti-narcotics campaign, the dissemination of information through the mass media, and a fund-raising campaign for drug abuse control projects. A seminar on preventive education had been conducted for school management and teachers. In 1985, an evaluation of the prevention programmes was initiated.
Treatment, rehabilitation and social reintegration
Seven countries and territories provided information on treatment, rehabilitation and social reintegration, which is summarized below. In Burma, 1,709 opiate addicts received treatment in 1985. Detoxification was carried out at treatment centres operated by the Department of Health, and rehabilitation was undertaken at social support centres, trade training centres and vocational training centres operated by the Social Welfare Department. Two rehabilitation centres providing comprehensive care had been set up by the Central Committee for Drug Abuse Control. Social reintegration, after-care and follow-up services were provided by voluntary social workers supervised by drug abuse control committees. The Social Welfare Department, which provided short training courses for volunteer social workers, envisage training 50 such volunteers per year and increasing the number of trade training centres. Rehabilitation was achieved in 40.4 per cent of cases.
In the territory of Hong Kong, 17,705 persons were treated for addiction to opiates, mainly heroin, in 1985. Twenty-four voluntary, out-patient, methadone treatment clinics for heroin addicts were operated by the Medical and Health Department. In addition to detoxification and maintenance services, the clinics provided support services, such as counselling and financial and housing assistance. Methadone was prescribed by medical officers. It was administered in the clinics under strict control to prevent its diversion into illicit channels. The treatment was not associated with any significant side-effects and helped patients to achieve family and social stability, as well as gainful employment. Treatment with methadone had been found to be particularly useful in the case of heroin addicts whose treatment by other programmes had failed repeatedly.
In Malaysia, over 14,000 opiate addicts were treated on a compulsory basis in 1985. The "cold turkey" method was applied in detoxification wards. Rehabilitation was carried out in centres which provided addicts with moral, religious and other forms of counselling, education, work therapy and vocational training. Job placement was provided by non-governmental "half-way houses" which co-operated with the private sector. Voluntary and other community organizations played an important role in after-care, mobilizing resources through a "neighbourhood counselling scheme". Drug rehabilitation committees, established in various localities, provided guidance and assistance in job placement, after-care and social reintegration. The average recidivism rate among opiate abusers one year after leaving treatment was 39.1 per cent.
In the Philippines, 2,409 drug abusers were treated at residential treatment centres, rehabilitation centres and drop-in centres in 1985. After-care and social reintegration services were provided by social workers. The average recidivism rate among cannabis abusers one year after leaving treatment was 20.1 per cent.
In Singapore, 2,150 opiate addicts were treated on a compulsory basis at drug rehabilitation centres in 1985. Approximately six months before discharge, they were placed in a "release programme", operated as a half-way house. They were allowed to work outside and to go home at weekends and on the eve of public holidays. Upon their return, their urine was tested for the presence of drugs. After completion of the release programme, they were placed under statutory supervision. The relapse rate among opiate addicts two years after leaving the drug rehabilitation centres decreased from 70 per cent in 1977 to 57.3 per cent in 1983.
In Thailand, 43,914 opiate addicts were admitted for treatment and rehabilitation in 1985. In Sri Lanka, the figure was 775.
Drug abuse assessment
Eighteen reporting European countries conducted drug abuse surveys and 21 maintained statistics on treatment for drug abuse or drug-related medical emergencies. Twelve kept central registers of known drug abusers and 18 maintained statistics on drug-related deaths.
Prevention
Most reporting countries carried out prevention programmes. They were usually targeted at young persons at risk of becoming involved with drug abuse, but they were also intended to reach parents and others such as teachers, who had a good deal of contact with children and youth. The public was usually reached through the mass media, and various target groups through the dissemination of printed materials. Several countries used audio-visual set-ups for educational or training purposes. Many countries conducted training courses for professionals in drug abuse prevention techniques and had incorporated drug education into the regular school programmes, often within the framework of health education. There was a general tendency for local community members to become involved in school programmes aimed at preventing drug abuse. Non-governmental organizations were also increasingly involved in drug abuse prevention programmes in Europe. Some specific programmes that were implemented in particular countries are indicated below.
In the Federal Republic of Germany, the Government used the media to promote drug abuse prevention programmes for young persons. The programmes were directed particularly to youth clubs. Drug educational programmes were sponsored by state authorities. In Luxembourg, in addition to information and documentation centres, an association of parents of drug users was active in providing information and assistance on abuse prevention. In the Netherlands, in addition to initiatives at the local or community level, so-called consultation bureaus on alcohol and drugs carried out prevention programmes in various parts of the country. In Norway, an experimental drug education programme was under way in primary schools, starting with first grade. In addition, social workers in approximately 60 communities were involved in street-level prevention programmes. In Poland, "alternative-to-drugs" programmes for youth, which included sport and other leisure-time activities, were organized by an association for drug abuse prevention. In Switzerland, a multidisciplinary school-level prevention programme was being prepared. In France, centres had been established to promote the involvement of families in drug abuse prevention. Moreover, "prevention clubs" had been set up to promote the participation of youth in healthy, "alternative" activities.
In Italy, health education programmes for youth in school and in the army included drug abuse prevention. In Spain, drug information and educational programmes were being implemented for local and provincial administrations.
In the United Kingdom, a national campaign on heroin abuse prevention, featuring television commercials and other forms of advertising, which began in February 1985, was directed towards youth "at risk". Two video packages had been produced, one for training non-specialized social workers who work with youth, and the other for use in schools. The campaign was seen to be yielding positive results.
Treatment, rehabilitation and social reintegration
Most European countries reported a variety of treatment programmes. Detoxification was usually carried out under medical supervision, after which different forms of treatment, rehabilitation, after-care and social reintegration programmes were available. In most countries, these programmes were multidisciplinary. In some they were financed by the Government; in the majority, however, they were the responsibility of provincial or local authorities. In many countries, voluntary non-governmental and religious organizations were increasingly involved in providing social reintegration services for former drug addicts. The rehabilitation and social reintegration of opiate addicts involved long-term care. This was provided by various facilities, such as after-care, rehabilitation, and vocational training centres; therapeutic communities; and out-patient clinics. In Sweden, home care was also provided.
The effectiveness of the programmes depended to a large extent on the initiative and dedication of the personnel providing treatment. The unstable life-style of former addicts, their difficulty in getting jobs, and the reluctance of neighbourhoods, employers and schools to accept them were factors that unfavourably affected the success rate of treatment, rehabilitation and reintegration programmes. The reported success rates varied greatly. In Austria, the average recidivism rate one year after leaving treatment was 23 per cent for all drug abusers; in Bulgaria, 50 per cent for opiate abusers; in Iceland, 30 per cent for opiate abusers; in Poland, 35 and 20 per cent for opiate and psychotropic substance abusers respectively; and in Luxembourg, 30 per cent for opiate abusers.
In the Federal Republic of Germany, long-term treatment facilities can accommodate 3,000 drug abusers. Vocational training was part of all long-term treatment programmes. Italy reported that in 1985 some 20,000 opiate abusers were admitted for treatment. Social reintegration programmes were carried out in many cities and were financed by local authorities. In the Netherlands, approximately 15,000 opiate abusers were admitted for treatment in 1985. There were four general types of social reintegration programmes: supervised accommodation; training and adjustment to work; education of addicts; and after-care. These services were offered even when the addict was not completely detoxified. In Spain, 15,500 opiate abusers were admitted for treatment during 1985. An evaluative pilot study of the effectiveness of treatment commenced in 1986 and a programme for registration of heroin addicts will be implemented in 1987. In the United Kingdom, the authorities, as well as voluntary services, provided rehabilitation facilities in either residential accommodation, day centres or advisory and counselling centres. In addition, the Department of Employment offered help in finding employment for drug addicts following treatment.
Drug abuse assessment
Egypt and Kuwait conducted drug abuse surveys and Kuwait, Qatar and Pakistan kept statistics on treatment for drug abuse or drug-related medical emergencies.
Prevention
In Egypt, an extensive prevention campaign included the use of mass media and the dissemination of printed material to the general public. Symposia and conferences were organized by professional and non-governmental organizations for various population groups. In Kuwait, prevention programmes were carried out in schools and universities. Seminars and symposia were organized on the topic of drug abuse and the mass media were used to disseminate relevant information. In Qatar, the mass media carried out programmes on drug abuse prevention and preventive education was provided in schools and universities.
Treatment, rehabilitation and social reintegration
In Egypt, social reintegration included psychological counselling and vocational training. The average recidivism rate one year after leaving treatment was 17.3 per cent. In Iraq, treatment was available in two psychiatric hospitals and in a medical centre. In Kuwait, a hospital for psychological medicine treated 304 cases of drug addiction in 1985. In Qatar (which reported 784 multiple drug abusers for 1985), after treatment, social reintegration was provided through the mosque. In Pakistan, two post-treatment rehabilitation and vocational training programmes were available.
Drug abuse assessment
Australia and New Zealand conducted surveys of drug abuse and collected statistics on drug abuse treatment and drug-related medical emergencies and deaths. In Australia, some states, particularly those that operated methadone maintenance programmes, kept registers of known drug abusers. Papua New Guinea maintained a central register of known drug abusers.
Prevention
In Australia, prevention programmes were carried out at national or regional levels for specific groups and for the general population. New or expanded programmes focused on promoting awareness and providing training for health workers. The awareness campaigns were aimed at reducing the demand for benzodiazepines, tranquillizers and other depressants. Special educational programmes had been carried out in areas in which the abuse of volatile solvents was increasing. In New Zealand, the Department of Education carried out drug education programmes in primary and secondary schools. The programmes also dealt with problems of alcohol and tobacco consumption.
Treatment, rehabilitation and social reintegration
In Australia, as part of a national campaign against drug abuse, facilities for the treatment of heroin abusers had been expanded and the number of places in the methadone maintenance programmes increased; further increases were envisaged. Social reintegration and vocational training assistance was provided by voluntary community groups, religious groups, employment services, self-help organizations, community health centres and psychiatric hospitals. In New Zealand, clinics, religious groups and the private sector provided abusers with treatment, as well as rehabilitation and social reintegration services.
"Review of drug abuse and measures to reduce illicit demand", report of the Secretary-General (E/CN.7/1987/9), pp. 3-22.
002"Report of the Commission on Narcotic Drugs at its thirty-second session" (Official Records of the Economic and Social Council, 1987) (E/1987/17-E/CN.7/1987/18), pp. 26-31.
