PET scans of brains
Although different drugs have different effects they often affect the same part of the brain. Brain scans of drug users show that almost every drug triggers activity in the nucleus accumbems, a part of the brain where neural pathways from all over the body come together.

Recreational drugs are much more powerful than natural highs produced by chemicals in the brain and body. One dose of cocaine releases two to ten times the amount of dopamine produced by a natural stimulus such as favorite meal or song.

In a study by a team led by Prof. David Nutt of Britain’s Bristol University published in the British medical journal Lancet, alcohol and tobacco were ranked as worse than cannabis and ecstasy using a ranking system that took into consideration physical harms caused by a substance, the potential for addiction and cost to society from its use. In the study heroin and cocaine ranked as the most dangerous drugs followed by barbiturates and street methadone, Alcohol was listed as the fifth most harmful drug with tobacco coming in ninth. Cannabis was 11th.

Books: “Buzzed” by Cynthia Kuhn Ph.D. Scott Swartzwelder, Ph.D., Wilkie Wilson Ph.D. of the Duke University Medical Center (Norton, 2003); “Consuming Habits: Drugs in Anthropology and History” by Goodman, Sharratt and Lovejoy; “Drug War Heresies: Learning from Other Vices, Times and Places” by Robert MacCoun and Peter Reuter (Cambridge University Press).

Websites and Resources: U.S. Drug Enforcement Administration (DEA) ; Vaults of Erowid ; United Nations Office of Drugs and Crime (UNODC) ; Wikipedia article on illegal drug trade Wikipedia ; Frank’s A-to-Z on Drugs ; ; Illegal Drugs, country by country listing, CIA

Fentanyl Becomes More Dangerous Than Heroin

According to the World Drug Report 2018: “The non-medical use of prescription drugs is becoming a major threat to public health and law enforcement worldwide with opioids causing the most harm and accounting for 76 per cent of deaths where drug use disorders were implicated, according to the latest Fentanyl and its analogues remain a problem in North America, while tramadol — an opioid used to treat moderate and moderate-to-severe pain — has become a growing concern in parts of Africa and Asia. Accessibility of fentanyl and tramadol for medical use is vital for treating pain, but traffickers manufacture them illicitly and promote them in illegal markets causing considerable harm to health. [Source: World Drug Report 2018,United Nations Office on Drugs and Crime (UNODC), June 26, 2018]

Global cocaine manufacture in 2016 reached the highest level ever reported, with an estimated 1,410 tons being produced. Most of the world's cocaine comes from Colombia while the Report also showed that Africa and Asia are emerging as cocaine trafficking and consumption hubs. From 2016-2017, global opium production jumped by 65 per cent to 10,500 tons, the highest estimate recorded by UNODC since it started monitoring global opium production at the start of the twenty-first century. A marked increase in opium poppy cultivation and gradually improving yields in Afghanistan resulted in opium production there last year reaching 9,000 tons.

Cannabis was the most widely consumed drug in 2016, with 192 million people using it at least once during the previous year. The global number of cannabis users continues to rise and appears to have increased by roughly 16 per cent in the decade to 2016, reflecting a similar increase in the world population.

Drugs such as heroin and cocaine that have been available for a long time increasingly coexist with new psychoactive substances (NPS) and prescription drugs. A growing stream of pharmaceutical preparations of unclear origin destined for non-medical use, together with poly drug use and poly drug trafficking, is adding unprecedented levels of complexity to the drug problem.

According to the United Nations annual report on drugs, issued in June 2009, global use of heroin, cocaine and cannabis all fell in 2008 while production of stimulants — namely methamphetamines and ecstasy — rose. In 2009, the Economist magazine reckoned that the production of cocaine and heroin was roughly the same as it was a decade earlier but the production of cannabis had increased.

Drug Users

It is said people drink alcohol to have a good time; smoke marijuana to relax; take stimulants to stay away; take sedatives to sleep; and experiment with hallucinogens to expand their mind. An estimated 200 million people, or about 5 percent of the world’s population, took illegal drugs worldwide in the late 2000s. This is roughly the same proportion as a decade earlier.

People everywhere, in rich countries and poor countries, take recreational drugs. While the vast majority of users take these drugs without harming anyone or themselves too much, so people abused them and become dependent on them and sometimes seriously hurt themselves and others. Drug researcher Valerie Curran of University College London told the Times of London, “Drug use is almost normative nowadays in the 18-30 age group. Most will take drugs for a while and come through at the end and have no problems. They are a different population to drug addicts. We should accept that people are going to take drugs and say: ‘Here is the science. Here is the risk-benefit profile. It’s your informed choice.’”

According to the World Drug Report 2018: “The number of people worldwide using drugs at least once a year remained stable in 2016 with around 275 million people, or roughly 5.6 per cent of the global population aged 15-64 years. Cannabis is a common drug of choice for young people. However, drug use among young people differs from country to country and depends on the social and economic circumstances of those involved. There are two extreme typologies of drug use among young people: club drugs in nightlife and recreational settings among affluent youth; and use of inhalants among street children to cope with their difficult circumstances. [Source: World Drug Report 2018,United Nations Office on Drugs and Crime (UNODC), June 26, 2018]

Harm Caused by Drugs table

Looking at vulnerabilities of various age groups, the Report finds that drug use and the associated harm are the highest among young people compared to older people. Most research suggests that early (12-14 years) to late (15-17 years) adolescence is a critical risk period for the initiation of substance use and may peak among young people (aged 18-25 years).

Drug use among the older generation (aged 40 years and older) has been increasing at a faster rate than among those who are younger. This, although there is only limited data available, requires attention, the Report finds. People who went through adolescence at a time when drugs were popular and widely available are more likely to have tried drugs and, possibly, to have continued using them. Older drug users may often have multiple physical and mental health problems, making effective drug treatment more challenging, yet little attention has been paid to drug use disorders among older people.

Globally, deaths directly caused by the use of drugs increased by 60 per cent from 2000 to 2015. People over the age of 50 accounted for 27 per cent of these deaths in 2000, but this had risen to 39 per cent in 2015. About three quarters of deaths from drug use disorders among those aged 50 and older are among the ageing cohort of opioid users.

The majority of people who use drugs are men, but women have specific drug use patterns, the Report finds. The prevalence of non-medical use of opioids and tranquillizers by women remains at a comparable level to that of men, if not actually higher. While women may typically begin using substances later than men, once they have initiated substance use, women tend to increase their rate of consumption of alcohol, cannabis, cocaine and opioids more rapidly than men as well as rapidly develop drug use disorders.

Women with substance use disorders are reported to have high rates of post-traumatic stress disorder and may also have experienced childhood adversity such as physical neglect, abuse or sexual abuse. Women continue to account for only one in five people in treatment. The proportion of females in treatment tends to be higher for tranquillizers and sedatives than for other substances. Drug use treatment and HIV prevention, treatment and care should be tailored to the specific needs of women.

Illegal Drug Business

According to Europol: Drug trafficking is big business, bringing in a fifth of all profits from organised crime. The market for synthetic drugs runs into the billions of euros each year and the sophistication of producers and traffickers continues to rise. Over the last decade, illegal online markets have changed how drugs are bought and sold. Criminal activity on the Darknet has become more innovative and more difficult to predict. Darknet markets provide a largely anonymous platform for trading in a range of illicit goods and services. It is estimated that around two thirds of the offers on Darknet markets are drug-related. [Source: Europol, June 28, 2018]

The annual global turnover from the illegal drug trade is estimated to be between $400 billion and $500 billion. This sum is larger than the individual gross national products of nearly 90 percent of the world’s countries. If alcohol is included it is estimated that the recreational drug market may be worth $2 trillion or more a year. [Source: The Economist]

According to the Economist, "The drug industry is simple and profitable. Its simplicity makes it relatively easy to organize; its profitability makes it hard to stop. At every level, its pricing and structure are shaped by the high level of risk from enforcement: the risk of seizure and jail." With the large profits involved, some drug experts assert that the drug problem is "insoluble." Otherwise drugs are a business like most others: It requires capital, raw materials, reliable supplies, manufacturing, shipping, contractors, distributers, wholesalers, retailers and marketing. A particular emphasis is put on transportation, often the most risky and profitable part of the business. Much of the marketing is done by the retailers (the dealers).

"The price of illegal substances is determined more by the cost of distribution than by production. The mark-up of cocaine from the time farmers are paid for their coca leaves to the time cocaine is sold on the street is a hundred fold. The street price is generally set by risks on smuggling the drugs into consumer countries not prices in places where they are produced. The large gap between the cost of production and the price than consumers pay means that a lot of people along the production, trade and distribution chain get rich but they usually don't include the farmers.

Money spent in the United States on drugs in 1994: 1) $44 billion on marijuana; 2) $18 billion on cocaine; 3) $4 billion on heroin.

Regionalism and the Illegal Drug Business

As is true with terrorism, the drug production business thrives in places where the rule of law is weak, such as the outlying provinces of Afghanistan, Myanmar and Laos and rebel controlled territories in Columbia.

Matthew Brezinski wrote in the New York Times magazine: “The narcotics industry has adapted what may be called the Osama bin Laden approach to management: base your operation in a remote safe haven, the more war torn and chaotic the better; stay small and shifty; use specialized subcontractors or freelancers on a need-to-know basis; vary your routes and routines; and most importantly always insulate yourself with expendable intermediaries in case someone gets caught and talks.”

Immigrants often run the drug businesses in Europe and North America. They often have ties to the producers into their home countries, have a strong loyalty to members of their group and speak languages local police can’t understand.

The drug business is getting more efficient. This is reflected by the reduction in prices. On the street dealers are using techniques like micro branding: producing specific good for particularly niches. In New York, for example, dealers sell heroin in vials with color-coded plastic caps that indicate their purity, place of origin and price. An effort has also been made to make drugs affordable. Doses large enough to give people a good buzz often sell for as little as $20.


20120527-380px-Rational_scale_to_assess_the_harm_of_drugs_(mean_physical_harm_and_mean_dependence).svg.png Heroin, cocaine, amphetamines, alcohol and nicotine are regarded as the five drugs hardest to give up. As of the late 2000s, 22 million Americans were hooked on at least one of these substances.

Drug-taking usually begins with a person taking the drug to get high. When addiction sets in the drug is taken just to feel normal. When addiction really takes hold consumption of the drug becomes instinctive, more important than food and more urgent and destructive and people need to take it to avoid pain and withdrawal.

Only about one in ten people that try an addictive drug actually become hooked on it. Geneticists have found gene variants that predispose people to addictions and that people vary in their innate sensitivity to dopamine. This partly explains why addiction seems to run in families. A gene that codes for a dopamine receptor designated D1 comes in several different types and concentrations of receptors. People with fewer receptors may receive less natural stimulation from dopamine and may feel a need to seek artificial highs from drugs.

For more detailed information see Heroin, Cocaine and Amphetamines

Addiction Versus Tolerance and Dependence

Long-term use of prescription opioids, even as prescribed by a doctor, can cause some people to develop a tolerance, which means that they need higher and/or more frequent doses of the drug to get the desired effects. Drug dependence occurs with repeated use, causing the neurons to adapt so they only function normally in the presence of the drug. The absence of the drug causes several physiological reactions, ranging from mild in the case of caffeine, to potentially life-threatening, such as with heroin. Some chronic pain patients are dependent on opioids and require medical support to stop taking the drug. Drug addiction is a chronic disease characterized by compulsive, or uncontrollable, drug seeking and use despite harmful consequences and long-lasting changes in the brain. The changes can result in harmful behaviors by those who misuse drugs, whether prescription or illicit drugs. [Source: National Institute on Drug Abuse, National Institutes of Health, U.S. Department of Health and Human Services, June 2018]

According to PBS: The mechanism of addiction is still not fully understood. Generally speaking, addiction is a socially-derived word that refers to a person's compulsive use of a drug in spite of being harmed by it. Dependence and tolerance are conditions that can lead to addiction.“Dependence occurs when, after a constant supply of the opiate, the brain shows adaptation, or a change in its circuitry. When that drug is taken away, neurons that have long been inhibited start pumping out neurotransmitters again. This imbalance of chemicals in the brain interacts with the nervous system to produce the classic opiate withdrawal symptoms: nausea, muscle spasms, cramps, anxiety, fever, diarrhea. [Source: PBS, WGBH, Frontline 1998]

“Tolerance, another poorly understood phenomenon, describes the need for a drug user to administer larger and larger doses of the drug to achieve the same psychoactive effect. A general hypothesis says that when the body's chemical equilibrium is upset, as in habitual drug-taking, the body sets up oppositional processes to restore itself. More of the drug is needed to overcome these efficient corrective processes. Tolerance occurs with regular use of almost all psychoactive drugs."

Addiction Treatments

Researchers are increasingly looking upon addiction as a disease that can be cured with medicine. Seeking treatments that fiddle with the dopamine system are dangerous in that dopamine is also vital to voluntary movement and messing with that can can cause symptoms resembling Parkinson’s disease.

Vigabatrin is a drug that stimulates the production of Gamma-aminobutyric acid, or GABA, a neurotransmitter that has an inhibitory effect on neurons. In one study, 30 percent of the cocaine addicts that took it were able to stay off the drug, compared to just 5 percent in a control group. What was perhaps most remarkable about the treatment was that it was effective with people written off as hopeless addicts.

Camparal is drug that has been on the market for a while as a treatment for alcoholism. It suppresses the brain chemical glutamate which is linked to cravings for drugs.

Researchers are trying to develop a vaccine that would prevent drug users from getting high. An experimental cocaine vaccine is made of cocaine molecules attached to cholera-causing bacteria, which causes the immune system to respond by creating cocaine antibodies. If cocaine enters the body antibodies will bond to it preventing it from passing to the brain and triggering a buzz. Such a vaccine is already being studied under its first wave of large-scale clinical human trials. The same strategy is being used to develop vaccines for nicotine, heroin and methamphetamines.

For more detailed information see Heroin, Cocaine and Amphetamines

Combating Drug Supply

Increased border and immigration security and the fight against terrorism since September 11th has made it tough for drug smugglers. Even so, most of the U.S. government's efforts to combat the supply of drugs has had little effect other than relocating and reorganizing production.

Heroin World

Most programs combating the drug supply are doomed because drugs are simply too profitable and there is not enough manpower or cover the vast areas where drugs are produced. With the wholesale price being so high, distributors can easily afford to pay growers more money if necessary without profits being affected too much. If authorities crack down in one place, distributors can use growers in other areas where are authorities not present. Local people are often reluctant to cooperate with anti-drug authorities operating in their area and often openly hostile to them for threatening their livelihoods.

Schemes to introduce other crops always have to address the problem that growers earn so much more growing drug-yielding plants than they can growing food or fiber crops.

The huge profits in the drug business provide money for huge slush funds used to bribe customs officers, policemen and other officials. Those that are bided usually have few other options. Either they accept the money or suffer retribution to themselves of their families.

Drug Laws

In February 1909, the first ever international meeting to ban the trade of narcotics was held in Shanghai. Foreign diplomats that attended agreed to set up the International Opium Commission.

In 1988, the United Nations General Assembly committed member nations to achieving a “drug-free world” and to “eliminating or significantly reducing” the production if opium, cocaine and cannabis by 2008.

In March 2009, ministers from around the world gathered in Vienna to shape international drug policy for the 2010s.

20120527-Alcohol DemonRumLeadsToHeroin.jpg
Demon Rum Leads to Heroin

The United States alone has spent $40 billion each year on trying to crack down on the drug trade. More than 1.3 million people are arrested each year on drug charges and a half million are put behind bars.

Drug Legalization

One of the must public advocates of drug legalization is The Economist magazine. In a 2009 article it called the 100-year war on drugs “illiberal, murderous and pointless... by any sensible measure,” adding the “least bad policy is to legalize drugs.” “Least bad” does not mean good. Legalization though clearly better for producer countries, would bring (different) risks to consumer countries...Many vulnerable drug-takers will suffer. But in our view, more would gain...There is no correlation between the harshness of drug laws and the incidence of drug-taking. Citizens living under tough regimes (notably the United States but also Britain ) take more drugs not fewer.”

“Imprisoning addicts and drug offenders takes up a lot of resources and it doesn’t accomplis much as the same drug offenders often appear again and again in courts and prisons. Drug seizures may drive up the price and reduce the purity but this does not seem to have much impact on drug use. The drug market quickly adapts to make up for disruptions. Effective crackdowns on production in one place simply force a shift to a new place. The current system doesn’t deter organized crime rather it provides a means for gangsters to earn billion of dollars as they did during prohibition.”

“Legalization,” the Economist article went on, “ would not only drive away the gangsters it would transform drugs from a law-and-order problem into a public health problem, which is how they ought to be treated. Governments would tax and regulate the drug trade, and use the funds raised (and the billions saved on law enforcement) to educate the public about the risks of drug-taking and to treat addiction. The sale of drugs to minors should remain banned. Different drugs would command different levels of of taxation and regulation. This system would be fiddly and imperfect, requiring constant monitoring and hard-to-measure trade offs. Most tax policies ought to be set at a level that would strike a balance between damping down use on one hand , and discouraging black market and desperate acts of theft and prostitution to which addicts now resort to feed their habits.”

anti-alcohol poster

Image Sources: DEA (Drug Enforcement Administration); Wikimedia Commons

Text Sources: 1) “Buzzed, the Straight Facts About the Most Used and Abused Drugs from Alcohol to Ecstasy” by Cynthia Kuhn, Ph.D., Scott Swartzwelder Ph.D., Wilkie Wilson Ph.D., Duke University Medical Center (W.W. Norton, New York, 2003); 2) National Institute on Drug Abuse, National Institutes of Health, U.S. Department of Health and Human Services; 3) United Nations Office on Drugs and Crime (UNODC) and 4) National Geographic, New York Times, Washington Post, Los Angeles Times, Wikipedia, The Independent, Times of London, The New Yorker, Time, Newsweek, Reuters, Associated Press, AFP, , Lonely Planet Guides, and various books and other publications.

Last updated April 2022

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