Nonmedical Drug Use

Drug Use, Nonmedical

Although drug use generally refers to the nonmedical use of psychotropic (mind-affecting) drugs - eg, cannabis (marijuana and hashish) - opiate narcotics (eg, heroin and morphine), amphetamines, cocaine, hallucinogens (eg, LSD, psilocybin and mescaline) and volatile solvents (including certain fast-drying glues, fingernail-polish removers and petroleum products), most drug-related problems in Canada derive from use of alcohol and tobacco. While some of these drugs have legitimate medical uses, their social use is generally considered potentially physically or psychologically harmful. Volatile solvents, alcohol and tobacco are readily available, but the importation, production, sale and in most cases possession of the other drugs are criminally prohibited - except for very narrow medical functions.

History

Prior to this century, the use of psychotropic drugs was not considered a serious social problem and was not a criminal offence - even though more Canadians were dependent on opiates at the turn of the century than at any time before or since. Canada's decision in 1908 to prohibit under criminal law the importation, manufacture and sale of opium (it was the first Western nation to do so) was inspired more, as were related statutes, by racial prejudice (particularly against Asians) and moralistic fervour than by any scientific knowledge.

Until the 1960s, addiction to opiates, particularly heroin, was the greatest social concern. While other nations, such as the UK, experimented with medical management and maintenance programs, Canada relied almost exclusively on increasingly punitive applications of the criminal law. As a result of zealous law-enforcement efforts and the elimination of licit sources of supply or avenues of therapeutic assistance, most morphine and heroin dependants were forced into subcultural ghettos, where they became the very kind of criminally involved persons who advocates of the criminal-law solution had always maintained they were. This situation has changed little. For at least 40 years heroin "addicts" have represented the stereotypical horrors of drug abuse in the public imagination, with "crack addicts" (obsessive users of a smokeable form of free base cocaine) sharing this notoriety from the mid-1980s. With heroin dependants, only a relatively small part of their plight derives directly from the chemical properties of the drug. It is the official response to this problem which drives these dependants to commit crimes to purchase drugs at grossly inflated prices.

In the 1960s concern about heroin was eclipsed by that about the consumption of cannabis, amphetamines and hallucinogens. The use of many of the hallucinogens, especially LSD, was relatively new, but small groups had been inconspicuously indulging in many of these drugs in most Canadian urban centres for at least a decade before the public noticed. While Parliament had incorporated most of these drugs into existing criminal statutes (and added the newer ones as soon as their chemical composition could be identified), the sudden public and media attention was undoubtedly caused by the ostentatious use of these drugs by middle-class youths who affected an apparently alien lifestyle associated with the hippie movement. Unlike heroin dependants, a largely invisible presence, marijuana, hashish and LSD users were increasingly vocal about their indulgences. Many openly championed what they perceived to be the beneficial attributes of recreational drug use and crusaded for legislative reform. By 1969 the number of persons charged with cannabis offences, almost negligible at the beginning of that decade, has risen to 5000, and by 1977 the annual figure had swollen to a relatively constant 50 000. Current annual charges for cannabis offences are closer to 30 000, but this is more reflective of changes in enforcement practice than levels of use.

In 1969 the federal government appointed a royal commission to investigate the problem of the nonmedical use of drugs. In a series of internationally respected reports published over 4 years, the inquiry generally recommended a gradual withdrawal of the use of the criminal law against nonmedical users of drugs. None of the inquiry's specific legal recommendations have yet been implemented in Canada.

Epidemiology

The incidence of regular use of illicit drugs appears to have generally stabilized or declined between the mid-1970s and the early 1990s. At least 5 million Canadians have tried cannabis (marijuana or hashish) at least once during their lives, and over 1 million have done so during each of the past several years. This use, like all unprescribed drug consumption, tends to be concentrated among adolescents and adults under 35 years of age.

National survey data for 1993 indicate that most marijuana and hashish users are relatively infrequent consumers; only 10% indulge at least once a week, while just over half use these drugs less than once a month. However, estimates of the prevalence and incidence of illicit drug use are often unreliable and tend to underestimate the dimensions of the phenomenon. For example, reputable studies in Ontario reported that 10.5% of adults aged 18 years and over used marijuana in 1989 and 1991, while national surveys in 1990 and 1993 indicated that the use of the same drugs among persons in Ontario age 15 or older in 1989 was 5.9%, and 4% and 3.6% in 1990 and 1993 respectively.

Adolescent Use of Drugs

Provincial surveys of high-school students have tended to indicate relatively constant or moderately declining levels of use of most drugs, including alcohol and tobacco, over the past decade. Statistical evidence suggests that, apart from cannabis, the adolescent consumption of illicit drugs is a generally infrequent phenomenon indulged in by a very small proportion. Anecdotal evidence strongly hints at increased use of marijuana and some psychedelic drugs, including LSD and ecstasy (MDMA), among pockets of Canadian adolescents and young adults in the early and mid-1990s. Renewed pressure for cannabis decriminalization, a renaissance of head shops (drug paraphernalia stores) and raves (psychedelically fuelled parties), and renewed interest in clothing and other products manufactured from hemp reinforce this widely shared impression.

The annual use of illicit drugs other than cannabis is reported to be 0.3% in 1993. However, survey data alone cannot capture the magnitude of use of such drugs, as users tend to be concentrated in populations that are likely to be underrepresented in random surveys. Surveys aside, there were undoubtedly explosions of crack use in some Canadian communities in the mid-1980s; the incidence of crack use appears to have been lower than in parts of the United States and has likely declined since this decade began.

Heroin use is the most difficult form of drug consumption to measure reliably. While the dependant population is usually estimated to be between 10 000 and 15 000 nationally, public health observers and media accounts suggest a burgeoning population of users, if not dependants, in such traditional centres of use as Vancouver and Toronto in the mid-1990s.

Alcohol Use

Approximately 75% of Canadians drink alcohol. Only about 10% of these are daily imbibers, approximately the same proportion who report a problem with their drinking. About a half-million Canadians are estimated to be alcoholics. The prevalence of cigarette smoking among Canadians has declined from 50% in 1965 to 31% in 1994, with the highest rates of use (30%) among those aged 20 to 24. National 1993 survey data indicate relatively low prevalence in the use of function-specific mood modifiers. Stimulants (amphetamines and other diet pills) were consumed by less than 1% of the Canadian adult population, sleeping pills and tranquillizers, chiefly prescribed, by about 4%, codeine or demerol by approximately 8%, and antidepressants by 2.5%.

Injected Drug Use and HIV

Approximately 100 000 Canadian drug users are estimated to at least occasionally inject drugs. Those who do risk contracting HIV, and consequently AIDS, if they share contaminated needles or some other paraphernalia. Heroin is traditionally administered by injection, but cocaine, anabolic steroids and some other drugs may also be used in this fashion. In 1994, HIV infection rates among injection drug users were reported to be 6% in British Columbia, 7.6% in Toronto and between 10% and 20% (depending on testing site) in Montréal. The HIV infection rate reported in 1993 among inmates in correctional institutions was approximately 10 times that in the general public, with the highest rates of prisoner infection being among those with a history of injection drug use.

Drug Trade

Apart from some insignificant hallucinogen manufacturing and the diversion of pharmaceuticals from their licit channels of distribution, Canada is not known historically as a source for illicit drugs. However, horticultural refinements and hydroponic technology have led to dramatically increased cultivation of potent strains of marijuana since the mid-1980s. A substantial portion of this production is now exported to American markets, especially from British Columbia. Only 5-10% of the drugs imported into Canada each year are intercepted. International efforts to stem the drug trade have proven equally ineffective but have contributed to a continual inflation of the price of drugs without any apparent abatement of demand. Financially, the drug trade has become the most attractive and corruptive criminal enterprise in the world.

Social Policy

Some policy makers have recommended a strategy specifically directed at the health and safety hazards associated with each drug, including alcohol and tobacco, based on a scientific appraisal of drug-related risks and a commitment to harm reduction as the primary social goal. The near-perennial national debates about cannabis reform and heroin maintenance are 2 examples of this possible reorientation.