Issue #33 March 2024
[This issue includes a modified and updated excerpt from “Buzz Kill: The Corporatization of Cannabis”. NOW AVAILABLE at https://blackrosebooks.com/products/buzz-kill-michael-r-devillaer or at your local independent bookstore. They could really use the support.
“I don’t have a drinking problem, except when I can’t get a drink.”
– Tom Waits
In the previous issue, I wrote about some of the history and challenges of collecting information on drug problems from those who attend drug treatment programs, and on what that picture looks like. In this issue, I write about one type of drug problem – dependence.
Drug problems can manifest in a variety of ways. Dependence is one way and has also been referred to as addiction. I have seen passion-infused proclamations that insist there is a difference. But those typically come from people who are more comfortable with being “dependent” than with being “addicted”. It’s understandable. The word addiction comes with a heap of stigma. Who wouldn’t want to avoid it? I try to avoid using it in my writing these days. That’s a big change from just a few years ago when its use was common – even among those with nothing but the best of intentions. Language is subject to the dictates of fashion. We should all avoid being sanctimonious about the language we use and expect of others. The politically correct language of today may be denounced as the language of oppression only a few years later.
Regardless of what we call it, the essence is a compulsion to continue using a drug, even in the face of harmful consequences, and an inability and/or an unwillingness to change that. A definition that has been proposed by the World Health Organization introduces another element:
…a cluster of physiological, behavioural, and cognitive phenomena in which the use of a substance takes on a much higher priority for a given individual than other behaviours that once had greater value….
The emphasis on a change in a person’s priorities is one that will be sadly appreciated by anyone who has witnessed a family member or close acquaintance on the journey from occasional use of a drug to seemingly helpless dependence.
Dependence typically arises from daily or near daily use of a drug. That will increase the risk of health and/or social problems. This is particularly true for drugs like alcohol, tobacco, cannabis, opioids, or stimulants. I can imagine some eye-rolling occurring with the inclusion of cannabis on that list. But remember that I am not talking about occasional use, but daily use.
While daily use and dependence tend to increase the risk of social or health problems, there are certainly exceptions. Someone who uses nicotine patches as a harm reduction alternative to smoking cigarettes can prevent the adverse health consequences of chronically filling one’s lungs with tar & carcinogenic chemicals. That’s a good thing. But the person is still very much dependent on nicotine. The advantage of a methadone maintenance program is to allow someone to function safely and productively in their daily lives without impairment. But the person is still very much opioid dependent. I once advised that a single small glass of wine with dinner each night, while being habitual, was probably not harmful. Canada’s 2023 Low-risk Drinking Guidelines (discussed in Issue #28 – Higher Risk Drug Use) included the results of more recent research. Those results compel us to reconsider that advice.
One caveat about problem-free dependence is that if one ever needs to completely curtail use of the drug, the withdrawal experience can be a very unpleasant one, lasting from days to weeks. In some cases, involving alcohol or opioids, withdrawal for health-compromised individuals can be fatal without monitoring and proper care.
So, how common is drug dependence? We can use The Canadian Tobacco and Nicotine Survey (CTNS) of Canadians aged fifteen and over to provide estimates. Using the criterion of daily cigarette smoking and daily vaping of nicotine (and removing those who do both to avoid double-counting) provides an approximate estimate of 10.6% for dependence on nicotine. The estimate would be only negligibly higher if other sources of nicotine (cigars, pipes, chew, water-pipes) were included. CTNS also provides an estimate of 6.2% who use alcohol daily, and of 3.5% for daily cannabis use. The prevalence of use of other drug types is too low to allow statistically reliable estimates of dependence.
So, the prevalence of drug dependence in Canada is highest for tobacco and alcohol – our two legacy legal drugs. Cannabis, the new legally commercialized drug on the block, may be poised to catch up. Future surveys are poised to watch.
In the last several issues of this newsletter, I have covered the stages of initial drug use, continued use, higher risk use, and the development of problems, including dependence. These stages do not necessarily occur in a linear, one directional process. The world is not that simple. Once past initial use, people can move back and forth among occasional, daily, high risk, and problem use over time. Even after success in a treatment program, relapse to problem use is common. Another complication is that a person who uses multiple drug types can be at a different stage for each one. In an admittedly extreme example, a person could be:
- dependent upon tobacco and experiencing adverse health effects from smoking
- a daily user of alcohol, engaging in higher risk drinking, but without having experienced any harms (yet)
- a daily or almost daily user of small amounts of cannabis edibles, and not engaging in other higher risk use of cannabis
- an occasional user of magic mushrooms
All those drug use patterns could be in play when the person tries cocaine for the first time.
Yes, complicated. Such complicated cases regularly appear at specialized addiction treatment programs. Counsellors have seen it all. Dependence is only one of the many manifestations of drug use and problems.
The creation of dependence is the ultimate goal of drug industries – with alarming indifference to its harms. With few exceptions (low alcohol beer), they rarely willingly bring lower concentration drug products to market. Tobacco companies did so only under duress and skillfully managed to compromise the effectiveness of those products. Drug industries tend to push for higher concentration products. We are seeing an example now as cannabis lobbyists in Canada are pushing government for the right to bring products with higher THC concentrations to market.
In his 1996 book “Smokescreen”, Philip Hilts describes how teams of molecular biology researchers employed by tobacco companies worked for decades on innovating the modern cigarette as an optimum nicotine delivery device – designed to create dependence as quickly as possible, and to assuredly sustain that dependence.
Large cannabis companies also employ molecular biology researchers. What might they be getting up to? After British American Tobacco (BAT) became the largest shareholder at Canadian cannabis producer Organigram, BATs Director of Scientific Research, David O’Reilly, had this to say: “This move takes us into a new space and we are not ruling out any product innovation”.
One thing is for certain. Organigram’s marketing department will not call it addiction. Product devotion might fly.
Mike DeVillaer
Hamilton Ontario Canada
March 19 2024