Issue #24 June 2023
[This is a modified excerpt from “Buzz Kill: The Corporatization of Cannabis”. https://blackrosebooks.com/products/buzz-kill-michael-r-devillaer]
So, here’s the thing – people want to use drugs, and they take their drugs seriously. Some people’s quality of life, and even their lives, depend upon specific drug products from pharmaceutical companies. The recreational use of legal drugs, such as alcohol, tobacco, caffeine, and cannabis, is not life saving, but their use is still important to people. In Canada, producers, distributors, and retailers of alcohol and cannabis were widely protected as “essential services” during the COVID-19 pandemic – just as important as food supplies. I recall a discussion on alcohol policy just a few years ago in which Catherine Zahn, CEO of The Centre for Addiction and Mental Health (CAMH) at the time, exclaimed “There are no beer emergencies.” I agree. Apparently, Canada’s provincial governments do not. In 2021, Zahn stepped down from CAMH to become the Deputy Minister of Health for Ontario. Beer and liquor stores in Ontario remained anointed as essential services.
People who use illegal drugs are also very serious about it, and well organized. They have formed not-for-profit organizations with formal memberships. They fund-raise, they stimulate discussion among the public, and lobby the government for legislative reform. Some of these organizations have a President, a Board of directors, and written constitutions and bylaws. They maintain websites where they cite articles from academic journals to support their cause. Consider the Canadian Association of People Who Use Drugs (http://capud.ca/). Then consider The International Network of People Who Use Drugs (https://www.inpud.net/) with dozens of regional and national affiliates. #PWUD has become a widely recognized acronym and hashtag on social media. I admire these organizations. Not because their members use drugs—anyone can do that. It is their untiring, lived experience commitment to a compassionate rather than punitive approach to drug policy that is praise-worthy. This is a concept that continues to elude many leaders in almost all nations. One aspect of the plight of these groups raises an interesting contradiction. They resent that government-imposed laws threaten their personal control over their bodies. But those who are drug-dependent, perhaps for reasons beyond their control, have already surrendered control of their bodies to one or more types of drugs. It is important to recognize that this surrender is cultivated, at least in part, by the people who manufacture and sell drugs legally and illegally.
So, why do people use drugs? The question is asked by students working on a class project and by academics devoting their careers to the pursuit of the elusive answer. This seemingly simple question has been discussed and disputed, sometimes fiercely, for many decades. It has been addressed in an unimaginable number of books, movies, documentaries, interviews, reports from health authorities, journal articles, lectures, debates, and seminars. The ubiquity of the question continues with its presence on websites, podcasts, blogs, social media posts, as well as in many substance-fueled pub discussions. I will attempt only a summary of the predominant views.
Across centuries and continents, we have used drugs to rid ourselves of illness and other discomforts, or to make them and injuries easier to endure. We use drugs to alleviate or prevent a wide variety of unwanted physical and psychological sensations. Simply put, drugs can make us feel better, or at least less miserable for a while.
We have also shown a persistent curiosity for using drugs to amuse ourselves—essentially, by playing with our body chemistry. This is what we now colloquially call recreational use.
To do it justice, the answer to the question of why people use drugs must be broken down into three sequential stages: initial use, occasional use, and daily or almost daily use. The potential for entering a fourth category—high-risk use; and a fifth category– problem use, exists at all three sequential stages. However, the likelihood of engaging in high-risk use or problem use would tend to increase as one moves from initial use to daily use.
Before describing each of these categories of drug use, it is important to appreciate that they are not distinct categories. Rather, they represent sequential stages along a spectrum of drug use, with only vaguely defined separation points. Any attempt to quantifiably distinguish the sequential stages from each other is somewhat arbitrary. The anchors used for each stage give only an approximate appreciation for the differences in drug use along the spectrum from initial use, through occasional use, to daily or almost daily use.
Given that drug use and associated problems comprise such a complex phenomenon, we must draw upon several data types or indicators:
- drug use
- high-risk drug use
- harm from drug use (morbidity)
- drug dependence (addiction)
- death from drug use (mortality)
- drug-related costs to the economy.
An additional overarching concept is that the transition from use of a drug to higher risk use can be mediated by three aspects of use: frequency of use, quantity of use, and circumstances of use. Using a drug every day (frequency) presents an increased risk for dependence and harm. Using high amounts of a drug (quantity) either at once or continually over time, increases the likelihood of biomedical trauma. Using a drug just before driving is a high-risk circumstance for harm. I will give more attention to each of these aspects as I explore the stages and types of use and harm in subsequent issues of this newsletter.
Hamilton Ontario Canada
June 23 2023