Drugs, Users and Society Risk Analysis and Risk Management

O
HO
OH
Drugs, Users and Society
Risk Analysis and Risk Management
Drogok, fogyasztók és a társadalom:
kockázatelemzés és kockázatkezelés
Ujv
áry Istv
án
Ujváry
István
Chemical Research Centre
Hungarian Academy of Sciences
istvan@chemres.hu
istvan@chemres.hu
100
0
A Nemzeti Kábí
Kábítószer Adatgyűjtő és Kapcsolattartó Központ
„A Korai Jelzőrendszer szerepe és működése Magyarországon”
Magyarországon”
(The Early Warning System in Hungary)
Hungary)
című rendezvényén elhangzott előadás
Budapest, 2005. március 3.
Medicines,
Medicines, licit
licit and
and illicit
illicit drugs
drugs
MEDICINE:
MEDICINE:
to prevent, alleviate or cure diseases or unwanted health
conditions - maintain health & improve quality of life!
DRUG:
DRUG:
psychoactive chemical substance influencing behavior,
mood, perception and cognition
ILLICIT (narcotic) DRUG*:
psychoactive DRUGs regulated by (inter)national
(inter)national treaties
(UN Conventions 1961, 1971 & 1988)
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„„Sors
Sors bona,
”?
bona, nihil
nihil aliud
aliud”
Alea iacta est.
RISK:
HAZARD
AZARD, we want to avoid.
The possibility of hazard, harm, injury, loss, or
inconvenience caused by an action or undertaking.
The degree of probability of such a peril or loss.
Kockázat,
Kockázat, rizikó, risk
risicare
to dare
merészelni
RISK is a choice rather than a fate.
The actions we dare to take depend on how free we are to make
choices.
choices.
Health
Health consequences
consequences of
of drug
drug use
use
Biological / psychological effects
DESIRED ←→ UNDESIRED
UNDESIRED
to SELF ←→ to OTHERS
Acute
Acute ←→
←→ Chronic
Chronic
Direct ←→ Indirect
2
Risk and Harm of Drug Use by Individuals
H A R M = Harmfulness x Intensity of use x Frequency of use
toxicity
dose
prevalence, popularity
drug
toxicity,
intensity
exposition,
ug_toxicity
y, intens
sity_exposition
sition,, exposition
RiskI = f (dru
dr
toxicit
inten
expo
exposition_frequency)
RISK
RISK
IDENTIFICATION
IDENTIFICATION
RISK
ASSESSMENT
((1)
1)
RISK
RISK
MANAGEMENT
MANAGEMENT
© 1994 by Sydney Harris
3
Risk
Risk analysis
analysis of
of drug
drug use
use
Risk identification
Risk characterization
Risk management
„„hazard”
hazard”
hazard”
„„use”
use”
use”
„„action”
action”
action”
Risk assessment
„„decision”
decision”
decision”
Ujváry I: Hazards and side effects: A risk analysis model of drugs of abuse.
abuse. Magyar Tudomány 110(4),
4404)
440-452 (200
(2004)
Risk
Risk analysis
analysis of
of drug
drug use
use -- The
The details
details
Hazard identification
toxic
colo
toxi
ology data
toxicology
pharma
armac
colo
ata
ph
ology d
ata
pharmacology
data
dependence liability
huma
uman studies*
studies*
occurrence / availability
economic
economic
costs
costs
Risk characterization
Risk management
dose - response relationship
frequency / prevalence of use
“collateral damage”
“unknown” factors
demand reduction
supply reduction
education
international treaties
regulation
Risk assessment
political
political
values
values
ccultural
ultura
ultural
values
values
legal
legal
issues
issues
4
Ranking
cute** toxicit
y
Ranking of
of drugs
drugs according
according to
to their
their aacute
toxicity
(typical
(typical administration)
administration)
metamphetamine
metamphetamine heroin
alcohol
marijuana
GHB
phenobarbit
enobarbital
al
ph
phenobarbital
>100 g
LSD
nicotin
ine
e
nicot
nicotine
flunitrazepam
flunitrazepam
cocain
ine
e
coca
cocaine
codeine
MDMA
((THC)
THC)
THC)
>10 g
methadone
>1 g
>100 mg
moderate
moderate toxicity
toxicity
low toxicity
Typical
fatal dose
>10 mg
high
high toxicity
toxicity
*single substance, single dose
Based on Gable, RS: Comparison of acute lethal toxicity of common abused psychoactive substances.
Addiction 99:686
99:686--696 (2004)
““Safety
Safety M
argin” of
Margin”
of some
some drugs
drugs
“Safety” Margin:
argin:
Therapeutic Index
For example,
“Fatal”
atal” dose
Dose to elicit desired effect
(always
(always >1!)
>1!)
Route of
““SM”
SM”
SM” administration
6
heroin
alcohol
10
10
GHB
metamphetamine
metamphetamine 10
15
cocain
ine
e
coca
cocaine
16
MDMA
LSD
11000
000
>>1000
1000
marijuana
intravenous
oral
oral
oral
Tolerance
e!
Toleranc
Tolerance!
intranasal / smoked
oral
oral
Sensitization!
Sensitization
Sensitization!!
smoked
Gable, RS: Comparison of acute lethal toxicity of common abused psychoactive substances.
Addiction 99:686
99:686--896 (2004)
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Ranking
use / addictive potential
Ranking according
according to
to ab
abuse/addictive
potential**
amph
phetamin
etamine
e ccocaine
am
amphetamine
ocaine
LSD
solvents
caffeine
MDMA??
??
marij
juana alc
cohol
mari
marijuana
al
alcohol
heroin
nic
cotine
ni
otine
nicotine
meth
hadone
met
adone
methadone
temazepa
am
temazep
temazepam
moderately
ddictive
moderately aaddictive
lightly addictive
highly
dictive
ad
highly addictive
addictive
*based on animal experiments, as well as
on human withdrawal symptoms, tolerance and epidemiological studies
Goldstein, A & Kalant, H: Drug policy: striking the right balance. Science 249:1513
249:1513--1521 (1990)
Henningfield, J.E. & Benowitz, N.L.: personal communication for The New York Times (1994)
The Royal College of Psychiatrists:
Psychiatrists: Drugs: Dilemmas and Choices (2000)
Dependence potential and acute toxic effect of drugs
Severe risk of fatality
opium
alcohol
heroin
morphine
MDMA
amphetamines
mescaline
N2O
secobarbital
ketamine
cocaine
PCP
nicotine
caffeine
Very low
dependence potential
LSD
methaqualone
methaqualone
Very high
dependence potential
Chronic
Chronic
adverse
adverse effects
effects
??
diazepam
marijuana
psilocybin
injected
oral
inhaled
Neglibile risk of fatality
Based on:
on: Gable, RS: Am J Drug Alcohol Abuse 19:
19:263263-281 (1993)
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3D
3D surface
surface SPECT
SPECT image
image of
of the
the brain
brain of
of
abstinent
and
m
ari
j
u
ana
smoker
(chronic
effect)
abstinent and marijuana smoker (chronic effect)
normal brain
underside surface view
brain of 18 y/o, 4 x week for 3 years
underside surface view
Gutta cavat lapidem.
Amen DG, http://www.brainplace.com
http://www.brainplace.com
Risk and Harm of Drug Use by Individuals in Society
H A R M = Harmfulness x Intensity of use x Prevalence
toxicity
dose, frequency
frequency, popularity
drug
toxicity,
intensity
exposition,
ug_toxicity
y, intens
sity_exposition
sition,, exposition
RiskI = f (dru
dr
toxicit
inten
expo
exposition_frequency)
((1)
1)
Total HarmS = f (user’
’s_harm,
user
harm, exposition
exposition_frequency,
frequency, number_of_users) (2)
user’s
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Life
time prevalence
Lifetime
prevalence of
of drug
drug use
use in
in Hungary
Hungary**,,##
91.1
Alcohol
73.3
Smoking
Marijuana
14.1
5.7
4.2
2.0
3.5
1.6
4.3
1.6
1.1
0.8
3.2
0.7
4.7
0.6
3.4
0.5
Ecstasy
Amphetamine
LSD
Cocaine
Opiates
Inhalants
Other drugs
0
9-10. grade students*
Adults (18-65)#
% of
respondents
10
20
30
40
50
60
* Elekes Zs. & Paksi B.: Drogok és fiatalok (2002);
2002);
70
80
90
100
#
Paksi
Paksi B.: Drogok és felnőttek (2003)
2003)
Drug
*
Drug users
users receiving
receiving treatment
treatment in
in the
the USA
USA 2002
2002*
((>12
>12 year
old
year old)
old))
Alcohol
2,222
Marijuana
974
Cocaine
796
Analgesics
360
Heroin
277
Hallucinogens
275
Stimulants
268
Tranquilisers
197
Sedatives
163
Solvents
thousand
139
0
500
1,000
1,500
2,000
2,500
* Overview of Findings from the 2002 National Survey on Drug Use & Health. SAMSHASAMSHA-DHHS, Sept 2003.
2003.
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Social risk/harm and prevalence of some drugs
Severe risk of fatality
heroin
MDMA
alcohol
amphetamines
nicotine
caffeine
Very low
dependence potential
Very high
dependence potential
LSD
marijuana
Neglibile risk of fatality
Based on:
on: Gable, RS:
RS: Am J Drug Alcohol Abuse 19:
19:263263-281 (1993)
„„We
We can
can risk
risk everything
everything for
for our
our health,
health,
but
”
but must
must not
not risk
risk our
our health
health for
for anything.
anything.”
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