Drugs, Users and Society Risk Analysis and Risk Management

Transcription

1 0 HO O OH Drugs, Users and Society Risk Analysis and Risk Management Drogok, fogyasztók és s a társadalom: t kockázatelemz zatelemzés és s kockázatkezel zatkezelés Ujváry István Chemical Research Centre Hungarian Academy of Sciences istvan@chemres.hu A Nemzeti Kábítószer Adatgyűjtő és Kapcsolattartó Központ A A Korai Jelzőrendszer szerepe és működése Magyarországon (The Early Warning System in Hungary) című rendezvényén elhangzott előadás Budapest, március Medicines, licit and illicit drugs MEDICINE: to prevent, alleviate or cure diseases or unwanted health conditions - maintain health & improve quality of life! DRUG: psychoactive chemical substance influencing behavior, mood, perception and cognition ILLICIT (narcotic) DRUG * : psychoactive DRUGs regulated by (inter)national national treaties (UN Conventions 1961, 1971 & 1988)

2 RISK: ISK: Sors bona, nihil aliud HAZARD,, 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.? Alea iacta est. Kockázat, rizikó, risk risicare to dare merészelni RISK ISK is a choice rather than a fate. The actions we dare to take depend on how free we are to make choices. Health consequences of drug use Biological / psychological effects DESIRED UNDESIRED to SELF to OTHERS Acute Chronic Direct Indirect

3 Risk and Harm of Drug Use by Individuals HARM = Harmfulness x Intensity of use x Frequency of use toxicity dose prevalence, popularity Risk I = f(drug_toxicity,, intensity_exposition, ty_exposition,, exposition_frequency) (1) RISK IDENTIFICATION RISK ASSESSMENT RISK MANAGEMENT 1994 by Sydney Harris

4 Risk analysis of drug use Risk identification hazard Risk characterization use Risk management action Risk assessment decision Ujváry I: Hazards and side effects: A risk analysis model of drugs of abuse. Magyar Tudomány 110(4), (200( 2004) Risk analysis of drug use - The details Hazard identification Risk characterization Risk management toxicologyology data pharmacology data dependence liability human studies* occurrence / availability dose - response relationship frequency / prevalence of use collateral damage unknown factors demand reduction supply reduction education international treaties regulation economic costs Risk assessment cultural values political values legal issues

5 Ranking of drugs according to their acute * toxicity (typical administration) alcohol (THC) GHB metamphetamine cocaine codeine MDMA phenobarbital al nicotineine flunitrazepam methadone Typical >100 g >10 g >1 g >100 mg fatal dose >10 mg low toxicity moderate toxicity high toxicity *single single substance, single dose Based on Gable, RS: Comparison of acute lethal toxicity of common abused psychoactive substances. Addiction 99:686 : (2004) Safety Margin of some drugs Safety Margin: Therapeutic Index Fatal dose Dose to elicit desired effect (always >1!) For example, SM 6 alcohol 10 GHB 10 metamphetamine 10 cocaine 15 MDMA >1000 Route of administration intravenous intranasal / smoked smoked Tolerance! Sensitization! Gable, RS: Comparison of acute lethal toxicity of common abused psychoactive substances. Addiction 99:686 : (2004)

6 Ranking according to abuse/addictive addictive potential* solvents caffeine MDMA?? amphetamine cocaine alcohol nicotine ine temazepam methadone lightly addictive moderately addictive highly addictive dictive *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 : (1990) Henningfield, J.E. & Benowitz, N.L.: personal communication for The New York Times (1994) The Royal College of Psychiatrists: Drugs: Dilemmas and Choices (2000) Dependence potential and acute toxic effect of drugs mescaline Very low dependence potential ketamine caffeine Severe risk of fatality MDMA N 2 O Chronic adverse effects? alcohol amphetamines secobarbital PCP diazepam opium cocaine nicotine morphine methaqualone Very high dependence potential psilocybin injected inhaled Neglibile risk of fatality Based on: Gable, RS: Am J Drug Alcohol Abuse 19: (1993)

7 3D surface SPECT image of the brain of abstinent and ana 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, Risk and Harm of Drug Use by Individuals in Society HARM = Harmfulness x Intensity of use x Prevalence toxicity dose, frequency frequency, popularity Risk I = f(drug_toxicity, intensity_exposition, ty_exposition, exposition_frequency) (1) Total Harm S = f(user s_harm, exposition_frequency, number_of_users) users) (2)

8 Lifetime prevalence of drug use in Hungary *,# Alcohol 91.1 Smoking 73.3 Marijuana Ecstasy Amphetamine Cocaine Opiates Inhalants Other drugs grade students* Adults (18-65)# % of respondents * Elekes Zs. & Paksi B.: Drogok és fiatalok (2002); # Paksi B.: Drogok és felnőttek (2003) Drug users receiving treatment in the USA 2002* (>12 year old) Alcohol 2,222 Marijuana 974 Cocaine 796 Analgesics 360 Heroin 277 Hallucinogens 275 Stimulants 268 Tranquilisers 197 Sedatives Solvents thousand ,000 1,500 2,000 2,500 * Overview of Findings from the 2002 National Survey on Drug Use & Health. SAMSHA-DHHS, Sept 2003.

9 Social risk/harm and prevalence of some drugs MDMA Severe risk of fatality alcohol amphetamines caffeine nicotine Very low dependence potential Very high dependence potential Neglibile risk of fatality Based on: Gable, RS: Am J Drug Alcohol Abuse 19: (1993) We can risk everything for our health, but must not risk our health for anything.