Street drug analysis and its social and clinical implications

Book reviews Street Drug Analysis and its Social and Clinical Implications. edited by JOAN A. MARSHMAN.Addiction Research

Foundation Research

of Ontario. No further information given.

on Methods

and Programs

of Drug

Education,

edited by MICHAELGOODSTADT. Addiction Research Foundation of Ontario. No further information given. Social Aspects of the Medical

Use of Psychotropic

Drugs,

edited by RUTH COOPERSTOCK. Addiction Research Foundation of Ontario. No further information given. The Treatment of Alcoholism Theory. Practice and Evaluation, edited by E. J. LARDRIK.Addiction Research Founda-

tion of Ontario. $2.95. Students of drug and alcohol abuse have long felt grateful to the province of Ontario for establishing and maintaining their Addiction Research Foundation. For many years they have consistently researched these problems and provided a forum where critical topics can be examined. All of these volumes come from the Addiction Research Foundation and the first three are based on symposia which they have organised-in association with the Canadian department of Health and Welfare and the International Council on Alcohol and Addictions. It is encouraging to see a national organisation contributmg so much to an international venture. A symposium on the findings and implications of street drug analyses makes particularly fascinating reading for a reviewer in a country where established services providing routine assay of drugs “on the scene” have never really developed. As one author points out “The Summer of Love of 1967 in the Haight-Ashbury area of San Francisco soon became the Autumn of Deception”. It seems that hallucinogens. particularly those purporting to be of a more esoteric kind. are notoriously unreliable. A Californian stud? by Brown and Malone IS reported where. in only 9 19 of the 23 15street drug analyses. was the alleged material actually present. Such massive deception raised questions about the faith and gullibility of the user. The very wide range of substances sold as psychoactive drugs presents great problems for the clinician trying to help a patient who has taken an overdose or experienced an unexpected toxic reaction. Some of the contents of streel drugs were most alarming. for instance; the Munich report of sodium cyanide being sold as heroin. or strychnine masquerading as amphetamine in California. It is clear]? important to identify such poisons on the drug scene as rapidly as possible. Such cases were fortunatel? rare. and deception more often took the form of diluting or misrepresenting the active ingredients. Optimal means of collecting and disseminating the analyses were 3 recurrent concern of the participants. The primary sources of chemical information about street drugs come from: (1) police seizures. (2) clinic populatlons and (3) field studies. Information from the last is probabl! least biased. but the methods of collecting the samples present considerable problems. In some areas the abusers themselves are encouraged to offer samples for analysis thereb) Introducing a bias toward suspect goods. Or. as m Amsterdam. users are employed to buy drugs and have them sampled as a kmd of quality control. All authors agreed that such programmes could only operate Mhen confidentialit! was strict11 maintained. The possible benefits of facts on street drug analyses are outlmed b! Dr Leo Hollister. The) are; (1) education to the user about potentiali! hazardous drugs on the market. (2) zsslstance to physicians in treating the adverse consequences of drug use (most contributors had recognised that these programmes had been of ver! little value in treatmg indnidual intoxications). (3) epidemiological informanon about trends and (41 assistance to Iam enforcement agencies about the comparative availability of the dltTerent substances. “If the use of substance A is expanding in the markst. mol-c‘efforts should be directed against that

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and perhaps less to substance B which may show a declining use”. This whole symposium is well presented and raises many important ethical.and social issues concerning the monitoring of a social phenomenon and the legitimate uses which may be made of the information obtained. Hollister comments that “apparently the faith that drug takers have in their dealers is about the same as the faith that patients often have in their healers”. This would have been an equally appropriate introduction to the symposium entitled “Social aspects of the medical use of psychotropic drugs”. Here readers of this journal will find themselves on more familiar ground: Apart from a handful of largely ineffective but harmless preparations the physician. at the turn of the century. had little more to offer than his presence and his concern. He now has at his disposal an armamentarium of drugs which are powerful for good as well as for evil. “The absolute number of prescriptions are increasing on a yearly basis and psychotropic drug prescriptions as a proportion of all prescriptions are increasing at a striking rate”. It is hard to escape the view that for some doctors the prescription pad is used as a means of cutting short the diagnostic interview and as a substitute for offering his time and personal concern. Many of the factors influencing these developments are discussed in this excellent symposium. The role of the pharmaceutical industry is analysed with characteristic frankness by Kettil Bruun from Finland stating; “The fundamental point too often neglected is that legal suppliers create demands”. It is estimated that drug marketing costs in USA are currently $4000 per physician per year. The industry’s role in creating demand has been insufficiently studied and they could probably play a more active part in promoting controls. Coinciding with the growing availability of psychotropits has come a changed expectation on the part of the consumer. In this medicated society, he comes to expect a drug solution to every human ill and stress. In a most useful analysis of patients, doctors and prescribing; Ann Cartwright notes that 54 per cent of adults in 1964 said they would consult their doctor about a constant feeling of depression; while in 1969. 72 per cent said they would consult with identical symptoms. A greater willingness to seek help with emotional difficulties and psychological problems is probably desirable; but the choice of the doctor as the recipient of these concerns presents a dilemma for the physician with a dilemma. On the one hand, he is being trained to be more aware of the psychosocial needs of his patients and psychosocial factors impinging on almost every facet of his medical practice. from prevention to rehabilitation. At the same time. he finds himself lacking in the basic knowledge or skills to deal with these issues but is nevertheless pressed by his clinical perspective to do something. These developments coupled with the doctors’ natural inclination to do something rather than nothing and do it quickly. go some way to explain the turn to readily available tranquillisers and antidepressants. Lennard and Bernstein discuss the masking effect which these drugs may have on social issues which demand action rather than sedation: Drugs used ,Jbr the elderly’s depression and loneliness. the mental patient’s aggressiveness. the womans emptiwss. the prisorwrs rebelliousness. the ghetto childs disruptiCCHPSS:ma>. represent a medical way of‘ d+sing a social problem. There is much food for thought here both for

the clinician and the sociologist. A symposium concerned with “Research on methods and programs of drug education” presents some interesting research findings and a great deal of theorising and yet leaves the reader curiously unsatisfied. I suspect that this dissatisfaction arises from the subject itself which appears to recede as you seem about to grasp it. The introduction

>tatcs -tIlLit one 0) ti1c t,laJor concerns 01 lilt’ S! rnpo~tunl bould be n itll varto~~s models for drug rducatlon rflorts” .At times one suspects that bullding and discardmg models becomes ;I same m Itself and :I suhstltute for arduous factlindmg. .An absence of evidence made parts of this hook [rather frustrattng. as one pushed aside successive webs of conJecture m search of the hidden treasure of fact. The Idea that Information imparted m chtldhood will mflurncr behavlour at 3 part) IOyr later 1s in Itself an act of faith which detirs measurement. Attempts to cvaluate the impact of drug rducatton ubl! reviewed by Goodstadt reveal the near impossible nature of the task and the ch;mscs observed are often trivial and inconclusive. Globetti discusses the particular problems of alcohol education in whtch no consensus exists about the ObJectIves of the tash. The dlstinctton between attitude change and action change is often overlooked. Most authors seemed more hopeful about Influencing attitudes. rather than changmg established hehawour. Inevitably the render’s thoughts turn to more fundamental questions about the nature and put-pox of educatton. and it was difficult to avoid feeling that we required a reappraisal of the adequacy of current tcuching methods as a preparation for living. Why ior IIIbtancc IS the emotional climate in one school so different from that in another in the same district’? How can we help children develop their critical abilities so that they can resist Ill-founded persuasion’? Such issues remained unanswered. perhaps they always will. This book poses man! qucsttons uhich is surely a sien of a successuI symposium. “The trcatmcnt of alcoholl opposed Much of \rhat hc 11;~sto \av .Ihout the concept of loss of control. hchav~~~u~-modilic;tt;on and teaching alcoholics to drmk nurmall~ I\ well prc\ctited and adequately rcfcrcnced. The dlscac concept 01 alcoholism is being shaken ‘II it5 foundation\ at prcs2nt a\ the author- \uggc?ts. 111,. lll11lX~\V I)r,,ll~lrIr ( ‘Ir,!,c~. R~l\~Il I.i/rlrlUrl?//r 1/f,\/“/“/. I.
t:. B. RIISON

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