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Substance use among medical students in Barcelona (Spain). A comparison with previous surveys
Drug and Alcohol Dependence, Elsevier
Scientific
Publishers
18 (1986) Ireland
311-318
311
Ltd.
SUBSTANCE USE AMONG MEDICAL STUDENTS IN BARCELONA (SPAIN). A COMPARISON WITH PREVIOUS SURVEYS*
MARIA
ELENA
RODRIGUEZ
and JORDI
CAMI**
Znstitut Municipal d’Znvestigacio Medica and Department of Pharmacology Therapeutics, Autonomous University of Barcelona (Spain) (Received
May 12th,
and
1986)
SUMMARY
During the academic year 1983---1984, a survey on drug consumption was conducted among medical students in Barcelona. There was a high proportion of smokers in both sexes. Alcohol consumption was four times higher among men than women; high proof beverages were becoming the most common drinks. Coffee was the caffeine drink consumed by almost the whole population studied. Although cannabis derivatives had been tried at least once by almost all the students, regular consumers were almost non-existent. Amphetamine consumption was restricted to examination periods. The use of opiates, cocaine, hallucinogens, and solvents was rare for the sample. Results from this study are compared with those from similar surveys conducted 5 and 10 years ago. Key
words:
Drug use - Medical students -
Spain
INTRODUCTION
Substance use among medical students in Barcelona has been the object of our interest for several years. In 1973,1974 and 1977 surveys of the drug habits of medical students in Barcelona were conducted [ 1,2]. To determine possible changes in their patterns of drug use, in the 1983-1984 academic year another survey was carried out of medical students at the Autonomous
*Study supported by a grant from CIRIT (Generalitat **To whom requests for reprints should be sent at: Medica, Passeig Maritim s/n, 08003 Barcelona, Spain.
0376~8716/86/$03.50 0 Elsevier Scientific Printed
and Published
Publishers Ireland in Ireland
Ltd.
de Catalunya), 1982. Institut Municipal d’Investigacio
312
University of Barcelona (AUB) and the University of Barcelona (UB). The surveys conducted 10 and 5 years ago demonstrated that drug use in Spain’s medical schools showed similar trends to those observed in medical schools in the western society [3-61. At that time in Barcelona most medical students consumed tobacco and alcohol, and some occasionally used cannabis derivatives, a few amphetamines, and other substances. The study presented here is based on a survey similar to those conducted previously. It showed that the characteristics of use among current medical students differed from those found in the previous samples. MATERIALS
AND METHODS
The instrument used in this study was the same as that used in similar studies conducted among Spanish medical students in the two academic years 1973-1975 and the 1977-1978 academic year [1,2]. Questionnaires were anonymous; the first page included a note stressing the importance and confidentiality of the project. Basic epidemiological data were asked. The instrument included three sections. In the first section of the instrument students checked their frequency of use (daily, weekly, monthly, in the last 6 months, or never) of 4 tobacco varieties, 14 alcoholic beverages, and 5 caffeine-containing drinks; the amount in each case was asked as well. In the second section students were requested to indicate their consumption of drugs for medical use. The last section consisted of a list of 7 drugs, including cannabis derivatives, hallucinogens, cocaine, opiates, amphetamines and inhalants; in these cases students reported the extent of drugs use (never, only sometimes, or regularly). The caffeine content in a cup of coffee was estimated to be 125 mg, 75 mg in a cup of tea, and 22 mg in a cola drink of 150 ml. Alcohol content was calculated according to the average content of each drink and Mello’s normogram [ 71. ‘Regular consumer’ denotes a respondent who was taking the drug for 6 months before the interview. During the 1983-1984 academic year, 2 weeks before the first quarter examinations, questionnaires were distributed to all medical students attending the UB and the AUB. Students were requested to answer the questions during the first 10 min of a class session. Usable responses were collected from 2308 students (40% of registered students for the 5-year period); 1112 were from men and 1196 from women. The data do not show whether the students’ epidemiological characteristics changed over the 10 years covered by the three studies. In spite of sampling deficiencies, we did compare the three populations in an attempt to find changes in the patterns of drug use among medical students. Data were distributed according to use/non-use of each drug, sex and amount of drug used. In addition, data on alcohol and caffeine consumption were grouped following a modal distribution model. All the data collected were analyzed by an SPSS statistical package.
313 RESULTS
Tobacco smoking Overall, 998 respondents (43.5%) stated that they smoked. The percentage of male and female smokers was 42.2% and 44.7%, respectively; this difference between sexes was not statistically significant. Analysis of the type of tobacco smoked revealed that 7.4% of students smoked French tobacco only, 23.6% smoked Virginia blends only, 8.8% smoked both tobacco varieties, and 3.6% were pipe and/or cigar smokers (see Table I). There was a significant difference between the proportion of the sexes smoking Virginia blends (P < 0.001). When only smokers were considered, the percentages changed to 16.9%, 54.7%, 20% and 8.4% respectively. Significant differences were found between the sexes both in smoking Virginia blends and smoking Virginia blends and French tobacco (P = 0.0002 and P = 0.003). The mean number of cigarettes smoked was 152.l/month (162.1 for men and 142.1 for women). When the type of tobacco was considered, the mean number of French cigarettes smoked was Gl/month; the mean for Virginia blends was 91.5. The figures when only smokers were considered increased to a mean of 350 cigarettes/month (394.5 for men and 314.4 for women). A significant difference between sexes was found in this respect (P < 0.001). The study of the type of tobacco smoked by men and women smokers revelaed that the mean number of Virginia cigarettes smoked by women was higher than that of French cigarettes (205 vs. 110); this difference was not found among men. Moreover, a significant difference was shown between the proportions of sexes smoking French tobacco (P < 0.001). Alcohol consumption For the total of the population studied, the average amount of alcohol consumed was 307 g/month with a highly significant difference between TABLE
I
DISTRIBUTION SMOKED
OF THE SAMPLE
ACCORDING
Men
Total N French tobacco Virginia blends only Virginia and French Pipe and cigars Non-smokers
170 542 202 a4 1296
Total
2294
TO THE TYPE OF TOBACCO
% 7.4 23.6 8.8 3.6 56.5 100
N 75 204 112 75 637 1103
Women % 6.8 18.5 10.1 6.8 57.8 100
N 95 338 90 9 695 1191
% 8.0 28.4 7.5 0.7 55.3 100
314
sexes (P < 0.001); men reported drinking amounts more than twice those of women. Table II shows the alcohol consumption of drinking students according to different beverages. The distribution of the drinker population according to the daily amount of drinks demonstrated that a high proportion of students drank only one beverage a day; high proof beverages were consumed daily in a higher number than beer or wine. Caffeine consumption The average amount of caffeine consumed by the respondents was 726.2 cg/month; significant differences between sexes were found (P = 0.004). Thus, women’s consumption was around 100 cg higher than that of men. Only 8.2% of students denied caffeine consumption. When types of caffeinecontaining drinks were considered differences between consumption of coffee, tea and cola drinks were found. The average amount consumed per month for each beverage was 802.2 cg, 182.3 cg, and 35 cg, respectively. The distribution according to the number of daily drinks showed a difference between coffee drinkers and tea and cola drinkers; in the former group there were differences in the proportions of students who drank from one to three cups of coffee daily, those drinking more were still considerable (18%). In this respect, tea and cola drinkers showed distributions similar to alcohol drinkers. Consumption of other drugs Amphetamines had been used at least once by 203 students (9%); 1 .l% of the students had used amphetamines regularly; and 6.2% restricted their use to examination periods. No difference was demonstrated between sexes, nor among regular or occasional consumers. Overall, 67.9% of the students surveyed denied use of cannabis derivatives in any form although this drug had been offered to 16.4% of them. The number of non-consumers was higher among women. Of the total respondents, 20.7% had used cannabis derivatives. Of all women, 16% were users and of all men, 25.6%; this difference was statistically significant (PC 0.001). Only 2 students (0.9%) were regular consumers of cannabis. TABLE
II
ALCOHOL
CONSUMPTION
OF DRINKING Amount
Average Average Average Average
total alcohol beer wine high proof beverages
STUDENTS consumed
(g/month)
Men
Women
556.5 224.8 374.5 261.2
284.5 119.8 217.8 165.9
315
The question about use of hahucinogenes, cocaine, opiates or inhalants, was answered by 85% of the students. None of them admitted regular use of any of those drugs at the time of interviewing. The proportion of students who had tried one of those drugs differed from 3% for cocaine and hallucinogens to 1.2% for opiates and 1.4% for inhalants. For all the drugs mentioned, significant differences between sexes were found. COMPARISON
OF THIS STUDY
WITH PREVIOUS
SURVEYS
The data obtained in 1973-1974 and 1977-1978 [1,2] were compared with the results of this study. In 1977-1978 more than two thirds (69.5%) of students smoked tobacco against less than half of the respondents in 19831984. Women represented higher proportions of smokers in both studies (71.5% vs. 67.5% for men in 1977-1978, and 44.5% vs. 42% for men in 1983- 1984). Comparisons of these results with those from the 1982 survey about smoking in Catalunya [ 81, shows that among the general population the proportion of all women smokers was less than half that of the women medical students surveyed. However, when only the young women smokers in the general population are considered, the percentage of women medical students who smoke was lower (59.3% vs. 44.5%). The different proportions 200 -r
T 80
180 --
-- 70
160 --
-- 60
140 -120 --
-- 50
100 --
-- 40
80 --
-- 30
60 --
-- 20
40 --
-- 10
20 -0 1
+O 1973 /75
197717% 4par
Fig. 1. Means of cigarette consumption, according (-o-) or Virginia (--=-) (Units along left vertical (Units along right vertical axis).
1983/84 to the type of tobacco used, French axis). Percentage of smokers (-•-)
316
of smokers and type of tobacco smoked, are summarized in Fig. 1. There was a higher proportion of Virginia blend smoking among the 1983-1984 population. Data from Tabacalera Espanola (National Tobacco Factory) showing an increase in the amount of Virginia tobacco sales would corroborate that finding [ 91. The average amounts of alcohol consumed by the populations surveyed in 1973. -1975,1977-1978 and 1983--1984 were 621,627 and 302 g/month, respectively. Similar differences obtain when consumption of beer, wine and other alcoholic beverages is considered separately. In the three surveys total caffeine consumption was similar: on an average 906.6 cg/month in 1973. 1975,786.5 cgjmonth in 1977-1978, and 727 cg/month in 19831984. Amphetamine consumption differed between normal and examination periods. ‘Normal’ consumption has remained similar while during examination it was 18.4% in 1973-1975; 19% in 1977-1978; and 10% in 19831984. In 197331975 cannabis derivatives were sporadically used by 9% of the students surveyed. This figure increased to 22% in 1977-1978 and leveled off at 21% in 1983-.-1984. In 1977-1978, 8.5% of the student population were regular users of cannabis derivatives against only 0.1% in 1983-1984. The use of hallucinogens, opiates and inhalants was minimal in all the three studies. The proportion of sporadic cocaine users increased from 0.4% in 1973--1975 to 1.4% in 1977-1978 and 3.1% in 1983-1984. DISCUSSION
The present survey corroborates the idiosyncratic characteristics of substance abuse among medical students in Barcelona. When compared with results from studies in medical schools elsewhere [3- 61, we found a higher prevalence of tobacco smoking (43.7%), in accord with the trends in the general Spanish population [ 8,9]. When compared with results from previous surveys in Barcelona, several findings can be highlighted. Tobacco smoking is lower among contemporary generations in medical schools than it was 5 and 10 years ago. However, the proportion of women smokers has increased, as has the proportion of women studying in medical schools. Among current generations Virginia blends are more popular than French tobacco; this coincides with data about national tobacco sales; recently, Tabacalera Espanola has found an enormous increase in Virginia blend sales at a national level [ 91. Alcohol and caffeine consumption was similar in our sample and previous ones. The pattern of alcohol use according to sex did not change, men drinking more than twice the amount that women do. Coffee is still consumed in higher amounts than tea and cola drinks. Availability of cannabis derivatives has increased in Spain in the last years [ 111; they have become very popular drugs. The proportion of students familiar with cannabis derivatives and their effects was comparable in
317
the present and previous surveys. However, the proportion of regular users of cannabis derivatives was markedly lower for current students, possibly because medical students, are a highly select group of serious, disciplined scholars with no time for recreational drugs. The remarkable reduction in the percentage of exam-related amphetamine consumption may be a consequence of a considerable decrease in the availability of these drugs. In the last five years the Spanish Drug Administration has established several restrictions on the purchase of amphetamines, notably the control of drug dispensation in pharmacies and the review of approved amphetamine containing drugs resulting in the elimination from the market of many of the drugs commonly used by students [lo]. The use of the so-called illegal drugs is not high enough to allow solid conclusions to be drawn. Nevertheless, cocaine use has become more common which coincides with national figures [ 111 on sporadic use of the drug. Medical students constitute a specific group of youth; the selection factors for admission to medical school differentiate them from other university students. Consequently, results obtained here are neither generalizable to other groups of youth nor do they reflect the influence of current drug use trends in general upon university students. Our study was not a longitudinal nor a follow up of the earlier samples, and sampling deficiencies make it impossible to study the evolution of drug consumption patterns over the 10 years covered by the three surveys. Nevertheless, the comparison of these three available studies does shed some light on the topic of drug use among medical students. These kind of studies, in spite of inherent methodological bias and the difficulties of comparing with similar surveys from other countries [6], are extremely valuable as indirect indicators of the drug use phenomenon. Physicians play a role in shaping society’s attitudes toward the use of drugs. Medical students’ experience with drugs will thus not only influence their own opinions, but also the opinions of other social groups. It is in this context that data from studies such as this one also become an interesting tool for knowing and preventing possible health problems. In this sense, drug education for medical students could be one of the most important issues in planning actions to solve drug abuse problems. REFERENCES
J.R. Laporte et al., Eur. J. Clin. Pharmacol., 11 (1977) 449. J. Laporte et al., Med. Clin. (Barcelona), 73 (1980) 317. W.E. McAuliffe, M. Rohman and P. Fishman, J. Health Sot. Behav., 25 (1984) 34. R. Epstein and E. Eubanks, N. Engl. J. Med., 311(1984) 923. W.P. Kory and L.A. Crandell, Int. J. Addict., 19 (1984) 871. J.F. Maddux, S.K. Hoppe and R.M. Costello, Am. J. Psychiatry, 143 (1986) 187. A. Paton and J.B. Saunders, Br. Med. J., 183 (1981) 1458. L. Salleras et al., Med. Clin. (Barcelona) 85 (1985) 525. Tabacalera Esptiola, Series histbricas de consume de tabaco elaborado 1957-1984, Madrid, 1985.
318 10
11
Programa Selective De Revision Farmacoterapeutica Des Los Medicamentos Espanoles (PROSEREME). Informe de la Direcccion General de Farmaciay Productos Sanitarios, Madrid, 1985. J. Navarro, S. Lorente, J. Varo and M. Roiz (Eds.), Cuaderno Tecnico editado por Cruz Roja Espafiola y el Ministerio de Trabajo y Seguridad Social, Madrid, 1985.
Scientific
Publishers
18 (1986) Ireland
311-318
311
Ltd.
SUBSTANCE USE AMONG MEDICAL STUDENTS IN BARCELONA (SPAIN). A COMPARISON WITH PREVIOUS SURVEYS*
MARIA
ELENA
RODRIGUEZ
and JORDI
CAMI**
Znstitut Municipal d’Znvestigacio Medica and Department of Pharmacology Therapeutics, Autonomous University of Barcelona (Spain) (Received
May 12th,
and
1986)
SUMMARY
During the academic year 1983---1984, a survey on drug consumption was conducted among medical students in Barcelona. There was a high proportion of smokers in both sexes. Alcohol consumption was four times higher among men than women; high proof beverages were becoming the most common drinks. Coffee was the caffeine drink consumed by almost the whole population studied. Although cannabis derivatives had been tried at least once by almost all the students, regular consumers were almost non-existent. Amphetamine consumption was restricted to examination periods. The use of opiates, cocaine, hallucinogens, and solvents was rare for the sample. Results from this study are compared with those from similar surveys conducted 5 and 10 years ago. Key
words:
Drug use - Medical students -
Spain
INTRODUCTION
Substance use among medical students in Barcelona has been the object of our interest for several years. In 1973,1974 and 1977 surveys of the drug habits of medical students in Barcelona were conducted [ 1,2]. To determine possible changes in their patterns of drug use, in the 1983-1984 academic year another survey was carried out of medical students at the Autonomous
*Study supported by a grant from CIRIT (Generalitat **To whom requests for reprints should be sent at: Medica, Passeig Maritim s/n, 08003 Barcelona, Spain.
0376~8716/86/$03.50 0 Elsevier Scientific Printed
and Published
Publishers Ireland in Ireland
Ltd.
de Catalunya), 1982. Institut Municipal d’Investigacio
312
University of Barcelona (AUB) and the University of Barcelona (UB). The surveys conducted 10 and 5 years ago demonstrated that drug use in Spain’s medical schools showed similar trends to those observed in medical schools in the western society [3-61. At that time in Barcelona most medical students consumed tobacco and alcohol, and some occasionally used cannabis derivatives, a few amphetamines, and other substances. The study presented here is based on a survey similar to those conducted previously. It showed that the characteristics of use among current medical students differed from those found in the previous samples. MATERIALS
AND METHODS
The instrument used in this study was the same as that used in similar studies conducted among Spanish medical students in the two academic years 1973-1975 and the 1977-1978 academic year [1,2]. Questionnaires were anonymous; the first page included a note stressing the importance and confidentiality of the project. Basic epidemiological data were asked. The instrument included three sections. In the first section of the instrument students checked their frequency of use (daily, weekly, monthly, in the last 6 months, or never) of 4 tobacco varieties, 14 alcoholic beverages, and 5 caffeine-containing drinks; the amount in each case was asked as well. In the second section students were requested to indicate their consumption of drugs for medical use. The last section consisted of a list of 7 drugs, including cannabis derivatives, hallucinogens, cocaine, opiates, amphetamines and inhalants; in these cases students reported the extent of drugs use (never, only sometimes, or regularly). The caffeine content in a cup of coffee was estimated to be 125 mg, 75 mg in a cup of tea, and 22 mg in a cola drink of 150 ml. Alcohol content was calculated according to the average content of each drink and Mello’s normogram [ 71. ‘Regular consumer’ denotes a respondent who was taking the drug for 6 months before the interview. During the 1983-1984 academic year, 2 weeks before the first quarter examinations, questionnaires were distributed to all medical students attending the UB and the AUB. Students were requested to answer the questions during the first 10 min of a class session. Usable responses were collected from 2308 students (40% of registered students for the 5-year period); 1112 were from men and 1196 from women. The data do not show whether the students’ epidemiological characteristics changed over the 10 years covered by the three studies. In spite of sampling deficiencies, we did compare the three populations in an attempt to find changes in the patterns of drug use among medical students. Data were distributed according to use/non-use of each drug, sex and amount of drug used. In addition, data on alcohol and caffeine consumption were grouped following a modal distribution model. All the data collected were analyzed by an SPSS statistical package.
313 RESULTS
Tobacco smoking Overall, 998 respondents (43.5%) stated that they smoked. The percentage of male and female smokers was 42.2% and 44.7%, respectively; this difference between sexes was not statistically significant. Analysis of the type of tobacco smoked revealed that 7.4% of students smoked French tobacco only, 23.6% smoked Virginia blends only, 8.8% smoked both tobacco varieties, and 3.6% were pipe and/or cigar smokers (see Table I). There was a significant difference between the proportion of the sexes smoking Virginia blends (P < 0.001). When only smokers were considered, the percentages changed to 16.9%, 54.7%, 20% and 8.4% respectively. Significant differences were found between the sexes both in smoking Virginia blends and smoking Virginia blends and French tobacco (P = 0.0002 and P = 0.003). The mean number of cigarettes smoked was 152.l/month (162.1 for men and 142.1 for women). When the type of tobacco was considered, the mean number of French cigarettes smoked was Gl/month; the mean for Virginia blends was 91.5. The figures when only smokers were considered increased to a mean of 350 cigarettes/month (394.5 for men and 314.4 for women). A significant difference between sexes was found in this respect (P < 0.001). The study of the type of tobacco smoked by men and women smokers revelaed that the mean number of Virginia cigarettes smoked by women was higher than that of French cigarettes (205 vs. 110); this difference was not found among men. Moreover, a significant difference was shown between the proportions of sexes smoking French tobacco (P < 0.001). Alcohol consumption For the total of the population studied, the average amount of alcohol consumed was 307 g/month with a highly significant difference between TABLE
I
DISTRIBUTION SMOKED
OF THE SAMPLE
ACCORDING
Men
Total N French tobacco Virginia blends only Virginia and French Pipe and cigars Non-smokers
170 542 202 a4 1296
Total
2294
TO THE TYPE OF TOBACCO
% 7.4 23.6 8.8 3.6 56.5 100
N 75 204 112 75 637 1103
Women % 6.8 18.5 10.1 6.8 57.8 100
N 95 338 90 9 695 1191
% 8.0 28.4 7.5 0.7 55.3 100
314
sexes (P < 0.001); men reported drinking amounts more than twice those of women. Table II shows the alcohol consumption of drinking students according to different beverages. The distribution of the drinker population according to the daily amount of drinks demonstrated that a high proportion of students drank only one beverage a day; high proof beverages were consumed daily in a higher number than beer or wine. Caffeine consumption The average amount of caffeine consumed by the respondents was 726.2 cg/month; significant differences between sexes were found (P = 0.004). Thus, women’s consumption was around 100 cg higher than that of men. Only 8.2% of students denied caffeine consumption. When types of caffeinecontaining drinks were considered differences between consumption of coffee, tea and cola drinks were found. The average amount consumed per month for each beverage was 802.2 cg, 182.3 cg, and 35 cg, respectively. The distribution according to the number of daily drinks showed a difference between coffee drinkers and tea and cola drinkers; in the former group there were differences in the proportions of students who drank from one to three cups of coffee daily, those drinking more were still considerable (18%). In this respect, tea and cola drinkers showed distributions similar to alcohol drinkers. Consumption of other drugs Amphetamines had been used at least once by 203 students (9%); 1 .l% of the students had used amphetamines regularly; and 6.2% restricted their use to examination periods. No difference was demonstrated between sexes, nor among regular or occasional consumers. Overall, 67.9% of the students surveyed denied use of cannabis derivatives in any form although this drug had been offered to 16.4% of them. The number of non-consumers was higher among women. Of the total respondents, 20.7% had used cannabis derivatives. Of all women, 16% were users and of all men, 25.6%; this difference was statistically significant (PC 0.001). Only 2 students (0.9%) were regular consumers of cannabis. TABLE
II
ALCOHOL
CONSUMPTION
OF DRINKING Amount
Average Average Average Average
total alcohol beer wine high proof beverages
STUDENTS consumed
(g/month)
Men
Women
556.5 224.8 374.5 261.2
284.5 119.8 217.8 165.9
315
The question about use of hahucinogenes, cocaine, opiates or inhalants, was answered by 85% of the students. None of them admitted regular use of any of those drugs at the time of interviewing. The proportion of students who had tried one of those drugs differed from 3% for cocaine and hallucinogens to 1.2% for opiates and 1.4% for inhalants. For all the drugs mentioned, significant differences between sexes were found. COMPARISON
OF THIS STUDY
WITH PREVIOUS
SURVEYS
The data obtained in 1973-1974 and 1977-1978 [1,2] were compared with the results of this study. In 1977-1978 more than two thirds (69.5%) of students smoked tobacco against less than half of the respondents in 19831984. Women represented higher proportions of smokers in both studies (71.5% vs. 67.5% for men in 1977-1978, and 44.5% vs. 42% for men in 1983- 1984). Comparisons of these results with those from the 1982 survey about smoking in Catalunya [ 81, shows that among the general population the proportion of all women smokers was less than half that of the women medical students surveyed. However, when only the young women smokers in the general population are considered, the percentage of women medical students who smoke was lower (59.3% vs. 44.5%). The different proportions 200 -r
T 80
180 --
-- 70
160 --
-- 60
140 -120 --
-- 50
100 --
-- 40
80 --
-- 30
60 --
-- 20
40 --
-- 10
20 -0 1
+O 1973 /75
197717% 4par
Fig. 1. Means of cigarette consumption, according (-o-) or Virginia (--=-) (Units along left vertical (Units along right vertical axis).
1983/84 to the type of tobacco used, French axis). Percentage of smokers (-•-)
316
of smokers and type of tobacco smoked, are summarized in Fig. 1. There was a higher proportion of Virginia blend smoking among the 1983-1984 population. Data from Tabacalera Espanola (National Tobacco Factory) showing an increase in the amount of Virginia tobacco sales would corroborate that finding [ 91. The average amounts of alcohol consumed by the populations surveyed in 1973. -1975,1977-1978 and 1983--1984 were 621,627 and 302 g/month, respectively. Similar differences obtain when consumption of beer, wine and other alcoholic beverages is considered separately. In the three surveys total caffeine consumption was similar: on an average 906.6 cg/month in 1973. 1975,786.5 cgjmonth in 1977-1978, and 727 cg/month in 19831984. Amphetamine consumption differed between normal and examination periods. ‘Normal’ consumption has remained similar while during examination it was 18.4% in 1973-1975; 19% in 1977-1978; and 10% in 19831984. In 197331975 cannabis derivatives were sporadically used by 9% of the students surveyed. This figure increased to 22% in 1977-1978 and leveled off at 21% in 1983-.-1984. In 1977-1978, 8.5% of the student population were regular users of cannabis derivatives against only 0.1% in 1983-1984. The use of hallucinogens, opiates and inhalants was minimal in all the three studies. The proportion of sporadic cocaine users increased from 0.4% in 1973--1975 to 1.4% in 1977-1978 and 3.1% in 1983-1984. DISCUSSION
The present survey corroborates the idiosyncratic characteristics of substance abuse among medical students in Barcelona. When compared with results from studies in medical schools elsewhere [3- 61, we found a higher prevalence of tobacco smoking (43.7%), in accord with the trends in the general Spanish population [ 8,9]. When compared with results from previous surveys in Barcelona, several findings can be highlighted. Tobacco smoking is lower among contemporary generations in medical schools than it was 5 and 10 years ago. However, the proportion of women smokers has increased, as has the proportion of women studying in medical schools. Among current generations Virginia blends are more popular than French tobacco; this coincides with data about national tobacco sales; recently, Tabacalera Espanola has found an enormous increase in Virginia blend sales at a national level [ 91. Alcohol and caffeine consumption was similar in our sample and previous ones. The pattern of alcohol use according to sex did not change, men drinking more than twice the amount that women do. Coffee is still consumed in higher amounts than tea and cola drinks. Availability of cannabis derivatives has increased in Spain in the last years [ 111; they have become very popular drugs. The proportion of students familiar with cannabis derivatives and their effects was comparable in
317
the present and previous surveys. However, the proportion of regular users of cannabis derivatives was markedly lower for current students, possibly because medical students, are a highly select group of serious, disciplined scholars with no time for recreational drugs. The remarkable reduction in the percentage of exam-related amphetamine consumption may be a consequence of a considerable decrease in the availability of these drugs. In the last five years the Spanish Drug Administration has established several restrictions on the purchase of amphetamines, notably the control of drug dispensation in pharmacies and the review of approved amphetamine containing drugs resulting in the elimination from the market of many of the drugs commonly used by students [lo]. The use of the so-called illegal drugs is not high enough to allow solid conclusions to be drawn. Nevertheless, cocaine use has become more common which coincides with national figures [ 111 on sporadic use of the drug. Medical students constitute a specific group of youth; the selection factors for admission to medical school differentiate them from other university students. Consequently, results obtained here are neither generalizable to other groups of youth nor do they reflect the influence of current drug use trends in general upon university students. Our study was not a longitudinal nor a follow up of the earlier samples, and sampling deficiencies make it impossible to study the evolution of drug consumption patterns over the 10 years covered by the three surveys. Nevertheless, the comparison of these three available studies does shed some light on the topic of drug use among medical students. These kind of studies, in spite of inherent methodological bias and the difficulties of comparing with similar surveys from other countries [6], are extremely valuable as indirect indicators of the drug use phenomenon. Physicians play a role in shaping society’s attitudes toward the use of drugs. Medical students’ experience with drugs will thus not only influence their own opinions, but also the opinions of other social groups. It is in this context that data from studies such as this one also become an interesting tool for knowing and preventing possible health problems. In this sense, drug education for medical students could be one of the most important issues in planning actions to solve drug abuse problems. REFERENCES
J.R. Laporte et al., Eur. J. Clin. Pharmacol., 11 (1977) 449. J. Laporte et al., Med. Clin. (Barcelona), 73 (1980) 317. W.E. McAuliffe, M. Rohman and P. Fishman, J. Health Sot. Behav., 25 (1984) 34. R. Epstein and E. Eubanks, N. Engl. J. Med., 311(1984) 923. W.P. Kory and L.A. Crandell, Int. J. Addict., 19 (1984) 871. J.F. Maddux, S.K. Hoppe and R.M. Costello, Am. J. Psychiatry, 143 (1986) 187. A. Paton and J.B. Saunders, Br. Med. J., 183 (1981) 1458. L. Salleras et al., Med. Clin. (Barcelona) 85 (1985) 525. Tabacalera Esptiola, Series histbricas de consume de tabaco elaborado 1957-1984, Madrid, 1985.
318 10
11
Programa Selective De Revision Farmacoterapeutica Des Los Medicamentos Espanoles (PROSEREME). Informe de la Direcccion General de Farmaciay Productos Sanitarios, Madrid, 1985. J. Navarro, S. Lorente, J. Varo and M. Roiz (Eds.), Cuaderno Tecnico editado por Cruz Roja Espafiola y el Ministerio de Trabajo y Seguridad Social, Madrid, 1985.