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Drug abuse 

Drug abuse
Chapter:
Drug abuse
Author(s):

Don C. Des Jarlais

and Robert L. Hubbard

DOI:
10.1093/med/9780199218707.003.0076
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date: 20 June 2019

Abuse and dependence on alcohol and other drugs is a particularly complex and very important public health problem. Drug dependence disorders involve biomedical, pharmacological, psychological, and social factors. Drug abuse often involves multiple pharmacological agents used within a complex social environment in which some substances are legal and others illegal. The consequences of drug abuse are many and varied. Over the last 40 years, there have been major advances in prevention and treatment of drug abuse, but given present worldwide trends, the problems associated with psychoactive drug use are likely to continue increasing. Human immunodeficiency virus (HIV), the virus that causes acquired immunodeficiency syndrome (AIDS) has emerged as the most dramatic adverse consequence of drug use. HIV is not transmitted through drug use per se, but through the sharing of equipment to inject drugs and through unsafe sexual activities that are often facilitated by drug use. Sharing of injection equipment can lead to extremely rapid transmission of HIV, with half or more of a local drug user population becoming infected over a period of a few years. Conversely, programmes such as community outreach and syringe exchange can be highly effective in reducing injection-related HIV transmission. It is possible to prevent epidemics of HIV among injecting drug users. The main problems have been not implementing programmes to prevent HIV among injecting drug users at all, but waiting until after an epidemic has already occurred to implement programmes, or implementing programmes on an inadequate scale. The HIV/AIDS crisis has spurred development of the ‘harm reduction’ perspective towards the problems of psychoactive drug use. This perspective is based in a human rights approach to drug users—drug users should be treated with dignity and respect—and a pragmatic, public health perspective on drug related problems. It is not likely that the problems associated with drug use can be eliminated, so public health policy should focus on the many different ways in which those problems can be minimized.

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