Anthropology Lecture 1

introduction

Common Misconceptions with Drugs

. The effect of a drug is caused solely by its pharmacological properties and effects.

. Some drugs are instantly addictive
. The gateway/ stepping stone theory - the use of 1 drug leads to the use of other more dangerous drugs

What are drugs ?

Krivanek's definition : Drugs are substances that are introduced into the body knowingly but not as food.

Therefore illicit drugs, legal recreational drugs and legal but regulated pharmaceutical drugs that aren't recreational at all.

- Whether if a drug is considered bad and is prohibited depends on the culture of the society in a particular period.

What is culture ?

The definition of culture = Through Roger keesing and Andrew Strathern's definition it is a system of shared ideas, rules and meanings that underlie and are expressed in the ways that human live.

- This includes : law, beliefs, political economy, media and popular culture - this perceives ideas about what is normal and abnormal to society.

" Culture is always changing and contested, not unified"

Enthography as a method for studying drug use

It is a process of observing, recoding and describing other peoples way of life through intimate participation the community being studied".

- Participation observation, involving yourself in the life of the community , taking up the life of the other person, observing their actions, asking questions and learning what questions to ask.

Zinberg's theory of drug use

Effect of drug use is due to three variables and their interaction:

0. DRUG : The pharmacological action of the substance itself

SET : The attitude of the person at time of use, including his or her personality structure, and what they expectation the drug to do. ( Individual attitudes are significantly influenced by social values and social expectations.

2. SETTING : The influence of the physical and social setting in which it occurs. There are 2 dimensions regarding this :

social sanctions - the informal and informal values and conducts used around drug use - example ( defines when it is appropriate to do something, a social influence )

4. social rituals

Both shape how drugs are used.

The myth that drugs are defined and determined by their pharmacological properties - NOTE NOT IMPORTANT.

0. The choice between legal and illegal drugs is done by socially and historically determined and not based on its dangers.

1. Drug and its effect can be understood by taking into account the particular social, cultural, political and economic contexts as well their pharmacological properties.

A portrait of drug addiction- and NOT addiction : Meth

0. Drug is never 100 percent addictive

1. drugs are not always bad

Post- Propaganda approach to studying drugs

0. how drugs work in bodies - (neuropharmacology)

1. how addictions work - (psychology)

2. how experiences with drugs are mediated by

1 . culture symbolism ( anthropology)
5888. the social organisation ( subculture) of users ( anthro and sociology)
5889. drug law and international markets ( political science and economics)

23. the history of drug use ( history)

24. drugs in popular culture and media ( media/ culture studies) how drugs are pleasurable for many ( philosophy and literature) In short: AN INTERDISCIPLINARY APPROACH.
Drug branding and symbolism

5889. "The diversity of the branding demonstrates the vigour of the business and dynamism of the market" - many different names for it , it is recognised widely.

Comparing between laws and use prevalence in the European union, what conclusion we can make between illicit drug use and countries drug laws is that

- the more restrictive the law, the more drugs are used.

Moral of the story

-Illegal drug tree and the pharmaceutical market are massive.

0. Enormous economics implications where there are large profits made " Wars against drugs" - profits and criminality associated with drug trafficking
1. Temper the horror stories we hear of drug use : for every addict with a ruined life there are more people who do not become part of these stories .

Basic categories of illicit drugs

Narcotics - Qualities : it relieves pain, induces euphoria , create physical dependency

Hypnotics - Qualities: habit- forming, causing sleep and stupor. Tranquilisers are similar but recede anxiety without causing sleep Stimulants - Qualities : cause excitement, increase mental and physical energy, create dependency, may cause psychotic disturbance
Inebriants
Hallucinogens- Qualities: causes complex changes in visual, auditory and other perfections and may cause acute psychotic disturbance.

lecture 2 What has cannabis research mostly focused on? psychedelics/ Hallucinogens

- its medial uses or the harmful health consequences of heavy and uncontrolled used.

Why no scientific research on spiritual/ mystical/ pleasurable effects of drugs ?

- Dichotomy of mind and body in western trough , emphasis on the primary reason of it - "Aesthetic horror" of drug use in mainstream society

Pervasive puritan ethic, fear of hedonism and of Dionysian pleasure - Manderson

Natural hallucinogenic drugs in pre-industrial Europe

23. Belladonna ( deadly nightshade)

24. Datura ( Jimson Weed, thorn apple)
25. Mandragora ( Mandrake)

Used in Europe mainly for ritualistic purposes e.g witches ' sabbath.

New world and hallucinogens

The New world has the highest concentration of plant hallucinogens of any region in the world

Mckenna " The new world subtropical and tropical zones are phenomenally rich in hallucinogenic plants - for religious purposes

The cults and religious orders that use hallucinogens for ritual ,religious and healing purposes also cluster in the tropical new world.

Some new world hallucinogens

Ayahuasca - Harmaline - western Amazon

Datura - Scopolamine - america ( as examples )

Shamanism

Shamans who play a dominant role in their societies

Definition - a religious and ritual specialist who gains control/ power over supernatural force. They have a ability to enter visionary trance - states ( altered states of consciousness, including visions)

Shamanic trance can be induced by

5888. tobacoo
5889. hallucinogenic drugs
5890. fasting
-mediation, hypnosis
23. music, dancing
24. controlled breathing

functions of shamanic trances

community functions

- shamans as mediator between supernatural and the community. Shaman communicates with spirits uses spiritual power to gain control over supernatural forces for the benefit of the community.

Healing: the shaman uses visionary trances to dig nose illness. Shaman can 'see' or visualise the cause of an illness and fight the battle against evil and harmful supernatural forces causing illness. Effect of changing the mental state of the patient- a form of faith healing or psychotherapy

Personal spiritual functions - hallucinogens may contribute to the development of religious awareness. Common religious theme in shamanic trances.

Andrew Weil on hallucinogens and social controls

Weil applies Zinberg's theory to use of hallucinogens by Amazonian indians and apply that the indians have no problems with this :

5888. The drugs are used in their natural forms, not refined drugs

5889. They consider the human desire to periodically experience altered states of conscicious to be normal, not deviant.
5890. The taking of hallucinogens is usually under the supervision of an experienced user, such as a shaman
5891. The use of hallucinogens is highly ritualised. Avoids negative effects by ' establishing a framework of order around their work.
5892. Hallucinogens are not taken for negative reasons but for positive reasons.

- Weil argues that indian do not appear to have any problems with hallucinogens

A critique of weil : weil claims that drug use is not linked to antisocial behaviour and is therefore a romantic view of the absence of social conflict in amazonian tribal societies. Shamans are seen as key figures and use their magical power in conflicts - Timothy krab ; War of witches.

Hallucinogens in the west

Lyserigic Acid Diethylamide ( LSD) first synthesised from ergot by Dr. Albert Hofmann

From Hoffman to Hubbard to Huxley

23. He ingested some LSD and experienced vivid hallucinations and started it on himself and volunteers

24. It was claimed that it could be used to investigate schizophrenia
25. Dr. Ronald Sandison gave some LSD to Alfred M hubbard - former intelligence officer and millionaire
26. Hubbard gave Aldous Huxley his first LSD experience . Hubbard ordered 43 Cases of LSD from sandoz and became a LSD missionary ( 1955)

CIA AND LSD

1942 - General Bill Donovan, launched a speech inducing drug

5888. Initial OSS experiments showed it was too inconsistent for use in interrogation : OSS volunteers had to be weaned off it. Marijuana extract referred to as Truth Drug
1951 - CIA launched a new secret program in search of a miracle drug operation called antichoke. Psychoactive properties for looked for. LSD was chosen as promising

1950s research fianced by CIA found that LSD produced transitory psychoses and symptoms that were similar to schizophrenia called a "psychotomimetic drug" - CIA also financed 15 experiments in 15 prisons and mental institutions using inmates as guinea pigs.

1953 : Artichoke program by new CIA secret drug and mind control program called MK-ULTRA. Went through normal experiments and LSD would cause people to act strangely in public; in normal lives e.g in CIA annual party ( LSD in the punch) .

George hunter white would slip LSD to observe their behaviour.

1955 : white initiated operation midnight climax. Prostitutes hired to pick up men and bring them back to CIA- financed brothel. Fed drinks laced with LSD while white watched behind two- way mirror, sipping martinis - continued until 1963.

Army testing of LSD on soldiers

23. LSD found to be more useful for interrogation as an anxiety producing drug. LSD used as an interrogation aid from 1950s to 1960s.
24. Late 1950s US army considered LSD in aerosol form as a madness gas which could disorient enemy populations.

Moral entrepreneurs : Huxley

Aldous Huxley experimented with mescaline under supervision of psychiatrist Osmond. Describing experience in The doors of perception - perception of flowers, books and furniture described in terms of " a sacramental vision of reality" and "inner light"

Huxley's theory and the function of the brain was eliminative - it acts as a screening mechanism " to protect us from being overwhelmed and confused by the mass of largely useless and irrelevant knowledge". Hallucinogens by-passed this screening process, intensifying visual impressions, heightened the perception of colour, dissolving the ego.

Huxley and osmond on terminology

Huxley and Osmond argued that terms "hallucinogen" and "psychotomimetic" were inappropriate because it implied negative states. Osmond coined the term "psychedelic" as " mind - manifesting" implying that the drug elicits whatever is latent in the unconscious.

Moral Entrepreneurs : Leary and Ginsberg

Dr Timothy Leary

1954- 1959 - director of clinical research

1959- appointed to harvard where he experimented with psilocybun and conduced experiment with theology students who reported to experience religious experiences when taken shrooms.

1960 - leary introduced sacred mushrooms to poet Allen Ginsberg.

Huxley made this research quietly , in contrast to that leary and Ginsberg wanted to take it to masses. Utopian fantasy of biochemical world revolution. Arthur Koestler on sacred mushrooms: "i solved the secret of the universe last night but this morning i forgot what it was" .
Leary and Alpert were accused of conducting research outside the medical model and were dismissed from harvard in 1963. But notoriety helped popularise leary and psychedelics. Leary coined phrase " Tune on, tune in and drop out" .

After leaving Harvard, leary and Alpert retreated to a mansion called Millbrook. Psychedelic commune with 30 other people, it had a fairy tale atmosphere.

Millbrooke atmosphere was important to leary as it had proper "set" and "setting" to achieve euphoric, religious experience with the aid of Pyschedelics, where as CIA labelled LSD as a psychotomotic drug.

LSD is neither inherently transcendental nor anxiety - producing. It simply amplifies existing psychic and social proclivities within the individual .

LSD banned - Black Market boom

In 1963 - LSD classified by FDA as "experimental drug" all uses has to be approved by FDA

23. 1966 – LSD became illegal in the USA
24. Last LSD research project ended in 1975.
25. DRUGS ABUSE WITH NO MEDICAL VALUE
26. Making it illegal only made it popular and the black market developed an intensive demand for LSD.

Moral Entrepreneurs : - head for making it illegal - Kesey

5888.
5889. First experience LSD as MK-ULTRA subject
5890. assessed psychedelics in mental asylum where is worked.
5891. Band of LSD heads called the "Merry pranksters" toured US in a psychedelically decorated bus.

Politicisation of LSD

- In 1964: Kesey's scene began to attract people from Berkley Free speech Movement. The start of politicisation of US campuses, and politicisation of LSD. LSD and marijuana became a form of protest against authority and therefore increased tension between the activist and hippies. Leary - " The choice is between being rebellious and being religious".

Psychedelics and Counter- culture aesthetics

23. Haight - ashbury in San Francisco as centre of psychedelic lifestyle- LSD was sold on a mass scale.

Beatles expressed the psychedelic ideals and aesthetics. Timothy leary claimed the beatles " prototypes of revolutionary agents sent by GOD with a mysterious power to create a new species".

1969 - Woodstock music festival as apogee of the psychedelic revolution and counterculture.

The decline of Psychedelics

New drugs hit the market and the hippies were coming in with a different attitude more focused on sex and the rebellion but didn't share religious ideas of peace, love and transcendence of bourgeois ideals.
5889. LSD on the black market: tainted supplies, controlled by mafia
5890. Manson murders attributed to LSD.
5891. the events had undermined the psychedelic subculture. The symbols had remained of their lifestyle as commercial exploitation of the symbols.

Key points from the lecture.

• The relevance of Zinberg's theory of set and setting determining experience of drugs.

5888. Himmelstein's theory of moral entrepreneuers in shaping the way a drug is seen in society.
5889. Different approaches to describing drugs in society - psychedelic drugs in west compared to anthropological accounts of shamanic use of hallucinogens.
The scientific approach we use to studying drugs determines what we look for and, to some extent, what we find. Research that looks only for public health harm or biomedical benefits associated with drugs will never capture religious , spiritual, transcendental striving that many people ae looking for they use drugs and it was this scientific bias that researches like Hukley, leary and Alpert were trying to rebel against.

Lecture 3 - Cannabis

23. Botanical names - cannabis saliva and Cannabis Indica

24. Main forms - Marijuana, sincemila , hashish, hashish oil ( high potency) and hemp.

History of Cannabis

5888. originated in central Asia

5889. Mentioned in ancient medical and religious Chinese and Indian texts.
5890. In the west cannabis was initially used for practical purposes - as hemp fibre ( for sails and ropes)
5891. W.B.O Shaughnessy is credited with introduction of medical use of cannabis. Between 1842 - 1900 over 100 reports published on therapeutic qualities of cannabis.
5892. Recreational use in the west:
23. French Hashish club ( Baudelaire and Gautier, 1843)
24. Hashish bars in Europe and USA ( 2nd half century).

Symbolic Dimensions of Cannabis Legislation

Himmelstein ( From killer weed to Drop- Out Drug):

-" Moral entrepreneurs" : Moral crusaders who play a key role in drug legislation by influencing public images of a drug (e.g Harry Anslinger)

5888. Social locus : the social position (e.g. class, ethnic, generational) position of the drug users

5889. "Symbolic politics" - drugs and drug prohibition as "symbolic counters in wider social conflicts". Drugs as political scapegoats.

Cannabis (ganja) in jamaica and class conflict :

- Introduced by indian labourers in 1830s and quickly spread to black population.
1. Ganja : a scapegoat for elite and middle - class anxieties about deviant behaviour ( crime, violence, laziness) of poor working class

2. In 1937 Anslinger pressured British colonial authorities in jamaica to introduce mandatory minimum sentences for cannabis possession.

Rastafarianism

. Founded by Marcus Garvey: political activist and black rights in Jamaica, England and USA.

. Belief in black messiah: Emperor Haile Selassie ( Ras Tafari Makonnen) strict rules of conduct ( no alcohol, gambling, cutting of hair).
. Cannabis ( kaya) as a sacred herb.
. Symbolic politics : a colonial authorities considered: Rastafarianism dissident movement and a threat to social stability.
. The suppression of cannabis was synonymous with keeping down Rastafarians.

Cannabis and inter-generational conflict ( Himmelstein)

0. In USA the public image of cannabis/ marijuana had changed from a drug violence to a "drop out" drug linked to "amotivational syndrome"

1. " Social locus" - of use changed to middle class youth.

" Symbolic politics" - cannabis a symbol of conflict between generations.

- The social characteristics of the counterculture, as perceived by the dominant society, were projected on to marijuana and then claimed to be the psychological effect inherent in the drug".

Cannabis Legislation

Prohibition: Moves made in the 20th century to prohibit cannabis as a dangerous narcotic: 1 . Geneva convention Dangerous Drugs act 1925.
. Individual country legislation : Great britain, 1928; Australia 1928; USA 1937.
. Single convention on narcotic Drugs, 1961.

Legal Status of Cannabis in the U.S.

Since 1970 twelve states in the US have decriminalised cannabis. 18+ Washington, D.C. have legalised " medial marijuana" use.

- November 2012 : 2 states ( colorado, washington) legalised cannabis for recreational use… but this is at odds with federal laws and will be bought out in the court.

Cannabis Legalisation : Australia

- Since 1987 all Australian states have decriminalised cannabis ( for possession of small amounts) through systems of fines or cautioning.

Cannabis Legalisation : Netherlands

- "De facto legalisation" since 1976. Non- enforcement policy for sale in coffee shops. ( Dutch police were more likely to enforce anti- smoking bans than cannabis bans)?

Gateway theory

Theory that cannabis use in adolescence leads to the use of more dangerous "hard" drugs ( e.g heroin)

David Fergusson and John Horwood: Classic articulation of the Gateway theory in 2000. " Does cannabis use encourage other forms of illicit drug use"

Processes independent of socio- economic background:

0. Cannabis provides a blueprint for experimentation with other illicit drugs, reducing inhibition for further illicit drug use.

1. Existence of factors and processes that encourage both cannabis and other illicit drug use "common factor" explanation. - Availability
2. common or correlated genetic factors that may increase the risk of various forms of illicit drug use ( " neurochemical" explanation - genetics)

Gateway theory often used as argument against decriminalisation or legalisation of cannabis. BUT critiques of Gateway Theory point out:

0. Almost all hard drug users first used cannabis however temporal precedence cannot be equated with casualty.

1. Research shows only small proportion of those who use cannabis go on to use heroin.
2. There is a " reasonably strong association between regular and early cannabis use and other illicit drug use" ( Hall and Lynsky).

Major Adverse health and psychological effect of Cannabis use.

5888. Anxiety, dysphoria, panic and paranoia.

5889. Psychomotor impairment and risk of injury.
5890. Increased risk of low weight babies during pregnancy
5891. Respiratory diseases
5892. Cancer link
5893. Cannabis dependence syndrome
5894. Cognitive impairment
5895. Psychosis ( including Schizophrenia).

Cannabis and Psychosis

-Cannabis use exacerbates the symptoms of schizophrenia

23. Cannabis use precipitates schizophrenia in people who already have a history of personal or family history of schizophrenia.
Young cannabis users who begin use at an early age and subsequently use cannabis regular expose themselves to an increased risk of experiencing psychotic symptoms.

Can you overdose on Cannabis?

short answer - it is nearly impossible as the acute toxicity of cannabinoids is very low. -BUT that does not mean that cannabis users do not end up in emergency rooms due to
5888. psychomotor impairment while driving
5889. Heart attack ( cannabis raises heart rate 25% - 50% and raises blood pressure - not a problem for young healthy users but potential danger to at risk populations).

Philippe Bourgois on U.S political economy of cannabis

The mystery of why marijuana is so severely repressed by law enforcement should be especially humbling for public health researches in the US and for the field of science studies more broadly.
5889. " Objective scientific evidence" - does NOT shape drug policy , media coverage and popular opinions.
5890. Medical, epidemiological and scientific evidence that cannabis consumption is less risky than alcohol use.
5891. Yet in the 2000s, U.S spent over $4 billion a year arresting people on marijuana charges
5892. Despite ( or perhaps because of ) law enforcements efforts, hip-hop culture defiantly celebrates marijuana and this probably represents a public health boon.

Bourgois says that hip hop cultures celebration of cannabis is a public health boon because there is a good possibility that increasing marjiuana use has decreased use of more dangerous drugs, particularly crack cocaine and heroin.

5894. ' The greatest harm caused by marijuana comes form the collateral damage of its illegality"' Criminalization leads to an increase in profitability of marijuana

5895. criminalisation also leads to an increase in the violence surrounding trafficking.
5896. prison terms for sellers punish the poorest members of the society, who then have a hard time getting jobs after prison.

Legalisation of Cannabis?

the removal of criminal penalties for personal possession does not increase use of marijuana or more dangerous drugs

- although MacCoun and Reuters predict that legislation would increase prevalence and possibly intensity of use and encourage aggressive commercial promotion.

Lecture 4 - Sacred Tabacco

Tabacco

23. Used in different contexts in Europe and Native America

24. European culture : intent on trade and colonising new worlds. Europeans took tobaccos and made a commercial product out of it.
25. Native Americans: Domesticated tobacco and made a sacred drug out of it.

All plants in including corn, peanuts, vanilla and tobacco have pituri common.

Pituri

Aboriginal people used nicotine prior to European discovery.

5888. local species of Nicotiana
5889. some used a nicotine- containing plant called Duboisia hopwoodii
5890. Drug made from it called "pituri" - high nicotine content.
5891. alkali ash used to enhance action of the drug.
5892. used for shamanistic purposes to achieve altered state of consciousness
5893. effects ranging from euphoria to stupor and catalepsy.

South American Varieties of tobacco that became dominant:

23. Key varieties of tobacco came from south america.

24. Rustica tobacco produced largely for insectide and "Turkish cigarettes"
25. Tabacum is milder than Rustica , now more dominant - Indians of south america domesticated the tobacco and grew it.

Nicotine

5888. main tobacco ingredient
5889. Pure nicotine : a clear oily liquid. A single drop is fatal.
5890. Have to smoke about 400 cigarettes all together to get a fatal dose ( Nick Modjeska's calculation).

Measuring addictiveness of nicotine

23. it is more addictive than heroin

24. Measure is by seeing how many people give up a drug and are still clean after a year, heroin addicts are more often clean

The problem with this way of measuring is that ?

5888. It is a lot easier to buy tobacco than heroin
5889. cigarettes are less stigmatised than heroin , more widely used.

Another way of measuring is : The addiction severity index.

only 7 percent are still clean after a year .

Withdrawal symptoms include : uptight , fidgety, anxious, irritable.

Two main types of tobacco :

Nicotiana tabacum and Nicotiana rustica

Originated from wild species in Boliva, peru and Ecuador , over 50 wild species. How is it prepared ?
24. Cured and fermented and aged before smoking , native americans dried tobacco leaves over the fire.

How Native americans used it

- Columbus found the natives used it for healing by blowing it over body parts

Other techniques - blowing smoke, tobacco chewing, some tribes : men take turns blowing dust up each others nose and drinking the juice, rubbing over skin or enema. -Drinking the juice cases body trembles, vomiting and then sleep or semi unconsciousness.
-Indian shamans also achieved this by smoking large cigars
- Traditionally the use was mainly to put the smoker or drinker into a deep sleep.

Pharmacology

5888. Nicotine stimulates production of neurotransmitters :

5889. Dopamine, serotonin and noradrenaline.

5890. Tobacco inhibits the production of enzyme MAOB which breaks down dopamine - thus dopamine levels rises.

Range of reactions for smokers:
5891. calm relaxation
5892. stimulation and euphoria
5893. high doses : Severe stimulant effect, leading to hyperactivity, vomiting, trembling and convusions.
5894. Extreme high doses - make you pass out.

5895. Reaction depends on dose, environmental conditions, and mood and personality of user.

Effects on hearts

23. Blood vessel constriction

24. increases concentration of triglycerides and cholesterol in the blood
25. Stimulates components of the blood clotting process
Carbon monoxide combines with haemoglobin to form Carboxyhaemoglobin. Reduces oxygen carrying capacity of blood, making the heart work harder and COHb is very stable and takes a long time to break it down.

Result : huge increase to mortality from heart attacks amongst smokers.

Possible benefits of smoking

5888. Reduces anxiety and stress

5889. Aids in sociability : not because of the drug , but because of rituals.
5890. Promotes alertness
5891. Relieves discomfort and pain
5892. Reduces weight loss
5893. Also somewhat relieves the symptoms of Parkinsons, Alzheimers and Tourettes.

Tobacco and Shamanism
23. Tobacco is not a true hallucinogen. Shamans used " tobacco narcosis" to reach the spirit world

24. smoked throughout the Newworld for ritual purposes
25. Plains indians did NOT smoke themselves into unconsciousness; puffed on the peace pipe and passed it around; regarded as a sacred drug and act.
26. tobacco to native americans: equivalent of grapes to christianity as without it there could be no communion with the divine.
27. Tribes who knew of real hallucinogens sometimes mixed it with tobacco to get a combined effect.

What is Shaman?

Wilbert uses the expression " Shamanistic ecstasy"

Etymology of Shaman: from Russian; Russians got it from indigenous people Siberia- a people called the Tungas, who had a a well established magical tradition of shamans who entered the spirit world to find out why people were sick.

. Shamans of siberia didn't have tobacco - got their high through controlled breathing.
But shamanistic idea of getting into the spirit world and fixing things up DID spread from siberia down into the Americas, all the way down to Patagonia and Tierra del Fuego.
After about 1700, smoking for pleasure because more and more the norm for Native Americans, and smoking for trance and spirit communication purposes became less and less commons.

Enthnographic account of a Shaman's use of tobacco from Wilbert

This is not a pleasurable drug, but one that is necessary for obtaining knowledge about the spirit world.

The Warao

-Warao Indians of the Orinoco Delta in eastern Venezula

. 15,000 people speaking the Warao language in Venezula, Guygana, Suriname.
. Very isolated people at the time that Wilbert was there in the 1950s.

Shamanism and tobacco among the Warao

. Have three different kinds of Shaman who use tobacco for both curing an causing sickness

. Tobacco essential in inducing ecstatic trance experiences.
. Everyone smokes, but long indigenous "cigars" used only by shamans
. Priests or shamans in the Warao visit the spirit world regularly. They use no other drug substances than tobacco.
-" Light" shamans maintain a bridge of tobacco, smoke with the bright part of the spirit realm; bridge must be constantly renewed by shamans smoking
. dark part of the spirit world sends out a blood siphon at night
. tobacco smoke : proper food to give to good spirits, and proper seance medicine to see the bad spirits, which cause most illness
. Novices become shamans by becoming culturally conditioned for a specific ecstatic experience.

Wilbert's Conclusions :

. Tobacco smoke used both healing and sorcery ( both good and bad) in many Native American Cultures

Before columbus ( pre- columbian), tobacco was mostly smoked for medical and magical purposes, in post columbian American, Virginia tobacco was smoked increasingly for pleasure.

Not a hallucinogen buts its role in shamanism in the Americans is very similar to that of hallucinogenic/ psychotrophic plantts. Difference is that with more psychotrophic drugs you are hallucinating while awake; with tobacco, you hallucinate while unconscious.

What the shamans sees is a " non- ordinary reality" - this is a term coined by Carlos Castaneda to speak of things that other people see and which are real to them, but which may not be seen and perceived by others who are not trained to se and perceive them.

Parallels between shamanism in the Americas and Siberia are so numerous and extensive that Wilbert believes it must have been a single intellectual tradition that spread and travelled over the continent and across the Bering Straits.

Wilbert proposes that for a tradition to spread so far it would have to be very old and to have spread for a very long time- he estimates 15- 20,000 years for tobacco being domesticated and spread throughout the americas.

Downbeat conclusion : Between the missions and the traders, the chances of the Warao keeping their traditions and continuing to smoke tobacco in this sacred way are pretty minimal.

Lecture 5 : Ethnographies of Drug use.

What is Enthography

Definition: The process of observing, recording and describing another peoples way of life ( culture) through " participant observation" of the community studied.

What is meant by " participant observation"

. Ability to communicate in the local language

. Residence in the community - to live in the area
. Participation in everyday activities and frequent interaction with informants within the community over a long period.
. Direct observation of subjects in natural settings - in the natural setting of the drug user.
. Focus on informal, unstructured interviews with a small number of informants.
. Establishments of relationships of trust with informants.

How do ethnographies of drug use differ from other social science approaches ?

- Do not start from the assumption that the behaviour of drug users is determined by the chemical properties of the drug.

Zinberg's critique of " Pharmacomythology"

According to zinberg, the effect of a drug on an individual depends on the interaction of pharmacological psychological and social variables.

. " Drug" : the pharmacological action of the substance itself.
. "Set" 'the attitude of the person at the time of use including his personality structure'
. " Setting" : 'the influence of the physical and social setting within which the use occurs'

Zinberg on " controlled drug use"

"Setting" and social controls

. "Rituals" " 'Stylized , prescribed behaviour surrounding the use of a drug'.

. 'Sanctions'

. ' formal laws and policies regulating drug use'
. 'informal and often unspoken values or rules of conduct shared by a group'

Social Sanctions among illicit drug users in Perth

. buying drugs from a known dealer

. don't use drugs during the week
. don't use drugs with strangers
. seek advice from a experienced drug user when in doubt
- consume only a small amount of a drug in case of first users, when trying a new batch of a drug or when buying from a new dealer.

" David moore" social controls, harm minimisation and interactive outreach .

Drug rituals - definitions by different authors.

. Zinberg: definition of drug rituals encompasses only functional aspects of drug use.

. Agar: rituals have 'special meaning' for the drug user
. Grund et al : symbolic dimension of front loading ritual ( Rotterdam heroin and cocaine users). - sharing ritual between users.

How do ethnographies of drug use differ from other social science approaches ?

. Don't start from the assumption that drug use in itself is an expression of psychopathology or mental illness

. Are critical of the assumption that the behaviour of drug users can be understood through a clinical setting :

. clinical samples are restricted to drug users in treatment or picked up by the legal system

. clinical research, based on formal surveys, removes drugs from their social context and tells us little about the everyday life, motivations and behaviours of drug users.

How do enthographies of drug use differ from other social science approaches?

Participant observation enables the researcher to have extended, on- going interaction with drug user over along period of time, which enable the researcher to:

. Throw light on the diversity of contexts and day-to-day variability of drug use.

. Making serendipitous discoveries of unanticipated forms of drug use and dealing.
. Uncover the meaning of drug use in social context.

Have access to "real" people and their "lived experience", allowing drug users to tell their own stories in their own words. By thus giving them a 'voice' anthropology humanises drug users and prevents their demonisation. (Sexed work; Gender , race and in Drug market).

Lecture 6 - Drug Symbolism

Manderson's Analysis of drug symbols

. D. Manderson ' Metamorphoses : Clashing symbols in the social construction of drugs'

We need to move away from the reasons for drug laws towards aesthetics i.e to consider ' the sensory reaction ( emotional reaction) provoked by drug images and the symbolic meaning of that imagery'.

Drugs and pollution - the view on hypodermic syringe (needle) a emotional response.

- Hypodermic syringe (needle) and aesthetic aversion - The needle as 'boundary violation' and pollution.

' Influence of anthropologist Mary Douglas: pollution as 'matter out of place'. Manderson : needle is 'metal out of place'.

Drugs and possession

. D. Manderson 'possessed: drug policy, witchcraft and belief'

. Theory and laws of property: ' possession' assumes humans actively appropriate and use passive things.
. Criminal laws of drug ' possession': mere proximity establishes a presumptive crime. The drug attaches itself to a person.
. Drugs are invested with a powerful agency. ' The crime of possession is the crime of being possessed'

Seductive power of drugs

- Chinese immigrants in 19th century. Australia : seductive power of opium. - Parallel with witchcraft beliefs of 16th and 17th century Europe.

-Witches - woman who had been seduced and possessed by the devil and believed to be a 'addicted' to the sexual pleasure. - Manderson" ' The devil, like the drug, or indeed the chinese opium pusher, seduces and destroys the will'.

Drugs and the loss of human rationality and autonomy

. Catholic Inquisition : proving the existence of the Devil to contest growing influence of empiricism and scientific rationality

. Modern Western thought : protecting the mind/body dichotomy. Primacy of reason and rationality. Humans as autonomous agents.
. Drugs challenge boundaries erected between mind and body and between rationality and irrationality.
. Prohibition and absolutism : fear of loss of human agency and autonomy.

Drugs : the irrational and the ecstatic

- Davenport - Hines : prohibition is the 'policy of idealist who cannot appreciate that the use drugs often reflects other sets of human ideals: Human perfectibility, the yearning for the perfect moment, the peace that comes from oblivion'. - " Pursuit of oblivion " A social History of drugs 2001.

' Double - sideness' of drug symbolism - the good and bad side of it rather than just negative.

- Manderson (1995) on the double meaning of drugs and drug objects (e.g. hypodermic syringe).

Drug fetishism: the law and the addict

-Both the law and the addict share a common obsession.

. 'Literalization the symbolic' . Drugs and fetishism.
Prohibitionist legislation: drugs as symbols of certain fears are treated as if they were the cause of those fears. Drugs become convenient scapegoat to displace these fears.

Drugs as Scapegoats for social anxieties and conflicts

- 19th cent. Australia : Anxiety about safeguarding the purity of Western ('White') identity. Opium as a cause of racial pollution. - Himmelstein ' from killer weed to drop out drug'. In the 'symbolic politics' of marijuana the drug was a scapegoat for:

a. fears about immigrant Mexicans (1920s and 1930s), and

b. middle- class fears about Counterculture and passivity of youths (1960s and 1970s). - drugs were seen as the magical reason to cause all this.

- Methamphetamines in Thailand; from a 'diligent drug' to a crazy 'crazy drug'.

- Meth : a scapegoat for elite and middle- class anxieties about deviant youth behaviour. " youth culture and identity "

Lecture 7 : From Tears to Hope.

Drugs used for three purposes

. Medicine
. Religion
. Recreational reasons

Lecture 8 : How and why Drugs work

What is a drug ?

. A substance used in the diagnosis , treatment, or prevention of a disease or as a component of a medication
. such a substance as recognised or defined by Food and drug Administration.
. A chemical substance, such as a narcotic or hallucinogen, that effects the CNS, causing changes in behaviour and often addiction

Problems :

. Herbal medicines ?
. Food that alter neurotransmitter levels
" there is not a legal or commonly accepted definition for drug".

Drug Information

. USE ( Main effect) : what disorder it is used to treat ( how it works)

. DOSE - what dose to prescribe depending on what it is used to treat
-CONTRAINDICATIONS - drugs or disorders that this drug should not be prescribed with/for. PRECAUTIONS: take care when using drugs
ADVERSE REACTIONS : unwanted effects.
SIDE EFFECTS - unwanted effects for one treatment yet may be wanted for another ( e.g sedative effects of antihistamines). INTERACTIONS - what drug interactions will occur
PACK- how the drug is packaged.
HALF LIFE- time to remove half of the active drug amount.

Therapetic Vs Lethal dosing

ED50 : Dose at which 50 percent of population found drug to be effective - Therapetic (intended) dosing

LD50: Dose at which 50 percent of the population found to be Lethal - keep below this dose

Drug Potency - ability for drug to take effect ( how much is needed) Drug toxicity - potential to do irreversible harm to body functions
- poisons or excessive amount of any substance

Each drug as a 'Therapeutic index ( margin of safety) - Difference between LD50 and ED50.

High therapeutic index - large margin for dosing, difficult to harm patient.

Low therapeutic index - little margin for dosing, easier to overdose.

Human physiology : Pharmacokinetics

Pharmacokinetics : what happens to the drug once it has entered the body (fate)

Drug effect is modulated by

. Absorption ( bioavailability - routes of administration)

. Distribution - blood flow, tissue permeability
. Metabolism ( biotransformation ) - liver, enzymes in tissue
. Excretion - kidneys, lungs.

. Pharmacokinetics determined by chemical properties of the drug e.g lipophilicity ( soluble in lipids (fats) all cell membranes)).

Absorption

Drug pass into blood circulation

Bioavailability - fractional extend of drug which reaches its site of action routes of drug administration

. Tropical applications - transdermal and eye
Oral - first pass metabolism through the liver -Pulmonary absorption (inhalants)
. subcutaneous ( under the skin, diabetes) .
. Intraperitoneall
. intramuscular
. intravenous

Drug absorption

Oral administration ( Enteral)

Absorption pattern is variable , it is convenient and economical and safe.

However patient co-operation is needed

. not used for drugs that are poorly soluble, slowly absorbed, unstable , or extensively metabolised by the liver.
. Emesis due to irritation of gastric mucosa

Sublingual - good for high lipophilic drugs - they dissolve quickly through mucosa to vena cava.

Rectal - 50 percent will bypass liver- very good when patient can not take drugs orally ( vomiting, unconscious). There is irregular absorption and many drugs irritate rectal mucosa.

Injections ( Parenteral)

Intravenous

. limitations reduced of absorption
. immediate and accurate effects
. permits titration of dose
. increased risk of adverse effects and overdose.

Subcutaneous

. prompt action from solutions, slow release from repository preps
. good for insoluble suspensions and solid pellets.
. can't use with large volumes, may cause necrosis.

Intramuscular

. prompt action from solutions, slow release from repository preps
. good for moderate volumes
. can alter distribution by changing blood flow to area ( massaging of the arm) and is not ideal in obese patient.

Inhalants

. use of gas exchange at lungs - very fast access to the circulation
. avoid hepatic first pass
. good for pulmonary disease ( asthma) - local effect.
Mucous membrane application

- Nasal, vaginal, colon, urethra - for local effects ( e.g. decongestants)

Directly into cerebrospinal fluid ( brain and spinal cord)

Intrathecal ( epidurals)

- inject directly into the subarachnoid space ( spinal ages)

Intracerebroventricular ( intraventricular)

- inject directly into ventricles (brain tumours)

Drug Absorption

From blood to brain .

Crossing the Blood Brain barrier

- Brain capillary endothelial cells have continuous tight junctions

only high lipophilic drugs can cross ( phospholipid membrane) from blood capillaries to cerebrospinal fluid (CSF) -- this can benefit if no centreal effect is desired

. All drugs that reach the brain effect the rest of the body ( unless locally applied - intrathecal/ or intercerebroventricular)

. many drugs used ( or abused) in pyschopharmacology increase or reduce communication in the brain
. Brain cells communicate with other brain cells by NEUROTRANSMISSION.

Types of Brain Cells.

Neurons - main cells that coordinate brain function

Glial cells - astrocytes and oliogdendrocytes - support neurones
Ependymal cells - line the CSF- filled ventricles ( neurogenesis)
Microglia - remove dead or generating neurones or glia ( phagocytosis)

Neurons

4 main parts to a neuron

. soma ( cell body) - houses nucleus dendrites - they receive information -points out like tree branches axon - sends information from one end to another presynaptic terminals - to another neurone. - lots of branches with swells at base of axon. Contains neurotransmitters -Axon + dendrites = Neurites.

Neuron network

- human brain starts with approx 100 billion neurones , hugh network for communication and complex processing.

Neuron communication

. Electrical communication : Gap junction (electrical synapses between cells)

. Chemical communication - synaptic cleft ( chemical synapses)

Chemical communication = neurotransmission.

Dendrites receives and passes cell body or soma and sends a electrical signal down which is called a action potential and the neurotransmitter is released.

Neurotransmission

. Action potential triggers release of neurotransmitter from presynaptic terminal

. NT binds to receptor on post synaptic cells
. Bound NT causes a change in post- synaptic dendrite
. NT released from receptor
. NT transported back into pre-synaptic cell or metabolised in synapse.

Major roles

. Glutamate - major excitatory NT - learning and memory ( Neuroplasticity and excitotoxicity)

. GABA - Major inhibitory NT , modulator of many processes
. Dopamine - short term memory, strategy and planning, reward and movement
-Acetylcholine - memory , perceptual learning, movement and REM sleep
. Serotonin - cognition, emotion and reward
. Noradenaline - attention, fight/ flight and sleep.

How to neurotransmitters communicate with the next neurone?

. They communicate via receptors

. Release of a neurotransmitter binds to a receptor to tell the next neurone what to do.
. Allows for sophisticated ( and quite complex) transfer of information
. Appropriate behavioural output to an environmental stimulus

We can use drugs to change this transfer of information

. improve disorders
. stop pain
. produce euphoria!

There are heaps of receptors ! allows fine-tuning of cell communication

Receptor Pharmacology

. Activation of some receptors stimulate neurones
. Activation of other receptors inhabit neurones

Agonist are drug 'keys' that unlock the receptor 'door' - They act like the neurotransmitters to open the door

Antagonist are drug 'keys' that fit the lock but can't open the 'door' - They compete with neurotransmitters for the keyhole.

Affinity Vs Efficacy

. Affinity - the attraction that a drug has for a receptor site

. Efficacy - the ability for a drug to induce a response once bound to the receptor site

Agonists have affinity and efficacy

Antagonist have affinity but not efficacy

Negative Drug Interaction : Antagonism

. The effect of one drug ( or neurotransmitter) minimised or abolished by another

. Receptor block 'competition' antagonism ( most common) , it is reversible and irreversible
. Non- competitive antagonism ( block occurs IN neurone or cell, not at receptor site)
. chemical antagonism
. pharmacokinetic antagonism
. physiological antagonism.

Chemical Antagonism

Two substances may mix in solution before administration

. Activity of drug is lost
. uncommon

Pharmacokinetic Antagonism

Once drug has entered the body its activity is reduced

. interaction with other medication/ ingested compound
. broken down by gut and liver enzymes - cytochrome P450 cycle

. Fast pass metabolism

. oxidises drug ( adds an oxygen atom to drug - inactivates)
. Liver : CYP1, CYP2, CYP3 enzymes
-CYP1A2 oxidises caffeine
. CYP2C9 oxidises ibuprofen
. CYP2E1 oxidises alcohol - ALSO needs alcohol dehydrogenase

Physiological Antagonism

The physiological effect of two administrated drugs counteract each other

. ingest alcohol - leads to stupor at high doses
. ingest meth - increases motor activation
. ingest both alcohol and meth - alcoholic stupor requires greater alcohol consumption , meth counteracts the effect of alcohol.

Positive Drug interactions : Agonism

- The effect of one drug ( or neurotransmitter) increased by another

-Additive : sum of the effect of each drug to get the double effect

- Synergism - one drug potentiates the effect of another ( more than addictive)

Example of synergism

. Long term anxiety in rats after binge treatment of Saline ( control) , alcohol , meth, meth combination with alcohol

. measured on elevated plus Maze
. MA/EtOH treated animals show synergistic effect. ( meth and alcohol)

KEY POINTS.

- Drugs are substances introduced to the body that change regular functioning.

The effect of the drug is modulated by

– Absorption
– Distribution
– Metabolism
– Excretion

-Most drugs increase or decrease communication within the brain.

-Brain communicates via a process of neurotransmission -Some drugs act as AGONISTS and magnify normal effects -Some drugs act as ANTAGONISTS and prevent normal functions
-Mixing drugs can have positive or negative interactions (eg: Meth + Alcohol)

lecture 9 drugs of Abuse

Many substances are abused by humans including :

0. narcotics
. consciousness - altering drugs
. depressants
. neuroleptics
. pharmaceuticals

stimulants - Arouses or accelerates activities

. cocaine
. amphetamine
. Amphetamine derivaties - meth derivaties
. Methylphenidate
. Mepedrone
. Nicotine ( tobacco)
. Caffeine
Psychostimulant - stimulates the brain .

Major effects of stimulants short term
. euphoria and well being
. increased alterness
. increased self confidence
. increased energy
Ecstasy (MDMA) & Mephedrone (Miaow) are also ENTACTOGENS (touchy feely) promotes closeness to others

Cocaine and Amphetamine

. Amphetamines affect similar regions to cocaine

. Both increase dopamine transmission in the nucleus accumbens (NAc)
. Striatum - stereotypy (repetitive movemet)

Nicotine

. Quick to cross BBB - reaches brain in about 20 secs
. Half - life is about 2 hours
. Nicotinic receptors - Acetylcholine
. Increase dopamine release in the NAc

Caffeine
Water and lipid soluble

- peaks in blood stream within 1 hour

caffeine is a competitive antagonist for Adenosine receptors

- these interact with the dopaminergic system

Metabolised in the liver by the cytochrome P450 enzymes Variable half life

- 4.9hrs to 15 hours.

Side effects of stimulant use

Acute ( short term)
. seizures
. Depression and anxiety
. Psychosis

Chronic ( Long term)

. anxiety
. paranoia depression -psychosis
. Neurotoxicity

Nacrotics : induces narcosis - sleep or stupor = numbing

- opium, heroin , morphine , methadone, codeine.

Major effects of opiates

. Euphoria and well being
. drowsiness
. relief of pain.

Opiates

- Activation of mu opiate receptors directly act in the NAc AND indirectly stimulate dopamine release in the NAc by cells in the VTA (mu and delta opiate receptors)

Opiates stimulate opiate receptors and increase dopamine in NAc

Opiates ( Morphine) opiates bind to :
. cortex : movement / sensory
. cingulate cortex ; judgement
. thalamus and spinal cord: pain centre - analgesia.

Side effects of opiate use

. Chronic constipation

. Tolerance and withdrawal - symptoms and stop use
. coma / death from OD due to low tolerance
. coma/ death due to mix with depressants.

Consciousness- altering

Hallucinogens/ psychedelics - produce hallucincations - LSD, DOI, PCP, magic mushrooms, marijuana.

Pharmacology of Cannabis

. active constituent of cannabis is D9 Tetrahydrocannibional ( THC)

THC binds to cannabinoid receptors to increase DA release in the NAc. -Cannabinoid receptors : CB1and CB2.
. Anandamide is the natural 'endogenous' ligand for receptors.

Effects of cannabis

. cortex : motor / sensory

. cingulate cortex : judgment
. hippocampus - blunts memory
. cerebellum - blunts motor coordination.

Neuroleptics

Neuroleptic/ Antipsychotic : literally to seize neurons- to control abnormal neuron activity - Anti- schizophrenic e.g chlorpormazine
-Anti- depressants. ( tricyclic's like imipramine)

Depressants

Depressant - depresses activity

. Benzodiazepines
. Barbituates
. Alcohol ( stimulant at low doses)

Effects of Depressents

Used to treat
. anxiety
. insomnia
. pain relief
. muscle relaxation

Facilitate GABA

Reduce Glutamate.

Side effects of Depressants

. Cognitive impairment

. Memory impairment
. Dissociation
. Respiratory depression
. Decreased BP and Heart Rate
. Aggression.

pharmacology of Alcohol

. GABA-A receptor agonist

. NMDA glutamate receptor antagonist
. Modulates opioid peptide systems
. Increases Dopamine release in the Nucleus accumbens.

Lecture 10 - Reward and drugs

Reward = positive reinforcement

initial exposure to certain drugs will produce feelings of reward
. Elation
. Excitement
. Relaxation

Usage reinforced - becomes a drug of abuse.

Reward pathway : Dopamine (DA)

The mesolimbic dopamine system

Ventral Tegmental area - VTA.

Nucleus accumbens - NAc - all drugs of abuse increase dopamine here

Reward and Dopamine

. Increased DA in the NAc makes a substance rewarding
. natural rewards ( sex, food, nurturing) also increase dopamine in the NAc.

Self- stimulation and Drug self administration

Rats will self stimulate ( electrically) - Median forebrain bundle
( dopamine fibres of passage)
. nucleus accumbens
. Lateral Hypothalamus.

. Rats will self - administer cocaine until death ( 90%)

. heroin is less toxic at 36 percent deaths

Rewarding effect of cocaine is blocked by:

- Dopamine antagonist.

Dopamine and addiction

. What makes a substance addictive ?

. Speed and magnitude of increased dopamine in the nucleus accumbens RUSH which is determined by
0. potency of the drug
. route of administration - oral ( less potent) , subcutaneous, intramuscular, intranasal , inhalation intravenous ( most potent)

Dopamine = reward

. lead to the hypothesis that if dopamine causes the sensation of reward then it is responsible for addiction to abused substances " Dopamine Theory of addiction".

One limitation ( of several) of the Dopamine theory of addiction

. adverse stimuli such as stress of handling, electric footshock, tailpinch or aggressive attacks in animals increase dopamine neurotransmission.

Other limitation of dopamine theory of addiction

. Mice lacking the dopamine transporter will still self- administer cocaine

. individual differences - all drugs increase dopamine but only a small percent of people become addicts

Diagnostic and statistical Manual of Mental disorders ( DSM-IV)

- Until last year DSM-IV- had categories for substance Abuse and substance dependence.

Problems with DSM-IV

. physical dependence vs 'drug dependence'
. compulsive drug seeking vs normal side effects of medication
. Evidence for 'substance abuse category
. Non- pharmacological addictions.

DSM-V

. change back to term 'addiction' - addiction and related disorders

. Different sub-types based on drug - alcohol and cannabis use disorder
. inclusion of a behavioural category - like gambling
. able to rate severity of the addiction
. Removal of substance abuse category, however there are now diagnostic criteria for intoxication and withdrawal.
. Inclusion of caffeine in intoxication and withdrawal categories.

DSM-V Example

alcohol use disorder

- problematic pattern of alcohol use leading to clinically significant impairment or stress by at least two of the following occurring within a 12 month period.

. Alcohol is often taken in larger amounts or over a longer period than was intended

. There is a persistent desire or unsuccessful efforts to cut down or control alcohol use
. A great deal of time is spent in activities necessary to obtain alcohol, use alcohol or recover from its effects.
. Craving, or a strong desire to use alcohol
. Recurrent alcohol use resulting in a failure to fulfill major role obligations at work, school or home.
. Continued alcohol use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by alcohol.
. Important social, occupational, or recreational activities are given up or reduced because of alcohol use.
. Recurrent alcohol use in situations in which it is physically hazardous
Alcohol use is continued despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by alcohol.
. Tolerance, as defined by either of the following:
A need for markedly increased amounts of alcohol to achieve intoxication or desired effect.
. A markedly diminished effect with continued use of the same amount of alcohol.

11. Withdrawal, as manifested by either of the following

Alcohol intoxication

. Recent ingestion of alcohol
Significant problematic behavioural or psychological changes e.g inappropriate sexual or aggressive behaviour , mood liability etc C. One (or more) of the following signs or symptoms developed during, or shortly after, alcohol use: 1. Slurred speech 2. Incoordination 3. Unsteady gait 4. Nystagmus

5. Impairment in attention or memory
6. Stupor or coma

D. The signs of symptoms are not attributable to another medical condition and are not better explained by another mental disorder, including intoxication with another substance.

Alcohol withdrawal

A. cessation of ( or reduction in) alcohol use that has been heavy and prolonged

B. two ( or more) of the following, developing within several hours to a few days after the cessation of alcohol use described in A.

Autonomic hyperactivity (e.g., sweating or pulse rate greater than 100 bpm)
. Increased hand tremor
. Insomnia
. Nausea or vomiting
. Transient visual, tactile, or auditory hallucinations or illusions
. Psychomotor agitation
. Anxiety
. Generalised tonic-clonic seizures.

. The signs or symptoms in Criterion B cause clinically significant distress or impairment in social, occupational, or other important areas of functioning

The signs of symptoms are not attributable to another medical condition and are not better explained by another mental disorder, including intoxication or withdrawal from another substance.

Specify if: With perceptual disturbances: This specifier applies in the rare instance when hallucinations (usually visual or tactile) occur with intact reality testing, or auditory, visual or tactile illusions occur in the absence of a delirium

Drug dependence

physical dependence

. stop taking the drug produces withdrawal symptoms
. heroin - abrupt cessation causes sweating, goosepimples, diarrohea
. Alcohol and benzodiazepines ( valium) - hyper sensitivity to sound and light, anxiety, convulsions, coma and even occasionally death ( if withdrawal is too abrupt)

Pyschological dependence

- craving of the drug during abstinence.

Physiological components of dependence

Tolerance - loss of effect of a drug with repeated administration

Withdrawal - appearance of symptoms associated with termination of chronic drug use

- Neuroadaptive processes to counter the acute effects of the drug

A key element in the drug dependence is sensitisation :

. The increased response to a drug following repeated administration
. LONG TERM ( chronic) neuroadaptions which are manifested after repeated drug administration

Long term use includes : anxiety, paranoia, psychotic episodes

High incidence of relapse - intense cravings.

Addiction

- the state characterised by :

. A compulsion to seek and take the drug continuously or periodically
. inability to control intake
. Negative emotional state when access to the drug is denied

Often failure to function in society

. relationships breakdown - work, family and friends
. increase in crime rates to support habit
. big socio-economic problem

Addiction has both positive and negative reinforcement processes

3 part cycle of Addiction

- Binge intoxication

tolerance - social/ occupational activities compromised
- Withdrawal negative effect. sensation - preoccupied with obtaining drugs/ persistent problem -- preoccupation / Anticipation

Animal model of addiction

Binge intoxication

. Drug / alcohol self administration
. conditioned place preference

Withdrawal/ negative affect

. anxiety like responses
. elevated reward thresholds

Preoccupation/ Anticipation( Craving)

. Reinstatement ( replase)
. drug induced, cue- induced, stressed induced.

Reinforcement theories

Positive reinforcement theory :

. response in a situation becomes more common in future if it is rewarded
. similar to incentive- sensitisation theory.
0. problem with theory : not all addictive substances are pleasurable to begin with ( nicotine, caffeine).

Negative reinforcement theory:

. Repeat behaviour to escape unpleasant side effects
. " Prevention" similar to opponent- process theory
. Problem with theory : not all drugs that produce tolerance and withdrawal symptoms but don't have the compulsive pattern of use seen in other substances.

Incentive - sensation theory

. Drugs produce long- lasting changes ( neuroadaptations) in the brain
. the systems that are changed are involved in motivation and reward
. sensitisation of the dopamine system leads to incentive salience of drugs
Transforms ordinary 'wanting' to obessive craving. Opponent - process theory
Transition of drug use to drug dependence is the result of tolerance to the positive rewarding effects of the drug ( hedonic tolerance) and the development of negative states ( withdrawal e.g increased anxiety)
. taking of drugs removes the negative state.

Hedonic homeostatic dysregulation

. inability to maintain homeostasis prompts impulsive behaviour

. failure to self- regulate leads to emotional distress
. sets up 'spiralling distress - addiction cycle'
. combination of opponent- process theory and incentive- sensitisation theory.

Addiction

symptoms arising from drug addiction
. anxiety
. depression
. psychosis

Risk factors

. environment - shared and unique
. existing mental health conditions ( depression, psychosis conduct disorder, ADHD)
. Genetics ( alcoholism, marijuana, heroin but not cocaine).

Addiction - treatments

can be treated with available pharmacotherapies

- most available pharmacotherapies are 'replacement' therapies ( methadone)

Neurotransmitters and Craving

. Glutamate appears to be the main neurotransmitter involved in craving

Abstinent cocaine users shown video of either Nature ( neutral) or crack paraphernalia ( drug taking). , the experiment showed that glutamate neurotransmission triggers craving in humans. (PET studies).

Associations with drug- taking stimulates glutamate transmission to nucleus accumbens

. Anterior cingulate cortex and amydala neurones contain glutamate which signals to neurones in the nucleus accumbens

. Glutamate is involved with learned associations with the drug- taking environment.

Effective treatment for addiction

. glutamate in the nucleus accumbens triggers craving in abstinent individuals

. future treatments may involve specific glutamate receptor antagonists to stop flow of information to the nucleus accumbens, preventing relapse to drug use.

BUT- chronic drug use also appears to alter the brain at a genetic level ( epigenetics)..

Ecstasy - induced neurotoxicity

MDMA , ECTASAY

. reduced serotonin transporters

. positron emission Tomography (PET) scan.
. ecstasy reverses the serotonin transporter and causes serotonin depletion in neurons.

Repeated Ecstasy use

. loss of serotonin , serotonin metabolites and transporters

. cell bodies are still intact but function abnormally
. depleted stores of serotonin in the brain or neurotoxicity of serotonin neurones
. chronic depressive and or anxiety states.
. ecstasy cause degeneration of serotonin nerve terminals.

. in monkeys who have been treated with ecstasy generation of serotonin cells is very slow.

. Damage is long- term.

Methamphetamine and Neurotoxicity

. Meth may also produce depletions in serotonin to produce depressive and anxiety symptoms

. Meth has great effect on Dopamine neurones
. Neurotoxicity of dopamine neurones ( Nigrostriatal)
. Reduced dopamine increases the filter of the basal ganglia - information for movement cannot get through
. Cases of parkinson-like symptoms have been reported.
. Similar to the 'frozen addicts ' who took MPTP by mistake.

Methamphetamine Decreases DAT binding

- abstinent users DAT = dopamine transporter - helps to clear dopamine from the synapse loss of DAT shows that the dopamine neurones are not functioning well or are injured.

Lecture 11 - Globalisation of Tobacco

Why tobacco - Ads

Australia

- worlds most comprehensive tobacco control legislation - plain packs in 2012.
Number of smokers have been dropping a lot

Yet smoking remains the ' largest single preventable cause of death and disease in australia" 3.3 mn smokers 18th between 2007/2010

15,000 deaths per year (excluding second hand smoke exposure health)

exceeds combined tolls from

. road accidents
. alcohol
. skin cancer etc.

Associated economic costs ( tangible and intangible)

AUS 31bn.

Smoking is a habit of lower working class people

Lung disease , respiratory diseases ( pneumonia) etc etc. Fertility and reproductive effects

Tobacco production and consumption : a global health crisis that requires global solutions

Currently :

5.4 million deaths annually
. approx one death every 6 secs due to tobacco
. accounts for one in 10 adult deaths
. 600,000 non smokers exposed to second - hand smoke.

projections - 21century

8m deaths annually by 2030

1 billion deaths attributed

an imbalanced burden of disease

. 2000 - roughly even spilt between low and middle income countries

. by 2030s - 75-80 percent will be LMICs massive rise predicted among woman in LMICs

Globally smoking is increasing

- not only is the burden of smoking there but there is also burden to do with production where the land is used for this purposes.

How did we get to this point

20c - the cigarette century

- most production, consumption and mortality has not always been in LMICs

1901- cigarettes accounted for less than 3 percent of total tobacco consumption by weight in USA.

Mechanisation first adopted by James Duke of North carolina - 1880s : the american tobacco company.

Mechanisation led to overcapacity . Dukes response was 'aggressive solication of new smokers' in US and abroad Coincidental developments
. safe, portable matches in the late 1880s
. the new intensive techniques for modern advertising

BAT and Global Growth

by 1910 : - East africa, Indonesia , malaysia - sales of 10 billion + cigs

by 1920s

. shipping cigarettes to some forty countries and territories
. introduction of modernised production into china and india
. leading manufacturer in australia , canada , china ,india
. us presence ; 1927 takeover of brown and williamson

0. aimed at woman, men and almost everyone through propaganda.

Decline of traditional tobacco markets

1950s : first US significant decline in US cigarettes sales

. tobacco market saturation
. health warnings

From 1970s : steady downward trend in smoking prevalence and sales in US and other traditional markets

By 1980s : TTC considering exit from tobacco business - diversification ( real estate/ insurance / retail/ food).

Globalisation's rescue of the tobacco industry

What is globalisation

. range of processes ( not simply economic )
. compression of time and distance
. acceleration of communication
. movement of capital
. technology
. neo-liberal/market - driven

Key components

A) trade liberalisation
' free trade is likely to improve health if what if being traded is harmful' - garner and Mckee.

since the mid - 1980s

- cigarette exports increased at increasing rate ; following decades of negligible growth

Uruguay round of WTO negotiations = rapid expansion in trade in tobacco : 1994 - 97 - 12.5 percent growth in raw tobacco exports ;

1993- 96 growth in cig exports

5 percent growth in global cigarette consumption during this same period.

Impact
" the expansion of trade in tobacco products has worked in much the way that the economics textbooks would predict" - ira shapiro

Trade liberalisation - caused tobacco moving quickly having the most impact on low income countries.

B) rise of the transnational cooperation (TNC)

- firms that own/ control production facilities in more than one country through direct foreign investment.

Impact of globalisation on public health

. trade liberalisation ( WTO/ Regional/ bilateral free trade agreements?

. privatisation / deregulation - pressure on health services
. pressure on national sovereignty
. :westernisation" / consumerism - eclipse of local culture
. exacerbated disparities between and within countries.

How globalisation rescued the industry industry

. trade liberalisation across key Asian markets

. regime change in FSU and Eastern Europe
. transformation in future prospects: - foreign direct investment in overseas markets / joint venturers / licensing agreements/ merges / takeovers

. support of governments of industrialised countries for leading TTCs.

Because of court cases in the US we know more about the tobacco industry and globalisation - Patrick O kefee.

4 Waves of TI expansion

1. Latin - america - 1940s / 1950s

. first significant competition for BAT

. TTCs motivated by first declines in number of US smokers post wwii
. acquisition of existing firms
. aggressive marketing and pricing policies - local manufacturers unable to compete
US - supported denationalisation in the 1960s allowed TTCs to entrench their place in latin American markets TTCs " aggressive promotional campaigns has had to some 100 million current smokers" - Blanco

2. SE ASIA - 1980s

. late 1980s - '301 countries ' - japan, korea, taiwan, thailand - state monopolies

. united states cigarettes export association ( USCEA)
. United states trade representative (USTR)
. forced to drop restrictions on imported cigarettes under the threat of trade sanctions - japan and taiwan 1986, south korea 1988 , thailand 1990

. mounting trade deficits with all 4 countries.

Bi-partisan support / connections

“Tobacco exports should be expanded aggressively because Americans are smoking less.” -Vice President Dan Quayle, 1990 High-profile support from
(R) Robert Dole /Howard Baker/Jesse Helms
(D) George Mitchell / Ann Richards / Al Gore US embassy staff

Impact: consumption increase in 301 countries

•per capita cigarette consumption 10% higher in ‘301 countries’ in 1991 than predicted without bilateral trade agreements;

•biggest increases among youth and women: -smoking among Tokyo women 20-29 increase -10% (1986) to 23% (1991)
•Korea 1987-1988 -massive rise among teen smokers: males 18% to 29%; females 1.6% to 8.7%
•attributed to lower prices -aggressive TTC advertising
-Japan: cigarettes 40th to 2nd most heavily advertised product on television

iii) Former Soviet Union -1990s

. 1991 -collapse of the Soviet Union / emergence of deregulated market economy

. privatisation of state owned tobacco monopolies and rapid, unregulated entry of TTCs (PM,BAT, JTI, Gallaher, Imperial)
By 2000, almost US$3 billion in FDI had been poured into ten countries to take over privatised monopolies and modernise production
• consumer demand for TTC brands been ensured through aggressive promotion, often targeted at women and young people

iv) sub-Saharan Africa

12% of global population
4% of global tobacco users

-low smoking rates due to widespread poverty

Selected male smoking rates:

Ghana 10%;
Democratic Republic of Congo 14%;
Nigeria 12%

Increasing TTC activity

BAT:South Africa to Congo and west to Ghana, and throughout North Africa -2003 built a US$150 million factory in Nigeria

PMI:15% of the market across North Africa / 10% elsewhere

-new factory in Senegal

Selling and marketing single sticks

aimed at the poor, the uneducated and the young

PMI ( Philip morris international)

•employs over 80,000 people worldwide •brands sold in 160 countries
•50 factories around the world
. leader in 11 of 30 biggest markets/2nd in 8 others
. Marlboro largest selling private brand

BAT-the most global company • sells 900 billion cigarettes pa in 180 countries ( British american tobacco)

. 70% of sales in Africa, Asia, Latin America, FSU
. leader in 50 markets
. 52 cigarette factories in 44 countries -55,000 people
. uniformity of marketing strategies
. Dunhill, Kent, Lucky Strike, Pall Mall, 555

TTC success in LMIC markets

Increased consumption result of:

. price competition
. aggressive promotional strategies targeted at groups with previously low levels of consumption (women SE Asia e.g.)
. introduction of new smoother brands that are more attractive to smokers and easier for new smokers
. powerful political lobby vs. tobacco control measures

Advertising/promotion

TTCs radically alter “how tobacco is presented, how it’s advertised, how it’s promoted. And the result is the creation of new demand, especially among women and young people.”

sponsorship

•aspirational western imagery; •cost effective;
•comparatively uncontroversial;
•broad range: from global reach to grassroots; •political influence;

•circumvent regulation

Philanthropy

Charitable contributions have been a part of this company's culture for more than 40 years.
Society expects a company our size to be socially responsible, and we're doing our best to meet those expectations. -Philip Morris website, 2010

Value of influence in policy process:

-keep tobacco control off policy agenda -pre-empt legislation via ‘self-regulation’ -block or dilute proposed legislation -annulment, obstruction, evasion and revision

Be Marlboro Campaign 2012-

50+ countries associates Marlboro with risk-taking, exploration, freedom and defying authority advertising features attractive young people sponsorships -Music events in Saudi Arabia
-beach tours in Tunisia and Latin American countries -online promotional videos and-interactive promotional booths at shopping malls in Ukraine

Summary impact of the globalised tobacco industry

-trade liberalisation and FDI(legal and illicit trade) -aggressive global marketing

-beyond regulatory capacity of many individual states

What to expect:

~ 5 mn deaths annually -1 bn this century

Regulating a global industry

Framework Convention on Tobacco Control (FCTC)

-an explicit response to the globalised tobacco epidemic

The FCTC recognises:

-limits of national governance
-political and economic obstacles to regulation -global industry, transborder effects

Lecture 12

Pharmaceutiical Drug trials and ethics

causation vs correlation

Causation - when it is shown that one thing definitely affects another. correlation - when 2 things happen and they aren't neccearily linked

Ethical considerations need to be taken into account before experimenting on people

. Harm from the receiving drug being tested
. Harm from not receiving drug being tested - withholding a drug that would provide benefits

Drug trials need to stopped whenever even during the trial it is found that the drug trials are actually providing a negative effect. e,g, Estrogen and heart attack

How drug trials work

1. Open trial - the researcher and patient are aware of the details of the treatment. problems - bias and placebo effect

2. Blind , placebo - controlled trials

. single - blind trial - only the researcher is aware of the treatment details and not the patient

b. Double blind trial - both the patient and researcher are unaware of the treatment - it is most accurate as there are no bias, controls for placebo affect.

A convincing placebo treatment is too dangerous to be to ethically possible is a case where trials cannot be blinded. E.g Surgery Phsyiotheraphy , dieting and exercise where people are forced to do the negative - they will know if they are not doing anything

The Ethics of International Drug trials and Placebo Use

. Brief history of medical research ethics Nazi human experimentation ( Nuremberg trials and the Nuremberg code)

. Experiments were donated to find a vaccine for typhus to treat burns caused by mustard gas. it was good to inform but not enough to stop the tragedies - mostly on black poor people

-should have voluntary informed consent from research participants -only proper trained scientists should carry out the research
. no coercion to participate in research - can't blackmail them
. the risks must be outweighed by human benefits
. minimise risk and suffering
. participants can end experiment at any time; researches must stop if outcomes harmful

Alabama experiment - syphilis cure was not there before but there was no " effective" treatments. Black american people were documented to see what the disease does to the body but they were lied that they would be treated.

Helsinki Declaration : World medical Association , 1964

. as an Elaboration of Numerburg code

. it stated that no one group or society should disproportionately bear the costs of, or reap the benefits of research.
. Any research participant should receive the best treatment available
. the populations in which the research is carried out must stand to benefit from research results.

Helsinki Declaration and controversy over ART trials in africa

-In the early 1990s, there were clinical trials to test anti- retroviral therapy (ART) for reducing mother to child transmission of hit

. Treatment regimen ( ACT6 076) was found to be effective but it was expensive and required many interventions.
Most trials used a placebo as the justification was that it was too expensive to provide the proper regimen but in the US all HIV positive patients had access to the actual ART and not the placebo.

-NEJM editorial - argued that most of the trials are unethical and lead to hundreds of preventable HIV infections in infants.

-Lurie and Wolf - if unequal distribution to drugs and ethical drug trials then drug countries are given a incentive to use poor people as guinea pigs , different ethical standards in poor countries.

-Essentially a reminder of when placebo use can be unethical

Example 1 - lecture room - stimulant vs depressant whereby all pill was a placebo.

Example 2 - people naturally get better when they have a placebo effect - thinking they are getting the treatment Placebo effect has high rates of effectiveness - no effect - nocebo

Potential for therapeutic use - the problem would be that it involves deception and the ethics of medication if informed consent.

Can therapeutic use of placebos be ethical ?

- the patient wants a treatment but receives a placebo . On these grounds some have maintained that placebo treatment will always be unethical, a violation of the patients right to be honestly and fully informed about the treatment.

" Disclosing to a patient that he is receiving a placebo will not necessarily diminish its effectiveness". - Lichtenberg

- heroin addicts can get high from injecting what they know is saline . This phenomena reflects the lingering effect of conditioning but

Sustained disclosure overtime will extinct the conditioned behaviour and therefore extinct the placebo effect.

Lichtenberg et al.’s guidelines for the ethical use of placebo in clinical practice

The intentions of the physician must be benevolent: her only concern the wellbeing of the patient. No economical, professional, or emotional interest should interfere with her decision.

The placebo, when offered, must be given in the spirit of assuaging the patient’s suffering, and not merely mollifying him, silencing him, or otherwise failing to address his distress.

if ineffective the placebo should be immediately withdrawn. In these circumstances, not only is the placebo useless, but it also undermines the subsequent effectiveness of medication by undoing the patient’s conditioned response and expectation of being helped.

The placebo cannot be given in place of another medication that the physician reasonably expects to be more effective. Administration of placebo should be considered when a patient is refractory to standard treatment, suffers from its side effects, or is in a situation where standard treatment does not exist.

. The physician should not hesitate to respond honestly when asked about the nature and anticipated effects of the placebo treatment he is offering.

. If the patient is helped by the placebo, discontinuing the placebo, in absence of a more effective treatment, would be unethical.

Placebo effect as meaning effect

Their argument : placebos do not cause placebo effects . Placebos are inert and don't cause anything. Placebo effect is not about placebos - placebo effect is about meaning.

Moerman and Jonas argue that we should look at the placebo effect as the meaning effect because placebo cannot do anything but their meaning can

Definition of the 'meaning response' - the physiologic or psychological effects of meaning in the origins or treatment of illness; meaning responses elicited after the use of inert of sham treatment may be called ' placebo effect ' when they are desirable and 'nocebo effect' when they are undesirable'.

Steven Levitt on wine and sensory perception - conclusion taken from it was that fancy people with lots of training can tell cheap wine from expensive wine but regular people cannot.

The placebo effect ( or meaning response) : whats happening in the brain ?

subjects told " cheap wine vs expsenive wine

hypothesis - chanes in the price of a product can influence neural computations associated with experienced pleasantness". Findings - increasing the price of a wine increases :
- subjective reports of flavour pleasantness
- blood oxygen level dependent activity in medial orbitofrontal cortex ( pleasure associated area)

Bottom line : if you think wine is more expensive you enjoy it more.

Key points to remember

1. placebo effect is really a meaning effect

2. Meaning has physiological action in our brain
3. Three aspects of ethics of placebo use :
- limitations on placebo use when there is known effective treatment
- distribution of placebo use in international drug trials , i.e. political economy of placebo use, as illustrated in debate over the ART trials - deception in therapeutic use of placebos

4. and it is possible to enjoy cheap wine as long as a) - you don't think your drinking cheap wine b) you aren't a wine expert.

Lecture 13 opium

It is the sap of a particular kind of poppy

- Morphine is one of the 23 alkaloids found in opium. The morphine content of opium is about 10 percent - Heroin is a synthesis of morphine and the industrial acid - aceti anhydride.

Areas of cultivation

- Golden Triangle ( N.E. Burma/ Myanmar , N.Thailand, N.laos) - Golden Crescent ( parts of pakistan , Afganistan and iran ) Columbia , Mexico

opium is cultivated legally for pharceutials in 19 countries including india, china, japan, turkey, france, UK and australia ( Tassie)
The trocki thesis

. the development of capitalism in Europe was linked to the expansion of drugs and drug economics.

. Drug provided the first mass consumer markets due to their addictive qualities
. the problem of the tea trade with china : drain on European sliver supplies
. opium as the solution to trade deficit with china.

. In 1773 the east india company was granted a monopoly over production and sale of opium, following British colonisation

. Opium became a fully capitalised commodity - mass produced and with a mass consumer market. :

a ) - opium cultivated, under strict control, in Bengal by more than a million farmers

b) - EIC created a well organised system of packaging, storage , pricing and quality control c? The mass market was china and S.E Asia.

Opium addiction and mass consumer markets

. 15 million chinese opium addicts by 1830s

. opium wars fought ( 1839- 42 and 1856-58) to maintain lucrative trade

. legalisation of opium imports (1860) encouraged local cultivation in S.W. china by hill tribes

. opium production in china reached 30,000 - 40,000 tons by 1906.

. 40 million opium addicts in china by 1890.

. Mass market development in S.E Asia due to famines in south china ( migration of chinese)

. Colonial govt established opium dens for chinese addicts. Opium monopolies sold opium imported from india to licensed chinese merchants.

. By 1930 there were more than 6,000 govt opium dens in S.E Asia supplying about 500,000 registered addicts.

Chinese opium merchants formed interconnected syndicates which then allowed rapid accumulation of capital and investment in commodity production and first Asian Banks.

Opium cultivation in the Golden Triangle

. Opium cultived in GT region by hill tribes who fled from china in repines to chinese military campaigns

. Local opium cultivation at first discouraged by opium monopolies as threats to profits.
. But local cultivation encouraged during WW2 due to problems of obtaining supplies from india and middle east.

Post war in opium cultivation in golden triangle

- prior to ww2 = 80 tons late 1950 - 700 tons early 1970 - 1000 tons mid 1990s = 2700 tons.

Causes of rapid increase in opium production in Golden Triangle

. Decline in opium cultivation in India, Middle East and China.

U.S. 'cold war' strategy of containing Communist china. CIA support for Chinese Nationalist Army to seal China- burma border. KMT expanded opium production in Burma to finance food and arms.
. Spread of heroin use by U.S troops in vietnam in late 1960s. Heroin set up labs in GT.
. Ethnic insurgency and warlordism.

Ethnic insurgency and warlordism in Burma

. Ethnic minority revolts in response to uncompromising centralist policies of Burma's military government

. By 1990s there were 16 armed ehtnic groups in rebellion against central government . Most armies trafficked in opium to finance rebellion.
. Changing alliances between opium- trafficking armies.
. Burma's military government (SLORC) unable to gain political control over N.E. Burma until mid 1990s. following cease- fire agreements with most rebel armies.

Diversification: methamphetamines and opiates

. Warlord Khun Sa surrenders in 1996 and promotes methamphetamine production.

. Drug traffickers diversify into methamphetamines and opiates.
. 2009: cease-fire agreements break down as Burma’s military pressure cease-fire ethnic armies to become Border Guard Forces.
. Ethnic (minority) armies increase drug production (opium/heroin/ meth.) to purchase armaments.

Opium in Afgan

1982 = 250

1988 = 750
1991 = 2000
1999 = 4600

Causes of rapid increase in opium production in Afghanistan

. Islamic guerrilla groups (mujaheddin) financed war against Soviet Union by collecting taxes in opium.

. 1989-1996: Rival mujaheddin factions financed fighting in civil war with profits from opiates.
. 1996-2000: Taliban expanded opium, production by 20% tax on drug shipments by traffickers.
Ethnic insurgents and criminal syndicates created new trafficking routes for distribution of heroin to Russia and Europe. Now heroin also smuggled into Pakistan and Iran from Taliban strongholds in southern Afghanistan.

. Taliban bans opium cultivation in July 2000. Production reduced to 80 tons in 2001.

Taliban have renewed dependence on opium to fund guerrilla war and win support from local farmers. Taliban traffickers supply poppy seeds and fertilizer to farmers and pre-purchase opium crop.
. Pro- government warlords also invest heavily in opium cultivation and trafficking.
. This has led to a surge in opium production to 4100 tons in 2005 and 7,400 tons in 2007 (93% of world’s illicit supply).
. Area of cultivation has increased from 193,000 ha in 2007 to 209,000 ha in 2013 though volume has declined to 5,500 tons (73% of world production).

Opium and Demand Reduction

Demand Reduction

It has been a part of the UN drug control policy since creation of UNDCP in 1991. Though supply reduction takes precedence, there is a assumption that continuing local consumption of opium will encourage local cultivation.

Highland household opium uses

- for cash
. medicine

. rites and ceremonies
. medicine for physical ailments
. exchange for goods and livestock.

problem of drug addiction among drug- crop cultivators e.g. hill tribes of N.Thailand and N.Laos (Akha, Lahu, Lisu). Addiction rates of upto 10 percent of population

What are the causes of opium addiction ?

. Availability

. Traditional use a as medicine
. used as tranquilliser to relieve anxiety
. recreational use

NB rates of addiction vary from village to village depending on factors such as village leadership, village factionalism, village location on trafficking routes and wage labour.

Community - Based Drug Abuse control

- CBDAC : strategy ( developed in N thailand by NGOs) based on a 'participatory' model and includes medical detoxification, physical and occupational rehabilitation and prevention

Phases of Detoxification Program

Preparation - Village data collection, raising awareness of community, addicts ' volunteer needed for detoxification'. Signing of form agreements and destruction of smoking equipment. Medical checks .

. Detoxification

. 14-21 days in school rooms or camp built by villagers
. Medical support * herbs, paracetmol and valium )
. Village social support
. lectures by local officials
. closing ceremony

3. Follow up - Health checks, treatment and counselling.

Problem of RELAPSE

. CBDAC programmes in N. thailand and N. Laos participatory in name only. Addicts are passive recipients of treatment and subjected to enforcement and punishment.

. High rates of relapse of detoxed addicts

Reasons for high relapse : inadequate follow-up activities, little genuine participation of villagers or 'dialogue' between villagers and government/ agency workers , and weak village leadership.

Creation of an ‘addict identity’

in the Demand-reduction campaigns in N.Laos (Sing district) created an ‘addict identity’, leading to stigmatisation and marginalisation of addicts and relapsed addicts (see P.T.Cohen and C. ‘Opium-reduction programmes, discourses of addiction and gender in northwest Laos’ (Course Reader).
. Opium and opium addicts viewed as obstacles to ‘development’.
. Opium was demonised in lectures and poster iconography. Contrast with traditional Akha values (e.g. myths).

. Increasing distinction between addicts and non-addicts and new category of the 'degenerate addict'.

. Labelling process often becomes internalised with addicts expressing feeling of 'shame'.

Lyttleton - CBDAC : process of labelling, surveillance and stigmatisation pressures addicts to smoke secretively and to turn to other more dangerous drugs ( e.g. heroin, amphetamine- type stimulants) that are easier to conceal and consume furtively.

- By 2003 there were 800 meth users in sing district ( a third were Akha). By 2008 : 35000 - 40,000 meth addicts in laos.

Manderson on detoxficiaiton - in the middle ages , a lot of woman were burnt to save them from demons. lucky ones were exorcised, in the modesn world woman are imprisoned to save them and lucky ones are detoxified.
CBDAC deco - volunteers are lucky compared to detainees of compulsory drug treatments and detention centres in laos. Very very bad conditions are suffered. Thailand, vietnam, china and cambodia.

In 2012 11 U.N agencies jointly called for the closure of drug detention centres and expansion of access to community based, voluntary drug dependency treatment.

. N. Thailand and Sing district (N. laos ): even community based can be punitive, with high relapse rates.

However , CBDAC run by Norwegian Church Aid in Long district ( N.Laos) was quite successful : only 19 villages, active village headmen, good follow up and low relapse rates.

Beyond Silk Road - Lecture 14 Digital frontier

silk road was a illicit drug website

Enter the dark net - how to illicit drugs net operate TOR!

The onion Router launched in 2002

. free encryption software
. Masks user identity and location
. intended to facilitate anonymous communications between political dissidents living under authoritarian regimes.
. extraordinarily difficult to 'crack' TOR encryption

Proto sites

. farmers market in operation from 2006- 2012

. distributed approximately 1 million USD worth of drugs to 3000 people in 35 different countries
. 2 year DEA- led transnational investigation
. payments conducted via international wire transfer services.

Bitcoin made its easier to be untraceable

. Encrypted electronic currency launched in 2009

. Allowing financial transactions that are effectively untraceable
. Wildly flluctuating 'floated ' value
. used for a growing number of legitimate purposes.

Cybercrime + cryptomarkets

- it is a online forum where goods and services are exchanged between parties who use digital encryption to conceal their identities - Martin

They also share the following characteristics

§ reliance on the TOR network

§ use of cryptonyms to conceal user identity
§ use of traditional postal systems to deliver goods § third-party hosting and administration
§ decentralized exchange networks
§ use of encrypted electronic currency (e.g. Bitcoin).

Silk Road - a crypto market case study

promotion - information feedback system

Shipping costs are included too Refund policy - top sellers offer refunds. Drug quality chemical analysis

Creating trust in an anonymous virtual environment

. Variety of systems used to create trust in a virtual environment - user ' karma' , feedback, terms and conditions etc.

. Remarkable similarity to legitimate online business and trading platforms.
. Online reputation critical to vendor success
. vendor ranking ensured 'good' suppliers rewarded with additional business
. Extraordinarily high levels of user satisfaction

Online vs. Conventional drug distribution

Conventional distribution networks

. Global illicit drug market estimated 322 billion USD (UNODC 2005)

. Large, complex, decentralised networks
. Multiple layers of distribution – traffickers, wholesalers, mid-level distributors and street retailers
. Connections between different groups facilitated by brokers
. Retail levels most exposed to detection and arrest ( most dangerous)
. Suppliers insulate themselves from law enforcement by including additional ‘intermediary’ nodes

Network Inefficieny

. Complex and large networks are resilient but also relatively inefficient

. each distributing node has to be compensated for participation

Outcomes

. prices incase
. product is altered

Market- Based Violence

. Drug producers need to establish partnerships with organised crime groups for security and distribution

. organised crime groups use violence to settle disputes and establish control over trafficking routs and retail territory 'turf wars'.

Cutting out the middlemen

. online drug distribution networks will be significantly more efficient

. more direct links between drug producers and consumers - reduced participation of intermediary nodes
. illicit drugs delivered cheaper and less opportunity for product adulteration
. elimination of intermediary and retail sections has the potential to significantly reduce market based violence.

Challenges for law enforcement - customs and postal interception

. Huge increases in volume of legitimate trade

. Vast majority of goods not subject to inspection
. Customs profile suspect items based on risk profiles
. ‘Stealth’ improved by: . competitive vendor rankings . leaked customs documents . online forum communications . online drug purchases typically small

Evidence Gathering and resource allocation

. goods detected through most are not enough to justify prosecution

. extra evidence is resource intensive ( surveilance )
. Generally small quantities result in lower level possession charges
. successful prosecutions end with consumers - no capacity to follow up the chain of supply.

Dynamic and Hardening Targets

. conventional anti- drug policing strategies ( raids, undercover ) unlikely to be successful in combating crytomarkets

. crypto markets adapt quickly to law enforcement
. users share information and learn from previous mistakes
. successful trafficking techniques preliterate through competitive processes
. scare police resources put under increased pressure
. need to develop and expand cyber investigation and code- breaking capacities but at what cost ?

Conclusions

. Cryptomarkets represent a small but expanding section of the global drug market

. Online drug distribution networks offer significant advantages to drug producers and consumers
. Potential to render intermediary nodes redundant and reduce violence associated with the drugs trade
. Cryptomarkets are complex and resource intensive targets for law enforcement
. More research is necessary in order to better determine impacts and implications for all stakeholders involved with the global drugs trade.

War on drugs

-Nixon initiated modern war on drugs in early 1970s. He expanded the punitaitve approach to drugs through new laws, increased funding and enlargement of anti- drug bureaucracy.
. He also extended drug war abroad to strike at sources of supply.
. presidents reagan and bush escalated drug war ( e.g. militarisation in SA, and changing prison sentencing laws).
. Major protagonists in modern war on drugs: US and UN drug control programme ( UNDCP) and united nations nations office of Drug control and crime prevention.

Drug War supply- side strategy

. Anti- drug agencies target illicit drugs at their source by pressuring foreign governments to target growers and destroy refining facilities.

. Anti- drug agencies attempt to intercept illicit drugs en route or at the borders of the U.S. and other Western countries.
. Drug enforcement agents and police arrest drug dealers and seize drug supplies.
Assumption : Law enforcement measures will function to make it more dangerous and costly for growers, refiners and traffickers to produce and sell illicit drugs. This will reduce production and availability, drive up prices, and discourage consumers.

Drug War failure

- U.S. federal budget for drug law enforcement 1970 - 52 million
1995 - 8.2 billion
2003 - 19 billion
2012 - 26 billion

despite the costs there is Steady rates of illicit drug use in US - 12 years and over who have ever used illicit drugs :
2002 : 8.3 %
2007 : 8.7 %

trends : suggest decline in numbers using cocaine but not in overall consumption; drop then increase in heroin use with availability of non- injectable versions; steady rise in cannabis, methamphetamine, etc).

Failure abroad

. Global coca cultivation - has increased then decreased

. Global illicit opium production - a lot ( increased steadily)

Coca - production gone down

Drug war and hydra effect - production of the drug trade / Balloon effect

Examples:

. coca eradication in Bolivia and peru
. opium production in Pakistan and Afghanistan
. opium production in Thailand and Burma ( also : rise in methamphetamine production)
. Role of the state.
. Drug sellers will never be over.

"The profit Paradox" - Bertram

. The drug war was raised the cost to traffickers of doing business and of the prices of drugs in Western countries.
. However, the prices are not high enough to reduce demand by consumers
. The paradox is that the raising of prices also inflates profits.
. High profits provide an incentive for drug supplies to remain in the trade for new supplies to enter.
. The drug war, therefore, acts as an effective price-support scheme for drug dealers.

Alternative development

. 'Alternative development' ( AD) is the international aid component of supply-side policies.

. The precursors of AD are 'crop substitution' of the 1970s and 'integrated rural development' of the 1980s.
. AD emphasises ' people participation'.

Problems with alternative development

Crop substitution ( Farrell; Hellin)

- Substitue crops ( e.g. bananas, pineapples, coffee rarely possess economic advantages of illicit drug cropss:

. Marketing often a problem due to poor transport system and low profit-to weight ratio.
. Long period of time without income for substitute crops ( e.g. coffee , fruit trees).
. Volatility of domestic and international markets.

-Success of crop substitution undermined by unrealistic eradication deadlines:

. drug war symbolism and obsessive concern and supply reduction targets.

. Rapid elimination of opium in Laos ( 2000 - 2005) allowed insufficient time for adequate alternative development.
. Negative impact of rapid opium elimination in Laos: rice shortages and migration

Limits to peoples participation

. People participation and voluntary nature of alternative development is limited by the 'conditionality' of development aid.
. Alternative development is implicitly punitive.

Alternatives to 'alternative development'

. Alternative legal markets for illicit coca and opium as prohibition has actually stimulated global trafficking in illicit drug ( McCoy 2004).

. Some scholars, politicians and institutions recommend alternative legal markets for illicit coca and opium.
. subsidies for substitute crops
. A gradualist approach that realistic eradication deadlines and requires AD to precede and succeed prior to illicit crop eradication.

Political Economy of Coca and cocaine

Traditional uses of coca in Andean Region.

cocoa leaf is indigenous to the indi ( ecudor, colombia, peru ) hill regions of south america

. Coca chewing was part of the indian culture before and during Inca Empire
. religious significance of coca for incas
. in bolivia and peru, coca continues to have religious significance, as well as a work stimulant and medicine.

Growth of global market for coca and cocaine

. International demand for coca and cocaine began in 1860s with growth of market in U.S. and Europe for tonic medicines and drinks e.g. Vin Mariani, Coco cola.

cocaine was first extracted from coca in 1860 by german chemist and promoted by pharmaceutical industry in U.S. and Europe. Recreational consumption of cocaine also increased. Europe : restricted in 1886; U.S not until in 1900s. ( 1903 - no more coca in cocaa cola ) .

expanding international demand for coca and cocaine encouraged cultivation of coca outside sOUTH america. Dutch East indies was the major producer of coca from 1911 to late 1920s.

. Bolivia and Peru regained pre- eminence of coca production after WW2. Colombia has also become a major coca producer.

Causes of post - war expansion of Coca cultivation in Sliver triangle

. collapse of colombian marijuana industry by late 1970s
. increased demand from late 1970s for cocaine in the us and emergence of Medellin and Cali 'cartels' to supply us market.
. Economic crisis of 1970s and 1980s : decline in prices of agricultural exports and increased foreign debt.
. collapse of Bolivias tin industry in 1985 and rise in unemployment

. Govt colonisation programs for poor peasants in Bolivia and Peru.
Colombia : left- wing ( FARC) and right wing armies promote coca cultivation to retain peasant support. Colombias coca cultivation exceeds that of Bolivia and peru by 2000.

Cocaine as a transnational commodity chain ( Wilson and Zambarano )

Cocaine : five part transnational commodity chain part 1 - cultivation

. - growth by peasants on small family farms

. - labour intensive; weeding, pruning, hand harvesting , processing.

Cocoa is good to produce because

. seedlings harvest after 1 year of growth
. crops can maintain high yields for upto 40 years without fertiliser.
. it tolerates extreme fluctuations in temperature.
. yields up to 4 harvest a year
. Low susceptibility to disease
. low perishability
. high profit - to - weight ratio.

Part 2 : Coca Paste production

. undertaken by many small producers

. coca is soaked in pits and treated with kerosene, lime, water, sodium bicarbonate and sulphuric acid.
. coca leaves are trampled by poor labourers.

Part 3 : coca refining

. Cocaine hydrochloride is produced from coca paste, hcl, ether, acetone ,methanol etc. Most refining is in colombia.

. Cocaine refinement requires considerable capital e.g. expensive equipment and imported chemicals.

Part 4 : Cocaine export

. cocaine export in 1980s dominated by Medellin and Cali " cartels"

. since 1990s these 'cartels' replaced by smaller, low - profile trafficking organisations which also export heroin to U.S.
. Colombians have dominated cocaine exports due to : a ) - strategic geographic location of colombia. b) - large colombian population in U.S.

c. ) Weak state unable to control drug traffickers ('narco entrepreneurs') .

Part 5 : Distribution in Western Markets

United states

- colombians play important role in distribution within the U.S. ( especially NY with a large Colombian population).

Australia

. Australia : small market compared to U.S.
. Large quantities imported in bulk on ships from South America. Smaller quantities sent through mail or by courier.
. Cocaine imports increased during heroin 'drought' ( from 2001).

According to Robson - cocaine and addiction

14 - compulsively addicted
28 - use the drug more frequently , having cocaine related friends. 29 - buy their own supplies and use it controlled, infequnt

29 - take it if there is a opportunity to consume it

Lecture 15 Drug law reform in australia

Last 50 years drug markets have expanded and become more riskier

. the production , consumption
. prices have declined
. purity has increased
. availability remains high
. increasing number of new drugs ( WODAK).

Drug policy outcomes - prohibition have caused more crime .

Last 50 years spectacular increase :

deaths -disease
. crime
. corruption
. violence
. threats national security

Does drug prohibition work ?

. there is bigger and more dangerous markets with worse outcomes . The alcohol prohibition in USA didn't work drug won't too.

. prohibition will make the price heroin increase x 300.
. Traffickers have more money than law enforcements.

Fairness and justice:

. Oscar Wilde 1895 2 years hard labour sex another man - fair & just ?

. is it fair 2014 punish people who have minority taste drugs if they don't hurt others ?
. punishment for risk to themselves ? what about cig smokers , mountain climbers, solo round world sailors ? - Husak.

Global drug law reform :

. Global commission Drug policy 2011

. Kofi Annan ; George shultz; paul volker; former presidents : Brazil , mexico colombia, switzerland ; sire richard branson
. ' the global war on drugs has failed with devastating consequences for individuals and societies'.

Start global drug law reform:

- 2012 : November CO, WA states USA 55 percent : 45 percent voted tax, regulate cannabis. -2013 : uruguay legislature voted legalise cannabis
2013 : NZ parliament voted regulate some new drugs , new system starts - Newberry.
The big drug policy debate :

. Primarily ' health and social' OR ' law enforcement' ? - threshold question

Now primarily law enforcement
. Political rhetoric
. Government spending

. Government expenditure implications

The mini debates include :

. what sort of punishments should be provided for possession

. should we have safer injecting facilities near large drug markets ?
. should cannabis be medically used ? should we have needle syringe programs ? what about prisons ? -herion assisted treatments ? - mather .

Options for regulation of drugs

. prescription

. pharmacy
-on licence - consume on permesis
. off licence
. blackmarket

Options for australia

. tax , regulate cannabis
. MDMA
. Edible opium australia until 1906
. methadone as a model prescription control
. dilute , small quantities , selected drugs commercial sale ?

How can drug law reform be achieved ?

-By incremental steps, rigorous evaluation

base policy on evidence and recognise diversity the world. Importance
. community opinion
. young people
. leaders medical profession
. complex international spider web.

Conclusions

. Debate is over : drug prohibition an expensive , comprehensive failure.

. not clear yet what post prohibition arrangements will be move from criminal justice to predominately health, social response - increased funding. Evidence now strong many reforms
. tax regulating cannabis.
. recognise drugs a market : sellers and buyers increasing punishment also increases profits.
0. why the debate ? - failure current policy - takes too long
. what to do ? - redefine as health , social issue and regulate
. when ? maybe another 30-50 years but started
. how ? - slowly , carefully, respectfully.

Drugs, conflict and displacement ( Thai border) lecture

Conflict - induced displacement

Conflict important cause of global motility

45 million displaced by conflict

. Africa, Asia, Middle East
. Remain within those regions
-camps/ collective settings or dispersed less than 1/2 of urban

2/3 internally displaced persons ( IDPS)

1/3 refugees ( under international law) with a average stay of around 20 years.

Substance use among conflict displaced

High death rates due to non- combat related causes communicable and non-communicable diseases substance use as a underlying behaviour and determinant , substance use disorders is being recognised.

This is through Rapid Assessment

. Mixed methods

. intervention focus
. rapidity
. triangulation of data
. community participation in all phases
. inductive thinking
. understanding social, economic and cultural context.

Mae la Refugee camp

Methods - documentary review , quantative analysis - health services and qualitative - direct observation, interviews.

Facts bout the camp

. 1984, it is the largest of 9 camps along thai- burma border n = 150,000

. it has a population of 40,000 with 97 percent being karen
. KNLA armed rebellion since 1948
. ongoing forced relocation , many karen are stateless
. thailand has not signed to refugee convention
. around 3 million ( illegal) migrant workers in thailand.

1970s - unofficial settlements
. villages were displaced across border intact , there were a lot of rural communities.

. integral to ethno- political resistance struggle. , there was some external support through autonomous village committees.

1980s - From sanctuary to cage

' Consolidation Camp'

-Thai government had abandoned 'buffer zone' approach ( supporting anti- communist activities) seeking containment.

Development of ' humanitarian enterprise'

- Multimillion dollar aid budget

Fear of 'refugee warrior' communities

- forced distinction of combatants and civilians .

2000s - Mae la as transit station

Refugee regime 'durable solutions'

-Repatriation, integration and resettlement
. programme of 3rd country resettlement 2005.
. Resettled replaced by new arrivals

Other options employed by population

. family splitting
. irregular movement ( illegal work in thailand and other places)

Forced distinction of economic migrant and refugee

- 1/3 population mobile, mainly young men within thailand and the region

Increasing cultural, ethnic and economic diversity

- 97 to 83 percent karen, the karen cultural percentage had dropped and the gradients of poverty was more than 20 times difference

Common substances

Alcohol - used commonly and not permitted to be sold in the camp, beer whisky, carbonated wine drinks bought in shops and bars nearby , Artisanal alcohol ( distilled rice liquor - made locally) .

Ya ba ( metamphetamine + caffeine ' crazy pill' ) opium/ heroin

Dizephem Inhalants ( glue)

Population concerns.

Alcohol use created important concerns and was recognised as a cause of insecurity , physical assault, violence against women an suicide.

Slide 22 has statistics. Burma has mostly homemade compared to thailand ( men and woman drink more)

Mae la Data

Antenatal clinic ( n=636)

risky drinking - a lot of woman where drinking and men were drinking more. Refugees in UK drink more compared to Mae la.

‘Traditional’

Established use in Karen culture

Socialisation : often referred to in Karen as ‘happy water’

‘it is like we drink alcohol in order to make us happy … I have a lot of friends sometimes we buy a bottle of alcohol and drink together with friends’ (Saw S, a 42-year-old man 17 year resident of Mae La)

Manufacturing skills brought from Burma

‘sometimes in the farm, it is cooked for religious purposes. Not for income. Sometimes just for buying food. Sometimes, it is sold for survival ... and prepared by the wife’ (Maung M, 33 man who arrived a year ago)

Social controls

‘Small amounts of alcohol were considered ‘good to eat rice’ (improve appetite) and ‘like medicine’ (improve health).

‘I come back to eat after drinking but I do not continue to have more. Ijust drink it in moderation’. (Saw S, 43-year-old man 17 year resident)

Intoxication proscribed. ( shameful)

‘[if alcohol is drunk] within limits, it is like medicine. If it is over the limit, it is dangerous.’ (Saw E, 43-year-old man, long term resident) One of these dangers was being loose tongued and indiscreet, described frequently as: ‘the theft of the buffalo is revealed’.

Gendered norms

Use by women proscribed, abstinence associated with femininity

Becoming dangerous - alcohol from different refrugee camps was considered bad as they were suspicious of how they made it.

- Alcohol was creating problems and fighting and it would be frightening the lives of the people in the camp.

Intimate partner violence ( IPV)

. partners left home as males came home drunk scared of partner violence.

. abuse of alcohol caused diseases and led to dependence in comparison to people who didn't abuse it.

changing in displacement

Shift from celebratory to every day

From traditional to dangerous

rationales -economic imperatives, psychosocial stressors of life in displacement, changing power structures and social hierarchies, economic imperatives.

psychosocial stressors of life in displacement - hopelessness, powerlessness and confinement. Jobless and lack of identity. " drinking to avoid thinking" social stressors - they felt confined and trapped so to release the tension they drunk alcohol.

social structures and power structures were changing - people do not know who to listen to as UN and thai authorities have power so people from outside were influencing them and people were not listening. Deep mistrust of ' new arrivals' of non karen people and deep mistrust thinking that there are spies leading to more fighting. ( More different types of people more problems) - growing social complexity
Livelihood imperatives - people try earn a livelihood by selling alcohol as they cannot get out of the camp to work.

Implications

Theoretical perspectives

• ‘Social stress’ model : social stressors may promote community substance use culture (eg Galea 2007)

. ‘Self medication’ hypothesis : substances are used to relieve individual suffering (Khanztian 1974, Singer 2008)

BUT

. Too easy to paint substance use as an individual escape (Fitzgerald 2005)

. Doesn’t explain, for example, gender differences, and ignores benefits and underlying macro structural and economic influences (eg marketing)
. Use ≠ harm

EG Gender equity

. Substance use norms deeply gendered

Globally, increased gender equity associated with decreased gender differences in drinking and decreased alcohol related problems Alcohol on causal pathway between gender inequity with gender based violence in many refugee settings

Conflict and social determinants

. Conflict, and the resultant change in social conditions, is an important social determinant of health.

Social determinants of health include living conditions across the life course – such as education, environment, and access to health care – and the underlying economic and political structures determining the distribution of resources and power.

Social determinants

-Influence the magnitude, prevalence and distribution of substance-related harm among displaced populations

-Access to cash can increase access to substances

-Poor more likely than to experience harm from same pattern of use due to

. Decreased access to health care
. Differential policing patterns.
. Poor quality food and nutrition
. limited social resources

Conclusions – Mae La

Economic, cultural and social transitions contributed to changes in alcohol use behaviours and norms, and increased the potential of alcohol related harm.
. Risky alcohol use was common among men but not women and warrants public health and clinical intervention.
. The population may have been partially protected from rapid rises in problem alcohol use observed in the host country, Thailand.

General conclusion

. Substance use among populations displaced by context is an important behaviour with social and health implications

. More intervention-oriented research is required
. Methodological challenges need to be acknowledged and explored
. Importance of social and structural context when studying alcohol use behaviours, risks, harms and meanings and designing interventions

Steroids

Neuroanthropology - relo between brain and culture , how training affects developments. 1998 - the year of the biggest baseball match , Mark Mcguire hit the 70th home run.

' performance enhancing drugs' - he was accused of it and admitted.

The steroid era - we live in it

The paradox is that we ask the athletics to strive as hard as they can but this one is reprehensible and it can destroy them.

Androstenedione or andro was considered a dietary supplement . It is a steroid hormone produced in the adrenal gland precursor to sex hormones including testosterone. - It is anabolic , it builds the body.

Perfomance enhancing drugs - the 2012 prohibited list international standard - lists the drugs that are all illegal

-Lean mass builders ( anabolic steroids, human growth hormones)

. stimulants ( caffeine , methamphetamine)
. painkillers ( over the counter , narcotics )
. sedatives - to become abnormally calm
. diuretics ( especially for weight graded sports)
. masking drugs ( epitestosterone)

World anti doping agency states that doping is fundamentally against the ethos of spirit of the olympic games : the fair play. Many of the prohibited substances and methods are harmful to athletics' health and can cause short and long term damage. " fair play and health consequences are highlighted".

Thomas hicks - 1904 gold medalist in marathon received strychnine injection.

during 6 day bicycle races, rides sometimes hallucinated from fatigue campagne and nitrogglyercine tablets as PED.

- there was very little moral concerns and authrories recommended different substances to make the performance better.

Around WW2

. japanese swimmers in 1932 had unexpected victories after receiving pure O2 before races
. german athletics in the 1936 olympics were given amphetamines as was hitler
. british military used 72 million odes of amphetamines.

peptide induce anabolic steroid formation

Sandor Earl was banned for peptide use and trafficking

In 2007, at 60 years old, Sylvester stallone arrest at syndey interet airport with high vials of HGH ( human growth hormone) charged with importing controlled substance.

Steriods causing balls reduction, brain problems, man boobs and woman gaining masculine features.

The east german olympic team

- from 1960s to 1980s population 16 million ' the wonder girls' in montreal 1976

Oral- Turinabol given to 10,000 athletes who got 160 gold medals.

Wold biermann - ' a large- scale animal experiment on living people'.

The athletes did not know what they were taking but it was controlled by Manfred Ewald.

Heidi Kreiger - under went sex change later because the pills accelerated her transexual tendencies.

Communist coercive vs capitalist individual illegal ( both took andro) it was developed by E. german doctors.

Andro - it was a 'bridging drug' to maintain steroid - induced growth until competition, after steroids discontinued to avoid testing positive. Situation today
. a paradoxical pharmacological puritanism - they love it but it is illegal .

on one hand a demand for constant improvement, high stakes and massive technology and on the other hand higher standards than for the general public.

Athletics are instilled fear in terms of the risks and on the other hand there is a assumption that athletics should do everything in their power to succeed , including run risks.

Ewalds obituary in the Guardian

- Most significantly scientific training regimens are now the norm in all world- class sport, with support staff outnumbering coaches and centres of excellence taking on children at a younger and younger age. the goal may have changed from the glorying state to making a profit, but the methodology remains worryingly familiar ( carlson 2002).

Steriod Use in Australia

- paradox of a ' performance enhancing drug' with no performance

' fastest growing drug in interdiction in australia : 100% + increase last year.
. Postal seizures
. users : bodybuilders, bouncers, police officers.

. recent news report on IV drug injection rooms in Gold Coast, originally created to fight spread of HIV in addicts, now being used by body-builders.

. largest category of users: clinics 'now overrun with muscly young men'.

It is easy to say these users are illegitimate and their use is illegitimate - it is because of changing expectations of male bodies.

Dwayne Johnson - studios are now aware of potential scandal. A expectation is faced and the shifting expectations is what causes the problems and pressure upon the actors to use PED.

Point is shifting expectations. - to our change in diet, supplements, workout and techniques to get shredded. a body builder from 1953 no longer looks like a bodybuilder to us .

Rising prescription of testosterone to middle aged and older men

one quarter of men prescribed testosterone had never been blood tested for natural testosterone level , the number has tripled since 2001.

Just because something isn't common doesn't mean it should not be treated - Abraham Morgentaler. ( referring to testosterone)

Andropause - the refusal to say ageing is normal.

A 2012 study in Minnesota found 6% of teenage boys reported steroid use.

Through shifting expectations bodies are forced to conform to distorted ideals.

The paradoxes of Pharmacological purianism in sport

. some people argue that, with technology, humans will be able to perfect themselves.

. if we 'listen to steroids', i think we see paradox:
. puritanism around the notion of 'fair play' - never get drugs get into sporting space.
. few scruples about using technology for vanity
. use of steroids is normalising.

Imagining American Sexuality in debates over access to emergency contraceptive pills

New productive health technologies

. Stem cell research, cloning, medical abortion, in vitro fertilisation, preimplantation genetic testing, erectile dysfunction drugs, emergency contraception.

. not just about health; about life itself: when does life begin ? what creates and ends life ?
. not just about life; also about sex; sex and sexuality amongst moralised areas of private behaviour.

Female pituitary gland releases follicle growth hormone ( FSH) the follicle triggers ovulation and then dissolves and gets shredded away.

EMP - cause prevention before implantation not after and do not cause induced abortion.

Plan B - the brand of EC sold in the U.S.

A preview of the theory

- Debate over EC in the U.S. - woman bodies are a site of control where the politics of sexuality, discourses on public health, and medical contractions of biological processes intersect.

What is emergency contraception ?

EC : methods of contraception used after sex

. reduce ( but not eliminate ) risk of pregnancy
. EC methods include pills and copper IUD
. ECPs ( =EC pills): contain same hormones in 'birth control pills', but in higher doses.
. can be taken upto 5 days after sex.
. in australia avail from pharmacists

Brands in aus

. postinor 1 , postinor 2
. levonelle -2
. Norlevo

Mechanisms of action

- there are 3 theorised mechanisms of action for emergency contraception (ie.e the way that the drug works in the body to prevent pregnancy)

. by delaying ovulation

. by blocking the transport of either sperm or egg.
3. by preventing the implantation of a fertilised egg ( zygote/ blastocyst) - not anymore

The last mechanism of action is considered least likely by scientist. Yet it is most controverisal.

DIY emergency contraception in AU

. can cut up a regular pack of controlled pills

. take 50 pills within 120 hours after unprotected sex : Microlut, microval.

Oral contraceptives used for EC/ progestin-estrogen combined

. take 2 pills within 120 hours after unprotected sex and 2 more pills 12 hours later - nordiol
. take 4 pills within 120 hours after sex an 4 more pills 12 hours later : levlen, microgynin-30, monofem, nordette.
. take 5 pills within 120 hours after unprotected sex and take 5 more pills 12 hours later. Loette . Microgynon 20, microlevlen.

Dedicated ECPs:

' dedicated' means drugs that are packaged and labeled for EC use (ie. not do -it - yourself cutting up pill packs in your bathroom)

FDA hearing on Plan B

people providing for and against arguments for pills to be available over the counter.

Structure of FDA hearing

FDA
. Non presception Drugs Advisory committee
. Advisory committee for Reproductive health drugs
. 4 voting consultants
6- non voting FDA participants.

Vivian Dickerson says that Plan B meets the FDA citeria for over the counter status and that people need it.

Carol Ben Maimon - plan B works like other progestin only oral contraceptive and only prevents ovulation.

Open Public hearing

FOR expanded EC access :

. planned parenthood federation of america

. national family planning and reproductive health association
National organisation of woman ( NOW) Erin Mahoney - if it is not over the counter , it is hard to already get a appointment to get a appointment with a doctor and get the pill.

Against expanded EC access :

. concerned woman for america -Nurse ( Jill Stanek ) - that adult sexual predators will molest family members and wil feed them the pills after raping.

catholic medical association - john Bruchalski - we all know that 2/3 of 12th grade of woman have had sex and that 3 to for million new std cases will be teens. Over the counter decreases conversations and therefore EC is bad.

american life league - it was abortiion as she believed that human being begin at conception and not implantation so if a human zygote cannot implant, he or she will die. - judie brown

. human life international -Jennifer taylor - that woman should control themselves and know their fertility circle

Robert Marshall , state legislator from Virginia said primary beneficiers will sell it to high school kids and it will cause more problems.

Outcome of FDA hearing

. voting at the end of day :

. 3 bush appointees voted against makning plan B available OTC

. 23 committee members voted yes to the nonprescription switch

. with wide majority most expected the FDA to approve the plan B application BUT

. In May , 2004, the FDA issues a 'not approvable' letter. citing lack of data on teen use of Plan B
. medical authorities publicly condemned the FDA dickerson, president of ACOG, called the decision ' morally repugnat'.

FDA hearing as a kay moment n the social life of this pharmaceutical produt

. things , not just people have social lives

. FDA hearing encapsulated activism of the main players in the public opinon- making around women's reproductive health many of these same players have also been vocal participants in debates over other new reproductive technologies in the US including medical abortion, stem cell research etc.

FDA memo from curtis Rosebraugh

- a internal memo realised in 2006 says that 'urban legend' status that would lead adolescent to form sex based cults

Imaginations of American Sexuality in FDA debate over nonprescription access to ECPs

1 . An exploitative male sexual predator - woman are cast in the role of weak sexual gatekeeper.

2. A responsible condom- using woman in a committed relationship with an equally responsible man

What kind of sexual encounters and possibilities are absent in this debate ?

. Non- hetrosexual, non penetrative sex that off since this is debate about contraception

. consensual sex under the influence of alcohol or
. getting ' caught up in the heat of the moment" - no contraceptive used in the first place

Research strongly supports the idea that the two poles of hypothetical sexuality potrayed in this debate (the two poles) are NOT the face of 'typical american sexuality or especially of unintended pregnancy.

. The possibility that woman might be exploiters rather than men

the highly gendenered portrayal of sexual encounters in the anti- EC position is revealed if we try a little thought exercise: can we imagine an alternative scenario in which the roles are switched?

Woman as gatekeeper of sexuality image whereby EC was lobbied but not viagra as facilitating the sexual exploitation of women.

Erectile dysfunction lecture

- first vaccining into the penis.

History of pharmacological treatments for erectile dysfunction

Professor Giles Brindley presentation at 1983 annual meeting of the American Urological Association in Las Vegas.

Demonstrated his research of the use of Phenotolamine for erectile dysfunction in most unusual way - injecting in his penis.

different cultures have different ideas bout sexuality, masculinity and pharmaceutical products.

. This exercise : snapshot of young ,middle class multicultural, urban australian ideas about relationship between sexuality and masculinity and pharmaceutical use.
. seeing what is unique about our culture by comparisons with other culture e.g eygpt and china

Different cultures have different ideas about sexuality, masculinity and pharmaceutical products

. Shame vs promise of exuberant sexuality

. in egypt, histórical association with the black market/ gift economy
. more than just drugs, more than just commodities: they have a special aura.

Links between modern biomedicine and indigenous health benefits

- taking the notoriety of a global pharmaceutical product and using it to rebrand products that evoke indigenous beliefs about health, virility and sexual potency.

Chinese anthropologist Everett Zhang on men's medicine ( nanke) in China.

“Moral symptomatology”: “a mixture of institutionalized judgment, knowledge, and practice concerning what illness symptoms qualify as disease and whether an illness deserves medical attention.”

. a single illness may be accepted or rejected as diseases by the medical system, depending on power structure and larger social context.

. Male impotence recognized by Chinese medicine since 220 BC.

. Impotence was scarcely recognized in China during the era of Maoist collectivism. Under Mao, the prevalent moral symptomatology was hostile to sexual desire.

Sex supposed to be about reproduction, not pleasure:
– Moral symptomatology in Mao era only justified seeking medical treatment for impotence for reproductive reasons.
– Medical cases published in journals of Chinese medicine in the 1960s and 1970s: men who had not yet fathered children constituted the majority of impotence patients.

Moral symptomatology in post-Mao era

. But by late 1990s: “nanke” (men’s medicine) clinics all over the country; a chief complaint was impotence.
. Less concern with reproduction, more concern with sexual satisfaction.
. Moral ethics of the country had shifted from seeing sex and masculinity in terms of reproduction to seeing these in terms of sexual pleasure and sexual satisfaction.

Zhang’s key points

. Emergence of nanke (men’s medicine) in 1980s: response to changing political economy in China.

Maoist period hostile to individual desire, and impotence was not so much associated with masculine shame – the real shame and fear was about revealing concern with sexual desire. “The body that desired was more shameful than the body that was impotent.”
Post-Mao China: rise of consumer culture and diminishing ethic of collectivism. New ideas about shame: shameful to not be able to have sex and pleasure one’s partner.
What Zhang calls “the changing moral symptomatology” in China increasingly encouraged individual desire, thus increasing the visibility of impotence in post-Mao China by the 1990s when he did his research.

A Law Enforcement Perspective on Drugs:

shit load of drugs in cabramatta - the officer pretends to be a drug dealer. Ending up arresting and charging people who were conducting drug shootings. Drug supply and trade was a catalyst between organised and violent crime. Cohesive hearing - the process that requires a lot of lawyers. Working at ACC showed the profits from organised crimes.

A lot of money was laundered in and out. 2011 - drug squad -2 main areas -

operational arm ( drug investigation )

-General drugs operation team - high level drug supplies

-clandestine drug laboratory team

-cannabis team

Development and implementation of strategic policy. National drug strategy

Supply reduction - legislation and law enforcement demand reduction - prevention and treatment strategies Harm minimisation - needles program and etc

Drug law reformed debate - there is a lot of unknowns on how to do it. cannabis crops , eradication

When things go wrong

chemical hazards and fire/ explosions Emerging challenges
. Ever changing and dynamic organised crime networks

. synthetic drugs - new and emerging psychoactive substances - bath salts, ivory wave and legal highs.

. online anonymous drug markets.

Effects of drug use - it stuffs you up.

Readings for Week 3

Daniel Moerman and Wayne Jonas, 2002. “Deconstructing the Placebo Effect and Finding the Meaning Response.” Annals of Internal Medicine136 (6):471-476.

- placebos are inert and do not cause anything as they don't cause the placebo effect.

-We define the meaning response as the physiologic or psychological effects of meaning in the origins or treatment of illness; meaning responses elicited after the use of inert or sham treatment can be called the “placebo effect” when they are desirable and the “nocebo effect”

-Placebo analgesia can elicit the production of endogenous opiates. Analgesia elicited with an injection of saline solution can be reversed with the opiate antagonist naloxone and enhanced with the opiate agonist proglumide
-Practitioners can benefit clinically by conceptualiz- ing this issue in terms of the meaning response rather than the placebo effect.

The political economy of opiates readings

Cohen, PT (2013) Symbolic dimensions of the anti-opium campaign in Laos, TAJA 24:177-192

. argues that the discourse of opium as a cause of poverty reflects the symbolic dimensions of the process of Laoisation in post-socialist Laos.

. Eradication began in 1984

-It is apparent from this opium-causes-poverty discourse that poverty is caused both by opium as a drug that weakens the body and a drug-crop that is unproductive.

-Traditionally opium was a highly valued commodity and drug for the Akha. Opium had manifold uses: for exchange for goods and livestock, for the hiring of labour, for rituals and ceremonies, for recreational use (including visiting guests), and particularly as a medicine for ailments such as diarrhoea, coughing, malaria and other fevers, physical pain and anxiety.

" the danger of opium addiction" poster. - Manderson’s claim that drugs often ‘take on a malevolent life and character of their own’ (1995: 812) and, moreover, are frequently perceived as agents of sexual seduction that destroy the will (2005: 43). Manderson draws a parallel with beliefs in sixteenth century Europe that female witches were sexually possessed by the Devil and indeed became ‘addicted’ to the sexual pleasure afforded them (2005: 43).

The fixation on opium as a potent cause of deterioration – of the individual and social body – reflects the obsession in Laos with economic development and thepervasive anxiety, illustrated by the ‘discourse of lack’, of failure to compete in the capi- talist world market.

That opium is a cause of poverty is not supported by anthropological and agronomic research either in northern Laos or elsewhere in the Golden Triangle region.

The fast-tracked opium eradication campaign in Laos was more than a politically motivated ‘showcase’ to notch up an easy victory in the War on Drugs, as Ducourtieux suggests; it was also, to use Manderson’s analogy (2005: 58), a ‘kabuki theatre’ that aimed to dramatise the absolute distinction between normal and abnormal, good and evil, civilisation and primitiveness.

Trocki, C. A. (1999) ‘All the Drowsy Syrups of the World’. In Opium Empire and the Global Political Economy: A Study of Asian Opium Trade, 1750-1950. London: Routledge, pp. 13-32.

-drugs has been for healing, or at least to remedy or alleviate some physical distress

-work drugs": those substances which kill pain, increase stamina and dull hunger while one labours, travels, hunts or engages in warfare.

-A third type of drug use involves the "healing" of the spirit, or at least changes our perceptions of "reality" and thus moves us to an "altered stat

-Finally, is the aim of pure enjoyment, indulgence or recreational intoxication. In this case, we use drugs for "play." vVe may use, and perhaps abuse, the same drugs we take in the medicinal or ritual contexts, but with no "serious" intent

-There was social pressure to dispose of drugs to reach trance states because of their unpredictability, and the possibility that the information obtained in the trance might upset accepted orthodoxy.

-Generally speaking, traditional long-distance trade seems to have focused on four major types of products, or trade goods. Simply put, these were: exotic chemicals, precious metals and minerals, luxury manufactures, and human beings

-The "profound changes" that Mintz sees here are the expansion of the market and the commensurate lowering of prices that came with the expansion of production. Basic capitalist growth, economies of scale, comparative advantage and division of labour all came together.

-it was necessary to do to opium what had already been done to commodities such as sugar, tobacco, cotton, and coffee It was necessary to make it too a "commodity"; to organize its production with a force of cheap and malleable labor, on land that was already controlled for as cheap a price as possible.

-It is in the creation of the opium trade that we can see the invisible hand of capitalism at work

Week 4 readings

Martin, J. (2013) ‘Lost on the Silk Road: Online drug distribution and the ‘cryptomarket’. Criminology and Criminal Justice, Online. pp.1-17, http://crj.sagepub.com/ content/early/2013/10/06/1748895813505234

Silk Road article - The article has two related aims: the first seeks to locate the offences associated with Silk Road within the realm of cybercrime.

-Given the limitations apparent to conceptualizing Silk Road as cybercrime, it may be more useful to view it rather as a specific type of OIM, particularly a cryptomarket. Cryptomarket is a colloquial term that originated on internet hacker forums.

Ideal type crypto- markets may also share the following characteristics:

. reliance on the TOR network;

. use of cryptonyms to conceal user identity;

. use of traditional postal systems to deliver goods;

. third-party hosting and administration;

. Decentralized exchange networks;

. use of encrypted electronic currency (e.g. Bitcoin).

Buyers using Silk Road are advised on discussion forums and seller Q&A pages to use pseudo- nyms and have goods posted to addresses other than their place of residence

-Buyers and sellers may be lazy or complacent and fail to conceal adequately their goods or protect their online anonymity; they may engage in risky dealing methods to ‘sell on’ goods purchased online; or they may simply be unlucky and fall foul of random or unexpectedly rigorous inspections.

-The long-term implications of these changes have important implications for the global drugs industry. More direct online distribution networks between drug producers and consumers may significantly curtail the involvement of narco-traffickers and street- level gangs in global and domestic drug distribution. Cryptomarket technology – of which Silk Road is just the largest iteration – therefore presents one of the most prom- ising opportunities to remove much of the violence associated with illicit drugs

the potential of Silk Road to minimize the violence associ- ated with illicit drug distribution may become evident as the site continues to grow, it is difficult to perceive any broader social benefit offered by other cryptomarkets which deal in explicitly malicious goods or services, such as stolen credit cards, child pornography or contract killing.

Leons, M. B. & H Sanabria (1997) ‘Coca and Cocaine in Bolivia: Reality and Policy Illusion’. In MB Leons & H Sanabria (eds), Coca, Cocaine, and the Bolivian Reality. New York: State University of New York Press, pp. 2-46.

Bolivians follow policies that are dictated by the U.S that generally don't serve its best interest is that bolivians are cored to do so by their dependence on the US and their extremely unfavourable position in the world market

Why does U.S. push poles that exact such a high price from bolivians ?

In the words of one of Eduardo Gamarra's informants, "Because we can" (Gamarra, this volume) Tullis, in a recent analysis (1995) that applies a harm reduction measure to drug trafficking policies,

maintains that continuing the present course is probably the best option that Bolivia has"
He concludes that Bolivia's best harm reduction package is probably its present prohibition regime and that "[t]he task is to pursue the present course of nominal crop eradication and more aggressive alternative devel- opment as a way of getting international money into the country that might enter competitive, labor intensive, market oriented activities"

Sanchez de Lozada's opci6n cero plan was a desperate attempt to up the ante in capturing such international resources for the country.

The policy course the U.S. has set to control the harm per- ceived to be caused by the cocaine trade is based on two keystone principles: disproportionate investment in control of supply rather than control of demand, and emphasis on punitive and repressive law enforcement.We would contend that however one measures the results, these are in fact ineffective strategies for achieving the goals ofthe policy.

We see these interrelated goals as the following: 1) reducing significantly the amount of coca grown, thus deprivingthe cocaine trade of its raw material; 2) therefore reducing the flow of cocaine into the US; 3) consequently increasing the price of cocaine and crack to unaffordable levels; 4) resulting in lowering the consumption of cocaine; and 5) doing away with the crime and violence associated with the drug trade.

Wilson, S & M Zambrano (1997) ‘Cocaine, Commodity Chains and Drug Politics: a Transnational Approach’. In Commodity Chains and Global Capitalism. Westport, CT: Praeger, pp. 297-315.

Coca, a South American plant, has been cultivated in Peru, Bolivia, and Colombia for over a millennium

The U.S engaged in its first war on cocaine. As a result o f this war, the U . S . government banned cocaine and coca from flee consumption and classified them as illegal narcotics in 1915, which resulted in soaring numbers of illegal dealers and skyrocketing cocaine prices (Courtwright, 1982; Musto, 1987). By the 1920s, lower-priced heroin had largely replaced cocaine in the market and in drug- control officials' concerns

Two significant legacies horn this first war persist in today's war on cocaine. On the domestic flont, dominant discourses on dmg abuse viewed cocaine use as a criminal activity, employing racist imagery to purport that the majority of users were blacks, despite the fact that studies at the time showed that they were white, a pattern similar to today's (Courtwright et al., 1989). In the international ar·ena, the U,S.. government started advocating international drug policies to control coca production at source countries

The cocaine-consuming population also switched from being predominantly well-off, middle·class, and white in the 1970s to being more heterogeneous in terms of race, ethnicity, and income by the 1990s

Crack's appearance in the mid-1980s expanded the availability of cocaine- based products to lower-income groups. Crack's roots lie in smoking freebase, a "purer, more solid form" of cocaine

Using Hopkins and Wallerstein's (1986: 159) definition of a commodity chain as "a network of labor and production processes whose end result is a finished commodity," we can depict cocaine as a five-part transnational commodity chain:

coca cultivation, coca paste production, refining coca paste into cocaine, cocaine export to consumer markets, and distribution within cocaine-importing countries.

In order to produce coca paste, the mixers first add kerosene and SUlflIIic acid to the coca leaves Stompers, called pisadores, then pound the mixture to fOIm the coca paste. Like coca cultivation, this procedure is very labor·intensive and does not require sophisticated equipment.

wholesale distributors, retail sellers, and low··level distributors

Money laundering, a key component of the trade, thus ties the illegal economy with the legal economy by recycling drug money into the legal financial system.

In brief, the cocaine trade binds Pemvians and Bolivians, who cultivate coca and process the coca paste, with Colombian drug organizations, which refine, transport, and distribute cocaine to the United States, where US. wholesalers, middlemen, and peddlers sell it to the world's largest market of cocaine con- sumers

Difference between cocaine and other commodity

. it is illegal in the U.S. - giving it high market prices and high return.

Second, cocaine is not regulated in the same manner as other commodities. There are no state policies, no taxation, or no tariffs to promote the trade and cocaine manufacturing

On the domestic front, tIre main thrust of narcotics policy is directed toward arresting low-level street dealers and most domestic funding

On the international front, most narcotics aid has been given to the military, resulting in "de facto" aid for counterinsurgency programs and repression of local populations In recent years, under the Bush administration, the trend toward increased militarization has accelerated

Similarities - Changes in the global economy (e. g.. , tIends toward less state intervention and the informal economy growth) have affected cocaine like other commodities.. Not only has the cocaine tIade benefited from the decline in formal labor arrangements, drawing horn the flexible reserves of labor thereby created, but it has been able to provide better-paying jobs to the unskilled and skilled

Our analysis has also shown that despite the fact that cocaine is an illegal commodity and that a regional, Latin American elite controls production, it still shares similarities with other transnational commodities-profits remain within core countIies and the trade is tied to the global economy by links to legal industIies such as chemical and arms manufactuIing and the world's financial system,

Mather, LE, Rauwendaal, ER, Moxham-Hall, VL and Wodak, AD (2013) (Re)introducing medicinal cannabis. Medical Journal of Australia 199(11):759-762

. After considering extensive scientific and medical evidence, a New South Wales Legislative Council multiparty committee recommended that medicinal cannabis should lawfully be made available for selected- use pharmacotherapy.

. The evidence indicates that cannabis has genuine medicinal utility in patients with certain neuropathic conditions, with acceptable levels of risk from mostly mild side effects.

. The potential medical benefits of cannabis pharmacotherapy have largely been overlooked, with research and society’s attention, in most parts of the world, being directed towards the hazards of its recreational use.

. The NSW Government has since dismissed the unanimous and compassionate recommendations of their committee.

Cannabis terminology, substances and preparations

Cannabis (Latin, meaning hemp)

. Portions of the Cannabis sativa plant producing a resinous exudate secretion rich in specified terpenoid chemicals.

. Historical source of fibre, food, dietary supplement and medicine (as a tincture).

. Also known as marijuana or marihuana, and by a variety of street names, and varietal names related to botanical cultivars.

. Concentrations of chemical constituents can vary by plant strain and conditions of growing,

storage, harvest and preparation. Standardisation of any plant material, extract or blend for medicinal use is essential, and the chemovar is the most reliable predictor of medicinal value.

Cannabinoids

. Substances (regardless of chemical structure and whether they are natural or synthetic) that bind to biological receptors and produce the classical spectrum of pharmacological effects demonstrated by extracts of C. sativa.

. Principal botanical cannabinoids are tetrahydrocannabinol (THC) and cannabidiol (CBD), a major non-psychoactive component that attenuates the cognitive effects of THC and may have useful effects of its own.

. With all modes of administration, chemical components of cannabis other than cannabinoids probably contribute to the medicinal and other effects; pharmacological effects may therefore be enhanced by synergies between constituents of cannabis not present in isolated or synthetic cannabinoid pharmaceuticals.

Preparations currently available

. Synthetic THC (dronabinol [Marinol, Solvay Pharmaceuticals]): oral capsule.

. Synthetic analogue of THC (nabilone [Cesamet, Meda Pharmaceuticals]): oral capsule.

. Natural THC (Namisol, Echo Pharmaceuticals): early development; oral tablet with novel emulsifying drug delivery technology.

. Whole-plant extract; THC:CBD, 2:1 (Cannador, IKF Berlin): oral capsule.

. Standardised plant matter in granular form;THC:CBD,19:1(Bedrocan),12: