Bulletin on narcotics最新文献

Despite a substantial reduction in the level of high-risk behaviours among injecting drug users (IDUs) documented in an impressive number of studies from many countries, human immunodeficiency virus (HIV) infection continues to spread among and from this population, reflecting the high baseline levels of these risk behaviours before the epidemic. In many countries, the control of HIV spread among IDUs is critical to efforts to control the epidemic in the population as a whole. Although the evaluation of individual or multiple strategies is problematic, there is accumulating evidence and increasing confidence that the course of the epidemic can be altered by implementing some or all of a range of strategies. Authorities mindful of their public health responsibilities should estimate the risk of spread of HIV among and from IDU populations in their jurisdiction and plan their response accordingly by selecting prevention measures that are appropriate for local conditions and by vigilantly monitoring developments.

Long-standing patterns of drug injecting in mainly developed countries have been joined by the introduction and expansion of drug injecting in developing countries, often followed quickly by outbreaks of human immunodeficiency virus (HIV) infection. Drug injecting has been identified in 80 countries and HIV infection in 52 of these. Given the continued recruitment of new injectors where injecting is endemic, the diffusion of drug injecting in countries where the practice was formerly rare and the potential for this diffusion to occur, HIV prevention must also consider interventions that discourage drug injecting. Particularly at risk are countries in drug-producing regions and along drug transit routes in Africa, south-east and south-west Asia and South America. Injecting can spread in less time than it takes to introduce HIV prevention activities. The task of the public health system will be to find a balance between activities targeted at helping current injectors change their behaviour and activities targeted at discouraging the adoption of drug injecting.

In 1988, the Institute for Epidemiological Research on Drug Dependence conducted an ethnographic study designed to assess the results of liberalization of the sale of syringes. In that study, drug addicts were found to have gradually altered their customary practices by limiting the sharing of syringes. Two years later, a second study was conducted to further assess the behavioural changes under way. The whole survey covered 359 subjects--165 in Paris, 110 at Marseille and 93 at Metz. Almost all the subjects stated that they knew about the risks of transmission of the human immunodeficiency virus (HIV) by needle and during unprotected sexual intercourse. Almost all of them (98 per cent) knew that syringes were freely sold at pharmacies. Most of them (84 per cent) felt that they were generally well informed on the subject of AIDS and the ways in which the virus was transmitted. Prostitutes accounted for 17 per cent of the sample, with more women (32 per cent) than men (13 per cent) included in that category. The overwhelming majority of the subjects bought their syringes at pharmacies, and the trend towards the non-sharing of syringes was confirmed, a change in behaviour that has emerged mainly since 1987. Among the "new generation" of drug addicts, namely those who began to inject after 1987, the changes are reflected in a much lower rate of infection--2 per cent instead of 28 per cent of the total. About a third of the subjects, however, continued to engage in practices involving a certain level of risk. In a global context, including subjects who do not know how to properly clean a syringe, a variety of usually ineffective practices are followed, for example rinsing with water, lemon juice, or scent. The use of bleach remained limited, and few people considered cleaning with it. Liberalization of the sale of syringes seems to be essential to the prevention of AIDS among drug addicts. But this measure is not enough in itself. Apart from the overall problems of looking after the health of drug addicts and ensuring access to medical care, certain specific measures remain highly desirable. Of particular importance is the dissemination of information clearly describing effective methods of sterilizing syringes (including the use of bleach).

Although reported rates of human immunodeficiency virus (HIV) infection and related risk behaviours among drug injectors vary considerably throughout the world, and comparison of findings is often hampered by methodological variability among centres. In 1989 the World Health Organization initiated a comparative study of current drug-injecting behaviour and HIV infection using a standardized methodology. Centres were asked to recruit at least half of their samples outside drug treatment settings in order to achieve as representative a group of injectors as possible. Respondents were interviewed using a questionnaire designed by an international working group, and they were asked to provide blood and/or saliva specimens for voluntary testing. Data from 13 centres (Athens, Bangkok, Berlin, Glasgow, London, Madrid, Naples, New York, Rome, Rio de Janeiro, Santos, Sydney and Toronto) are reported here. A total of 6,390 injectors were recruited to the study from October 1989 to March 1992, with sample sizes ranging from 85 at Santos (Brazil) to 1,300 in New York. Weekly or daily sharing of injecting equipment was reported by less than a quarter of injectors in all centres. A high proportion of those sharing made some effort to clean equipment before use, although not always by efficient methods. In all centres, the majority of respondents were sexually active; however, rates of unprotected sexual intercourse were high, particularly between regular sexual partners. The overall HIV prevalence rate was 22 per cent, ranging from 0 per cent in Athens to 60 per cent in Santos. Caution should be exercised in postulating a link between HIV prevalence and current risk behaviour, particularly since injectors appear to behave in similar ways across a diverse range of study locations. This is the first report on an international collaborative study for which a large number of injectors were successfully recruited from a variety of settings. The wealth of data now available provides a greater understanding of the social epidemiology of drug injecting, which is essential for the implementation and evaluation of campaigns and interventions designed to limit the spread of HIV infection.

Data from various countries show considerable variation in the rate of spread of the human immunodeficiency virus (HIV) among drug injectors. Although further research is needed to predict the rate of increase of seroprevalence at Rio de Janeiro, preliminary data confirm the presence of the virus, with a seroprevalence of about 33 per cent in 1990. Issues arising from research into the probable determinants of viral spread among the thousands of drug injectors in the city are outlined in the present paper. Even before the research is completed, however, it is clear that interventions are needed to reduce further viral transmission both among drug injectors and from them to their sexual partners and offspring. Efforts should be made to prevent the population at risk from initiating the practice of drug injection, and to promote a major expansion in drug abuse treatment facilities. Drug injectors should also be encouraged to reduce the risk of their becoming infected or passing on the virus to others, through educational outreach, through the distribution of supplies that facilitate risk reduction (bleach, syringes, condoms), and through innovative approaches to behaviour change.

In the present paper, major issues related to drug testing are discussed. For example, drug-testing techniques measure the presence of a drug or drugs but are not sophisticated enough to measure impairment from drug use. Moreover, it is difficult to determine the route of drug administration, quantity or frequency, as well as when the drug was taken, on the basis of the laboratory results. Selection of the drug to be tested should depend on the local availability of the drug, its abuse potential and clinical effects, as well as on the availability of analytical technology and expertise in testing and in interpreting laboratory results. The most sophisticated drug-testing approach is gas chromatography coupled with mass spectrometry (GC/MS), which is regarded as a "gold standard"; it is used in confirmatory testing. Typically, GC/MS is preceded by a rapid immunoassay method to eliminate the majority of the "negative" samples. Despite the existence of sophisticated drug-testing methods, it is still possible to obtain incorrect test results. Such results may be caused by the presence of interfering substances or adulteration of the urine sample. A number of techniques can be employed to reduce the likelihood of obtaining erroneous results and to detect adulterated urine samples. A "positive" drug finding can have a serious impact on the livelihood of an individual, therefore, persons conducting such tests should adhere to the strictest standards of laboratory performance. Only qualified and experienced individuals with proper laboratory equipment should perform these analyses. The standards of laboratory performance must meet local legal and forensic requirements. Access to patient samples and laboratory records must be restricted in order to prevent the tampering of samples and results. In order to maintain confidentiality, the results must be communicated only to the medical review officer. Chain-of-custody documents and all file so that they can be examined in case of a legal challenge. The laboratory must have a complete record on quality control. Finally, specific initial and confirmatory testing requirements should be met.

Opium has been produced and consumed since the nineteenth century in the areas of Asia currently referred to as the Golden Crescent and the Golden Triangle. In the 1970s and 1980s, most countries from Afghanistan to Japan experienced a heroin epidemic of varying degrees of severity. Opium and heroin abuse appeared to be more severe in countries and areas where those drugs were produced, an exception being Hong Kong, which has had a large population of heroin abusers for more than two decades. Drug injecting was far more common in countries of the Golden Triangle than in those of the Golden Crescent. In Myanmar and Thailand, for example, up to 90 per cent of chronic heroin abusers practised intravenous injection, which appeared to spread to heroin abusers in nearby territories such as the State of Manipur in India. Yunnan province in China, as well as Malaysia and Viet Nam. Amphetamine abuse was more frequent in Japan and the Republic of Korea for a number of years, while illicit production and consumption in the Philippines have recently shown significant increases. The injection of amphetamines was common only in the Republic of Korea. The prevalence of injecting among institutionalized methamphetamine abusers was reported at about 90 per cent. Most countries in Asia first reported cases of infection with the human immunodeficiency virus (HIV) in the mid-1980s. An extremely rapid spead of the epidemic and high prevalence, at rates of from 30 to 90 per cent, of HIV infection among the sample of intravenous heroin abusers were observed in a few countries with a high prevalence of intravenous injecting, such as India (in the State of Manipur), Myanmar and Thailand. The rest had either few reported cases or none at all, even though needle-sharing was found to be common. Great caution should be exercised in interpreting prevalence because of vast differences in methods of assessment. Given the vulnerability of intravenous drug abusers to rapid transmission of HIV infection, the prevention of drug injecting is of paramount importance in arresting the spread of the epidemic. Efforts to contain drug abuse, though difficult, are a principal means of achieving that end.

The abuse of heroin and other opiates by intravenous injection is identified as the major risk for the spread of infection by the human immunodeficiency virus (HIV) and of acquired immunodeficiency syndrome (AIDS) to the population at large. From 1980 to 1992, 2,712 opiate-addicted intravenous drug users with severe complications and behavioural problems were treated at the Institute on Addictions, Belgrade; 2,090 of them were from the Belgrade area and 622 from other urban areas. All of them had used heroin by intravenous injection during a certain period of their addiction careers. A majority of the patients had started using heroin by the age of 20, and begun treatment after six or more years of addiction. An informal survey of heroin-addicted intravenous drug users newly admitted for treatment showed that every respondent knew from 10 to 20 other heroin users who had not sought treatment. It was estimated that a majority of intravenous drug users may not have been known to the authorities. Of 551 intravenous-opiate-addicted patients from the Belgrade area tested between 1987 and 1992, 43.7 per cent were HIV-seropositive, or 47.9 per cent of HIV-seropositive males and 32.9 per cent of females, while for the same period, of 366 tested patients from other urban areas, 4.6 per cent were HIV-seropositive, 5.2 per cent of them males and 1.8 per cent females. The distribution by sex of the intravenous-opiate-addicted patients indicated that the percentage of females who started using heroin earlier in their lives and the percentage of those who sought treatment late--after six or more years of addiction--were higher than the corresponding percentages of males. Also, female patients tended to become infected with HIV earlier in their lives than male patients.

This study of the State of Rondônia in Brazil sheds light on how and why the cultivation of illicit narcotics crops and drug trafficking are affecting non-industrialized regions. It also highlights the negative impact of such activities on tropical ecosystems and human population.

Drug trafficking and drug abuse are among the major social issues that the world has to grapple with. The far-reaching consequences of drug abuse in humanitarian, social and economic terms have led to intensive action on the part of Governments, intergovernmental and non-governmental organizations. The International Criminal Police Organization (ICPO/Interpol) plays a key role as the central command for the joint efforts of the national law enforcement agencies of its 158 member States. The present paper outlines the role of ICPO/Interpol, particularly its Drugs Sub-Division, in international drug control efforts. It includes a discussion of ICPO/Interpol policies and practices related to drug control and of recent developments in its information and communication capabilities.