Chapter III.
United States Efforts to Reduce Demand for Drugs
D. Addressing Emerging Drug Threats
1. Domestic Heroin Initiatives
An estimated 810,000 Americans are chronic users of heroin. Between the first half of 1988 and the first half of 1997, heroin medical emergency mentions increased 99 percent from 18,100 to 36,000 mentions. As noted in the July 1997 National Narcotics Intelligence Consumers Committee Report "heroin remained readily available to addicts in all major metropolitan areas throughout 1996." The same report notes that "stable wholesale process per kilogram and high retail-level purities indicated increasing supplies."
Heroin Addiction Can Be Treated: Methadone treatment, along with counseling and other interventions, is being used successfully to treat heroin addiction. Methadone is an agonist agent for opiates. In other words, methadone operates by occupying the brain receptor sites that are affected by heroin and blocks the craving attendant to addiction. Approximately 115,000 Americans are able to lead stable lives as a result of methadone treatment received at the more than 900 methadone treatment programs.
Yet many of the nation’s 810,000 heroin addicts do not have access to methadone treatment or any other effective form of drug abuse treatment. Methadone treatment is not available in Idaho, Mississippi, Montana, North Dakota, New Hampshire, South Dakota, Vermont, and West Virginia. The laws governing methadone treatment, the Controlled Substances Act (CSA) and Narcotic Addict Treatment Act (NATA), date from the 1970s and pre-date research breakthroughs on the nature of addiction. These laws arbitrarily limit the expansion of treatment capacity.
SAMHSA/CSAT is developing an accreditation system for methadone treatment. Regulatory oversight responsibility will be transferred from the FDA to SAMHSA/CSAT. The current regulatory approach will be replaced by an accreditation system. In this system, programs will be subjected to clinically based performance standards that emphasize comprehensive treatment. Law enforcement (anti-diversion) responsibilities will remain with the DEA.
Increased Public Awareness: Efforts are also underway to increase public awareness of the dangers of heroin use, especially among youth. The National Anti-Drug Youth Media Campaign is showing heroin messages on prime-time television, as well as in newspapers, magazines and other media. Areas of the country in which heroin use is growing are receiving concentrated exposure to anti-heroin programming.
2. Countering the Methamphetamine Threat
Methamphetamine: Over the past few years methamphetamine trafficking and abuse in the United States have steadily increased. According to the 1997 National Household Survey, an estimated 5.3 million people (2.5 percent of the population) tried methamphetamine in their lifetime. The estimate has increased significantly since 1994, when 1.8 percent of population had ever used methamphetamine. In the past, methamphetamine was largely produced and supplied by outlaw motorcycle gangs. More recently, however, organized crime poly-drug trafficking groups are dominating the wholesale trafficking in the United States. These large organized groups have developed large-scale laboratories both in Mexico and the United States that are capable of producing large quantities of methamphetamine.
The Attorney General and the Director of ONDCP are co-chairs of a Federal Task Force on Methamphetamine. In the past year, the Demand Reduction component has met twice, and is reviewing all federal programs relating to education, prevention and treatment as they apply to methamphetamine.
Funding to implement the demand component of the National Methamphetamine Strategy is included in the Department of Health and Human Services drug control budget. Specifically, the National Institutes on Drug Abuse annually spends approximately $20 million in research to understand the epidemiology of methamphetamine use, its mechanism of action and effects on brain functions, behavioral consequences, and treatment and prevention implications and approaches. Furthermore, the Center for Substance Abuse Treatment, Substance Abuse and Mental Health Services Administration, allocates funding to investigate the treatment paradigms that may prove effective to treat addiction to methamphetamine.
3. Increasing Awareness of Inhalant Abuse
Inhalants are a chemically diverse group of products commonly found in every household. Although they are not illicit substances, they are often the first substances abused. Inhalants are legal, easily obtained, commercial products found in most homes. They include such products as glue, paint, typewriter correction fluid, felt tip markers, gasoline, and many others. When these products are inhaled, however, the consequences can be deadly. Death can occur the first time one sniffs, or the tenth, or the hundredth. Damage can occur to the liver, kidneys, and bone marrow, even irreversible brain damage. According to the National Household Survey on Drug Abuse, there were an estimated 805,000 new inhalant users in 1996, up from 382,000 in 1991. Approximately 20 percent of adolescents nationwide have used inhalants in their lifetime.
In order to raise public awareness of inhalants, the ONDCP Director has made a video in conjunction with SC Johnson Corporation and Deloris Jordan, mother of pro-basketball star Michael Jordan, that has been sent to educators and parents groups around the country warning them of the dangers of inhalant abuse.
