Measures to assess drug abuse and the health, social and economic consequences of such abuse : summary of information from 21 countries

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Measures to assess drug abuse and the health, social and economic consequences of such abuse : summary of information from 21 countries

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Pages: 19 to 32
Creation Date: 1983/01/01

Measures to assess drug abuse and the health, social and economic consequences of such abuse : summary of information from 21 countries

United Nations Secretariat

ABSTRACT

This article summarizes the replies received from 21 Governments to a survey undertaken in June 1982 of measures to assess drug abuse and its consequences. A large number of programmes for the assessment of drug abuse were reported, and these were classified either as population surveys or as reporting systems of existing institutional data on drug abuse, depending on the methodology used. Each method was described as having certain advantages and limitations, which varied according to the aims of the assessment and the circumstances under which it was carried out. A well-established reporting system, which obtained data from law enforcement agencies, health services or other institutions that came into contact with drug abusers, was reported to be an effective means of assessing the consequences of drug abuse, but it provided information only on cases that were brought to the attention of the authorities. On the other hand, a survey covering, for example, the general population, students or conscripts, based on a probability sample, represented the population studied and detected cases of drug abuse that were not recorded by institutions.

In many of the replies it was stated that drug abuse imposed a considerable burden on society in terms of health impairment and disabilities, as well as in terms of its social and economic consequences. Drug abuse diminished the ability and motivation of drug abusers to engage in the complex tasks required in modern society. Dropping out of school, performing poorly at work and losing employment were the most common consequences of drug abuse. It was also reported that drug abuse played an important role in the development of criminal ,delinquent and anti-social behaviour.

Introduction

The Commission on Narcotic Drugs decided at its seventh special session in February I 982 that it should address itself at its thirtieth session to measures to assess the nature and extent of drug abuse and the health, social and economic consequences of such abuse.[[1]] In an effort to prepare documentation on this subject for the Commission, the Secretariat distri- 19 20 buted a questionnaire to Governments of Member States in June 1982 requesting relevant information. By February 1983, 21 Governments1 had replied to the questionnaire.

At its February 1983 session, the Commission requested the Secretariat to summarize the information made available by Governments and to publish this summary in the Bulletin on Narcotics [[2]] . Accordingly, this article highlights responses received from the Governments, and the documents referred to by the Governments in their responses are also considered. The article consists of two sections -one outlines the salient points of measures to assess the nature and extent of drug abuse and the other shows the main health, social and economic consequences of such abuse.

Measures to assess the nature and extent of drug abuse

A variety of programmes on the assessment of drug abuse were reported. Many countries indicated two methods of assessing drug abuse: population surveys or reporting of data from institutions, such as law enforcement agencies and health services, that came into contact with persons abusing drugs in the course of their work.

Population surveys

Many countries described population surveys on drug abuse that were conducted by academic institutions or governmental agencies to elicit information on drug abuse. There were two major types of survey: a single survey at a given point in time, which provided descriptive information about drug abuse and the population studied, and a survey repeated over time, which provided data for trend analysis. The methods used and the extent to which surveys covered national populations varied considerably. In general, surveys required considerable technical skills in sampling, in designing a questionnaire or interviewing schedule and in coding and analysing data.

Nation-wide household surveys

Two countries, Pakistan and the United States of America, reported nation-wide household surveys based on probability samples.

In Pakistan, a household survey was conducted in all districts of the country in 1982. Adults, selected at random, were interviewed in their homes.The survey showed that 6.7 per cent of the male adult population used drugs. Of an estimated 1.3 million drug users, 61 per cent lived in the rural areas and 39 per cent in urban areas. Drugs used were mainly cannabis, opium, heroin, psychotropic substances and mixed psychoactive substances. Hypnotic substances were used in 6 per cent of the households and in 12 per cent medication was used for relaxing. The survey also revealed that in 12 per cent of the households opium was used as medication for children.[[3]]

Argentina, Australia, Belize, Brazil, Canada, Colombia, Denmark, German Democratic Republic, Greece, Kiribati, Mexico, Monaco, Pakistan, Philippines, Poland, Singapore, Sweden, Thailand, United Kingdom of Great Britain and Northern Ireland, United States of America, Upper Volta.

A national survey on drug abuse in the United States is carried out biennially. A household interview is used in a probability sample which covers the population aged 12 years and older. The 1982 survey, compared with 1979, showed a significant decrease in drug use. In the 18 to 25 age group, which was mainly afflicted, the percentages of those who used drugs within 30 days prior to the 1982 survey, by drug used, were : cannabis, 27.4 per cent (35.4 per cent in 1979) ; cocaine, 6.8 per cent (9.3 per cent in 1979); hallucinogens, l.7 per cent (4.4 per cent in 1979) ; and non-medical use of psychotherapeutic drugs, such as stimulants other than cocaine, sedatives, tranquillizers and analgesics, 7.0 per cent (6.2 per cent in 1979). The percentages of drug users were by far lower for the 12 to 17 age group and in the 26-year-old and older group of respondents[ [4]]

The fact that a relatively small probability sample could be extrapolated to the general population was stated to be an advantage of nation-wide household surveys. Such surveys also allowed in-depth studies of associated factors to drug abuse. Repeated surveys were good indicators of trends, allowing the comparison of changes in drug abuse over time. The relatively high cost of the surveys was, however, one of the limitations.

Other population surveys

A number of countries, among them Australia, Argentina, Canada, the Philippines and Sweden, reported conducting surveys of specific groups of the population. The surveys were usually carried out on an ad hoc basis to gather information on the extent of drug abuse in a given population or geographical area, and the aim was mainly to assess community needs for designing and implementing programmes on the prevention and reduction of drug abuse. Such surveys often focused on population groups in a community that tended to have higher frequencies of abuse of certain drugs or those groups of the population whose pattern and extent of drug abuse could be extrapolated to the whole community. Out-of-school youth was an important target.

The two most commonly used techniques were the personal interview and the self-administered questionnaire. While the interview had the advantage that the interviewer could explain questions to the respondent, it was rather expensive and time-consuming. In contrast, the self-administered questionnaire was less costly and less time-consuming but required reading proficiency on the part of the respondent.

It was indicated that, generally, such surveys provided a reasonable picture of the drug abuse situation in the population studied. However, surveys often differed in methodology and in the drugs studied, and thus, the results were of limited value in estimating the overall national drug abuse situation and monitoring trends at the national level.

School surveys

It was reported that a nation-wide survey of high school seniors, based on a probability sample, had been conducted in the United States annually since 1975. The survey provided an accurate picture of the current drug abuse situation and trends among seniors, and it also helped to gain a better understanding of life styles and social environment factors associated with drug abuse. The most recent survey had shown that the use of illicit drugs among high school students, though still at an unacceptably high level, had been gradually decreasing. Between 1981 and 1982, the use of au illicit drugs had shown a decline, except for heroin and inhalants, which showed no appreciable change. The survey had indicated that daily cannabis use, following a period of rapid increase from 6 per cent in 1975 to 11 per cent in 1978, decreased remarkably in later years and fell to 6 percent in 1982, or approximately 1 in 16 high school seniors.

The annual survey was considered to have achieved a high -'level of accuracy, permitting the detection of fairly small changes in drug abuse from one year to the next. The period when a young person completed high school represented an important developmental stage, accumulating both home and school influences and, as such, provided a unique opportunity to study the influence of environmental factors on the occurrence of drug abuse. One limitation of the survey was that it did not include students who dropped out of high school; however, the percentages of those dropping out was similar from year to year, and thus the omission was considered to have introduced little or no bias in the analysis of changes in drug abuse over time. However, the use of heroin might have been under-reported, because heroin use was. associated with illegal behaviour [[5]] .

Using a similar method as that for the study described above, a survey on habit-forming substances among pupils in grades 6 and 9 had been conducted in Sweden annually since 1971. A school survey was being conducted in all provinces of Thailand using the interview technique for pupils in primary schools, since they needed clarification of questions, and the self-administered questionnaire for older students.

Other countries, such as Australia, Brazil, Mexico and the Philippines, also reported conducting school surveys, but on a more limited scale, studying one or more schools or all schools in a given geographical area. Some surveys studied only cannabis and some included other drugs, but the number of substances varied from one survey to another. School surveys were generally carried out by means of an anonymous self-administered questionnaire that was easily applied and quickly completed by large groups of students. In contrast with the interview technique used in household surveys, the self-administered questionnaire required no trained interviewers.

Conscript survey

Methods similar to those described above for school surveys were being used in the annual conscript survey in Sweden. As the level of literacy was fairly high among conscripts in Sweden, it was possible to use a self-administered questionnaire, which would not be feasible in countries where there were illiterate conscripts.

Self-administered questionnaires that were machine-readable and easy to process were used in some school surveys and the conscript survey, thus reducing costs and labour. The refusal rate in surveys using self-administered questionnaires distributed in a regular school class or similar setting was reported to be very low in contrast to the relatively high refusal rate using questionnaires mailed to intended respondents.

Existing data and reporting systems

Drug abuse assessment programmes that used data available from law enforcement agencies, health and welfare services and other institutions that came in contact with persons abusing drugs were described in most of the replies. In several cases there were no organized programmes on the assessment of drug abuse, apart from routine police records. In a few cases, the assessment programmes using institutional data were unable to assess with accuracy the extent of drug abuse at the national level.

Reporting systems

In a number of replies it was stated that data on drug abuse available in various services and agencies were reported on a regular basis to a central body which, in turn, compiled and analysed the data for the entire country. The following reporting systems were used [[6]] :

  1. Reporting of events, such as admissions to drug abuse treatment programmes or drug offences. During the reporting period, the same person, however, might be admitted to more than one treatment programme or might commit more than one offence. Thus, one person might be reported more than once and accounted for more than one event during a given period. In such a case, the statistics compiled for the whole country accounted for a number of events rather than a number of individuals ;

  2. Reporting of cases so that a case reported by an institution represented an individual. In other words, one person could not be reported more than once by the same institution for the same drug-related problem during a reporting period. But there was a possibility that a person could be reported more than once by different institutions;

  3. Case registers. Names and other identification characteristics of individuals were reported together with data on drug abuse so that a central body could immediately check whether or not a given case had previously been reported, thus avoiding duplication.

Law enforcement statistics

Most responses described the type of drug charges and drugs seized that were reported by law enforcement agencies to a central governmental body that compiled and analysed the data. The main items were drug offences reported as "events" and persons charged in relation to drug possession, trafficking, prescription forgery, theft, burglary, diversion of licit drugs into illicit channels and property crimes. A drug offender might not necessarily be an addict.

In many replies it was noted that law enforcement statistics were useful in estimating the magnitude of drug-related problems and in determining current and future trends. Such statistics were particularly helpful in determining new patterns and new drugs on the illicit market.

In addition to law enforcement statistics, some law enforcement authorities gathered relevant information from other sources to identify the immediate problems and to predict future trends. For that purpose, the Royal Canadian Mounted Police issued a monthly publication of drug intelligence trends and two publications annually, one on drug intelligence estimates and the other on drug trend indicators. The publications were disseminated to law enforcement agencies to keep them apprised of the current illicit drug situation.

Health service statistics

A large number of drug assessment programmes were said to be sponsored by health or welfare services. Some countries indicated that statistics on the treatment of drug addicted persons were not collected at the national level, although such statistics existed at the local or regional levels. Others described various assessment programmes including, in some countries, national reporting systems of data on treatment of drug addicted persons.

National reporting systems within the health service

In the United States a "drug abuse warning network" collected information on adverse reactions to drug abuse from approximately 800 hospital emergency rooms and on drug-related deaths from county medical examiners or county coroners. The network provided important infor- 25 mation on emerging drugs and combinations of drugs, the abuse of which had serious consequences. There was also a national reporting system in the United States that collected data from all clients of the federal drug abuse treatment programmes. It was operated with the voluntary participation of the States and was useful for evaluating drug abuse treatment programmes and determining drug abuse patterns, but the limited amount of information that was collected did not allow for in-depth studies.

In the United Kingdom of Great Britain and Northern Ireland, bimonthly statistics of patients treated for narcotics addiction were reported to a central body by treatment centres and hospitals in England and Wales. The programme provided ready information about narcotic addicts under treatment and the amount of heroin and methadone prescribed, but it did not provide information about addicts treated by doctors outside of treatment institutions.

All narcotic treatment centres in Thailand were required to report to a central body, but the system was being consolidated and complete information was not available at the time the reply was sent.

An annual report on drug addicts under treatment was sent to a central body by treatment institutions in Denmark. These institutions also gave an estimate of the total number of addicts in the region they served. It was stated, however, that there was no reliable information in the country about frequencies of abuse by d rug type.

Studies of drug addicts admitted to out-patient clinics and hospitals were carried out in Greece, but the limitations involved in such studies were that they were not representative of the actual drug abusing population.

Case registers

Case registers, operated either by a central narcotics control body or by a body within the Ministry of Health or the Ministry of the Interior, were reported in, inter alia, the German Democratic Republic, the Philippines, Poland and Singapore. Pakistan reported a national case monitoring system.

In the United Kingdom, medical doctors, treatment centres and penal institutions were obliged to notify the Home Office of any person dependent on the "notifiable" drugs, which included opiate type drugs and cocaine.

Case registers were capable of following an individual's contacts with different institutions, but the information provided was limited to reported cases only. It was indicated that the question of confidentiality deserved particular attention in dealing with case registers [[6]] .

Other reporting programmes

A national reporting system on poisons and overdoses which covered both legal and illegal drugs, was being introduced in Australia. A similar 26 programme, but confined to adverse reactions and poison control of legal drugs, was operated on a voluntary basis in Canada. Both programmes were designed to distinguish between self-imposed and accidental overdose and poisoning.

The replies from Australia, Denmark and the United Kingdom stated that drug-related deaths were reported to a central body in their respective countries and such records formed part of the mortality statistics. It was noted, however, that it was difficult to ensure that drug addiction was recorded on death certificates in all relevant cases.

In Canada, monthly reports of laboratory analysis of illicit street drug samples were found useful as supplementary information for drug abuse assessment. Reports from licit drug control programmes that gathered information from pharmacies, practitioners, hospitals and licensed dealers about patterns of drug distribution and their consumers were also found useful.

The health, social and economic consequences of drug abuse

The burden on societies in terms of health impairments and disabilities, as well as the social and economic consequences arising from drug abuse were mentioned in several replies. Several replying countries reported no available information, while others pointed out that it was difficult to estimate social and economic consequences of drug abuse as such estimates are complex and costly.

Most responses ranked heroin or other opiates first on the list of drugs that produced the consequences of drug abuse; however, they were countries where heroin or other opiates are considerably abused. A few countries indicated that it was difficult to make such a list, since the problem resulting from drug abuse depended on the extent and circumstances of abuse and the abuser's background.

Health consequences

The replies indicated that all drugs of abuse had powerful effects on the nervous system and, to a lesser extent, on other systems of the body, mostly involving behavioural disorders. The effects varied according to the drug abused; the method, amount and frequency of use; the user's background; and the social and physical environment in which the drug was abused. The presence of drugs in the body could exert an influence on the effects of an additional drug taken; such drug interaction involved a number of important factors such as the cumulative effects of taking one drug several times and the effects of taking two or more drugs at once[ [7]] .

The main effects of drug abuse on health, as reported in the replies, are highlighted below.

Opiates

Tolerance to opiates, including heroin, morphine and synthetic narcotics such as pethidine and methadone, was rapidly developed, as was both psychological and physical dependence. Physical dependence was characterized by intense physical disturbance (an abstinence syndrome) after the use of the opiate was discontinued. Abrupt and complete withdrawal resulted in severe health disturbances and occasionally in death. Overdoses caused respiratory depression and other health disorders that often resulted in death. Abuse of opiates together with alcohol, sedative-hypnotics or tranquillizers produced potentiated effects and, thus, increased risk of death. Prolonged abuse of opiates produced loss of appetite and body weight, constipation and malnutrition. When opiates were injected, the use of unsterilized needles often caused viral hepatitis, abscesses, endocarditis and other infectious diseases.

Cocaine

The highly reinforcing properties of cocaine caused well-integrated persons who used it to become compulsive abusers. In the past, it had been believed that cocaine did not induce tolerance, but that assumption had been based on small doses of cocaine taken by sniffing. The new pattern of coca paste or cocaine base smoking and also injection of cocaine hydrochloride led to very high and prolonged cocaine concentration in the blood and in turn to tolerance. Intense euphoria of short duration was followed by the feeling of displeasure and depression. Both euphoria and displeasure drove people towards compulsive cocaine abuse, which resulted in impaired judgement, personal dysfunctions, tactile hallucinations, delusions and paranoid psychosis that provoked aggression against an imagined persecutor. There had been an increase in cocaine-related deaths. Homicides in connection with the illicit cocaine market were also reported. Injecting cocaine, similarly to that cited for opiates above, caused hepatitis and other infections.

Cannabis

Abuse of cannabis produced intoxication, which was dose-related. While there were different points of view on the hazards of cannabis abuse, there seemed to be no disagreement that the abuse of cannabis by children and young persons was highly undesirable. Young people, who were undergoing rapid changes in physical development and psychological and social maturing, could not fully benefit from academic studies and day-to- day experiences while intoxicated by cannabis. Available evidence suggested that acute cannabis intoxication interfered with learning, immediate me- 28 mory and intellectual performance, as well as with driving skills and the operation of complex machinery. Evidence, however, remained as yet inconclusive on a number of important issues such as effects of cannabis abuse on the immune system, structural changes of the brain, endocrine system, reproductive functions and chromosomes.

Prolonged cannabis abuse induced tolerance and certain degrees of psychological and physical dependence. Such abuse caused psychological disturbances that ranged from anxiety reactions to the severe alteration of sensory and perceptual functions and acute psychosis, and in such cases it took several weeks to clear intoxication after the abuse of cannabis was discontinued.

Hallucinogens

Hallucinogens include a number of substances, such as lysergic acid diethylamide (LSD), phencyclidine and dimethyltryptamine (DMT) that could, in small doses, produce intense effects that cause detachment from reality and an inability to function normally. The abuse of hallucinogens produced a distortion of perception, hallucinations, psychotic reactions and often led to accidental deaths and suicides. Substances that were not pure hallucinogens, such as phencyclidine, could, in addition to the hallucinogenic action, produce stimulant and analgesic effects. Phencyclidine abuse caused the disintegration of the psyche, sometimes with irreversible damage or death.

Amphetamines

Amphetamine, dextroamphetamine, methamphetamine, phenmetrasine and methylphenidate are used in medicine as stimulants for the central nervous system in the treatment of a few rather uncommon conditions. Prolonged abuse of amphetamines produced tolerance and dependence and caused malnutrition, high blood pressure, rapid or irregular heart beat, tremors, loss of co-ordination and collapse. Aggressive behaviour and paranoid psychosis were also a common feature. Withdrawal was char- acterized by fatigue, deep depression and often suicidal tendencies. Amphetamine-related deaths often occurred as a result of heart failure, burst blood vessels in the brain and high fever.

Sedative-hypnotics and tranquillizers

Sedative-hypnotics and tranquillizers include a large number of substances, e.g. barbiturates, methaqualone, benzodiazepines and meprobamates, which are widely used in medicine to treat such conditions as anxiety, tension and high blood pressure. These substances could slow down or decrease vital body functions, including respiration; their abuse induced tolerance, psychological and physical dependence and a syndrome similar to drunkenness. Larger doses produced unconsciousness and death. Abrupt 29 withdrawal involved the risk of delirium, convulsion and death. Both prolonged abuse and withdrawal interfered with the essential functions of sleep. When the substances were abused in combination with alcohol or opiates, they potentiated each other's effects, which considerably increased the risk of respiratory depression and death, and were also an important factor in the occurrence of road and industrial accidents.

Multiple drug abuse

Multiple drug abuse, as well as the use of drugs and alcohol, had serious health consequences and could lead to death. Easily available psychoactive substances were abused in various combinations, often in order to experience stronger effects or to replace a drug of choice which was not available.

The following data, though representing one country only, illustrate the extent of multiple drug abuse. Among drug addicted persons admitted for treatment in federally funded facilities in the United States, whose total number was over 251,000 in 1981, the percentages of addicts who were not involved in multiple drug abuse were very small for amphetamines (14 per cent), hallucinogens ( 15 per cent), barbiturates (17 per cent) and cocaine (17 per cent) and, by contrast, somewhat higher for cannabis (28 per cent), opiates other than heroin (34 per cent) and heroin (44 per cent).

Social consequences

At the national level, social and economic consequences of drug abuse were studied less than the health consequences. There was, however, general agreement that societies were deprived of valuable contributions that drug addicted individuals could make had they not been enslaved to drugs. It was indicated that drug abuse severely affected normal social functioning, intelligent and responsible behaviour and the ability and motivation to engage in the complex tasks required in modern societies.

Prolonged drug abuse caused persons to become defensive, violent or submissive, precluding them from taking part in the social events of normal life which, in turn, was the major cause of their social seclusion. In several replies, the deterioration of personal, family and other social relationships was described.

Both students and employed adults who were heavy drug abusers showed very pronounced tendencies towards inactivity, apathy and self-neglect.

Loss of interest in conventional goals and lethargy led to low school and job performance and, in turn, to decreased productivity in both school and work situations. Thus, dropping out of school and loss of employment were frequently observed to be consequences of drug abuse. 30 Other social problems, such as prostitution and gambling, were also often associated with drug abuse.

It was noted in many replies that drug abuse, usually in association with a number of psycho-social factors, assumed an important role in the development of criminal, delinquent and anti-social behaviour. Some countries had made no relevant studies in that area.

In one reply it was pointed out that drug abuse constituted a serious threat to the security of the country.

Economic consequences

Most countries reported that drug addicted persons most commonly resorted to criminal activities, mainly to support their drug habits. The crimes reported included murder, rape, robbery, assault, burglary, larceny, theft, forgery and others.

Three studies carried out in the United States gave clear evidence of the links between crime and male heroin addiction. In the first study, carried out in Miami in 1978, 239 heroin addicts admitted to having committed 80,644 criminal acts during 1977. On an average, every heroin addict committed 337 offences per year. It was concluded that many heroin addicts would resort to violence if there was an opportunity for financial gain - 42.7 per cent of the addicts surveyed had used a weapon in committing some or all of their crimes. Only 2 per cent of the crimes reported in the study led to arrest. In the second study, which included a group of 243 heroin addicts in Baltimore, it was found that the mean number of crime days per addict during a year was 178. The group of heroin addicts admitted committing crimes on 248 days per year while addicted, whereas when not addicted, the number of crime days was only 40.8 per year, which clearly indicated the role of treatment in decreasing heroin-related crimes. In the third study of 460 addicts, carried out in 1978 and 1979 in Baltimore, the mean amount stolen by individuals while actively addicted was US$ 669 per week. That figure included robbery, burglary and theft but did not include profits from drug dealing, which was US$ 1,044 per week for the same group of addicts [[8]] .

Some responses pointed. out that criminal networks, which gained enormous profits from illicit drug trafficking, caused considerable damage to the economies of those countries where there was a great demand for illicit drugs created by a large number of drug addicted persons.

Many countries described economic costs involved in the establishment and operation of various services and agencies that dealt with drug abuse problems such as health, welfare and social services for the prevention of drug abuse and treatment of drug dependent persons, drug law enforcement agencies, prisons, criminal justice systems and other institutions involved in combating drug-related problems. The costs incurred varied between countries according to the extent of drug abuse problems and the responses of society in coping with such problems. The expenditures of drug abusers for buying illicit drugs were a substantial burden on their families - also an important part of the economic consequences of drug abuse.

The indirect economic consequences of drug abuse arising from such conditions as drug-related unemployment and consecutive losses in overall national manpower and productivity were listed in many replies. It was also indicated that, in addition to the costs of drug-related crimes and incarcerations, there were heavy costs inflicted on national economies by disabilities, absenteeism, accidents and deaths due to drug abuse.

In some countries, vast areas of land that otherwise could be used for cultivating and producing useful income crops are used for illicit cultivation of opium poppy, cannabis plants and coca bush.

Three countries reported estimated annual economic costs of drug abuse at the national level in national currencies. In Canada, the overall retail sales of illicit substances was on the order of 10 billion Canadian dollars annually. The annual values in Canadian dollars were : heroin, $ 2,065,056,000 ; cocaine, $ 517,764,000 ; and cannabis, $ 6,541 ,925,680. In the Philippines, approximately l 8 million pesos were spent annually on the national programme for the prevention and control of drug abuse. In the United States, a study estimated that the minimal cost of drug abuse to the national economy in 1977 was over US$ 16 billion. That study took into account the costs of health care, security and the criminal justice system and losses in productivity and involvement in criminal activity but did not include the expenditures of drug addicts for buying illicit drugs, the transfer of illicitly acquired assets to other countries and the costs of violent and property crimes associated with drug abuse [[9]] .

References

001

Official Records of the Economic and Social Council, 1982. Supplement No. 3 (E/1982/13), p. 60.

002

Ibid., 1983. Supplement No. 5 (E/1983/15), p. 61 .

003

Pakistan Narcotics Control Board, Public Attitudes Towards Drug Abuse (Islamabad, Pakistan Institute of Public Opinion, 1982), pp. 3 - 64.

004

4. J. D. Miller and others , National Survey on Drug Abuse: Main Findings 1982 (Rockville, Maryland, National Institute on Drug Abuse, 1983), 153 p.

005

L. D. Johnston, J. G. Bachman and P. O&rsquoMalley, Student Drug Use, Attitudes, and Beliefs (Rockville, Maryland, National Institute on Drug Abuse, 1982), pp. 1 - 132.

006

I. Rootman and P. H. Hughes, Drug-Abuse Reporting Systems (Geneva, World Health Organization, 1980), pp. 11 - 50.

007

World Health Organization, Report of the Expert Committee on Implementation of the Convention on Psychotropic Substances, Technical Report Series No. 656 (Geneva, 197 1), pp. 20 - 42.

008

National Institute on Drug Abuse, Drug Abuse Prevention, Treatment, and Rehabilitation in Fiscal Year 1981, Fourth Annual Report from the Secretary of the Department of Health and Human Services to the President and Congress of the United States (Rockville, Maryland).

009

Federal Strategy for Prevention of Drug Abuse and Drug Trafficking 1982 (Drug Abuse Policy Office and Policy Development, Washington, D. C., 1982).