International Board Concerned about Overprescribing of Legal Drugs

By Judy Aita
Washington File United Nations Correspondent

United Nations -- Releasing its annual report on worldwide illicit drug production, trafficking and abuse February 21, the International Narcotics Control Board (INCB) highlighted what it sees as a growing problem in the overprescribing of legal drugs and the misuse of drugs to treat social problems rather than real mental illness or physical disease.

The board is concerned about frequent long-term use of psychotropic substances to treat psychological reactions to social pressure without a diagnosis for a specific disorder. Controlled drugs are being extensively used in medicine today to treat different forms of insomnia, anxiety, obesity and child hyperactivity as well as various kinds of pain.

Calling it the "medicalization of social problems," Ambassador Herbert Okun pointed to the growing trend in industrialized countries where pharmaceutical companies produce consumer-directed ads that promote drugs invented to treat previously unknown medical problems, contributing to the creation of "a true pill-popping culture."

At a press conference releasing the report, Okun, who is an INCB member, read an advertisement aimed at people who are shy or anxious in social situations, telling them to consult their doctors because there is a medication to help. The result is "treating symptoms instead of underlying problems" with drugs, he said.

Another problem is the increasing use of the Internet to buy illegal drugs, Okun said.

In its 79-page report, the INCB said that while drugs to relieve pain and suffering are not readily available in many parts of the developing world, there is an excessive consumption of drugs in developed countries. Countries experiencing rapid economic growth such as Malaysia, Singapore and Thailand are also seeing the problem, especially with anorectics that are used by some people who want to look fashionably thin. In developed countries, the prevalence of anxiety and insomnia, and the consumption of sedative hypnotics, are growing -- the elderly being the main group of consumers.

But the board also stressed that drugs "have revolutionized the care of the mentally ill over the past 50 years and medications containing narcotic drugs and psychotropic substances have an important place in health care."

The inappropriate prescription of controlled medicines includes uninformed prescribing, inconsistent or lax prescribing, willful and consistent prescribing for abuse, and self-prescribing and self-administration, the report said.

Reducing the excessive use of prescription drugs, however, depends much more on educating doctors and other health care professionals in rational prescribing than in reducing the consumption of illegal drugs, such as cocaine, which requires educating the general population, especially adolescents, the INCB said.

The report also gave an overview on the illicit production, trafficking and abuse of heroin, cocaine and cannabis.

In Africa, drug abuse appears to be rising, the age of initiation to drug abuse is falling, and the number of women and children abusing drugs is growing, the report said. There has also been an increase in injecting heroin, which is of particular concern because of the high rate of HIV/AIDS infection in the region.

Africa continues to be a major supplier of cannabis, which is the most widely abused drug. Although the continent serves mainly as a transit point for smuggling heroin and cocaine, falling prices in cities across sub-Saharan Africa have resulted in increased abuse. Cocaine abuse is especially prevalent in southern Africa, the report said.

Western African syndicates, with their experience in smuggling cannabis and heroin, are actively looking for new connections in Latin America and are bringing cocaine trafficking to all parts of sub-Saharan Africa, the report said. They are also using a growing number of nationals of different African countries as drug couriers and smugglers.

Drug traffickers continue to take advantage of the location of Central America and the Caribbean between the major producing and consuming countries, and the region's hundreds of small islands and myriad of cays. In Central America, ports on the Caribbean Sea and on the Pacific Ocean are increasingly being used for transshipment of illicit drugs, and the spillover of that traffic is having a noticeable impact on drug abuse, particularly cocaine and "crack," the report said.

In the Caribbean, airdropping drug consignments into coastal waters and then having them picked up by speedboat has become a common practice. Because of the increased efforts by authorities in some countries, traffickers have been quickly moving their operations to weaker jurisdictions and regularly stockpiling drugs in isolated locations. Traffickers have increased their activities using the Caribbean as a transit point, and are taking advantage of the potential offered by the growing tourism industry, making sure that "crack" and cocaine are increasingly available in the region.

In the report, the Narcotics Control Board emphasized concern about "the often too liberal attitude of some governments towards offshore banking and gambling activities, which, without the appropriate control machinery, are likely to be taken advantage of by persons who engage in money laundering."

Cannabis remains the most common drug abused in Canada, Mexico and the United States. In the United States, while the overall level of cocaine abuse has remained unchanged, the rate of abuse among adolescents dropped by 14 percent from 1998 to 1999, the report said. The board attributes the drop to measures taken to educate people about the harmful consequences of drug abuse. Overall, heroin abuse has declined as well.

South America is still the sole source of illicit cocaine hydrochloride. Despite significant reduction in the extent of coca bush cultivation in Bolivia and Peru in recent years, the overall capacity of the region to manufacture cocaine hydrochloride does not seem to have been significantly reduced, the report said.

Trafficking methods vary, but it appears that all countries on the continent are being used as transshipment points. In most countries the abuse of cocaine continues to rise, but the abuse of heroin is negligible, the report said.

The board said that while illicit opium production has declined in recent years, the abuse of opiates remains a serious problem in the countries of the Mekong area. It said there continues to be a correlation between heroin trafficking, the prevalence of heroin abuse, and the spread of a specific type of HIV infection because of the practice of injecting heroin.

In East and Southeast Asia, there has been a drastic increase in the manufacture of, trafficking in, and abuse of amphetamine-type stimulants in the past few years, the report said.

Seizures of heroin in South Asia show that Afghanistan and Myanmar are major sources, not only of heroin smuggled through the region, but of the heroin for illicit markets in Bangladesh, India and Sri Lanka, the report said. Seizures and other drug-related arrests indicate that multinational drug trafficking groups are operating in South Asia.

The board is concerned that opium production in Afghanistan and the resulting smuggling and criminal activities in West Asia as a whole "may undermine the economic and social stability and jeopardize peace and security in the region," the report said. "There is growing evidence of links between firearms smuggling, insurrection and drug trafficking in the central Asian states."

Because of record harvest crops in 1998/99, opiate stocks are plentiful, prices are low, and supply abundant. In Afghanistan, which produces 75 percent of illicit opium, large-scale cultivation -- which increased significantly in crop year 1998/99 -- decreased by only about 10 percent in 1999/2000 due to unfavorable weather conditions and the reduction of poppy cultivation.

Most countries in the region are used by traffickers as transit points for opiates originating in Afghanistan and headed to Europe, and it has had serious repercussions for drug abuse. Heroin addiction rates in Iran and Pakistan are among the highest in the world, the report said.

While the Taliban rulers in Afghanistan have banned the collection of taxes on heroin, it appears that opiates are sold freely throughout the country, the report said. The huge increase in heroin seizures made in West Asia is an indication that heroin processing in Afghanistan has increased substantially in the last two years.

The report also noted that the Taliban has said it intended to enforce a ban on opium poppy cultivation in the territory under its control. But because of the large amount of opium stocks from previous harvests, the ban -- if implemented -- will have no immediate impact on the prices or availability of opiates from Afghanistan.

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