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:
- 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.
- 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 )
- social rituals
Both shape how drugs are used.
The myth that drugs are defined and determined by their pharmacological properties - NOTE NOT IMPORTANT.
- The choice between legal and illegal drugs is done by socially and historically determined and not based on its dangers.
- 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
- Drug is never 100 percent addictive
- drugs are not always bad
Post- Propaganda approach to studying drugs
- how drugs work in bodies - (neuropharmacology)
- how addictions work - (psychology)
- how experiences with drugs are mediated by
1 . culture symbolism ( anthropology)
2. the social organisation ( subculture) of users ( anthro and sociology)
3. drug law and international markets ( political science and economics)
- the history of drug use ( history)
- 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
- "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.
- Enormous economics implications where there are large profits made " Wars against drugs" - profits and criminality associated with drug trafficking
- 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
- Belladonna ( deadly nightshade)
- Datura ( Jimson Weed, thorn apple)
- 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
- tobacoo
- hallucinogenic drugs
- fasting
-mediation, hypnosis
- music, dancing
- 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 :
1. The drugs are used in their natural forms, not refined drugs
2. They consider the human desire to periodically experience altered states of conscicious to be normal, not deviant.
3. The taking of hallucinogens is usually under the supervision of an experienced user, such as a shaman
4. The use of hallucinogens is highly ritualised. Avoids negative effects by ' establishing a framework of order around their work.
5. 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
- He ingested some LSD and experienced vivid hallucinations and started it on himself and volunteers
- It was claimed that it could be used to investigate schizophrenia
- Dr. Ronald Sandison gave some LSD to Alfred M hubbard - former intelligence officer and millionaire
- 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
- 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
- LSD found to be more useful for interrogation as an anxiety producing drug. LSD used as an interrogation aid from 1950s to 1960s.
- 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"
- 1966 - led became illegal in the USA
- Last LSD research project ended in 1975.
- Making it illegal only made it popular and the black market developed an intensive demand for LSD.
Moral Entrepreneurs : Kesey
- First experience LSD as MK-ULTRA subject
- assessed psychedelics in mental asylum where is worked.
- 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
- 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.
- LSD on the black market: tainted supplies, controlled by mafia
- Manson murders attributed to LSD.
- 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.
- Himmelstein's theory of moral entrepreneuers in shaping the way a drug is seen in society.
- 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
- Botanical names - cannabis saliva and Cannabis Indica
- Main forms - Marijuana, sincemila , hashish, hashish oil ( high potency) and hemp.
History of Cannabis
- originated in central Asia
- Mentioned in ancient medical and religious chinese and indian texts.
- In the west cannbis was initially used for practical purposes - as hemp fibre ( for sails and ropes)
- 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.
- Recreational use in the west:
a. French Hashish club ( Baudelaire and Gautier, 1843)
b. 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)
- Social locus : the social position (e.g. class, ethnic, generational) position of the drug users
- "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.

- Ganja : a scapegoat for elite and middle - class anxieties about deviant behaviour ( crime, violence, laziness) of poor working class
- 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)
- In USA the public image of cannabis/ marijuana had changed from a drug violence to a "drop out" drug linked to "amotivational syndrome"
- " 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.
2. Individual country legislation : Great britain, 1928; Australia 1928; USA 1937.
3. 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:
- Cannabis provides a blueprint for experimentation with other illicit drugs, reducing inhibition for further illicit drug use.
- Existence of factors and processes that encourage both cannabis and other illicit drug use "common factor" explanation. - Availability
- 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:
- Almost all hard drug users first used cannabis however temporal precedence cannot be equated with casualty.
- Research shows only small proportion of those who use cannabis go on to use heroin.
- 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.
- Anxiety, dysphoria, panic and paranoia.
- Psychomotor impairment and risk of injury.
- Increased risk of low weight babies during pregnancy
- Respiratory diseases
- Cancer link
- Cannabis dependence syndrome
- Cognitive impairment
- Psychosis ( including Schizophrenia).
Cannabis and Psychosis
-Cannabis use exacerbates the symptoms of schizophrenia
- 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
- psychomotor impairment while driving
- 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.
- " Objective scientific evidence" - does NOT shape drug policy , media coverage and popular opinions.
- Medical, epidemiological and scientific evidence that cannabis consumption is less risky than alcohol use.
- Yet in the 2000s, U.S spent over $4 billion a year arresting people on marijuana charges
- 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.
- ' The greatest harm caused by marijuana comes form the collateral damage of its illegality"' Criminalization leads to an increase in profitability of marijuana
- criminalisation also leads to an increase in the violence surrounding trafficking.
- 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
- Used in different contexts in Europe and Native America
- European culture : intent on trade and colonising new worlds. Europeans took tobaccos and made a commercial product out of it.
- 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.
- local species of Nicotiana
- some used a nicotine- containing plant called Duboisia hopwoodii
- Drug made from it called "pituri" - high nicotine content.
- alkali ash used to enhance action of the drug.
- used for shamanistic purposes to achieve altered state of consciousness
- effects ranging from euphoria to stupor and catalepsy.
South American Varieties of tobacco that became dominant:
- Key varieties of tobacco came from south america.
- Rustica tobacco produced largely for insectide and "Turkish cigarettes"
- Tabacum is milder than Rustica , now more dominant - Indians of south america domesticated the tobacco and grew it.
Nicotine
- main tobacco ingredient
- Pure nicotine : a clear oily liquid. A single drop is fatal.
- Have to smoke about 400 cigarettes all together to get a fatal dose ( Nick Modjeska's calculation).
Measuring addictiveness of nicotine
- it is more addictive than heroin
- 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 ?
- It is a lot easier to buy tobacco than heroin
- 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 ?
- 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
- Nicotine stimulates production of neurotransmitters :
- Dopamine, serotonin and noradrenaline.
- Tobacco inhibits the production of enzyme MAOB which breaks down dopamine - thus dopamine levels rises.
Range of reactions for smokers:
- calm relaxation
- stimulation and euphoria
- high doses : Severe stimulant effect, leading to hyperactivity, vomiting, trembling and convusions.
- Extreme high doses - make you pass out.
- Reaction depends on dose, environmental conditions, and mood and personality of user.
Effects on hearts
- Blood vessel constriction
- increases concentration of triglycerides and cholesterol in the blood
- 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
- Reduces anxiety and stress
- Aids in sociability : not because of the drug , but because of rituals.
- Promotes alertness
- Relieves discomfort and pain
- Reduces weight loss
- Also somewhat relieves the symptoms of Parkinsons, Alzheimers and Tourettes.
Tobacco and Shamanism

- Tobacco is not a true hallucinogen. Shamans used " tobacco narcosis" to reach the spirit world
- smoked throughout the Newworld for ritual purposes
- Plains indians did NOT smoke themselves into unconsciousness; puffed on the peace pipe and passed it around; regarded as a sacred drug and act.
- tobacco to native americans: equivalent of grapes to christianity as without it there could be no communion with the divine.
- 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'
a. ' formal laws and policies regulating drug use'
b. '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 :
a. clinical samples are restricted to drug users in treatment or picked up by the legal system
b. 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 ?
1. A substance used in the diagnosis , treatment, or prevention of a disease or as a component of a medication
2. such a substance as recognised or defined by Food and drug Administration.
3. 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
1. Action potential triggers release of neurotransmitter from presynaptic terminal
2. NT binds to receptor on post synaptic cells
3. Bound NT causes a change in post- synaptic dendrite
4. NT released from receptor
5. 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 :
- 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
- 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.
1. Alcohol is often taken in larger amounts or over a longer period than was intended
2. There is a persistent desire or unsuccessful efforts to cut down or control alcohol use
3. A great deal of time is spent in activities necessary to obtain alcohol, use alcohol or recover from its effects.
4. Craving, or a strong desire to use alcohol
5. Recurrent alcohol use resulting in a failure to fulfill major role obligations at work, school or home.
6. Continued alcohol use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by alcohol.
7. Important social, occupational, or recreational activities are given up or reduced because of alcohol use.
8. Recurrent alcohol use in situations in which it is physically hazardous
9. 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.
10. Tolerance, as defined by either of the following:
a. A need for markedly increased amounts of alcohol to
achieve intoxication or desired effect.
b. 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.
1. Autonomic hyperactivity (e.g., sweating or pulse rate greater than 100
bpm)
2. Increased hand tremor
3. Insomnia
4. Nausea or vomiting
5. Transient visual, tactile, or auditory hallucinations or illusions
6. Psychomotor agitation
7. Anxiety
8. Generalised tonic-clonic seizures.
C. The signs or symptoms in Criterion B cause clinically significant distress or impairment in social, occupational, or other important areas of functioning
D. 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 :
1. A compulsion to seek and take the drug continuously or periodically
2. inability to control intake
3. 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.
- 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
- 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 its advertised, how its 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 201250+ 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
a. 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 patients 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 patients 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 Burmas 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 worlds 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
1. Preparation - Village data collection, raising awareness of community, addicts ' volunteer needed for detoxification'. Signing of form agreements and destruction of
smoking equipment. Medical checks .
2. 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
a. Global coca cultivation - has increased then decreased
b. 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
1. The drug war was raised the cost to traffickers of doing business and of the prices of drugs in Western countries.
2. However, the prices are not high enough to reduce demand by consumers
3. The paradox is that the raising of prices also inflates profits.
4. High profits provide an incentive for drug supplies to remain in the trade for new supplies to enter.
5. 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:
a. Marketing often a problem due to poor transport system and low profit-to weight ratio.
b. Long period of time without income for substitute crops ( e.g. coffee , fruit trees).
c. Volatility of domestic and international markets.
-Success of crop substitution undermined by unrealistic eradication deadlines:
a. drug war symbolism and obsessive concern and supply reduction targets.
b. Rapid elimination of opium in Laos ( 2000 - 2005) allowed insufficient time for adequate alternative development.
c. 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
a) - growth by peasants on small family farms
b) - 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.
- 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)
Doesnt 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)
1. by delaying ovulation
2. 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, histrical 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 (mens 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.
Zhangs key points
Emergence of nanke (mens 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 ones
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. - Mandersons 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 Mandersons 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 arena, 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, middleclass, 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 laborintensive and does not require sophisticated equipment.
wholesale distributors, retail sellers, and lowlevel 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 societys 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:<1(Bedrobinol),

6:75 (Bediol), 14:< 1 (Bedica): produced by Bedrocan BV for the Netherlands Ministry of
Health, Welfare and Sport; pharmacy-supplied for vaporisation or tea preparation.

Botanical cannabis extract with minor cannabinoid and other plant-derived substances; 2.7 mg THC and 2.5 mg CBD per 0.1 mL (nabiximols [Sativex,
Bayer]): oromucosal spray

Wodak, A (2000) Developing More Effective Responses. In G Stokes, P Chalk & K Gillen (eds), Drugs and Democracy, Melbourne: Melbourne University
Press, pp. 183-200.
At the 1925 Geneva Convention, Australia agreed to enact laws to 'limit exclusively to medical and scientific purposes the manufacture, import, sale,
distribution, export and use of medicinal opium, cocaine, morphine, Indian hemp and heroin'
In 1997, using the Delphi technique," a diverse group of clinicians, researchers, law enforcement officers, government officials and drug users estimated
that there were currently 100000 regular injecting drug users with an additional 175000 occasional injecting drug users
Australia's drug policies were originally adopted for cannabis on an almost arbitrary basis, and those for heroin following international pressure. Experience
with more than seven decades of cannabis prohibition and almost five decades of heroin prohibition suggests that these policies are expensive, ineffective and
counterproductive. 'Fine tuning' of these policies or 'more of the same' is unlikely to achieve improved outcomes. A fundamental review of drug policies is required that
redefines the problem of illicit drugs as primarily a health and social issue Unless such a redefinition is accompanied by a major re-allocation of funding, progress will not
occur. Although, the vast bulk of government funding has been allocated to law enforcement, the few successes of Austraha's drug policy can be attributed to the harm
reduction programs.
Australia now has the example of other more successful countries to emulate. Attracting drug users from the illicit supply system into drug treatment will
improve the lives of drug users and their families as well as reducing crime for the entire community. It now appears that the reform of Australia's drug policies is more a
question of 'when' than 'whether'.
The most important step is to redefine illicit drug use as primarily a health and social issue rather than a criminal justice problem,.
Week 5 readings.
Ezard, N (2013) Its not just the alcohol: Gender, alcohol use and intimate partner violence in Mae La Refugee Camp, Thailand, 2009. Substance Use and Misuse:
1-10
This study from one long-established refugee camp describes how alcohol use and IPV are shaped by the specific social context and embedded within gendered power
rela-tionships. More research is required on the relationship between alcohol, violence against women, and gender in general; intervention-oriented research among
popula- tions displaced by conflict is particularly warranted. Programming efforts addressing problem alcohol use among long-term displaced populations in alcoholconsuming cultures need to be assessed on their impact on IPV against women. Practitioners and policy makers need to under- stand gendered roles and power
relationships when de- signing interventions. Further economic, epidemiological, and social science research to improve understandings of common causal pathways is
required as a basis for identi- fying and implementing complex interventions.
Hoberman, J. (1995). Listening to Steroids. The Wilson Quarterly Vol. 19, No. 1, pp.35-44
it is easy to endorse the medical wisdom of warnings against the widespread use of steroids and other potentiallydangerousdrugs, the historyof athleticdoping in
this centuryshows that it has been very difficult to enforce such phar- macological Calvinismin thefaceof growing demands for the "therapeutic"benefits of
enhanced Theelastic of performance. concept
therapywill help to legitimizehormonalma- nipulationas a mass therapyof the future.It
is interestingto speculateabouthow the advertisingexpertswill promotetheseproducts. Itishardtoimaginethattheywillnotturnto
elite athletes,portrayingthem as pharmacologicallyimprovedexamplesof supercharged health.Onecansee theathletesnow, linedup
atthestartof anOlympicfinalearlyin thenext
century,theirdrug-companylogosgleaming in the sun.
Fishman (2007). Making Viagra: From Impotence to Erectile Dysfunction.
Men had a choice of either accepting and adjusting to these changes or consuming morally and medically questionable elixirs or nostrums such as Brown- Sequard's
"PoW's Spermine Preparations,"
As Marshall and Katz summarize, "impotence was still largely regarded as a disease of the young, and a condition of the 0Id,"7 Therefore, psychotherapy was
recommended (and considered successful) for men under 45, while impotence in men over 45 was still considered a "normal" part of the physical decline of aging.
- first rods inserted
greater blood flow, erections were rein- terpreted as a function of blood flow. Like implants; injections such as these could produce erections regardless of the etiology of
the impotence, and regardless of whether or not a man had any difficulty getting an erec- tion "on his own."26
In 1992, this shift of impotence from a psychological to a biomedical disorder was stabilized and codified by a "consensus development confer- ence" sponsored by the
National Institutes of Health. This also marked the beginnings of the transformation of terminology from impotence to "erectile dysfunction" (ED)
erections are dependent upon a complex interplay between vascu- lar and neurological events. As described in the NIH Consensus State- ment, erections are most often
initiated by a central nervous system response to psychogenic stimuli (e.g., "desire," perception, etc.), which then activates the sympathetic and parasympathetic
innervation of the penis.
The parasympathetic aspects of the arousal response were newer elements in the theory and ran counterintuitive to previous notions of sexual arousal.
nitric oxide as a messenger signal of the cardiovascular sys- tem, inducing relaxation of the smooth muscle of blood vessels. In the 1990s, he and Rajfer conducted some
of the research identifying nitric oxide as the neurotransmitter responsible for smooth muscle dilation in the penis, enabling erections. Nitric oxide is released by both the
caver- nosal nerves and the epithelial cells of the corpus cavernosum. Up to this time, a number of neurotransmitters were considered responsible for cre- ating
erections, including both vasoactive intestinal polypeptide (VIP) and prostaglandin El' Prostaglandin El does play a role in inducing erections; it is the active compound in
penile injections.
Phase I is a clinical trial on a few persons to determine the safety of a new drug and its dosage or toxicity limits. Phase II of a clinical drug trial is when a drug is tested on
human subjects to evaluate its fficacy and side effects. Phase III is a large clinical trial of a drug that in phase I and phase II has been shown to be efficacious with

tolerable side effects; after successful conclusion of phase III clinical trials. a company applies for formal approval from the U.S. Food and Drug Administration (FDA).
the psychologization of impotence in the 1960s and 1970s pathologized impotence, such that it was no longer considered a component of normal aging, but as a
dysfunction in need of treatment. The organicization of impotence beginning in the 1980s relo- cated impotence from a problem of the mind to a problem of the body,
focusing attention on the penis as an "organ."
Sildenafil in effect enhances the effect of the cGMP path- way for erectile function.

Wynn & Trussell (2006). Images of American Sexuality in Debates Over Nondescription Access to Emergency Contraceptive Pills Obstetrical Gynecology
108(5):1272-

Over the counter approach is the best to this contraceptive pills no matter what the situations are.
- for kids having the pills will not increase sexual vulnerability.
Desmond Manderson (2011). Possessed: The unconscious law of drugs. In S Fraser and D Moore, eds., The Drug Effect: Health, Crime and
Society. Melbourne: Cambridge University Press, pp.225-239.
- harm minimisation measures seek to improve the halt and longevity of drug users even if those measures lead to an overall increase in use
- Zero tolerance measures seek to decrease drug use even if those measures worsen the health and longevity of those who use drugs.
- law is not just instrumental but also symbolic, a vehicle for the representation and organisation of our underlying anxieties, fears and desires.
- the legal structure of law is not the solve the problem but to dramatise an ideology and to entrench an anxiety by the obsessive, repetitive predictable and destructive
performance of a symptom.

Farrell, G (1998) A Global Empirical View of Drug Crop Eradication and the United Nations Substitutionand Alternative Development Strategies, Journal
of Drug Issues, 28(2): 395-436.
The drug crops in question were coca bush, opium poppy, and the cannabis plant. With respect to crop substitution and development work, evidence relates primarily to
two decades of United Nations programs and projects in 11 countries. The available empirical evidence suggests that at the global level there have rarely been
more than 10 percent of any one type of illicit crop eradicated in a given year, and the risks to farmers of imprisonment are minimal; hence, farmers' risks are
generally low, and they can quickly resume cultivation. A range of obstacles obstruct the implementation of eradication, including popular opinion and public
demonstrations, corruption, and sabotage. Where eradication is implemented, farmers use a range of adaptive responses to minimize the impact; the most notable
adaptive response is relocation and the new planting of crops. Apparently, current eradication strategies hold little prospect for making substantial inroads into
illicit cultivation. What began as crop substitution in the 1970s became integrated rural development in the 1980s and emerged in the 1990s as alternative
development. The changes in terminology reflect refinements in methodology of the approach according to proponents and mark the failure of various policies
according to critics; however, despite efforts to tailor and improve the theoretical underpinnings of the approaches, the empirical evidence regarding their
effectiveness shows little reductions in illicit cultivation; however, because development work is less punitive than eradication and far more politically acceptable
within producer countries, it seems likely to continue.

William A. McKim, 2007. Dependence,Addiction, and the Self-Administration of Drugs. Chapter 5 ofDrugs and Behavior: An Introduction to
Behavioral Pharmacology, sixth edition. New Jersey:Pearson Prentice Hall, pp.92-127 (on eReserve).
The American Association for the Cure of Inebriates was established in 1870 and became the forerunner of the temperance movement. Its first principle
was, "Inebriety is a disease." The idea that alcoholism was a disease was not based on any medical research at the time but was motivated strictly by humanitarian
concerns.
addiction to refer exclusively to the excessive use of drugs and to replace terms such as intemperance and inebriety
DSMIV does not say disease but disorder and does not day addiction but says substance dependence or substance abuse.
2 theories - people born with the diease or people become addicted later on.
Jellinek suggested that alcoholism is a diease and people are born with it as if a alcoholic does not drink alcohol they will never have a problem.
definitions of addiction have two elements in common: Ca) The addicted individual has impaired control over the use of the drug, and (b) the drug use has
harmful consequences
They proposed a hypothetical substance called an autotoxin-a metabolite of opium that stayed in the body after the drug was gone.This autotoxin had
effects opposite to opium, and when left in the body, it made the person very sick.
The sickness that remained after the drug was gone became known as withdrawal or abstinence syndrome, and more accurate expla- nations were
developed to account for it
The tenn physical dependence or physiological depen- dence was used to describe the state in which the discontinuation or reduction of a drug would
cause withdrawal symptoms.
habituation (meaning "habit forming") should be used for drugs that do not create physical dependence. "Habituation is a condition in which the habitue
desires a drug, but .suffers no ill effects on its discontinuance"
the term psychological dependence became widely used. It expanded the dependence model by assuming that drugs such as cocaine caused unobservable
psychological withdrawal symptoms, that is, psy- chological, or psychic, dependence. In short, psy- chological dependence presumed that there was some sort of
psychological, as opposed to physical, withdrawal that caused a craving for a drug.
Mid 1950s addictive behaviour was only related to humans as attempts to create addictions in animals was only through oral routes and because of taste this was
normally rejected.
positive reinforcement model. This model assumes that drugs are self-administered because they act as positive reinforcers and that the principles that
govern behavior controlled by other positive rein- forcers apply to drug self-administration. a positive reinforcer is any stimulus that increases the frequency ofa behavior
it is contingent on - rate experiment of thomas and pickens.
When punishing consequences occur infre-quently and after a considerable delay, no matter how severe they might be, they are less likely to exert as much
control over behavior as will immediate gratification. This effect is known as the discounting delay
Similarties between human and nonhuman animals - type of drug used and patterns of self admistriation.
task demands, stress a reason to use drugs.
previous experience - former sedative users will reuse the drug
priming effect - many reinforcing stimuli
vt has long been known that if a neutral stimulus is paired with a reinforcing stimulus, it will acquire reinforcing properties through classical condition- ing.
Second order schedule - When a drug is admin- istered, it is preceded or accompanied by a distinc- tive stimulus, such as a light. Eventually, the animal will learn to bar
press just to make the light come on; that is, the light acquires reinforcing properties because of its association with the dmg. These rein- forcing properties can be
demonstrated using a second-order schedule

If drug-related stimuli cause a compensatory effect, they will reduce the effect of the drug when they are presented along with the drug. This is called conditioned
tolerance.
The moivation control system also receives sensory information about the environment. This information is processed by the thalamus and conex and then sent to the
amygdala and the hippo- campus, which are part of a learning and m.emory system that holds the memory ofpreviollsly experi- enced stimuli and past actions and their
outcomes. incentive salience - easily noticed.
Pleasure is a subjective state that often accom- panies activation of the mesolimbic dopamine system.
Thus, the mesolimbic dopamine system and the nucleus accumbens in particular constitute a "wanting" sys- tem rather than a pleasure system.
The animal becomes more sensitive to the drug rather than less sensitive. It is now known that the cause of the animal's becoming more active is the increased sensitivity
of the mesolimbic dopamine system to the drug.
The incentive sensitization theol)' uses this change in sensitivity to explain addictive behavior.
Their theory is a hedonic, physical/psychological dependence theory; that is, it is based on the presumption that the reinforcement caused by drugs is a result of pleasure
created when drugs activate the nucleus accumbens and related structures they call the extended amygdala and the effect of withdrawal on that system.
spiral to addiction - drug controlling a addicts life
Sign effect - the finding that normally positive or rewarding events are discounted at a higher rate than losses or negative events of equal value.
Demand curve states that if anything else is positive one would take the alternative if they wish. This research shows that the effect of a price increase on demand for a
commodity depends on the availability of competing commodities that dm act as substitutes.
CHAPTER SUMMARY

Because drug abuse appeared to be particularly compulsive and self-destructive, historically, it was viewed as an abnormal type of behavior that could not be
explained by the same rules that govern normal behavior.

Originally, people who abused drugs were thought to be deficient in willpower or morality, and drug abuse was thought to be a problem for the clergy and the
church to handle. Later, the medical profession became involved in attempts to treat people who were abusing opium and morphine because these substances
were widely used as medicines. The idea that addiction was a disease was proposed in the mid-1800s but did not become formally recognized as such until the
1950s. Substance dependence is now officially a disorder in the DSM-IV .

Despite explanations involving biochemical deficiency and allergies, the disease of addiction has never been identified. There are two types of dis- ease theories.
Predisposition theories say that some people are born with a predisposition to become addicted, and exposure theories that say that excessive exposure to a drug
will make you an addict.

Most definitions of addiction describe drug use that is "out of control"; that is, the addict cannot stop using the drug. The problem with this is that there is no way of
defining whether any behavior is controlled.

The physical dependence model suggests that exces- sive dmg use is motivated by a fear of the withdrawal symptoms that occur when a person stops using a
drug. Proponents of the dependence model explain the abuse of drugs that do not cause physical depen- dence by suggesting that these dlUgS cause psychological dependence.

In the 1950s, when it became known that non- humans would give themselves drugs in the same manner as humans, it was easily demonstrated that some
assumptions of the disease model and the physical dependence model were not correct.

Experiments with nonhumans showed that physical dependence was not necessary for self-administration.

Researchers came to realize that drug administra- tions could control the behavior of organisms in the same way as more traditional positive reinforcers, such as
food and water.

Some drugs can act as negative reinforcers, and animals will avoid infusions of these drugs.

A positive reinforcer is any stimulus that will increase the frequency of a response on which it is contingent. It often is accompanied by the experi- ence of pleasure,
but this is not necessary.

The positive reinforcement explanation of drug use and addiction may seem to be circular, but it can be shown that the brain mechanisms of positive
reinforcement are similar to those common to all drugs that are used and abused.

Nearly all the drugs that nonhumans will self- administer are used and abused by humans. The exceptions are most hallucinogens.

In humans and nonhumans, the pattern of self- administration of particular drugs is similar.

-Rate of responding, progressive ratio schedules, place conditioning, and choice experiments have been used to assess the incentive value or reinforcing
properties of drugs. These techniques have shown that the following factors can alter the incentive value of drugs: type of drug, dose, genetics, relief of some unpleasant
symptoms, task demands, stress, depriva- tion, exposure to the same or other drugs, and, to some extent, physical dependence.

-The reinforcing effects of drugs can be conditioned to stimuli paired with drug administration. Two tech- niques that have demonstrated this are (a) place
conditioning and Cb) second-order schedules.
- A part of the brain important in motivation is the mesoIimblc dopamine system, which is composed

A part of the brain important in motivation is the mesoIimblc dopamine system, which is composed of cells in the ventral tegmental area that release dopamine in the
nucleus accumbens. This system, in conjunction with the motor loop and the learning and memory system, is responsible for positive reinforcement by giving stimuli
incentive salience; that is, these stimuli are easily noticed, and we are attracted to them-we want them. This is not a pleasure system.
All drugs that are self-administered are known to cause a release of dopamine in the mesolimbic dopamine system.
The incentive sensitization theory proposes that with repeated administration, the reinforcing effects of a drug (incentive value) and related stimuli become sensitized.
This means that the drug and related stimuli will have increased incentive salience, which expresses itself as craving for the drug.
Another neurological theory is the hedonic dysregulation theory, which proposes that with repeated use of a drug, an opponent process or compensatory response
increases. This causes tolerance to the pleasurable effect of the drug. In addition, the set point of the pleasure system changes so that the person becomes increasingly
insensitive to pleasure. As a result, the person must take increasing amounts of the drug.

The application of economic principles to under- standing operant behavior is called behavioral economics. Drug use can be understood in terms of behavioral
economics. It can explain both choice to use drugs and the effect of economic factors, such as price and availability, on the extent of drug use.
Organisms will distribute their behavior among a number of tasks in accordance with the rate of rein- forcement on each task. Known as the matching law, this means that
we can alter the reinforcing value of drugs by increasing the other sources of reinforcement available in the environment.
The value of a reinforcer or a punisher decreases hyperbolically as the event becomes further and further away in time. This can explain why people can make irrational
decisions and often change their minds.
Some drugs can control behavior because the use of those drugs diminishes the availability of other reinforcers that could compete with them, thus starting a spiral of
addiction.
- I f people spend less on a commodity when the price increases, the demand is said to be elastic. If they do not decrease spending on the drug (or increase spending),
the demand is said to be inelastic. For many drugs, demand is inelastic up to a point at which it becomes elastic.
- Providing an alternative reinforcer can greatly diminish the demand for a drug reinforcer. The effect of providing an alternative reinforcer is greatest when the cost of the
drug is high,
-

Both other drugs and a variety of nondrug rein- forcers have been shown to act as alternatives for drug reinforcers.

Parott article
The half-life (tl/2) is the time required for the concentration of a drug to reach half
its peak plasma concentration and provides a guide to the duration of action of the
drug and the dosing interval required to maintain optimal therapeutic concentrations.
Reserpine inhibits the synaptic vesicular storage of the monoamines: dopamine,
serotonin and noradrenaline.
D-amphetamine stimulates the release of monoamines independently of the
electrical activity of the neuron. This release leads to an increased concentration of
monoamines in the synaptic cleft and, thus, an increase in receptor stimulation.
Tolerance is defined as the need for an increasing dose of a drug to achieve the
same psychopharmacological effect. There are various underlying causes of tolerance:
pharmacodynamic tolerance reflects the changes in receptor activity which accompany
repeated drug use.
Pharmacokinetic tolerance
results in the reduced bioavailability of the drug and, usually, involves changes in drug
metabolism; this is often caused by the enzymatic induction of cytochrome P-450 in the
liver.
Mid semester Quiz question and answer

All drugs - legal or illegal - represent a potential threat to the well-being of a fetus, with the risk being particularly acute during:
The correct answer is: the first three months of development.
psychomimetic is a term used to refer to a drug that
The correct answer is: is 'madness inducing'
The legal theorist D. Manderson examines modern legal and cultural understandings of drugs with attention given to:
c. spirit possession and witchcraft laws

Question 4
In 'Dependence, Addiction and the Self Administration of Drugs', the 'priming effect of drugs' is a phrase that McKim uses to refer to:
Select one:
a. a situation where a user is exposed to a drug to which they were previously addicted, thereby heightening the risk of relapse.
b. the ways that stressful stimuli can trigger a relapse in addiction for abstinent former addicts.
c. the ways that stimuli previously associated with drug delivery (e.g., a 'crack pipe') can spark a relapse.
d. all of the above.

Feedback
The correct answer is: all of the above.

Question 5
In Zinberg's theory of drug use the term 'set' has the following meaning:
Select one:
a. the network of drug users surrounding an individual user.
b. the shared style of drug use.
c. the attitude of the person at the time of use, including his/her personality structure
d. the influence of the physical and social context within which drug use occurs.

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The correct answer is: the attitude of the person at the time of use, including his/her personality structure

Question 6

Which neurotransmitter is most involved in craving:

Select one:
a. Glutamate
b. Serotonin.
c. Dopamine.
d. Acetylcholine.

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The correct answer is: Glutamate

Question 7
According to Kraushaar, mixing methamphetamine with alcohol is a good exmaple of:
Select one:
a. a way of minimising harm associated with both drugs.
b. a fun night out.
c. physiological agonism.
d. physiological antagonism

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The correct answer is: physiological antagonism

Question 8
we find the most natural hallucinogens in
Select one:
a. The Himalayas
b. Continental Europe
c. North Africa
d. the New World (the Americas)

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The correct answer is: the New World (the Americas)

Question 9
social locus refers to
Select one:
a. the social position of drug users
b. the perceivable social and material environment at the exact time of drug consumption
c. the social dynamics that encourage or discourage drug use
d. none of the above

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The correct answer is: the social position of drug users

Question 10
Shamans are spiritual healers that enter trance like states for various community or personal functions. Please identify the following answer which
is NOT a way that Shamans enter into trance in the new world:
Select one:
a. tobacco.
b. fasting.
c. music and dance.
d. controlled breathing.
e. all previously mentioned answers are means by which shamans enter into trance states.

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The correct answer is: all previously mentioned answers are means by which shamans enter into trance states.

Question 11
In Jamaica cannabis consumption is:
Select one:
a. generally uncommon.
b. differently meaningful depending largely on who is consuming it
c. something only the lower class engages in.
d. something only the middle class engages in.

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The correct answer is: differently meaningful depending largely on who is consuming it

Question 12
Drugsalter functioning in the central nervous system because they can:
Select one:
a. cross the blood brain barrier.
b. stimulatespecialist receptor sites.
c. block specialist receptor sites
d. all of the above

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The correct answer is: all of the above

Question 13
Zinberg argues that 'social controls' shape the effect of a drug; social control refers to:
Select one:
a. the attitude of the person at the time of drug use and their personality structure.
b. the people using the drug with you.
c. both the social sanctions and social rituals surrounding drug use
d. all of the above.

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The correct answer is: both the social sanctions and social rituals surrounding drug use

Question 14
Why did cannabis/THC use fall out of favour in western medicine?
Select one:
a. medical professionals did not believe it to be an effective treatment of diseases and mental conditions.
b. because it was illegal.
c. it was not water soluble and dosages were hard to judge, so medical professionals were fearful about overdosing
d. because it was associated with crime and madness.

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The correct answer is: it was not water soluble and dosages were hard to judge, so medical professionals were fearful about overdosing

Question 15
Ethnographic studies of drug use:
Select one:
a. are seriously hampered by taking subjective approaches to drug use, being more or less dependent upon the unreliable views or
narratives of people in altered states of consciousness.
b. start from the assumption that drug users are mentally ill or sociopathic.
c. are reliant solely on surveys and statistical quantification.
d. are not characterised by any of the above statements.

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The correct answer is: are not characterised by any of the above statements.

Question 16
Drugs like nicotine, cocaine, and alcohol create sensations of reward in the brain by:
Select one:
a. blocking serotonin receptors in the prefrontal cortex
b. increasingdopamine release in the nucleusaccumbens
c. increasing blood flow to pleasure centers of the brain
d. increasingentactogenreceptors in the cerebellum

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The correct answer is: increasingdopamine release in the nucleusaccumbens

Question 17
What are the main types of brain cells that co-ordinate brain function?
Select one:

a. neurons
b. microglia.
c. glial cells.
d. ependymal cells.

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The correct answer is: neurons

Question 18
The suspected origin of tobacco is:
Select one:
a. modern day Canada.
b. Peru, Bolivia, Ecuador.
c. the Himalayas or India
d. modern day Europe.

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The correct answer is: Peru, Bolivia, Ecuador.

Question 19
Ethnographicstudies of drug-using communities have revealed that:
Select one:
a. the personalities of drug users are primarily responsible for their addiction.
b. drug users generally engage inbehaviorsthat allow them to assert some control over their drug use.
c. drug users will do absolutely anything to get hold of drugs.
d. drug use patterns can be explained solely by the pharmacological properties of drugs.

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The correct answer is: drug users generally engage inbehaviorsthat allow them to assert some control over their drug use.

Question 20
Which of the following is the least potent form of cannabis?
Select one:
a. Hemp
b. Marijuana (leaves and tops)
c. Hashish
d. Hashish oil.

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The correct answer is: Hemp

Question 21
Andrew Weil has argued that the Amazonian Indians have devised effective social controls pertaining to the use of hallucinogens; please indicate
which of the following claims are NOT one of Weil's explanations for this phenomena:
Select one:
a. they believe its ok to be deviant once in a while
b. they are not taken for negative reasons (such as to rebel) but for positive reasons.
c. they do not use refined drugs.
d. the use of hallucinogens is highly ritualised.
e. the use of hallucinogens is usually done under the supervision of an experienced user, such as a Shaman.

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The correct answer is: they believe its ok to be deviant once in a while

Question 22
MDMA is another name for:
Select one:
a. PCP.
b. heroin.
c. ecstasy
d. LSD.

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The correct answer is: ecstasy

Question 23
Which of the following substances is not a true hallucinogen:
Select one:
a. belladonna.
b. datura
c. tobacco
d. san pedro cactus.
e. none of the above - all are true hallucinogens.

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The correct answer is: tobacco

Question 24
In Thailand perceptions about methamphetamine have shifted:
Select one:
a. from being a 'productive' drug to one that induces 'madness' and 'violence'
b. From being 'lethal' to being seen as 'harmless'.
c. from it being a drug used mainly by 'traditional' and backwards Thais, to one that is increasingly popular amongst 'modern' Thai
youth.
d. From being relatively 'non-addictive' to being 'highly addictive'.

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The correct answer is: from being a 'productive' drug to one that induces 'madness' and 'violence'

Question 25
A 'moral entrepreneur' is:
Select one:
a. a crusader who influences laws by shaping public perceptions of drugs, utilising support from interest groups in society and the
media.
b. a person who uses drugs in social settings for spiritual or moral reasons (e.g., Rastafarians, Shamans).
c. a member of the elite classes in society who actively defends drug use (e.g., Timothy Leary).
d. none of the above.

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The correct answer is: a crusader who influences laws by shaping public perceptions of drugs, utilising support from interest groups in society
and the media.

Question 26
The term 'neurotransmission' refers to:
Select one:
a. the communication between dopamine receptors.
b. the absorption of drugs through inhalation.
c. chemical communication between neurons.
d. electrical communication between neurons.

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The correct answer is: chemical communication between neurons.

Question 27
The medicinal uses of cannabis were introduced to Europe by:
Select one:
a. WB Oshaughnessy
b. Christopher Columbus
c. Sir Joseph Banks
d. Jamaican Rastafarianism

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The correct answer is: WB Oshaughnessy

Question 28
the US military took an interest in LSD thinking it was
Select one:

a. a truth drug
b. a drug being used by the USSR to enhancethe performance of soldiers in the battlefield.
c. a drug that terrorist and militant groups might use to attack the US and its allies
d. none of the above

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The correct answer is: a truth drug

Question 29
According to Philippe Bourgois, the celebration of cannabis in hip hop culture is positive for public health because:
Select one:
a. it is likely to contribute to its decriminalization or legalization.
b. it is preferable to artists celebrating more dangerous drugs, like crack and heroin .
c. it is a way that the underclass can gain an income and thus pay for health services.
d. it is a means by popular culture may lend legitimacy to the therapeutic effects of cannabis consumption.
e. all of the above.

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The correct answer is: it is preferable to artists celebrating more dangerous drugs, like crack and heroin .

Question 30
true or false: smoking remains the largest single, preventable cause of death and disease in Australia:
Select one:
a. false
b. true

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The correct answer is: true

Question 7
Which one of the following is NOT a way that Native Americans consumed tobacco:
Select one:
a. chewing
b. enemas
c. blowing tobacco dust into the nose
d. drinking tobacco juice
e. the native americans consumed tobacco in all the above ways

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Your answer is correct.
The correct answer is: the native americans consumed tobacco in all the above ways

Question 6
What is the suspected origin of cannabis?
Select one:
a. Mexico
b. North Africa
c. India
d. The Americas

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Your answer is correct.
The correct answer is: India

Question 5
'Midnight Climax' was the name given to the CIA operation that experimented with
Select one:
a. Opium
b. Viagra
c. LSD
d. Cannabis

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Your answer is correct.
The correct answer is: LSD

Question 1
The 'gateway hypothesis' is used to explain why:
Select one:
a. drug induced psychosis emerges in only some users.
b. people who are addicted to heroin are likely to have previously used cannabis
c. there are genetic differences in tolerance to certain drugs: some genes act as a 'gateway' to drug abuse.
d. some drugs are highly addictive (e.g., nicotine) and others less so (e.g., LSD)

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Your answer is correct.
The correct answer is: people who are addicted to heroin are likely to have previously used cannabis

Question 2
what drug was developed into an aerosol form by the US military, with the intended use being a madness gas?
Select one:
a. LSD
b. Opium
c. Alcohol
d. Caffeine

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Your answer is correct.
The correct answer is: LSD

Question 3
According to Kraushaar, mixing methamphetamine with alcohol is a good exmaple of:
Select one:
a. a way of minimising harm associated with both drugs.
b. a fun night out.
c. physiological antagonism
d. physiological agonism.

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Your answer is correct.
The correct answer is: physiological antagonism