Summary of Proceedings from the Latin American Epidemiology Network La Red Latinoamericana de Investigadores en Drogas (REDLA) June 2008

Acknowledgements the both the Inter-American Drug Abuse Control Commission (CICAD) and the The Inter-American Observatory on National Institute on Drug Abuse Drugs (OID/CICAD), and the National (NIDA). Institute on Drug Abuse (NIDA) would like to recognize the work done by the The network is comprised of academic members of the Latin American drug researchers from a variety of institutions research network – Red in Latin America. Members are Latinoamericana de Investigadores en nominated by the national drug Drogas (REDLA), and their commissions of the OAS member states, contributions which have made this and are selected by a review by the report possible. We would also like to coordinating teams at CICAD and extend our appreciation to the other NIDA. The REDLA also includes researchers who contributed information liaisons to the CICAD network of for this report. The following paper is a National Observatories on Drugs in synopsis of findings from the REDLA Latin America, the National Hispanic members. Sources for this paper were Science Network on Drugs in the United the presentations made at the REDLA States (NHSN) and voluntary Meeting on June 11 and 12. Summary participants vis a vis the NHSN. papers and copies of the presentations ______follow in this compendium. ______Inventory on Drug Research Programs in Latin American About the REDLA Network Universities

The REDLA network is a group of The information presented on the academic researchers who share an inventory of drug research programs in interest in developing research on the Latin American universities showed that drug problem and whose geographic there are few programs in the region focus and arena is Latin America. aimed specifically at drug research. REDLA is supported and financed by Nevertheless, there are a variety of

1 Proceedings from the Meeting of the Red Latinoamericano de Investigadores sobre Drogas (REDLA), June 2008 academic programs that address the drug Brazil stands out as having the highest research theme. In the majority of cases rate of inhalant use among students in lines of research on drugs are the region, surpassing 15% for past year interdisciplinary. This could be an use. There appears to be a great deal of advantage in the sense that the drug use of pharmaceuticals without a phenomenon is not limited to once single prescription. The use of field, rather it tends to be a transversal benzodiazepines is common among the problem. general population (3.8% in the past The primary problem found year), while 5% of women report using across graduate level research programs benzodiazepines without a medical is the extremely low graduation rate. A prescription at some point in their large number of programs that offered lifetime. lines of research in the drug theme had a postgraduate completion rates between Colombia 2% and 12%. This problem was not In Colombia, the use of pharmaceuticals limited to programs in the drug theme, without a prescription among secondary but rather appears to be common across school students stands out as one of the graduate level studies, and represents a major drug misuse issues among minors. significant obstacle to any effort that 9.9% of secondary school students supports the education of future reported use of tranquilizers at some researchers in the health sciences field. point in their lifetime, while 6.3% ______reported use during the past year, and 5% during the past month. Marijuana Highlights from REDLA use was somewhat lower among secondary school students. Country Reports: Approximately 7.6% reported use of marijuana at some point in their lifetime. Argentina Past year and past month rates were The drugs seen as the primary problem 6.6% and 2.3% respectively. in Argentina are cocaine and marijuana. These two substances define problematic Costa Rica use for the country. Perception of risk There has been a general upward trend associated with marijuana and cocaine is in marijuana use since 2001 among both low in comparison to the rest of the males and females in the general South American region. The use of population. Lifetime use of cocaine pasta base or cocaine paste is also on the remained unchanged between 2001 (3%) rise in Argentina. The government of and 2005 (2005), but increased in Argentina believes that the country has women from (0.1% to 0.7%). The become a processing point for pasta base lifetime prevalence of crack use is at into cocaine HCL for eventual shipment about 0.9% overall, but this has been north. increasing since 1995. Dependency on crack is one of the principal reasons for Brazil seeking drug treatment in Costa Rica. Marijuana, inhalants, cocaine and pharmaceuticals without a prescription Chile are common drugs of misuse in Brazil. 2 Proceedings from the Meeting of the Red Latinoamericano de Investigadores sobre Drogas (REDLA), June 2008 In Chile the most commonly consumed remained stable, while inhalants and psychoactive substances in the general cocaine paste show decreasing trends. population are alcohol (72%), and tobacco (46.4%). Marijuana is the most Puerto Rico commonly used illicit substance (7%), The 2008 Household study in Puerto followed by cocaine (1.2%) and cocaine Rico estimated that the lifetime use of paste (0.6%). Trends over time have marijuana is about 15.5%, and for shown a significant increase in cocaine 6.3%. Heroin is also present in marijuana use between 2002 and 2006, the population, with at lifetime rate of while the use of cocaine and cocaine 1.3%. Among secondary school paste have remained stable. students, lifetime use of marijuana was estimated at about 7.4% and 4.6% for

inhalants. Guatemala It is difficult to draw conclusions about the state of drug consumption in Increases in Drug Use Guatemala due to the lack of recent data. Argentina (2001-2005) and Brazil Previous studies are somewhat (2001-2005) report measurable increases contradictory in terms of drug use. This in the use of marijuana and cocaine use has to do with the type of studies in addition to increases in other illicit performed and lack of comparability substances. Chile showed marked between them. increases in marijuana use from 2001- 2005, while cocaine use remained

relatively stable. However, use of Mexico Drug use rates in Mexico are highest cocaine paste (pasta base) increased in among the secondary school population. Chile during this period. Increases in Of key interest is the fact that marijuana use were found in Costa Rica differences in drug use by gender are as well. diminishing. Patterns of drug use vary ______by region, and are particularly high in Emerging Trends and Patterns of Use the regions that are contiguous with the across Countries: United States. Mexico also notes a high correlation between depression and drug Perception of Risk use in the country. Countries with time series data reported decreases in the perception of risk

associated with drug consumption Peru Studies in Peru between 1998 and 2006 between 2001 and 2005, particularly demonstrate that alcohol and tobacco are with respect the consumption of the most commonly consumed marihuana. psychoactive substances, with higher consumption of both among males than The Culture of Self Medication – females. The proportion of alcohol users Nearly all the countries reported the use who demonstrated signs of alcohol of pharmaceuticals without a dependency in 2006 was 8.1%. prescription as a common occurrence. Marijuana is the most commonly For the most part there are few controls consumed illicit drug. The prevalence in place in Latin America regarding the and incidence of cocaine use have commercial purchase of prescription 3 Proceedings from the Meeting of the Red Latinoamericano de Investigadores sobre Drogas (REDLA), June 2008 drugs. Many countries do not require prescriptions for medications that would Merla – This is a new pattern reported be by prescription only in the United only by Brazil. Merla is a smokable States, and countries that do have laws, combination of cocaine paste or crack these are not carefully enforced or the with tobacco and cannabis. According system itself is abused. The overall to the Brazil data, normally users choose result is that it is both common practice either cocaine paste or crack, but rarely and culturally acceptable to use a variety are the two mixed. Cocaine paste of medications without a medical smoked alone may also be referred to as prescription. “merla”.

In Brazil the use of benzodiazepines Heroin with Xylazine – A new pattern without a prescription is common, of use seen only in Puerto Rico is the especially among women. Rates of use mixture of heroin with xylazine, an of benzodiazepines among women were animal tranquilizer. This trend appeared 2.9% for past year use, and 1.91% for over the past two or three years, but past month use. In Chile, past year seems to be picking up momentum prevalence of use of tranquilizers among heroin users on the island. A without a prescription, among secondary 2008 qualitative study showed that about school students was 2.8% and 1.9% for ¾ of the population of heroin users that stimulants. An increase in were studied reported use of xylazine. pharmaceutical use without a prescription was seen in Mexico as well. Information Gaps It is clear that there is a great deal of “Binge Drinking” – Binge drinking is a high quality information on the behavior that was previously rare among epidemiology of drug use in the national Latin American youth. Nearly all the databases of the REDLA member countries report that their most recent countries. Nevertheless, it appears that drug surveys show some amount of this information is not being used to its binge drinking, defined as five drinks or full capacity. In addition, a great deal of more at a single event. This behavior is data is available at CICAD through the seen primarily among youth and is Observatory on Drugs that could be associated with botellón which is an utilized for secondary analysis and the event similar to what is known as a production of more in-depth studies on tailgate party in the United States. the drug problem.

Jarra Loca – This is a mixture of vodka Some primary information gaps or any other strong liquor and identified: pharmaceutical drugs. The pharmaceuticals used could by of any · The need for more detailed type – stimulants or depressants. classification of pharmaceuticals that Although the prevalence of this behavior are commonly misused or abused by is not high, this pattern of drinking and the target populations, and more drugging had only been seen in Paraguay detailed description of patterns of previously, and is now reported by use, Argentina and Peru. 4 Proceedings from the Meeting of the Red Latinoamericano de Investigadores sobre Drogas (REDLA), June 2008 · A need for more detailed classification of inhalants, patterns and motives of use,

· More detailed information on socioeconomic level and drug use,

· Time series data on drug use in key populations,

· The need for additional studies on the relationship between crime (particularly violent crime) and drug use.

For further information on this report, please contact: Marya Hynes Dowell Inter-American Observatory on Drugs CICAD/OAS [email protected]

5 Proceedings from the Meeting of the Red Latinoamericano de Investigadores sobre Drogas (REDLA), June 2008 REDLA Members and Contributors to this Report Members as of June 2008

Graciela Ahumada Antonio Cepeda Liaison with National Drug Steering Committee, Liaison with Observatories National Hispanic Science Network Coordinadora Area de Investigaciones (NHSN) Observatorio Argentino de Drogas Associate Dean of Faculties Texas A&M SEDRONAR University Argentina Tel: (979) 845-4274 Tel: +54-11-4320-1232 Professor of Psychology [email protected] Tel: (979) 845-8038 www.observatorio.gov.ar Chair, International Collaborations, NHSN Maria Elena Alvarado [email protected] Steering Committee Medico, Epidemiologa Francisco Cumsille Escuela de Salud Pública Coordinator of the Observatory on Facultad de Medicina Drugs Universidad de Chile CICAD/OAS Santiago de Chile Washington, DC, USA Tel: 562-978-6818 Tel: 202-458-3629 [email protected] [email protected]

Prof. Helena M. Barros Dr. Rubén Ferro Steering Committee Director, Insituto de Salud Mental Universidade Federal de Ciências da Escuela de Salud Pública, Facultad de Saúde de Medicina. Porto Alegre, Brasil Universidad Nacional de Córdoba, 55-51- 8124-3959 Argentina 55-51-3303-8754 [email protected] 55-51-3303-8755 [email protected] Luis Florez [email protected] Director, Centro de Estudios e Investigaciones sobre Adicciones y Julio Bejarano Violencia Steering Committee Universidad Nacional de Colombia Director del Departamento de Colombia Investigación Tel. 571 652 5480 Instituto sobre Alcoholismo y [email protected] Farmacodependencia de Costa Rica Costa Rica Robert Hanson Tel: (506) 824-9591 Liaison with Health Canada (506) 224-8793 Manager, Surveillance Unit / [email protected] Office of Research and Surveillance 6 Proceedings from the Meeting of the Red Latinoamericano de Investigadores sobre Drogas (REDLA), June 2008 Drug Strategy and Controlled [email protected] Substances Program / Health Canada Mario Rodolfo Salazar Tel:(613) 948-8954 Coordinador Maestría en Salud Pública, Fax: : (613) 948-7977 Facultad de Ciencias Médicas, [email protected] Universidad de San Carlos Guatemala Marya Hynes Dowell Tel.502 2-485-1962 REDLA Coordinator Fax: 502 2-485-1955 Specialist in Drug Research [email protected] Observatory on Drugs CICAD/OAS Jorge A. Villatoro Velázquez Washington, DC, USA Investigador en Ciencias Médicas Tel: 202-458-6119 Instituto Nacional de Psiquiatría Ramón [email protected] de la Fuente Múñiz Cal. México- Xochimilco 101 Col. San Lorenzo- Iván Montoya Huipulco CP 14370 México, DF Of. Steering Committee, Liaison with NIDA Tel: (55) 3640 8752 Deputy Director, Division of (55) 8995 4037 Pharmacotherapies and Medical (55) 5655 2811 ext.157 y 401 Consequences of Drug Abuse Fax (55) 5513 3446 National Institute on Drug Abuse www.inpsiquiatria.edu.mx/javv (NIDA) [email protected] Rockville, MD, USA [email protected] Other Contributors to this Report

Juan Carlos Reyes Pulliza Dr. Juan Daniel Gomez Catedrático Asociado Centro de Estudios e Investigaciones Departamento de Bioestadística y sobre Adicciones y Violencia Epidemiología Universidad Nacional de Colombia Facultad de Ciencias Biosociales y [email protected] Escuela Graduada de Salud Pública Recinto de Ciencias Médicas Universidad de Puerto Rico Teléfono: 758-2525, ext. 5120 [email protected]; [email protected]

Fernando Salazar Steering Committee Chair Profesor, Universidad Cayetano Heredia Lima, Peru Tel: 51-1- 319-0000 x2466 Cel : 51 -1- 988-46-092 Fax: 51-1-482-2954 [email protected] [email protected] 7 Proceedings from the Meeting of the Red Latinoamericano de Investigadores sobre Drogas (REDLA), June 2008

Drug Use in Argentina Graciela Ahumada Translation by Marya Hynes Dowell

Introduction recent national survey in 2006, the The following is an analysis of the drug present prevalence rate of tobacco use situation in Argentina based on the consumption of was 32.1% (35.2% epidemiological studies carried out by among males 29.1% among). Among the Argentine Observatory on Drugs those age 18 to 49 years rates are even (OAD) of the Secretary on Programming higher exceeding 35%. Approximately and Planning for the Prevention of Drug 90% of the population who smokes does Addiction and the Fight against so on a daily basis, and 30% smoke an Narcotraffic (SEDRONAR) of the average of 20 cigarettes per day, the President of the Nation. Specifically, the equivalent of one pack. The intensity of national studies in secondary school consumption increases as the age of the population, and the National Study on smoker increases. Both prevalence and Drug Use in the Population Age 12 to 65 frequency are greater among males. years (2006), provide information on the magnitude of drug consumption, With respect to alcohol, approximately frequency of use, dependence on drugs, 50.4% of the population between 12 and and the associated risk and protection 65 years of age drank at least one factors. Upon review of these two alcoholic beverage in the month prior to studies, it can be demonstrated that the the survey (60.6% of males and 41% of consumption of licit and illicit females). Alcohol consumption is substances in the country is high, placing markedly higher among persons between Argentina among the countries of 18 and 34 years of age, with rates around highest prevalence in South America for 58%. The most frequently consumed marijuana and cocaine consumption. alcoholic drinks were beer (72%), wine (59.4%) and strong drinks or mixed Drug Consumption in Argentina drinks (18.3%). There are no major The following summary of the drug differences between gender with regard consumption problem in Argentina to type of drinks, but there are reflects the principal results from the differences with respect to frequency of national 2006 SEDRONAR study in the use, where females tend to consume general population (ages 12 to 65 year) more at social events, but in daily use and in national secondary school studies the differences fade, specifically for the between 2001 and 2007. consumption of beer and strong drinks. Current alcohol consumption by age General population data was taken groups shows differences by type of among the population age 12 to 65 years, drink. Youth drink greater amounts of located in cities of 80 thousand beer and strong drinks than the adult inhabitants or more, which represent population, while the inverse is true for approximately 70% of the population of the consumption of wine. the country. According to the most 8 Proceedings from the Meeting of the Red Latinoamericano de Investigadores sobre Drogas (REDLA), June 2008 Problematic use of alcohol, measured the fact that this survey takes into through the Escala Breve de Bebedor account people who live in households Anormal de Alcohol (EBBA) which and excludes the population that lives on applies seven questions regarding the street or collective homes where dysfunctional behavior with respect to inhalant use has a greater presence. the consumption of alcohol beverages, demonstrated that among those who The consumption of illicit drugs is 7.3% used alcohol during the past month in the general population, 1.2 million 12.8% of them, or one million one persons, 8.8% male and 5.9% females. hundred thousand people, between the The majority of this illicit drug ages of 12 and 65, showed criteria for consumption is explained by the use of problematic use of alcohol. Problematic marijuana (6.9%) and cocaine (2.6%). use of alcohol is highest among males, Highest rates of drug use are seen among adolescents and youth between 12 and males ages 18 to 34 years. 24 years (14.8% and 18.5% respectively). The consumption of marijuana is frequent (monthly, weekly and daily) in The consumption of pharmaceuticals 59.6% of consumers, similar in both merits its own chapter on misuse without genders, but the intensity of use differs a medical prescription. Tranquilizers by age. The highest rates of daily use and anti-anxiety medications without are in the population age 35 to 49 years. medical prescription have the highest The population using marijuana in the past year prevalence (1.2%) compared past year and that presents signs of with stimulants or antidepressants dependency reaches 27.7%, with similar (0.4%). The general population study rates among males and females, and looked at the use of pharmaceuticals exceeds 30% among both adolescents without a medical prescription any time and the population of 35 year of age. during the subject’s lifetime. In the case of tranquilizers, 19.7%, approximately Cocaine consumption is just as frequent 3.4 million persons, especially women, as marijuana, but in this case, females consumed these medications, with show greater frequency of use than greater proportions among higher age males, although the prevalence among groups. Use under medical prescription females is lower. People between 18 is greater among people in older age and 34 years of age tend to use more groups, and it found in 54% and 67% frequently. Signs of dependency are among adolescents and young adults seen in 45/3% of past year users, more between 18 and 24 years old. Use of among males, and with similarity across stimulants with or without a medical age groups. prescription is lower, about 3.4% (approximately 600 thousand persons), Consumption of cocaine paste and but use without a prescription is higher ecstasy each have annual prevalence with few differences between gender. rates of 0.5%. The consumption of cocaine paste is highly addictive, about The consumption of inhalants in this 61.5% of these users meet criteria for study has an annual prevalence rate of dependent use, which is highlighted in 0.1%, which is certainly explained by the adolescent and young adult 9 Proceedings from the Meeting of the Red Latinoamericano de Investigadores sobre Drogas (REDLA), June 2008 population between 18 and 24 years of consumption. Perception of risk is age. greater for cocaine and cocaine paste use 92% and 88.7% respectively. Around Age of initiation for alcohol and tobacco 85% of the population share the opinion begins around 16 and 17 years, that ecstasy if of high risk, as well as respectively. The difference by gender marijuana and the occasional use of can be observed, with remarkably lower cocaine paste. The perception of great age of first use among males. The risk associated with legal substances average age of first use for inhalants is such as alcohol and tobacco, and 15.8 years, without major differences frequent use of pharmaceuticals without between males and females. Average a medical prescription, and the age of first use for tranquilizers without occasional use of ecstasy is at about a medical prescription is seen at about 80%. The occasional consumption of 23 years; slightly lower among males at marijuana has the lowest perception of 22 years and females at 24 years. For risk associated with it, at about 62.8%. consumption of stimulants without a The analysis of the risk perception by medical prescription, there are also clear sex indicates that women perceive differences by gender. Males initiate greater risk associated with tobacco, consumption at the average age of 16 alcohol, pharmaceuticals, and marijuana, and females at 19 years of age. and the occasional use of marijuana and cocaine. With respect to other With respect to illicit substances, the substances, the differences are not average age first use of marijuana significant between males and females. consumption is about 18 years, followed The greatest perception of risk regarding by cocaine paste and cocaine, which substance use is seen in the 12 to 17 age have an average age of first use close to group. 19 years. Average age of first use of ecstasy is about 20 years. In each of the There is a strong association between the above cases there no significant perception of risk and drug consumption. differences between males and females. For example, the annual rates of marijuana use decrease from 31.9% to About 35.7% of past year illicit drug 1.6%, by perception of risk from “no users used more than one illicit risk” to “high risk”. Something similar substance during this period, which is occurs with cocaine consumption, which considered “poly drug use”. This pattern oscillates between 15.2% and 1.7% is observed in both males and females, according to perception of risk. and occurs to the greatest extent among persons 35 to 49 years of age. The drug The perception of easy access to illicit of choice is marijuana; more than 80% drugs is seen as an important risk factor of past year illicit drug users consume as it indicates the accessibility of drugs marijuana alone or in combination with within the population. Marijuana, the at least one other drug. most commonly used illicit drug, has a rate of perceived ease of access at 45% The perception of risk is considered a in the population and although the protection factor for drug use as it perception is high in all age groups, it is creates a subjective barrier to drug highest in the population age 18-34 10 Proceedings from the Meeting of the Red Latinoamericano de Investigadores sobre Drogas (REDLA), June 2008 years. Approximately 34.7% of the The analysis of trends from the studies population considers it to be easy to in 2001, 2005 and 2007, in general terms access cocaine, and 26.6% believe it is shows that the use of alcohol has easy to access cocaine paste. These rates increased in the last period, following a are always slightly higher among males decrease between 2001-2005 and a between the ages of 18 and 34 years. stabilization in annual consumption of tobacco at a high rate of about 30%. One clear risk factor is the direct availability of drugs that the population The consumption of marijuana and experienced during the past year, cocaine has an increasing trend, as well whether for purchase or consumption. as tranquilizers without a medical According to this indicator, 41.6% of prescription. Consumption has people between ages 12 and 65 years stabilized in the other substances, were offered marijuana, 23.3% were following an increase between 2001 and offered cocaine, 12.7% were offered 2005, cocaine paste (known as paco) and 11.3% were offered ecstasy. In synthesis, Argentina is concerned about the consumption of alcohol, Consumption among secondary school particularly the problematic use of this students, according to the last national substance, especially in the adolescent study in 2007, the principal substances and young adult populations. Smoking used are alcohol and tobacco, whose past is present in large proportions as is the month prevalence rates are 59.8% and use of pharmaceuticals, especially 21.9% respectively, with few gender tranquilizers and anti-anxiety medication differences. About 9.3% of students without a prescription. All the consumed at least one illicit drug and the epidemiological studies presented agree primary drug consumed is marijuana that the frequent consumption of (7.6%), followed by cocaine (2.5%), marijuana and cocaine and its use solvents or inhalable substances (2.2%) combined denote a specific problem in and cocaine paste (1.4%). The use of the country. tranquilizers without a medical prescription reaches 3.8% among students, and for stimulants 1.9%. For further information on this report, Males present greater illicit drug please contact: consumption than females. As age Graciela Ahumada Observatorio increases, so does substance use, but the Argentino de Drogas (SEDRONAR) greatest leap in rates is observed after 15 [email protected] years of age.

References

Estudio Nacional en población general de 12 a 65 años, SEDRONAR, 2006 Estudios nacionales en población escolar del nivel medio SEDRONAR, 2001 Estudios nacionales en población escolar del nivel medio SEDRONAR , 2005 Estudios nacionales en población escolar del nivel medio SEDRONAR , 2007 11 Proceedings from the Meeting of the Red Latinoamericano de Investigadores sobre Drogas (REDLA), June 2008 Estudio nacional en población universitaria, SEDRONAR 2005 Estudio nacional en pacientes en salas de emergencia, SEDRONAR 2003 Estudio nacional en pacientes en salas de emergencia, SEDRONAR, 2005 Estudio nacional en pacientes en salas de emergencia, SEDRONAR, 2007 Registro Continuo de Pacientes en Tratamiento, SEDRONAR, 2003 Registro Continuo de Pacientes en Tratamiento, SEDRONAR, 2005 Registro Continuo de Pacientes en Tratamiento, SEDRONAR, 2007 Estudio piloto en población detenida reciente, SEDRONAR, 2005 Estudio piloto cuantitativo en población privada de libertad, SEDRONAR, 2006, Estudio cualitativo en población privada de libertad, SEDRONAR, 2007 Análisis de mortalidad por causas directas e indirectas según estadísticas vitales, SEDRONAR, 2004 Estudio de costos económicos asociados al consumo, SEDRONAR , 2007 Consumo de alcohol en adolescentes escolarizados en el nivel medio, SEDRONAR, 2005 Consumo de psicofármacos en sectores medios y bajos de la población general, SEDRONAR, 2006 consumo de pasta base-paco en pacientes en tratamiento, SEDRONAR, 2007

12 Proceedings from the Meeting of the Red Latinoamericano de Investigadores sobre Drogas (REDLA), June 2008 Prevalencia de año de consumo de sustancias Consumo problemático (EBBA) según edad. Total país. psicoactivas. Total país. 2006-Población 12 a 65 años 2006. Población 12 a 65 años prevalentes de mes

Prevalencia de mes de tabaco y alcohol, según sexo. Total Prevalencia de año de drogas ilícitas según edad. Total país 2006-Población 12 a 65 años país. 2006. Población 12 a 65 años

Consumo problemático (EBBA) según sexo. Total país. Porcentaje de consumidores con signos de dependencia, 2006-Población 12 a 65 años prevalentes de mes. según sexo. Total país. 2006. Población 12 a 65 años prevalentes de año

13 Proceedings from the Meeting of the Red Latinoamericano de Investigadores sobre Drogas (REDLA), June 2008 Percepción de facilidad de acceso a drogas ilícitas. Total Porcentaje de estudiantes que tienen curiosidad país. 2006. Población 12 a 65 años de probar alguna droga ilícita según sexo.

Prevalencia de año de consumo de sustancias Porcentaje de estudiantes que tuvieron Oferta de psicoactivas. Total país 2007. Estudiantes Nivel Medio drogas ilícitas según sexo

Porcentaje de estudiantes que tomaron más de la cuenta y Tendencia en el consumo del último año de tabaco y se emborracharon en el último mes. Estudiantes del nivel alcohol. Estudiantes del nivel medio. Total país. medio. Total país. 2007

14 Proceedings from the Meeting of the Red Latinoamericano de Investigadores sobre Drogas (REDLA), June 2008 Pacientes en tratamiento Tendencia en el consumo del último año de drogas ilícitas. Registro Continuo de Pacientes en Tratamiento Estudiantes del nivel medio. Total país. Tercera fase -2006-2007. Total nacional

• 3596 pacientes en 85 centros de todo el país •Perfil: varones en un 84.6%, el 50% tiene hasta 24 años •El 31.4% es mono consumidor (excluidos tabaco y alcohol) y más del 50% consumióentre 2 y 3 drogas. Diferencias por sexo y edad. • Drogas principales de inicio à alcohol, tabaco y marihuana •Entre la 1ºy 6ºdroga de consumo à 3 años • Demanda de tratamiento: 33.8% alcohol 23.1% marihuana 21.1% cocaína 8.2% pasta base-paco

Relación entre el consumo y la morbilidad aguda. Tendencia en el consumo del último año de sustancias de Estudio Nacional en salas de emergencia 2007 uso indebido. Estudiantes del nivel medio. Total país. •13.208 pacientes, 52% varones y el 45% menor de 30 años • El 8.8% (1.163 pacientes), la consulta vinculada al consumo actual (últimas 6 horas), principalmente varones y jóvenes de 12 a 30 años • Están vinculadas al consumo: ü El 21% de los accidentes de tránsito ü El 48.1% de las situaciones de violencia ü El 79.3% de los intentos de suicidio • Las sustancias de mayor consumo: alcohol, tabaco, ansiolíticos y tranquilizantes, marihuana y cocaína

15 Proceedings from the Meeting of the Red Latinoamericano de Investigadores sobre Drogas (REDLA), June 2008 Drug Use in Brazil Helena M. T. Barros, M.D., Ph.D.

Indicators There are around 300 active Research The main statistics presented come from Teams on Drug Abuse, located mainly in MEM-OEA 2005-2006, Observatório the Southeast and South regions. Almost Brasileiro de Informações sobre Drogas; 50% are from the Health Sciences field. Rede de Pesquisa sobre Drogas Publications from these groups are in (SENAD), Levantamento sobre Uso de alcohol or drugs in general, most of them Drogas Psicotrópicas Entre Estudantes dealing with epidemiological or no Brasil (2004 and previous years), treatment issues. Research financial aid Levantamento Domiciliar sobre Uso de comes mainly from CNPQ- MCT; Drogas Psicotrópicas no Brasil (2001 & CAPES-MEC and the Health Ministry. 2005); Levantamento Nacional sobre o SENAD has implemented financial aid Uso de Drogas entre Crianças e for several nationwide Brazilian studies Adolescentes em Situação de Rua (2003 and educational efforts. and previous years); Centro de Políticas Sociais- FGV (2007); Vigilância de Drug use in Brazil Doenças Crônicas por Inquérito Alcohol is the most frequently used drug Telefônico- MS- ( 2007); CAPES and by elementary and high school students, different publications. followed by tobacco and inhalants. These drugs were recently used (within Graduate and Courses Specialization the last 30 days) by 44% (alcohol), 10% on Drugs of Abuse (tobacco) and 9% of the students There are no specific graduate programs (inhalants). Lifetime experience with in the area, but 378 Programs in Health, marijuana is close to 8% and with Biological Sciences, Law or Social cocaine is almost 3%. There is a Sciences have research interests in drug decreased trend for frequent use of abuse and dependence, producing alcohol among students. While the published papers in the last 5 years. The lifetime use trend for alcohol, tobacco most frequent areas of the studies are and inhalants is stable for the last 15 psychology, education, medicine and years, marijuana and cocaine use by public health. There are programs for students tends to increase. When the masters and doctorate degrees. These population from 12 to 65 years old is programs are concentrated in the considered in the Household Surveys, Southeast Region (226); followed by the there is an overall increased lifetime use South (73), Northeast (49), Central-West for all drugs, licit and illicit, in 2005, (25) and North (5).There are very few compared to 2001. In comparison to 10- specialization courses on drugs of abuse; 12 year olds, students 16- 18 years old most have regional perspectives and double the lifetime experience for most there are some nationwide “on line” drugs. For tobacco and marijuana the courses, aided by Secretaria Nacional increase according to age is much higher Antidrogas. (7 and 18 times higher, respectively). Considering the Household Surveys 16 Proceedings from the Meeting of the Red Latinoamericano de Investigadores sobre Drogas (REDLA), June 2008 (population 12 to 65 years of age), of age, and cocaine, when less than 14 alcohol maintained its high recent use years old. prevalence, while the recent use of tobacco is two times higher and most of There are some studies showing the the other drugs use is much lower in the relationship between drug use and general population, due to less use by violence or delinquent behaviors adults and elderly than in younger ages. amongst youngsters. Teenagers and Males use more drugs than females. children in juvenile wards tend to have Prevalence for tobacco use peaks at adult more chances of consuming drugs than age and decreases after 55 years of age children in State Care for social issues. and is lower for more educated Adults who declare expenses related to individuals. Binge drinking is higher drug trade also declare having more among young adults and decreases after violence related problems. Almost fifty 45 years of age. Education does not percent of homicide victims are found to influence the prevalence of binge be under the influence of alcohol or drinking. other drug. It has been proposed that 1/3 of all traffic-related accidents leading to Possible causes and consequences of deaths are related to alcohol use. drug use: Nationwide studies for motor vehicle Street children use drugs in a higher rate accidents, work accidents or truancy than students, considering the same age from workplace, drug-related morbidity range. University students are also at and mortality in general are still to be risk of higher lifetime experience with presented. The overall number of drug- most illicit and prescription drugs. related deaths is underestimated. Students in humanities courses tend to use more illicit drugs; those in biological Treatment Centers: areas use more alcohol and inhalants and Brazilian institutions were mapped in those in mathematical sciences courses 2007 and are classified as related to use less drugs than other university prevention measures, treatment, students. White male university students, rehabilitation and education or research. 20 to 29 years old, from high income Centers use different prevention social classes are at higher risk of buying strategies, targeting students or street drugs. children in most cases. Treatment There is a fairly low risk perception for centers are more frequently therapeutic the use of 1 to 4 weekly doses of alcohol communities and the most frequent by the general population; similar therapeutic strategies are inpatient figures are seen for lifetime use of activities in communities, or individual marijuana and inhalants. Risk perception or group therapies, along with family for lifetime use of cocaine or crack was therapy, motivational interventions and higher than for the other drugs. occupational therapy. Most centers offer Children under State Care, who usually treatment for alcohol and illicit drug- have higher risk to be/become street- related problems. The treatment children, recall having used alcohol and outcomes according to treatment types in tobacco for the first time when younger Brazil still need to be measured. Low than 12 years old, inhalants and compliance may be related to many marijuana, when younger than 13 years different factors. 17 Proceedings from the Meeting of the Red Latinoamericano de Investigadores sobre Drogas (REDLA), June 2008 For futher information on this report, Conclusion: please contact: The drugs mostly used in Brazil are Helena M. T. Barros alcohol and tobacco, followed by Universidade Federal de Ciências da marijuana, cocaine and inhalants and Saúde de there is a trend for drug use increase. Porto Alegre, Brazil The intensity of drug use in Brazil is [email protected] intermediate, higher than in some Latin American countries and lower than in some North American/European countries. The most prevalent age group for drug use varies from teenagers to young adults, up to 35 years old. Males show higher drug use. The use of illicit drugs is higher among different groups: street children and university students. Causes and consequences of drug use need more socially and culturally-related studies. Also more comprehensive studies are needed to determine the associations, causal effects and consequences of drug use through logistic analysis (in order to eliminate confounders).

A nationwide system for drug treatment outcomes evaluation is missing. Even though there is data collection in respect to drug apprehension and drug dealing-related convictions, more systematic data gathering and evaluation in respect to public security is needed.

Key elements for future studies: a) the efficacy evaluation of prevention and treatment programs, because drug use/abuse is still growing; b) study trends in women of different ages and in university students; c) study drug- associated corruption and violence, the main way to prevent early deaths among young adults.

18 Proceedings from the Meeting of the Red Latinoamericano de Investigadores sobre Drogas (REDLA), June 2008

Levevantamento sobrobre Uso de Drogrogaass Psicotrópicas Third Meeeeting of the Red Latinoamericacana de Invveestigadores en Entre Estudantes nono Brasil –2004 Drogogasas (REDLA) Hotel Normandie San Juan, Puerto Rico June 11-12, 2000808 90

80

70

Report on the state of the drug situation in Brazil 60 50 10 a 12 13 a 15 40 16 a 18 Helena M. T. Barros, MD, PhD >18 UniversidadeFederal de CiênciasdaSaúdede Porto Alegre, Brasil 30 0.6% 0.5% 20

10

0 alc tob can coc inh

II. Drug Use FrequentUse Levevantamento sobrobre Uso de Drogrogaass Psicotrópiicas 12 meses 30 dias Entre Estudantes nnoo Brasilil (1993,1997,2004)

20 18 16 14 12 Alcohol 10 8 Tobacco 6 s t u d e n ts 4 % 2 0 1993 1997 2004

frequent>= 6 times in onemonth Prevalenceof druguse bystudents-MEM Brasil, 2005-2006

Lifetimeuse trends II.II. Drug Use Levantamentos sobre Uso de Drogas Psicotrópicas Entre Estudantes no Brasil

18 Inhalants 16 Anxyolitics 14 Amphetamines 12 Cannabis 10 8 Cocaine % s tu d en ts 6 4 2 0 1987 1989 1993 1997 2004 Ano

HouseholdSurvey-general Population-MEM Brasil, 2005-2006

19 Proceedings from the Meeting of the Red Latinoamericano de Investigadores sobre Drogas (REDLA), June 2008 Levantamento Domiciliar sobre Uso de Drogas Psicotrópicas no II. DrDrug Use Brasil Lifetime use -2005- % population Percentsmokersaccordingto age, genderandschoolingranges Cannabis VIGITEL 2006, Alcohol 25 100

HealthMinistry, 80 15 Brazil, 2007 60 40 5

20 Cocaine

0 -5 12 a 17 18 a 24 25 a 34 > 35 4 12 a 17 18 a 24 25 a 34 >35

Male Female Male Female

Tobacco -1 12 a 17 18 a 24 25 a 34 > 35 50 20 Inhalants Male Female 40

30 10 20

10

0 0 12 a 17 18 a 24 25 a 34 > 35 12 a 17 18 a 24 25 a 34 > 35

Male Female Male Female

II.II. Drug Use LEVANTAMENTO NACIONAL SOBRE O USO DE DROGAS ENTRE CRIANÇAS E • Riskyalcohol use -males3 to5 times more riskyuse thanmales • Notinfluencedby education ADOLESCENTES EM SITUAÇÃO DE RUA 2003

100 80 60 40 20 0 50

40 Alcohol Cocaine Tobacco Inhalants Cannabis c h i l d r en 30 lifetime last year

20 s t r eet

% 10

0

Alcohol Cocaine VIGITEL 2006, Tobacco Inhalants Cannabis Lastmonth HealthMinistry, Brazil, 2007

Levevaantamento Domiciliiliar sobobre Uso de DrDrogasas Psicotrópicacass nnoo Brasil –20200101 & 2005005 – III.I. Druugg Use Experimental use ChildrenunderStatecare Ageof drug use initiation Collors2005

2001

9% 80% 8%

7% 60% 6%

5% 40% 4% y e a r s o ld 20% 3% 2% % p o pu l a t i n 1 2 - 6 5 1% 0% % popul a t ion 1 2 - 65 y ea r s o ld Alcohol Tobacco Illicit drug 0% Cannabis Inhalants Cocaine

20 Proceedings from the Meeting of the Red Latinoamericano de Investigadores sobre Drogas (REDLA), June 2008 II. Druugg Use- Universitystudents II.II. Druugg Use Whoisbuyingdrugs? O estado da Juventude: Drogas, Prisãoe acidentes-Centro de Políticas Sociais, FGV, 2007 Lastyearuse Men

10-19 y

20-29 y

GA Wagner, VA Stempliuk,MLZ, LP Barroso; AG Andrade. Alcohol anddrug use among universitystudents: genderdifferences, RevBrasPsiquiatr. 2007;29(2):123-9 Total population Presentdrug-relatedexpenses

Studentsin humanitiescoursestendtouse more illegaldrugs; in biologicalareastouse alcohol orinhalantsandthosein mathematical sciencescoursestouse lessdrugs. (Stempliuk-DoctorateThesis, 2004)

Who isbuyingdrugs? O estado da Juventude: Drogas, Prisãoe acidentes-Centro de Políticas Sociais, FGV, 2007

VA Stempliuk, LP Barroso; AG Andrade, S Nicastri, A. Malbergier RevBrasPsiquiatr. 2005;27(3):185-93 Total population Presentdrug-relatedexpenses

Femaleuniversitystudentsshowedlesstrend toincrease(more frequent) drug use II. RiskPerception

Risk perception No risk Slight Risk Moderate Serious Risk According to amount used n= 454 n(%) n(%) Risk n(%) n(%) 1 or 2 drinks/week 69(15) 142 (31) 132 (29) 111(25) 3 or 4 drinks/week 17(4) 71(6) 146(32) 220 (49) 5 or more drinks/week 4(1) 20(4) 77(17) 353(78) Uses alcohol daily 3 (1) 5(1) 13 (3) 433(95)

inhalants 1 or 2 times lifetime 45(10) 66(15) 55(12) 288(63) inhalants 1 or 2 times/week 2(0,4) 10(2) 50(11) 392(86) inhalants daily 1(0,2) 4(1) 6(1) 443(97)

cannabis 1 or 2 times/ vida 90(20) 81(18) 40(9) 243(54) cannabis 1times per month 29(6) 59(13) 72(16) 294(65) cannabis 1 or 2 times/week 10(2) 19(4) 54(12) 370(82) cannabis daily 4(1) 5(1) 19(4) 426(94)

cocaine 1 or 2 times lifetime 23(5) 54(12) 49(11) 328(72) cocaine 1 timesper month 3(1) 20(4) 43(10) 388(85) cocaine 1 or 2 times/week 2(0,4) 5(1) 12(3) 435(96) cocaine daily 0 0 3(1) 451(99)

crack 1 or 2 times lifetime 15(3) 35(8) 34(7) 370(82) crack 1 time per month 1(0,2) 11(2,4) 26(6) 416(92) crack 1 or 2 times/week 0 3(1) 10(2) 441(97) crack daily 0 0 2(0,4) 452(99) Data frromom Rio Grand e do Sul at Leevavantamento Domicilia r sobobrre Us o de

Drroogas Psicotrópicas no Brasil- Lifetimeime use -2005 GA Wagner et al., Alcohol anddrug use amonguniversitystudents: genderdifferences, RevBrasPsiquiatr. 2007;29(2):123-9

21 Proceedings from the Meeting of the Red Latinoamericano de Investigadores sobre Drogas (REDLA), June 2008 Psychosocialaspectsassociatedto Psychosocialaspectsassociatedtodrug use drug use

•Drug-relatedviolence??? •There is a scarcity of processed information regarding traffic accidents, workplace accidents, workplace

protected detention truancy, morbidity and mortality associated to drug * related disorders, direct and indirect costs to the health * Problems * withviolence system, but the indicators exist. *

Delayin rent pay

Total population Drug-related expenses

Gawryszewskiaetal. Linkingof informationfromhealthand securitydatabases on homicides. RevSaúde Pública Conclusions 2005, 39(4):627-33. In Brazil, there is nationwide data available for drug use in most population groups Around6000 homicidesin the firstsemesterof 2001, in São Paulo More comprehensive studies are needed for factors associated to drug use; causal effects and consequences of drug use, using logistic analysis to eliminate confounders

More systematic data gathering and analysis in respect to drug market is needed

More systematic data gathering and analysis in respect to drug treatment (number of individuals treated and outcomes for treatments)

Key elements Use/abuse is still growing: a) need to evaluate efficacy/effectiveness of prevention programs b) study use trends in women and university students c) study drug-associated violence/corruption

Drug-relateddeaths

MEM, 2005-2006

22 Proceedings from the Meeting of the Red Latinoamericano de Investigadores sobre Drogas (REDLA), June 2008 Drug Use in Chile Maria Elena Alvarado Translation by Marya Hynes Dowell

I. Introduction The Seventh National Study on Drugs in the Secondary School Population, 8th year basic The consumption of illicit substances dates and 4th year middle, 2007. Chile, Chile, back to the late 1960’s. Nevertheless, the Ministry of the Interior, National Council for rapid economic development in our country the Narcotics Control Consejo Nacional para has facilitated access of both legal and illegal el Control de Estupefacientes (2008). drugs and increasing their consumption. Revision of Judicial Expedients in Criminal Beginning in 1990 through the present the Tribunals in Connection with Crime-Drugs. country of Chile has advanced an integral Final Executive Report, Santiago de Chile. strategy to address the drug problem. During Ministry of the Interior, National Council for that same year, the strategy drove the the Narcotics Control Consejo Nacional para creation of the National Council for el Control de Estupefacientes (2001). Narcotics Control, Consejo Nacional para el Control de Estupefacientes, CONACE, and Study on Alcohol and other Drug its Executive Secretariat, with the mission of Consumption among Condemned for implementing public policies on the drug Robbery with Violence and Intimidation problem and prevent the consumption and Crime, Final Executive Report, Santiago de trafficking of illicit substances in the country. Chile. Ministry of the Interior, National In order to comply with its commitment, a Council for the Narcotics Control Consejo National Observatory on Drugs was formed Nacional para el Control de Estupefacientes with the objective of compiling, & Gendarmería (Organism Responsible for systematizing and disseminating statistics the Prison System) of Chile (2002). and information relevant to the drug phenomenon. In accordance with these III. General Population goals, Chile has systematically carried out annual National Studies on Drug III.a. Prevalence of Drug Consumption in Consumption on the General Population, the General Population since 1994 and in the school population since The prevalence of psychoactive substance 1995. consumption in the general population for the year 2007 is presented in table 4. In Chile, II. Data Sources the most commonly used substance is alcohol, with a past year prevalence rate of The Seventh National Study on Drugs in the 72%, followed by tobacco (46.4%) and General Population of Chile, 2006, Chile, marijuana (7%). Ministry of the Interior, National Council for the Narcotics Control Consejo Nacional para el Control de Estupefacientes (2007).

23 Proceedings from the Meeting of the Red Latinoamericano de Investigadores sobre Drogas (REDLA), June 2008

Table 1: Prevalence of Substance Consumption in the General Population, Chile, 2007. Lifetime Past Year Past Month Prevalence (%) Prevalence (%) Prevalence (%) Alcohol Males 84.0 75.3 62.7 Females 83.0 69.2 51.0 Total 83.5 72.2 56.7 Marijuana Males 32.2 9.9 5.9 Females 16.7 4.2 2.0 Total 24.3 7.0 3.9 Cocaine Paste Males 4.4 1.0 0.5 Females 1.0 0.2 0.0 Total 2.6 0.6 0.3 Cocaine Males 8.8 1.9 0.9 Females 3.0 0.6 0.3 Total 5.9 1.2 0.6 Hallucinogens 1.2 0.3 0.03 Inhalants 1.2 0.1 0.06 Heroin 0.1 0 0 Energy Drinks 18.9 13 4.1

III.b. Age of First Substance Use Figure 1: Trends in Substance In the general population the average age of Consumption in the General Population first use of tobacco appears at about age 16, two year before the first use of tobacco and marijuana. Average age of first use of 80 cocaine paste appears at 21 years, two years later that cocaine (Table 2). 60 III.c. Use Trends in the General 40 Population in Chile 20

The trends in use of marijuana have shown a 0 remarkable increase, while cocaine paste and 1994 1996 1998 2000 2002 2004 2006 cocaine use have remained stable. In figure 1, the trends in past year use for marijuana, tabaco alcohol marihuana cocaine and cocaine paste are displayed, in pasta base cocaína addition to the trends in drug use for the past month for alcohol and tobacco.

24 Proceedings from the Meeting of the Red Latinoamericano de Investigadores sobre Drogas (REDLA), June 2008 III.d. Diagnostic Criteria for Substance dependence on illegal substances according Abuse and Dependence to ICD-10 criteria, and the abuse of legal substances, such as alcohol and tobacco, The surveys carried out between 2002 and according to DSM-IV criteria. The principal 2006 estimated the rates of substance results are shown in table 3.

Table 3. Trends in the Rates of Abuse and Dependence on Substances 2002 2004 2006

Dependence (%) Marijuana 27.8 24.3 23 Cocaine paste 51.9 50.7 50 Cocaine 28.5 35.6 30 Abuse of alcohol (%) 12.5 13.5 13.0

IV. School Population

IV.a. Prevalence of Drug Consumption in the School Population

Marijuana is the most frequently used illegal substance consumed in the school population for both males and females. Marijuana has demonstrated a notable increase in the higher grades (table 4) . Table 4: Prevalence of Substance Consumption in the School Population, Chile, 2008. Marijuana Cocaine Cocaine Alcohol Tobacco (%) (%) Paste (%) Total 15.7 2.9 2.5 37.9 35.4 Gender Males 16.2 3.9 3.3 37.5 32.8 Females 14.8 1.9 1.7 38.4 37.9 School year 8th grade 9th Grade - 1º 5.4 1.7 1.8 18.4 20.4 medio 12.8 2.8 2.6 30.2 31.7 10th Grade - 2º 17.4 3.0 2.5 41.0 37.7 medio 21.9 3.2 2.3 50.7 44.8 11th Grade - 3º 23.5 4.1 3.1 54.7 45.6 medio 12th Grade - 4º medio Type of School Municipal 15.5 3.2 3.1 33.9 35.3 Subvencionada 15.8 2.8 2.1 39.1 35.4 Private 16.4 1.6 1.2 52.8 36.3

25 Proceedings from the Meeting of the Red Latinoamericano de Investigadores sobre Drogas (REDLA), June 2008

IV.b Trends in Substance Consumption in the School Population in Chile The trend in illegal substance use, past year, has remained stable over the years of study. In 2007 the consumption of alcohol and tobacco decreased somewhat (Figure 2). Figure 2: Substance Consumption Trends in the School Population

50 45 40 35 30 25 20 15 10 5 0 2001 2003 2005 2007

tabaco alcohol marihuana pasta base cocaína

V. Other Studies Studies have been carried out in the university population, which demonstrate findings consistent with those from that age group in the general population (19 - 25 years) de and of high socioeconomic status (table 5). Studies carried out in the prison population show that this population consumes substances at much higher prevalence rates than the general population. Approximately 45% of the total population in prison was frequent and or occasional users of cocaine paste prior to entering prison (table 6).

Table 6: Prevalence of Substance Consumption in Specific Populations in Chile Alcohol Marijuana Pasta base Cocaine Prison Population Lifetime 95.7 83.2 55.8 56.9 Past Year 16.1 23.9 8.2 5.4 Past Month 3.7 13.2 1.7 0.7 University Population Lifetime 92.6 39.1 0.8 7.6 Past Year 86.5 21.3 0.1 0.5 Past Month 69.9 14.0 0.0 0.0

26 Proceedings from the Meeting of the Red Latinoamericano de Investigadores sobre Drogas (REDLA), June 2008 - Highest rates of drug use are found among males, between 19 VI. Conclusions and 25 years of age. Chile possesses a statistical monitoring - Substance use is higher among system that provides information on drug the population in prison than in consumption in the general population, the general population. school population, and is constantly working - The illegal drug most commonly to improve these figures. associated with crime is cocaine paste. In Chile, the substance most associated with health and social problems is alcohol. Among illegal drugs, the substances of highest For further information on this report, please consumption are marijuana, cocaine paste contact: and cocaine. Maria Elena Alvarado - Women have increased drug use, Escuela de Salud Pública particularly with regards to Facultad de Medicina tobacco, alcohol and marijuana, Universidad de Chile approaching the rates of [email protected] consumption among men.

27 Proceedings from the Meeting of the Red Latinoamericano de Investigadores sobre Drogas (REDLA), June 2008 Last year marihuana consumption and risk perception young (19 to 25), Chile 2000-2006

Drug Use in Chile: 60 Epidemiology and Trends 50

40

30

20

Maria Elena Alvarado MD, MPH 10 2000 2002 2004 2006 School of Public Health Prevalence 16 14 15 19 University of Chile Risk Perception 61 59 55 43

Fuente: Séptimo Estudio Nacional de Drogas en Población General de Chile, 2006 Área de Evaluación y Estudios, CONACE, Chile

Pastyearmarihuana consumptiontrend comparisonbetweenmenandwomen, Past year marihuana consumption trend Chile (1994-2006) by school grade, Chile 2001-2005

12 30

10 25

8 20

6 15

4 10

2 5

0 1994 1996 1998 2000 2002 2004 2006 0 8°grade 9°grade 10°grade 11°grade 12°grade men 5.98 6.04 7.36 8.75 8.13 7.87 9.9 2001 5.5 11.3 16.7 20.9 23.1 women 1.51 1.78 2.06 2.62 1.98 2.85 4.2 2003 5 8.6 14.5 19.3 22.5 total 3.7 3.9 4.7 5.6 5 5.3 7 2005 4.8 10.1 16.9 22.4 27.1

Source: Séptimo Estudio Nacional de Drogas en Población General de Chile, 2006 Área de Evaluación y Estudios, CONACE, Chile Fuente: Sexto Estudio Nacional de Drogas en Población Escolar de Chile, 2005 Área de Evaluación y Estudios, CONACE, Chile

Pastyearmarijuanaconsumptiontrend Past year cocaine consumption trend adolescents(12-18), youths(19 a 25) comparison between men and women, andyoungadults(26 a 34) Chile 1994-2006

20 10 18 9 16 8 14 7 12 6 10 5 8 4 6 3 4 2 2 1 0 1994 1996 1998 2000 2002 2004 2006 0 1994 1996 1998 2000 2002 2004 2006 Adolescents 5.88 7.05 8.14 8.37 6.57 6.45 7.8 men 1.43 1.33 2.16 2.52 2.54 2.16 1.9 Youths 9.28 11.23 12.57 15.36 13.62 15.05 18.8 women 0.26 0.29 0.41 0.44 0.46 0.45 0.6 Young Adults 4.92 3.47 4.86 6.95 6.85 6.71 9.7 total 0.8 0.8 1.2 1.4 1.4 1.3 1.2

Source: Séptimo Estudio Nacional de Drogas en Población General de Chile, 2006 Área de Evaluación y Estudios, CONACE, Chile Fuente: Séptimo Estudio Nacional de Drogas en Población General de Chile, 2006 Área de Evaluación y Estudios, CONACE, Chile

28 Proceedings from the Meeting of the Red Latinoamericano de Investigadores sobre Drogas (REDLA), June 2008 Pastyearcocaineconsumptiontrend adolescents(12-18) , youths(19-25) PPaast month allcoholl consumptption and andyoungadults(26-34) alcohol abuse trend, Chileile 191994-20200606

70

10 60 9

8 50

7 40 6

5 30

4 20 3

2 10

1 0 1994 1996 1998 2000 2002 2004 2006 0 1994 1996 1998 2000 2002 2004 2006 Total 39 45 52 53 59 56.8 57 Adolescents 0.95 0.88 0.96 1.25 0.94 0.79 0.7 Men 50.2 55 61.5 62.1 64.9 64.1 62.7 1.95 2.63 3.6 3.86 4.29 3.58 3 Youths Women 31 39.7 42.9 46.2 53.5 49.9 51 Young adults 1.53 1.24 2.03 2.47 2.9 2.16 1.8

Fuente: Séptimo Estudio Nacional de Drogas en Población General de Chile, 2006 Área de Evaluación y Estudios, CONACE, Chile

Fuente: Séptimo Estudio Nacional de Drogas en Población General de Chile, 2006 Área de Evaluación y Estudios, CONACE, Chile

Past year coca paste consumption trend Past month alcohol consumption trend By school grade, (2001-2005) by school grade, Chile 2001-2005

10

9 70

8 60 7 50 6

5 40

4 30 3 20 2

1 10

0 0 8°grade 9°grade 10°grade 11°grade 12°grade 8º 9º 10º 11º 12º 2001 1.2 2.3 3.7 4.3 5 2001 21 33 42 51 56 2003 1.6 1.8 3 3.7 6 2003 22 32 43 52 59 2005 1.7 2.7 3.3 3.2 3.9 2005 22 37 49 56 63

Source: Sexto Estudio Nacional de Drogas en Población Escolar de Chile, 2005 Fuente: Sexto Estudio Nacional de Drogas en Población Escolar de Chile, 2005 Área de Evaluación y Estudios, CONACE, Chile Área de Evaluación y Estudios, CONACE, Chile

Last year drug consumption Past month alcohol consumption trend by income level, Chile 2006 by sex (8º-12ºgrade), Chile 2001-2005

20

18 70 16 60 14

12 50

10 40 8 30 6

4 20

2 10 0 Low Low-Medium Medium-high High 0 Marihuana 5,6 5,6 7,6 18,8 2001 2003 2005 Cocaine 1,8 1 0,9 0,4 Men 39.9 40 43.6 Coca Pasta 1 0,4 0,3 0 Women 38.2 39.4 43.6

Source: Séptimo Estudio Nacional de Drogas en Población General de Chile, 2006 Fuente: Sexto Estudio Nacional de Drogas en Población Escolar de Chile, 2005 Área de Evaluación y Estudios, CONACE, Chile Área de Evaluación y Estudios, CONACE, Chile

29 Proceedings from the Meeting of the Red Latinoamericano de Investigadores sobre Drogas (REDLA), June 2008 Past month tobacco consumption trend Comparative study on substance use in comparison between men and women, high school students in South American Chile 1994-2006 countries

70 80

60 70

50 60

50 40 40 30 30

20 20

10 10

0 0 Argentina Bolivia Brasil Colombia Chile Ecuador Paraguay Peru Uruguay 1994 1996 1998 2000 2002 2004 2006 Alcohol* 42.3 16.4 48 51.9 40.1 28.1 40.1 25.9 50.1 Men 43.28 44.45 45.52 46.86 45.71 44.83 42.7 Tobacco* 23.6 13.3 11 23.7 38.3 18.4 13.3 16.2 23.9 Women 34.84 34.89 34.94 38.75 39.2 40.37 39.2 Marihuana 6.7 2.3 5.1 7.1 12.7 3.6 2.7 2.6 8.5 Total 38.94 39.53 40.08 42.69 42.36 42.54 40.6 Cocaine 2.5 0.9 1.7 1.7 2.4 1.2 0.6 1 1.4

Source: Séptimo Estudio Nacional de Drogas en Población General de Chile, 2006 Fuente: Primer Estudio Comparativo sobre Uso de Drogas en Población Escolar Secundaria Área de Evaluación y Estudios, CONACE, Chile Organización de Naciones Unidas, Oficina Contra la Droga y el delito

Past month tobacco consumption trend by school grade, Chile 2001-2005 CONCLUSION

70 n After experiencing a steady increase iin thethe 9900s, illicit drug consumption has sttaabbiliilized. 60 n Illicit drug consumptiion among adolescentcents has 50 decreased whereaeas consumption in youuthths has 40 remaiined stable, alblbeit at a hiigghheer llevel.

30 n Meenn continuenue to be grgreateater consumers of drugs butut women are catchcatchiing up. 20 n Chile has a wellll orrggaannized ddrrug consumption 10 monitoring system. 0 8º 9º 10º 11º 12º n Genneeral popullatiion aannd school surveys are by far 2001 27 38 45 52 54 CONACE’s maiin data sosourcece.. Addidditional and 2003 24 33 42 48 52 2005 26 38 47 51 52 complementary data sosources are neneeded.

Fuente: Sexto Estudio Nacional de Drogas en Población Escolar de Chile, 2005 Área de Evaluación y Estudios, CONACE, Chile

Past month tobacco consumption trend by sex (8º-12ºgrade), Chile 1995-2005

70

60

50

40

30

20

10

0 1995 1997 1999 2001 2003 2005 Men 33.3 44.5 41.1 38 35.1 35.1 Women 36.3 48.2 44.7 44.8 40.8 45

Source: Sexto Estudio Nacional de Drogas en Población Escolar de Chile, 2005 Área de Evaluación y Estudios, CONACE, Chile

30 Proceedings from the Meeting of the Red Latinoamericano de Investigadores sobre Drogas (REDLA), June 2008 Drug Use in Costa Rica, Preventive Interventions and Related Actions

Julio Bejarano, M.Sc.

The need to reduce the demand for drugs in measurable increase since the beginning of Costa Rica has been examined the past decade. The age of first use of systematically, as part of a research project alcohol is slightly over 11 years, which is the on the Institute of Alcoholism and Pharmaco- lowest found in any Latin American country, dependence (I.A.F.A), beginning in 1990. and even Europe. Even though the Since the seventies, efforts have been made experiences with getting drunk, and the to study alcohol and its associated problems contexts in which is ingested do not show in the general population, through the differences by sex, the most serious situation methodology for household surveys. is found in the educational environment Presently, there are many sources of rather than the general population. information (Antidrug police, judicial research organisms, the Costa Rican Institute Regarding marijuana, there is an evident on Drugs); nevertheless, the information in increase in experimental use among men and the following report comes from information women since 1995. The general prevalence from IAFA. rate is 7.5% and past year consumption is (1%), which is lower than the established rate Lifetime tobacco consumption has stabilized worldwide (3.5%, according to data from the to a certain degree and although there is World Health Organization). Nevertheless, a greater consumption among males than third of the national population has been females, there has been a significant offered marijuana at some point. The rates reduction in use over the years. Past year of active consumption are low, and such consumption has also decreased among values may remain stable, if no changes in males, but has increased among female the social situation occur. population. Data on tobacco consumption show lower rates than other Latin American Although the local consumption of cocaine is countries, but it still has a considerable relatively low (1.9% of the total population), impact over the national healthcare system. past year consumption (0.2%) is similar to the worldwide rate (0.3% among people over Regarding alcohol consumption, it is age 15, according to the data from the United interesting that a reduction in lifetime use Nations 2003). The consumption of cocaine occurred in the country for both males and is a predominantly adult male activity and the females. Past month use has declined increase in this group over time is important. significantly among males, but has remained stable among females. The rates of abuse In synthesis, the consumption of alcohol and and dependence in the population are on the tobacco are public health issues of first order, order of 14.5% and 11%, respectively. In the while the consumption of marijuana and case of females, this is close to three times cocaine has shown increases in the past lower than among males, but has shown a decade.

31 Proceedings from the Meeting of the Red Latinoamericano de Investigadores sobre Drogas (REDLA), June 2008 parental involvement. In addition, it was Research in the population of high school age demonstrated that mental health issues were youth (13 to 17 years), during the latest study present in 9% of males and 18% of females. carried out in 2006, showed aspects of great Both conditions are considered key for interest. Tobacco is the first drug used, with understanding drug use among youth, an average age of first use at 12 years old. Its especially the abuse of alcohol. consumption is related to alcohol use and the prevalence increases as the student ages. Finally, some studies have been carried out 78% of the students who smoked during the among primary school children (4th grade), past twelve months, smoked marijuana, establishing lifetime tobacco use in 8.4% of compared with 21% who smoked marijuana students and alcohol in 23%. Both situations but did not smoke tobacco in the past year. are worrisome considering they refer to individuals with an average age of ten years. Those who smoke and drink alcohol excessively had a greater probability of Given this epidemiological panorama, the having been offered marijuana or cocaine country has developed and universalized a during the thirty days prior to the survey. prevention plan based on life skills, titled 20% of students reported having consumed Aprendo a valerme por mi mismo (I learn to alcohol in the past month. Half of those value myself), which has shown to be highly indicated having used alcohol excessively in useful. The evaluation of the program the two-week period prior to the survey. It is revealed that experimental use of tobacco important to highlight those differences by showed an increase from 7.8% to 10% over a sex and that the prevalence of the excessive three year period. Nevertheless, active drinking is greatest among students whose consumption remained stable. With respect parents showed little involvement. to alcohol, something similar occurred in lifetime consumption while active use The consumption of any illicit drug was remained stable. reported by 15.6% of the students. Females reported lower rates of marijuana In Costa Rica there is growing evidence that consumption and cocaine than the males, but the contribution of alcohol and tobacco in the when they are compared with information development of morbid states and in the case collected in 1993, a significant increase is of alcohol, its role in the production of observed. Compared with data from other injuries associated with violence and traffic Latin American countries, the local accidents resulting in injury or death for both consumption of any drug is greater in Costa drivers and pedestrians. In terms of public Rica nevertheless the consumption of health, the impact is noteworthy. In relation marijuana and cocaine is greater among to illegal drugs, despite having a lower Chilean and Argentine students. profile when they are compared tobacco and Experimental use of crack, ecstasy and other alcohol, experimental use has increased, drugs in local students in Costa Rica is especially among males. comparatively low. Prevention programs developed in the One notorious aspect of this research country appear to be working; however, there experience was the low levels of parental is a great deal to do in the development of involvement with their children. Only in specific policies on drugs. In the case of 35% of the sample was involved reported alcohol, there still need to be initiatives that 32 Proceedings from the Meeting of the Red Latinoamericano de Investigadores sobre Drogas (REDLA), June 2008 impact the age of initiation, and in general, affect the generation of patterns of consumption that place young boys and girls at greater and greater risk of consuming other drugs and of harming their health. Ensuring that these prevention strategies reach parents or family constitutes an objective of primary importance.

For further information on this report, please contact: Julio Bejarano Instituto sobre Alcoholismo y Farmacodependencia de Costa Rica [email protected]

33 Proceedings from the Meeting of the Red Latinoamericano de Investigadores sobre Drogas (REDLA), June 2008

Tercera Reunión de la REDLA Prevalencia de vida y de últimos treinta días de y NIIDA IIntternrnational FFororum 2008:2008: consumo de tabaco en hombres y mujeres, por Globallllyy Imprroving aand Applyying Evidencece-Basaseedd IInteerveventiions foorr Addddiictiioonsns JJune 111, 122 // 13-144, 20008 año Costa Rica, 1990, 1995 , 2001 y 2006

60 Situacióndel Consumode 50 40 Drogasen Costa Rica, 30 IntervencionesPreventivas 20 y AccionesRelacionadas 10 0 1990 1995 2001 2006

Hombres (Vida) Mujeres (Vida)

Julio Bejarano, M.Sc. Hombres (Mes) Mujeres (Mes)

Fuentes de Información Prevalencia de vida y de últimos treinta díasde consumo de alcohol en hombres y sobre Drogas mujeres, por año Costa Rica, 1990, 1995 , 2001 y 2006

IAFA 100 80 60 40

Policía Antidrogas Comisión Nacional de Drogas Política Nacional de Drogas 20 0 1990 1995 2001 2006

Hombres (Vida) Mujeres (Vida

Hombres (Mes) Mujeres (Mes) Organismo de Investigación Judicial

NationalInstituteonAlcoholismand Distribución de la población según tipo de Drug Dependence bebedor, por sexo Costa Rica, 2006

Encuestas Nacionales de Hogares Hombres Mujeres

- Estudios transversales repetidos 61% - Individuos de 12 a 70 años 21% 7% 5% - Diseño muestral multietápico 88% - Tasa de respuesta 97% 18% - Cuestionario: entrevista personal de 160 preguntas Abst/Mod Abuso Dependencia Abst/Mod Abuso Dependencia

1990 1995 2001 2006

34 Proceedings from the Meeting of the Red Latinoamericano de Investigadores sobre Drogas (REDLA), June 2008 Prevalencia de vida y de últimos treinta días de consumo de marihuana en hombres y mujeres, por año Costa Rica, 1990, 1995 , 2001 y 2006

12 10

8 Encuesta Nacional en Jóvenes de Educación 6 Secundaria 4 (7º, 9ºy 11°años) 2 2006 0 1990 1995 2001 2006

Hombres (Vida) Mujeres (Vida)

Hombres (Mes) Mujeres (Mes)

Consumo de tabaco en jóvenes escolarizados Prevalencia de vida y de últimos treinta días de consumo de cocaína en hombres y mujeres, por año Sexoo//Tipipo de PPrrevalencia PPrrevalencia IC Costa Rica, 1990, 1995 , 2001 y 2006 Hombres Vidaida 36,1 3333,9,9 - 38,138,1 Año 18,2 1616,5,5 - 19,919,9 Mes 9,7 8,3 - 10,9 3,5 Mujeres 31,4 3 Vidaida 2929,3,3 - 33,333,3 Año 15,5 7,2 1313,9,9 - 17,017,0 Mes 6,1 - 8,3 2,5 Hombres (Vida)

2 Mujeres (Vida) Consumo de alcohol en jóvenes escolarizados 1,5 Hombres (Mes) Mujeres (Mes) 1 Sexoo//Tipipo de PPrrevalencia Prevalencia IC Hombres 0,5 Vidaida 52,652,6 50,450,4 - 5454,8,8 Año 33,633,6 - 3737,8,8 35,735,7 18,318,3 - 2121,8,8 0 Mes 20,120,1

1990 1995 2001 2006 MuMujeres

Vidaida 53,853,8 51,651,6 - 5555,9,9 Año 36,136,1 34,134,1 - 3838,2,2 Mes 19,919,9 18,218,2 - 2121,6,6

Episodios de abuso de alcohol en las dos semanas previas Aspectos a la encuesta, según sexo sobresalientes Costa Rica, 2006

El consumo de sustancias lícitas tiene una importancia extrema, lo mismo qu e las diferencias en tre hombres y muj eres. Los niveles de consumo de alcohol y tabaco constituyen problemas de salud pública. 100

80 Pese a las diferencias existentes por sexo, el consumo experimental de 48,7 marihuana y cocaína muestra una importante elevación en la última 60 década. 24,7 40 18,6 La prevelenciade vidade consumode “crack”esdel ordende 0,9%, pero 40,8 8 ha experimentadoun aumentoaceleradodesde1995. En personas 20 23 22,2 jóvenesen riesgosocial el consumoalgunavezestápresenteen un 18%, 14,1 en tantoqueen jóvenesen conflictocon la leyla proporcónes33%. La 0 Ninguno 1 2 a 3 4 o más

dependen ciade crack esunalasprincipalesrazonesde la demandade tratamien to, lo cualrevelala rápidaevoluciónde unadrogaintroduciaen el paísa finales de los añosochenta. Hombres Mujeres

35 Proceedings from the Meeting of the Red Latinoamericano de Investigadores sobre Drogas (REDLA), June 2008 Consumo de cualquier droga ilícita 15.6%

Consumo de cualquier droga ilícita en el año anterior

12% 11°

9% 11% 9° Hombres Mujeres

6% ° 7 No No afectada ó afectada ó depresión depresión leve leve Depresión 82% moderada 91% Depresión 5% moderada Depresión 9% severa Depresión 4% severa 9%

Consumo de marihuana en jóvenes escolarizados

Sexoo//Tiippo de PPrrevalencia IC PPrrevalencia Hombres Vida 9,19,1 7,97,9 -10,410,4 Año Año 5,75,7 4,7 - 6,8 3,03,0 Mes 2,3 - 3,8 Mujeres Vida 5,75,7 4,74,7 – 6,7 Año 3,33,3 2,52,5 – 4,1 1,4 Mes 1,4 0,90,9 – 1,9 Encuesta en Estudiantes de Consumo de cocaína en jóven es escolarizados Enseñanza Primaria Sexo/o/Tipo de PPrrevalencia IC Prevalencia Hombres (4ºaño) Viidada 2,3 1,6 - 2,92,9 Año 1,6 1,0 - 2,12,1 0,8 2005 Mes 0,4 - 1,21,2

MuMujeres Vida Vida 1,1 0,6 - 1,51,5 Año 0,7 0,4 -1,1 Mes 0,5 0,2 – 0,8

Frecuencia de conductas en los padres y en los y las estudiantes para establecer el nivel de involucramiento paterno/materno Prevalencia de vida de consumo de tabaco Costa Rica 2003

91,6

8,4

Padres poco o nada Sí No involucrados: 65%

36 Proceedings from the Meeting of the Red Latinoamericano de Investigadores sobre Drogas (REDLA), June 2008 Prevalencia de vida de alcohol de tabaco Costa Rica 2003

77,1

22,9

Sí No

Notas finales en relación con la demanda de drogas

-El problema del consumo

-La intervención preventiva

37 Proceedings from the Meeting of the Red Latinoamericano de Investigadores sobre Drogas (REDLA), June 2008

Drug Use in Guatemala Mario Rodolfo Salazar M. Translation by Marya Hynes Dowell representing 19.3% and 45 to 65 years, The following document is a description of representing 22.%. the overall drug use situation in Guatemala. This analysis was developed based on The results indicate that drug consumption information from the CICAD Multilateral begins between 13 and 17 years of age. Evaluation Mechanism (MEM), and the first Alcohol is the most widely used substance, national study on health, alcohol, tobacco and followed by tobacco, and tranquilizers. other additive substances, 2005 and 2007. Males consume three to four times more than females. The consumption of these Drug Consumption in Guatemala substances increases among males in the 19 It is difficult to obtain a clear global view of to 25 year age group, reaching 17.9%. The illicit drug use in Guatemala given the highest prevalence rate for these substances scarcity of information on the subject, and was among women in the 45 to 65 year age that which is available, needs to be reviewed group. carefully. Regarding illicit drug consumption, the most In 2005 the Executive Secretariat of the commonly used substances; with a lifetime Commission on Addictions and Illicit Drug prevalence of 2.7% is marijuana. Solvents Trafficking - La Secretaría Ejecutiva de la and cocaine use are significantly lower. Comisión Contra las Adicciones y el Tráfico Illicit substance use is higher among males Ilícito de Drogas (SECCATID) in than females – 6.56% among males, and Guatemala, carried out its first national .75% among females. .. Household Survey on Health, Alcohol, Tobacco and other Addictive Substance Use, in order to determine the prevalence of drug For further information on this report, please consumption and other factors associated contact: with drug use. Mario Rodolfo Salazar Facultad de Ciencias Médicas, Universidad The study involved 4,899 participants in 29 de San Carlos, Guatemala urban municipalities with populations of over [email protected] 30,000 inhabitants or more. The study is not representative at a national level, as it only covered a geographic are of 17 of the 24 departments in the country. Approximately 41% of the sample was male and 59% female. Five different age groups were included 12 to 18 years, accounting for 16.5% of the sample, 19 to 25 years, representing 18.5%, 26 to 34 years, representing 23.3%, 35 to 44 years,

38 Proceedings from the Meeting of the Red Latinoamericano de Investigadores sobre Drogas (REDLA), June 2008

Drug Use in Mexico: The Present Situation, Challenges and Perspectives Jorge A. Villatoro Velázquez Ma. Elena Medina-Mora Icaza Ma. de Lourdes Gutiérrez López Midiam Moreno López Michelle Bretón Cirett Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz Translation by Marya Hynes Dowell

Mexico has a long history of drug use, in Monterrey and Mexico City has been higher both basic research, through a variety of (Fleiz and cols., 2006) (Figure 2). studies, and at a national level. Methodologies applied are comparable at an Furthermore, the data on mortality show that international level, and include household in the border with the north of the country, surveys in the population age 12 to 65 years, especially in the Pacific states and those that school community surveys at different share borders with California and Arizona, education levels, information systems, not mortality is centered on causes associated only in government centers (Centers of Youth with drug consumption. Similarly, mortality Integration), but also in non-governmental in the South of the country is centered on (Addiction Monitoring System, SISVEA) and causes related to alcohol. Mortality related to a variety of studies in child laborers and users tobacco is spread across the entire country of specific drugs. (SISVEA, 2007) (Figure 3).

The national addiction surveys show lifetime Similar situations are shown in the SISVEA consumption among 5.5% of the urban registers1. With regard to treatment centers population, principally marijuana (3.8%), in the northern region, the principal drug of followed by cocaine (1.44%). The regions of impact reported was heroin, which is the country most affected are the north presently being displaced by crystal meth. In (7.5%) and center (4.8%) (Figure 1). In the the center of the country, initially inhalants South of the country, although drug and cocaine were the main drugs; however consumption is low, high indices of they have been displaced by alcohol. This is consumption are found in Cancun; however, similar to what took place in the South of the the problem is centered on the excessive country, although previously the drug of consumption of alcohol (ENA, 2004). impact was marijuana and not cocaine in this region (SISVEA, 2007) (Figure 4). In addition, specific studies have been done in the principal urban areas of the country, or in those with high social problems. In Tijuana the highest proportion of 1 Beginning in 2002, treatment centers have consumption is found, even though collected data on acohol as “drug of impact” more proportionally the increase in Juarez City, accurately, which could explain to some extent why this substance si higher in the Central and Southern parts of the country. 39 Proceedings from the Meeting of the Red Latinoamericano de Investigadores sobre Drogas (REDLA), June 2008 In the official treatment centers (CIJ, 2007), We can observe that the consumption of the trends on lifetime use are recorded methamphetamine is low among the school (Figure 5), among the patients who are population, although in the state of admitted for the first time to treatment. The Aguascalientes, the students in 10th to 12th main drugs of consumption among this group grades have prevalence rates as high as 10% are marijuana as well as cocaine and crack. among males (Graph 9). In the beginning of the 90’s, inhalants were highly prevalent, but they have since Drug consumption in this population is rising decreased in consumption, although there has overall (Graph 10), in addition, the difference been a slight rise in the past two years. in use between males and females is diminishing. In particular, the consumption Through the Border Epidemiology Work of marijuana is highest in this population and Group (BEWG) and the Community is followed by the consumption of inhalants, Epidemiology Work Group (CEWG), there which is increasing in treatment centers, and have been a variety of studies and works is also increasing in the population in higher from the information from treatment centers studies rather than only among adolescents, comparing what is taking place on either side as had occurred in the past (Villatoro and of the border (Maxwell, Cravioto y cols., cols., 2007). 2006). Specifically, in 2006 it was observed clearly that the situation on one side of the There has been a decrease in tobacco border is mirrored in the other country, consumption in this population (Graph 11) although the percentages of consumption are and the difference in consumption between lower on the Mexican side (Figure 6). The males and females has disappeared. It is North-West Border is characterized by a hoped that the new national policies combination of methamphetamine, in the restricting tobacco consumption in closed Central border by heroin and cocaine and the places will have a further impact on the North-East border by cocaine consumption. decrease of consumption of this substance. Similarly, we can see that the age of Mexico has carried studies on initiation, which was beginning to go down, methamphetamine consumption in response now there are a smaller proportion of to the high rate of increase worldwide and the students that initiate use prior to twelve years high demand for methamphetamine in the of age. An important point of data to United States, particularly in California and highlight is how early initiation of Arizona (Figure 7). Data show that in consumption increases the risk of consuming Mexico meth consumption is high in the psychoactive substances by 400%, in northern region of the country and has an comparison to those who use for the first important presence in the center, and is time at a later age or who do not consume nearly non-existent in the South. Along the tobacco (Villatoro y cols., 2004). border with the United States, we can see that in Baja California (contiguous with A similar phenomenon occurs with alcohol California) and in Sonora (Contiguous with regarding the impact when use is initiated at Arizona), the levels of consumption among an earlier age. This substance continues to treatment service users have percentages increase in both prevalence and in early higher in comparison with other border states initiation of use; its impact at a national level and the rest of the country (Figure 8). is very high and it is the primary consumption problem the country, 40 Proceedings from the Meeting of the Red Latinoamericano de Investigadores sobre Drogas (REDLA), June 2008 highlighting the importance of improving Adicciones, Epidemiología. México. ISBN: policies associated with alcohol (Figure 12). 978-970-721-421-7. In fact, there are states where 50% of adolescents report the abusive consumption Fleiz C, Medina-Mora ME, Villatoro J, of alcohol, consuming 5 or more drinks in a Gutiérrez M, Rojas E. (2006) Encuesta de single occasion at least once a month (Figure Adicciones y Seguridad en el Distrito 13). Federal. Reporte Ejecutivo: Drogas. Gobierno del Distrito Federal, Instituto Co morbidity associated with substance Nacional de Psiquiatría Ramón de la Fuente consumption is also widespread, although it Muñiz, Instituto de Asistencia Social e is difficult to establish the dynamics and Integración. México. progression of the problem across studies, we Medina-Mora, ME., Cravioto, P., Villatoro, can observe how in male and in female drug J., Galván, F., Fleiz, C., Rojas E., Kuri, P., users the proportion of those reporting sexual abuse, depressive symptoms, suicide Ruiz, C., Castrejón, J., Velez, A., García A. attempts, risk of eating disorder and possible (2006). Encuesta Nacional de Adiciones attention deficit disorder are twice as high as 2002, Capítulo de Alcohol. Consejo Nacional among those who do not consumed drugs contra las Adicciones, CONADIC, Instituto (Figure 14). Nacional de Psiquiatría Ramón de la Fuente Muñiz, INPRFM, Dirección General de Therefore it is important that the direction Epidemiología, DGE, Instituto Nacional de that prevention programs take should not Estadística, Geografía e Informática, INEGI. only involve the development of social skill México. ISBN: 970-721-314-0. or life skills, but should also combine its goals with the overall mental health of our SISVEA, Consejo Tutelar para Menores adolescents and their families, given the high (CTM), 2007. cost that drug consumption imposes on health. SISVEA, Centros de integración Juvenil (CIJ), 2007. For further information on this report, please Villatoro, J., Medina-Mora, ME., Cravioto, contact: P., Fleiz, C., Galván, F., Rojas E., Kuri, P., Jorge A. Villatoro Velázquez Ruiz, C., Castrejón, J., Velez, A., García A. Instituto Nacional de Psiquiatría Ramón de la (2006). Encuesta Nacional de Adiciones Fuente Múñiz Cal. Instituto Nacional de Psiquiatría Ramón de la [email protected] Fuente Muñiz, INPRFM, Dirección General de Epidemiología, DGE, Instituto Nacional Referencias de Estadística, Geografía e 2002, Capítulo de Drogas. Consejo Nacional contra las Fleiz C, Medina-Mora ME, Villatoro J, Adicciones, CONADIC, Informática, Gutiérrez M, Rojas E. (2006) Encuesta de Consumo de Alcohol, Tabaco y Drogas, INEGI. México. ISBN: 970-721-314-0. 2005. Ciudad Juárez, Monterrey, Tijuana y Querétaro. Reporte Ejecutivo: Drogas. Villatoro, JA., Medina-Mora, ME., Fleiz, C., Instituto Nacional de Psiquiatría Ramón de la Amador, N. y Bermúdez, P. (2004). El Fuente Muñiz, Consejo Nacional contra las consumo de tabaco y alcohol y su relación con el uso de otras drogas. En: Observatorio 41 Proceedings from the Meeting of the Red Latinoamericano de Investigadores sobre Drogas (REDLA), June 2008 Epidemiológico en Drogas 2003: El fenómeno de las adicciones en México. CONADIC, SSA. México, D.F.

42 Proceedings from the Meeting of the Red Latinoamericano de Investigadores sobre Drogas (REDLA), June 2008 Figura 1: Tendencias del Uso de Drogas. Figura 4: Tendencia droga de Impacto en Centros de Encuesta de Hogares Tratamiento No Gubernamentales (ONG´s) 1994 -2007 Nacional 75 Norte 75 Centro 6 5.27 5.03 65 65 5 Norte Región 3.90 55 55 4 3.33 45 45 3 8 % 7 % 7.45 35 35 2 6 6 5 25 1 4 4.92 25 3 3.7 0 2 15 15 1988 1993 1998 2002 1 0 5 5 1988 1993 1998 2002 Centro -5 -5 7 5.97 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 6 19941995199619971998199920002001200220032004200520062007 5 100 4 4.78 Sur 3 3.58 3.71 2 80 1 Droga de Impacto 0 1988 1993 1998 2002 60 % Mariguana Inhalables Sur 40 3.5 Alcohol 3 2.5 3.08 20 Cocaína * 2.69 2 2.5 2.29 1.5 * Cocaína, Basuco, Crack Heroína 0 1 0.5 Cristal

0 19941996 1997 19981999 2000 200120022003 200420052006 2007 1988 1993 1998 2002 ENA 1988, 1993, 1998, 2002 Fuente: SISVEA-Centros de Tratamiento No Gubernamentales, 1994-2007

Figura 2: Tendencias del Consumo de Cualquier Droga alguna vez, en Figura 5: Uso de drogas alguna vez en la vida entre Población de 12 a 65 años solicitantes de tratamiento en CIJ, 1990-2006 (N= 212,477) Tijuana Ciudad Juárez Monterrey Distrito Federal 80 40 70 30 28.9 31.1 30 25.5 %20 60 17.5 17.8 13.8 7.2 8.9 10 50 6.7 4.0 7.8 3.4 5.9 1.3 2.5 0 1998 2005 1998 2005 1998 2005 1998 2006 % 40 30 Cualquier Droga Médica alguna vez 20 10 8 6.3 6 6.1 0

% 4 3.2 3.7 2.7 2.5 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2.8 2.4 2.7 2004-12004-2 2005-12005-22006-1 2 1.6 1.8 1.2 1.7 1.7 Mariguana Inhalables Cocaína y/o crack 0.4 0 0 1998 2005 1998 2005 1998 2005 1998 2006 Depr. uso médico Heroína Metanfetamina

Alucinógenos

Fuente:Sistema Institucional de Información Epidemiológica del Consumo de Drogas, 2007. México: Centros de Fuente: Fleiz, Medina-Mora, Villatoro y cols. (2006), Medina-Mora, Cravioto, Villatoro y cols. (1999) Integración Juvenil, Dirección de Investigación y Enseñanza.

Figura 3: Entidades con Mayor Mortalidad por Figura 6: Perspectiva Global en la Frontera

consumo de drogas en México, 2006 California 50 Arizona 50 31 40 27 40 30 30 19 20 20 12 9 6 10 10 DROGAS 0 0 Nuevo México ALCOHOL 50 40

30 12 TABACO 20 9 4 Baja California 10 44 0 Texas 50 34 50 40 40 26 30 30

20 20 10 8 10 3 10

0 0

Sonora

50 35 40 Tamaulipas 30 18 13 50 20 35 40 10 30 0 18 20 0 10 Chihuahua 0 43 50 Coahuila 40 50 30 Nuevo León 19 40 20 25 50 0 30 10 40 Cocaína 20 28 0 6 0 30 10 20 Heroína 0 1 10 1 Fuente: SISVEA, 2007 Metanfetaminas 0 Fuente: Maxwell, Cravioto y cols. (2006)

43 Proceedings from the Meeting of the Red Latinoamericano de Investigadores sobre Drogas (REDLA), June 2008 Figura 7: Consumo de Metanfetaminas por región, 2007 Figura 10: Encuestas en estudiantes, Cualquier Droga alguna vez según sexo 7º-9ºgrado 10º-12ºgrado

Inicio 5.1% 9.2% 3.6% Sonora 16.4% 12.5% 6.8% 6.3% Nuevo León Norte: Impacto 29.3% Nuevo León

7.0% 5.1% Consumo 37.9% 9.3% 6.2% Yucatán Baja California 30.5% 18.1% Aguascalientes 13.4% 8.9% 8.5% 5.0% Campeche Campeche 6.8% 5.6% 10.7% 8.5% Querétaro Colima

5.3% 6.5% Inicio 0.1% 23.4% 12.0% Colima 13.8% 12.8% 25.2% 21.2% Querétaro D.F. 7.1% 2.8% D.F. 9.8% 6.2% Sur: Impacto 0.6% Tlaxcala Tlaxcala 10 Mariguana Inhalables Cocaína 20 Consumo 2.0% 19.1 8.8 16.9 16.5 8 15.5 16.8 7.2 15 6.7 14.3 14.1 13.5 5.8 Inicio 0.9% 12.6 6 5.4 5 5 5 % % 4.4 4.7 4.7 4.6 10 4.1 5.2 8.9 8.9 3.8 Centro: Impacto 4.8% 8.2 4 3.5 3.5 3.5 4.3 4 4 2.8 3.9 3.3 5 2 1.9 1.6 Consumo 8.5% 0.9 1 0.9 0.5 0.7 1.6 0 0 0.5 1989 1991 1997 2000 2003 2006 1976 1978 1980 1986 1989 1991 1993 1997 2000 2003 2006 Fuente: SISVEA-Centros de Tratamiento,2007 Hombres Mujeres Fuente: De la Serna y cols., 1991; Medina-Mora y cols., 1991; Villatoro y cols., 2003-2006; Velázquez y cols., Colima 2007

Figura 11: Tendencias del Consumo de Tabaco en Figura 8: Porcentaje de consumo de Metanfetaminas por ciudad población escolar de 7ºa 12ºgrado de la Frontera Norte, 2007 Consumo alguna vez Proporción de inicio antes de los 13 años

63.4 39.4

59.7 16.9 10.3 0.9

Tijuana 63.4% Mexicali 39.4% 0 Ensenada59.7% Tecate 67.9% 53.4 3.0 0.4 Relación entre la edad de inicio del consumo de tabaco y otras 6.0 40 drogas 34.1 1.0 34.2 30 28.8 Tranquilizantes 0.6 24.5 Mariguana 8.1 Cocaína 20 18.1 16.9 16.3 16.9 17.6 Alucinógenos 0 15.6 11.5 Inhalables 7.3 9.5 10 9.5 9.0 5.6 5.3 7.4 Metanfetaminas 6.5 5.0 2.2 4.2 3.9 1.6 3.1 3.8 Cualquier droga 0 1.1 1.4 0 0.6 0.2 Fuente: SISVEA. Organismos No Gubernamentales (ONG´s). DGE. SSA. 2007. No consumo 15-17 años 13-14 años 11-12 años 10 o menos Fuentes: De la Serna y cols., 1991; Medina-Mora y cols., 1991; Villatoro y cols., 1997, 2000, 2003 y 2006

Figura 9: Encuestas en estudiantes Figura 12: Tendencias de Consumo de Alcohol en Metanfetaminas alguna vez según sexo población escolar de 7ºa 12ºgrado

Consumo alguna vez Proporción de inicio antes de los 13 años

75 50 46.5 69.4 43.9 42.7 66.1 68.8 42.0 41.6 2.6% 0.9% 62.6 39.8 39.4 61.4 65.8 68.2 40 39.3 Nuevo León 65.5 37.6 60 35.1 36.0 56.7 60.6 30 30.3 % 54.4 % 52.2 20 10.0% 3.1% 45 Aguascalientes Total Hombres Mujeres Total Hombres Mujeres 2.3% 1.5% 10 7º-9ºgrado Campeche 2.1% 1.7% 30 0 Colima 1997 2000 2003 2006 1997 2000 2003 2006 5.0% 1.3% Sonora

0.1% **% 5.9% 2.8% Relación entre la edad de inicio del consumo de alcohol y otras Nuevo León Querétaro 3.6% 2.7% drogas 5.0% 1.0% D.F. 1.9% 0.4% 35 Baja California 2.4% 1.6% Tlaxcala Inhalables Yucatán 30 10º-12º 25 Mariguana 1.3% 0.8% 20 Campeche Cocaína 1.7% 2.7% Querétaro 15 Crack

10 Alucinógenos

5 1.1% 1.5% Cualquier droga Colima 1.8% 1.5% 0 D.F. 3.9% 1.2% Cualquier droga ilegal No Bebe 15-17 13-14 11 a 12 10 o - Tlaxcala ** El consumo es casi nulo en esta población Fuente: Villatoro y cols., 2003-2006; Velázquez y cols., Colima 2007 Fuente: SEP, INPRFM, Villatoro y cols. 1997; 2000, 2003, 2006

44 Proceedings from the Meeting of the Red Latinoamericano de Investigadores sobre Drogas (REDLA), June 2008 Figura 13: Abuso de Alcohol según Sexo en población escolar

32.3% 19.2% Nuevo León

50.8% 32.8% Aguascalientes 24.9% 14.0% 7º-9ºgrado Campeche 32.0% 24.5% Colima

9.4% 7.8% Sonora 7.9% 7.3% 33.9% 21.8% Nuevo León Querétaro 38.9% 31.5% D.F. 28.8% 21.1% Tlaxcala 10.3% 7.3% Yucatán 8.2% 10.3% Baja California 10º-12ºgrado

9.9% 10.1% Campeche 14.9% 11.3% Querétaro

16.6% 15.8% Colima 16.6% 17.0% D.F. 9.9% 6.7% Tlaxcala Fuente: Villatoro y cols., 2003-2006; Velázquez y cols., Colima 2007

Figura 14: Relación entre diferentes conductas y el consumo de drogas en población escolar 35 32.3 30 25

20 16.7 14.4 15 8.9 10 7.9 4.0 5.1 3.8 5 2.6 3.5 0 Abuso sexual Intento suicida Síntomas Conducta TDA depresivos alimentaria Consumidor No consumidor

59.6 60

50 39.5 40 28.0 30 23.4 19.8 20 12.9 14.7 7.3 7.8 10 5.4

0 Abuso sexual Intento suicida Síntomas Conducta TDA depresivos alimentaria Consumidor No consumidor Fuente: Villatoro, Gutiérrez, Medina-Mora y cols. 2007

45 Proceedings from the Meeting of the Red Latinoamericano de Investigadores sobre Drogas (REDLA), June 2008 Drug Use in Peru

Fernando Salazar Eduardo Haro Translation by Marya Hynes Dowell

The General Population. considered conclusive. In each of the three In Peru, in 19982, 20023 and 20064 three studies, alcohol and tobacco use rates are national studies were carried out on the higher among males than females. The magnitude of licit and illicit drug greatest proportion of male drug users is in consumption in the urban population of cities the 20 to 40 year age range, and for females with 20 thousand or more inhabitants across in the 20 to 30 year age range. The the country. The studies examined drug proportion of alcohol users who prevalence rates as well as factors associated demonstrated signs of alcohol dependency in with drug consumption, characteristics of the 1998 was 10.1%, in 2002 it was 10.6% and in individual, the family, and social situation in 2006 8.1%. Regarding tobacco use the population ranging from 12 to 64 years of dependency was 7.8%, 4.4% and 10.3%. age. These studies were carried out in While dependence on alcohol appears stable, accordance with standard technical there appears to be an increase in dependency procedures in order to control for potential on tobacco between 2002 and 2006. biases in sample selection, misclassification of data thus providing an acceptable degree Regarding illegal drugs, the highest of confidence of the validity of the data in prevalence and incidence rates are observed obtained in this study. In addition the ethical for marijuana use. There is an apparent norms for carrying out direct and private decrease in cocaine paste consumption, and interviews, with prior informed consent of although this report does not include a the persons selected for the sample3. statistical comparison to verify this trend, other studies indicate that this downward Highest prevalence rates are for alcohol and trend is indeed real.5 tobacco consumption. There is no clear pattern regarding alcohol use, neither for The prevalence and incidence of cocaine use lifetime nor past year prevalence can a clear have remained stable, while inhalant use pattern be seen. Regarding tobacco, a shows a decreasing trend. The marked decreasing trend can be observed with difference in the prevalence of ecstasy respect to both indicators; however this between 2002 and 2006 combined with the merits further exploration in order to be lack of information on its use from 1998 make it difficult to draw conclusions about trends in use of this drug in the general 2 DEVIDA. Encuesta Nacional Sobre Prevención y Uso de Drogas. Lima, Perú 1999. (http://www.devida.gob.pe/documentos.asp ) population. 3 DEVIDA. INFORME EJECUTIVO: II Encuesta Nacional de Prevención y Consumo de Drogas 2002 Proyecto RLA/AD/PER/99/D77. Lima, Perú 2003. (http://www.opd.gob.pe/cdoc/_cdocumentacion/II%20ENCUESTA%20N ACIONAL%202002.pdf ) 5 Universidad Peruana Cayetano Heredia. Estudio de consumo de drogas 4 DEVIDA. III Encuesta Nacional de Consumo de Drogas en Población General de Perú 2006. Lima, Perú 2006. en hogares de Lima Metropolitana 2005. Lima Perú 2006 (Juárez J. Prevalencia e incidencia del consumo de tranquilizantes sin indicación (http://www.devida.gob.pe/Documentacion/Encuesta_Nacional_De_Con médica en población de 12 a 64 años en Lima Metropolitana. [Tesis de sumo_De_Drogas.pdf ) maestría]. Lima: UPCH; 2006.) http://www.upch.edu.pe/duiict/vs2005/LeeIsisScript.Asp 46 Proceedings from the Meeting of the Red Latinoamericano de Investigadores sobre Drogas (REDLA), June 2008 In all three studies, use of illicit drugs, use were in the adolescent population, from specifically marijuana, cocaine and cocaine age 12 to 18 years and the second highest paste is between four and five times greater rates of use occurred in the young adult among males than females. However, the population up to age 25. 2006 study reported a greater proportion of women consumed inhalants and demonstrated little difference in ecstasy consumption by gender. All three studies showed consistently that the highest rates of

Drug use Prevalence 1998-2006:

Lifetime Prevalence Annual Incidence 19982 20023 20064 19982 20023 20064 Alcohol 90,00 94,20 83,00 49,80 52,80 30,20 Tobacco 71,00 68,00 58,00 15,60 12,10 9,35 Marijuana 5,60 5,80 3,60 0,20 0,70 0,40 Cocaine Paste 3,90 2,10 1,40 0,20 0,20 0,20 Cocaine 1,70 1,80 1,40 0,10 0,10 0,10 Inhalants 1,40 1,00 0,30 0,20 0,30 0,07 Ecstasy ---- 6,50 0,10 ------0,05 Tranquilizers 4,80 6,50 7,4 1,20 1,10 1,01

One phenomenon that deserves attention is The Secondary School Population the increase in lifetime prevalence of In a study carried out in the secondary school tranquilizers without a medical prescription. population during 20056 showed a similar There were some differences in the way pattern to the findings from the general questions were asked regarding the use of population with regard to the highest rates of tranquilizers and stimulants between 1998 substance use. Lifetime prevalence of and 2002. However between 2002 and 2006 alcohol is 53.5% and 44.9% for tobacco. questions on tranquilizer and stimulant use Marijuana is the illicit drug of choice among without a prescription were consistent. secondary school students at 4.8%, followed Nevertheless, taking these differences into by inhalants 4.6%, cocaine 1.8% cocaine account, tranquilizer use increased between paste 1.3%, and ecstasy 1.0%. The lifetime 1998 and 2002, and increased at an even prevalence of tranquilizers without a medical higher rate between 2002 and 2006. All three prescription was 4.5%. Two studies in 2004 studies consistently showed that tranquilizer and 20057 among secondary school students use is highest among adolescents and young in Lima, the capital of Peru, which is adults, and that there are no significant inhabited by one third of the population, differences in use between men and women. 6 DEVIDA. Estudio Nacional: Prevención y consumo de drogas en estudiantes de secundaria 2005. Lima Perú 2006. (http://www.devida.gob.pe/Documentacion/Estudio_Prevencion_Pop_Pu p_Enero_2007/Encuesta_Nacional_Escolares_PERU.pdf ) 7 Universidad Peruana Cayetano Heredia. Estudio de consumo de drogas en hogares de Lima Metropolitana 2005. Lima Perú 2006 (Aguilar M. Prevalencia del consumo de tranquilizantes en escolares de secundaria de colegios estatales de, Lima 2005. [Tesis de maestría]. Lima: UPCH; 2007.) http://www.upch.edu.pe/duiict/vs2005/LeeIsisScript.Asp

47 Proceedings from the Meeting of the Red Latinoamericano de Investigadores sobre Drogas (REDLA), June 2008 showed an increase in the prevalence and incidence of misuse of prescription drugs. The prevalence in 2004 was 3.4% increasing to 5.9% in 2005. The annual incidence of misuse of prescription drugs was 1.7% in 2004 rising to 2.75% in 2005.

Recommendations for Intervention and Further Research The data from the national household and secondary school studies indicate that the principal task at hand should be to control the consumption of alcohol and tobacco, and establish prevention programs for the consumption of illicit substances. Nevertheless, the phenomenon that we are observing with respect to the use of pharmaceuticals without medical prescription in particular, tranquilizer use, compels us to emphasize the need to study this pattern of substance use more carefully, as it could be an indicator for other problems associated with illicit drug use, or the misuse of licit substances.

For further information on this report, contact: Fernando Salazar, PhD [email protected] Universidad Peruana Cayetano Heredia Av. Honorio Delgado 430

48 Proceedings from the Meeting of the Red Latinoamericano de Investigadores sobre Drogas (REDLA), June 2008 Drug Use in Puerto Rico. Juan Carlos Reyes Translation by Marya Hynes Dowell

Introduction Administración Auxiliar de Prevención y Substance abuse is probably the mental Promoción de la Salud Mental de la health problem of greatest impact in the Administración de Servicios de Salud Mental Puerto Rican population. In 2002 it was y Contra la Adicción (ASSMCA), estimated that 1 out of 7 persons between the commissioned to a group of researchers at the ages of 15 and 64 years suffered from abuse Department of Family and Community on dependence on alcohol, illicit substances, Medicine at the Central University of the or controlled medications (Colón et al., Caribbean, and the University of Puerto Rico. 2002). Furthermore, these disorders carry The sample was weighted in order to be with them severe social economic and health generalized to the universe of students from costs for the general population, far beyond seventh to twelfth grade, utilizing the total the mere number of persons directly affected matriculated from each strata obtained from by substance abuse (Harwood, 1998). In the Department of Education and the General Puerto Rico, as in other parts of the world, Education Council (N = 309,878). violence, the AIDS epidemic (21.6 cases for every 100,000 inhabitants in Puerto Rico), Among the general findings of this study school drop-outs, traffic accidents, domestic were the following: the substance most violence and child abuse and neglect are commonly used by adolescents was alcohol, strongly associated with substance abuse followed by cigarettes, marijuana, (Movig, 2004; Reyes et al., 2004, 2008; prescription medicine without a prescription Townsend et al. 2007). The following paper and inhalants. University level students were presents a general description of the more likely to use alcohol cigarettes, substance use Problem in Puerto Rica marijuana and medication without a compiled from findings from different prescription than high school students. epidemiological studies carried out on the Middle school students were more likely to island. report inhalant use. Comparing data by gender, it was found that males reported Methodology and Results of the Different cigarette and licit drug use than females, but Studies not for the use of alcohol where the The first study, presented in figures 2-8 is a prevalence rates were higher among females national survey. Since 1990, Puerto Rico has than males. Findings by substance type applied a series of school surveys known as were: Consulta Juvenil. Consulta Juvenil consists of biannual school surveys designed to Alcohol –56.2% of the total student monitor substance use among youth, in population reported having consumed at least addition to risk and protection factors one alcohol beverage at some point in their (Moscoso et al., 2007). Periodic repetition of lifetime, which translates into approximately studies allows us to examine the patterns of 173,333 students. 48.0% reported having use in secondary schools and changes over consumed alcohol during the past year, and time. Consulta Juvenil is a project of the 32.2% reported recent alcohol use (past

49 Proceedings from the Meeting of the Red Latinoamericano de Investigadores sobre Drogas (REDLA), June 2008 month). Females were slightly more likely to report alcohol use than males (figure 7). Inhalants – 4.6% of secondary school Alcohol use reached its highest level in the students reported having used inhalants. This 1994 survey and gradually declined to its corresponds to an estimated 14,024 students lowest level in 2007 (figure 2). using inhalants experimentally. 3.0% reported having used inhalants during the Cigarettes - 16.0% of the students reported year prior to the survey, and 1.8% reported having smoked cigarettes at some point in recent use (past month). The use of inhalants their life, which translates into approximately reached its highest prevalence rate in 1992 49,293 students who have smoked cigarettes then decreased to 3.2% in the 2002 survey at least once. Of these 10.0% reported (figure 6). In the 2007 survey, inhalants once having smoked during the year prior to the again demonstrated high use. survey and 6.2% reported recent use (past month). Males were more likely to report Finally, in figure 8 we can observe the strong cigarette use than females (figure 7). relationship between alcohol and illicit drug Cigarette use reached its highest prevalence use with respect to suicidal behavior. In this in 1997 then declined to a prevalence rate of graph, it can be seen that adolescents who 16% in 2007 (figure 3). report polydrug use where significantly more likely to attempt suicide. Multivariate Illicit Drugs – 10.7% of the students analyses reflect that a dose-response reported having used an illicit substance relationship exists where the greater the (marijuana, inhalants, cocaine, heroin, crack number of substances used, the greater the or designer drugs) at some point in their probability of attempting suicide, lifetime. It is estimated that 33,049 have independently of the presence or absence of experimented with an illicit drug at least once symptoms of depression (Poster accepted to in their lives. 8.2% reported having used an be presented at the next meeting of the illicit drug during the year prior to the survey American Public Health Association, 5.6% reported recent use (past month) of one October, 2008). or several of these drugs. Males were more likely to report illicit drug use than females Figure 9 presents of the most important (figure 7). The use of illicit drugs reached its findings from the Estudio de Necesidades de highest prevalence in 1997 and declined to a Tratamiento para Alcohol y Drogas prevalence of 10.7% in the 2007 survey sponsored by the Administración de Servicios (figure 4). de Salud Mental y Contra la Adicción; carried out by researchers from the Central Marijuana – 7.4% of the students reported University of the Caribbean during 2001-02 having used marijuana at some point in their (Colón et al., 2002). The sample for this lifetime, which translates into an estimated household study is representative of all of the 22,725 students who have experimented with people between ages 15 and 64 years in this illicit drug. 6.1% reported having used Puerto Rico, excluding individuals in marijuana during the year prior tot he survey residential treatment or homeless people. A and 4.1% reported recent use (past month). total of 4,322 were interviewed, with a The use of marijuana reached its highest response rate of 81.7%. The questionnaire prevalence rate in 1997 which has since included questions regarding the pattern of declined to a prevalence rate of 7.4% in the substance use, abuse and dependence on 2007 survey (figure 5). alcohol and drugs, psychiatric diagnoses 50 Proceedings from the Meeting of the Red Latinoamericano de Investigadores sobre Drogas (REDLA), June 2008 based on the DSMIV and the utilization of reported having used marijuana at some point treatment services. In summary, the results in their lives (Perez et al., 2005, 2007). It is of this study estimated that 7.1% of the important to note that this study utilized the population of Puerto Rico, approximately (ACASI and interview in a mobile unit) data 178,000 individuals, is in need of specialized collection methodology which provides more treatment services for substance treatment privacy and trust in the interview process, and that 186,000 additional individuals which improves reporting on substances (7.5%) need help for substance abuse. among study participants. Among these, with solely a dependence disorder, only 15.0% have received In figures 11 to 18 the findings from the specialized treatment services during the past study on HCV prevalence among injecting year. Amount the persons who present with a drug users in Puerto Rico are presented substance abuse disorder, only 3.4% received (Reyes et al., 2006). This study had the services for their condition. principal objective of estimating the prevalence of HCV and identifies the In figure 10 shows the substance use associated risk factors in a sample of prevalence rates resulting from the different injecting drug users. The study sample studies carried out in Puerto Rico over the consisted of injecting drug users (IDUs) past 15 years, including the treatment needs outside treatment, who reside in communities study of 2001 and preliminary estimates of with high incidence of crime, in the the survey that is being carried out in 2008. metropolitan area of San Juan in Puerto Rico. In general, it can be observed that the use of In figure 12 a map of Puerto Rico is substances in Puerto Rico has experienced an presented that identifies the recruitment area. increasing trend over the past five years. It is A total of 400 IUDs were recruited using a important to highlight that there exist major variety of recruitment strategies. The methodological differences (sample, interview utilized included questions instruments of measurement, methodology regarding the pattern of substance use and for data collection, etc.) among these studies, risk factors associated with the spread of HIV which makes comparison difficult over time. and Hepatitis C. In order to estimate the Nevertheless, between the 2001 and 2008 prevalence of HIV and HCV the ELISA, surveys an increase of slightly more than Western Blot and PCR tests were applied. 10% in the prevalence of alcohol can be observed. The same can be observed for The characteristics of the sample are marijuana, where an increase of 12% is seen presented in figure 13. The sample was between the study by Dr. Canino (Canino et predominantly male (77.8%). The average al., 1993) and the 2008 study. Regarding age was 32.8 years, with a 39% of the study cocaine use, an increase of almost 5% can be between ages 25 and 34 years. Almost have seen between 1993 and 2008. In the case of the sample (47.9%) had not finished high heroin, there is no clear trend as the school. The average number of years of prevalence from 1993 (1.2%) is similar to the injection was 11.6, with almost 61% estimate from 2008 (1.3%). Unlike the other reporting that they had been injecting for investigations, the study by Dr. Perez in 2005 more than five years. In this table it should obtained prevalence rates much higher than be noted that more than 90% of these the entire period under study, where 80% of injection drug users are poly-drug users, as Puerto Ricans reported alcohol use, almost more than 94% use speedball (combination 15% reported cocaine use and close to 30% of heroin and cocaine). In figure 15 a 51 Proceedings from the Meeting of the Red Latinoamericano de Investigadores sobre Drogas (REDLA), June 2008 comparison is presented between the high problem, which brings with it a variety of risk behaviors in the Puerto Rican injectors associated conditions such as violence, and the injectors in the United States. suicide, mental illness, hepatitis C and HIV According to this table, it can be observed among others. The study of needs reflected that the Puerto Ricans who reside on the that only 15% of the people who present a island are more likely to show high risk dependence problem receive specialized behavior in comparison to the Puerto Ricans treatment for their condition. Based on these who reside in the Untied States and other findings it is imperative that the Department ethnic groups. In addition, it is important to of Health of Puerto Rico, in collaboration highlight the HIV incidence rate among with the community organizations and the Puerto Ricans on the island is significantly private sector, concentrate their efforts in higher than the estimate for the Puerto Ricans increasing access and availability of in New York. In figure 16 the prevalence of treatment services on the island. HIV and HCV among drug injectors in Puerto Rico can be seen. The prevalence of References HIV infection was 17.0% and the prevalence of HCV was 89.0%. In comparison with Canino G, Anthony JC, Freeman DH, Shrout studies among drug users worldwide, the P, Stipec-Rubio M. Drug abuse and illicit prevalence rates are considerably high, drug use in Puerto Rico. American Journal of especially the prevalence of hepatitis C, Public Health. 1993; 83,(2):194-200. where 9 out of 10 users are infected. In figure 17 the prevalence of HCV can be seen Colón HM, Robles RR, Deren S, Sahai H, by the number of years that the person has Finlinson HA, Andía J, Cruz MA, Kang S-Y, been injecting drugs. In this graph, it can be Oliver-Vélez D. Between city variation in observed that there is a positive relationship frequency of injection among Puerto Rican in which the number of years that the person injection drug users: East Harlem, New York, has been injecting increases the prevalence of and Bayamón, Puerto Rico. Journal of HCV infection. It is important to note that Acquired Immune Deficiency Syndromes close to 60% of injectors contracted HCV 2001;27:405-413. within a year of beginning injecting drugs. Figure 17 presents the prevalence of new Colón HM, Robles RR, Cabassa M, López drugs in Puerto Rico. This graph CM, Orraca O. Needs Assessment Program demonstrates that nearly three quarters of the for Substance Abuse Services. San Juan, PR: sample under study had used Xylazine during Mental Health and Anti-Addiction Services the past year. Recent qualitative studies Administration & Universidad Central del (2008) utilizing focus groups and in-depth Caribe; 2002:1-40. interviews with injection drug users have registered the use of Xylazine beginning on Deren S, Kang S-Y, Rapkin B, Robles RR, the island approximately three months ago. Andia JF, Colon HM. The utility of the PRECEDE model in predicting HIV risk Figures 19 and 20 present a summary of the behaviors among Puerto Rican injection drug key findings from the studies in this users. AIDS and Behavior, 2003, 7: 405-412. presentation. Based on these results we can conclude that the substance use problem in Harwood HJ, Fountain D, Livermore G. Puerto Rico has been increasing and has Economic costs of alcohol abuse and transformed into a serious public health 52 Proceedings from the Meeting of the Red Latinoamericano de Investigadores sobre Drogas (REDLA), June 2008 alcoholism. Recent Dev Alcohol. risky factors among street-recruited injection 1998;14:307-30. Review. drug users in San Juan, Puerto Rico. J Urban Movig KL et al., Psychoactive substance use Health. 2006 Nov;83(6):1105-13. and the risk of motor vehicle accidents. Accid Anal Prev. 2004 Jul;36(4):631-6. Reyes JC et al., Neighborhood Disorganization, Substance Use, and Moscoso MR, Colón HM, Reyes JC, Violence Among Adolescents in Puerto Rodríguez L. El Uso de Substancias en los Rico.J Interpers Violence. 2008 Mar 4. Escolares Puertorriqueños. Consulta Juvenil VII. San Juan, PR: Administración de Townsend L, Flisher AJ, King G. A Servicios de Salud Mental y Contra la systematic review of the relationship between Adicción y la Universidad Central del high school dropout and substance use. Clin Caribe; 2007:1-56. Child Fam Psychol Rev. 2007 Perez CM, Suárez E, Torres EA, Román K, Dec;10(4):295-317. Review. Colon V. Seroprevalence of hepatitis C virus and associated risk behaviours: a population- based study in San Juan, Puerto Rico. Int J Epidemiol. 2005 jun;34(3):593-9.Epub 2005 Mar31.

Perez CM, Albizu C, Peña, M, Torres, EA, Reyes JC, Colon HM, Ortiz, AP, Suarez E. Hepatitis C in Puerto Rico: a time for public health action. Puerto Rico Health Sciences Journal 2007; 26(4):395-400

Reyes JC, Moscoso M, Velez CN, Rodriguez F, Colon HM, Robles R, Parrilla I, Ramos G, Suarez CM, Mercado H, Suarez RA. Risk and protective factors associated with youth violence among secondary school students in a nationally representative sample in Puerto Rico. Bol Asoc Med P R. 2004; 96(4):253- 60.

Reyes JC, Colón HM, Robles RR, Negrón J, Marrero CA, Matos TD, Calderón J, Perez, O. Alcohol use among adolescents in Puerto Rico: the influence of physical and social neighborhood disorder. Bol Asoc Med P R. 2006 Jul-Sep;98(3):186-191.

Reyes JC, Colón HM, Robles RR, Ríos E, Matos TD, Negrón JL, Marrero CA, Calderon JM, Shepard EW. Prevalence of hepatitis C virus infection and associated 53 Proceedings from the Meeting of the Red Latinoamericano de Investigadores sobre Drogas (REDLA), June 2008 Description of Drug Use in Nine South American Countries Marya Hynes Dowell

Data Sources students in Uruguay are explained by the use Primary sources for this analysis were of marijuana alone. two studies carried out jointly between the CICAD Inter-American Observatory on Inhalants: Inhalant use is problematic across Drugs and the United Nations Office on the region, and are consistently the second Drugs and Crime – Peru Office, Jóvenes y most common illicit substances of use among Drogas un Desafío para las Políticas secondary school students, with the exception Publicas: Primer Estudio Comparativo entre of Chile where they are third, and Brazil Estudiantes Secundarias en Nueve Países where they the most commonly used illicit Sudamericanas, 2006 CICAD/OAS, which substance. In Brazil, past year prevalence describes drug use among secondary school rates of inhalant use among secondary school students between 13 and 17 years of age; and students reach 15.3%, followed by Colombia Elementos Orientadores para las Políticas at 3.49% and Argentina 2.63%. Publicas sobre Drogas en la Subregión: Primer Estudio Comparativo sobre Consumo Cocaine: Cocaine is problematic among de Drogas y Factores Asociados en across the nine countries studied. Among Población de 15 a 64 Años, 2008, secondary school students, past year CICAD/OAS, and UNODC/Peru. prevalence for cocaine use was 2.65% in Chile, followed by Argentina (2.38%) and Drug Use among Secondary School Uruguay (1.39%). Cocaine is the second Students most commonly used illicit drug among students in Chile, and the third most common Marijuana: Marijuana is the most commonly in Argentina and Uruguay. consumed illicit drug among secondary school students in almost every country Ecstasy: Colombia had the highest past year studied. Past year prevalence rates were prevalence of ecstasy (3.0%), followed by 12.7% in Chile, Uruguay (8.5%), Colombia Chile (1.6%) and Ecuador (1.1%). The (7.1%), and in Argentina (6.7%). Although, lowest rates of ecstasy use were in Bolivia these are among the highest rates in the (0.5%) and Paraguay (0.4%). region, they are much lower than rates for similar age groups in the United States Pharmaceuticals without a prescription: (25.2%)8, and Canada (25.6%)9. Over 60% Bolivia and Paraguay, countries with some of of illicit drug use among students in Chile the lowest drug use rates overall among and over 70% of illicit drug use among students had among the highest rates of use of pharmaceuticals without a prescription. 8 Monitoring the Future, National Survey Results on The highest rates for tranquilizer use were Drug Use, 1975-2005, Vol 1, National Institute on found in Bolivia (7%) and Paraguay (7.1%) Drug Abuse, National Institute on Health 9 respectively. Colombia (3.5%), and Brazil Adlaf & Paglia-Boak, Drug Use Among Ontario (3.4%) had the highest rates of stimulant use Students 1977- 2007, CAMH Research Document Series No. 30 followed by Bolivia (3.1%). 54 Proceedings from the Meeting of the Red Latinoamericano de Investigadores sobre Drogas (REDLA), June 2008 showed criteria for dependency were high. Drug Use in the General Population age Approximately 1.4% of the general 15-64 years: Argentina, Bolivia, Chile, population consumed cocaine during the past Ecuador, Peru and Uruguay year. Of that 1.4% over 40% demonstrated criteria for cocaine dependence. Alcohol: Alcohol is culturally accepted and widely used on a regular basis throughout Conclusions Latin America. The CICAD/UNODC study applied the EBBA scale for problematic There are both contrasts and similarities in alcohol use. According to survey responses, drug use patterns among secondary school 7.5% of the people who had consumed students from country to country. Marijuana alcohol during the past month demonstrated is the most commons illicit drug in most criteria for alcohol dependence. This was countries. However, over 60% of drug use in greatest among the population between 18 Brazil is attributable to the abuse of inhalant and 34 years of age. Nearly 1 in 8 of the drugs lone, while a similar proportion of drug general population between the ages of 18 use in Chile and Uruguay is attributable to and 24 years demonstrated positive criteria marijuana use alone. for alcohol dependence. Similarly, nearly 1 in 10 of 24 to 34 year olds also showed Argentina shows the largest proportion of demonstrated criteria for alcohol dependence. polydrug use, and the majority of their problem drug use is defined by cocaine use. Marijuana: Marijuana is the most frequently Colombia showed relatively high endemic used illicit drug among the general rates of nearly all illicit drugs among population in the six countries studied. The secondary school students, although polydrug overall rate of marijuana use during the past use was limited. year 4.8%. Rates ranged from over 7% in Chile and Argentina to 0.7% in both Ecuador Bolivia and Paraguay were the countries and Peru. Among the 4.8% who used demonstrating the lowest rates of overall use marijuana during the past year, while at the same time demonstrated some of approximately 1 in four demonstrated criteria the highest rates of use of pharmaceutical use for marijuana dependence, equaling about without a prescription. Both showed rates of 1.2% of the general population surveyed. tranquilizer use exceeding 7%.

Cocaine: Cocaine use in these six countries The rates of alcohol use among youth of is comparatively high. The overall rate of concern in every country in the region, cocaine use during the past year for the six surpassing 50% in prevalence rate Colombia, countries in South America was 1.4%, followed by similar rates in Paraguay, slightly higher than in Europe, which is Uruguay (50%), Brazil (48%), Argentina 1.3%10. Past year cocaine use was 2.67% in (42.3%), and Paraguay (41%). Even among Argentina, followed by Uruguay 1.6%, Chile the under 14-year age group, rates topped off (1.31%), Bolivia (0.66%), Peru (0.31%) and at 37% in Colombia and came close in Brazil, Ecuador (0.11%). Proportions of people who Uruguay, and Argentina, the lowest being consumed cocaine during the past year who 8.6% in Bolivia.

10 The State of the Drugs Problem in the European Union and Norway, European Monitoring Centre on Drugs and Drug Addiction, 2007 55 Proceedings from the Meeting of the Red Latinoamericano de Investigadores sobre Drogas (REDLA), June 2008 de Drogas y Factores Asociados en Población de 15 a 64 Años, 2008, CICAD/OAS, and For further information on this report, please UNODC/Peru. contact: Marya Hynes Dowell, Jovenes y Drogas un Desafio para las Inter-American Observatory on Drugs Politicas Publicas: Primer Estudio CICAD/OAS Comparativo entre Estudiantes Secundarias [email protected] en Nueve Paises Sudamericanas, 2006

Monitoring the Future, National Survey References Results on Drug Use, 1975-2005, Vol 1, National Institute on Drug Abuse, National Adlaf & Paglia-Boak, Drug Use Among Institute on Health Ontario Students 1977- 2007, CAMH Research Document Series No. 30 The State of the Drugs Problem in the European Union and Norway, European Elementos Orientadores para las Politicas Monitoring Centre on Drugs and Drug Publicas sobre Drogas en la Subregión: Addiction, 2007 Primer Estudio Comparative sobre Consumo

56 Proceedings from the Meeting of the Red Latinoamericano de Investigadores sobre Drogas (REDLA), June 2008