Special Report Epidemiologic Report on the Use and Abuse of Psychoactive Substances in 16 Countries of Latin America and the Caribbean1 One of the responsibilities of the World ment of an extensive system for compil- Health Organization (WHO) and the Pan ing and evaluating data on the subject American Health Organization (PAHO) was proposed, and this task was as- is the collection and dissemination of in- signed to PAHO and the Organization of formation on both currently prevalent American States (OAS), in conjunction and emerging health problems. Particu- with other specialized agencies, such as larly important among these problems, the South American Agreement on Nar- by reason of its growing magnitude, is cotic Drugs and Psychotropic Substances the use and abuse of psychoactive sub- (ASEP). These organizations received a stances. WHO is the technical agency of specific mandate to set up an inter- the United Nations charged with imple- American data bank on alcoholism and menting the health-related aspects of in- drug abuse. ternational treaties on narcotics and psy- One of the strategies derived from the chotropic substances. meeting, and one that responded to a re- As part of this responsibility, PAHO quest contained in Resolution XVII of the convened an August 1987 meeting in XXIX Meeting of the PAHO Directing Buenos Aires of the Advisory Group on Council, was a proposal to prepare the Epidemiology of Drug Abuse which epidemiologic profiles of psychoactive had as an aim the undertaking of a pre- substance use in the countries of the cise and practical study of the magnitude Americas, as well as assessments of the of the problems of drug abuse and drug countries’ responses to problems related trafficking and their consequences to this use. throughout the Region for individuals In order for the necessary information and society. At this meeting, establish- to be compiled in a homogeneous man- ner, a data collection guide was prepared This report is a summary of a paper entitled “Per- files epidemiologicos nacionales sobre consumo de and distributed to 16 countries in the Re- alcohol y otras drogas en America Latina,” by gion. Each country was requested to col- Lenn Murrelle, Rodrigo Escalona, and Ramon lect data in the following areas: socio- Florenzano, Center for Alcohol Studies and De- partment of Psychiatry, University of North Caro- demographic and economic indicators ha. Chauel I-Ii& North Carolina. U.S.A. The oa- relative to the production and marketing per. wasLpresented at the II Meeting of ihe of psychoactive substances, the diversion l?4HOWI-IO Study Group on Public Health Rob- lems Related to Alcoholism and Drug Abuse, held of such substances from licit channels, in Miami, Florida, 31 January-3 February 1989. levels of consumption, health indicators Bulletin ofPAH0 24(Z), 1990 97 that showed the effects of illicit consump- project was assigned to a group of re- tion, the sociocultural framework, gov- searchers at the Center for Alcohol Stud- ernment or health sector responses to ies and the Department of Psychiatry of problems related to the improper use of the University of North Carolina School such substances, rehabilitation and social of Medicine in Chapel Hill, North Caro- reintegration of drug-dependent individ- lina, U.S.A. The present report summa- uals, primary prevention, research, and rizes the data collected. The omission of education and training. one or more of the categories referred to Analysis of the data collected in the 16 above means that such information either countries participating in this stage of the was not available or was unreliable. ARGENTINA Production and Marketing of als. Some of the drugs produced are ex- Psychoactive Substances ported, but the market is very small. At the present time the Ministry of Health The most important psychoactive sub- and Social Action does not maintain sta- stances produced in the country are alco- tistics on the production and marketing holic beverages, tobacco, and some psy- of psychoactive medications. There is no chotropic medications. With regard to evidence that clandestine production alcohol, 121,392,277 liters of distilled bev- exists. The Government has the re- erages were produced in 1986, which sponsibility for coordinating the licens- equals 28537,483 liters of absolute alco- ing system for the licit production and hol, for an increase of 23.5% over the pre- control of narcotics and psychotropic vious year. Beer production for that year medications. was 544,590,OOO liters, the approximate There is no state monopoly on the equivalent of 27229,500 liters of absolute production or importation of alcoholic alcohol. beverages, tobacco, or psychotropic Most wine produced is for the domestic substances. market. According to data from the Na- A medical prescription is required for tional Viticulture Institute, authorized the sale of psychoactive drugs. Require- production of wine for domestic con- ments for the dispensing of drugs vary sumption reached a total of 1,856,691,100 according to the list on which a substance liters in 1986, or 213,404,476 liters of ab- appears. Forgery of prescription forms solute alcohol. has been detected. Tobacco production for 1984-1985 was Argentina has a special administration, estimated at 63,220 tons. In 1983 the area the Department of Psychotropic Sub- occupied by tobacco crops was 3.8% of stances and Drugs, which is responsible the total surface devoted to industrial for enforcing the provisions of the 1961 crops and 0.02% of the total agricultural Single Convention on Narcotic Drugs area of the country. The production of and the 1971 Convention on Psychotro- cigars and cigarettes declined in 1980 by pic Substances. 10.1% compared to 1975. Surprise attacks have occurred on mo- Approximately 90% of the production bile units that distribute manufactured of psychoactive medications in Argentina drug products, which are then resold is carried out with imported raw materi- illegally. 98 Bulletin ofPAHO 24(l), 1990 Consumption tional Center for Social Rehabilitation ad- mitted 603 cases (476 males and 127 fe- In 1986, the annual per capita con- males). In the same year the Toxicological sumption of alcoholic beverages for the Care Fund attended 525 outpatient cases population 15 years of age and over was (420 males and 105 females). estimated at 12.8 liters of absolute alco- A research project was carried out in hol, of which 1.3 liters was in distilled 1988 on the nature and magnitude of psy- beverages, 1.3 liters in beer, and 10.2 li- choactive substance abuse cases seen by ters in wine. In that same year the con- hospital emergency services.2 Approxi- sumption of distilled spirits increased by mately 5% of the emergencies seen in a 23%, and that of beer by 27%. one-week period were related to drugs, It is estimated that a third of the coun- and of those, 64% were due to abusive try’s adult population smokes habitually. consumption of alcohol, 20% to the in- Although in recent years the proportion gestion of psychoactive medications, and of smokers has stayed at a constant level, 16% to mixed consumption. a slight reduction in numbers has been There are no beds in general hospitals observed among males, whereas a con- assigned specifically for alcoholic and siderable increase has been detected drug-addicted patients, who are admit- among women. ted to different services depending on the According to data provided by the Ar- particular clinical consequences of their gentine Ministry of Agriculture and Live- drug abuse. Very few cases are attended stock, cigarette sales in 1984 reached by the psychiatric services. 1,772 million packs, while annual per Special mention should be made of a capita consumption was 1,220 cigarettes. study of blood alcohol levels in drivers Per capita consumption has increased by carried out in the Federal Capital in 1978 30% since 1947. by the Institute of Biology and Experi- There is no official information avail- mental Medicine. Blood alcohol levels be- able on the use of psychoactive medica- tween 0.03% and 0.07% represented tions. 14.2% of the sample tested, and levels higher than 0.07% corresponded to 9.1% Health Indicators of the sample. Studies carried out in a hospital in Of the 266 patients hospitalized for im- Buenos Aires in 1985 indicate that the proper use of drugs in the municipal hos- most frequent discharge diagnosis of pa- pitals of the city of Buenos Aires and dis- tients admitted for alcoholism was absti- charged during 1983, 249 cases were nence syndrome (48.8%), followed by a alcohol-related and 17 were associated diagnosis of gastrointestinal hemorrhage with other drugs. Drug-related psychosis (20%).3 Mortality among patients hospi- accounted for 11% of all cases with a dis- talized for diseases associated with exces- charge diagnosis of psychosis. Of pa- sive ingestion of alcohol was 15.4%. In tients discharged with the diagnosis of neurotic personality disorder, 29% of cases were related to abuse of psychoac- 2Hugo A. Miguez and Ricardo W. Grimson, “Con- s&as de urgencia por abuso de sustancias psicoac- tive substances, and 27% to alcohol de- tivas en hospitales de Buenos Aires,” Bol Of Sanit pendence syndrome. Panam 107(4):296-306,1989. Data collected by the National Com- 3H. Rambla and C. Tarasiuk, Diagnbsticos aI egreso de 84 pacientes alcoh6licos internados en el hospi- mission Against Drug Trafficking and tal de San kidro” (Buenos Aires, Mimeographed Drug Abuse indicate that in 1987 the Na- document), 1985. SpecialReport 99 the same period, overall mortality at the from the Government or international hospital was 11.5%. It was estimated that agencies are trying to develop actions in there is extensive underregistration of al- the area of prevention and treatment.