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Impact of Drug Trade on Physical & Mental Health

The impact of the drug trade/abuse on the physical and mental health of the population can be categorized in terms of impact on the individual and on the society at large.
 
Impact on the Individual
 
• Physical Health
- Physical symptoms related to abuse – states off dependency, abuse, psychosis, poisoning or overdose.
- Indirect effects of drug use – cirrhosis, nutritional or metabolic disorders, viral infections such as HIV/AIDS or hepatitis, trauma resulting from traffic accidents, other accidents or personal attacks.
- Requirements for medical attention/hospitalization – loss of earnings, depletion of savings, poverty.
- The ultimate price – death.
 
• Mental Health
 
Drug abuse can result in a number of disorders including:
 
- Schizophrenia
- Manic depression
- Paranoia
- Personality disorder
- Depression
- Anxiety
- Panic attacks
- Agitation
- Lower self esteem
 
In Trinidad and Tobago the following conditions predominate:
 
- Paranoia
- Depression
- Low self esteem
- Anxiety
 
In Trinidad and Tobago the majority of these respondents (63.8%) self medicated on crack cocaine (64.3%) and marijuana (28.6%), thereby indicating a need for better treatment access.
 
Impact on the Society
 
The cumulative impact of individuals represents impact on the society. In this regard the costs are very virtually incalculable. It is the society that ultimately bears the costs associated with individual abuse including:
 
- Treatment in public and private institutions, including hospital/rehab admissions and duration of stay.
- Deaths or serious injuries by homicide, accident, or suicide associated with psychoactive substance use.
- Increased stress and psychological burdens on society, especially in response to escalating serious crime rates associated with the trade including property loss, murders and kidnappings.
- Cost of premature death.
- Substance abuse reduction costs associated with creating awareness and encouraging attitudinal and behaviour change for current, past and non-users.
 

Review of Responses to the Measures Applied to Combat the Drug Trade with special reference to International Conventions and Multilateral Plans of Action.

Trinidad and Tobago has ratified an umber of international conventions and multi-lateral plans of action. It has also engaged in regional initiatives and bi-lateral arrangements with the United States, United Kingdom, Canada, Venezuela, Cuba and St. Kitts/Nevis.
 
Review of Responses
 

The agreements and arrangements outlined above produce an umber of supply side outcomes including, arrests, seizures, destruction of cultivated areas and other initiates such as the establishment of the National Drug Observatory. In this regard there has been some success. Demand reduction initiatives are insufficient given the scale of the problem and where they do exist quantifiable results have not been produced since the period 1999 – 2000, as far as this Consultant is aware. Consequently the review of responses must be placed against:
• Inadequate resource allocation, even on the supply side but moreso on the demand reduction initiatives.
• Lack of understanding of the nature and extent of the problem by policymakers.
• The absence or inadequacy of developmental alternatives.
 

Current Patterns and Emerging Trends in Drug Use and Supply
 
Current Patterns and Emerging Trends in Drug Use – Global
 
• Increasing youth participation.
• Drugs of choice – cannabis (#1); heroin (#2); and cocaine (#3).
• Increase in drug-related problems, including crime and violence, susceptibility to HIV/AIDS and hepatitis, demand for emergency room visits and breakdown in the social order.
• Profile of the drug abuser – upper and middle class, not limited to youth, not mostly the poor.
 
Current Patterns and Emerging Trends in Drug Use – Local
 
Trinidad and Tobago demonstrates similar trends to the global picture, except with respect to drug of choice. Local abusers appear to have thus far resisted heroin. This is merely a perception as little current research has been undertaken on the subject. The trends of Trinidad and Tobago are as follows:
 
• Increasing penetration of the in-school population
• Increasing danger of crack cocaine which contains additives such as crushed bulbs, cleaning powders (harpic) and kerosene. These produce a ‘faster hook’ but result in severe deterioration of the body.
• Increase in prostitution and HIV infection, particularly among the high risk 15 – 44 age group.
• Increase in use of synthetic drugs.
 
Current Patterns and Emerging Trends in Drug Supply – Global 

 
• Shipment of Colombian cocaine to Eastern Europe and then onto the west.
• Increased involvement by Eastern European States and former Soviet Republics in the production of opium poppies and amphetamines for distribution in the west.
• Increase in production of synthetic drugs especially methamphetamine.
 
These developments increase the competitiveness in the marketplace resulting in reduced prices. This state of affairs increases usage among existing users; expands market size; and encourages entry into the market of new price-conscious users, in particular, the youth segment. Market enlargement in turn encourages further production increases as producers seek economies of scale and mass production becomes necessary in light of lower prices and the need to sustain levels of profitability.
 
Additionally, a more diversified client base necessitates additional product offerings that spur new product development – hence the expansion of the synthetic drugs market.
 
Given this scenario there appears to be no end in sight for the abatement of the ‘drug problem’ and policymakers would need to work diligently at stemming the entry of new users which is the fulcrum around which market expansion will be based. This is mandatory and is imperative now if they are to have any chance of overcoming the powerful drug interests.
 
Current Patterns and Emerging Trends in Drug Supply – Local/Regional
 
• Increasing share of cocaine in the trade (currently 85%, up from 72% in 1990)
• Shift from viewing Caribbean participants in the trade as mere victims of geography to one in which they are viewed as active participants.
• Change in payment within the ‘industry’ from cash to kind, resulting in the increased supply in the local market and the proliferation of weapons to protect the merchandise.
• Increasingly apparent links between drug traffickers and organized crime, especially within the context of ethnocentric groups.
• Increasing incidence of swallowing as a trafficking strategy. However, this remains a small percentage of the trafficking strategy with go-fast boats and sea containers remaining the primary mode of transport.
 
Observations and Theories on the Impact of Drugs on Crime
 
Definition of Crime:
An act or commission of an act that is forbidden or the omission of a duty that is commanded by a public law and that makes the offender liable to punishment by that law; grave offence, especially against morality.
 
User Crimes
 

- Pharmacologically-induced crimes – as people become ‘ mad’.
- Economically-motivated crimes – acquisition-type crime to fund crack purchase.
- Systemic crime – among rival groups of turf³.
 
Non-user (Distribution) Crimes
 
- Laundering of illicit profits.
- Intimidation/Elimination of witnesses.
- Murders and kidnappings of competitors, colleagues, law enforcement, public/private officials.
- Illegal importation of firearms for use in traffic and commission of other crimes.
 
Theoretical Perspectives
 
There is a little scientific evidenced for the assertion that drug abuse cause crime. Writers on the subject have suggested that:
 
• Illegal drugs contribute to crime
• Illegal drugs to hand in hand with crime
• Crime is a lifestyle issue and therefore drug use does not lead to crime but is merely a manifestation of deviant behaviour by the individual.
• Crime is too complex a phenomenon to be related to a single factor. Instead a complex web of social, economic and psychological factors converge to induce deviant behaviour.
• Drugs can actually reduce anti-social behaviour as not all drug use has violent outcomes.
 

Review of the Concept of the ‘Community Leader’ and its Relation to the ‘Drug Lord’
 
The term ‘Community Leader’ has traditionally been used in a ‘community development’ context and has been in associated with leadership within a given community based on membership of the Village Council or performance in business, politics or social spheres.
 
The term “Drug Lord’ in the traditional sense refers to an individual who heads an illegal drug empire, as occurs in South America.
 
Strictly speaking there are no ‘drug lords’ in Trinidad and Tobago. The connection between the two terms was the result of a specific set of circumstances undertaken by the administration in trying to develop solutions to the drug problem in a particular area in Trinidad, Laventille. To complicate the issue, in Laventille they speak of the ‘Elders’ who are the de facto ‘community leaders’ of the area. Therefore, the connection is a tenuous one although it is possible for a local version of the ‘drug lord’ to become a ‘community leader’. Drug users use the term ‘drug pusher’ interchangeably with the ‘drug lord’ which suggests that the connection between these two terms is stronger than ‘community leader’.
 

Strategic Framework for Drug Demand Reduction in Trinidad and Tobago
 
Strategic Framework
 
A strategic framework provides a strategic perspective on what should be done, why it should be done, and how it should be done. It sets out the key elements which provide a reference or benchmark against which the activities of relevant national programmes should be assessed. It should build on elements of the country’s strategic foundation for drug abuse prevention, including its mission and vision and the strategic goals that are being articulated. The framework should also define our core objectives as well as our intermediate-level expected outcomes.
 
Core Elements of the Strategic Framework
 
Indication of core elements for a strategic framework emerged, when they were not actually articulated by key personnel and experts in the field.
 
Strategic Objectives

 
Specific strategic objectives gleaned from observation and from the concerns and insights of members of the NDC were:
 
i. Identify a vision for the future consistent with national development plans.
ii. Reach and engage the non-traditional actors in order to enrich the demand reduction effort by broadening and deepening participation.
iii. Improve networking among individuals, agencies and institution to achieve greater consistency, improved capability and effective collaboration.
iv. Strive to have the notion of accountability embedded in the culture of the demand reduction activity.
 
Analysis
 
Despite the measures taken and efforts made the drug abuse appear to be continuing unabated. Conclusions are that the situation is influenced significantly by the strength of the demand for the illegal substances, a scenario that requires new and more effective and productive responses.
 
Fundamental change in the way of country goes about its demand reduction business is necessary and it is advanced that ‘a paradigm shift’ that perceives the illegal drug question as a development issue is a most appropriate change. A paradigm shift is an intellectually violent revolution where one conceptual world view is replaced by another. Shifting the emphasis of the drug trade from merely a legal/health issue to the more inclusive development issue therefore require fundamental changes’.
 
The desirable change must result in an ‘end state’ which should be congruent with the declared vision of 2020. End state conditions would manifest themselves in healthy communities throughout the Nation.
 
Critical Thoughts

The Role of the National Drug Council
 
Strategic leadership, which Caldwell (q2993) describes as the capacity to take charge of one’s own, is the responsibility of the NDC. The NDC must undergo some transformation in its administrative and organizational structure to give it the best chance of meeting the challenge.
 
Elements of an Appropriate Framework for Demand Reduction.
 
The element of the framework below are categorized into a strategic objective (a vision), strategic priorities (core strategies), and action plans.
 
 

Strategic objectives
 
Tangible elements of the emerging vision include:

i. Communities where people can live in peace, feel secure, confident of a
future of sustainable prosperity.
ii. Information of drug use that is relevant, and current and easily accessible.
– Using state-of-the-art technology.
iii. Partnerships that cross sectors, institutions, boundaries and perspectives.
 
Some key partners include the protective service, education authorities, the universities, the media, Ministry of Sport and Youth Affairs, the religious sector, arts & culture, business, labour, the judiciary, health, women’s organization.
 
Core Strategies
 
Short Term

• Establish confidence in the nation’s ability to significantly reduce drug abuse
• Explore a paradigm shift to treat demand reduction as a development issue
• Rely on research driven policies
• Re-examine existing bilateral and multilateral initiatives in relation revised and newly declared national objectives.
 
Medium Term

• Develop programmes to remove conditions that promote susceptibility to drug
use.
• Target for change, conditions in Trinidad and Tobago that facilitate the drug
trade.
• Focus specific awareness and training initiatives to address particular situations and communities.
 
Long Term

• Exploit and maximize the potential impact of treatment and rehabilitation.
• Seek and utilize up-to-date technology in Prevention endeavours
• Develop and maintain the technical capacity to meet and treat with drug
problems.
• Adopt inclusive methodologies to secure optimum autonomous participation of the national community (How people perceive themselves as implications for how they behave).
 
Action Plans

These action plans cut across the core strategies.
 
Short term
• Develop a cadre of adequately trained management personnel
• Support the effort of agencies that provide a catalyst for prevention work.
• Design and implement a specific Schools Programme and Youth Programme.
• Develop and implement a Tobago specific plan for demand reduction.
• Develop a consultation and feedback mechanism to support a continual assessment process for identifying and reducing vulnerabilities and for evaluating the impact of conditions and initiatives.
 
Medium Term
• Secure the institutional transformation of the NDC
• Enhance NADAPP’s profile and efficacy
• Enhance treatment and rehabilitation capacity
• Establish a research organization/mechanism to monitor and support the
demand reduction initiatives
• Review and implement programme of research

Long Term
• Establish, promote and nurture a Domestic Network of Organisations
• Enhance the awareness raising activities of The NDC and its partners
 
Many of these actions represent initiatives already being undertaken but together with new ideas they have the potential to support most of the core strategies described above.
 
This draft strategic framework can serve as a road map for the journey towards the strategic goal of healthy communities. It should be considered a significant element of the country’s national development, a work in progress, all inclusive, transcending perceived boundaries, discovering new ways to move forward, collaborating, pooling resources and joining forces to attain the prosperous and sustainable future that is envisaged.
 
SUMMARY OF RECOMMENDATIONS
 
Further Research
 
The Consultant is of the view that the following research topics represent gaps in the information needs of the National Drug Council. It is important that the organisation closes these gaps if it desires to effectively discharge its obligations to the Executive. These topics are as follows:
 
Impact Assessment of:

• Current strategies, that is, arrests, seizures, property confiscation, awareness
/educational campaigns in schools and the public domain.
• Treatment centres.
• Harm reduction strategies – e.g. Oasis.
• The drug trade on the economy.
• Implementation of strategies in Trinidad versus Tobago.

Benchmarking

Benchmarking of international best practice in relation to:
• ‘Drug Courts’, with a view to implementation in Trinidad and Tobago.
• Standards of Care, with a full view to implementation in Trinidad and Tobago.
 
Feasibility Study
 
The NDC must commission a study on the feasibility of repositioning the ‘drug question’ as a developmental issue and not merely a criminal/national security issue. As part of this exercise the organisation will undertake an assessment of the economic and social costs of drug abuse and drug trafficking. A formula for undertaking this activity has already been proposed. It is hoped that this accomplishment will galvanise support for better resource allocation, focus on demand reduction activity and produce a similar effect to that which was successfully undertaken for HIV/AIDS.
National Drug Survey
 
The Consultant recommends that the National Drug council undertakes a National a Drug survey. This survey will be positioned in a similar manner to the national census. Although a significant of under-reporting is anticipated, in the opinion of this Consultant, the benefits far outweigh the cost. It is expected that this exercise will:
 
• Place the drug issue firmly at the top of the National agenda
• Create awareness of the crud issue and its impact on the society
• Establish indices for different aspects of the drug issue that can be benchmarked and tracked overtime.
• Create a store of research that can be used by