Article Comparison: Stimulant Use in Different Geographies

The abuse of stimulants such as amphetamines and cocaine is a public health concern, with addiction to these drugs leading to negative physical and mental effects on their users. As Achterberg et al. (2014) explain, amphetamines affect neurotransmitters dopamine, norepinephrine, and serotonin in the brain, with the greatest effect on dopamine.  Amphetamines attack the nerve cell prior to the synapse, where they cause more dopamine than normal to be released into the synapse.  They then block the molecules that would typically transport the excess dopamine back into the nerve cell to regulate dopamine levels.  This causes the extra dopamine to remain suspended in the synapse, causing a euphoric or intensely pleasurable feeling. In some situations this euphoria can affect transporter molecules and cause more dopamine to be released into the synapse, further heightening the pleasurable feelings produced.  Over time, repeated abnormal dopamine production alters the body’s normal balance of the neurotransmitter, leading to reduced dopamine production from the amphetamine stimulation and addiction to the amphetamines to maintain dopamine production.  Amphetamines similarly enhance noradrenaline neurotransmission.  A stimulant with similar major and side effects as drugs in the amphetamine family, cocaine prevents the reuptake of dopamine more than amphetamines and also blocks voltage-gated sodium channels (Achterberg et al., 2014).

Summaries

Two articles that address the increasing abuse of amphetamines and cocaine are from Degenhardt et al. (2008), who report on global cocaine trends based on a recent WHO survey, and Maxwell and Rutkowski (2008), who report on the trends in amphetamine use in the United States.  Although investigating other drugs in addition to cocaine, Degenhardt et al. (2008) drew data from the WHO’s World Mental Health Survey to construct a global view of cocaine use and epidemiological patterns in seventeen countries.  They sought to document cumulative use in each country as well as examine the age when people were beginning use in each country and how social demographics related to drug use.  As descriptive research, the authors did not present a hypothesis.  The WHO conducted eighteen surveys across seventeen countries involved 85,052 participants.  Surveys collected demographic data such as age, gender, education, and income as well as information on drug use, symptoms, age use began, and other information related to drug use.  Researchers analyzed cumulative incident and found notable differences between countries.  The United States was the highest user of alcohol and drugs, with sixteen percent of respondents having tried cocaine in comparison to 4.3% in the second-ranked country for its use.  People in the US were more likely to use cocaine younger, although within the standard 19-28 age range typical internationally for first use.  The authors linked this to income, with countries that had higher disposable income more likely to also have more drug use (Degenhardt et al., 2008).

In a similar but narrower study, Maxwell and Rutkowski (2008) examined drug use in North America, concentrating on methamphetamines and amphetamines.  Instead of examining drug use across different countries, they studied it across different regions of the United States.  As this was also descriptive research, there was no hypothesis.  They also examined survey data that included information regarding demographics and drug use, although drug production data was also gathered as part of this study.  The researchers used data from the 2006 US National Survey on Drug Use and Health, which had 67,802 respondents, the 2004 Canadian Addiction Survey, which had 13,909 participants, and the 2002 Mexican National Comorbidity Survey, which had 5782 partakers.  After accounting for age differences between countries, as the US survey started at age 12, the Canadian at age 14, and the Mexican at age 16, they found use in the United States to be around 16% of the population.  The number increased to 25% in states that bordered Mexico, as the researchers report that the main conduit for these drugs into the US is across the Mexican border.  The researchers conclude that amphetamine use has shifted over the past decade from misuse of prescription drugs to drugs manufactured for illegal sale, and that amphetamine use is uneven, with Western states having significantly more drug abuse than Eastern states in term s of amphetamines.  They postulate that this is because it is sold nearer to its production, but do not have firm conclusions based on findings from this research.

Critique

Critiquing both studies, both use data from broad surveys that provide a high volume of respondents but does not investigate beyond surface prevalence, leaving the authors to speculate regarding why certain trends or incidence are occurring.  Both do use a very high number of respondents, making the data more credible, and survey based on varied geographic locations, which provides good contrast points for consideration.  Both studies used credible, established methods for drawing information from existing raw survey data, and also similar employed standard cumulative methods for analyzing data.  Both studies report findings in line with their data and come to reasonable conclusions.  In addition, both are limited in that they use data already collected but both benefit from large and diverse samples (Maxwell & Rutkowski, 2008).

Conclusion

These two articles support that stimulant use varies from region to region, both in the United States and in the world.  In general, populations with greater access to stimulants and greater disposable income with which to purchase them are more likely to abuse the drugs (Degenhardt et al., 2008; Maxwell & Rutkowski, 2008).  Younger people are more likely to use stimulants than older people, with most beginning use in their late teens or twenties.  One can infer from these articles that to combat the use of stimulants in the United States; however, the articles do not provide any substantial suggestions for combating drug misuse in the United States or internationally beyond limiting supply, although both imply the necessity of taking action of some kind.

References

Achterberg, E. J., M., Trezza, V., Siviy, S. M., Schrama, L., Schoffelmeer, A. N., . . . J. (2014). Amphetamine and cocaine suppress social play behavior in rats through distinct mechanisms. Psychopharmacology, 231(8), 1503-15. doi:http://dx.doi.org/10.1007/s00213-013-3272-9

Degenhardt, L., Chiu W. T., Sampson, N., Kessler, R. C., Anthony, J. C., et al. (2008). Toward a Global View of Alcohol, Tobacco, Cannabis, and Cocaine Use: Findings from the WHO World Mental Health Surveys. PLoS Med 5(7): e141. doi:10.1371/journal.pmed.0050141

Maxwell, J. C. & Rutkowski, B. A. (2008).The prevalence of methamphetamine and amphetamine abuse in North America: a review of the indicators, 1992-2007. Drug and Alcohol Review, 27(3):229-35