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In Russia, a Glut of Heroin and Denial

Location: 
Russia
Twenty one percent of the 375 tons of heroin produced from Afghanistan's opium fields now finds its way through central Asia into Russia, according to the United Nations. Unlike most countries around the world, Russia refuses to finance harm reduction programs such as needle exchanges, or to legalize methadone. Over the past few months, Moscow has decided to discontinue the work of foreign donors and NGOs with heroin addicts. Critics go as far as to accuse Moscow of willfully neglecting its citizens and thereby fueling what the World Health Organization says is one of the fastest growing HIV/AIDS epidemics in the world.
Publication/Source: 
The Vancouver Sun (Canada)
URL: 
http://www.vancouversun.com/health/SPECIAL+REPORT+Russia+glut+heroin+denial+Part/4172354/story.html

Perspective: To Prevent AIDS in Russia, Drug Addicts Need Care

Location: 
Russia
Russia has one of the fastest spreading HIV epidemics in the world, driven largely by the government's refusal to institute measures to treat the country's drug addicts — measures that have dramatically reduced HIV infections in drug addicts in other countries, including the U.S.
Publication/Source: 
TIME (US)
URL: 
http://healthland.time.com/2011/01/18/perspective-to-prevent-aids-in-russia-drug-addicts-need-care/

This Year's Top 10 International Drug Policy Stories

This year saw continued turmoil, agitation, and evolution on the international drug policy front. While we don't have the space to cover all the developments -- the expansion of medical marijuana access in Israel, the rise of Portugal as a drug reform model, the slow spread of harm reduction practices across Eurasia -- here are what we see as the most significant international drug policy developments of the year.

The Mexican Tragedy

San Malverde, Mexico's patron saint of narco-traffickers
Mexico's ongoing tragedy is exhibit number one in the failure of global drug prohibition. This month, the official death toll since President Felipe Calderon deployed the military against the so-called cartels in December 2006 passed 30,000, with 10,000 killed this year alone. The multi-sided conflict pits the cartels against each other, cartel factions against each other, cartels against law enforcement and the military, and, at times, elements of the military and different levels of law enforcement against each other. The US has spent $1.2 billion of Plan Merida funds, mainly beefing up the police and the military, and appropriated another $600 million this summer, much of it to send more lawmen, prosecutors, and National Guard units to the border. None of it seems to make much difference in the supply of cocaine, heroin, marijuana, and methamphetamine coming over (under, around, and through) the border, but the horrorific violence of Mexico's drug war is eroding public confidence in the state and its ability to exercise one of its essential functions: maintaining order. The slow-motion disaster has spurred talk of legalization in Mexico -- and beyond -- but there is little chance of any real movement toward that solution anytime in the near future. In the mean time, Mexico bleeds for our sins.

The Rising Clamor for a New Paradigm and an End to Drug Prohibition

The critique of the international drug policy status quo that has been growing louder and louder for the past decade or so turned into a roar in 2010. Impelled in part by the ongoing crisis in Mexico and in part by a more generalized disdain for failed drug war policies, calls for radical reform came fast and furious, and from some unexpected corners this year.

In January, the former French Polynesian President Oscar Temaru called for Tahiti to legalize marijuana and sell it to European tourists to provide jobs for unemployed youth. Three months later, members of the ruling party of another island nation spoke out for reform. In traditionally tough on drugs Bermuda, leading Progressive Labor Party members called for decriminalization.

In February, an international conference of political figures, academics, social scientists, security experts, and activists in Mexico City called prohibition in Mexico a disaster and urged drug policies based on prevention, scientific evidence, and respect for human life. By August, as the wave of violence sweeping Mexico grew ever more threatening, President Felipe Calderon opened the door to a discussion of drug legalization, and although he quickly tried to slam it shut, former President Vicente Fox quickly jumped in to call for the legalization of the production, distribution, and sale of drugs. "Radical prohibition strategies have never worked," he said. That inspired Colombian President Juan Manuel Santos to say that he supported the call for a debate on legalization. The situation in Mexico also inspired two leading Spanish political figures, former Prime Minister Felipe Gonzales and former drug czar Araceli Manjon-Cabeza to call for an end to drug prohibition in the fall.

Midsummer saw the emergence of the Vienna Declaration, an official conference declaration of the World AIDS Conference, which called for evidence-based policy making and the decriminalization of drug use. The declaration has garnered thousands of signatures and endorsements, including the endorsements of three former Latin American presidents, Henrique Cardoso of Brazil, Ernesto Zedillo of Mexico, and Cesar Gaviria of Colombia. It has also picked up the support of public health organizations and municipalities worldwide, including the city of Vancouver.

Great Britain has also been a locus of drug war criticism this year, beginning with continuing resignations from the Advisory Council on the Misuse of Drugs. Several members of the official body had quit late last year in the wake of the firing of Professor David Nutt as ACMD after he criticized government decisions to reschedule cannabis and not to down-schedule ecstasy. In April, two more ACMD members resigned, this time in response to the government's ignoring their recommendations and banning mephedrone (see below).

The revolt continued in August, when the former head of Britain's Royal College of Physicians joined the growing chorus calling for radical reforms of the country's drug laws. Sir Ian Gilmore said the government should consider decriminalizing drug possession because prohibition neither reduced crime nor improved health. That came just three weeks after Nicholas Green, chairman of the Bar Council (the British equivalent of the ABA), called for decriminalization. The following month, Britain's leading cannabis scientist, Roger Pertwee called for cannabis to be legalized and regulated like alcohol and tobacco, and the chairman of the Association of Chief Police Officer's drug committee said marijuana should be decriminalized. Chief Constable Tim Hollis said decrim would allow police to concentrate on more serious crime. The following day, the Liberal Democrats, junior partners in a coalition government with the Conservatives, were lambasted by one of their own. Ewan Hoyle called for a rational debate on drug policy and scolded the party for remaining silent on the issue. And just this past week, former Blair administration Home Office drug minister and defense minister Bob Ainsworth called for the legalization of all illicit drugs, including cocaine and heroin.

From Mexico to Great Britain, Vancouver to Vienna, not to mention from Tahiti to Bermuda, the clamor for drug legalization has clearly grown in volume in 2010.

Opium and the Afghan War

More than nine years after the US invaded Afghanistan in a bid to decapitate Al Qaeda and punish the Taliban, the US and NATO occupation drags bloodily on. This year has been the deadliest so far for Western occupiers, with 697 US and NATO troops killed as of December 20. And while the US war machine is fueled by a seemingly endless supply of borrowed cash -- another $160 billion was just authorized for the coming year -- the Taliban runs to a large degree on profits from the opium and heroin trade. In a Faustian bargain, the West has found itself forced to accept widespread opium production as the price of keeping the peasantry out of Taliban ranks while at the same time acknowledging that the profits from the poppies end up as shiny new weapons used to kill Western soldiers and their Afghan allies. The Afghan poppy crop was down this year, not because of successful eradication programs, but because a fungus blighted much of the crop. But even that is not good news: The poppy shortage means prices will rebound and more farmers will plant next year. The West could buy up the entire poppy crop for less than what the US spends in a week to prosecute this war, but it has so far rejected that option.

The Netherlands Reins in Its Cannabis Coffee Shops

Holland's three-decade long experiment with tolerated marijuana sales at the country's famous coffee shops is probable not going to end under the current conservative government, but it is under pressure. The number of coffee shops operating in the country has dropped by about half from its peak, local governments are putting the squeeze on them via measures such as distance restrictions (must be so far from a school, etc.), and the national government is about to unveil a plan to effectively bar foreigners from the shops. The way for that was cleared this month when the European Court of Justice ruled that such a ban did not violate European Union guarantees of freedom of travel and equality under the law within the EU because what the coffee shops sell is an illegal product that promotes drug use and public disorder. Whether the "weed pass" system contemplated by opponents of "drug tourism" will come to pass nationwide remains to be seen, but it appears the famous Dutch tolerance is eroding, especially when it comes to foreigners. Do the Dutch really think most people go there just to visit the windmills and the Rijksmuseum?

Russian Takeover at the UNODC

In September, there was a changing of the guard at the UN Office on Drugs and Crime (UNODC), one of the key bureaucratic power centers for the global drug prohibition regime. Outgoing UNODC head Antonio Maria Costa, a former Italian prosecutor, was replaced by veteran Russian diplomat Yury Fedotov. Given Russia's dismal record on drug policy, especially around human rights issues, the treatment of hard drug users, and HIV/AIDS prevention, as well as the Russian government's insistence that the West resort to opium eradication in Afghanistan (Russia is in the throes of a heroin epidemic based on cheap Afghan smack), the international drug reform community looked askance at Fedotov's appointment. But the diplomat's first missive as ONDCP head talked of drug dependence as a disease, not something to be punished, and emphasized a concern with public health and human rights. Fedotov has shown he can talk the talk, but whether he will walk the walk remains to be seen.

US War on Coca on Autopilot

Coca production is ongoing, if down slightly, in the Andes, after more than a quarter century of US efforts to wipe it out. Plan Colombia continues to be funded, although at declining levels, and aerial and manual eradication continues there. That, and a boom in coca growing in Peru, have led to Peru's arguably retaking first place in coca production from Colombia, but have also led to increased conflict between Peruvian coca growers and a hostile national government. And remnants of the Shining Path have appointed themselves protectors of the trade in several Peruvian coca producing regions. They have clashed repeatedly with Peruvian police, military, and coca eradicators. Meanwhile, Bolivia, the world's number three coca producer continues to be governed by former coca grower union leader Evo Morales, who has allowed a limited increase in coca leaf production. That's enough to upset the US, but not enough to satisfy Bolivian coca growers, who this fall forced Evo's government to repeal a law limiting coca leaf sales.

Canada Marches Boldly Backward

Canada under the Conservatives continues to disappoint. When the Liberals held power in the early part of this decade, Canada was something of a drug reform beacon, even if the Liberals could never quite get around to passing their own marijuana decriminalization bill while in power. They supported Vancouver's safe injection site and embraced harm reduction policies. But under the government of Prime Minister Steven Harper, Canada this year fought and lost (again) to shut down the safe injection site. Harper's justice minister, Rob Nicholson, in May signed extradition papers allowing "Prince of Pot" Marc Emery to fall into the clutches of the Americans, in whose gulag he now resides for the next four years for selling pot seeds. And while Harper's dismissal of parliament in January killed the government's bill to introduced mandatory minimum sentences for a number of offenses, including growing as few as five pot plants, his government reintroduced the bill this fall. It just passed the Senate, but needs to win approval in the House of Commons. The Conservatives won't be able to pass it by themselves there, so the question now becomes whether the Liberals will have the gumption to stand against it. This as polls consistently show a majority of Canadians favoring marijuana legalization.

A New Drug Generates a Tired, Old Response

When in doubt, prohibit. That would seem to be the mantra in Europe, where, confronted by the emergence of mephedrone, a synthetic stimulant derived from cathinone, the active ingredient in the khat plant, first Britain and then the entire European Union responded by banning it. Described as having effects similar to cocaine or ecstasy, mephedrone emerged in the English club scene in the past 18 months, generating hysterical tabloid press accounts of its alleged dangers. When two young people supposedly died of mephedrone early this year, the British government ignored the advice of its Advisory Council on the Misuse of Drugs, which called for it to be a Schedule B drug, and banned it. Poland followed suit in September, shutting down shops that sold the drug and claiming the power to pull from the shelves any product that could be harmful to life or health. And just this month, after misrepresenting a study by the European Monitoring Center on Drugs and Drug Addiction, the EU instituted a continent-wide ban on mephedrone. Meet the newest entrant into the black market.

Heroin Maintenance Expands Slowly in Europe

Heroin maintenance continues its slow spread in Europe. In March, Denmark became the latest country to embrace heroin maintenance. The Danes thus join Germany, the Netherlands, Switzerland, and, to a lesser degree, Britain, in the heroin maintenance club. In June, British scientists rolled out a study showing heroin maintenance worked and urging the expansion of limited existing programs there. The following month, a blue-ribbon Norwegian committee called for heroin prescription trials and other harm reduction measures there. Research reports on heron maintenance programs have shown they reduce criminality among participants, decrease the chaos in their lives, and make them more amenable to integration into society.

Opium is Back in the Golden Triangle

Okay, it never really went away in Laos, Burma, and Thailand, and it is still below its levels of the mid-1990s, but opium planting has been on the increase for the last four years in the Golden Triangle. Production has nearly doubled in Burma since 2006 to more than 38,000 hectares, while in Laos, production has more than doubled since 2007. The UNODC values the crop this year at more than $200 million, more than double the estimate of last year's crop. Part of the increase is attributable to increased planting, but part is accounted for by rising prices. While Southeast Asian opium production still trails far behind that in Afghanistan, opium is back with a vengeance in the Golden Triangle.

Portuguese Drug Reformers Look Beyond Decriminalization [FEATURE]

The Portuguese government has garnered well-earned plaudits for its nine-year-old policy of the decriminalization of drug possession, first last year from Glenn Greenwald in a White Paper commissioned by the Cato Institute, and just last month in a new academic study in the British Journal of Criminology. But while they applaud the Portuguese government for embracing decriminalization, some drug user advocates there are saying there is more to be done.

Lisbon, capital of Portugal
Portugal broke new ground back in July 2001 when it decriminalized the possession of up to a 10-day supply of all illicit drugs. Under the new policy, drug users caught with drugs are not arrested, but are instead referred to regional "committees for the dissuasion of addiction." Those committees are empowered to impose warnings or administrative penalties, including fines, restrictions on driving, and referral to treatment.

But in most cases, the committees simply suspend the proceedings, meaning that, in effect, no punishment is meted out. The decriminalization policy has been accompanied by increased investment in treatment and harm reduction services, including methadone maintenance for people addicted to heroin.

As Greenwald found last year, and researchers Dr. Caitlin Hughes and Professor Alex Stevens last month, decriminalization is working. Hughes and Stevens found that while there had been a modest increase in drug use by adults, it was in line with increases reported by other southern European countries.

While drug use increased modestly, Hughes and Stevens were able to report that the harms associated with drug use had decreased under decriminalization. They found a reduction in the rate of spread of HIV/AIDS, a reduction in drug-related deaths, and a reduction in drug use by adolescents. They also found that drug seizures had increased under decriminalization.

"Contrary to predictions, the Portuguese decriminalization did not lead to major increases in drug use," the researchers concluded. "Indeed, evidence indicates reductions in problematic use, drug-related harms and criminal justice overcrowding.”

For Hughes and Stevens, the Portuguese experiment was also significant because it showed that decriminalization reduces harm for all drugs, not just marijuana. "Such effects can be observed when decriminalizing all drugs," they wrote. "This is important, as decriminalization is commonly restricted to cannabis alone."

Speaking in New York last week, Stevens elaborated: "The evidence from Portugal suggests that we could end the criminalization of users of all types of drugs -- and not just marijuana -- without increasing drug use and harms. It also shows the importance of continued investment in treatment services and harm reduction to reduce drug-related deaths and HIV."

But while Portugal's decriminalization is gathering praise from abroad, the view from the ground is a bit more nuanced. Decriminalization has improved the lives of drug users, but much remains to be done, said Jorge Roque, a Portuguese attorney who works with the European Coalition for Just and Effective Drug Policies (ENCOD), the International Network of People Who Use Drugs (INPUD), and the Portuguese group Diferenca Real, which attempts to improve conditions for drug users there.

"Decriminalization allowed drug users to stop being persecuted by the police and helped many of them realize they are not criminals simply because they chose to use drugs," said Roque. "And many people are now receiving help from the drug attendance centers," where addicted drug users may be sent after being caught. "Many drug users are trying hard to stay within the law, because if one isn't a criminal just for using drugs and one can pay for his drugs through his job, he doesn't want to be identified as a criminal, which was impossible before decriminalization."

Decriminalization has also led to changes in policing, said Roque. "After some time, the police shifted from arresting drug users to going after small-time dealers," he noted. "The police realized that arresting the small-timers is the best way to catch the big sharks," he said, alluding to the continuing black market drug trade. "The black market remains. Decriminalization didn't stop that," Roque said.

"The majority of drug-related crime wasn't caused by using a drug," the attorney continued, "but by committing an offense to buy drugs. Decriminalization is an important step, but it is only a step. Drug distribution is still forbidden in Portugal, and that means traffickers have a monopoly on the drug supply, and as a result, the prices are very high. So many people commit small thefts to buy their drugs, and the police try to control them and the drug neighborhoods with all the usual abuses."

The Portuguese government should not be sitting on its laurels, Roque said. While it deserves praise for what it has done, it has not done enough, he said.

"We are completely happy that the government decriminalized drug use, but the drug situation is very complex and touches on many different aspects -- legal, political, health, social, economic, morality -- and we have some demands that we think the government is not addressing because it is satisfied with what it has done with decriminalization," said Roque.

That point was echoed by Joep Oomen, head of ENCOD. If the Portuguese government stops with just decriminalization, it will be just as hypocritical as any other government, he said.

"By decriminalizing the use and possession of small quantities of illegal drugs, Portugal has reduced the immediate damage of drug prohibition," Oomen said. "The police don't persecute users and petty dealers as much, and problematic users find their way to health services. But decriminalization has not solved the main problem of prohibition: Drugs continue to be distributed by traffickers who inflate the price, impose criminal marketing methods, and have minimal concern for product quality or the safety of consumers. If Portuguese authorities do not take the next step toward legal regulation of the market, their policies will remain as hypocritical as those of any other country," he said.

But that's unlikely any time in the near future, said Roque. Even other drug reforms this side of ending prohibition are now stalled, he said.

"After all the international news reporting on the success of decriminalization in Portugal, the politicians' egos are so big they think they don't need to do anything else," said Roque. "But many drug users want to see safe injection sites, heroin maintenance programs, and the like, instead of just decriminalizing use. Similarly, the cannabis reform bill is still stuck in parliament waiting for approval. The government says it is busy with the international financial crisis and now our own public deficit, and can't do anything, even though this could mean revenues for the government."

With its drug decriminalization policy, Portugal has indeed become a beacon to the world, a model of progressive drug reform that could and should be emulated elsewhere. But as Roque and Oomen make clear, decriminalization is only half the battle.

Portugal

Fraser Health Authority Urged to Push Needle Exchanges Into Hostile Cities

Location: 
Canada
Injection drug addicts are at much greater risk of catching and spreading disease in the Fraser Health region because health authority officials have failed to deliver on the promise of their harm reduction policy, reform advocates charge. They say access to needle exchanges, safe injection sites and methadone clinics is much poorer than in the Vancouver area – largely due to opposition from hostile city councils and police forces who think an abstinence policy is best.
Publication/Source: 
Hope Standard (Canada)
URL: 
http://www.bclocalnews.com/fraser_valley/hopestandard/news/106728428.html

The World Can Learn from Switzerland's Drug Policy

In the late 1980s, Switzerland saw a significant increase in injection drug use, and the crime and public health harms that are associated with it under our prohibition system. A new video from the Hungarian Civil Liberties Union features a range of Swiss experts discussing the science-based policies that the country has adopted to deal with those issues, including Professor Ambros Uchtenhagen, head of the first heroin maintenance program in Switzerland; Felix Lengweiler, the chief of security police and policing of narcotics crime at the Zurich City Police; and Uwe Serduelt, deputy director, Centre of Research on Direct Democracy at the Zurich University.

The video's release coincides with a new report on the subject by the Open Society Institute, Read From the Mountaintops: What the World Can Learn from Drug Policy Change in Switzerland.

Swiss Drug Policy Should Serve As Model: Experts

Location: 
Switzerland
Switzerland's innovative policy of providing drug addicts with free methadone and clean needles has greatly reduced deaths while cutting crime rates and should serve as a global model, health experts said. Countries whose drug policy remains focused on punishing offenders, including Russia and much of Eastern Europe and Central Asia, should learn from a Swiss strategy based on "harm reduction" that protects both users and communities, they said.
Publication/Source: 
Reuters
URL: 
http://www.reuters.com/article/idUSTRE69O3VI20101025

Doctor Calls Ontario's Methadone Program Oppressive and Discriminatory

Location: 
ON
Canada
A Toronto doctor says Ontario's methadone program for addicts is "oppressive" in the way it discriminates against patients and forces them to give up their privacy. Patients who are prescribed methadone for addiction to drugs such as heroin or morphine are shackled to the health-care system and must sign away their privacy rights in exchange for treatment, Dr. Philip Berger told a legislative committee.
Publication/Source: 
Winnipeg Free Press (Canada)
URL: 
http://www.winnipegfreepress.com/life/health/doctor-calls-ontarios-methadone-program-oppressive-and-discriminatory-105215519.html

FDA Approves Once-A-Month Injectable Drug to Fight Opiate Addiction

The US Food and Drug Administration (FDA) announced Tuesday that it had approved a once-a-month injectable drug for use in treating opiate addiction. The drug, marketed as Vivitrol, is a form of naloxone, an opioid atagonist that blocks the action of opioids on brain cells and is currently used in responding to overdoses.

In approving Vivitrol, the FDA cited a Russian study with 250 heroin addicts that found it reduces relapse rates and blocks cravings for narcotics. In that study, after six months, 86% of subjects taking Vivitrol had stayed off opiates and were functioning in work or school, compared to only 57% who were given a placebo.

Unlike methadone and buprenorphine, which are commonly used in opiate substitution treatments, Vivitrol is not addictive and does not maintain opiate dependency. Additionally, unlike those two substitutes, Vivitrol does not need to be taken daily, but is instead administered monthly via intramuscular injection.

The approval of Vivitrol for opiate addiction is "an important turning point in our approach to treatment," said Dr. Nora Volkow, head of the National Institute on Drug Abuse, in a statement greeting the FDA announcement.

Nearly 810,000 Americans are addicted to heroin, with more than twice that number using prescription opioids, such as Oxycontin and Vicodin, for non-prescription purposes, Volkow noted.

Washington, DC
United States

FDA Appoves Drug to Treat Heroin, Morphine Addiction

The Food and Drug Administration has approved an injectable drug designed to treat people addicted to opiates who have undergone detoxification treatment. Vivitrol, made by Massachusetts drug maker Alkermes, is a so-called extended-release formulation of the drug naltrexone that is injected once a month into the muscle, according to an FDA statement. The drug works to block opioid receptors in the brain.
Publication/Source: 
All Headline News (FL)
URL: 
http://www.allheadlinenews.com/articles/7020200536?FDA%20Appoves%20Drug%20To%20Treat%20Heroin,%20Morphine%20Addiction

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