Editing Substance abuse (section)

==Classification==
===Public health definitions===
[[File:Injecting heroin.jpg|thumb|A drug user receiving an injection of the [[opioid]] [[heroin]]]]
[[Public health]] practitioners have attempted to look at substance use from a broader perspective than the individual, emphasizing the role of society, culture, and availability. Some health professionals choose to avoid the terms alcohol or drug "abuse" in favor of language considered more objective, such as "substance and alcohol type problems" or "harmful/problematic use" of drugs. The Health Officers Council of [[British Columbia]] — in their 2005 policy discussion paper, ''A Public Health Approach to Drug Control in Canada'' — has adopted a public health model of psychoactive substance use that challenges the simplistic black-and-white construction of the binary (or complementary) [[antonym]]s "use" vs. "abuse".<ref>{{cite web|url=http://www.cfdp.ca/bchoc.pdf|title=A Public Health Approach |access-date=1 April 2017}}</ref> This model explicitly recognizes a spectrum of use, ranging from beneficial use to chronic [[Substance dependence|dependence]].

===Medical definitions===
[[File:Rational harm assessment of drugs radar plot.svg|thumb|upright=1.35|A 2007 assessment of harm from recreational drug use (mean physical harm and mean dependence liability)<ref name="Nutt"/>]]

'Drug abuse' is no longer a current medical diagnosis in either of the most used diagnostic tools in the world, the [[American Psychiatric Association]]'s [[Diagnostic and Statistical Manual of Mental Disorders]] (DSM), and the [[World Health Organization]]'s [[International Classification of Diseases]] (ICD). According to the DSM, substance abuse is the abuse of one of the 10 classes of drugs which include cannabis, alcohol, caffeine, hallucinogens, hypnotics, opioids, anxiolytics, inhalants, tobacco, and sedatives as well as other, possibly unknown, substances.<ref name=":72">{{cite book |title=Diagnostic and statistical manual of mental disorders: DSM-5 |date=2013 |publisher=American Psychiatric Association |isbn=978-0-89042-557-2 |edition=Fifth |pages=490}}</ref>

===Value judgment===
[[File:Correlations between drugs usage.png|thumb|upright=1.4|right|This diagram depicts the correlations among the usage of 18 legal and illegal drugs: alcohol, amphetamines, amyl nitrite, benzodiazepines, cannabis, chocolate, cocaine, caffeine, crack, ecstasy, heroin, ketamine, legal highs, LSD, methadone, magic mushrooms (MMushrooms), nicotine and volatile substance abuse (VSA). Usage is defined as having used the drug at least once during years 2005–2015. The colored links between drugs indicate the correlations with {{math|{{pipe}}''r''{{pipe}}>0.4}}, where {{math|{{pipe}}''r''{{pipe}}}} is the [[absolute value]] of the [[Pearson correlation coefficient]].<ref name="Fehrman2015">{{Cite book |last1=Fehrman |first1=Elaine |last2=Muhammad |first2=Awaz K. |last3=Mirkes |first3=Evgeny M. |last4=Egan |first4=Vincent |last5=Gorban |first5=Alexander N. |title=Data Science |chapter=The Five Factor Model of Personality and Evaluation of Drug Consumption Risk |date=2017 |editor-last=Palumbo |editor-first=Francesco |editor2-last=Montanari |editor2-first=Angela |editor3-last=Vichi |editor3-first=Maurizio |chapter-url=http://link.springer.com/10.1007/978-3-319-55723-6_18 |series=Studies in Classification, Data Analysis, and Knowledge Organization |location=Cham |publisher=Springer International Publishing |pages=231–242 |arxiv=1506.06297 |doi=10.1007/978-3-319-55723-6_18 |isbn=978-3-319-55722-9|s2cid=45897076 }}</ref>]]
History professor [[Philip Jenkins]] suggests that there are two issues with the term "drug abuse". First, what constitutes a [[drug]] is debatable. For instance, [[Gamma-Hydroxybutyric acid|GHB]], a naturally occurring substance in the central nervous system is considered a drug, and is illegal in many countries, while [[nicotine]] is not officially considered a "drug" in most countries.

Second, the word "abuse" implies a recognized standard of use for any substance. Drinking an occasional glass of wine is considered acceptable in most [[Western Countries|Western countries]], while drinking several bottles is seen as abuse. Strict temperance advocates, who may or may not be religiously motivated, would see drinking even one glass as abuse.  Some groups (Mormons, as prescribed in [[Word of Wisdom#Tea and coffee|"the Word of Wisdom"]]) even condemn [[caffeine]] use in any quantity. Similarly, adopting the view that any (recreational) use of [[cannabis (drug)|cannabis]] or [[substituted amphetamine]]s constitutes drug abuse implies a decision made that the substance is harmful, even in minute quantities.<ref>{{Cite book |last=Jenkins |first=Philip |url=https://www.worldcat.org/oclc/45733635 |title=Synthetic Panics: The Symbolic Politics of Designer Drugs |date=1999 |publisher=[[New York University Press]] |isbn=978-0-8147-4244-0 |location=New York |pages=ix-x |oclc=45733635 |author-link=Philip Jenkins}}</ref> In the U.S., drugs have been legally classified into five categories; these are schedule I, II, III, IV, or V in the [[Controlled Substances Act]]. The drugs are classified on their deemed potential for abuse. 

The usage of some drugs is strongly correlated.<ref name = "FehrmanGorbanBook">{{cite book |last1= Fehrman|first1= Elaine|last2= Egan|first2=Vincent |last3= Gorban|first3= Alexander N. |last4= Levesley|first4= Jeremy |last5= Mirkes|first5= Evgeny M. |last6= Muhammad|first6=Awaz K. |date= 2019|title= Personality Traits and Drug Consumption. A Story Told by Data|doi = 10.1007/978-3-030-10442-9|publisher= Springer, Cham|isbn=978-3-030-10441-2 |arxiv= 2001.06520  |s2cid= 151160405}}</ref> For example, the consumption of seven illicit drugs (amphetamines, cannabis, cocaine, ecstasy, legal highs, LSD, and magic mushrooms) is correlated and the [[Pearson correlation coefficient]] ''r''>0.4 in every pair of them; consumption of cannabis  is strongly correlated (''r''>0.5) with the usage of nicotine (tobacco), heroin is correlated with cocaine (''r''>0.4) and methadone (''r''>0.45), and is strongly correlated with crack (''r''>0.5)<ref name = "FehrmanGorbanBook"/>

===Drug misuse===
Drug misuse is a term used commonly when [[prescription medication]] with [[sedative]], [[anxiolytic]], [[analgesic]], or [[stimulant]] properties is used for mood alteration or intoxication ignoring the fact that overdose of such medicines can sometimes have serious adverse effects. It sometimes involves [[drug diversion]] from the individual for whom it was prescribed.

Prescription misuse has been defined differently and rather inconsistently based on the status of drug prescription, the uses without a prescription, intentional use to achieve intoxicating effects, route of administration, co-ingestion with [[alcohol (drug)|alcohol]], and the presence or absence of [[Substance dependence|dependence]] symptoms.<ref name=misuse>{{Cite journal |vauthors=Barrett SP, Meisner JR, Stewart SH |title=What constitutes prescription drug misuse? Problems and pitfalls of current conceptualizations |journal=Curr Drug Abuse Rev |volume=1 |issue=3 |pages=255–62 |date=November 2008 |pmid=19630724 |doi=10.2174/1874473710801030255 |url=http://www.bentham.org/cdar/openaccsesarticle/cdar%201-3/0002CDAR.pdf |url-status=dead |archive-url=https://web.archive.org/web/20100615214225/http://bentham.org/cdar/openaccsesarticle/cdar%201-3/0002CDAR.pdf |archive-date=2010-06-15 }}</ref><ref>{{Cite journal|vauthors=McCabe SE, Boyd CJ, Teter CJ |title=Subtypes of nonmedical prescription drug misuse |journal=Drug Alcohol Depend |volume=102 |issue=1–3 |pages=63–70 |date=June 2009 |pmid=19278795|pmc=2975029 |doi=10.1016/j.drugalcdep.2009.01.007 }}</ref> Chronic use of certain substances leads to a change in the central nervous system known as a "tolerance" to the medicine such that more of the substance is needed in order to produce desired effects. With some substances, stopping or reducing use can cause withdrawal symptoms to occur,<ref>{{Cite book |last=Antai-Otong |first=D. |url=https://www.worldcat.org/oclc/173182624 |title=Psychiatric Nursing : Biological & Behavioral Concepts |date=2008 |publisher=Thomson Delmar Learning |isbn=978-1-4180-3872-4 |edition=2nd |location=Clifton Park, NY |oclc=173182624}}</ref> but this is highly dependent on the specific substance in question.

The rate of prescription drug misuse is fast overtaking illegal drug use in the United States. According to the National Institute of Drug Abuse, 7 million people were taking prescription drugs for nonmedical use in 2010. Among 12th graders, nonmedical prescription drug use is now second only to [[cannabis (drug)|cannabis]].<ref>{{cite web|publisher=PDMP Center of Excellence|title=The Prescription Drug Abuse Epidemic|url=http://www.pdmpexcellence.org/node/10|date=2010–2013}}</ref> In 2011, "Nearly 1 in 12 high school seniors reported nonmedical use of [[Hydrocodone/paracetamol|Vicodin]]; 1 in 20 reported such use of [[Oxycodone|OxyContin]]."<ref>{{Cite web |date=December 2011 |title=Topics in Brief: Prescription Drug Abuse |url=http://www.drugabuse.gov/publications/topics-in-brief/prescription-drug-abuse |url-status=dead |archive-url=https://web.archive.org/web/20140924064448/http://www.drugabuse.gov/publications/topics-in-brief/prescription-drug-abuse |archive-date=24 September 2014 |website=[[National Institute on Drug Abuse]]}}</ref> Both of these drugs contain [[opioids]]. Fentanyl is an opioid that is 100 times more potent than morphine, and 50 times more potent than heroin.<ref>{{Cite journal |last=宋 |first=建燮 |date=2020-05-30 |title=A Study on the Communication Index and Efficiency Evaluation of Regional Governments: Application of DEA, SEM, Super-SBM Models |url=http://dx.doi.org/10.38134/klgr.2020.22.1.021 |journal=National Association of Korean Local Government Studies |volume=22 |issue=1 |pages=21–49 |doi=10.38134/klgr.2020.22.1.021 |s2cid=225870603 |issn=1598-0960|url-access=subscription }}</ref> A 2017 survey of 12th graders in the United States, found misuse of OxyContin of 2.7 percent, compared to 5.5 percent at its peak in 2005.<ref name=NIDA2017>{{cite web |title=Vaping popular among teens; opioid misuse at historic lows |url=https://www.drugabuse.gov/news-events/news-releases/2017/12/vaping-popular-among-teens-opioid-misuse-historic-lows |website=National Institute on Drug Abuse |access-date=10 April 2019 |language=en |date=14 December 2017 |archive-date=29 May 2020 |archive-url=https://web.archive.org/web/20200529174445/https://www.drugabuse.gov/news-events/news-releases/2017/12/vaping-popular-among-teens-opioid-misuse-historic-lows |url-status=dead }}</ref> Misuse of the combination [[hydrocodone/paracetamol]] was at its lowest since a peak of 10.5 percent in 2003.<ref name=NIDA2017/> This decrease may be related to public health initiatives and decreased availability.<ref name=NIDA2017/>

Avenues of obtaining prescription drugs for misuse are varied: sharing between family and friends, illegally buying medications at school or work, and often "[[doctor shopping]]" to find multiple physicians to prescribe the same medication, without the knowledge of other prescribers.

Increasingly, law enforcement is holding physicians responsible for prescribing controlled substances without fully establishing patient controls, such as a patient "drug contract". Concerned physicians are educating themselves on how to identify medication-seeking behavior in their patients, and are becoming familiar with "red flags" that would alert them to potential prescription drug abuse.<ref>{{Cite web |last=Westgate |first=Aubrey |date=22 May 2012 |title=Combating Prescription Drug Abuse in Your Practice |url=http://www.physicianspractice.com/difficult-patients/content/article/1462168/2074772 |url-status=dead |archive-url=https://web.archive.org/web/20120618014634/http://www.physicianspractice.com/difficult-patients/content/article/1462168/2074772 |archive-date=18 June 2012 |website=Physicians Practice}}</ref>