Category Archives: Relationships

Teens in South Africa Smoke Anti-Retroviral Drug for Cheap High

No Turning Back’: Teens Abuse HIV Drugs

A drug intended to treat HIV and AIDS is sweeping the townships of KwaZulu-Natal, South Africa. It is cheap and powerfully addictive.

South Africa has one of the highest HIV infection rates in the world and KwaZulu-Natal province has the highest rate in South Africa — 40 percent. For the infected, anti-retroviral drugs, or ARVs, are the only things standing between life and a painful death.

The drug is so cheap and plentiful, thanks in part to a well-meaning effort by the American government to distribute ARV’, a program that has helped extend the lives of more than 500,000 AIDS patients.
But as the medical director of one U.S.-funded clinic said, ARV abuse is threatening to turn an HIV success story into a health crisis.

“It’s extremely frustrating,” said Dr. Njabulo Masabo, from the AIDS Healthcare Foundation. “It’s extremely, you know, discouraging because on one end you’re trying to fight this epidemic that has ravaged the world so much … the results are catastrophic.”

How ARV abuse began is uncertain. Taken as prescribed, Efavirenz can cause vivid dreams. Someone — possibly an HIV patient experimenting — discovered that smoking the drug greatly enhances those hallucinations.
Today, some of the illegal drugs come from HIV patients selling their own lifesaving medication for profit. Others are stolen from patients or pharmacies.

Pharmacies in the townships have banklike security. The drugs are kept behind vault doors, because they have an enormous black market value. Just one container of the ARVs is worth $60, and a whole shelf is worth $3,000.
Driving through the townships, a local AIDS health worker named Zola Shezi showed us the extent of the black market in ARVs. She saw drug dens everywhere; one she identified had children playing right outside.
“Just here, the man he owns the house, he built all these rooms … one, there’s one room where his customers stay and crush and do things.”

The few police we saw did nothing.

In just three years, ARVs have grown from a niche drug abused by a small number of HIV patients into a widespread addiction, increasingly among young people.

Many ARV abusers are young students, and in a neighborhood like the one we visited you’ll find dealers on almost every street, selling to students during school hours and just after.

In his house that doubles as a drug den, we met one of the dealers face-to-face. Dinda — he gave us a false name to hide his identity — said he earns many times what he could make, if he could find a job.

He acknowledged that the drugs are meant for people with HIV, but said “nobody can give me that money while I’m sitting at home; I have to go and do something for money.”

Recounting a story that’s not unusual in the area, he said he’s the only one of eight siblings still alive. His siblings were all victims of HIV or gang violence, leaving him to take care of a large, extended family.

“I’m unemployed, four of these years I am not working, if I can stop this we can all suffer,” he said. “So they shouldn’t blame me for what I’m trying to make a living out of.”

HIV Could Build Resistance to Medication

For families of abusers, it’s a very different story. ARVs are powerful enough to turn even young people into violent addicts. We met Dudu, who told us her 21-year-old son steals from her to pay for his habit.

“Sometimes if I said I’m going to call the police he said he going to kill me,” she said. “I believe him.”

Now, South Africa may soon face a deadly consequence of ARV addiction. By smoking the drug, abusers are in effect giving HIV a small taste of anti-retroviral medication — not enough to kill the virus, but enough for it to potentially develop resistance to the drug.

It’s like “educating the HIV,” said Masabo. “And so you’ll find that we have a second epidemic emerging, an epidemic that we cannot control with the current drug that we have.”

Back in the drug den, the teenage addict Joshua told us what happens to HIV patients isn’t his problem.
“I feel guilty sometimes, but hey. I know what I’m doing is wrong, but what I’ve started I must carry on.”
The cemeteries of South Africa are already crowded with victims of HIV. Now, a new danger is threatening to put the country’s best defense up in smoke.

Read JIM SCIUTTO’s story here:


Understanding Addiction

“Oops: How Casual Drug Use Leads to Addiction”

By Alan I. Leshner, Ph.D., Director, National Institute of Drug Abuse, National Institutes of Health

It is an all-too-common scenario: A person experiments with an addictive drug like cocaine. Perhaps he intends to try it just once, for “the experience” of it. It turns out, though, that he enjoys the drug’s euphoric effect so much that in ensuing weeks and months he uses it again — and again. But in due time, he decides he really should quit. He knows that despite the incomparable short-term high he gets from using cocaine, the long-term consequences of its use are perilous. So he vows to stop using it.

His brain, however, has a different agenda. It now demands cocaine. While his rational mind knows full well that he shouldn’t use it again, his brain overrides such warnings. Unbeknown to him, repeated use of cocaine has brought about dramatic changes in both the structure and function of his brain. In fact, if he’d known the danger signs for which to be on the lookout, he would have realized that the euphoric effect derived from cocaine use is itself a sure sign that the drug is inducing a change in the brain — just as he would have known that as time passes, and the drug is used with increasing regularity, this change becomes more pronounced, and indelible, until finally his brain has become addicted to the drug.

And so, despite his heartfelt vow never again to use cocaine, he continues using it. Again and again.

His drug use is now beyond his control. It is compulsive. He is addicted.

While this turn of events is a shock to the drug user, it is no surprise at all to researchers who study the effects of addictive drugs. To them, it is a predictable outcome.

To be sure, no one ever starts out using drugs intending to become a drug addict. All drug users are just trying it, once or a few times. Every drug user starts out as an occasional user, and that initial use is a voluntary and controllable decision. But as time passes and drug use continues, a person goes from being a voluntary to a compulsive drug user. This change occurs because over time, use of addictive drugs changes the brain — at times in big dramatic toxic ways, at others in more subtle ways, but always in destructive ways that can result in compulsive and even uncontrollable drug use.

The fact is, drug addiction is a brain disease. While every type of drug of abuse has its own individual “trigger” for affecting or transforming the brain, many of the results of the transformation are strikingly similar regardless of the addictive drug that is used — and of course in each instance the result is compulsive use. The brain changes range from fundamental and long-lasting changes in the biochemical makeup of the brain, to mood changes, to changes in memory processes and motor skills. And these changes have a tremendous impact on all aspects of a person’s behavior. In fact, in addiction the drug becomes the single most powerful motivator in the life of the drug user. He will do virtually anything for the drug.

This unexpected consequence of drug use is what I have come to call the oops phenomenon. Why oops? Because the harmful outcome is in no way intentional. Just as no one starts out to have lung cancer when they smoke, or no one starts out to have clogged arteries when they eat fried foods which in turn usually cause heart attacks, no one starts out to become a drug addict when they use drugs. But in each case, though no one meant to behave in a way that would lead to tragic health consequences, that is what happened just the same, because of the inexorable, and undetected, destructive biochemical processes at work.

While we haven’t yet pinpointed precisely all the triggers for the changes in the brain’s structure and function that culminate in the “oops” phenomenon, a vast body of hard evidence shows that it is virtually inevitable that prolonged drug use will lead to addiction. From this we can soundly conclude that drug addiction is indeed a brain disease.

I realize that this flies in the face of the notion that drug addiction boils down to a serious character flaw — that those addicted to drugs are just too weak-willed to quit drug use on their own. But the moral weakness notion itself flies in the face of all scientific evidence, and so it should be discarded.

t should be stressed, however, that to assert that drug addiction is a brain disease is by no means the same thing as saying that those addicted to drugs are not accountable for their actions, or that they are just unwitting, hapless victims of the harmful effects that use of addictive drugs has on their brains, and in every facet of their lives.

Just as their behavior at the outset was pivotal in putting them on a collision course with compulsive drug use, their behavior after becoming addicted is just as critical if they are to be effectively treated and to recover.

At minimum, they have to adhere to their drug treatment regimen. But this can pose an enormous challenge. The changes in their brain that turned them into compulsive users make it a daunting enough task to control their actions and complete treatment. Making it even more difficult is the fact that their craving becomes more heightened and irresistible whenever they are exposed to any situation that triggers a memory of the euphoric experience of drug use. Little wonder, then, that most compulsive drug users can’t quit on their own, even if they want to (for instance, at most only 7 percent of those who try in any one year to quit smoking cigarettes on their own actually succeed). This is why it is essential that they enter a drug treatment program, even if they don’t want to at the outset.

Clearly, a host of biological and behavioral factors conspires to trigger the oops phenomenon in drug addiction. So the widely held sentiment that drug addiction has to be explained from either the standpoint of biology or the standpoint of behavior, and never the twain shall meet, is terribly flawed. Biological and behavioral explanations of drug abuse must be given equal weight and integrated with each other if we are to gain an in-depth understanding of the root causes of drug addiction and then develop more effective treatments. Modern science has shown us that we reduce one explanation to the other — the behavioral to the biological, or vice versa – at our own peril. We have to recognize that brain disease stemming from drug use cannot and should not be artificially isolated from its behavioral components, as well as its larger social components. They all are critical pieces of the puzzle that interact with and impact on one another at every turn.

A wealth of scientific evidence, by the way, makes it clear that rarely if ever are any forms of brain disease only biological in nature. To the contrary, such brain diseases as stroke, Alzheimer’s, Parkinson’s, schizophrenia, and clinical depression all have their behavioral and social dimensions. What is unique about the type of brain disease that results from drug abuse is that it starts out as voluntary behavior. But once continued use of an addictive drug brings about structural and functional changes in the brain that cause compulsive use, the disease-ravaged brain of a drug user closely resembles that of people with other kinds of brain diseases.

It’s also important to bear in mind that we now see addiction as a chronic, virtually life-long illness for many people. And relapse is a common phenomenon in all forms of chronic illness — from asthma and diabetes, to hypertension and addiction. The goals of successive treatments, as with other chronic illnesses, are to manage the illness and increase the intervals between relapses, until there are no more.

An increasing body of scientific evidence makes the compelling case that the most effective treatment programs for overcoming drug addiction incorporate an array of approaches — from medications, to behavior therapies, to social services and rehabilitation. The National Institute on Drug Abuse recently published Principles of Effective Drug Addiction Treatment, which features many of the most promising drug treatment programs to date. As this booklet explains, the programs with the most successful track records treat the whole individual. Their treatment strategies place just as much emphasis on the unique social and behavioral aspects of drug addiction treatment and recovery as on the biological aspects. By doing so, they better enable those who have abused drugs to surmount the unexpected consequences of drug use and once again lead fruitful lives.