Press release

More Ontario teens drinking, smoking and using hallucinogens

p. 451  Recent findings from the Ontario Student Drug Use Survey — Edward M. Adlaf, PhD; Frank J. Ivis, BA [abstract / résumé]

p. 485  A time for everything: changing attitudes and approaches to reducing substance abuse — John S. Millar, MD [full text]

More Ontario teens are smoking, drinking alcohol and using hallucinogens, 1995 and 1997 surveys funded by the Addiction Research Foundation of Ontario indicate. On the positive side, the ongoing surveys also indicate that the use of 8 other street drugs has stabilized after escalating sharply earlier this decade, but researchers say this is no excuse for complacency.

Between 1993 and 1995, teens' use of cannabis, glue, heroin, methamphetamines, hallucinogens, cocaine, crack cocaine, PCP (phencyclidine) and MDMA (methylenedioxymethamphetamine, commonly known as "ecstasy") increased. But a follow-up survey in 1997 of 3990 intermediate and high school students in 168 schools showed that only the use of hallucinogens, such as mescaline and psilocybin, had increased significantly. There were, however, minor increases in the use of MDMA and hallucinogens. In addition, the prevalence of smoking has increased from 21.7% in 1991 to more than 27% in 1995 and 1997, and the use of alcohol rose slightly to 59.6%.

Dr. Edward M. Adlaf and Frank J. Ivis conclude that much work needs to be done to achieve the province's goals for 2000: to reduce alcohol use among people aged 12-18 to 50%, and to reduce tobacco use to 10%.

In a related editorial, BC's provincial health officer, Dr. John Millar, calls for a fundamental change in public attitude and political will to tackle the hugely expensive problem of substance abuse. The indirect cost of substance abuse is estimated at $18.4 billion, while its direct costs are $6.6 billion annually. Cost to individual and societal health are impossible to estimate. Dr. Millar outlines a plan of primary prevention aimed at children and mental health patients, as well as interventions for specific substances.

p. 509  Prostate cancer: 1. The descriptive epidemiology in Canada — Isra G. Levy, MB, BCh; Neill A. Iscoe, MD; Laurence H. Klotz, MD [full text]

Prostate cancer has now surpassed lung cancer as the most frequently diagnosed cancer in Canadian men (except for nonmelanotic skin cancer, which is rarely fatal). And as Canada's population ages, its prevalence will likely increase. In recognition of this new challenge, CMAJ is publishing a series of 13 articles on prostate cancer as part of its new Clinical Basics section, the first of which appears in this issue.

Isra G. Levy and colleagues examine the epidemiology of prostate cancer, noting that 1 in 8 Canadian men will be diagnosed with the disease during their lifetime. This has increased from 1 in 20 in the early 1970s. The authors also examine the emotional, physical and financial impact of diagnosis and treatment. According to 1 survey, these include an incontinence rate of 25%, and erectile failure in 20% to 90% of patients who undergo surgery.

p. 481  Secrecy and the Health Protection Branch — Joel Lexchin, MD [full text]

Information about drugs undergoing regulatory approval is shrouded in secrecy, writes Dr. Joel Lexchin. The Health Protection Branch does not yet publicize which drugs are under review, has no public, external advisory committees to discuss these drugs and provides limited information following the review. This deprives both health care professionals and consumers of essential information.

Dr. Lexchin also found it's difficult to obtain studies used in the approval process. He has already waited 21 months for the studies used to approve certain pediatric antidiarrheal agents. He writes that this lack of access to information can create hazards.

In the US, requests for studies about a new drug are honoured within 10 working days, a summary for the basis of approval is also released, and the review of many drugs is referred to an expert advisory committee before a final decision. These committees are open to the public.

Dr. Lexchin points out that due to government cutbacks the Canadian directorate in charge of regulating drugs and devices now receives about 70% of its financing from fees paid by pharmaceutical and other companies. To assure public safety and demonstrate that there is no conflict of interest, he argues for rapid and open access to more information.

p. 493  Funding Canada's health care system: a tax-based alternative to privatization — Michael Gordon, MD; Jack Mintz, PhD; Duanjie Chen, PhD. [full text]

p. 497  Still here, still flawed, still wrong: the case against the case for taxing the sick — Steven Lewis, MA [full text]

In CMAJ's new section called Controversy, Dr. Michael Gordon and colleagues open the debate with a call for a tax-based alternative to the privatization of medicare. They argue that the costs of using the health care system should be attributed to patients, who should be required to declare health care services as a taxable benefit.

Steven Lewis responds with a defense of medicare and attempts to demolish the tax argument. Brief rebuttals then follow.