Archive for January, 2013

An eye for an eye

Wednesday, January 30th, 2013

There have been some big stories in the news over the last week which raise some fairly weighty moral questions. There is the grandmother who has been sentenced to death by firing squad in Bali, a series of deaths related to dodgy ‘ecstacy’ use, and a bereft father who killed his son’s friend who he believed was responsible for his son’s ecstacy overdose death.

Whilst the reporting of these stories is, largely, one-sided and either takes the line that the subjects were pitiful victims or deserving criminals, it’s not hard to see how these stories sell newspapers, as they make a controversial statement which the reader either agrees of disagrees with. But if we cast our minds back to last week’s blog, ‘Drugs are bad, kids’, it’s maybe worth considering that this value-load is unhelpful in getting to the core issues.

What anyone promoting the decriminalisation of drugs must accept is – regardless of legal status, drug use will take its casualties. Yes, the recent blight of PMA in tablets believed to be ecstacy, which has killed a number of people in Lancashire and Derbyshire, was avoidable, and probably wouldn’t have occurred had the Trading Standards legislation recommended by the peers’ review been in place. Under these suggested changes to the law, the ‘ecstacy’, had it been bought through a trusted supplier and not on the black market, would have been labelled as PMA, with the relevant health warnings and expected effects, and, in all likelihood, would never have been ingested or even purchased by the now dead users, as it was not the drug they wanted to take or had experience of using relatively safely.

The Lindsay Sandiford case again exists as a byproduct of the international ‘War On Drugs’ and goes something like this – drugs kill people, drugs are only here because people bring them, so the solution is to… kill… people… No it doesn’t make sense to me either. I mean, I understand why they want to make an example of her, but they could probably achieve the same minimisation of risk she personally poses by sending her home and taking her passport off her.

And then there’s the newest development: a charity is advising her to sue the Foreign Office for not supporting her on appealing against the sentence – a decision which, although she has clearly made an informed choice with obvious consequences, does seem a bit harsh given that we are, I think, still harbouring Abu Qatada. I would think the money spent on the legal case attempting to extradite him would have been better used by the British Government supporting her appeal and attempting to get this admittedly stupid, but probably not evil, woman back to the UK. Again, it seems that replacing morality with logic would make more sense (although I acknowledge my own moral belief in this argument that killing someone is just plain wrong, and do find it difficult to separate morality from reason – hence using words like ‘evil’ – spot the *ahem* deliberate mistake). Also, I’m not quite sure what she’s planning on doing with the money if she wins her case…

However, possibly the most morally-complex case, and the one which no amount of changes to the war on drugs would have made the blindest bit of difference to, is that of Roy Allison. Roy’s son, Roy Jr, was found dead the morning after celebrating his 28th birthday with friends. The cause of death was noted as an ecstacy overdose (I have to admit I would like to know of they came to this conclusion as he had also been taking cocaine and alcohol, but I’m sure these coroners know what they’re doing), and after several months becoming suicidal and “consumed with grief”, Roy Sr killed his son’s friend, who he believed had supplied the ecstacy, and then killed himself.

I find this story incredibly sad. It’s like a Shakespearian tragedy. Even the murdered man’s mother said “He wanted some kind of justice, he wanted a life for a life, it’s just a shame that it was my boy”.

Drug-related deaths are not going to disappear because of changes to the law. The law, or rather the Government, are going to leave themselves wide open to criticism when people, although probably in smaller numbers, continue to die from taking drugs. Families of the dead, looking for scapegoats to make sense of their grief, will blame those in power.

But let’s not worry too much. I’m more likely to get spiked with PCP and eat my own face off than I am see David Cameron change drug policy. Because, much like Lady Macbeth, he doesn’t want blood on his hands.

Drugs are bad, kids

Sunday, January 20th, 2013

I’ve just read another engaging, scary article from America about their drug policy – Reefer Madness Redux: If You Smoke It, You Will Become Addicted! Much like the Storyville documentary I recommended last week (see Wonkblog for an interview with the director), it points out the freakish hysteria that surrounds drug policy in the States – which is frightening not only because of its extremity (reminiscent of Brass Eye’s ‘cake’), but also because it exposes the origins of our own society’s beliefs about drugs and those who use them.

I have to admit, the recent blogs I have written on decriminalisation, the comments that have followed, and then the paper released a week ago by, of all people, the supposedly stuffy old folk from The House of Lords, have had quite a profound effect on me. Possibly because the primary focus of my work for so long has been heroin users, I have discounted the idea of legalising drugs as a ludicrous notion. The cycle of hard dependency is awful, debilitating, inhumane even, and to enable that process, to support it, is just not right. If you prescribe a heroin user heroin, he will always be a heroin user. Where is the motivation to stop? And hence he will always be trapped in that miserable existence, always dependent and disempowered.

And to be fair, whilst working with heroin users, I couldn’t really muster up the energy to even entertain the discussion. I didn’t read newspapers, I didn’t watch the news, I didn’t even watch documentaries which I knew would be interesting but which required some emotional investment and deep thought. My coping mechanism to manage the daily adrenaline come-down and affective exhaustion was to shut down any chance of a conversation, social or internal, with something so conclusive and sharp that there was really nowhere for the enquirer to go. And so the topic of decriminalisation remained, as with anything else contentious, packed at the back of my mind, stacked underneath more important and unattended issues such as ‘stopping smoking’ and ‘life direction’.

But recently, for the first time, and from the perspective or decriminalisation instead of legalisation, I thought about it more fully. Heroin users make up a small proportion of illicit drug users (I think there are about 160,000 heroin users in treatment at present, which is tiny percentage of the population when you think about it – I mean, in the UK 10 years ago, 500,000 people were taking ecstacy every weekend night, by way of comparison) and I realised how fixated I had become on the misery of opiate addiction.

And so, thanks to this blog, my mind has been reopened to the debate. The questions I am asking myself, and the possible conclusions that could be drawn, are honestly head-mangling. Here are my confessions…

The first thing I have realised, which may sound obvious but clearly I’m not that bright, is – drugs have been conceptualised in our society as being ‘bad’ (as in “Drugs are bad kids, m’kay” – Mr Mackey, school counsellor, South Park). Of course I appreciate that there are obvious links between drug use and crime – if you have a physical dependence on heroin, you are more prone to stealing something to avoid painful and anxiety-provoking withdrawal symptoms. However, how many ecstasy, or cannabis, users do you know that have ever stolen anything? Anyone who went clubbing during the height of ecstacy use will know that you were more likely to leave a club with a selection of random presents (eg a dog made out of drinking straws, a crown made out of flowers – people were very creative in showing their boundless pleasure to meet you) than you were to get your wallet or phone snatched. And in terms of violence, you were a hundred times more likely to get an exuberant hug from some sweaty random on the dance floor than you were a slap.

And where the American Government got the idea that cannabis smokers were likely to be violent… You’re more likely to get a fight out of road kill.

Now I have always known that the Americans made most of this scare-mongering up to maintain control – my understanding was that, in the case of cannabis, it was to ensure the ongoing success of the cotton trade on which the American economy depended, to safeguard against the main market rival, hemp. The documentary I keep banging on about, The House I Live In, states it was used as a method of controlling and criminalising the Mexican population. The article I mentioned at the top of this page points out that as these theories have become unsustainable, the fear-badgers are claiming that 1 an every 6 adolescents who try cannabis will become addicted, develop mental health problems and need treatment.

The jump for me is to see the bare truth of this process – making drug use and drug users immoral – in our own country and with all the drugs that come somewhere on the sliding scale between cannabis and heroin. To disclose drug use outside of closed drug-using circles is social suicide – people will look you differently, watch next time you go to their house to make sure you don’t nick that fiver they’ve left on the side, and definitely not trust you with their children. Now these are moral judgements. They are not based on any evidence about you as a person, nor are they based in evidence about drug use. (Well they could be, you might be a right dodgy little scally for all I know, I’ve got no idea.)

But the shocking realisation for me is that I have, to some degree, internalised this moral code and perpetuated it. Despite my education, despite the years spent surrounded by drug users, and despite even my own substance use, it is only now that I realise that I accepted, at some subconscious level, that drug use was bad. People who took them were either to be pitied for needing them, or deserved what they got because they were choosing to break the law. And breaking the law must be immoral, because why else would these rules be made if not to protect us? God, it is scary acknowledging one’s own indoctrination. And yes, possibly my substance use served to prove what I had always known – that I was frankly a pathetic and despicable human being (Catholic-style guilt, must beat oneself with a stick).

Yet despite this, I still worked with people, to some degree, by categorising them in one of these two genii – to be pitied or getting what they deserved. To some extent, I understand that a) this was a survival technique, one can’t manage a horrendous caseload AND be philosophical, and b) there is some truth in these sub-groups – people do make choices, both as a result of their past experiences and their present, informed options. But what if I dumped the value-load? What if drug users were just people who chose to put substances in their bodies, not bad or sad?

Were this standpoint adopted, it would have an impact on the drug treatment system. For a start, a significant group currently receiving drug treatment would not want it. Without the label of illegality, those just trying to avoid prison would almost certainly lose their motivation to engage with services. This could be a positive and a negative thing – but it would free up resources for people who wanted to make changes to their lifestyles (instead of the pointless, endless investment in people who have no interest in reducing their drug use or making it safer, as per current service provision), and would certainly make drugs workers’ jobs less depressing.

However, it would open drug treatment to a much wider group – those who don’t want negative repercussions, such as having their drug use recorded on their medical records, which could cause problems with insurance or employment in the future, or those with children who fear judgement by the authorities and worry that by speaking about their problems with substances they may lose the right to parent. These people, surely, deserve access to advice and support as much as any other – and think about how the country would run if the next generation weren’t burdened with the hidden harm of substance misuse.

The epiphany for me is – it is not just our legislation that needs to change in this country, although of course this is a major part of social change (look at what the smoking ban has achieved). It is our conceptualisation of drug use, a paradigm shift from the domain of morality to that of health and economics. Again, look at the changes to social perceptions of smoking since the introduction the ban in public places, which has been, in some ways, the reverse process – smoking is bad now, and people who do it are wrong for polluting other people’s air. But that was for a substance at the other end of the scale, that was too sociably acceptable, to the point that it was difficult to enjoy a meal in a restaurant, going out in the evening came with a guarantee of waking up smelling like an ashtray, and those in the pub trade were becoming ill and even dying because of other people’s substance use. What I am starting to realise is that drugs that have been, for many years, unacceptable even in one’s own home with no negative impact on anyone but possibly oneself, need to be ‘less bad’, or even not bad at all, for there to be any honest discourse about the real problems they cause people. Imagine a smoker refusing to present for lung cancer treatment because they thought they would have their kids taken off them.

There is really no difference, morally, between the smoker with lung cancer and the amphetamine user with psychosis. Or between the businessman who drinks every day and has a heart attack, and the heroin user with a deep vein thrombosis. All make choices to use a substance that puts them in need of a health intervention. Without that health intervention taking place as early as possible, the cost of the intervention itself will increase as the problem becomes more complicated and effects other areas of the individual’s health. The person’s level of productivity and function will decrease. This all costs the taxpayer. So, like it or not, moral judgements can be expensive.

Sweet jesus, first I acknowledge my secret affiliations with the Iron Bitch, now I’m putting my hand up to judging drug users. I’m doing a pretty good job of discrediting myself and my life’s work. Well done me.

Summary of new drug policy recommendations

Tuesday, January 15th, 2013

So I have now ploughed through the full document, ‘Towards a Safer Drug Policy: Challenges and Opportunities arising from ‘legal highs” and thought it might be useful to provide my non-executive summary. I’m not attempting a full review – I’m just picking out a few bits that might be interesting. Please feel free to circulate if useful.

– A new psychoactive substance arrived on the market on average every 6 days in 2012, with a new marketplace – Internet and social media.

– Drug laws were developed from moral disapproval, when little evidence existed.

– The Misuse of Drugs Act intended to classify substances according to risk – however politicians have not responded to evidence by down-grading safer drugs, and there is now a lack of correlation between drug harm and classification.

– Young people often don’t care about risk, the focus should be on information and support.

– “Drug use in the UK is described as common if not normal activity”, with 16-19 year olds the most common group, and twice the percentage of young people in the UK using ‘legal highs’ than the European average.

– Banning one substance can make matters worse as it may be replaced by something more dangerous and about which even less is known. It does not decrease use.

– Drugs being sold under the same name may have widely varying contents.

– A need for Trading Standards, health and safety legislation, and a national testing centre, encouraging suppliers to focus on product safety and protecting vulnerable consumers.

– Countries which have introduced decriminalisation have not seem an increase in drug use but have seen positive results in terms of employment, housing, family relationships and costs to the taxpayer.

– New Zealand model: onus is on supplier, not state, to evidence low risk of harm, and harm of regulations should be not greater than harm of the substance being regulated.

– Decriminalisation in Portugal has reduced number of young people addicted to drugs and reduced drug-related deaths.

– New drugs are substitutes for old, possibly less dangerous drugs, so it makes sense to also decriminalise these.

– USA trials have shown that preventive interventions should be interactive, involve parents and their parenting, and be community-based (nothing too ground-breaking there).

– Information on drug properties and prevalence needs to be pooled and made available to public service workers.

– Police seizing white powders currently do not know whether they are removing legal substances and arresting law-abiding citizens until a drawn-out and costly forensic analysis has taken place.

– Introduction of Club Drug Clinics.

– Drug taxation is being considered.

For those bothered enough to read the whole thing, I finally found the full doc at

Possibly also of interest is a documentary that was on BBC4 last night about America’s ‘war on drugs’, which was excellent, and although at times went a bit too far down the pro-drugs road for my liking (trying to imply that crack and methamphet are falsely associated with violence???), it was an intense and honest review of the use of drugs legislation as a method of social control. One scary figure was that 13% of drug use in the US was by black Americans – exactly proportional to the 13% of the overall population they represented – but that 90% of those incarcerated on drug offences were black. Scary stuff. It was a broad-reaching documentary though, looking at how the political and media hysteria around drugs has got to where it is today, watch it.

Cheer the Peers!

Monday, January 14th, 2013

So, today’s news tells us that a cross-party group of peers has advised that certain drugs be decriminalised and even sold by the Government. Not that David Cameron will listen, of course. But even so, the report has come as a pleasant surprise. I admit I am pretty jaded when it comes to politics, but this report seems to be me to be research-led instead of media-hysteria-led, and has some pretty good points to make. The idea of avoiding unknown adulterants and even involving Trading Standards by having similar labelling to food and alcohol, and the opportunity of providing harm reduction information at point of sale, all seem like jolly good ideas to me. However, this would presumably still not allow for these products to be taxed, which raises the question of whether the recommendations go far enough.

As regular readers will have realised, my position on this issue has changed since the influx of ‘legal highs’. Whereas peer information about the old faithfuls (heroin, cocaine, cannabis – all of which have been used for thousands of years and about which we have plenty of information) is generally good amongst user groups, almost nothing is known about the new generation of drugs. This makes using these substances dangerous, and means that we as workers have no information about how to make it less so. An obvious example discussed on an earlier blog is MCat (mephedrone) and its sister drugs. It’s rapid introduction into the UK and the panic that followed inverted the relationship between drug users and the public services meant to be protecting them – they had no idea what they were taking, we had no idea how to respond, and the relationship had to be turned on its head as we asked users for information because we had nothing. If health services genuinely want to reduce the harm people choose to cause themselves, the gap between substance users and the authorities needs to be reduced and an honest discourse needs to begin, and the only way to do so is to reduce the risk of criminalisation for those that have first-hand experiences that are vital for gaining much-needed harm reduction information.

There is no doubt that the old Misuse of Drugs Act needs updating, and whilst few people want to see drug use promoted, we need to accept that times have changed – and that drugs are freely available to anyone with an Internet connection. We don’t know what these drugs are or what harm they can cause, but one thing is for sure – if we keep these substances, and the people that use them, on the fringes, there is no way of predicting what this will cost our public health services. The only way to make using such substances safer and less damaging is to not just enable but encourage people speak honestly about their experiences, and to collate and distribute this information as soon as it becomes available. Maybe the reduction in costs from no longer treating the matter as a criminal offence could even help fund research as new drugs come out so that advice and information could be timely, relevant and accurate.

However I am still pleasantly surprised that a group of peers could be so objective and apparently unbiased. Maybe there’s hope for the old country yet…

Cameron does cocaine

Wednesday, January 2nd, 2013

Writing my post on decriminalisation and the thought-provoking discussions that followed, I spent some of my Merry Christmas costing up the production, import and distribution of cocaine. Festive, joyous and in Jesus’ name. I mean, who wouldn’t want a big bag of the white stuff from Marks and Sparks’ next Christmas? (‘This isn’t any old chang, this is legal, 90% pure, Columbian chang.’) Answer: anyone with anxiety issues, a family history of bipolar or schizophrenia, problems with any organs (especially heart), abuse of other substances, or more money than sense. But then again, as we concluded in the post-blog discussion, if people are going to take drugs, they may as well be paying tax on it (so at least they are contributing to their own physical health / mental health / substance misuse treatment if/when the time comes that they require it).

So come on a journey from Columbia to Milton Keynes – a journey with no knowledge-base, no real method, and some dodgier estimates than my mate’s weigh-by-sight eighths…

I chose cocaine as my subject for a few reasons:

a) It is widely-used and the most popular substance used in the UK after alcohol and cannabis.
b) It is a more controversial drug to discuss than cannabis – which, let’s face it, there isn’t really much rational argument to keep ‘criminalised’ (yes there are health problems associated, but significantly less than with many prescribed medications and massively less than alcohol, other than for a minority in high-risk groups – the high-risk groups that largely have no problem accessing the drug at present – so stop wasting your time, Police, let people grow their own to cut out the association with serious crime, and get on with chasing some proper criminals, please).
c) Cocaine is used in a wide range of ways – from the ‘treat myself’ occasional snorters to the bareback-anal-funded IV snowballers – and so the range of market considerations is broader (it’s harder to put cocaine use into a box – not literally, Marks and Spencer, don’t panic).
d) I am guessing that the coca plant needs to be grown at high altitudes and so would need to be produced elsewhere and imported; making it, I would imagine, one of the higher-cost drugs – there may be ways round this, such as breeding new strains or recreating such an atmosphere and environment, but I’m not clever enough or technical enough to be able to make any educated guesses about this.

So, in order to (in a very crude, basic and unscientific manner) assess whether there may be any financial benefit to making cocaine legal, and therefore taking charge of the market, creating tax revenue and potentially even profit to be channelled back into health interventions and treatment (or bankers’ pockets, if you’re not utopical), I am going to attempt to approximate the cost of cocaine if the Government were to start producing and selling it for themselves, to see whether legalisation would not only reduce Government spending on punishing those that use cocaine, but also make money to offset the required increase in health interventions and market management.

So, step one – production. My brief wwwdotresearch has produced some widely varying figures, but it does appear that the cost of producing cocaine has multiplied in recent years, partly due to improved policing of trafficking routes and seizures which inevitably pushes up overall prices, but primarily because the cost of ‘precursor chemicals’ has dramatically increased. This seems to be as a result of Columbian authorities increasing the control over the supply of the chemicals used in the production of cocaine, meaning that substances such as sulphuric acid, acetone and potassium permanganate are harder to come by, and so chemicals either have to be acquired by illegal means or the coca paste has to leave the country for cocaine production to take place elsewhere. It also apparently takes 74-86 gallons of oil to produce 1kg of cocaine, and so it appears that the increased cost of crude oil hasn’t just affected our food prices.

It might also be making a slight aside at this point, for all the environmental leftie types out there who stick the odd line up their noses – hundreds of thousands of tons of these precursor chemicals are dumped in the South American jungle every year as unwanted by products of cocaine production. I’m not judging you, I’m just saying. ‘A cheeky line, monkey death chime.’ ‘Fancy a snort? L’arbres sont mort.’

So, aside from the environmental damage, it looks to me from my brief scour of the net as though the cost of producing cocaine has increased from around US$100-200 per kilogram twenty years ago, to somewhere around US$1000-$1250 per kilogram today. One source prices a gram of cocaine in the UK at twenty times the price of one purchased in Columbia, but as the purity would also be massively reduced in the UK gram it is difficult to draw any price comparisons from this. So if we imagine that the UK Government bought or rented some land and produced their own coca, and we work to a nice round approximated figure of £1000 per kilogram to produce cocaine (and I apologise to any lovers of the scientific method or mathematical precision), then lets move onto the cost of exporting the drug and getting it to the UK. (Again, my theoretical method goes a bit squiffy here, as it seems that Columbia are doing their best to reduce cocaine production following pressure from USA, whilst Bolivia appear to be embracing this valuable export and so seem to be more likely potential business partners – and my costings are for Columbia as this was all that was available – but let’s not be pedantic, for this is just an exercise, I am just a drugs worker, and this is a mere blog.)

So, stage 2 – export, transportation, and import into UK. Bolivian export duty is, according to my internet reading, set a a flat fee of 10%. Transport costs look to be around £5 per kilogram using airfreight from Bolivia to UK. Then, I have failed miserably at attempting to understand and apply the British import tax system to our hypothetical situation, given that there is no current legislation around importing cocaine (funny that, eh). The amount of duty varies wildly depending on what is being imported (it looks like medical equipment is not taxed, whereas alcohol seems to be subject to anything from a couple of quid a litre to nearly £30 on anything with high alcohol content) and so it would depend how legal cocaine would be conceptualised – as a medical substance or a recreational one. It seems more likely that it would be considered a luxury item such as alcohol, but whether the Government would minimise taxes to make importing legally more appealing, or to keep their resale value down, it is impossible to second guess – and let’s face it, this bit is boring as hell.

So yes, I am being simplistic yet again, but let’s pick some numbers out of the air and imagine that when cocaine enters Britain it is taxed like cigarettes – at a rate of £209 per kg and with 20% VAT payable at the docks. If we estimate that we will cut our pure cocaine into something a bit more manageable – reducing it to, say, 50% purity before letting it loose on the streets of Britain – we can estimate its value at £100 a gram, making a kilogram worth £100,000. So if we lost 10% of its value to Bolivia’s export tax, then a fiver in airfreight, then £209 and a further 20% in import duty and VAT, our kilogram of cocaine would have so far cost us £31,214.

So far, it’s looking good – high quality cocaine on British soil costing so far less than a third of its resale value.

Stage 3, then – distribution. Here we need to factor in a cutting agent, both to water down the cocaine to something that won’t completely blow people’s minds, and to make the sale more profitable. At 50% purity, our cocaine would still be significantly stronger than the cocaine on our streets today, which is currently estimated to be between 5% and 35% pure, meaning that the Government should be able to compete with the black market due to its superior goods. So we need to factor in the cost of a cutting agent, and consider that it needs to be something which causes no harm when inhaled or injected. I’m thinking whatever is used to pad out paracetamol or ibuprofen tablets must be pretty harmless, and has to be cheap given that you can buy a pack of those for a few pence. Let’s be as unscientific as we have throughout and guesstimate an additional £2 per kg.

Then, getting it out to the people – the drug users. As suggested by Josh in his comments following my decriminalisation blog, let’s say we distribute it through current drug service provision – so this could be via GPs, needle exchanges, pharmacies, or drug workers. These services are already commissioned to provide harm reduction interventions to drug users – and all recent service developments expect more work for the same money – so I can’t see there being a huge additional cost there. The cocaine could be distributed with existing medical supplies using the NHS logistics department (admittedly with increased security measures) and sold by NHS staff. Let’s stick a tenner a kilo onto the price to account for this. If 1kg of imported cocaine becomes 2000g of sellable product, I guess we’re looking at a full time employee per kilogram each week, so we ought to add a further £400 to the cost of each kilogram.

It’s brings the final cost of our fictional kilogram of cocaine to £31,626 (a very precise figure for such an imprecise calculation, I am sure you will agree). Given that it is worth £100,000, this is a pretty profit margin by anyone’s standard – and £68,374 could provide one hell of a lot of health provision for people who are probably already sticking significantly less healthy things up their noses and into their lungs and veins as we speak. Each kilo of cocaine could fund a drugs worker and a Police officer’s wages for a year.

So I know it has not been the most exciting blog I have ever written, and it’s economic and scientific validity is roughly equivalent to the personality of Cheryl Cole, but even so I think it goes some way to support the argument for the legalisation of drugs. And I didn’t even know that was what I was going to do. Funny how things turn out, eh. And if anyone who does actually have some business knowledge wants to take these figures and apply them properly (is export tax 10% of the sellable value, for example, or of the production value? I haven’t a clue), I’d love you to post your findings here.

Some references below, and remember, kids – cocaine leaves you feeling like a crisp packet that’s been shrivelled in the oven and then shat on.

Click to access WDR_2012_web_small.pdf

Click to access Colombia_Coca_cultivation_survey_2011.pdf

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