Archive for the ‘Drugs policy’ Tag

Alcohol – it’s not a drug, it’s a drink

Wednesday, September 25th, 2013

I have had somewhat of an epiphany recently. In light of my self-questioning around the application of morality to the laws of the land – specifically with reference to drug use – I have started to perceive alcohol differently. Anyone who knows me knows that I am a drinker. I always have been, and so has everyone around me. This is despite losing people to alcohol. And yet we all still drink drink drink like it was going out of fashion.

I still told my clients the dangers of drinking, indeed I knew them myself, and to be fair in recent years I have generally drunk within ‘safe’ limits. But that is far as I ever thought about going – after all, it was safe, so why would I question it any further?

Recently, I have pretty much stopped drinking – because after a spell of drinking very little, I realised that, when I do drink, I feel anxious the next day. Not only on the night itself, but the day after, I misjudge things, and my perception of the world and of myself is altered. This has nothing to do with ‘safety’ – but it definitely has a lot to do with health. If, as I am starting to wonder, alcohol can significantly affect mood the day after use – and bearing in mind that many people drink every night – does this not have huge implications for the mental state of the nation?

Then I saw a news report last week about the proposed ‘drunk tanks’. The idea was that people who were incapable of being responsible for their own welfare because of excessive alcohol consumption would be put into a unit overnight and then charged for the care they received – both to protect people and to reclaim some of the money in revenue spent on policing costs. It seemed like quite a good idea for me. But the man representing the alcohol industry gave me an insight into how much they care about the damage done by alcohol consumption and what they want to do to tackle it – which was, in summary, fuck all. The well-groomed young man in expensive glasses had a seemingly endless list about why no national mandates should be passed – why this was about local services making local decisions. Which, as anyone who works in the public sector knows, means doing nothing. Because everyone is too busy, are all praying to keep their heads above water and their jobs, and are not about to stump up the cash and time to commission and implement something so huge without imperative direction from the very top.

And as I sat there, watching this nicely-spoken young gent, something happened. Before my eyes, he morphed into every heroin and crack dealer I had ever met. His shirt was ironed, his face was clean – but his justifications for the continued sale of his product, his reasonings for why the deaths and the violence and the illnesses were not his fault, made him seem to me no different from the many dealers I have challenged about their choice of product and its impacts. The truth was – he didn’t give a shit about the number of young women getting sexually assaulted. He wasn’t the least bit interested in how much use of his product cost the taxpayer each weekend in policing and health interventions. And he certainly wasn’t willing to do anything about it.

Now, fear not – I am not about to go all evangelical about alcohol use and start praying to a higher power for strength to repel the demon drink. I am still going to have a drink when I feel like it and, likely as not, will drink too much on occasions. I suppose I am just realising, for myself, another layer to my indoctrination on the matter of legal and illegal drugs. Alcohol is not ‘bad’ – just like any other drug – and of course alcohol companies are only interested in taking your money, as per the capitalist mantra, or just like any other drug dealer. But where is the logic that most drugs should be illegal while just one remains legal – and what impact does this have on perceived safety and social acceptability?

My brother recently came back to the UK, and commented after a night out, “God, I’d forgotten how the English drink”. Recent reports indicate that, in fact, much like the truth-dodging representative for the licensing industry, we as a nation also forget how we drink. A report published by Alcohol Concern found that, in 2007-8, for Brits to drink within advised limits, alcohol consumption (excluding that brought into the country duty-free and home-brewed) would need to reduce by a third. The report found that if the alcohol bought in shops was divided between every adult, we would all be consuming twenty-six units a week.

However, an even scarier report published this year in the European Journal of Public Health , found that half the alcohol consumed in England was unaccounted for. (Again, this does not include imported of home-brewed alcohol, so the actual consumption is even higher.) The report exposed the discrepancy between self-reports of alcohol consumption, and alcohol sales. So at least three quarters of the population are estimated to drink above recommended limits – and no-one is admitting to it.

Now the alcohol industry clearly know this. If this wasn’t happening, they wouldn’t be eating caviar on their yachts. And yet, despite the serious health problems associated with drinking at these levels, they continue to push the drug. They continue to fight legislation to minimise the harm it causes. And they continue to put their hands up in objection when anyone suggests maybe they could be partly responsible for this problem and, as such, should maybe put their hands in their ever-deepening pockets and contribute towards reducing some of the damage done by their product. No less ruthless that the dealers who keep selling heroin they know contains congealants, or market their stash of PMA as ecstacy.

It also makes me wonder how much sway the alcohol firms have in the Tories’ drug policies. They bring in billions in revenue – and I am sure they are none-to-happy at the idea of someone muscling in on their market share by selling cannabis or other alternative products. Yet again, I am left questioning how much of our legislation is about the welfare of the population, and how much is about rich people scratching each other’s backs..

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What’s morality got to do with drugs?

Friday, September 13th, 2013

My beliefs about the criminalisation of drug use have changed over the last few months of researching and writing this blog. Although I always supported a health agenda, I spent years working alongside criminal justice agencies and, in essence, being part of the machine that maintained the War On Drugs. Drugs caused harm – that was for sure – and whilst I insisted on working for health services and within a harm reduction agenda, I still had to contribute drug tests and pre-sentence statements to criminal justice organisations on behalf of people I didn’t really think were doing anything wrong. Besides, most of the criminal justice drugs services were part of the NHS. The whole agenda was blurred – and the lines between health and justice disappeared under the weight of morality. As we all know, drugs are bad, kids.

But let’s face it – they’re not. They’re just drugs. If it’s a moral compass we’re using, some of them, such as anaesthetic, are definitely good. But this isn’t the issue I want to discuss here – I want to showcase a couple of the best resources I have found which outline the damage caused by unquestioningly taking this legal and moral standpoint on drug use.

Count The Costs has published an Alternative World Drug Report to coincide with the UN’s Global Commission On Drugs Policy (which I wrote about in The War On Drugs versus livers, and focuses on the public health implications of socially excluding drug users). Instead of relying on self-reporting by international governments, the Alternative Report collates its own data, looking at the unintended negative consequences of the War On Drugs.

It is organised into seven main areas of damage that is caused by the continuing approach taken by drugs policies across the world:

undermining development and security, fuelling conflict
threatening public health, spreading disease and death
undermining human rights
promoting stigma and discrimination
creating crime, enriching criminals
deforestation and pollution
wasting billions on drug law enforcement

For those of you who haven’t considered some of these arguments before, or if there is a particular issue that catches your attention, do have a look at this website. It really is the best, most comprehensive single resource I have seen, and isn’t so arrogant as to presume it has the answers – it merely forces the question.

A more capsule summary of the War On Drugs is available from Peter Watt of Sheffield University, whose recent piece on the upcoming legalisation of cannabis in Uruguay identifies the main motivations behind the problems in South America, the continent most damaged by the US-driven criminalisation agenda. Uruguay is an experiment worth watching – and it seems that the countries most crippled but the War On Drugs are starting to take matters into their own hands and make some interesting moves when it comes to drug policy (as previously discussed in Santos speaks out).

A specialist in the South American drug wars, Peter also identifies the value to the US economy of perpetuating the War On Drugs, by generating the private prison industry. Quoting journalist Chris Hedges, “Poor people, especially those of colour, are worth nothing to corporations and private contractors if they are on the street. In jails and prisons, however, they each can generate corporate revenues of $30,000 to $40,000 a year”.

This sentiment is shared in Eugene Jarecki’s excellent documentary, The House I Live In, which looks at the impact of the War On Drugs on the USA’s poorest, predominantly black, communities and asks who this system is benefitting. Despite drug use being proportional across racial groups in the US, almost all those incarcerated for drug offences are black – one in three young black men spend time in prison in the US.

I hope some of you will look at these links, and that, if you find them interesting, you will share them. This is not a small problem – areas of Asia, South America and Africa are being destroyed by this nonsensical battle, where poverty is exploited by organised criminals using fear and violence – and the continents providing the target markets, North America, Australasia and Europe, are also seeing their poorest and most excluded communities injured by the trade. Drug use isn’t bad – whether it is smoking crack or having a quiet pint on a Friday, we all do it to some degree, and until the moral and criminal precursors are removed from the debate, a practical, just solution will remain evasive.

Does MCat show up on a drugs test?

Tuesday, September 3rd, 2013

The main question that brings strangers to my blog is – does MCat show up on drug tests? I’m going to address this to the best of knowledge now, and if anyone has anything to add or knows any different, please leave a comment to inform others. There are some resources at the bottom for people wanting more information.

MCat, or mephedrone, is so called because of its chemical compound, 4-methylmethcathinone. It is just a happy coincidence that it smells like cat urine, hence sometimes being know as meow meow. Also known as mephedrone, it was originally marketed as plant food or bath salts so people could buy it without being detected, although it was never intended to be used as such. It seems to be able to be used as safely as other illicit drugs such as ecstacy. However, long-term effects are unknown, risks dramatically increased when used with other drugs, and I can say from my experience as a drugs worker that it can also be significantly, rapidly harmful to users’ mental health. It has also been described to me by more than one seasoned drug user as “more addictive than crack”. There have been various deaths linked to the drug.

In terms of drug testing, it IS now possible to test for mephedrone. It does, of course, depend on what you have actually taken – if you have bought it from a street dealer, it could be anything, and even substances bought via the Internet are not being monitored by Trading Standards and so might not be what you think you were buying. I have had loads of people tell me they have taken MCat, with widely-varying reports of the effects, and then test positive for amphetamine or methamphetamine, which have different chemical structures. I have even found a website which claims it can test for mephedrone using its methamphetamine testing kit (although I seriously doubt the validity of this). So be aware that, whatever you think you have taken, you could still flunk a drugs test.

In short, if you are being tested by your employer, it is possible that you could fail a drugs test after taking MCat. Basic testing windows for other stimulants (cocaine, amphetamine) are around two days in the bloodstream and five days in urine, so if you haven’t used any for a week you should be clear.

However, most standard workplace drug tests still do not test for MCat. It is, of course, possible that your employer is clued-up and has bought separate MCat testing kits, or has the samples sent off to the lab for detailed testing – and an article in the Welsh press this morning highlights that employers are becoming more aware of their staff using MCat – but the testing options are expensive, and my guess is your employer is just following their drugs and alcohol policy and covering their own backsides. Some drug services do now test for mephedrone, but some don’t.

If the test is via an oral swab (where a stick with cotton wool on is pressed against your gum or cheek for two minutes) then it is possible but unlikely to test for mephedrone, as, as far as I can gather, this test is only available via confirmation test (which costs about £30 per substance). Even if the lab did look for mephedrone, only the specific and original chemical compound would be detected. So in the case that the substance being used was some derivative of the original compound (such as any of those which flooded the market when mephedrone was made illegal to skirt legislation), then even if the sample was tested for MCat, it would still give a negative result. It is also possible to test for cathinone (khat), and given that mephedrone is a synthetic cathinone I thought this might also give a positive result for MCat, but on speaking to the lab this seems unlikely, as again the test only detects the specific chemical compound.

So if your employer or drugs worker is using oral fluid testing, it is unlikely but not impossible that you will give a positive result, unless they are willing to spend the money (for example, if they are testing as part of a court order). I’m not totally sure on testing windows for MCat, but given its short action and its similarity to amphetamine and other stimulants, I would hazard a guess that it only remains in the bloodstream (and so would be detectable through oral fluid testing) for a couple of days.

In terms of urine testing, again it is possible but not likely that employers will test for mephedrone. The mainstream-marketed dip-test strips or urine pots available for bulk-buying via the Internet do not test for MCat. Again, your employer could be on-the-ball, so there’s no way of ruling it out. Drugs will show up much longer in your urine than in your bloodstream, so if you have used MCat at the weekend it will probably still be present in your urine throughout your working week.

A good idea might be to get hold of your employer’s drugs and alcohol policy, and to look at your contract to see whether testing is mandatory. If possible, also find out what method of testing is used, and possibly even the company that provide the testing. (Oral swabs or urine pots will have the name of the company displayed on the side.) You can then look on the company’s website, or ring them, and ask whether they test for mephedrone and synthetic cathinones.

And if you interested in purchasing MCat drug tests, follow this link to my more recent post, MCat Testing.

For more information about MCat, it might be worth having a look at these resources:

– An excellent documentary called Legally High looks at new psychoactive substances, where they come from, the problems with legislating them, and the spectrum of drug use per se.

– Really interesting Wiki page about MCat, which charts its history, its researched neurochemical effects, and seems to me to under-report the negative effects and risks.

Frank’s generic drugs advice that slants to the negative, but also has links to help and support.

European Monitoring Centre For Drugs’ drug profile for synthetic cathinones, including mephedrone.

– My somewhat hopeless rant about my own experiences working with MCat users as a drugs worker – lets call it an industry insight.

Drug policy fails – again

Wednesday, July 24th, 2013

Another kick in the teeth this week for Theresa May and her determined squeal that drugs policy is working. After ignoring the research-based recommendations from a group of cross-party peers concerning decriminalisation, then developing selective deafness towards her drugs advisory board by banning khat, Theresa seems fixated on perpetuating the War On Drugs, whether anyone agrees with her or not.

It will be interesting, then, to see how she reacts to the news that cannabis psychosis admissions have actually increased since the drug was reclassified as a Class B substance. Yep, you’ve got us there, Theresa, you font of knowledge for all things street – clearly drugs policy is reducing use and minimising harm just as it should. Well done for sticking to your guns, and thank god those running the country know what they’re talking about. Phew.

Tottering Tory Totty aside, I have to admit this is a pretty bizarre finding. At no point did I think that reclassifying the drug would decrease the harm caused – why would it, it’s still illegal and that didn’t put people off before – but the inverted correlation between cannabis-related psychosis hospital admissions and reclassification of the drug is difficult to explain.

I have been pondering on this. Without subscribing to the Journal of Drug Policy (which is, I have to admit, surprisingly tempting, but takes money, of which I have little), I can’t see whether participants who suffered psychotic admissions had taken solely cannabis. My hunch is that something different may be afoot here. Rates of psychosis amongst my client-group have gone through the roof since MCat has surfaced, and I have heard similar reports from prisons regarding synthetic cannabanoids. I know that, until very recently, and certainly not within the confined dates of this longitudinal study, testing facilities for these drugs had not been developed – and even if they had, the average mental health ward would not have had access to them. So, my sneaky conclusion is that the increased rates of psychosis admission may have been due to the use of other substances – which were not only impossible to detect, but were also legal at the time and so potentially not reported or classified.

That is my suspicion. Just don’t tell Theresa. I can’t wait to see what shit she spins to explain away this one. Although, to be fair, I think she’s more likely to get a bad case of tinnitus than indulge in any scientific analysis. You keep on trucking girl, we’re all behind you (with a metaphorical spade).

Santos speaks out

Wednesday, June 5th, 2013

While we are all whining on about the impact of drugs on our communities, and the effects on individuals, South America and Mexico continue to deal with the shocking human cost of producing and distributing cocaine, methamphetamine, cannabis and other drugs. Much like the opium situation in Afghanistan, cocaine and cannabis are cash-crops – but unlike Afghanistan, it’s not just the fluffy types at the UN wanting the curb the trade. Pressure on South American and Mexican governments from the USA to stop the export of cocaine and other drugs has meant tough penalties for those manufacturing and trafficking, because failure to adhere to these US-enforced policies means risking international relations with their closest, richest neighbours and vital trade partners. This has caused a full-on war between the authorities and organised criminals, leading to death rates that surpass most genocides. In Mexico alone, between 2006 and 2011, it is thought that around 60,000 were killed or ‘disappeared’, many of whom remain unidentified after being found in mass ‘narco-graves‘.

In an unusual (and strangely under-reported) move, Columbian president Juan Manuel Santos has this week published an article in The Guardian’s ‘Comment Is Free’, outlining the main points of a report produced by the Organisation of American States (OAS) in partnership with Oxford University. The report suggests ways in which the issue could be tackled, not from a moral perspective (ie what should happen) but from a pragmatic standpoint (what could happen). Santos states that this new set of approaches broadens the debate past the polarised ‘warriors’ and ‘legalisers’ arguments – after all, this is not Star Wars, there is no good versus evil, and neither extreme offers valid ideas to vastly improve the lives of ordinary people.

The scenarios proposed in the report, which has been released as the OAS leaders meet this week in Guatemala, involve providing better health, education and employment opportunities to offer real economic alternatives to those embroiled in drug production and trafficking and their communities; strengthening public institutions to improve the welfare of citizens; better (and, I would imagine, less hierarchical) co-operation with international partners; and redirecting budgets currently spent on international priorities (law enforcement in an attempt to stop the drugs being produced and exported) to local priorities. Clearly some of these approaches will require international support to be implemented – as long as the US and the rest of us keep pushing for the problems to be contained, the internal wars and consequential deaths will continue.

However, the headline-grabbing proposal made in the report is to look at alternatives to criminalisation, starting with the legalisation of cannabis. It seems to me that the OAS have seen an opportunity to use the current cannabis debate in the US, which has resulted in Colorado and Washington legalising the drug, cleverly to their advantage. The report suggests South America and Mexico follow suit, and so appears to be jumping on the US bandwagon. After all, it would be highly hypocritical for the US to claim that the rights they offer their citizens were not applicable to the citizens of their neighbouring countries. But it also uses the US model to politely point out that the problems the War On Drugs causes the USA might cause one or two little problems in their countries too – and they don’t just have over-run prisons and drug treatment centres, they have pits of nameless dead.

Luckily, President Santos does seem to be getting some parallel support from this side off the pond. A letter from a group of MPs and celebrities to our Government was published in The Times this week, signed not only by candyfloss-haired minted powerhouse Richard Branson, marathon-shagging squealer Sting, and you-get-loads-of-sex-how? lanky slime-ball Russell Brand, but also politicians from the Conservatives, Labour, and the Liberal Democrats. The movement is being led by Caroline Lucas of the Green Party, whose personal stake in the matter may be the destruction of vast areas of rainforest as chemical byproducts of drug production are illegally dumped. The letter questions the validity of the War On Drugs and asks how the Government can justify their £3b a year spending on their current approach, suggesting that possibly an evidenced approach might be a better use of public money. (You know, try to see if something works before you spend our hard-earned cash implementing it. Just a thought.)

Whilst the letter does not make direct reference to the situation in America, it is yet another high-profile attack on existing drug policy – and only adds to the ever-increasing international momentum for things to change. It seems to me that we are on the cusp of the greatest social paradigm shift since the abolition of slavery. But then I am a bit of a drama queen.

The War on Drugs versus livers

Thursday, May 30th, 2013

Kofi Annan has been reading my blog again. Last week I again raised my concerns about the spread of Hepatitis C, and this week he and his Global Commission on Drugs Policy have concluded that current drugs policy has resulted in a Hep C pandemic. I’m impressed he managed to pull a paper together so quickly – but then he’s probably been a follower of mine for a while if his opinions on the futility on the War on Drugs are anything to go by.

He and his posse of world leaders have this week published a report stating that current drugs policy is “repressive” and “ineffective”. Claiming that, by treating drug use as a criminal justice issue instead of a health issue, governments are breaching human rights and putting their communities at unnecessary risk, their argument about the spread of Hep C is conclusive and damning.

The report claims that those countries with the harshest drug policies, including the USA, provide the biggest deterrent to accessing health services which would reduce the chance of contracting the virus. This has led the commission to conclude that “The war on drugs is a war on common sense”.

There are some positives though (and not just the Hep C type), with Scotland being hailed as a model of good practice. Having learned about blood-bourne virus (BBV) transmission the hard way with the HIV outbreak of the 80s, Scotland’s Hepatitis C Action Plan has succeeded in reducing the numbers of those infected, both by increasing preventative measures, such as hugely increasing access to clean injecting equipment to reduce new infections, and by improving access to treatment for those who already have the virus.

The biggest win, for me, is Scotland’s eight-fold increase in Hep C treatment in prisons. Working with the War on Drugs policies, rather than against them, this idea uses the revolving door of incarceration as an intervention opportunity. Whereas, in England, it’s still nigh on impossible to even get liver function tests done for someone in prison (to enable quicker prescribing of an opiate blocker to encourage no ongoing use on release – common bloody sense, but seemingly too much trouble for prison healthcare teams, whose responsibilities end the second the individual walks out of their door), Scotland are now offering full Hep C treatment in prisons.

This is refreshing – treatment services in England are notoriously out-dated and a nightmare to negotiate. I have taken clients to appointment after appointment at hospitals, only to be told that six months drug-free is not a long enough period of stability to ensure treatment success and reduce risk of reinfection (“because drug addiction is a relapsing condition” – thanks for the positivity, guys), or that reducing alcohol use from nine cans of Special Brew a day to two cans of Carling is still not enough of a reduction in consumption. There is no evidence-base to support their criteria – in fact some Hep C services go and dish out treatment on the streets to current drinkers and injectors – but the liver specialists in big hospitals do not particularly relish being forced into changing their treatment population. They’d much rather work with people with hereditary liver conditions, or even drinkers, than IV drug users, and they gate-keep their services accordingly.

Because of the potential and significant mental health impacts of the intense treatment, reported low mood is another classic reason for being deemed ‘not appropriate for treatment’. This seems to miss that point that, for someone whose existence is miserable, repetitive and cut-throat, and who may not have anywhere to live or food in their belly, low mood is kind of a must-have. So no drug or alcohol use, never feeling down, and a stable living environment – it makes you wonder who amongst us would actually qualify for Hep C treatment. (I would fail on all counts.)

But if this public health disaster isn’t bad enough, there is a hidden population who do not seek testing or treatment, because they perceive their injecting behaviour to be healthy. Steroid users are increasing in numbers, with little or no access to safer injecting information or blood-bourne virus prevention advice. I have heard many reports of one needle being passed around four or five men in a gym toilet, meaning a high risk for all of BBV infection and bacterial infection. And given that drug users generally spend their time working out and bulking up whilst in prison – and Hep C rates amongst IV drug users are estimated at 80% in the county I work in – it doesn’t bode well for the beefcakes, who may not know that the healthy-looking, fake-tanned meathead in front of them was once a pale, scrawny smackhead.

Whilst working in a busy city-centre needle exchange several years ago, one canny gym owner used to come and get boxes of needles to distribute to his customers. Most gym owners aren’t so conscientious – they will happily sell steroids to their members, but these come without injecting advice or equipment. One gym owner in the whole of one of the biggest cities in the country. That’s a whole lot of new livers required in twenty years’ time – for those whose hearts last that long.

Anyway, for the rest of you, some quick advice – don’t share toothbrushes or razors, and use a clean piece of paper or a straw each instead of sharing a grimy twenty pound note when you’re banging cocaine up your noses in pub toilets. Hep C can be transmitted by a single invisible drop of blood, and, unlike HIV, can live outside the body for up to four weeks. It’s a feisty little beast. And livers are quite handy.

Also here’s a shout-out to the big man, KA, and all his homeboys and girls. Good work on the report, guys, and let me know if you want me to join your little commission thing – and in the meantime, peace.

Cancer patients with acid smiles

Tuesday, March 19th, 2013

The New York Times reported last year that psychedelic drugs were being trialled in cancer treatment – not to encourage remission, but to help people face their own mortality. Far from being smacked up to the eyeballs to achieve this anxiety release, patients undertaking the trials experienced long-lasting benefits in terms of mood and attitude towards life – and death – from a single administration of psilocybin, the psychotropic substance found in magic mushrooms .

When taken in controlled conditions which encourage the participants to think about their lives and those they share them with, an emotional catharsis appears to take place. Subjects report being able to experience the emotions felt by their loved ones relating to their illness, and a spiritual connection to the world which enables them to see life as part of a process, therefore removing the fear of death. Effects were immediate, and scores on depression and anxiety scales were consistently lower at six-month follow-up.

Now this research is only small-scale, but if you cast your mind back, some of you will have read about David Nutt(bag)’s campaign to enable LSD and MDMA (esctacy) to be used in clinical trials to look at their efficacy in treating depression. Now I acknowledge that it’s probably the fault of the media, and it’s not that I contest what he has to say – I just find myself frustrated that I can see the world isn’t ready for his outlandish statements, so why can’t he? The man needs Alistair Campbell.

However, below the media hysteria that hangs precariously off his every word like a failed snot-rocket, are some incredibly interesting points, which not only support the research findings around treating the fear of imminent death, but have some potentially broader-reaching implications. Psilocybin, for example, has been found to reduce symptoms of depression and anxiety disorders, by shutting down parts of the brain associated with the unhelpful and repetitive thought processes on which the illnesses feed. It has also given some insight into the neuropsychology of schizophrenia. MDMA appears to enable post-traumatic stress sufferers to revisit problematic memories without experiencing overwhelming fear. It seems that the drugs associated with free love may in fact be capable of breaking introspective thought patterns and giving us back our sense of perspective. (Which, let’s face it, most of us in the western world would benefit from.)

Now I am not suggesting that wigging oneself out on pills and mushrooms everyday is a health intervention. Far from it. We all know the pie-eyed star-gazers who went a bit too far for a bit too long and, after a brief spell of drug-induced psychosis, now shuffle around talking to themselves, looking constantly surprised, devising conspiracy theories about the Government. Too much of these substances can cause long-lasting damage to the grey stuff. But who is to say that measured doses of these active ingredients couldn’t have their place in mental health treatment? Or, for that matter, addiction treatment?

Anyone who has ever had cognitive behavioural therapy, solution-focused therapy, hypnotherapy – pretty much any psychological intervention – will know that the their fundamental bases are breaking unhelpful, engrained thinking patterns. If you can help people lift their heads to see above these negative cycles, they realise that life doesn’t have to be like this. Now if a controlled dose of psilocybin can achieve this, a) the massive financial burden of treatment for depression, anxiety and addiction would be minimalised, and b) I’d be out of a job. Sounds like a plan.

In his usual ‘all right David, tone it down a bit’ way, Professor Nutt has claimed that it’s “outrageous” and “a scandal” that further studies into this have not been done, but I think he has a profound point – the only thing complicating this research taking place is the illegality of the substances involved.

Whether or not you agree with decriminalising drugs as a whole, I think there can be little argument that these substances should not be made available to medical researchers. And this is in a country where George Osborne is making beer cheaper. (How thick and easily-pleased do you actually think we plebs are, George?) I increasingly struggle to understand the arbitrary disparity between the Government’s treatment of different substances… Maybe I’m going a bit Nutts.

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.

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