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LAST YEAR ALMOST 80,000 people took part in the Global Drug Survey and helped us produce the world’s first harm reduction guide to be voted for by the experts: people who like taking drugs and want to keep themselves as safe as possible. It’s been downloaded 30,000 times so far. The guide included common sense strategies – don’t mix stimulant drugs with each other or with loads of alcohol, don’t take GHB with alcohol, don’t use drugs when you’re anxious or depressed – to reduce the risk of harm.
Uniquely, it also spoke about the impact of these strategies on the pleasure people got from drugs. But as we stated very clearly, the only way to avoid drug related harm is not to use.
This zero tolerance approach is applied oddly to a legal regulated drug: tobacco. The message governments put out about tobacco is that any level of use is associated with harm and it’s highly addictive so don’t smoke. This is good advice because the risk of addiction with tobacco is higher than for almost any other drug and even low levels of use are associated with an increased risk of lung illnesses and cancer.
The problem as I see it is that this same (but unevidenced) zero limit advice is applied to illegal drugs by governments. I guess they have no choice – they could hardly say a drug is illegal because it’s very dangerous and then say “look, actually if you don’t use too much X too often and make sure you don’t play with knives, go scuba diving or drive, then actually the risks of you running into serious harm is pretty low (not zero)”.
People ignore common sense strategies
Now while zero tolerance/‘just say no’/lifetime abstinence approaches works for a very large percentage – the majority in fact – of the population, it isn’t much use to those people who choose to take drugs. And in fact a zero tolerance approach might actually backfire and lead some existing users to ignore the difference between using a little and a lot.
In the drug treatment world there is a term called ‘abstinence violation’. It is used to describe the narrative that people dependent on drugs or alcohol use following the first episode of use after a period of not using. They say things like: “I was so committed to not using and never using again, that now that I have used once I am so angry with myself for having undone all the good work achieved during my period of not using, well sod it….I might as well continue using”.
In the same way, I think it is possible that a government’s zero tolerance approach to drugs may lead some users to ignore common sense self-regulation strategies. I also think that such intolerance to the acceptance of moderation may lose governments some credibility.
Alcohol is a drug with guidelines for us – so why not for drugs?
The question I pose then is could or should there be such a thing as safer drug using limits or guidelines? As a young doctor I asked an old boss of mine if he thought research into safer drug using limits (or guidelines) might be useful. He dismissed the suggestion (and me) as silly. Oh well. I have grown up and it seems like lots of people I meet think the idea might have some value in helping guide people towards more moderate levels of drug use. This is not radical in any way (unless you take a moral judgement over the choice of molecule a person chooses to ingest for pleasure).
In fact I think it’s rational. Here’s why. Alcohol is a drug. We have guidelines on its use aimed at reducing the long-term risk of health harms. So why not have guidelines for drugs? For alcohol and most drugs the risk of harm and dependence vary hugely between people. The risks of addiction are higher in at-risk individuals among those who start early in life, often because of other social, personal and emotional challenges. These significant challenges are best addressed by good social policy (investing in the well-being of people who won’t be voting for 18 years) by pre-birth family support and interventions focused on supporting vulnerable parents in the early years of a child’s life.
For most people the rates of addiction are relatively low (2-10%) and perhaps early signposting that use was escalating to problematic levels could avert the development of dependence in some. But for the majority of the population and in most instances, moderation of consumption can keep the risk of experiencing short and longer health harms low (drugs like GHB and heroin where the risks of overdose are so high might be exempt from such statements). And in almost all cases the risks of experiencing drug related harm can be significantly reduced by the adoption of safer using strategies (such as those reported in the harm reduction guide).
Guidelines will not fix everything
By suggesting safer drug using limits or guidelines for illicit drugs I am not suggesting that drugs are safe. Quite the contrary in fact. Drugs can be very dangerous. I spend my working day with people whose lives have been ruined by drugs. From acute toxicity and the risks of intoxication-related behaviours to longer-term physical complications and dependence, I know drugs can kill people. And I am not suggesting guidelines will be a panacea to society’s drug problems. But as social care budgets are slashed and governments are starting to embrace population-based strategies such as behavioral economics to moderate unhealthy behaviours, having some common sense guidelines that highlight that taking less drugs less often is associated with a reduced risk of harm might be a useful benchmark for people to reflect upon. And they may have value regardless of the legal status of a drug.
The challenge the Global Drug Survey has set itself this year is to try and develop the world’s first safer drug using limits. We’ll do this by asking tens of thousands of people who use drugs to rate (on a scale of 1 to 10) how the risk of harm from different drugs (including alcohol) increases with increasing levels use. Risk here refers to the probability, range and severity of harm. At the same time as asking people who use drugs around the world, we will also be asking drug science experts the same questions. So if you’ve ever used drugs or have thought about drug related harms and pleasures please share your experience and expertise at https://www.globaldrugsurvey.com any time between now and 20 December. And in June 2015 we’ll release the results. We think this is going to be fascinating.
Dr Adam Winstock is the founder of Global Drug Survey and a Consultant Psychiatrist , Addiction Medicine Specialist and researcher based in London.
Sensible drug policy based on evidence and public consultation needed. Not an outdated misuse of drugs act that only serves criminal gangs.
So Kevin how does one regulate the use of lets say Crystal Meth. Do you tell the Meth head they an only have two rocks a day?
What is a “Meth head”? I usually only comment on Cannabis but ill indulge. First off I would say that whatever our solution is going to be for Methamphetamine we must acknowledge that criminalisation only causes harms and despair. The War on Drugs has always failed and it can never be won.
I would quote Prof. David Nutt, the man hired by the UK government to advise on their drug policy.
“AMPHETAMINES/METHAMPHETAMINE
These would be sold over-the-counter in pharmacies with regulated access and a personal allowance – but only as low-dose pills. So they wouldn’t really be all that speedy, unless you took a handful of them, I guess.
Crystal meth would be banned completely. “Smoked methamphetamine is like crack, and smoking stimulants makes you very addicted, very fast,” says Nutt. “Methamphetamine is longer lasting than amphetamine, and certainly longer lasting than cocaine. Certainly injecting or smoking methamphetamine is a bad thing.”"
But it is not leaving it illegal continuing the “War on Drugs” that you claim is a failure?
Does it not defeat the whole legalize idea? The same with the opiate family of drugs. Do you tell a Junkie that requires lets say 10 hits a day, sorry but the recommend dosage is 5 hits a day. Or if you give them their 10 hits per day and when their tolerance level goes up do continually increase the dosage or do yo have a limit?
Mick, you seem to be focusing in on particular situations. The ‘cold hard facts’ are that people use all sorts of drugs for all sorts of reasons. We need to take the power away from criminals, we need to educate ourselves. Everyone can nit pick about this and that, but the blindingly obvious choice to make is ‘Legalise/regulate/educate’.
Ask your local guard how they would feel if cannabis was off their agenda, and if pills n powders were supplied by regulated company’s instead of the chain of misery they currently come through. I grew up just before Internet was widely available, I learned so many wrong things about drugs. But now we have access to information like never before.
Ask a heroin user or ‘meth head’ how they got addicted, find out the chain of events that led to their current situation. These young people that turn to a life of drug crime could be putting their skills to other productive uses if the ‘law’ wasn’t against them. I’m not suggesting for one moment that what they do today is anyway way beneficial, but the point is: how much more engaging would a community be with the Garda if the bit of weed wasn’t an issue?
Young lads and girls would grow up with a different outlook on our society if they saw us making positive pathways to escape addiction and substance abuse.
To whoever is asking how to regulate methamphetamine, take a look at Europe and the USA, it is a regulated prescription drug there under the names Pervitin and Desoxyn. Just because a drug is called crystal whatever does not make it any more or less dangerous or addictive.
The only problem with Zero Tolerance of drugs is that it does not work. It has failed in every society it has ever been tried in.
Like America with prohibition of Alcohol, its only impact on society has to funnel vast profits in to organized crime and embed them in to society.
A more balanced approach to drugs, their use etc has been shown to reduce the problems, the costs and the useage in society.
In Holland, they give addicts heroin, clean needles etc. They also have to go to treatment and rehab. They are about getting people off it, cutting the cost to society, solving a problem.
Results not faux morality.
Couldn’t agree more. A mature discussion on drugs is what is required. We just don’t have the politicians with the backbone/intelligence to have it
Read something by Peter McVerry about decriminalisation – the policy suggested actually helps people to deal with / manage their habits and addictions. Personally I think the damage done by a policy whereby Gardai stop ordinary nice young men on the streets and search them to see if they can find a joint so they can arrest them is hideous – way to go with bringing young people into the criminal justice system, with attendant serious stress on a young person from the whole process. Young people in particular transgress and we need to give them support and help.
Save the money from this wrong-headed policy and put it into better peer education on the effects of different substances – or even better on dealing with your emotions in other ways and support services for young people. Or perhaps invest in more beds for people who need help with more serious addictions – I understand there is a serious lack.
When will we understand that there are reasons why people use substances (from alcohol and prescribed tranquilizers to cannabis and other illegal drugs) – and it could be because they like them or because they don’t know how to deal with their feelings any other way… why can we not look at that instead of punishing them?
Isn’t it funny how zero tolerance drug policies and three strikes laws (both of which have actually increased crime and imprisonment rates) came in about the same time as prison privatization? Well have to drum up business some how.
I have to say when I see in local papers that a lad was in court after being stopped with – and I kid you not here – a half a joint with cannabis worth 3 Euro – his name dragged through the gutter press and fined 50 Euro or whatever, you have to ask yourself WTF are they trying to achieve. I wonder how this might have helped him.
I used to do drugs. I still do, but I used to, too..
This country should look at models that are effective in tackling drugs, false morality is not the way to go.
I attended a talk given by the head of Portugal’s Head of Drug policy – Since 1998 when they decriminalised possession they have reduced the number of heroin addicts from 100,000 to 50,000 …
And how did they do it ?
Well they …………. now that would be telling and giving government hacks ideas …Funny how there weren’t any politicians at the talk and they such caring individuals and all !
Dermot, go on ,tell us !
Unfortunately corporate interests have gotten the better of our contemporary drugs policy and have created this illusionary conversation about “drugs and alcohol” as if they were mutually exclusive.
We need a new approach to drugs.
Join the #ReformIreland movement at @SSDPIreland
Students for Sensible Drug Policy is an international network of students dedicated to ending drug prohibition. We have official chapters in UCC, NUIG, AIT, CIT and more on the way in Dublin
#SchoolsNotPrisons
We should extend the ‘just say no’ message to our lousy drug policy.
A Psychiatrist talking about drugs which is good, but does he acknowledge the damage caused by his own profession and the psychotropic drugs used & over prescribed in Psychiatry and also by GPs ?
Dr Peter Gøtzsche is Co-Founder of The Cochrane Collaboration, and Director of the Nordic Cochrane Center in Copenhagen, Denmark speaks in this video ~
https://www.youtube.com/watch?v=VIIQVll7DYY
His book ~ “Deadly Medicines and Organised Crime: How big pharma has corrupted healthcare” ~ http://www.radcliffehealth.com/shop/deadly-medicines-and-organised-crime-how-big-pharma-has-corrupted-healthcare
Glad that he visited Ireland recently, even though most of the national media did not report on it! Except for one broadcaster who had him on for 20 mins. In the interest of informed consent, something I and many more never got (some of who are RIP), it is in public’s interest to hear what he has to say.
“The Cochrane Collaboration is an independent, non-profit, non-governmental organization … formed to organize medical research information in a systematic way to facilitate the choices that health professionals, patients, policy makers and others face in health interventions according to the principles of evidence-based medicine”
{ Do not stop or change prescribed psychoactive drugs without talking to a good doctor, due to the dangers of withdrawal }
For more information on the well respected Cochrane Collaboration, which was co-founded by Dr Peter Gøtzsche ~ http://www.cochrane.org
That is where doctors are supposed to go for evidence base medicine. Time from them to stop listening to the marketing of pharma reps !
Not forgetting that more people die from prescribed drugs than illicit ones. As pointed out by Dr Gøtzsche but also in this article ~ Tranquillisers and methadone send drug-related deaths soaring by 30% ~
As a survivor of “anti-depressant” drugs (which were prescribed for panic but led to doctor/Psychiatrists really hard stuff to try to cover the damage done, thinking I wouldn’t wake up out of my drug induced haze!) I would like to have read this article ~
“Legal Drugs Are Ireland’s Real Killers
When it comes to premature death in Northern Ireland, heroin and cocaine area in the halfpenny place beside tranquilisers and anti-depressants”
The reason so many people got off ciggies is because the enabling information was made available to them from very influential and authoratative sources. They were eventually able to defeat the screechers with personal agendas by sheer dint of irrefutable information presented with clarity and an avoidance of all the hackneyed smoke and mirror arguments. Put the information out there. Drive it home relentlessly via strong media presentation. Currently, we have no difficulty in finding vast sums of money to imprison the weakwilled and their suppliers. Why not take some of that money and attack the problem from the other end……i.e….destroy the market by drawing off those who can be reached and providing the services to deal with the hopeless cases inevitably left behind. The USA has spent unimaginable cash trying to defeat drugs criminality and despite that approach now have the worst drugs problem in their history.
So much for ZERO TOLERANCE ! There are now more than twice the number of Methadone clinics in NY than there was two decades ago when ZT was introduced. Some ZERO that !!
“….don’t use drugs when you’re anxious or depressed – to reduce the risk of harm.”
You go to a doctor, tell him you’re anxious or depressed, and the first thing they do is give you a prescription for drugs.
Anxiety and depression are the most common psychiatric complaints.
“…people who like to ABUSE drugs…”
Fixed that for ya.
Michelle Ryan – you have nailed it perfect;y in your contribution here. The obsession with criminalising our young people because they choose to be wayward with inadvisable substances is pointless and just plain stupid.
We need an intelligent rethink on all these issues. Law enforcement agendas in this area are not to be relied upon because they are driven by a personalised self interest focus on the part of the enforcers. Utilitarianism should be the focus but it isn’t. There is a growing awareness of these realities but progress is painfully slow.
I’d just like to say when Ireland had the 48-Hour Drug Loophole, where Ecstasy, Magic Mushrooms and a bunch of other drugs were legal no incidents happened. There was no accidents, no drug-related deaths or overdoses those couple days and no trouble. I was out that night too and you felt safe. Even the hardcore amphetamine users seemed more relaxed.
I think making drugs a criminal offences needs to be re-adjusted. Alcohol was once illegal in some places. Perhaps it should be again and less harmful drugs should be legal? Did you know that LSD is safer for your body than caffeine? Did you know that mental illness is NOT caused by psychedelic use, unless individuals are already that way inclined? Did yo know that no deaths have been caused by LSD usage?
Many people have been killed by alcohol though.
Many people have been killed by tobacco.
Why should we endorse two very harmful substances that continually prove how dangerous to our health, but individually and collectively?
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