Out of the Frying Pan and into the FireHOW BAD POLICIES MAKE DRUGS MORE HARMFUL

Dr John RocheInternational Doctors for Healthier Drug PoliciesISAM, Dundee, October 2015

Overview

Drugs can cause harm Physical harm Addiction – the lack of the drug is harmful/unpleasant Social harm

Drug policy Protect society and users from these harms

Efforts to achieve this can be counterproductive

Drive for intoxication

When one intoxicant is made unavailable often alternatives are sought or provided

US Prohibition 1920-33

Effect of prohibition on alcohol consumption

1850 1900 1910 1915 1919 1934 1940 1950 1960 1970 19800

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Apparent Ethanol Consumption USA

Beer Spirits Wine

U.S. Alcohol Epidemiologic Data Reference Manual (Vol. 1, Rockville, Md. : U.S. Dept. of Health and Human Services,Public Health Service, Alcohol, Drug Abuse, and Mental Health Administration,

National Institute on Alcohol Abuse and Alcoholism, 1985):6

Poisoning the supply

By mid 1920s 60 million gallons of industrial alcohol stolen to supply drinkers In 1926 government added methyl alcohol and bitter compounds to industrial

ethyl alcohol to prevent recreational use Bootleggers employed chemists to “renature” the alcohol Further compounds added:

kerosene and brucine (a plant alkaloid closely related to strychnine), gasoline, benzene, cadmium, iodine, zinc, mercury salts, nicotine, ether, formaldehyde, chloroform, camphor, carbolic acid, quinine, and acetone.

More methyl alcohol (up to 10%) By 1933 at least 10,000 dead from poisoning

Deborah Blum (2010-02-19). "The Chemist's War: The Little-told Story of how the U.S. Government Poisoned Alcohol During Prohibition with Deadly Consequences". Slate. Retrieved 2015-09-27

MDMA to PMA

In 1988 precursors to MDMA banned including Safrole In 2010 50 tonnes of safrole seized and destroyed in

Cambodia Producers switched to anethole as chemically similar Yielded PMA instead of MDMA PMA aka “Dr Death”

Over 100 UK deaths in recent years More potent and delayed onset Often reported as “ecstasy deaths”

http://www.theguardian.com/commentisfree/2015/jan/05/superman-pill-ecstasy-pma-deaths-drugs-policy

Poppers

Amyl nitrite, a potent vasodilator, alleviates angina A prescription drug in USA from 1937 to 1960, FDA

removed need for prescription due to safety record, reinstated in 1969 following rise in recreational use

In UK amyl nitrite regulated under medicines act, therefore isobutyl nitrite most common ingredient

In 2007 isobutyl nitrite banned by EU due to carcinogenic effect

Replacement isopropyl nitrite is associated with visual impairment and maculopathy

Adverse ophthalmic reaction in poppers users: case seriesof ‘poppers maculopathy’. Davies et al. Eye (2012) 26, 1479–1486

NTP Toxicology and Carcinogenesis Studies of Isobutyl Nitrite (CAS No. 542-56-3) in F344 Rats and B6C3F1 Mice (Inhalation Studies). Natl Toxicol Program Tech Rep Ser. 1996 Jul;448:1-302.

Cannabis to Annihilation

Professor John W Huffman began to synthesise cannabinoids to study endocannabinoid system in 1980s

Potential utility in treatment of MS, HIV/AIDS, and chemotherapy 450 compounds synthesised. Recreational use from 2000s "I figured once it got started in Germany it was going to spread.

I'm concerned that it could hurt people.. I think this was something that was more or less inevitable. It bothers me that people are so stupid as to use this stuff” – JWH

Why use? Available, legal, avoid detection in urine tests

Synthetic Cannabinoids

In Global Drug Survey 2011 23 of 950 (2.4%) last year SC users attended emergency

room Anxiety, paranoia, breathing difficulties 43.5% reported chest pain

27 cases notified with serious adverse effects in USA including 18 deaths from Aug 2011 to Jan 2015

The 12-month prevalence and nature of adverse experiences resulting in emergency medical presentations associated with the use of synthetic cannabinoid products. Winstock and Barratt. Hum. Psychopharmacol Clin Exp 2013; 28: 390–393

Synthetic Cannabinoid–Related Illnesses and Deaths. Trecki et al. n engl j med 373;2:103-7

Sensible regulation

Education, restrict advertising, regulate availability E.g. smoking tobacco

Statistics on Smoking. 2015, Health and Social Care Information Centre.

The folly of youth

“I did lots of things before I came into politics which I shouldn't have done. We all did.” David Cameron

Thank You

Twitter: @drjohnroche www.idhdp.com