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Pontifications on Poison

Being some ramblings on events associated with poisonous plants.

Wednesday 14th March 2012

Shortly after coming to office in 2010, the UK Home Secretary, Theresa May, wrote to the chair of the Advisory Committee on the Misuse of Drugs (ACMD) setting out her view of what work it should be undertaking and what her priorities were for the results of that work.

Such letters have become an annual event, at least for as long as Ms May remains in that job, and her latest was published on 12th March. It can be read online.

The letter attracted a certain amount of media interest because it asks the ACMD to conduct an investigation into ketamine. Ketamine was developed as an anaesthetic for farm animals and humans but it was found to cause psychoactive effects in humans. These have been described as out of body experiences. There’s quite a lot of information about ketamine online but this BBC summary is a good place to start.

As Ms May’s letter states, the ACMD reported on ketamine in 2004. Though known since 1965, ketamine had not become a concern, because there was very little diversion of medical supplies to recreational use, until evidence emerged that it was being imported purely for club use. The 2004 report found evidence that ketamine was rarely used, with prevalence estimated at below 0.5% and found that what evidence there was suggested that many substance users did not like their first experience of ketamine and reported they would not use it again.

The report also noted that ketamine had been used medicinally for some time with no evidence of harm but noted that it could be problematic for some people with pre-existing mental health conditions. The ACMD recommended classification under the Misuse of Drugs Act in Class ‘C’ and the government of the day implemented that recommendation.

Interestingly, there is an important word that does not appear in the 2004 report; ‘bladder’.

It was, apparently, only in 2007 that people started to notice occurrences of bladder problems in regular ketamine users. Since that initial correlation, evidence on the potential for bladder damage has grown rapidly. The condition has been termed Ketamine Bladder Syndrome and has its own website. This New Scientist item gives more information.

So, very clearly much more is known about ketamine now than was the case in 2004 and it is quite reasonable for the Home Office to ask the ACMD to look at it, again. My concern, however, is that members of the ACMD are volunteers; they receive expenses but no salary. There is only so much work a committee of volunteers can be expected to complete and the risk is that pressure to complete more reports could lead to a lowering of standards.

The request to look at ketamine comes on top of the ACMD’s existing work on cocaine, polysubstance use, khat, driving with a controlled substance in the bloodstream and, importantly, new psychoactive substances.

Catha edulis, khat

Catha edulis, khat

That last is an unquantifiable workload because it is the authorities trying to keep pace with newly designed chemicals that have the effects of controlled substances but, being novel, are not controlled. Because concern about such substances if, often, driven by media campaigns it is very difficult to estimate the amount of time that the committee should spend investigating them.

But, given that new and worrying evidence is available about ketamine it seems quite right to ask the ACMD to look at it.

I'm not convinced that classification under the MDA makes any difference to the demand for a product. If anything, classifying a substance or raising its classification may make it more attractive. But I do think information about the potential harms of a substance should be studied and published especially one that seems to have the potential to completely destroy someone's quality of life by doing permanent damage to the bladder. 

With Catha edulis, khat, however, there is no new evidence since the ACMD’s report in 2005 and the current investigation is, clearly, based on the assumption that the Home Office wants a different conclusion to that reached previously that khat does not need to be classified.

The sensible for thing for Ms May to have done was to tell the ACMD to defer its work on khat, or drop it altogether. Instead, she notes that the ACMD believes the review will be completed by December 2012 and she says ‘I am very keen to ensure that this timeline is maintained’.

I think there is a real threat that those members of the ACMD who are concerned to undertake a proper review of the evidence and reach a reasoned conclusion will be silenced by the need to get the report out even if the resources to complete the investigation are not available.