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Pontifications on Poison

Being some ramblings on events associated with poisonous plants.

Tuesday 23rd August 2011

The Ayrshire Post has reported a trebling of drug deaths in the county over the past decade and says that a shortage of heroin is to blame. Before going any further, I should point out that, overall, the numbers are very small. So small, in fact, that the Ayrshire post compares averages per year over two five year periods.

From 1996-2000, there was an average of ten drug deaths per year but for 2006-2010 that number has risen to thirty-four. Looking at 2010, alone, the paper says nineteen people reported as ‘drug deaths’ had heroin in their systems, ten diazepam and one cocaine.

The story goes on to quote the director of mental health services who blames poor quality heroin resulting, he says, from a shortage brought about by enforcement action and the local MSP who blames harm reduction policies for leading to a softer attitude towards drugs.

Papaver somniferum, opium poppy

It is quite remarkable that one short piece in a local paper manages to say so much about the way current policy fails to deal the problem of heroin users. I’ll try and pick up some of the issues I think the piece raises.

First of all, the alleged shortage of heroin. Anyone who has tracked the UNODC’s annual World Drugs Report for the last decade will know that, in most years, the production of opium has been sufficient to be turned into far more heroin that the estimated world demand. Left to itself, the heroin market would not show any shortages.

So, how come that impure heroin is widely sold, throughout the world, not just in Ayrshire? It is possible that, at times, interdiction efforts may produce local shortages leading to dealers ‘cutting’ their products more than usual but it is always true that a dealer can reduce his risk but increase his profit if he smuggles only a small amount of heroin before diluting it to produce a much larger volume of product. In other words, attempts to enforce prohibition are the creators of the contaminated heroin often blamed for drug deaths.

The contaminants and adulterants used to make a small amount of heroin into a much larger number of ‘doses’ are not, necessarily, the cause of drug deaths. It can simply be that the percentage of heroin varies by supplier and batch so a user has no clear idea of how much heroin they are actually using and may, therefore, overdose without realising.

There is good evidence to show that those most at risk of death from heroin overdose are users recently released from a custodial sentence. Prisons may not be totally drug free, actually the ‘may’ is wrong, prisons always have drugs available in them, but the amounts are more restricted as are the opportunities to use so there is a tendency for overall consumption to reduce during incarceration. Upon release, the user may return to previous practice without realising that their tolerance has been greatly reduced. What would have been an acceptable dose becomes lethal.

It seems probable that many released prisoners do not understand the nature of the build-up and erosion of tolerance that an addictive substance like heroin causes. I can imagine the hysteria of papers such as the Daily Mail or the Daily Telegraph if the government announced it intended to teach prisoners about the safe use of heroin during their sentences but I find it abhorrent that the unsafe use is not even taught so that the number of deaths in this area could be reduced.

The idea that a shortage of heroin is driving people to use other substances misses a glaring simplicity underlying the real difficulty with reducing the harms cause by substance misuse. There are people who take drugs because they like to take drugs. They will take any substance available if it will give them the effect they are seeking. We saw, over the past couple of years, how demand for mephedrone escalated at a time when ecstasy being sold in clubs often had so little of the active ingredient, MDMA, that its only action must have been the placebo effect. That is, people behaving as they would after taking ecstasy because they believed they had taken ecstasy.

As an aside, the Ayrshire Post doesn’t give more details of the ten diazepam related deaths in 2010. The prohibition lobby, generally, likes people to think that deaths due to prescription medicines are the result of ‘addicts’ obtaining supplies illicitly and using them as a substitute for or supplement to heroin. There is a tendency to want to ignore the reality that ordinary people can develop problems with prescribed medicines because that means recognising that any of us could find ourselves facing that situation. It is probable that the difficulty of getting to grips with the growing problem of prescribed medicine overdose has something to do with the reluctance of people to accept that have a problem for fear of being branded as ‘junkies’ or ‘addicts’.

The comments of the MSP are typical of politicians who either haven’t bothered to try and understand the situation regarding psychoactive substances or understand it but are afraid to express their opinions for fear of being attacked by the prohibition lobby, which relies on instilling fear in the public to convince them that the only way to deal with drug use is to eliminate it.

The human race has been using psychoactive substances for as long as we have records of human activities. That does not, for a moment, mean we should condone such use and adopt a laissez faire attitude to substances. It does, however, mean that we should look at how to best help those of us who are unable to resist the lure of such substances.

Prohibition means that we focus on the statistics for seizures, arrests and punishment. We need a regulatory regime that is wholly focussed on the number of drug deaths and how to reduce it. The present system will only lead to the Ayrshire numbers being higher, again, in 2020. 


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