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Substance Abuse News

Please Note. This section is no longer being updated

The blog section of this site is now used for some of the stories about psychoactive substances.

So What's in the News?

Substance abuse, whether legal or illegal, is so widespread in modern society that there are many stories about it in the news everyday.

This page looks at a small selection of those stories, mostly to see what they tell us about our attitude to substance abuse.

And What Was in the News?

As the number of stories about substance abuse rises, this page became unmanageable. For that reason, older stories are now on separate pages organised by substance. Many of these stories are still of interest even if no longer 'news'. (Please note that links in older stories may be broken if the page has been removed by the external site.)

You can find these stories by clicking one of the following links;

Substance Use and Abuse in General
Cannabis
Cocaine
Alcohol
Tobacco
Opium, Morphine & Heroin
Mephedrone and Other Synthetics
Ecstasy and Other 'Party Drugs'

What does Richard Branson Know about Drugs?
24th January 2012

Enough for the Home Affairs Select Committee to call his as a witness to its inquiry into drug policy.

Read more in today's blog

UNODC Annual Afghanistan Opium Survey is Published
13th January 2012

But only serves to show how unreliable the data is.

Read more in today's blog

House of Commons Debate on Khat Reveals Extent of Ignorance of MPs
12th January 2012

A House of Commons Adjournment Debate reveals how little MPs know about the market for Khat.

Read more in today's blog

Report Published into Anthrax-infected Heroin Deaths
8th January 2012

The body responsible for dealing with the 2009/10 outbreak of anthrax from infected heroin has issued its report.

Read more in today's blog

Nearly 200 Dead in Poison Alcohol Tragedy in India
19th December 2011

Around 170 people are now thought to have died in West Bengal after drinking illegal alcohol with methanol added to it.

Read more in today's blog

Alcohol-related Hospital Admissions in England Double in 8 Years
12th December 2011

At over 1.1 million, hospital admissions for alcohol-related problems are double the 2002/3 level.

Read more in today's blog

Happy Anniversary Mexico? Not really
11th December 2011

Five years since Mexico's president launched his war on drug cartels and over 50,000 people are dead.

Read more in today's blog

The Lies They Tell to Justify Lying
10th December 2011

The US government tries to justify the lies it told about cocaine seizures and production (see 18th November entry) by telling lies

Read more in today's blog

HASC to Examine Drug Policy
2nd December 2011

The Home Affairs Select Committee is to comprehensively examine government drugs policy. The announcement produced an almost instant 'How dare they?' response from Kathy Gyngell.

Read more in today's blog

The Lies They Tell to Justify Prohibition
18th November 2011

A number of documents from official bodies (governments, agencies, UN organisations) all use misleading information and lies to try and sustain the myth that the 'war on drugs is working.

Read more in blog entries for today and yesterday.

US District Court judge rules against more effective warnings on cigarette packs
8th November 2011

A US District Court judge has allowed an injunction preventing the FDA was requiring more graphic warnings on tobacco packaging because he thinks it could harm their commercial interests.

Read more in today's blog

US Drug Enforcement Agency (DEA) says Peru is the No.1 producer of Cocaine
7the November 2011

In evidence to a US Senate committee, the DEA announced that Peru had overtaken Colombia to become the world's largest producer of cocaine. But, examining the available numbers doesn't show that.

Read more in today's blog.

NHS Publishes Detailed Summary of Alcohol Research
22nd October 2011

The NHS Choices 'Behind the Headlines' website has published a report summarising four years of alcohol studies and the media's treatment of alcohol.

Read more in today's blog.

Advisory Council on Misuse of Drugs (ACMD) on Simple Possession
15th October 2011

A small media storm results from a realisation that the ACMD has been saying, for some time, that those whose only offence is simple possession should not be processed via the criminal justice system.

Read more in today's blog.

Small Trial Suggest 'Tabex' Could be an Effective Smoking Cessation Aid
9th October 2011

A small randomised placebo-controlled trial suggests 'Tabex' might be as effective as much more expensive smoking cessation aids.

Read more in today's blog.

Saffron is Suggested as Alternative Crop to Opium.
7th October 2011

As the 10th anniversary of the war in Afghanistan passes, it has been suggested that opium poppy farmers might grow crocus for saffron instead.

Read more in today's blog.

Proposed Trial to Look at MDMA for treating PTSD
3rd October 2011

Following a small trial in the USA, UK researchers hope to get permission to use MDMA, the active ingredient in ecstasy, to treat sufferers with post-traumatic stress disorder.

Read more in today's blog.

England Brings in Vending Machine Ban for Tobacco
1st October 2011

A ban on selling tobacco from automatic vending machines came into force in England, today.

Read more in today's blog.

Smoking in Movies and its Influence on Children
24th September 2011

Should films that depict smoking be classified as '18' because children may try smoking after seeing it on screen?

Read more in today's blog.

Cathy Gyngell Agrees with Global Commission on Drug Policy
23rd September 2011

Attempting to rubbish GCDP report Gyngell demonstrates that the war on drugs has failed which is GCDP's main conclusion.

Read more in today's blog.

Drug Use in the Armed Forces
2nd September 2011

On average, 700 members of the UK's armed forces are dismissed each year after testing positive for drugs on their return from leave.

Alcohol is served on military bases even on active service in Afghanistan.

Read today's blog for more on the hypocrisy of this situation.

‘Smoking, drinking and drug use among young people in England in 2010’ published.
29th July 2011

The NHS in England publishes an annual survey of substance use by 11-15-year olds. A discussion of its findings can be found in the blog.

BCS Report, ‘Drug Misuse Declared’ Published
28th July 2011

The British Crime Survey (BCS) publishes an annual report on drug use based on a self-reporting survey. Some of its findings are discussed in the blog. A key finding, this year, is that mephedrone's legal status did not encourage new users to try a psychoactive substance for the first time.

DEA Administrator Says Cannabis has No Medical Use.
22nd July 2011

The USA's Drug Enforcement Administration Administrator, Michele M. Leonhart, has said that cannabis has no 'accepted' medical uses. For a discussion of what she might mean see my blog.

Collateral Damage from the 'War on Drugs'
21st July 2011

Al Jazeera English produced a documentary entitled 'Freedom from Pain' showing how the 'war on drugs' is preventing innocent people in pain from receiving medication. More on my blog.

Is Cannabis a 'Gateway' Drug?
19th July 2011

A new paper from Australia claims that users of cannabis are more likely to move onto other drugs. But, what it doesn't do is demonstrate that the cannabis use is the cause of the migration. You can read more on my blog.

Literature Review on Khat Published
15th July 2011

The UK Home Office has published a literature review entitled ‘Khat: Social harms and legislation’ written by David M. Anderson and Neil C. M. Carrier of Oxford University. You can read a discussion of this on my blog.

Five Killed in Explosion at 'Illegal Alcohol Factory'
14th July 2011

An explosion in an industrial unit in Lincolnshire killed five men and injured a sixth. Police are pursuing the probability that the men were engaged in producing fake vodka. Though impossible to be precise, it is thought that there is a large market for illegal, and hence tax-free, alcohol in the UK.

Go to today's blog post for more on this.

U.S. Sentencing Commission Rules that The Fair Sentencing Act of 2010 is to be Retrospective
5th July 2011

The Fair Sentencing Act of 2010 is intended to end the racial discrimination inherent in the USA because of mandatory minimum sentences. It has now been ruled that those already in prison can apply for their sentences to be cut. Read more in my blog entry.

2011 'World Drugs Report' Published
23rd June 2011

The United Nations Office on Drugs and Crime (UNODC) has published its annual 'World Drugs Report'. This is the first to be produced under the new Executive Director, Yury Fedotov, and, though it puts use ahead of production, which may be a significant change, it continues the tendency to highlight truths about the illicit drug world, such as that it provides enormous amounts on income to criminals, without drawing the obvious conclusion that fifty years of UN based prohibition has only succeeded in greatly increasing the harm caused to millions of people.

You can access the report from the UNODC website or read more about my thoughts on it in my daily blog.

'The global war on drugs has failed, with devastating consequences for individuals and societies around the world.'
4th June 2011

The opening sentence of the 'REPORT OF THE GLOBAL COMMISSION ON DRUG POLICY' published on the 2nd June expresses a truth that is becoming increasingly acknowledged in the mainstream and not just by those who have been calling for reform for some time.

This excellent report should be read in full (it is only 25 pages in total but the main text covers only 16 of those) and I shall not attempt to summarise it here.

Given the membership of the commission, including former presidents, a former UN Secretary General, former senior staff at the UN and high profile business leaders, it is not surprising that the report received large scale media attention.

Some of that coverage has continued to follow the idealistic line that 'drugs' should be eliminated from society but quite a large part has focussed on the healthcare issue and, especially, on the lack of quality control of substances supplied via illegal markets.

Some reformers are asking if this is, at last, the 'tipping point'. It may be, but concern remains that the current UK government is looking to reduce the harm reduction approach to substance use in favour of 'tougher' law enforcement. The reasons for this are all to do with the politics of being in a coalition with the Conservatives anxious to show the right wing that it has not been abandoned by the need to work with the Liberal Democrats.

I said I wouldn't attempt to summarise the report but there are three individual items that particularly struck me.

The 1961 UN Single Convention on Narcotic Drugs does talk in terms of complete eradication and this has been used to justify the 'war of drugs' since President Nixon declared it forty years ago. The report, however, notes that the convention 'made it clear that the ultimate objective of the system was the improvement of the ‘health and welfare of mankind’'. In other words, there is no need to throw out the 1961 convention which is what the opponents of reform claim reformers wish to do. Instead, a harm reduction approach is a way to implement it.

The report gives a number of case studies involving countries that have implemented harm reduction policies including things like substitution provision and decriminalisation for possession of small quantities. The Swiss experience is of particular interest. Switzerland's harm reduction policies including prescriptions for hard-core users not only produced the expected health benefits for addicts and crime reductions as users no longer had to commit property crimes to obtain their supplies. By reducing the demand for illegal heroin from these high users, it appears that the criminal market became less viable overall and the availability of heroin to new users was reduced. In Zurich, in 1990, 850 new heroin addicts were registered. In 2005, that number had fallen to 150.

And the third point in the report that struck me was the call for 'credible' information on the risk of drug use. That struck a particular chord with me because, on Thursday, I visited the Alnwick Gardens for the first time this year. New information boards have been placed on the fence close to the entrance to the Poison Garden and one of these says 'some plants become killers only in the hands of men, like tobacco, coca, cannabis and opium poppies'. Suggesting that cannabis is a 'killer' plant is not credible and, I would argue, destroys any hope of the Alnwick Garden's 'anti-drug' message being listened to by young people. You cannot expect people to accept what you say about heroin, alcohol or tobacco if what you say about cannabis is complete nonsense.

The Duchess of Northumberland has a strong commitment to improving the lives of young people in all manner of ways. It is, therefore, a pity that she is being ill-advised when it comes to what is 'credible' in the eyes of young people who may be tempted to experiment with psychoactive substances.

Alcohol - A Shameful Milestone
28th May 2011

A new report from the NHS in England shows that in 2009/10, there were 1,057,000 alcohol related admissions to hospital. This is the first time the figure has gone over one million and represents a 12% increase over the previous year in spite of the difficult economic conditions.

Alcohol related harm costs the NHS in England around £3bn a year.

When a couple of deaths were attributed (wrongly, as it turned out) to mephedrone there was a media frenzy calling for it to be banned. But, it seems, over 1 million people a year suffering proven harm from alcohol is not seen as a problem needing drastic action.

Ecstasy Does Not Impair Cognitive Function
16th February 2011

'Talk to Frank', the UK government backed website that aims to provide information for young people about drugs says of ecstasy,  'There’s some uncertainty about the long term side effects of Es. But evidence suggests it can cause damage to the brain causing long term problems – like depression, personality change and memory loss.'

This long-term damage to the brain has long been claimed to be one of the greatest dangers of ecstasy. And, of course, it has the bogey-man quality of not having to be immediately manifest. Take ecstasy today and you may be fine but who knows what might happen in ten or twenty years?

Now, new research published by Addiction journal indicates that the link between ecstasy and cognitive function impairment is a false one.

Researchers in the USA looked at 52 ecstasy users and found 'little evidence of decreased cognitive performance' compared to 59 non-users. Normally, a study involving only 52 people would raise concerns about the sample size but, in this case, the 52 subjects were carefully selected from an initial 1,500. The elimination was to remove users who took substances other than ecstasy currently or in the past and to identify only users who were members of the 'rave' subculture. These 52 subjects were matched with 59 non-users but, for the first time, these non-users were also involved in the 'rave' subculture so that users and non-users could be matched for things like exposure to noise, late nights, etc. In both cases, testing was done to confirm the chemical status of the subjects and controls.

The researchers conclude that they failed 'to demonstrate marked residual cognitive effects in ecstasy users'.

But, the researchers say, this does not amount to saying that ecstasy is safe because of the unknown contaminants and strength of ecstasy tablets and the lack of any supervision over its manufacture. So, while ecstasy may not cause problems, illegal ecstasy very possibly might.

The full paper is only available to subscribers but Addiction has a press release on its website with fairly full details.

Mephedrone Ban Makes No Difference
14th February 2011

The Independent Scientific Committee on Drugs (ICSD) has indicated that it will shortly publish results of a survey suggesting that the criminalisation of mephedrone has made little or no difference to its availability.

Though around half of respondents say they are less likely to use mephedrone since its banning, a similar proportion say they are more likely to use cocaine or ecstasy instead.

One effect of the ban that everyone seems to agree on is that the price of mephedrone has increased so, once again, the government has increased the profits of those selling substances with unknown effects.

Coroner Warns Against Mephedrone but Ignores Alcohol
14th February 2011

The coroner conducting the inquest into the suicide of two young men in Northumberland in July 2010 has issued a warning that mephedrone has been linked to many suicides after it was confirmed that both of the men had, at some point, used mephedrone. The coroner's comment is based on a report from a private forensic science lab. This shows that mephedrone was first detected in toxicology studies in March 2010 and between than and June 2010 a total of 16 post-mortem tests had identified mephedrone. It is said that in 3 cases mephedrone was the only drug detected. In fact, two of those cases say 'no data available' rather than nothing found and in the third prescribed medication was known to be present. In any event, none of these cases were suicides and the six suicides which were included all found ethanol to be present though the extent of intoxication is not given.

Certainly, in the cases that are the subject of this inquest, both men were found to have blood alcohol levels above those for defining drink driving. Yet the coroner made no mention of the harm alcohol can cause preferring to start another media hare running about mephedrone even though he is reported to have said 'there was nothing specific to say the drug caused both men - who left notes to their families and friends - to kill themselves'.

More Detail on Relative Harms
12th February 2011

In 2007, while still chairing the Advisory Committee on the Misuse of drugs (ACMD), Prof David Nutt and colleague published a study intended to try and establish a harm scale for a variety of substances, legal and illegal. That work can still be viewed on the Lancet website (link goes to a summary but the full paper is available with free registration). This paper was used as the basis for the Harm Scale page in this section of this website. One criticism I raised, was that by giving equal weight to the three areas examined, physical harm, dependence and social harm, the distinction between harm caused to those involved directly in consumption was being equated with harms to society.

Prof Nutt and his colleagues at the the Independent Scientific Committee on Drugs have now published, again in the Lancet, &'Drug harms in the UK: a multicriteria decision analysis' (as above, the link goes to a summary but the full paper is available with free registration). This looks at a more detailed way of evaluating harm and gives weight to the differences between harms caused to users and harms caused to society (referred to as 'others').

The paper concludes that overall the greatest harm to both users and others is done by alcohol with heroin, crack cocaine and metamfetamine following. Interestingly, metamfetamine scores its fourth place in spite of being judged to cause almost no harm to others.

The work has been portrayed by some as an attempt to change the classification scheme. Prof Nutt has said, however, that the work simply demonstrates, that 'the current classification is based on something other than harm'. He has called for an investigation to determine what the classification system is based on.

His point that harm is not the determinant of classification is best seen with Ecstasy which rates as 17th out of the 20 substances considered yet is classified as a Class A substance putting it alongside the No. 2 & 3 substances.

Though some commentators have expressed surprise that tobacco only ranks sixth in the list, Prof Nutt says this results from the analysis looking at a much wider range of harms than simply the shortening of life.

This new paper certainly offers a more detailed analysis than the earlier work but the recent pronouncement from the Home Secretary on what she believes the ACMD should do does not suggest that this rational approach to harm will be adopted by the government.

Alcohol Sponsorship
12th February 2011

A Welsh charity, Alcohol Concern Cymru, has called for a ban on sponsorship of sports or cultural events by companies selling alcohol.

The alcohol industry body, the Portman Group, always says that its aim is to promote responsible drinking to adults. The charity says that claim is difficult to substantiate when sporting events and music festivals have such a high incidence of alcohol sponsorship. It alleges that the thrust of the sponsorship is to make it appear that drinking is 'cool' and is an essential part of social activities.

Slight Fall in Alcohol-related Deaths in 2009
10th February 2011

Adding to the snippet of information, previously noted, the UK's Office of National Statistics has recently published its annual survey of 'Alcohol-related deaths'. I've put quotes around that because it is important to note that these figures relate only to deaths directly attributed to alcohol. There are known to be deaths due to, for example, falling when drunk that are not attributed to alcohol in such a way as to be included and there are known to be instances where deaths after long-term alcohol use are attributed to some other cause that would not have arisen unless the deceased had been a regular drinker. Thus, the total number of deaths in which alcohol is a factor is much higher than this report states but, by collecting data on a systematic basis, it may be more useful in terms of identifying trends.

(Because of the rather odd way that the UK is structured, this report gives figures for the UK, in total, and separate figures for England and Wales. Separate figures for Scotland and Northern Ireland are available.)

In total, in 2009, at 8,664, there were 367 fewer deaths in the UK directly attributed to alcohol than in 2008. This is the first year, since 2000, that such a year on year reduction has occurred but the total, 5,690 men and 2,974 women, is still substantially higher than the 2000 figures, 4,483 men and 2,401 women. Taken on a per 100,000 of population basis, alcohol deaths have risen from 11.2 in 2000 to 12.8 in 2009. These figures should be viewed with caution since they take no account of the change in the make up of the UK population over the period.

This relatively small reduction may be the result of the UK's economic situation rather than any realisation of the dangers of alcohol but, because the figures do not separate deaths from short-term high consumption as opposed to long-term abuse, it is not possible to estimate the effect this may have had.

What is undeniable is that alcohol continues to cause many, many more deaths than all the illegal substances combined.  

'And There is a Correct Answer'
8th February 2011

Very often people ask questions in such a way that the answer they are seeking is perfectly clear. This starts in childhood, 'Shall we clear up this mess?', and continues, for many, throughout their lives.

Thus, on 2nd February, UK Home Secretary, Theresa May, wrote to Prof. Les Iversen, Chairman of the ACMD, setting out the priorities for the ACMD in the coming year.

Before going further it is worth being reminded of the purpose of the Advisory Council on the Misuse of Drugs. The Home Office website says;

'The Advisory Council makes recommendations to government on the control of dangerous or otherwise harmful drugs, including classification and scheduling under the Misuse of Drugs Act 1971 and its regulations. It considers any substance which is being or appears to be misused and of which is having or appears to be capable of having harmful effects sufficient to cause a social problem.

'It also carries out in-depth inquiries into aspects of drug use that are causing particular concern in the UK, with the aim of producing considered reports that will be helpful to policy makers and practitioners.'

Granted, that suggests a degree of presupposition. The ACMD investigates a substance if it 'is having or appears to be capable of having harmful effects' so the ACMD wouldn't be investigating if the substance weren't harmful but the perceived purpose of the ACMD is to look at evidence and make recommendations based on that.

Ms May's letter contains a number of instances where she makes the correct answer she is seeking perfectly apparent. The ACMD has already indicated that it intends FOR THE FIRST TIME IN ITS HISTORY to look at the 'harms of cocaine as a single substance'. This review is because of 'the need to disabuse the misapprehension that cocaine is a relatively safe drug'. So, before the ACMD has even begun its review, it knows that the evidence about cocaine use is a 'misapprehension'. Quite why the committee needs to spend time on a review when the result is known is unclear.

In spite of completing a full review in 2005, and the fact that little or nothing has changed since then, the ACMD returned to the subject of khat in October last year. Commenting on this Ms May says that she understands that ACMD will make 'particular reference to the societal harms of khat'. Inclusion of 'possible' or 'potential' or 'extent of' might have left the ACMD thinking that Ms May did not already know what she expected the committee to report.

Ms May asks the ACMD to proceed with its work on cocaine 'with immediate effect' but then says that it should continue 'the review of khat at the next available opportunity within its work programme, giving khat priority over any other further planned work'. (my emphasis)

So, Ms May considers khat to be more important than the ACMD's work on novel psychoactive substances, more important than its work on polysubstance use and more important than assessing the effectiveness of treatment programmes.

It's quite hard to avoid the conclusion that the importance of khat, a substance used by a very limited number of people that shows no signs of becoming more widely adopted, is simply that the government has already decided to make it illegal and wants the cover of the alleged 'evidence' of the ACMD before it acts.

Hans-Christian Raabe 'Outed' by ACMD
7th February 2011

Just two weeks after his appointment raised concerns about the future direction of the Advisory Council on the Misuse of Drugs (ACMD), Dr Raabe has been dismissed from the committee. In the entry dated 22nd January, I wrote that Dr Raabe was known for his anti-gay views. These, most notoriously, came in a paper in which he contended that all paedophiles are gay and implied that this meant that all gays were paedophiles.

Though there was immediate condemnation of his appointment both online and in the conventional media, it seems the Home Office was not aware of the existence of this paper at the time of his appointment. He has, therefore, been dismissed for failing to advise the government of anything in the past that could cause controversy.

It does seem a little bizarre that, it appears, the extent of the checks into Dr Raabe's suitability for the role extended only as far as asking him. Especially as, in 2007, he was found to have concealed his anti-abortion views from a House of Commons committee to whom he gave evidence as a 'medical expert'.

The government has said it plans to move swiftly to appoint another GP in his place. Let's hope the move is not so swift that they don't assess the ability of the proposed new member to analyse evidence without prejudice.

Where's the Harm?
6th February 2011

It is often said, by opponents of prohibition, that the harm caused by the illegal substances is dwarfed by the harm that results purely from that status. Those arguing for the status quo are accused of using arguments that relate to the harm caused by criminalisation rather any innate harm in the substance itself. The most obvious, of course, being that drug users steal to be able to buy drugs so there must be criminal sanctions against them. That, of course, ignores the fact that, if drugs were regulated and problem users treated as in need of health care, the need to commit crime would be diminished.

Given the difficulty of dealing with a situation which is affected by two different factors, you would assume that any government would have looked at how to separate the two effects in order to design the best means of approaching them.

Not so.

On 1st February 2011, Bob Ainsworth* MP, the former Defence Minister in the UK's last Labour government, asked James Brokenshire, Parliamentary Under Secretary of State at the Home Office, a position which Ainsworth held from 2001 to 2003, whether the 'Department has (a) undertaken or (b) evaluated research on (i) harm caused by drugs and (ii) harm caused by the criminalisation of drugs'.

Mr Brokenshire detailed the extensive work undertaken in connection with section (i) of the question which I shan't reproduce here.

I shall, however, reproduce his complete answer on the government's level of interest in understanding the harm cause by criminalisation;

'(ii) The Home Office has not undertaken or evaluated any research into any harm caused by the criminalisation of drugs.'

*Mr Ainsworth was criticised in December 2010 for calling for all drugs to be legally available. He said that his time, 2001-2003, as the government minister responsible for drugs policy had led him to conclude that the war on drugs could not be won. Prohibitionists produced their usual arguments and anti-prohibitionists asked why Mr Ainsworth hadn't shared his thoughts during the seven years after leaving the Home Office when, as a member of the government, something might have been done.

Waiting until he was a back-bencher gave the impression that he did not want to blight any chance he might have of holding office by speaking out for all the people, drug users and victims of the crimes committed by problem users, whose lives are ruined by prohibition.

President Obama says it is time to talk
29th January 2011

The development of technology means politicians no longer have to go out on the streets to interact directly with the people. On Thursday, President Obama took part in a video forum, organised by YouTube, to enable selected members of the public to put questions to the president. In this extract, the off-screen moderator can be heard explaining that drugs policy had not been one of the subjects intended to be raised but that it had dominated the submissions from people requesting the chance to put a question to the president.

The selected question came from a former law enforcement officer who is now a member of LEAP (Law Enforcement Against Prohibition). It brought the response from President Obama that, though he does not believe in legalisation, he does believe it is "an entirely legitimate topic for debate". He goes on to compare the problem of reducing drug use to the way that attitude change was what made seatbelt wearing the norm.

His tone, that there should be a "serious debate" about how to reduce drug use and how to reduce the use of incarceration as the attempted means of control and that drug use should be looked at as a public health problem offers some encouragement that the topic of how to deal with these substances better may, finally, be on the table.

It certainly suggests a more pragmatic approach than that which seems to be emerging from the UK government. Here, the mindset seems to be a return to the failed notion that you can create a drug free society.

Mixed Messages on Substance Misuse
29th January 2011

Within the past week the UK's NHS has published information about use of illegal drugs and alcohol. Understanding what this information really means is complicated by a number of factors. Because of the different areas of responsibility for things like health and law enforcement, some of the figures cover the whole of the UK, some only England, some only Wales and some England & Wales. Drawing conclusions from comparing different data is, therefore, fraught with danger.

Another complication comes from the separation between illegal drugs and alcohol. This means that these two, strongly related, areas are dealt with in separate reports. On 27th January the NHS Information Centre released  Statistics on Drug Misuse, England - 2010 Report (note that the title makes no mention of Wales) and, on the same day, according to newspaper reports dated 29th January (for example, the Daily Mail) it published figures showing an increase in under 15 drinking, especially amongst girls.

So far, I have not been able to locate the source document for the press reports so it's hard to offer a considered analysis.

What I have found is this summary on alcohol deaths in the UK in 2009.

Both the report on drug use and the alcohol deaths figures suggest a decrease in usage. With alcohol, it is suggested that the economic downturn is responsible for the reduced deaths. With drugs, the tone of reporting has been to suggest that young people, in particular, are turning away from illicit drugs. This is being used, by some commentators, to suggest that current policy is working and enforcement efforts should be increased.

Given that alcohol related deaths may result from years of misuse it would seem to be a stretch to suggest that a decrease in deaths in one year was the result of economic conditions in that year. Indeed, if the Mail report is correct, the signs are not the economy did not affect consumption of alcohol in all sectors.

Because of the difficulties mentioned above, I shall try and avoid making the same mistakes these commentators have, that is over-stating the conclusions to be drawn from the data.

What does not appear to have been considered is the effect of a switch from illegal substances of dubious strength, like ecstasy and cocaine, to legal highs (for much of the period reviewed mephedrone was legal and widely available). Nor is it possible to estimate whether alcohol was substituted for illegal drugs to any large extent meaning that young people continued to expose themselves to harm in the interest of having a good time rather than eschewing all chemical manipulation of their physical and mental states.

Though there do seem to have been reductions in Class A drug use, the main downturn is reported for cannabis. With the lag between cause and effect, it is worth considering whether the move away from cannabis results from the downgrade to Class C which came to an end in January 2009. Note that the '2010' report actually looks at the period April 2009 to March 2010.

Reading this back, I realise I have, probably, done no more than create confusion in the reader's mind. I shall return to the subject once I have the source data on alcohol reported in the press and try for greater clarity.

One conclusion I think is clear; there is no chance of understanding the situation regarding use of potentially harmful substances unless they are dealt with in a single document covering 'drugs', alcohol and 'legal highs' so that substitution effects are brought out.

UNODC Publishes 2010 Afghanistan Opium Survey
22nd January 2011

Something rather strange happened to the opium industry in Afghanistan in 2010 according to the 'Afghanistan Opium Survey 2010' published by the United Nations Office on Drugs and Crime (UNODC).

Previous information had suggested that 2010 would be a bad year for opium due to the presence of a virulent plant disease. And, as expected, opium production fell dramatically. In spite of the area under cultivation remaining unchanged, at 123,000 hectares, from 2009, the estimated dry opium weight resulting fell from 6,900 tonnes to 3,600 tonnes a decrease of 48%. This takes output levels back to the sort of figures not seen since the early years of the century. So, nature has achieved something which all the human efforts to suppress output have failed to do.

Because opium, for all its illegal status, operates much like any other market, it should be no surprise that the reduction in output from farms in Afghanistan resulted in an increase in prices. UNODC reports that, on average, farm gate prices for dry opium rose 164% to $169/kg. There were, however, significant regional variations with prices in the north-east only rising 21% against the 192% in the southern region which includes Hilmand province, again, at US$350 million total farm-gate value, the largest producer in the country.

This increase in price per kilo meant that farmers earned a total of US$605 million from opium sales, 38% up from the US$438 million earned in 2009 from a much higher output tonnage. During 2009, wheat prices fell (though they are now increasing) so that the combined effect was that a farmer was six times better off using land for poppies rather than wheat.

None of this is unexpected. Where something strange seems to have happened is with the estimated export value of opium. UNODC, whilst acknowledging that surveying the trade after the opium leaves the farm is much less certain, estimates that traders made a total of US$1.2 billion in 2010, a 48% decrease from 2009. That's a US$1.1 billion drop in income that, coupled with the US$ 167 million increase in product cost means that the 'middle men' of the industry, generally believed to be the major source of funding for anti-government activities, saw their income fall from US$1.86 billion to US$0.60 billion.

It has been known that, for some years, production of opium has exceeded world demand though there seems to be no consensus on where the surplus stocks are held. It may be, therefore, that in order to sell their opium, traders in Afghanistan have had to match the price at which the stocks were sold in previous years.

It will be interesting to see if this fall in income has a noticeable effect on the anti-government forces or whether the idea that the opium trade finances the war will be shown to be an over-simplification.

One encouraging thought is that, once again, it appears that the demand for heroin is finite and thus, consumer prices have not risen in line with falling supply in the way that other commodities, whether copper, oil, gas or foodstuffs move.

New Appointments to the UK's ACMD
22nd January 2010

Following the changes to the requirements for membership of the UK's Advisory Council on the Misuse of Drugs (ACMD), see below, the UK Minister for crime prevention, James Brokenshire, has announced nine new appointments to the committee.

The function of the committee is to examine the evidence relating to substance use and recommend action, based on the evidence, to the government.

It is, therefore, no surprise that there has been considerable concern that the nine new appointees includes Dr Hans-Christian Raabe, a GP who is a prominent member of the Manchester-based Maranatha Community, an organisation with very strong anti-gay views. Dr. Raabe is on record as believing that the government and the nation must be totally committed to the ideal of a drug-free society. Not much chance there then that he will look at evidence in an open-minded way and provide advice based on science.

But Dr Raabe is not the only new appointee who may have less than perfect respect for scientific evidence. The announcement does not say why each appointee has been thought suitable so it can only be hoped that Susan Graham's appointment is not because she believes that acupuncture can be used to cure addiction.

It appears that, in the same way that Labour appeased its left by banning fox hunting, David Cameron is looking to appease the right-wing of the Conservatives by being 'tough on drugs' regardless of what additional harm is done to users as a result. And regardless of his personal belief that the present Misuse of Drugs Act needs re-examination.    

DrugScope Issues Media Guide
9th December 2010

The charity, DrugScope, has published 'The media guide to drugs: key facts and figures for journalists'.

The document is intended for journalists who are writing about drugs and drug use in the UK. DrugScope's hope is that, if journalists read and follow what the document says, many of the more extreme news items about drugs can be prevented.

This is a worthwhile intention but it assumes that current drug reporting is based on a lack of knowledge rather than on having an agenda and ensuring that reporting conforms to it.

DrugScope points out that not every substance user is a 'drug addict' but you have to doubt whether that will change the way drug use is reported in those papers who like to portray drug users as the cause of all society's ills.

There is a further problem with this type of endeavour which is that it can make matters worse if journalists quote selectively. For example, DrugScope gives the number of deaths in which each substance has been 'implicated' i.e. its use may have been a factor but may not have been the main cause. Those who die from water intoxication as a result of drinking too much water to accompany their ecstasy use have not died from ecstasy but ecstasy is clearly implicated because they would not have drunk so much water if they were not using the drug. But, the risk is that journalists will take the 'headline' number of deaths and ignore the complexities. Expect to see journalists quoting DrugScope on numbers of deaths 'caused' by a substance.

So, though I don't think this document will make any real changes to how substance use is reported in the mainstream media, I do recommend downloading it and keeping it to refer to when considering the validity of articles in the press, on TV and radio or on the Internet.

UK Government Plans Changes to the ACMD
9th December 2010

The Advisory Council on the Misuse of Drugs (ACMD) is a committee established under the 1971 Misuse of Drugs Act (MDA). It's remit is to provide the UK government with unbiased, scientific advice on the effects of substances and what, if any, action should be taken to control their availability.

For most of its history, the ACMD has been completely uncontroversial but, in 2008, for political reasons, the then government ignored the advice of the ACMD and re-classified cannabis as a Class B substance. In 2009 the chairman, Professor David Nutt, gave a talk about governments ignoring science and was forced to resign. Several other members followed him.

In 2010, the government decided to ban mephedrone, because of the press campaign about it, and looked to the ACMD to give it scientific cover without actually having the time to undertake a proper evaluation. In fact, the new chairman announced that ACMD was recommending classification while the ACMD was still meeting to discuss it. This led to further resignations.

For the government, these resignations were particularly troublesome because the MDA stipulates that, of the total membership of the ACMD, there must be at least one representative of six specific disciplines. These are  the practice of medicine (other than veterinary medicine), the practice of dentistry, the practice of veterinary medicine, the practice of pharmacy, the pharmaceutical industry and chemistry other than pharmaceutical chemistry. What the previous government found, to its cost, was that it only took the one vet, say, on the ACMD to resign and it could not function lawfully. Appointing a replacement vet and then expecting the ACMD to give advice before the new member had any chance to become familiar with the issues made the government look ridiculous.

It is, therefore, not surprising that the new government would take the first opportunity to revise the constitution of the ACMD but the proposed changes have created great concern in the scientific community.

Tucked away in The Police Reform and Social Responsibility Bill (see following item), are provisions to change the constitution of the ACMD. Instead of having to have at least one of each of the six disciplines the ACMD will be made up of people who "shall be appointed by the Home Secretary after consultation with such organisations as he considers appropriate."

So, it is for the Home Secretary to decide which organisations are 'appropriate' and he can then appoint whoever he wishes without any regard to their scientific qualifications or lack thereof.

Critics are concerned that this will make the ACMD an arm of government because the Home Secretary will only appoint people who are sure to be 'on message'. There is also concern that eminent scientists with the right qualifications and experience to help the ACMD do a useful job will refuse to serve because they fear membership would harm their credibility.

Dr Evan Harris, the former Liberal Democrat MP, has written this piece for the Guardian.

UK Government to Ban Alcohol & Tobacco
2nd December 2010

Actually, the UK government isn't planning to ban alcohol and tobacco but they do intend to give themselves the power to do so.

At present, the Misuse of Drugs Act (MDA) gives the government the power to classify a substance as Class 'A', 'B' or 'C' if there is evidence that the substance is harmful. The Advisory Committee on the Misuse of Drugs (ACMD) is the body which is supposed to look at the scientific evidence and make recommendations based on its findings.

This process, if it is to be done properly takes time and, faced with a media onslaught against a particular substance, time is something which government doesn't have. With mephedrone, media hysteria about deaths (which, later, turned out to be unrelated to mephedrone) forced the ACMD to abandon all pretence of being an independent scientific body. The chairman, Prof Les Iversen, was presenting the committee's conclusions to the, then, Home Secretary while the committee was still meeting to determine what those conclusions should be.

Realising the ridiculous position this created, the current government wants to give itself powers to issue a temporary ban on any substance that the Daily Mail decides is bad. Sorry, that should read any substance that is raising concerns about its harmful effects.

But, this is where the problem comes. Drafting any law is complex and can have unforeseen consequences but drafting laws in a hurry without having a clear idea of what is intended greatly increases the chance of something going badly wrong.

The Police Reform and Social Responsibility Bill deals with a great many areas of the criminal justice system.  Schedule 16 to the bill details amendments to the MDA to be made in order to give the temporary banning powers the government wants. This gives the government the ability to issue a 'temporary class drug order' against any substance that is not already classified as Class 'A', 'B' or 'C'. 'ANY' substance.

The grounds for making such an order are that 'the substance or product is a drug that is being, or is likely to be, misused, and that misuse is having, or is capable of having, harmful effects'. The definition of 'drug' is one of those circular ones beloved of governments. A substance is a 'drug' if it is subject to one of the four classes under the MDA. In other words, if the minister classifies something as being in the 'temporary class' of drugs, then it is a drug.

The classification as a 'temporary class' drug is to be made by means of Statutory Instrument and is, thus, not, normally, subject to consideration in parliament.

There can be no doubt that both alcohol and tobacco fall into the definition of substances causing or capable of causing harm if 'misused'. Though the government would, I'm sure, say that it has intention of banning these two substances, these amendments to the MDA, if passed, would create another law where the only control over draconian measures would be trusting a government not to use the powers it has.

Schedule 16 of the bill can be read here and the rest of the Police Reform and Social Responsibility Bill can be found by following links from that page.

Transform Renews Impact Assessment Call
2nd December 2010

Transform Drug Policy Foundation has renewed its call for an Impact Assessment (IA) to be made of UK drug policy.

Impact assessments are a standard tool of government designed to demonstrate that a policy, either in place or proposed, is the most cost effective way of dealing with a situation.

Nearly every area of policy has been subjected to an IA except drugs. In 2007, the, then, government concluded that an IA could not be successfully made on drug policy. In 2010, the UK Home Affairs Select Committee strongly disagreed and called for 'a full and independent value-for-money assessment of the Misuse of Drugs Act 1971 and related legislation and policy'.

Former PM, Gordon Brown, took a 'because I say so' attitude to drug policy by indicating that, regardless of the outcome, an IA into drugs policy would not change the policy and was, therefore, a waste of effort.

The UK's coalition government is led by two men, Prime Minister David Cameron and Deputy Prime Minister Nick Clegg, who have both, in the past, called for drug policy to be re-examined. Transform's renewed campaign points out that undertaking an IA is not making any commitment to change. People on all sides of the argument should be willing to subject their beliefs to review.  

Proposition 19 Fails in US Mid-terms
4th November 2010

Proposition 19, the Californian proposal to make growing and possession of small amounts of cannabis for personal use failed to gain the required support when voted on as part of the mid-term elections.

It seems that a number of factors reduced support as the campaign developed. Proponents had focussed on the decrease in crime that would result from not bringing cannabis from Mexico illegally but a number of people analysed the data to show that the effect would be small since most Mexican cannabis passes through California on its way to other states where it would still be illegal. The amount to be gained from tax was also shown to be over-stated, that is to say more people believed the argument that there was not a large gain to be made.

It also seems that some users of cannabis did not support the proposal for the simple reason that California already turns a blind eye to a lot of small scale use so they didn't think Prop 19 went far enough.

Finally, it appears that areas where cannabis for medical use is grown voted against because of fears, probably justified, that Prop 19 would have reduced the 'medical' need for cannabis and affected incomes in those areas.

The general swing to the right seen throughout the USA may also have had an effect on this particular referendum.

The campaign, however, brought the debate about cannabis into the mainstream media and it is likely that further proposals will come forward, nationally and in other states.

Blarney Castle in Drugs Raid
22nd October 2010

Earlier this year, I provided some suggestions to the head gardener at Blarney Castle about the poison garden they were putting in to add to the attractions for visitors. I also gave permission for them to use material from this site on the information boards around the garden.

They wanted to include the plants which affect the brain more than anything else and planted five Papaver somniferum, opium poppy, and one Cannabis sativa. In the Republic of Ireland, growing either of these plants is illegal. The poppy ban is ineffective as most garden centres sell the seeds every spring.

Blarney Castle consulted the Irish police, the Garda, who raised some concerns and said they would be in touch about whether they would issue a licence for growing these plants. Now, in the UK, people would take no action until a licence had been issued but Blarney Castle took the view that silence betokens consent and, when they heard nothing more from the police, went ahead with the planting.

Everything was fine and the plants have been seen by the many visitors to Blarney through the summer. But then, on 15th October, a reporter rang the Garda for an official comment on the illegal growing of these plants. On Thursday 21st October, Garda officers visited Blarney castle and removed the poppies and the cannabis. The owner was told he could face prosecution under the Misuse of Drugs Act.

California Proposition 19 'Too Close to Call'
10th October 2010

The USA's electoral system allows states to vote on referenda on specific items of law and enables individual citizens to put forward 'propositions' if they can show sufficient support.

In California, use of cannabis for medical purposes is tolerated, almost to the point of being legal. In theory, the federal government could act against it but President Obama signalled that he felt that would be a waste of federal money.

At present, different local areas in California take different views on the subject with some trying to use planning laws to prevent 'dispensaries' from operating while others make little effort to ensure that those buying cannabis have a proper medical need.

In November's country-wide mid-term elections, Californians will vote on Proposition 19 which would make it legal for over 21s to grow cannabis and possess up to one ounce for personal use.

The full title of Proposition 19 is Regulate, Control and Tax Cannabis Act of 2010 and, under California law, it needs only a simple majority of those voting to become law immediately. The inclusion of 'tax' in the proposal seems to be key since, at a time when like, so many governments, California is facing massive budget cuts an additional source of revenue coupled with savings on unsuccessful enforcement efforts may sway many who have no interest in cannabis use.

As polling day nears, so the debate intensifies and the view of those closest to the issue is that it is not possible to predict the outcome.

There is little doubt that the present position is chaotic and does not allow for proper quality control of cannabis being supplied. The questions are whether Proposition 19, if it passes, will result in a properly regulated system or, if it fails, will lead to a backlash against the existing situation.

UNODC Afghan Poppy Survey - Lower Yield, More Money
10th October 2010

The United Nations Office on Drugs and Crime (UNODC) has published its 2010 'Afghanistan Opium Survey - Summary Findings'. It finds that the area under cultivation of Papaver somniferum remained unchanged from 2009 at 123,000 hectares but, due mostly to a fungal infection arising late in the season and causing premature drying of the opium latex, total outturn fell from 6,900 tonnes to 3,600 tonnes.

In a very clear example of the workings of supply and demand, however, the survey believes that total farm-gate income rose from US$438 million to US$604 million as a result of a 164% increase in the per kg price.

This had the net effect of increasing income per hectare by 36% to US$4,900 per ha. At the same time wheat prices fell so that income per hectare was only US$770 increasing the financial incentive for farmers to grow opium.

Largely as a result of the change in US policy in relation to providing military assistance to eradication teams, the total area of poppy plants destroyed fell again to an insignificant 2,316 ha.

The survey simply provides figures without editorialising them. Though the press release accompanying the survey talks of 'good news' in terms of the number of poppy-free provinces remaining stable no other conclusions are drawn. That may be because the obvious conclusions from the survey are that attempts to limit production of illegal drugs simply increase the income of all those involved in the trade and that people who really know how wars work, the US military hierarchy, have demonstrated their understanding that the 'war on drugs' is unwinnable by refusing to waste military assets on eradication.

The survey is available to download. (Right click to save.)

Exploring the Fault Lines in 'Joined-up Government' - Cannabis & Skiing.
10th October 2010

The UK government commissioned a report into the perception that the ''elf 'n' safety' culture that has spread though the UK in the past decade or so has had a corrosive effect on a range of activities from school sports to traditional village festivals which have run for hundreds of years.

The report's author, former Conservative minister Lord Young, set out his view that the common sense should be put back into safety policy and that attempts to create a completely risk-free world were ridiculous.

Lord Young was interviewed on BBC Radio 4's 'Today' programme and said ‘Frankly, if I want to do something stupid and break my leg or neck, that’s up to me.’ Pressed by Evan Davis to confirm that view, he went on 'haven’t you ever been skiing?'

Anxious to see if this would be principle the government would apply across all policy areas Davis asked, 'So if I want to smoke cannabis, that’s up to me as well, presumably?

‘What principle distinguishes between me doing something dangerous that can break my neck and having a spliff?’

Lord Young's only response was that smoking cannabis is illegal. So, it seems we have the UK government considering changing the law to enshrine the principle that people can decide for themselves what risks to take when it comes to physical activities but blaming the law for not allowing them to apply that same principle to the use of cannabis.

USA Plans Merger of Research Bodies on Drugs and Alcohol
10th October 2010

The USA's National Institutes of Health (NIH) has control over two research bodies, National Institute on Drug Abuse (NIDA) and the National Institute on Alcohol Abuse and Alcoholism (NIAAA). On 15th September, after what some have said has been twelve years of consideration, its Scientific Management Review Board, meeting in Bethesda, Maryland, voted in 12 to 3 in favour of combining the two into a single body focussing on addiction.

Of the two bodies, NIDA is in favour of the merger but the smaller NIAAA is opposed. Some of the arguments on either side are concerned with alcohol research taking second place to 'drugs', countered by a better understanding of the interactions between 'drugs' and alcohol, with some people saying alcohol could actually get access to more research funds and others claiming some scientists, who would have done useful research on alcohol, may be reluctant to be associated with 'drug' use.

As often happens in this sort of situation, it is hard to separate valid concerns from vested interests. On the face of it it does appear to be a good idea in terms of focussing on the harm alcohol does, especially is used in conjunction with other substances. The drinks industry is keeping quiet but, one assumes, would not welcome its products being lumped in with 'drugs'.

There are, naturally, also those who say this is simply a move to cut costs.

It is up to the NIH Director to decide whether to recommend the move to the Secretary of the Department of Health and Human Services for her approval. The US Congress must also be 'advised' but can raise objections that would result in the matter being debated.

Post Release Deaths Amongst Ex-offenders
Added 8th September 2010

Two recent publications have, again, noted the greatly increased risk of death from heroin overdose of persons released from prison in the period immediately following that release.

In June 2009, the World Health Organisation published 'Prevention of acute drug-related mortality in prison populations during the immediate post-release period' (opens new window), which conducts a literature review on the subject and suggests ways in which mortality of recently released offenders can be reduced.

In the September issue, 'Addiction' includes a review entitled 'Meta-analysis of drug-related deaths soon after release from prison', which concludes that prisoners are three to eight times more likely to die in the first two weeks after release than in weeks three to twelve. By focussing on the first twelve weeks after release rather than making a comparison with the general population, this review shows that short-term intervention immediately post-release could have a substantial effect.

The abstract of the Addiction article is available to non-subscribers.   

Clinical Effects of Mephedrone
Added 8th September 2010

The Emergency Medicine Journal has published (online - click to open new window) a paper concerning reports to the UK's National Poisons Information Service (NPIS), in the twelve months from March 2009 to February 2010, about toxicity resulting from mephedrone use.

The NPIS is a service provided for medical professionals to access, and provide, information on poisons. It operates a database, where new case information can be uploaded in addition to accessing existing data, and a telephone advice service. It should be noted that it is not a compulsory system i.e. doctors are under no obligation to contact the NPIS.

The paper found that there were 2901 uses of the database related to cathinone type substances and 188 telephone enquiries. Of these 1664 TOXBASE enquiries and 157 telephone calls were specific to mephedrone. The number of contacts month by month showed a steady increase over the period. The authors looked at the reported clinical features in 131 of the 157 calls. These 131 were the cases where mephedrone had been used alone or with alcohol but no other substance was involved. Symptoms included agitation, tachycardia, confusion, nausea, palpitations, headache and convulsions. In one case, the subject died but post mortem examinations concluded that mephedrone was not responsible.

The authors use their data to conclude that 'Toxicity associated with recreational mephedrone use is increasingly common in the UK'. They do not, however, offer any evidence to support that claim. The month by month contact data are not provided so the trend cannot be seen. They do acknowledge that contacts are more likely to occur with novel substances than with those which are well understood by the doctors dealing with them. Nonetheless, they include the number of reports related to cocaine and MDMA (ecstasy) for the same period, which could lead people to assume that this reflects the levels of use.

There is a further problem in that there is no way to separate the effects of alcohol from those of mephedrone since the 131 cases studied in detail include an unknown number where an unknown amount of alcohol was also consumed.

The danger of a paper of this sort is that it will be used to 'prove' that mephedrone is harmful even though the authors acknowledge that 'Most mephedrone exposures are not associated with severe toxicity'. If anything, the paper confirms how little is understood about the effects of mephedrone especially when compared to the well-understood effects of cocaine and MDMA, in their pure forms.

Charity Says Alcohol Kills More than Heroin
Added 31st August 2010

That is hardly news but the charity concerned, Thames Reach, is referring specifically to homeless people. Its claim, reported in the UK's Observer Sunday newspaper seems to be timed to coincide with three debates which are current in UK politics.

The first is the recent suggestion, which was one of many options put out for comment, that drug addicts who don't keep up their treatment should lose their benefits. The second is the longer-running debate about the introduction of minimum alcohol pricing. The third, and most directly relevant, is about the new government's decision not to go ahead with the previous government's plan to increase tax on cider.

Though deciding that a blanket increase in cider tax would unfairly affect cider apple growers and cider producers, it is understood that the government are considering acting against so-called 'white cider'. White cider contains little real apple content and seems to be designed simply to pack as much alcohol into as little volume as possible. One can of the highest strength white cider contains 4.5 units of alcohol, more than the recommended daily allowance, and can sell for less than 60p.

It is this drink which is the frequent choice of the most socially disadvantaged and especially the homeless that Thames Reach believes is more life-threatening to users than heroin or crack cocaine. It reports that many more of the deaths of people using its hostels are attributable to alcohol than any other cause.

It is hard to understand why these super-strength drinks are produced other than to cause drunkenness as cheaply as possible and the withdrawal from the market by Heineken may increase the pressure on other big name manufacturers to follow suit.

What's in a Name?
Added 24th August 2010

When 'dustmen' became 'refuse collection operatives' there was a certain amount of ridicule but, over time, the title 'refuse collector' has almost completely taken over from 'dustman'. And there are many other examples, some from fact others from the minds of journalists with space to fill, where 'political correctness' has been cited as the reason for changing the names used to refer to particular functions or types of people.

So, when it comes to people whose lives have been adversely affected by their use of substances does it matter whether they are referred to as 'junkies' or 'addicts' or 'druggies' or 'problem users'?

A new report published by the UK Drug Policy Commission thinks it does. 'Sinning and Sinned Against: The Stigmatisation of Problem Drug Users' by Charlie Lloyd is the first part of a four part research study that asks why so much stigma is attached to drug addiction, how it may prevent social reintegration and whether society is ready for a shift towards a more compassionate approach, geared more towards care than punishment?

Lloyd looks at various studies into the effect of stigmatisation, noting that many of these are from the US and that there has been little research in the UK, not just of terms related to substance use but also areas like mental illness and disability.

He finds that even small changes in terminology can have a impact on perception. Even mental health professionals have been found to respond differently to the terms 'being a substance abuser' and 'having a substance abuse disorder'. The former is more likely to lead to identification of the subject as responsible for their condition and to suggest that punitive measures are more likely to be effective.

For some people, use of stigma is claimed to be positive in that they believe that calling someone an 'addict' or an 'abuser' is more likely to encourage them to seek treatment to come back into mainstream society and, also, it is felt that young people will be discouraged from joining a stigmatised group.

Lloyd points out that efforts to use scare tactics to discourage young people from starting to take drugs have been found to be ineffective and that attaching a stigma to a person actually decreases their likelihood to seek treatment.

One study, cited by Lloyd, found that there was even a difference between calling someone a 'substance abuser' rather than a 'substance user'.

With the growing tide in favour of treating problem substance use via the healthcare system rather than the criminal justice system, Lloyd concludes that efforts should be made to change the ways users are referred to so as to encourage them to seek treatment and, in the longer-term, allow them to fully return to normal society. Many people remain characterised as 'ex-drug addicts' many years after they achieve complete abstinence and that means they remain stigmatised and may find difficulty obtaining employment and housing.

Lloyd suggests that there may need to be a celebrity-endorsed campaign to get the media to stop using the most stigmatising terms such as 'junkie' and 'druggies'.

You can access the full report, which begins with a summary of the main findings, by downloading the pdf file.

The UK Drug Policy Commission's website is a useful resource for a find range of reports and information. (Opens new window.)

Many More Calls for Drug Law Reform
Added 17th August 2010

July & August 2010 saw a large increase in the number of people calling for changes in the prohibition based drug laws around the world. Those expressing their opinion that the 'war on drugs' is a harmful failure and another way must be found include a former Mexican president, the UK's Observer newspaper and Angus Macqueen who made a three part television documentary for Channel 4 entitled 'Our Drugs War' in which he explained why his assumption that drug prohibition must be the right approach was demolished when he began to look at the subject in detail.

Also adding his voice to the calls for change was Professor Sir Ian Gilmore, the outgoing president of the Royal College of Physicians, who welcomed, chairman of the Bar Council of England & Wales, Nicholas Green QC's call for decriminalisation of personal use but went further and called for 'a regulatory framework' around drugs.

A year ago, each of these pronouncements would have merited a separate section of this page but, it seems, what were isolated voices calling for change have become a clamour. It may be that the UK has started on a road which will lead to a more sensible way of dealing with the problems caused by substance (ab)use.

Who's Using?
Added 25th July 2010

Two recent reports in the UK, when taken together, illustrate how difficult it is to quantify illegal substance use.

The British Crime Survey (BCS) was established in the hope of getting a clearer view of the actual level of crime because it was recognised that police statistics for reported crime were missing crimes, generally minor in nature, which weren't  being reported to the police. As part of the BCS, a confidential self-report survey of illegal drug use is conducted.

The UK Home Office has just released 'Drug Misuse Declared: Findings from the 2009/10 British Crime Survey'.  The pdf file of the report is available here (opens new window).

The UK National Health Service (NHS) runs the National Treatment Agency for Substance Misuse (NTA) which, in turn, operates the National Drug Treatment Monitoring System (NDTMS) (click to visit website in new window). In February 2010, the NTA published the NDTMS annual report for 2008/9. Click here to access the pdf of the NDTMS annual report (opens new window).

The NTA estimates that there are 330,000 'problem users' of heroin and/or crack cocaine in England and the NDTMS annual report says there were 167,256 adults who received treatment for problem opiate use from a total of 210,815 total 'clients'. This could be taken to suggest that around  260,000 of the 330,000 'problem users' are using opiates. These figures are for England alone.

The BCS, which in spite of being the 'British' Crime Survey has data for only England & Wales, finds that 55,000 people use opiates and estimates the accuracy of its measure as being between 42,000 and 103,000.

Even taking the highest estimate, the BCS is saying opiate use is less than half the NDTMS estimate and, given that the NDTMS has actual data on treatment events which far exceed the BCS estimate you have to conclude that the BCS figures are unreliable.

The NDTMS numbers, however, are also not complete because they ignore opiate users who are not in the 'problem user' category. Now, for opiates, that may not be many but, with something like cannabis, only a tiny percentage of users will be 'problem users' and the NDTMS figures are no help in determining how many people are using cannabis.

So, if the NDTMS figures don't help with estimating cannabis users and if the BCS figures for cannabis are as unreliable as its figures for opiates clearly are, then there really does seem to be no answer to the question 'Who's using?'.

Bar Council Chairman in Call to Legalise 'Personal Use'
Added 29th June 2010

The UK's Bar Council is the organisation which represents, and regulates, barristers. On 29th June 2010, its Chairman, Nicholas Green, sent out a newsletter to members covering a range of topics.

By 19th July, the mainstream press had noted that one paragraph of this newsletter suggests that, if the growing evidence that decriminalising personal use can have positive consequences is correct then it would be 'rational' to pursue such a policy.

The reports draw on the 'usual suspects' to condemn Mr Green and try to paint the picture that he is advocating drug use amongst children. This sort of reaction is expected from the media. In this case its vehemence may be to do with the fact that, elsewhere in the same newsletter, Nick Green welcomes Kenneth Clarke's views on cutting the prison population and, when calling for a 'rational approach' to policy notes that 'A rational approach is not usually the response of large parts of the media when it comes to issues relating to criminal justice'.

The full newsletter, which amounts to just a single page, can be read at The Bar Council's website (opens new window).

Family Smoking Prevention and Tobacco Control Act Starts to Bite
Added 19th July 2010

Using powers granted to it under the 2009 FSPTCA, the U.S. Food and Drug Administration (FDA) introduced rules, effective 22nd June 2010, to outlaw the use of words which have been shown to create the impression that a particular brand is safer. Thus terms like 'light', "mild" and "low tar" are no longer permitted to be used in any way. As a result Marlboro Lights, the most popular brand of cigarettes in the USA, are now Marlboro Gold.

At the same time other rules have been introduced specifically aimed at youth smoking. It is now illegal to sell cigarettes in packs or less than 20 or to split packs to sell a few at a time.

New York Plans Big Increase in Tobacco Taxes.

New York state is to impose an additional $1.60 per pack tax on cigarettes together with increases on other tobacco products. In addition, the rules on monitoring sales by Native Americans to outsiders are to be tightened so that this is not a means of evading the taxes.

UNODC World Drugs Report 2010 - No Change

The United Nations Office for Drugs and Crime (UNODC) issued its 2010 'World Drugs Report' on 26th June. In its central features, it remains very much the same as previous reports.

In his introduction the Executive Director, Antonio Maria Costa, expresses his concern that drug users are being treated inhumanely.

'Around the world, millions of people (including children) caught taking drugs are sent to jail, not to treatment. In some countries, what is supposed to be drug treatment amounts to cruel, inhuman or degrading punishment – the equivalent of torture. In several Member States, people are executed for drug-related offences. In others, drug traffickers are gunned down by extra-judicial hit squads. As human beings, we have a shared responsibility to ensure that this comes to an end. Just because people take drugs, or are behind bars, this doesn’t abolish their right to be a person protected by the law – domestic and international.

He goes on to state that 'drug production and trafficking are both causes and consequences of poverty' and that 'Drug-trafficking has become the main source of revenue for organized crime, as well as to terrorists and insurgents: in other words, drug-related illegality has become a threat to nations in so many theatres around the world'.

The Executive Summary notes that, since 1998 when 'a special session of the UN General Assembly decided to work towards the “elimination or significant reduction” of illicit drug production' worldwide opium production has increased by 78%.

Of the estimated 155-250 million people who use an illegal substance at least once a year it is estimated that up to 38 million of them can be classified as 'problem users' and that the most optimistic view suggests only 30% of these people had access to treatment.

And what is the suggested answer to this situation where millions are being mistreated by their governments, where actions by governments are increasing the earnings of organised crime and terrorists and where up to 25 million people with health problems resulting from their substance use are unable to access treatment of any kind?

The answer, of course, according to Mr Costa, is to ignore 'the renewed calls to dump the three UN drug conventions that critics say are the cause of crime and instability' because 'dumping' the conventions would undo the 'progress' which has been made. 'Progress' which includes, lest we forget, a 78% increase in the production of opium, a significant increase in the adulteration of substances like cocaine and ecstasy and a major switch from the well-known psychoactives to novel formulations like ketamine and mephedrone whose long-term effects are not well understood.

In other words, the 2010 World Drug Report can be summarised in the same terms as it predecessors, 'The policy isn't working - let's have some more of the same policy'.

The full report and ancillary information is available from the UNODC website (opens new window). It is important to treat all the figures given with care. The report notes that collection of reliable data, especially from less-developed countries, is very difficult but then goes on to quote some figures as being accurate to within 100,000.

Dead Teenagers had not Taken Mephedrone

On 28th May 2010, BBC news reported that toxicology tests on two Lincolnshire teenagers whose deaths had been said to be due to mephedrone had shown that neither boy had used the substance. Neither the Humberside police nor the North East Lincolnshire Coroners Court were willing to discuss the case but, it is understood, that further tests are being undertaken to see if anything, other than alcohol, was involved.

It was the deaths of these two youths which led to the Labour government rushing through legislation to make mephedrone, and other cathinone analogues, Class B substances under the Misuse of Drugs Act.

At the time, there was huge press interest in the deaths with detailed and reports and many op-ed pieces opining on the effects of mephedrone. It will be interesting to see how much attention is given to the toxicology results.

Meanwhile, a coroner's court in Brighton has heard how a 46-year old man, who died after injecting large quantities of mephedrone, had a serious pre-existing heart condition which was a factor in his death.

Fungus 'Hits Afghan Opium Poppies'

The BBC says that Antonio Maria Costa, outgoing head of the UN Office on Drugs and Crime, UNODC, has told it that a fungus is attacking this year's opium poppies in Afghanistan and may reduce yield by as much as 25%.

The story contains very little detail. The fungus concerned is not named but it may be Fusarium oxysporum, the fungus that, in the 1960s, the USA used as a biological weapon against Erythroxylum coca plants being grown in Hawaii. Deliberate deployment of the fungus was stopped by President Clinton because he feared it could be seen as a breach of international treaties and lead to other countries developing and deploying biological weapons.

In the early years of the 21st century there were a number of reports of fungii being trialled, or used, against opium crops in Asia. At this time, there is no suggestion that the Afghan problem has been deliberately created.

Costa told the BBC that UNODC believes the farm gate price of opium has risen by 50% as a result of the poor crop. One year's crop failure, however, is unlikely to impact the supply of heroin since someone, usually assumed to be the Taliban, is holding large stocks from previous years' over-production. An increase in prices would boost the income from selling those stocks.

'World No Tobacco Day' to Focus on Women

The World Health Organisation (WHO) has announced that its 2010 'World No Tobacco Day' (31st May) will focus on tobacco use by women, especially in the developing world. This follows reports that tobacco companies are focussing marketing efforts in this area which they see as their "largest unexploited market".

Figures from Bangladesh, for example, suggest that the increase in adult tobacco use from 37% in 2004 to 43% now is due to more women starting to smoke because of marketing messages about tobacco making women more attractive, energetic and smarter.

Officially, tobacco advertising is banned in Bangladesh so the messages are spread by fly-posting, especially in rural areas, and the tobacco companies dent involvement.

It is even reported that the low birth weights associated with smoking during pregnancy are being  positively promoted as resulting in less painful childbirth.

More information on World No Tobacco Day can be found on the WHO website. (opens new window)

Who Said That?

The following are quotes extracted from a newly available 'discussion paper', but can you tell which organisation is behind this document?

Drug dependence is a health disorder (a disease)

In fact, incarceration in prison and confinement in compulsory drug treatment centres often worsens the already problematic lives of drug users and drug dependent individuals, particularly the youngest and most vulnerable

There is considerable evidence that effective drug dependence treatment offering clinical interventions (inpatient or outpatient) as an alternative to criminal justice sanctions substantially increases recovery, including a reduction in crime and criminal justice costs

The most rigorous and conservative scientific estimates from five “meta-analyses” have all concluded that drug courts significantly reduce crime by as much as 35 percent compared to imprisonment.

Treatment as an alternative to criminal justice sanctions is specifically encouraged in the international drug control conventions and it has been found to be more effective than imprisonment in encouraging recovery from drug dependence and reducing drug related crime.

All these quotes come from a draft discussion paper entitled 'From coercion to cohesion' with the subtitle 'Treating drug dependence through healthcare, not punishment'. It comes from the United Nations Office on Drugs and Crime (UNODC) though, it appears, it is not, yet, available from the UNODC website.

It can. however, be obtained from the International Drug Policy Consortium website. (opens new window)

It will be interesting to see if this document survives in its present form to go from draft discussion paper to formal UNODC policy.

[Update The full paper can now be found on the UNODC website (opens new window - pdf file) but it retains the status of a 'discussion paper' rather than being UNODC policy.] 

There are a number of occasions where the paper points out that treatment rather than sanction is encouraged by the UN conventions on drugs and it is true that Article 38 of the 1961 Single Convention on Narcotic Drugs mentions treatment as a means of dealing with 'persons involved' in drug abuse but this comes after Article 36 has said that dealing with serious offences, including possession, should be dealt with by 'adequate punishment particularly by imprisonment'. 

Simon Jenkins on Cannabis in California

One side effect of the travel chaos caused by the Icelandic volcano has been that stranded journalists have had the opportunity to take a closer look at subjects than their normal schedule permits.

The well-known writer and former newspaper editor, Simon Jenkins, took a close look at the 'medical marijuana' situation in California after finding himself stuck in Los Angeles.

His piece in the London Evening Standard (opens new window) finds that the current situation is somewhat confused since, in the right circumstances, use is now legal but supply remains an offence. There are also variations in what constitutes 'medical need'.

In November, California will vote on a proposal to make growth for personal use and possession of up to one ounce completely legal ending the facade of medical need. Ahead of that vote there is the inevitable backlash with moves, at local level, to reassert a more strict control regime.

Jenkins makes a point of stressing that he regards 'cannabis as a potentially dangerous substance for many young people' but concludes that the regime which California may vote for later this year makes a great deal more sense that which makes London home to 'the worst drugs problem in Europe'.   

Heroin on the NHS?

Speaking at the 2010 annual conference of the UK's Royal College of Nursing, Peter Carter, the RCN general secretary, said heroin should be available to addicts on the NHS. Three very small trials, involving 127 addicts in total, had shown that crime was substantially reduced if users didn't need to steal to score. As part of the trial, users were also offered a range of support services which helped them bring their lifestyles under control.

Given the pressure on public spending in the UK, Mr Carter pointed out that the trials indicated that there could be a net saving to the NHS by reducing the incidence of needle based infections and, generally, improving the health of addicts.

Aside from one or two objections from those who think solving substance abuse problems is simply about locking people up so they can't get substances. the reaction to Mr Carter's remarks has been favourable, though muted. That may be because, in the final stages of the UK's general election campaign, none of the three main parties wants this subject on the agenda.

The leaders of both the Conservative and Liberal/Democrat parties have, in the past, endorsed action to reduce the harshness of the Misuse of Drugs Act but would rather that does not become prominent in the campaign.

The current Prime Minister, Gordon Brown, has shown an arrogant disregard for scientific advice on drugs policy. This contempt for other opinions has got him into trouble and, thus, he has no wish to remind people of it by commenting on more expert advice that the current situation increases both harms and costs.

How Widespread is Combined Use of Cocaine and Alcohol?

It has been known for some time that cocaethylene, the unique metabolite resulting from use of cocaine and alcohol at the same time, is potentially much more harmful that the metabolites arising from cocaine use alone.

Now the Alcohol Education and Research Council (AERC)'s 'Alcohol Academy' has published a briefing paper looking into cocaethylene, 'Cocaethylene - responding to combined alcohol and cocaine use' (opens new window).

The paper finds that detailed evidence is lacking but it seems certain that there is a high level of combined substance use, intentionally to enhance and prolong the effects of cocaine, but only a low level of the increased risks arising.

The authors call for much more study of combined use noting that attention is often concentrated solely on the illegal substance use.

In 2008, of 235 deaths where cocaine was mentioned as a principal cause, 75 also mentioned alcohol.

UNODC Revises 'Cannabis Laws' Web Page 

Some time ago, I reported how UNODC had deleted a part of one of its own web pages which suggested that the total prohibition of cannabis was not effective. (Click here to read that entry.)

UNODC has now published a completely new 'Part 4' (opens new window) which follows the hard line on cannabis much more closely with great emphasis being placed on its illegal status and alleged harms. It also claims, against almost all available evidence, that cannabis's illegal status reduces its use.

For UNODC to recognise, as the previous version of this page did, that the current regime, based on prohibition, isn't working would be a bit like turkeys voting for Christmas so it is no surprise that it prefers to adhere to the strict reading of the single conventions. It is, nonetheless, a little disappointing.

What's in That?

A new report 'Cut - A Guide to the Adulterants, Bulking agents and other Contaminants found in illicit drugs' offers the first detailed study of what does actually get added to drugs to either bulk them up or change their effects.

The authors say there is little evidence of harmful substances being deliberately added which, as they say, would be a bizarre way for suppliers to act but they do note that many substances which are added are harmful in their own right and that poor manufacturing controls can lead to contamination. The present anthrax outbreak amongst heroin users is, probably, more to do with unhygienic processing that anything else.

Some examples are, however, given of adulteration for profit, such as lead in cannabis as a means of increasing the saleable weight and it is reported that up to 10% of cannabis seizures in the UK have glass present.

The report concludes that substances may be intentionally adulterated for a variety of reasons or contaminated by poor manufacturing practice. It also notes that too little attention is paid to identifying and quantifying adulterants in seized samples where the amount of the illegal substance is, generally, the only concern.

The report stops short, however, of the obvious conclusion that the way to control adulteration and contamination of drugs is to apply quality standards to manufacture within a regulated regime.

Medical Marijuana and the Law

An interesting piece in The New England Journal of Medicine written by Diane E. Hoffmann, J.D., and Ellen Weber, J.D. looks at the, frankly chaotic, situation in the USA over the use of cannabis for medical purposes. The authors note that nothing in any of the state laws being passed to allow for the use of 'medical marijuana' lays down any standards for quality or potency and that many whilst allowing the use of cannabis still prohibit its growth and take no line on whether it may be sold to patients.

They also note that the recent announcement that the Federal Government will not pursue users if they conform to state laws is, simply, an informal guideline and could be reversed at any time.

My fear is that approaching the question of cannabis use for medicinal purposes in such a piecemeal way is likely to result in more harm than good.

Anthrax Update

16th April 2010. The death toll in Scotland as a result of anthrax infected heroin has reached twelve with the latest victim coming from Lanarkshire. A total of 35 people are now known to have been infected.

See below for previous stories on this outbreak.

Health Protection Scotland has established a separate website with full information on the outbreak. (opens new window)

Money well spent?

The UK's House of Commons Committee of Public Accounts has published 'Tackling problem drug use' (pdf file, opens new window) the result of its investigation into the £1.2bn a year spent on trying to reduce the number of people, especially the young, who become problem drug users and reduce the estimated £13.9bn annual cost of drug related crime.

It's an understatement to say that the committee are not impressed. Its first conclusion is 'The Government spends £1.2 billion a year on measures aimed at tackling problem drug use, yet does not know what overall effect this spending is having.'

Finally, after pressure from the National Audit Office, the Home Office is to produce 'an overall framework to evaluate and report on the value for money achieved from the strategy' but this 'framework' is not expected to be available before late 2011 so it will be some time after that before useful data is collected.

For many people, one possible explanation for the absence of any proof that the government's drug strategy is working is that it knows it is not so does not want the spotlight turned on the failure to deal with substance use using prohibition as the main weapon.

Mephedrone - Unforeseen Consequences

The UK's Advisory Council on the Misuse of Drugs (ACMD) is a group of (unpaid) independent scientific experts whose role is to consider and summarise the scientific evidence about substances of abuse and advise the government on the action to be taken.

The ACMD is a statutory body, that is its composition, activities and responsibilities are set down in law.

When two teenage boys died after, allegedly, taking mephedrone, there were immediate calls for it to be brought within the Misuse of Drugs Act. The Home Office was faced with a problem, however. The ACMD was already engaged in a project to look at mephedrone and other 'legal highs' but its work was not due to be completed before the summer and had suffered delays following the sacking of the former chairman and the subsequent resignation of a number of members.

Happily, for the government, the new chairman has a less well-developed understanding of what independent scientific advice means and he colluded with the Home Secretary to bring forward the ACMD's recommendations to the 29th March. Apparently, only one obstacle remained; the ACMD was legally inquorate after the resignations. The simple answer to this was to announce three new appointments on the same day and to claim that the appointees had attended ACMD meetings as guests and were 'up to speed' on the issues.

This blatant manipulation of the rules in order to take action based on media hysteria, not science, might have succeeded had not Dr Polly Taylor resigned from the ACMD at the weekend. Dr Taylor is a vet, the only one on the ACMD, and having a vet on the committee is a statutory obligation.

Mr Alan Johnson, the UK Home Secretary, did not let the law stand in the way of his announcement and, as expected, announced that mephedrone, together with all cathinone derivatives, would be classified as Class B substances. The changes in the law are to be rushed through parliament before its dissolution for the general election.

What's interesting about this affair is the widespread reaction to the government blatantly ignoring its own laws and moving to ban these substances when there has not, yet, been a single instance where mephedrone has been shown to be the principal cause of death.

Many commentators are questioning the fundamental process of banning substances as a way of reducing drug use and concluding that passing a new market over to criminals is not a sensible way to proceed.

Though not everyone has made this point, a number of people have pointed out that the attraction of mephedrone is based on its purity when compared with the highly diluted/contaminated products which pass for 'cocaine' and ecstasy.

Far from reassuring the public that it knows how to deal with substance use/abuse, the government seems to have brought many new voices into the debate about the important differences between the harms caused by substances and the harms caused by their prohibition.

A word on mephedrone
I don't know if mephedrone is harmful and, if so, what are the circumstances in which harm can arise. But then, nor does anyone else because mephedrone has not been studied in enough detail to know these things.

Some people are claiming that mephedrone's popularity is based on its legality. Everything I've read from users themselves indicates that people have turned to mephedrone because they no longer get the results they are looking for from 'cocaine' and 'ecstasy' sold on the street.

The UK parliament's Home Affairs Select Committee, in a recent report, noted that some seizures of 'cocaine' contained less that 5% of the alkaloid, cocaine. In Hampshire, police were forced to release two young men, without charge, after analysis showed that the 1,000 or so 'ecstasy' pills they were taking to a town centre contained no MDMA, the chemical (methylenedioxymethamphetamine) which is supposed to be the sole constituent of ecstasy.

The New Scientist has an excellent article about mephedrone including its effects and some of the myths being spread about it. Click here to open the article in a new window.