tag:theconversation.com,2011:/au/topics/amphetamines-26014/articlesAmphetamines – The Conversation2024-01-02T16:50:06Ztag:theconversation.com,2011:article/2196582024-01-02T16:50:06Z2024-01-02T16:50:06ZA brief history of drug-fuelled combatants<p>My friend Luke used to drink a pint of beer before a game of rugby. I don’t know whether he thought that it might reduce pain or improve performance, but the idea of taking drugs before “going into battle” goes back to the beginning of recorded history. </p>
<p>Indeed, we find frequent mentions of mead drinking by the warriors in Edinburgh in the seventh-century epic poem <a href="https://www.maryjones.us/ctexts/a01a.html">The Goddodin</a>. These warriors feasted and drank mead for a year before riding out to their certain deaths in a hopelessly one-sided battle in Yorkshire. Similarly, Anglo-Saxon warriors were very fond of their mead-halls – think <a href="https://www.britannica.com/topic/Beowulf">Beowolf</a>. </p>
<p>These ancient warriors probably used alcohol to <a href="https://www.theguardian.com/books/2016/jun/10/shooting-up-history-drugs-warfare-luke-kamienski-review">reduce anxiety</a> and blunt the horrors they would face on the battlefield. </p>
<p>Other ancient cultures turned to psychoactive substances before doing battle. The berserkers were a gang of Viking warriors renowned for going into battle in a frenzied state, almost fighting friend and foe indiscriminately. They are believed to have used <a href="https://www.sciencedirect.com/science/article/abs/pii/S0378874119322640?via%3Dihub">hallucinogenic mushrooms</a> to achieve this state. Probably the red-capped <em>Amanita muscaria</em> or possibly a plant called <em>Hyoscyamus niger</em> – a member of the nightshade family. Although there would undoubtedly also have been a <a href="https://journals.sagepub.com/doi/10.1177/0957154X211014115">religious or spiritual</a> element to their mental state. </p>
<figure class="align-right ">
<img alt="A chess piece depicting a berserker biting his shield." src="https://images.theconversation.com/files/567548/original/file-20240102-23-dl0k0y.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/567548/original/file-20240102-23-dl0k0y.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=824&fit=crop&dpr=1 600w, https://images.theconversation.com/files/567548/original/file-20240102-23-dl0k0y.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=824&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/567548/original/file-20240102-23-dl0k0y.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=824&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/567548/original/file-20240102-23-dl0k0y.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1036&fit=crop&dpr=1 754w, https://images.theconversation.com/files/567548/original/file-20240102-23-dl0k0y.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1036&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/567548/original/file-20240102-23-dl0k0y.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1036&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">A chess piece depicting a berserker biting his shield.</span>
<span class="attribution"><a class="source" href="https://commons.wikimedia.org/w/index.php?curid=83115528">National Museums Scotland/Wikimedia Commons</a>, <a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></span>
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<p>Perhaps the next major advance in psychoactives for warriors was by the Germans in the second world war. <a href="https://www.amusingplanet.com/2020/05/pervitin-wonder-drug-that-fueled-nazi.html">Pervitin</a> (methamphetamine) was given almost freely to all arms of the German war machine. </p>
<p>The frontline Nazis called them <em>Panzerschokolade</em> (tank chocolate), due to the feelings of incredible strength and invincibility that the pills gave them. Hitler’s doctor gave him daily injections of <a href="https://www.wbur.org/news/2017/03/30/norman-ohler-blitzed">Eukodol</a>, a stimulant causing euphoria and, clearly, terrible judgment.</p>
<p>Similarly, the US army in the Vietnam war (or the <a href="https://www.theatlantic.com/health/archive/2016/04/the-drugs-that-built-a-super-soldier/477183/">“first pharmacological war”</a>) took unprecedented amounts of the amphetamine Dexedrine (“pep pills”). There were army instructions to take 20mg for 48 hours of combat readiness, but veterans report taking the drug “like candy”. </p>
<p>Jumping forward 60 years we find the combatants in the <a href="https://www.cambridge.org/core/journals/bjpsych-international/article/tramadol-captagon-and-khat-use-in-the-eastern-mediterranean-region-opening-pandoras-box/8E56B05DF8C6102E745F3F52151DE1F7">Middle East</a> continuing to use amphetamines, this time mostly a stimulant called Captagon – the manufacture of which makes up <a href="https://www.spectator.co.uk/article/how-syria-became-the-worlds-most-profitable-narco-state/">the bulk of Syria’s foreign income</a>.</p>
<h2>Behavioural effects</h2>
<p>The types of drugs taken by warriors can be lumped into <a href="https://www.medicalnewstoday.com/articles/types-of-psychoactive-drugs#types">three broad categories</a>: depressants, hallucinogens and stimulants. </p>
<p>Alcohol is a depressant that <a href="https://pubmed.ncbi.nlm.nih.gov/8094255/">calms the nerves</a> by reducing brain activity. Psychedelic mushrooms such as <em>Amanita muscaria</em> contain a variety of psychoactive substances. <em>Hyoscyamus niger</em> also has a variety of active compounds that cause hallucinations and, importantly, <a href="https://pubmed.ncbi.nlm.nih.gov/25386392/">aggressive and combative behaviour</a>.</p>
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<img alt="Amanita muscaria or " src="https://images.theconversation.com/files/567552/original/file-20240102-19-dvo2it.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/567552/original/file-20240102-19-dvo2it.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/567552/original/file-20240102-19-dvo2it.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/567552/original/file-20240102-19-dvo2it.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/567552/original/file-20240102-19-dvo2it.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/567552/original/file-20240102-19-dvo2it.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/567552/original/file-20240102-19-dvo2it.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Berserkers are thought to have eaten Amanita muscaria mushrooms.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/amanita-muscaria-red-white-spotted-poisonous-2214997525">ON-Photography Germany/Shutterstock</a></span>
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<p>It would be important for combatants to take the correct dose of these drugs; just enough to take the edge off. Too much might leave the person stupefied. The word “groggy” meaning dazed and unsteady came from <a href="https://militaryhealth.bmj.com/content/jramc/130/1/12.full.pdf">British navy sailors</a> exhibiting this behaviour after their daily ration of rum and water (grog). Intoxication in the 18th and 19th-century British navy was common.</p>
<p>Methamphetamine, Pervitin, Dexedrine and Captagon are all <a href="https://psycnet.apa.org/record/2020-11903-000">psychomotor stimulants</a>, that is they increase alertness and cause hyperactivity. Again, the dose of some of these drugs would be critical. Although it would be difficult to take too much nicotine and caffeine, mild stimulants that soldiers often take, it would be quite easy to overdose on the other stimulants. </p>
<p>Taking the correct dose of amphetamines would increase aggression and stamina, but high doses of amphetamines could lead to <a href="https://pubmed.ncbi.nlm.nih.gov/35894470/">paranoia and hallucinations</a> – hardly beneficial in a battle. </p>
<p>Ultimately, stimulants, if taken at very high doses, could lead to <a href="https://pubmed.ncbi.nlm.nih.gov/18279535/">cardiac arrest or stroke</a>. The stimulants, but especially methamphetamine, would also lead to significant <a href="https://pubmed.ncbi.nlm.nih.gov/8363202/">weight loss</a> even after only a few days of use. Long-term use, as we saw with the Nazis, would probably lead to emaciated soldiers. </p>
<h2>Smart drugs</h2>
<p>We have seen that soldiers take drugs before battles to calm nerves, deal with the horrors, reduce pain, tolerate lack of food and sleep and improve alertness. What will the soldiers of the future take? Probably not alcohol or mushrooms, more likely cognitive enhancers – known as “smart drugs” or “nootropics”. </p>
<p>The use of cognitive enhancers by <a href="https://pubmed.ncbi.nlm.nih.gov/33802176/">students</a> is well known and these might include low-dose stimulants and nootropics. </p>
<p>The stimulants include drugs such as amphetamine salt mixtures, methylphenidate and modafinil, while nootropics include piracetam, caffeine, cobalamin (vitamin B12), guarana, pyridoxine (vitamin B6) and vinpocetine. The pharmacological effects of the nootropics are largely unknown. </p>
<p>The integration of humans, technology and machines is thought to be the future of warfare and <a href="https://pubmed.ncbi.nlm.nih.gov/28720188/">drugs that facilitate</a> this are undoubtedly being researched by the military. </p>
<h2>Post-traumatic stress disorder</h2>
<p>So far, we have discussed drugs taken before or during combat, but what about afterwards? </p>
<p>There is a long history of soldiers taking alcohol and other drugs to deal with the horrors of what they have seen, or the disappointment of life after leaving the army. Think Tom Cruise in <a href="https://www.imdb.com/title/tt0096969/">Born on the 4th of July</a>.</p>
<p>But there is an emerging new cohort of ex-military drug takers. These veterans are taking <a href="https://pubmed.ncbi.nlm.nih.gov/34708874/">MDMA</a> and <a href="https://pubmed.ncbi.nlm.nih.gov/35711024/">psilocybin</a> on doctors’ orders as part of their treatment for PTSD. </p>
<p>It is thought that these drugs help the veterans open up about their experiences and form a stronger therapeutic alliance with their doctor, critical for psychotherapy to work. </p>
<p><a href="https://pubmed.ncbi.nlm.nih.gov/35688035/">Ketamine</a> is useful for treating depression and <a href="https://pubmed.ncbi.nlm.nih.gov/31636488/">LSD</a> is also being tested for various psychiatric disorders. </p>
<p>The relationship between combatants and psychoactive drugs is an old one and looks certain to continue.</p><img src="https://counter.theconversation.com/content/219658/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Colin Davidson has previously received funding from the US National Institute on Drug Abuse (NIDA). He is a consultant with the Defence Science and Technology Laboratory (UK).</span></em></p>From mead to magic mushrooms to methamphetamine – drugs have always fuelled battles.Colin Davidson, Professor of Neuropharmacology, University of Central LancashireLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1982232023-04-07T12:17:48Z2023-04-07T12:17:48ZMisuse of Adderall promotes stigma and mistrust for patients who need it – a neuroscientist explains the science behind the controversial ADHD drug<figure><img src="https://images.theconversation.com/files/519639/original/file-20230405-28-mn3qts.jpg?ixlib=rb-1.1.0&rect=110%2C100%2C6599%2C4345&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Many people with ADHD are finding it difficult to get their Adderall prescriptions filled amid the shortage.</span> <span class="attribution"><a class="source" href="https://newsroom.ap.org/detail/Adderall%20Shortage/59cf79948b4e43d388ac283673aff1b5?Query=adderall&mediaType=photo&sortBy=&dateRange=Anytime&totalCount=218&currentItemNo=5">AP Photo/Jenny Kane</a></span></figcaption></figure><p>The <a href="https://www.npr.org/sections/health-shots/2023/02/18/1157832613/adderall-shortage-forces-some-patients-to-scramble-ration-or-go-without">nationwide shortages of Adderall</a> <a href="https://www.nytimes.com/2022/10/13/health/adderall-shortage-adhd.html">that began in fall 2022</a> have brought renewed attention to the beleaguered drug, which is used to treat <a href="https://www.cdc.gov/ncbddd/adhd/facts.html#">attention-deficit/hyperactivity disorder</a> and <a href="https://www.ninds.nih.gov/health-information/disorders/narcolepsy#">narcolepsy</a>. </p>
<p>Adderall became a go-to drug for ADHD over the past two decades but quickly came under fire <a href="https://www.advisory.com/daily-briefing/2022/05/05/adderall">because of overprescription</a> and <a href="https://americanaddictioncenters.org/adderall/symptoms-of-abuse">misuse</a>. In some cases, people who do not have <a href="https://publichealth.jhu.edu/2016/adderall-misuse-rising-among-young-adults">a proper ADHD diagnosis</a> are <a href="https://americanaddictioncenters.org/adderall/adderall-abuse-among-college-students">using the drug</a> for its <a href="https://theconversation.com/stimulants-using-them-to-cram-for-exams-ruins-sleep-and-doesnt-help-test-scores-123661">perceived cognitive-enhancing effects</a>, leading to an <a href="https://www.samhsa.gov/data/report/dawn-report-emergency-department-visits-involving-attention-deficithyperactivity-disorder">increase in its abuse rates</a> and drug dependence. </p>
<p>Not only has misuse of Adderall led to its <a href="https://www.buzzfeednews.com/article/kelseyweekman/adderall-shortage-adhd-tiktok-telehealth-stigma">stigmatization as a drug of abuse</a>, it can also lead to <a href="https://doi.org/10.1016/j.drugalcdep.2017.09.033">negative physical side effects</a>, including cardiovascular complications, sleep disturbances and <a href="https://doi.org/10.1097/nmd.0000000000000551">addiction</a>.</p>
<p>I am a <a href="https://neuroscience.ufl.edu/profile/khoshbouei-habibeh/">neuroscientist with a focus on studying the dopamine system</a> in <a href="https://www.semanticscholar.org/author/Habibeh-Khoshbouei/50196943">both the brain and peripheral immune system</a>. My research specifically examines the short- and long-term effects of psychostimulant drugs like methamphetamine on a protein that transports dopamine, a chemical messenger that is not properly regulated in people with ADHD. </p>
<p>Through this work, I aim to better understand the complex interplay between drug use and the dopamine system, which may ultimately lead to new treatments for drug addiction and related disorders. Unfortunately, I’ve seen that the stigma and false narratives surrounding Adderall have made it more difficult for patients who need this medication to access it.</p>
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<iframe width="440" height="260" src="https://www.youtube.com/embed/kWAz1ZHzu2o?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">A surge in demand for Adderall during the pandemic along with supply chain issues have led to a nationwide shortage.</span></figcaption>
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<h2>How Adderall treats ADHD</h2>
<p>Adderall is the commercial name of <a href="https://doi.org/10.1177%2F0269881113482532">a mixture of a few types of amphetamines</a>, which are stimulants that increase dopamine levels in the brain to help address deficits in those with ADHD.</p>
<p>The underlying processes that lead to ADHD are poorly understood. The core symptoms include hyperactivity, inattention, mood swings, temper, disorganization, stress sensitivity and impulsivity. </p>
<p>Multiple studies suggest that <a href="https://doi.org/10.1111/j.1749-6632.2001.tb05770.x">these symptoms may be due to</a> the <a href="https://doi.org/10.1523/jneurosci.6033-11.2012">improper regulation of dopamine levels in the brain</a>. </p>
<p>Neurons have a protein called dopamine transporter that normally functions like a vacuum cleaner that sucks the chemical into the neuron. But people with ADHD have a leaky dopamine transporter, meaning that dopamine gets pushed out of the neuron into the surrounding environment of the synapse – the space between neurons where chemical messages are passed back and forth. </p>
<p>Adderall is thought to work by <a href="https://doi.org/10.1523%2FJNEUROSCI.6033-11.2012">blocking this leaky protein</a>, <a href="https://doi.org/10.1523%2FJNEUROSCI.0473-08.2008">preventing dopamine from spewing out</a> of the neuron through the dopamine transporter. This is thought to <a href="https://doi.org/10.1016/j.eclinm.2022.101524">stabilize dopamine levels</a> in the brain of ADHD patients, thus reducing their debilitating symptoms.</p>
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<iframe width="440" height="260" src="https://www.youtube.com/embed/5fYetx-UNEI?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">Adderall helps stabilize dopamine levels in the brains of people with ADHD.</span></figcaption>
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<h2>The paradoxical effects of Adderall</h2>
<p>People who don’t have ADHD usually have a functioning dopamine transporter that is able to maintain balanced levels of this chemical inside and outside of the neuron. When they use amphetamines like Adderall, however, the drug can disrupt the transporter’s ability to remove dopamine from the synapse as well as cause it to work backward and push dopamine out of the neuron. This results in <a href="https://doi.org/10.1038%2Fs41531-021-00161-2">too much dopamine in the synapse</a>, which can lead to feelings of euphoria and increased wakefulness. </p>
<p>While these effects might sound good on the surface, misusing the drug is problematic because it can lead to cardiovascular problems. <a href="https://doi.org/10.1001/jamanetworkopen.2022.43597">Current evidence</a> suggests that Adderall doesn’t significantly increase cardiovascular disease risk for people with ADHD. But people without ADHD who misuse Adderall can develop a dependence on the drug and take it at dangerous dosages.</p>
<p>Adderall misuse doesn’t just involve a harmful cycle that reinforces its use because of its rewarding effects. It also reinforces dependence by causing negative emotional states some researchers have dubbed the “<a href="https://doi.org/10.1097%2FNMD.0000000000000551">dark side” of addiction</a>. Excessive activation of the brain’s reward system disrupts how it normally functions, resulting in a decrease in overall sensitivity to reward signals. It also leads to persistent activation of the brain’s stress systems, which results in feelings of anxiety and restlessness in the absence of the drug.</p>
<h2>Adderall works when you need it</h2>
<p>Other drugs like methylphenidate, known by the brand name Ritalin, also treat ADHD by targeting the dopamine transporter.</p>
<p>While Adderall and Ritalin reduce the hyperactive, impulsive and inattentive symptoms in people with ADHD by stabilizing dopamine levels, they do so <a href="https://doi.org/10.1016%2Fj.neubiorev.2018.02.001">using different mechanisms</a>. Ritalin reduces the dopamine transporter’s leakiness by directly blocking entry. Adderall also reduces leakiness, but by competing with dopamine for entry into the transporter.</p>
<p>In people without ADHD, both Ritalin and Adderall significantly increase brain dopamine and induce euphoria, hyperactivity and other symptoms. However, both drugs are equally beneficial to patients with ADHD. </p>
<p>To treat anxiety, depression, narcolepsy and other neuropsychiatric diseases, <a href="https://doi.org/10.1016/s2215-0366(21)00292-3">millions of patients worldwide</a> take <a href="https://www.nimh.nih.gov/health/topics/mental-health-medications">medication that targets the transport</a> of dopamine and other neurotransmitters like norepinephrine and serotonin, but their use is not stigmatized by recreational misuse.</p>
<p>Because of the euphoria-inducing properties and hyperactivity that Adderall can induce for those who do not need the drug, its misuse and abuse have unfortunately promoted false narratives about Adderall for those who do need it. For ADHD patients, however, it can reduce negative symptoms and greatly improve quality of life.</p><img src="https://counter.theconversation.com/content/198223/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Habibeh Khoshbouei does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>For those who need it, Adderall and other stimulants can be game-changing medications that help restore the chemical imbalances underlying ADHD. But for those who don’t, these drugs can be harmful.Habibeh Khoshbouei, Professor of Neuroscience, University of FloridaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1637562021-07-06T22:03:48Z2021-07-06T22:03:48ZFish hooked on meth – the consequences of freshwater pollution<figure><img src="https://images.theconversation.com/files/409852/original/file-20210706-13-d05bln.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C2650%2C1662&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/underwater-photo-brown-trout-salmo-trutta-102700592">Kletr/Shutterstock</a></span></figcaption></figure><p>Around <a href="https://www.unodc.org/unodc/en/data-and-analysis/wdr2021.html">269 million people worldwide</a> use drugs each year. Often forgotten in this story is a problem of basic biology. What goes in must come out. Sewers are inundated with drugs that are excreted from the body, along with the broken down chemical components that have similar effects to the drugs themselves.</p>
<p>Sewage treatment plants don’t filter these things out – they were never designed for it. A lot of sewage also finds its way into <a href="https://www.theguardian.com/environment/2020/jul/01/water-firms-raw-sewage-england-rivers">rivers and coastal waters untreated</a>. Once in the environment, drugs and their byproducts can affect wildlife. In <a href="https://journals.biologists.com/jeb/article-lookup/doi/10.1242/jeb.242145">a recent study</a> published in the Journal of Experimental Biology, researchers in the Czech Republic investigated how methamphetamine – a stimulant with <a href="https://www.unodc.org/wdr2017/press/WDR17_Fact_sheet.pdf">a growing number of users</a> worldwide – might be affecting wild brown trout.</p>
<p>They examined whether concentrations of methamphetamine and one of its byproducts, amphetamine, which were estimated from other studies that have measured illicit drug concentrations in waterways, could be detected in the brains of brown trout. They also looked at whether these concentrations were enough to cause the animals to become addicted. </p>
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<img alt="White methamphetamine crystals on a black background with a glass meth pipe." src="https://images.theconversation.com/files/409868/original/file-20210706-27-y359uz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/409868/original/file-20210706-27-y359uz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=401&fit=crop&dpr=1 600w, https://images.theconversation.com/files/409868/original/file-20210706-27-y359uz.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=401&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/409868/original/file-20210706-27-y359uz.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=401&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/409868/original/file-20210706-27-y359uz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=505&fit=crop&dpr=1 754w, https://images.theconversation.com/files/409868/original/file-20210706-27-y359uz.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=505&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/409868/original/file-20210706-27-y359uz.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=505&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Recreational methamphetamine users often smoke crystal meth.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/small-pile-methamphetamine-crystals-blue-glass-1314852365">AMF Photography/Shutterstock</a></span>
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<p>The trout were exposed to the drug in large tanks over eight weeks and then put into withdrawal, going “cold turkey” in drug-free tanks for ten days. During that time, the researchers tested the fish’s preference for fresh water or water containing methamphetamine and compared this with the responses of fish that had never been exposed to the drug. </p>
<p>Their findings were intriguing. The methamphetamine-exposed fish preferred the water containing the drug, while no such preference was shown for the untreated fish. The researchers also found that during their withdrawal period, the methamphetamine-exposed trout moved less. The researchers interpreted this as a sign of anxiety or stress – typical signs of drug withdrawal in humans. </p>
<p>The brain chemistry of the exposed fish differed from the unexposed, too, with several detected changes in brain chemicals that correspond to what is seen in cases of human addiction. Even after the behavioural effects had waned after ten days of withdrawal, these markers in the brain were still present. This suggests that methamphetamine exposure could have long-lasting effects, similar to what is seen in people.</p>
<h2>How drugs affect ecosystems and fish biology</h2>
<p>Why should we care if trout are becoming addicted to drugs? There are several reasons.</p>
<p>If the trout are “enjoying” the drugs, as they appear to be in the recent study, they may be inclined to hang around pipes where effluent is discharged. We know that fish can <a href="https://www.sciencedirect.com/science/article/pii/S0301008221000071">behave</a> similarly to what is seen in humans suffering from addiction, not only from this trial, but from several studies on different fish species. One of the hallmarks of drug addiction is a loss of interest in other activities – even those that are usually highly motivated, such as eating or reproducing. It’s possible that the fish might start to change their natural behaviour, causing problems with their feeding, breeding and, ultimately, their survival. They may, for instance, be less likely to evade predators.</p>
<p>Exposure to drugs not only affects the fish themselves, but their offspring. In fish, addiction can be inherited over <a href="https://www.sciencedirect.com/science/article/pii/S0166445X14000265">several generations</a>. This could have long-lasting implications for ecosystems, even if the problem was fixed now.</p>
<p>This is not the first study to find illicit drugs in wildlife. In 2019, scientists in the UK reported <a href="https://www.sciencedirect.com/science/article/pii/S0160412019307160">cocaine</a> in freshwater shrimp in all 15 rivers they sampled. Interestingly, they detected illicit drugs more often than some common pharmaceuticals. </p>
<p>But the wider effects of those drugs remain largely unknown. There have, however, been comprehensive studies into the effects of pharmaceuticals in rivers. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/five-ways-fish-are-more-like-humans-than-you-realise-157929">Five ways fish are more like humans than you realise</a>
</strong>
</em>
</p>
<hr>
<h2>Pharmaceutical pollution</h2>
<p>Medicines do not fully break down in our bodies either and arrive at wastewater treatment plants in faeces and urine. Most are discharged with wastewater effluent, but some enter rivers by seeping from landfills or farm fields where human sewage is used as fertiliser. Wildlife living in rivers and coastal waters where effluent is discharged are exposed to cocktails of medicines, from painkillers to antidepressants.</p>
<p>Caged fish downstream of some water treatment plants changed sex from male to female <a href="https://www.tandfonline.com/doi/abs/10.1080/02757549408038554">within a few weeks</a> due to exposure to hormone-disrupting chemicals found in contraceptive pills. Recent studies have shown that antidepressants can cause a wide range of behavioural changes in aquatic organisms from <a href="https://www.sciencedirect.com/science/article/abs/pii/S0045653517302370?via%3Dihub">aggression</a>, <a href="https://www.sciencedirect.com/science/article/abs/pii/S0166445X10002122">attraction to light</a> and <a href="https://pubmed.ncbi.nlm.nih.gov/23413353/">increasing boldness</a>.</p>
<p>Drug addiction is a global health concern that can devastate communities, and tackling its environmental consequences will be expensive. One study has estimated it would cost <a href="https://www.nature.com/articles/485441a">over US$50 billion</a> (£36 billion) to upgrade wastewater treatment plants in England and Wales so that they can remove these chemicals. </p>
<figure class="align-center ">
<img alt="Water flowing out of a concrete grate into a river." src="https://images.theconversation.com/files/409876/original/file-20210706-19-175dya5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/409876/original/file-20210706-19-175dya5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=200&fit=crop&dpr=1 600w, https://images.theconversation.com/files/409876/original/file-20210706-19-175dya5.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=200&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/409876/original/file-20210706-19-175dya5.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=200&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/409876/original/file-20210706-19-175dya5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=251&fit=crop&dpr=1 754w, https://images.theconversation.com/files/409876/original/file-20210706-19-175dya5.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=251&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/409876/original/file-20210706-19-175dya5.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=251&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Drugs can’t be filtered from sewage without significant upgrades to existing infrastructure.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/processed-cleaned-sewage-flowing-out-water-1860614533">Marekuliasz/Shutterstock</a></span>
</figcaption>
</figure>
<p>It might seem obvious that prescribed and illegal drugs designed to change behaviour in humans also change the behaviour of wildlife. But this problem is potentially far more widespread and complex. We don’t even know if synthetic chemicals in everyday household products, such as cosmetics, clothes and cleaning agents, can affect the behaviour of people and other species. An international group of scientists has urged <a href="https://pubs.acs.org/doi/10.1021/acs.est.0c06493">companies and regulating bodies</a> to check their toxic effect on behaviour as part of risk assessments of new chemicals. </p>
<p>We must get to grips with the amount of pharmaceuticals in our waterways. The world is some way from fixing the problems of addiction and illicit drug use. But, at the very least, more should be done to improve filtration in sewage treatment plants, and to force water companies to take more responsibility for ensuring effluent doesn’t affect wildlife.</p><img src="https://counter.theconversation.com/content/163756/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Matt Parker receives funding from NC3Rs (UK), Ministry of Defence (UK), Alzheimer's Research UK, Foundation for Liver Research (UK), European Commission (INTERREG). </span></em></p><p class="fine-print"><em><span>Alex Ford receives funding from the Natural Environment Research Council (NERC) and the EU Interreg program (REDPOL & Horti-BlueC)</span></em></p>Chemicals in drugs can be excreted unchanged, infiltrating waterways via sewage and effluent.Matt Parker, Senior Lecturer in Neuroscience and Psychopharmacology, University of PortsmouthAlex Ford, Professor of Biology, University of PortsmouthLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1172362019-05-24T13:02:13Z2019-05-24T13:02:13ZDoping soldiers so they fight better – is it ethical?<figure><img src="https://images.theconversation.com/files/276123/original/file-20190523-187176-1bdn0zf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">A waxwork of Captain America on display at Madame Tussauds in Bangkok, Thailand. </span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/bangkok-july-22-waxwork-captain-america-302674247?src=uDJsZqGalBddn6FkQUoHTw-1-13">Nuamfolio/Shutterstock.com</a></span></figcaption></figure><p>The military is constantly using technology to build better ships, warplanes, guns and armor. Shouldn’t it also use drugs to build better soldiers?</p>
<p>Soldiers have long taken drugs to help them fight. <a href="https://www.ncbi.nlm.nih.gov/pubmed/16018329">Amphetamines like Dexedrine were distributed widely</a> to American, German, British and other forces during World War II and to U.S. service members in Korea, Vietnam, Kuwait, Iraq and Afghanistan. In 1991, the <a href="https://www.nytimes.com/2003/01/19/us/threats-and-responses-military-bombing-error-puts-a-spotlight-on-pilots-pills.html">Air Force chief-of-staff stopped the practice</a> because, in his words, “Jedi knights don’t need them.” But the ban lasted only five years. DARPA, an agency that does cutting-edge research for the U.S. Department of Defense, is trying to make soldiers “kill-proof” by developing super-nutrition pills and substances to <a href="http://www.dana.org/Publications/pressbooks/Details.aspx?id=50128">make them smarter and stronger</a>. New drugs that reduce the need for sleep, such as modafinil, are being tested. Researchers are even looking into <a href="https://apps.dtic.mil/dtic/tr/fulltext/u2/a535866.pdf">modifying soldiers’ genes</a>.</p>
<p>As a <a href="https://law.case.edu/Our-School/Faculty-Staff/Meet-Our-Faculty/Faculty-Detail/id/135">professor of health law and bioethics</a>, I began studying the use of drugs to enhance performance in sports, and I soon became interested in the use of performance-enhancing drugs in the military. Most people think <a href="http://globalsportsdevelopment.org/2014/01/28/doping-survey-reveals-public-opinion/">doping in sports is harmful cheating</a>; shouldn’t that be how doping in combat is viewed? The answer, I decided, was no: Doping in sports doesn’t produce any meaningful social benefit, but using drugs to improve performance in the military could save lives and make it easier to complete missions.</p>
<p>But the military still needs rules for how performance enhancements should be used. </p>
<h2>Mandatory use</h2>
<p>Can soldiers be ordered to take enhancement drugs? What if the drugs have dangerous side effects? What if there hasn’t been a lot of research on their long-term effects? It’s also important to realize that the risks from performance-enhancing drugs are not only to the soldiers who use them; in 2004, pilots in Afghanistan who accidentally dropped a bomb that killed four Canadian soldiers <a href="https://www.globalsecurity.org/org/news/2003/030104-speed01.htm">blamed their mistake on being hopped up on amphetamines</a>.</p>
<p>Soldiers generally have to follow orders, so it’s important for their commanders to carefully think through whether use of these drugs should be mandatory or voluntary. Applying a set of principles that I developed to guide <a href="https://doi.org/10.1080/15027570.2014.992214">bioethical decision-making in the military</a>, superiors should force troops to use enhancement drugs only when the advantages that the drugs provide and the importance of the mission outweigh the risks to the user. <a href="http://jpsl.org/archives/defending-against-biochemical-warfare-ethical-issues-involving-coercive-use-investigational-drugs-and-biologics-military/">Soldiers in the Gulf War were required to take drugs</a> that hadn’t been approved for the purpose for which they were given, which was to try to provide some protection in case Saddam Hussein’s forces resorted to chemical or biological warfare. Congress stepped in and said that troops could be ordered to take drugs for such “off-label” purposes only if the president authorized it directly or declared a national emergency.</p>
<p>Opponents of doping in sports maintain that athletes who win races by doping should not be rewarded. Should we adopt the same policy in the military? Should soldiers who act bravely or shoot straighter with the help of drugs get promotions or medals? If the soldiers are ordered to use the drugs by their commanders, I suggest the answer should be yes, since it doesn’t seem fair to punish them for doing something about which they had no choice, especially if the drugs they were ordered to use could have serious side effects.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/276148/original/file-20190523-187143-4sbdn4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/276148/original/file-20190523-187143-4sbdn4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=352&fit=crop&dpr=1 600w, https://images.theconversation.com/files/276148/original/file-20190523-187143-4sbdn4.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=352&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/276148/original/file-20190523-187143-4sbdn4.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=352&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/276148/original/file-20190523-187143-4sbdn4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=442&fit=crop&dpr=1 754w, https://images.theconversation.com/files/276148/original/file-20190523-187143-4sbdn4.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=442&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/276148/original/file-20190523-187143-4sbdn4.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=442&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Should soldiers take steroids to bulk up?</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/muscular-male-body-testosterone-hormone-formula-1169361682?src=gNNI4xg4SDagO1a5jn0ZRQ-1-79">BLACKDAY/Shutterstock.com</a></span>
</figcaption>
</figure>
<h2>Voluntary use</h2>
<p>What if soldiers take performance-enhancing drugs on their own, or if using them is illegal? A study in 2014 reported that <a href="https://doi.org/10.17226/12095">67% of active-duty service members</a> in all branches of the military took dietary supplements. In special forces like Navy SEALS, the percentage increases to over 75%.</p>
<p>What if these substances actually gave users a performance boost? The most popular doping drugs in sports are <a href="https://www.drugabuse.gov/drugs-abuse/steroids-anabolic">anabolic steroids</a>, which are Schedule III controlled substances that can be purchased legally only by prescription. In most states these can’t legally be prescribed for enhancement purposes. </p>
<p>You might think that the military should test soldiers to see if they were illegally using steroids just like athletes are tested in the Olympics, but currently the <a href="http://www.esd.whs.mil/Portals/54/Documents/DD/issuances/dodi/101016p.pdf">military is not allowed to do random drug testing</a> or “unit sweeps” for steroids. In short, the jury is still out on whether the military should reward or punish military success achieved with the aid of self-help drugs.</p>
<p>A final concern is when performance-enhancing drugs give troops advantages over civilians. Soldiers in the reserves, and those who serve on bases but reside with their families, have both military and civilian lives. What if they compete in sports or intellectual contests with civilians? One solution is to require them to disclose that they are taking enhancement drugs, but this could violate military secrecy and help enemies figure out ways of combating the drugs’ effects. </p>
<p>Some commentators argue that the effects of the drugs must be reversible, but soldiers may regard the advantages they get from the drugs as one of the benefits of being in the service; it could even be a recruiting incentive, like the prospect of being trained in a skill that can land them a good civilian job later.</p>
<p>Proper use of performance-enhancing drugs in the military could shorten wars and save lives. But with the development of more powerful drugs that increase strength and endurance and reduce the need for sleep and food, commanders need to carefully consider the risks to soldiers as well as the benefits for them and their mission.</p><img src="https://counter.theconversation.com/content/117236/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Maxwell Mehlman receives funding from the National Institutes of Health to study the ethical, legal, and social implications of using genomic technologies to enhance warfighter performance. He also was part of a team funded by the Greenwall Foundation that studied ethical, legal, and social implications of performance enhancement in the military.</span></em></p>Doping is condemned in sports. But what about in the military? Should soldiers be allowed or even encouraged to take drugs that make them superior fighters and more likely to complete a mission?Maxwell Mehlman, Professor of Biomedical Ethics, Case Western Reserve UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1033602018-09-19T10:43:17Z2018-09-19T10:43:17Z‘Legal highs’ may be more dangerous than traditional drugs of abuse<figure><img src="https://images.theconversation.com/files/237070/original/file-20180919-158234-tgidac.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/download/confirm/1023688015?src=Ta8hDAOycpEPHYMo_6bQ_w-1-12&size=huge_jpg">Shutterstock</a></span></figcaption></figure><p>Novel psychoactive substances (NPS), or “legal highs”, have had various definitions but can simply be thought of as new drugs of abuse. Some may be entirely new, some may be designed to mimic existing drugs, some are based on psychoactive plants and some are medicines. </p>
<p>In the UK, most were legal up until the 2016 Psychoactive Drugs Act, which has effectively banned all drugs which have a psychoactive effect, except alcohol, nicotine, caffeine and drugs used for medicinal purposes. Despite this, they remain widely, albeit illegally, available.</p>
<p>Drug users are a heterogeneous group: many have continued to use traditional drugs of abuse, such as cocaine and heroin, but others have embraced legal highs. It was estimated in 2014 that <a href="https://www.theguardian.com/society/2014/oct/05/-sp-drug-use-is-rising-in-the-uk-but-were-not-addicted">nearly half of all drug users</a> in the UK have taken an NPS. </p>
<p>The reasons for their popularity include the misconception that because they were once legal they are safe, the ease of obtaining them, and a subset of drug abusers who are “novelty seekers” and want to try something new and exciting. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/236933/original/file-20180918-158219-4zntcl.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/236933/original/file-20180918-158219-4zntcl.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=450&fit=crop&dpr=1 600w, https://images.theconversation.com/files/236933/original/file-20180918-158219-4zntcl.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=450&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/236933/original/file-20180918-158219-4zntcl.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=450&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/236933/original/file-20180918-158219-4zntcl.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=565&fit=crop&dpr=1 754w, https://images.theconversation.com/files/236933/original/file-20180918-158219-4zntcl.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=565&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/236933/original/file-20180918-158219-4zntcl.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=565&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Are synthetic cannabinoids like Spice worse than the real thing?</span>
<span class="attribution"><a class="source" href="https://en.wikipedia.org/wiki/Synthetic_cannabinoids#/media/File:USMC-100201-M-3762C-001.jpg">Damany S. Coleman/Wikimedia Commons</a></span>
</figcaption>
</figure>
<p>Prior to 2016, NPS were typically banned as individual drugs or more recently, as groups of <a href="https://www.gov.uk/government/news/legal-highs-to-be-banned-under-temporary-power">chemically related compounds</a>. This led to the synthesis and marketing of an NPS to take the place of the banned substance, while the novelty seekers also drove a market for new drugs.</p>
<p>Unfortunately, we now have close to <a href="http://www.emcdda.europa.eu/system/files/publications/8585/20181816_TDAT18001ENN_PDF.pdf">700 NPS</a> and this has exacerbated the health risk because, with a new drug, users are unsure how to take it safely and healthcare workers will also know very little about the drug, making effective treatment difficult. A legal high user in A&E might be reliant on medical staff who only have a packet of powder with an unhelpful street name such as “Ivory Wave” to go on.</p>
<p>We’re familiar with the side effects that come from long-term abuse of traditional drugs. Ketamine can lead to <a href="https://www.ncbi.nlm.nih.gov/pubmed/21777321">bladder problems and incontinence</a>, amphetamines can <a href="https://www.sciencedirect.com/science/article/pii/S0301008215001008">kill nerve cells</a> in a process called neurotoxicity, cannabis can increase the risk of developing <a href="https://www.frontiersin.org/articles/10.3389/fpsyt.2014.00054/full">schizophrenia-like symptoms</a>, MDMA may lead to <a href="https://www.sciencedirect.com/science/article/pii/S0002914907014634">heart valve problems</a> and numerous drugs lead to addiction.</p>
<p>The mechanisms underlying these problems are largely known and so we can predict the long-term problems of NPS use.</p>
<h2>How legal highs affect the body</h2>
<p>Synthetic cannabinoids were developed as a legal alternative to cannabis. The main psychoactive compound in cannabis is THC, which activates a cannabinoid receptor protein called CB1.</p>
<p>Spice or K2 has been found to be made up of a variety of synthetic cannabinoids, which are often <a href="https://www.sciencedirect.com/science/article/pii/S0028390815301817">more than ten times as potent</a> at the CB1 receptor. </p>
<p>The same dose of Spice will have a much bigger effect than the same dose of THC and long-term users of spice may therefore have a greater chance of developing schizophrenia than cannabis users. </p>
<p>Animal studies have long shown that amphetamine compounds can cause neurotoxicity, and may mean long-term amphetamine abusers have <a href="https://www.sciencedirect.com/science/article/pii/S0165017301000546">persistent dysfunction</a> in their brain dopamine systems. </p>
<p>Dopamine is not only the “reward” chemical in the brain, but is also critical to movement. Parkinson’s patients have part of their brain dopamine system destroyed, leading to problems initiating movement. More recently, studies have found long-term amphetamine users have a <a href="https://www.sciencedirect.com/science/article/pii/S0376871614018948">greater chance of developing Parkinson’s disease</a>, confirming what we’d already seen with animals.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/237075/original/file-20180919-158213-1bjkuqj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/237075/original/file-20180919-158213-1bjkuqj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=490&fit=crop&dpr=1 600w, https://images.theconversation.com/files/237075/original/file-20180919-158213-1bjkuqj.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=490&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/237075/original/file-20180919-158213-1bjkuqj.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=490&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/237075/original/file-20180919-158213-1bjkuqj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=616&fit=crop&dpr=1 754w, https://images.theconversation.com/files/237075/original/file-20180919-158213-1bjkuqj.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=616&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/237075/original/file-20180919-158213-1bjkuqj.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=616&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">3D image of a brain - red areas denote damage due to Parkinson’s.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-illustration/brain-degenerative-diseases-parkinsons-alzheimers-3d-616016804?src=9uyETuUW8gRrRNgnlY-rjw-1-26">Shutterstock</a></span>
</figcaption>
</figure>
<p><a href="https://www.vice.com/en_uk/article/9aa53a/the-story-of-mephedrone-the-party-drug-that-boomed-and-went-bust">One of the most popular</a> NPS since 2008 has been mephedrone, also known as MCAT or meow meow. Mephedrone is a synthetic drug, similar to the plant-based chemical cathinone. It is a stimulant, like amphetamine, and has a very <a href="https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1369-1600.2011.00384.x">similar effect in rats and mice</a> and could also leave users with a greater chance of developing Parkinson’s.</p>
<p>Examples abound of NPS which might be more dangerous than the drugs they were developed to replace. Desoxypipradrol (Ivory Wave) may be <a href="https://www.gov.uk/government/publications/acmd-report-on-desoxypipradrol">more likely to lead to psychosis than cocaine</a>. Benzofury, an MDMA-like drug, may also <a href="http://clok.uclan.ac.uk/18222/1/5APB%20in%20press.pdf">cause heart valve problems</a>, Mexxy (methoxetamine) a ketamine-like drug may also <a href="https://www.tandfonline.com/doi/abs/10.3109/15563650.2014.892605?journalCode=ictx20">cause bladder problems</a>. </p>
<p>Adding the relative ignorance among users and healthcare professionals about how to take these new drugs safely and how to treat overdoses, it’s clear that “legal highs” are anything but a safe substitute for traditional drugs of abuse.</p><img src="https://counter.theconversation.com/content/103360/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Colin Davidson receives funding from the European Union (EU Madness project) and the US NIH NIDA (National Institute on Drug Abuse) </span></em></p>We’ve got better at managing the health risks of traditional drugs of abuse, but novel psychoactive substances, or ‘legal highs’, are a dangerous unknown.Colin Davidson, Professor of Neuropharmacology, University of Central LancashireLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/886392018-03-08T19:26:46Z2018-03-08T19:26:46ZWeekly Dose: cocaine, the glamour drug of the ’70s, is making a comeback<figure><img src="https://images.theconversation.com/files/199863/original/file-20171219-27554-4kqhyr.jpg?ixlib=rb-1.1.0&rect=331%2C840%2C5636%2C2916&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">In Australia, cocaine is most commonly snorted.</span> <span class="attribution"><span class="source">Ralf Geithe/Shutterstock</span></span></figcaption></figure><p>Cocaine is derived from the <a href="http://anesthesiology.pubs.asahq.org/Article.aspx?articleid=1943164">leaves of the coca plant</a>, which is native to South America. For thousands of years, the leaves were used by the local inhabitants such as the Incas, who chewed or made them into a tea, because of the alertness and energy they provided. </p>
<p>German chemist Albert Niemann eventually isolated the active ingredient in 1859 and it was named cocaine. This <a href="https://www.wiley.com/en-au/Medical+Toxicology+of+Drug+Abuse:+Synthesized+Chemicals+and+Psychoactive+Plants-p-9780471727606">was the beginning</a> of the drug’s use as a medicinal and recreational substance in Western culture.</p>
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<a href="https://images.theconversation.com/files/209431/original/file-20180308-146666-lm97f3.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/209431/original/file-20180308-146666-lm97f3.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/209431/original/file-20180308-146666-lm97f3.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=735&fit=crop&dpr=1 600w, https://images.theconversation.com/files/209431/original/file-20180308-146666-lm97f3.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=735&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/209431/original/file-20180308-146666-lm97f3.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=735&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/209431/original/file-20180308-146666-lm97f3.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=924&fit=crop&dpr=1 754w, https://images.theconversation.com/files/209431/original/file-20180308-146666-lm97f3.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=924&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/209431/original/file-20180308-146666-lm97f3.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=924&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<h2>How many people use it</h2>
<p>Cocaine is the second most commonly used illicit substance in Australia, after marijuana. Reports of <a href="https://www.aihw.gov.au/reports/illicit-use-of-drugs/ndshs-2016-key-findings/contents/illicit-use-of-drugs">cocaine use</a> in the 12 months to June 2017 more than doubled since 2004 – from 1% to 2.5% (or around 170,000 to 500,000 people). </p>
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Read more:
<a href="https://theconversation.com/weekly-dose-cannabis-has-been-used-medicinally-for-millennia-why-is-legalising-it-taking-so-long-56064">Weekly Dose: cannabis has been used medicinally for millennia, why is legalising it taking so long?</a>
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<p>The number of people who have ever used cocaine has had a similar percentage increase – from 4.7% in 2004 to 9% in 2016. Cocaine use <a href="https://www.aihw.gov.au/reports/illicit-use-of-drugs/ndshs-2016-key-findings/report-editions">has reached</a> a 15-year high.</p>
<h2>History and use over time</h2>
<p>Cocaine gained prominence in the 1880s. Sigmund Freud <a href="https://www.wiley.com/en-au/Medical+Toxicology+of+Drug+Abuse:+Synthesized+Chemicals+and+Psychoactive+Plants-p-9780471727606">broadly praised its uses</a>, including in overcoming morphine addiction and treating depression. </p>
<p>Viennese ophthalmologist Carl Koller performed the first operation using <a href="http://anesthesiology.pubs.asahq.org/Article.aspx?articleid=1943164">cocaine as an anaesthetic</a> on a patient with glaucoma, which led to its use as a local anaesthetic. </p>
<p>But, soon after, practitioners began reporting side effects. Cocaine doses were administered at such high concentrations that there were <a href="https://books.google.com.au/books/about/Drug_Use_in_America_Problem_in_Perspecti.html?id=2DFLI2ib-1oC&redir_esc=y">200 cases of intoxication</a> and 13 deaths (in around seven years) as a result.</p>
<p>At the 1912 <a href="https://www.unodc.org/unodc/en/frontpage/the-1912-hague-international-opium-convention.html">Hague International Opium Convention</a> cocaine (and heroin) was added to the drug control treaty as problematic substance. This sparked the introduction of new drug control laws relating to cocaine in various countries.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/209449/original/file-20180308-146703-1w320h6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/209449/original/file-20180308-146703-1w320h6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/209449/original/file-20180308-146703-1w320h6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=399&fit=crop&dpr=1 600w, https://images.theconversation.com/files/209449/original/file-20180308-146703-1w320h6.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=399&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/209449/original/file-20180308-146703-1w320h6.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=399&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/209449/original/file-20180308-146703-1w320h6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=501&fit=crop&dpr=1 754w, https://images.theconversation.com/files/209449/original/file-20180308-146703-1w320h6.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=501&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/209449/original/file-20180308-146703-1w320h6.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=501&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">Crack cocaine is a solid, rock-like version of the drug which can be smoked.</span>
<span class="attribution"><span class="source">from shutterstock.com</span></span>
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<p>Cocaine use decreased after this, but later experienced a surge in popularity in the <a href="http://www.cesar.umd.edu/cesar/drugs/crack.asp">1970s</a>, peaking in the 1980s. During this time, cocaine was associated with celebrities, high rollers and glamorous parties.</p>
<p>Then a new, crystallised form of cocaine (crack cocaine) was developed. Crack cocaine is processed with ammonia or baking soda, producing a solid “rock” version of the drug which could be smoked. </p>
<p>Not only was crack cocaine more potent, but the effects of the drug (typically after smoking) were felt faster. It was also much cheaper, which allowed it to spread quickly into poorer communities. Its use <a href="http://www.columbia.edu/cu/ccbh/souls/vol1no1/vol1num1art4.pdf">became recognised</a> as an “epidemic” around 1985, which lasted for ten years. </p>
<h2>How it works</h2>
<p>The nervous system uses chemicals called <a href="https://qbi.uq.edu.au/brain/brain-physiology/what-are-neurotransmitters">neurotransmitters</a> to communicate. These move across the space between two nerve cells and bind to receptors on the receiving cell. </p>
<p>Neurotransmitters do different things. Dopamine, for instance, is involved in the reward system of the brain. It creates feelings of pleasure and contributes to motor control, reinforcement and motivation. </p>
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Read more:
<a href="https://theconversation.com/explainer-how-do-drugs-work-48665">Explainer: how do drugs work?</a>
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<p>The more neurotransmitters are present in the space between two cells, the more can bind to receptors and have a stronger effect. When the body no longer needs the neurotransmitter in its system, it gets reabsorbed into the cell that released it. This is called re-uptake. </p>
<p>One way to increase the level of a neurotransmitter in the brain is to prevent this re-uptake process from occurring. Cocaine inhibits the re-uptake of dopamine in the brain. The resulting increase in dopamine can cause heightened feelings of pleasure and well-being, among other effects.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/199869/original/file-20171219-27547-13r4z2k.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/199869/original/file-20171219-27547-13r4z2k.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/199869/original/file-20171219-27547-13r4z2k.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/199869/original/file-20171219-27547-13r4z2k.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/199869/original/file-20171219-27547-13r4z2k.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/199869/original/file-20171219-27547-13r4z2k.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/199869/original/file-20171219-27547-13r4z2k.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">The coca plant, from which cocaine is derived, is native to South America.</span>
<span class="attribution"><span class="source">Olmez/Shutterstock</span></span>
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<p>Some <a href="https://s3.amazonaws.com/academia.edu.documents/54130855/Goodman___Gilmans_The_Pharmacological_Basis_of_Therapeutics__12th_Edition.pdf">evidence suggests</a> cocaine also inhibits the uptake of the stimulant norepinephrine and the mood regulator serotonin.</p>
<p>Nerves also communicate through electrical signals. Cocaine inhibits electrical communication. In this way, it also works as an anaesthetic by blocking communication between peripheral nerve cells. Cocaine produces a numbing effect when applied to mucous membranes such as the mouth, throat and inside the nose. </p>
<h2>How much it costs</h2>
<p>The average price for cocaine is around A$300-$350 per gram. That’s A$50 more per gram than methamphetamine (ice). In 2017, <a href="https://www.globaldrugsurvey.com/">Australia ranked</a> as the <a href="https://www.smh.com.au/healthcare/global-drug-survey-2017-finds-australians-are-the-biggest-bong-users-pay-most-for-cocaine-20170523-gwb2jd.html">most expensive country</a> to buy cocaine.</p>
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Read more:
<a href="https://theconversation.com/weekly-dose-ice-and-speed-the-drugs-that-kept-soldiers-awake-and-a-president-young-61002">Weekly Dose: ice and speed, the drugs that kept soldiers awake and a president young</a>
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<h2>How it’s used</h2>
<p>Cocaine is used primarily as a <a href="https://www.australianpolice.com.au/main-drug-index-section/cocaine-drug-info/">recreational drug</a>. In Australia it’s most commonly snorted. Injecting, swallowing and smoking are less common.</p>
<h2>How it makes you feel</h2>
<p>The <a href="http://www.health.gov.au/internet/publications/publishing.nsf/Content/drugtreat-pubs-modpsy-toc%7Edrugtreat-pubs-modpsy-2%7Edrugtreat-pubs-modpsy-2-3%7Edrugtreat-pubs-modpsy-2-3-pcoc">effects of cocaine</a> depend on the dose, form, method of use and what the cocaine is cut with. Cocaine is commonly taken in doses of between <a href="http://drug.addictionblog.org/cocaine-overdose-how-much-amount-of-cocaine-to-overdose/">10mg and 120mg</a>. A high lasts between 15-30 minutes and has a half-life (time required before 50% of the drug has left the user’s system) of one hour. </p>
<p>Lower doses will cause a person to experience increased heart rate, body temperature and blood pressure. Cocaine also <a href="https://trove.nla.gov.au/work/16095168?q&sort=holdings+desc&_=1513628574313&versionId=46498173">brings out feelings</a> of euphoria, confidence, giddiness, alertness and enhanced self-consciousness. </p>
<p>Higher doses can cause <a href="https://www.projectknow.com/research/cocaine-overdose/">additional effects</a> such as sleep deprivation, hyper-vigilance, anxiety and paranoia. </p>
<p>Some people who use cocaine may also experience tactile hallucinations. A common example of this is the <a href="http://psycnet.apa.org/doi/10.1176/ajp.135.3.309">feeling of bugs crawling</a> on the skin.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/209456/original/file-20180308-146661-j5uvfd.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/209456/original/file-20180308-146661-j5uvfd.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/209456/original/file-20180308-146661-j5uvfd.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=338&fit=crop&dpr=1 600w, https://images.theconversation.com/files/209456/original/file-20180308-146661-j5uvfd.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=338&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/209456/original/file-20180308-146661-j5uvfd.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=338&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/209456/original/file-20180308-146661-j5uvfd.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=425&fit=crop&dpr=1 754w, https://images.theconversation.com/files/209456/original/file-20180308-146661-j5uvfd.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=425&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/209456/original/file-20180308-146661-j5uvfd.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=425&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Cocaine users can experience tactile hallucinations, such as the feeling of bugs crawling on their skin.</span>
<span class="attribution"><span class="source">from shutterstock.com</span></span>
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</figure>
<p>Using cocaine over a long time or in binges may lead to depression, irritability, disturbances of eating and sleeping, and tactile hallucinations. </p>
<p>Cocaine is also very <a href="https://www.healthdirect.gov.au/cocaine">addictive</a>. Withdrawal symptoms last up to ten weeks.</p>
<p>Cocaine can cause severe heart and neurological issues, and even death, when taken in too large a quantity.</p>
<p>Recent data show that seven people died due to <a href="https://ndarc.med.unsw.edu.au/sites/default/files/ndarc/resources/CokeMethDeaths_2013_Website_FINAL.pdf">cocaine overdose in 2013</a> in Australia. </p>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/209457/original/file-20180308-146650-1gc94if.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/209457/original/file-20180308-146650-1gc94if.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/209457/original/file-20180308-146650-1gc94if.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=960&fit=crop&dpr=1 600w, https://images.theconversation.com/files/209457/original/file-20180308-146650-1gc94if.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=960&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/209457/original/file-20180308-146650-1gc94if.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=960&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/209457/original/file-20180308-146650-1gc94if.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1206&fit=crop&dpr=1 754w, https://images.theconversation.com/files/209457/original/file-20180308-146650-1gc94if.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1206&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/209457/original/file-20180308-146650-1gc94if.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1206&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Cocaine used to be added to Coca-Cola.</span>
<span class="attribution"><span class="source">from shutterstock.com</span></span>
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<h2>Other points of interest</h2>
<p>In the 1880s in the US, cocaine was included in numerous medicines, and even in Coca-Cola. Coca-Cola had about <a href="https://www.sciencedirect.com/topics/neuroscience/coca">60mg of cocaine</a> in a 250ml bottle.</p>
<p>In <a href="https://www.pri.org/stories/2012-06-30/colombia-decriminalizes-cocaine-marijuana">Colombia</a>, <a href="https://www.loc.gov/law/help/decriminalization-of-narcotics/mexico.php">Mexico</a> and <a href="http://druglawreform.info/en/country-information/latin-america/peru/item/207-peru">Peru</a>, possessing small amounts of cocaine for personal use is decriminalised.</p>
<p>One of the more recent concerns about the resurgence of cocaine is the potentially deadly effect it has when cut with fentanyl, a <a href="https://www.businessinsider.com.au/fentanyl-cut-cocaine-causing-overdoses-2017-6?r=US&IR=T">potent opioid</a>. A number of recent drug overdoses in Sydney have been linked to heroin cut with fentanyl, highlighting its <a href="http://www.news.com.au/lifestyle/health/health-problems/the-drop-dead-drug-that-creates-zombies-tightens-its-grip/news-story/ddf9e269c84c7ec42dff126228023d41">deadly effects</a>. While this hasn’t yet become popular with cocaine, it very well could.</p>
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<strong>
Read more:
<a href="https://theconversation.com/princes-death-from-fentanyl-is-only-the-tip-of-the-global-overdose-iceberg-60441">Prince's death from fentanyl is only the tip of the global overdose iceberg</a>
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<p><em>A previous version of this article indicated the coca plant was native to Central America. This has now been corrected to South America.</em></p><img src="https://counter.theconversation.com/content/88639/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Jason Ferris is the chief biostatistician for the Global Drug Survey, founded by Adam Winstock. He has received funding from National Health and Medical Research Council, The Australian Research Council, the Foundation for Alcohol Research and Education, Queensland Government, Australian & New Zealand Association of Oral & Maxillofacial Surgeons, Tasmanian Department of Health and Human Services, Criminology Research Grant, Victorian Law Enforcement Drug Fund, Department of Health and Ageing, VicHealth, Australian National Preventive Health Agency</span></em></p><p class="fine-print"><em><span>Barbara Wood and Stephanie Cook do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Cocaine is the second most commonly used illicit substance in Australia, after marijuana.Jason Ferris, Associate Professor, The University of QueenslandBarbara Wood, Research Assistant, The University of QueenslandStephanie Cook, Research Assistant at the Institute for Social Science Research, The University of QueenslandLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/677042016-11-17T04:22:53Z2016-11-17T04:22:53ZWeekly Dose: Ritalin, helpful for many with ADHD but dangerous if abused by those without it<figure><img src="https://images.theconversation.com/files/144151/original/image-20161102-12150-17bcgq4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">For people with ADHD, Ritalin helps improve concentration and focus. </span> <span class="attribution"><span class="source">Kids in classroom from www.shutterstock.com</span></span></figcaption></figure><p>Ritalin is the most common brand name for methylphenidate, a stimulant used to treat attention deficit hyperactivity disorder (ADHD). </p>
<p>Pharmaceutical company Novartis owns the name Ritalin, but methylphenidate is marketed under other brand names by other manufacturers; such as Concerta which is produced by the company Janssen.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/146329/original/image-20161117-13383-1jk72bh.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/146329/original/image-20161117-13383-1jk72bh.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/146329/original/image-20161117-13383-1jk72bh.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=870&fit=crop&dpr=1 600w, https://images.theconversation.com/files/146329/original/image-20161117-13383-1jk72bh.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=870&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/146329/original/image-20161117-13383-1jk72bh.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=870&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/146329/original/image-20161117-13383-1jk72bh.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1093&fit=crop&dpr=1 754w, https://images.theconversation.com/files/146329/original/image-20161117-13383-1jk72bh.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1093&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/146329/original/image-20161117-13383-1jk72bh.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1093&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption"></span>
</figcaption>
</figure>
<h2>History</h2>
<p>Methylphenidate was <a href="http://www.cesar.umd.edu/cesar/drugs/ritalin.asp">developed in 1944</a> by pharmaceutical company CIBA, now Novartis, as a stimulant. Although methylphenidate is chemically different to amphetamines, its <a href="http://www.pbs.org/wgbh/pages/frontline/shows/medicating/backlash/un.html">pharmacological properties</a> are similar. </p>
<p>In the late 1950s, it was sold to treat chronic fatigue, depression, narcolepsy and also for <a href="https://www.ncbi.nlm.nih.gov/pubmed/13629025">sedation</a> caused by other medications.</p>
<p>It was later found to improve behaviour in children who were <a href="https://www.ncbi.nlm.nih.gov/pubmed/14410146">hyperactive and impulsive</a>. In the 1960s, research on Ritalin was focused around treatment of “hyperkinetic syndrome,” which would eventually be called attention deficit hyperactivity disorder.</p>
<p>In 1996, <a href="http://www.pbs.org/wgbh/pages/frontline/shows/medicating/backlash/un.html">it was reported</a> the United States accounted for around 90% of total world manufacture and consumption of Ritalin. </p>
<h2>What is attention deficit hyperactivity disorder?</h2>
<p>People with ADHD have deficits in their executive functioning, which means their thought processes are less efficient than those without the disorder. If a person with ADHD is going to <a href="http://www.intechopen.com/books/adhd-new-directions-in-diagnosis-and-treatment/therapy-for-adhd-directed-towards-addressing-the-dual-imbalances-in-mental-effort-and-reward-as-illu">complete a task</a>, the task either has to be easy, short, or sufficiently interesting or rewarding to fully engage their attention.</p>
<p>Tasks such as studying may require a prolonged and intense period of concentration which a person with ADHD would typically find difficult to maintain.</p>
<h2>How does Ritalin work?</h2>
<p>Methylphenidate is similar in structure and function to amphetamines, such as dexamphetamine, which is also used to treat ADHD. </p>
<p>These stimulants <a href="http://www.sciencedirect.com/science/article/pii/S0301008205000432">increase concentrations</a> of the neurotransmitters dopamine and noradrenaline in the brain, which <a href="https://www.ncbi.nlm.nih.gov/pubmed/?term=Effects+of+methylphenidate+on+extracellular+dopamine%2C+serotonin%2C+and+norepinephrine%3A+comparison+with+amphetamine">enhances communication</a> between brain cells. Effectively, this makes the mind work more efficiently, requiring less effort to get a task done.</p>
<p>ADHD is not a categorical diagnosis but a continuum. This means although some people clearly have ADHD and some clearly do not, there are many shades of grey between the two extremes. </p>
<p>It is therefore not surprising stimulants also improve mental efficiency in people without ADHD. The main difference is people with ADHD have more concentration problems and therefore show more scope for improvement on stimulants.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/144134/original/image-20161102-6277-1mwy4dw.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/144134/original/image-20161102-6277-1mwy4dw.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=312&fit=crop&dpr=1 600w, https://images.theconversation.com/files/144134/original/image-20161102-6277-1mwy4dw.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=312&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/144134/original/image-20161102-6277-1mwy4dw.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=312&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/144134/original/image-20161102-6277-1mwy4dw.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=392&fit=crop&dpr=1 754w, https://images.theconversation.com/files/144134/original/image-20161102-6277-1mwy4dw.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=392&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/144134/original/image-20161102-6277-1mwy4dw.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=392&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Ritalin is the most common brand name for methylphenidate.</span>
<span class="attribution"><span class="source">Editor182/Wikimedia Commons</span>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
</figcaption>
</figure>
<h2>How is Ritalin taken?</h2>
<p>ADHD is most commonly diagnosed in primary school, and the child is usually started on treatment at this time.</p>
<p>Both methylphenidate and dexamphetamine come in immediate-release tablets which last for around three to six hours; dexamphetamine lasts slightly longer than methylphenidate. </p>
<p>After taking a dose, the drug concentration rises to a maximum and then falls. Everyone has their own therapeutic range, which is the concentration the drug has to be in order to be effective.</p>
<p>The doctor normally establishes the appropriate dose by starting at a low dose and gradually increasing it over several weeks to find the most effective dose. If the person’s optimal dose is exceeded, their functioning becomes less efficient and negative effects increase. </p>
<p>The executive function deficits associated with ADHD are consistent over time, but people change as they go through different stages of development. As children progress through school, the demands on their concentration increase, and untreated ADHD is often associated with declining grades.</p>
<h2>How many people use it?</h2>
<p>Around 11% of Australian children and adolescents <a href="https://www.ncbi.nlm.nih.gov/pubmed/11990891">had diagnosable ADHD</a> in 2007 although most were not treated. Between 2002 and 2009, <a href="http://www.smh.com.au/lifestyle/diet-and-fitness/males-fuel-rise-of-the-ritalin-generation-20110123-1a18d.html">prescriptions for stimulant drugs</a> to treat ADHD among Australians reportedly rose by nearly 90%.</p>
<p>This can be explained by the introduction of newer, sustained-release tablets, which meant doctors could better tailor treatment to the individual – by combining immediate-release and sustained-release formulations for instance. This led to more prescriptions per person per year.</p>
<p>In 2015, around 906,754 <a href="http://www.pbs.gov.au/info/statistics/asm/asm-2015#table-1">scripts were written</a> for methylphenidate and dexamphetamine.</p>
<h2>What does it cost?</h2>
<p>Methylphenidate is subsidised under the <a href="http://www.pbs.gov.au/medicine/item/3440C">Pharmaceutical Benefits Scheme</a> (PBS). One packet of 30 Ritalin 10 mg capsules costs A$38.30 for those with a prescription, or A$6.20 for health care card holders. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/145136/original/image-20161109-16707-1vwssy6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/145136/original/image-20161109-16707-1vwssy6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/145136/original/image-20161109-16707-1vwssy6.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/145136/original/image-20161109-16707-1vwssy6.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/145136/original/image-20161109-16707-1vwssy6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/145136/original/image-20161109-16707-1vwssy6.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/145136/original/image-20161109-16707-1vwssy6.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Ritalin and other stimulants are sometimes used by those who do not have ADHD to boost cognitive performance.</span>
<span class="attribution"><a class="source" href="https://www.flickr.com/photos/stemonx/7209965342/in/photolist-bZ7Xvh-8KsHQi-4MVd7x-cNhBmf-9wpbUi-86pzDv-a1vR2q-8KvLgL-6YD2sU-6Xw3cw-GMgno-9WpdAh-cNhDBb-h6sMXB-ntp41t-a1cfTi-a1fcJQ-dnjKxW-4YiSdp-e3wk3A-iTGPv4-bZ3uRh-YFFY-akCDca-eDkcp3-eDea9z-ntroQy-335jX-a1cfsD-o3LcNr-5HDAMF-7GAHbc-5yb9sf-dAW32n-ahnorp-6myfGX-eDkhu3-a1sZ88-a1sYGc-a1cg4t-7U3Nqd-a1vQQy-a1vRdh-cEJusL-p9oPCQ-nrmFbU-qqLtzC-6y22DF-cNhAD5-mckoua">StefanoMontagner/Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
</figcaption>
</figure>
<h2>What are the side effects?</h2>
<p>The <a href="https://www.ncbi.nlm.nih.gov/pubmed/9310521/">side effects</a> of stimulants are dose-related, the most common being appetite suppression and insomnia. </p>
<p>In overdose, methylphenidate is <a href="https://www.ncbi.nlm.nih.gov/pubmed/12595781/">associated</a> with rapid heart rate, high blood pressure, irritability and agitation. Ongoing <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1925483/">stimulant abuse</a> can also be associated with malnutrition.</p>
<h2>Is it a performance-enhancing study drug?</h2>
<p>After leaving school a person with ADHD has more opportunity to choose a career that matches their strengths and interests and many stop treatment. But for those who go on to study at university, academic demands increase and students with ADHD are likely to remain on medication. </p>
<p>This means some people at university have legitimate access to Ritalin. But there is <a href="http://www.smh.com.au/national/education/hsc-students-use-drugs-to-get-through-exams-20161010-gryydk.html">ongoing concern</a> these stimulants are being diverted to, and abused by, those who do not have ADHD but are hoping for cognitive enhancement.</p>
<p>There is evidence of an increase in methylphenidate abuse by people who don’t have ADHD, with one <a href="https://www.ncbi.nlm.nih.gov/pubmed/26937669">study showing a threefold rise between 2004 and 2014 in NSW</a>.</p>
<p>It might be argued it’s not a problem for a person without ADHD, who understands how to use Ritalin, to take it for studying. But it is illegal, and it may give an unfair advantage in the same way as performance enhancing drugs in sport.</p><img src="https://counter.theconversation.com/content/67704/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Alison Poulton works for the University of Sydney, has consulted for the Shire and owns shares in GSK. She has received research funding from the Australian Women and Children's Research Foundation and the Nepean Medical Research Foundation. She is a Fellow of the Royal Australasian College of Physicians and the Australasian ADHD Association.</span></em></p>Ritalin is the most common brand name for methylphenidate, a stimulant used to treat attention deficit hyperactivity disorder (ADHD).Alison Poulton, Senior Lecturer Paediatrics, University of SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/562372016-03-23T13:29:37Z2016-03-23T13:29:37ZThe blanket drugs ban is necessary, but won’t solve the bigger problem – as I know from personal experience<figure><img src="https://images.theconversation.com/files/116040/original/image-20160322-32315-lwmbpx.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">What's in the bag?</span> <span class="attribution"><a class="source" href="http://www.shutterstock.com/pic-50152831/stock-photo-mephedrone-aka-meow-bubbles-powder-on-counter-top-in-plastic-bag.html?src=evAeViKq3GLPF0QHA7e0MA-1-9">Shutterstock</a></span></figcaption></figure><p>In April, “legal highs” will join the list of illegal highs under the much criticised <a href="https://www.gov.uk/government/collections/psychoactive-substances-bill-2015">Psychoactive Substances Act 2016</a>. This ban on legal highs, or novel psychoactive substances (NPS), is intended to cover a range of largely unregulated substances, such as nitrous oxide, while at the same time excluding more mundane – albeit, lethal – ones such as alcohol and cigarettes. But can it work?</p>
<p>The new restrictions continue the UK government’s attempt to use prohibition to control the use of drugs for recreational pursuits. The <a href="http://hansard.millbanksystems.com/acts/drugs-prevention-of-misuse-act-1964">Drugs Act 1964</a>, criticised at the time as hastily constructed, was arguably the first time controls were introduced in response to the “problem” of teenagers dancing all night. It banned <a href="http://www.talktofrank.com/drug/speed">amphetamines</a>, largely because young teenagers began hanging around Soho in the early hours of Sunday mornings – after their amphetamine all-nighters.</p>
<p>Prior to the introduction of the 1964 act, amphetamines were the dance drug of choice – and they were legal to possess. But they were not legal to sell so, officially, they could only be obtained on prescription. In practice, however, the fact that possession was legal meant that a grey market in the drugs flourished and pills widely were sold in the regular haunts of teenagers too young to be served alcohol. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/116053/original/image-20160322-32312-2jbm1m.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/116053/original/image-20160322-32312-2jbm1m.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=397&fit=crop&dpr=1 600w, https://images.theconversation.com/files/116053/original/image-20160322-32312-2jbm1m.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=397&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/116053/original/image-20160322-32312-2jbm1m.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=397&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/116053/original/image-20160322-32312-2jbm1m.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=499&fit=crop&dpr=1 754w, https://images.theconversation.com/files/116053/original/image-20160322-32312-2jbm1m.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=499&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/116053/original/image-20160322-32312-2jbm1m.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=499&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Once legal to possess.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
</figcaption>
</figure>
<p>But there were alternative sources of amphetamine, too, such as Benzedrine inhalers, over-the-counter decongestants that contained the equivalent of 110 5mg amphetamine tablets. This “legal high” was being used often enough by 1957 that P H Connell, a leading researcher of amphetamine abuse, <a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1974659/?page=1">wrote to the British Medical Journal</a> warning about the problems of psychosis caused by their use. </p>
<p>The potent effects of eating the cotton plug containing the active ingredients of the inhalers became folklore within the Mod-inspired, all-night dance culture that <a href="https://www.academia.edu/7515713/Northern_Soul_music_drugs_and_subcultural_identity_introduction_and_Chapter_1_">I joined in 1973</a>. By that time, the amphetamine had been replaced by propylhexedrine, a substance I found less memorable than the menthol burps caused by eating the cotton plug.</p>
<p>But alternatives soon took their place. I was soon introduced to illicitly manufactured amphetamines that were more palatable and effective. These blue pills copied the 5mg Drinamyl antidepressant that achieved cult status in the 1960s with its “purple heart” shape. </p>
<p>But in the early 1970s, drug squad arrests ended the supply of the illicitly-manufactured pills, leading to a shortage. This led some of my peers to burgle chemist shops, a practice that had begun as soon as amphetamines were <a href="https://www.academia.edu/7513756/Mixing_the_Medicine_the_unintended_consequences_of_amphetamine_control_on_the_Northern_Soul_Scene">criminalised in 1964</a>. Like many working-class lads without qualifications or prospects, we had little regard for personal safety or the law. Indeed, legislating to reduce supply is a blunt instrument that produces innovative responses to maintain access to drugs.</p>
<h2>Unintended consequences</h2>
<p>The new Psychoactive Substances Act is the latest episode of this ebb and flow between control and response that will fail to end these established patterns of drug use. In fact, changes to drugs law can even lead to some very unexpected consequences.</p>
<p>The 1964 law is a case in point. Cutting off the supply of amphetamines, it led to users resorting to the burglary of chemist shops. This in turn led to a change in the way amphetamines were stored – they were removed from the shelves of the dispensary and locked in secure cabinets with the Class A drugs. This led to problems of its own, as burglars looking for amphetamines would find them stored with opiates – and steal them as well. Before long, some amphetamine users were opiate users, too. </p>
<p>The worst aspect of this cross-pollination was the importation of an intravenous drug culture into a pill culture. This led to many premature deaths from hepatitis C.</p>
<figure class="align-right ">
<img alt="" src="https://images.theconversation.com/files/116051/original/image-20160322-32285-5zh7gb.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/116051/original/image-20160322-32285-5zh7gb.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=833&fit=crop&dpr=1 600w, https://images.theconversation.com/files/116051/original/image-20160322-32285-5zh7gb.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=833&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/116051/original/image-20160322-32285-5zh7gb.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=833&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/116051/original/image-20160322-32285-5zh7gb.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1047&fit=crop&dpr=1 754w, https://images.theconversation.com/files/116051/original/image-20160322-32285-5zh7gb.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1047&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/116051/original/image-20160322-32285-5zh7gb.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1047&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">What’s your poison?</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
</figcaption>
</figure>
<p>Much has changed since the 1970s. Hopes of a drug-free society have evaporated. More people are drug wise enough to know which drugs to avoid. There is increased recognition that prison does not offer a solution to drug problems. The consensus among the eight police forces interviewed for the <a href="https://www.academia.edu/7510408/A_rock_and_a_hard_place_drug_markets_in_deprived_neighbourhoods">2002 drugs market research</a> was that recreational use was not a policing problem. </p>
<p>But we also need to know why people take NPS – and what the new law might do to them. In a <a href="https://www.academia.edu/7760615/Why_Legality_Matters_The_Influences_Making_Legal_Highs_the_Drug_of_Choice">survey I carried out with Tammy Ayres</a> we found that people have a cluster of reasons for using these substances: availability, value, predictability (consistency of the product), legality, and safety. </p>
<p>Rather than single out any one factor it is better to think of the way each of these elements contributes to their attraction. Changing the legal status disrupts this relationship. The April 2010 <a href="http://news.bbc.co.uk/1/hi/uk/8623958.stm">ban of mephedrone</a>, one of the most popular “legal highs”, for example, had the effect of increasing the price and reducing its availability. It did not stop its production, however. Indeed, once it was removed from the legal market, producers were forced into finding a new “legal” replacement to fill the shelves of head shops and internet retailers. </p>
<p>This process invariably leads to the production of good, bad, and indifferent concoctions. And it can be a dangerous business – particularly for those who go on to use them. Research by <a href="http://cdn.basw.co.uk/upload/basw_124850-2.pdf">Rob Ralphs</a> of Manchester Metropolitan University on NPS use in prison illustrates the negative effects of Vertex, a synthetic cannabinoid developed to replace Spice, often referred to as <a href="https://www.drugabuse.gov/publications/drugfacts/synthetic-cannabinoids">“synthetic marijuana”</a>. Ralphs points out that the fact it is undetectable by prison drugs tests adds to its attraction. The low price and high demand for an addictive drug encourages smugglers to cash in. </p>
<h2>What hope, then?</h2>
<p>The new act is justified because we long have had the worst of both worlds. Before it, the more effective and toxicologically best understood substances (cannabis, ecstasy, LSD) were subject to legal regulation, while the least reliable and most untested ones were freely available. What’s more, as soon as one “legal high” was banned, chemists could simply tweak the formula and come up with something new that skirted around the law. </p>
<p>The government had little option but to introduce a blanket ban – but that doesn’t mean it will work. Instead, we need to completely rethink the categorisation of drugs. <a href="https://profdavidnutt.wordpress.com/2010/12/09/drug-harms-paper-a-summary/">Professor Nutt’s argument</a> that substances should be ranked according to harms makes sense. But until they are, legislation such as the PSA will only highlight the lack of logic in the current drug controls.</p><img src="https://counter.theconversation.com/content/56237/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Andrew Wilson is affiliated with the Welsh Government as a voluntary member of the Advisory Panel on Substance Misuse (APoSM). The views expressed in this article are the author's own, not those of the APoSM.</span></em></p>Changing drugs laws can have some very unexpected consequences.Andrew Wilson, Senior Lecturer in Criminology, Nottingham Trent UniversityLicensed as Creative Commons – attribution, no derivatives.