Why there should be safe use limits for illegal drugs, much like for alcohol

Taking it way too far. Mattysflicks, CC BY

Last year almost 80,000 people took part in the Global Drug Survey and helped us produce the world’s first harm-reduction guide. These experts are people who like taking drugs but want to keep themselves and their community as safe as possible.

There’s certainly appetite for this kind of information – the guide comprises of a “highway code” for different drugs and has been downloaded 30,000 times. As clearly stated, the only way to avoid drug-related harm is not to use them at all, but if people are then they should try and do it as safely as possible.

A zero-tolerance approach is appropriately applied to a legal regulated drug: tobacco. This is good advice because the risk of addiction with tobacco is higher than for almost any other drug and even low levels of use are associated with an increase risk of lung harms and cancer.

‘Just say no’ hardly works for all

But the problem is that this same (but not backed by evidence) zero-limit advice is applied to illegal drugs by governments – the “just say no” approach. I guess they have no choice – they could hardly say a drug is illegal (because it’s very dangerous) and then say: “actually, if you don’t use too much of X too often, not mix it with Y and make sure you don’t play with knives, go scuba diving or drive when you do it, then the risks of you running into serious harm is pretty low” (not zero).

While lifetime abstinence works for a very large percentage (the majority in fact) of the population, it isn’t much use to those people who choose to take drugs. And a zero-tolerance approach might actually backfire and lead some existing users to ignore the difference between using a little and a lot.

In the drug treatment world, for example, there is a term called “abstinence violation.” It is used to describe the narrative that people dependent on drugs or alcohol use following the first episode of use after a period of not using. They say “never using again was my goal that now that I have used once, well sod it … I might as well continue using.”

In the same way that it’s possible that a government’s zero-tolerance approach to drugs may lead some users to ignore commonsense strategies, such intolerance to the acceptance of moderation can also lose governments credibility. And credibility is important. It may mean well, but we’ve found in the survey that the Frank website, for example, is consistently voted the last place people would send a mate whose use of alcohol/drugs worried them.

And with a regulated cannabis market no longer the thing of smoked-up fantasy, it might be rather smart to rethink the message of “just say no” to: “if you’re going to say yes, then remember not too often.”

Rational not radical

The question I pose then is this: could or should there be such a thing as safer drug-using limits or guidelines?
This is not radical in any way (unless you take a moral judgement over the choice of molecule a person chooses to ingest for pleasure). In fact it’s entirely rational. Here’s why: alcohol is a drug – we have guidelines on its use aimed at reducing the long-term risk of health harms. So why not have guidelines for drugs?

The risks of addiction are higher in at-risk individuals – among those who start early in life, for example, often because of other social, personal and emotional challenges – and some people should probably never try drugs. These significant challenges are best addressed by good social policy (investing in the well-being of people who won’t being voting for 18 years) by pre-birth family support and interventions focused on supporting vulnerable parents in the early years of a child’s life.

But for most people, the rates of addiction are relatively low and, for most users, moderating consumption can keep the risk of experiencing short and longer-term health harms low (for drugs like GHB and heroin the risks of overdose are so high that it might be exempt from such statements). And in almost all cases the risks of experiencing drug-related harm can be significantly reduced by the adoption of safer using strategies.

Danger is exactly why it’s needed

By suggesting safer drug-using limits or guidelines for illicit drugs I am not suggesting that drugs are safe. Quite the contrary in fact. Drugs can be very dangerous. And I am not suggesting that guidelines will solve all of society’s drug problems. But as social care budgets are slashed and governments start to embrace population-based strategies such as behavioural economics to moderate unhealthy behaviours, having some commonsense guidelines which highlight that taking less drugs less often will reduce the risk of harm might be useful. And they have value regardless of the legal status of a drug.

We’re now working on the 2015 survey and one of the things we’re trying to do this time around is to establish the world’s first safer drug-using limits. We’ll do this by asking tens of thousands of people who use drugs to rate (on a scale of one to ten) how the risk of harm from different drugs (including alcohol) increases with increasing levels use. Risk here refers to the probability, range and severity of harm.

So if you’ve ever used drugs or have thought about drug-related harms and pleasures please share your experience and expertise from mid-November 2014.