tag:theconversation.com,2011:/ca/topics/illicit-drugs-671/articlesIllicit drugs – The Conversation2024-03-14T04:59:09Ztag:theconversation.com,2011:article/2256572024-03-14T04:59:09Z2024-03-14T04:59:09ZIs meth use really going up? Let’s look at the evidence behind the latest scary headlines<figure><img src="https://images.theconversation.com/files/581560/original/file-20240313-30-m9j8q7.jpg?ixlib=rb-1.1.0&rect=0%2C1%2C1000%2C664&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/heavy-drug-methamphetamine-crystal-isoalted-on-1662945838">Dima Sobko/Shutterstock</a></span></figcaption></figure><p><a href="https://www.theguardian.com/society/2024/mar/12/australia-drug-use-wastewater-testing-methamphetamine-increase">Widely reported</a> data released from the <a href="https://www.acic.gov.au/publications/national-wastewater-drug-monitoring-program-reports/report-21-national-wastewater-drug-monitoring-program">National Wastewater Drug Monitoring Program</a> this week appears to show the rising use of methamphetamine (also known as methylamphetamine). You may know it as speed (the powder form) or ice (the crystal form).</p>
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<p>But this reporting appears to contradict data released in recent weeks from the <a href="https://www.aihw.gov.au/reports/illicit-use-of-drugs/national-drug-strategy-household-survey/contents/about">National Drug Strategy Household Survey</a>. This 2022-23 survey shows methamphetamine use is falling and is at its <a href="https://theconversation.com/meth-use-is-declining-in-australia-but-the-public-still-sees-it-as-the-most-worrying-drug-224620">lowest in more than a decade</a>.</p>
<p>So what’s going on? Is methamphetamine use rising or falling?</p>
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<em>
<strong>
Read more:
<a href="https://theconversation.com/meth-use-is-declining-in-australia-but-the-public-still-sees-it-as-the-most-worrying-drug-224620">Meth use is declining in Australia – but the public still sees it as the most worrying drug</a>
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<h2>Looking at wastewater</h2>
<p>The <a href="https://www.acic.gov.au/publications/national-wastewater-drug-monitoring-program-reports">National Wastewater Drug Monitoring Program</a> collects samples of wastewater from sewage treatment plants. University researchers then test samples for traces of different drugs.</p>
<p>The way the samples are analysed differentiates between drugs that have been consumed and drugs that have been disposed of before consumption. This means we know the drugs detected have actually been used and excreted via urine, not just thrown down the toilet.</p>
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<a href="https://images.theconversation.com/files/581808/original/file-20240313-16-9lc1bf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Finger pressing toilet flush" src="https://images.theconversation.com/files/581808/original/file-20240313-16-9lc1bf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/581808/original/file-20240313-16-9lc1bf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/581808/original/file-20240313-16-9lc1bf.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/581808/original/file-20240313-16-9lc1bf.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/581808/original/file-20240313-16-9lc1bf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/581808/original/file-20240313-16-9lc1bf.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/581808/original/file-20240313-16-9lc1bf.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"></a>
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<span class="caption">Researchers can tell which drugs have been used and excreted via urine.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/cropped-view-womans-hand-pushing-button-2155659743">brizmaker/Shutterstock</a></span>
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<strong>
Read more:
<a href="https://theconversation.com/drugs-in-bugs-69-pharmaceuticals-found-in-invertebrates-living-in-melbournes-streams-106331">Drugs in bugs: 69 pharmaceuticals found in invertebrates living in Melbourne's streams</a>
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<h2>But there are limitations</h2>
<p>The <a href="https://www.acic.gov.au/sites/default/files/2024-03/Wastewater%2021%20FOR%20WEB2.PDF">report</a> of the wastewater data mentions measuring “consumption”, “demand” and “harm” from drugs. But the wastewater program doesn’t measure these directly.</p>
<p>It only measures overall amount of a drug consumed in the community at a single point in time.</p>
<p>Wastewater data can’t tell us whether a small number of people have used a large amount of a drug or a large number of people each used a very small amount of a drug. It can only tell us the overall volume of a drug used.</p>
<p>Some of the sampling sites have been chosen specifically because the <a href="https://www.acic.gov.au">Australian Criminal Intelligence Commission</a>, which runs the program, has an actual or potential concern that drug use is high in those areas. This kind of targeted sampling may overestimate how much of a drug has been used across Australia or at any given time point.</p>
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<p>
<em>
<strong>
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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</em>
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<h2>Surveys give us different answers</h2>
<p>The <a href="https://www.aihw.gov.au/about-our-data/our-data-collections/national-drug-strategy-household-survey">National Drug Strategy Household Survey</a> is a sample of, usually, around 20,000-25,000 households in Australia. It asks one person from each household aged 14 years and over about their use of a range of drugs in the past year and in their lifetime. Researchers refer to this as “self report”.</p>
<p>The survey asks about quantity, frequency and harms of drug use, and reports the data by a range of demographic measures such as age and gender. It also surveys the community’s attitudes to drugs. So the data is much more detailed than wastewater data.</p>
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<h2>Surveys have limitations too</h2>
<p>The National Drug Strategy Household Survey relies on people being honest about their drug use. </p>
<p>People tend to forget or <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9726603/">downplay their use</a>, especially for illicit drugs, so the survey results likely underestimate use. But the underestimate is probably similar across years because the way the data is collected has remained very similar across time.</p>
<p>However, as the survey is anonymous and there are no consequences to disclosing this information (for example, no risk of being arrested for drug use) it’s probably reasonably accurate.</p>
<p>The survey is best for looking at trends over time.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/young-people-are-drinking-less-in-real-life-but-film-and-tv-paints-a-different-picture-223854">Young people are drinking less in real life. But film and TV paints a different picture</a>
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</p>
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<h2>So what can we make of this?</h2>
<p>Over the years, there have been some ups and downs in methamphetamine volumes reported in the wastewater data. However, the average national volume (in kilos) of methamphetamine reported in the latest wastewater <a href="https://www.acic.gov.au/sites/default/files/2024-03/Wastewater%2021%20FOR%20WEB2.PDF">report</a> is pretty close to the average for the past seven years.</p>
<p>The most recent report shows an increase in <em>consumption per 1,000 population</em> in regional areas, but a decrease in capital cities, representing an overall decrease. The <em>total volume</em> of methamphetamine used has increased, however. But as the population has also increased during that time, this complicates the picture.</p>
<p>Changes up and down in volume of drug used could also be seasonal or in response to short-term changes in availability. So it’s better to look at long-term changes over time together with other data.</p>
<p>The proportion of the population who report using methamphetamine in the National Drug Strategy Household Survey has <a href="https://www.aihw.gov.au/reports/illicit-use-of-drugs/meth-amphetamine-ndshs">fallen</a>, continuing a long-term trend.</p>
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<em>
<strong>
Read more:
<a href="https://theconversation.com/2-200-deaths-32-000-hospital-admissions-15-7-billion-dollars-what-opioid-misuse-costs-australia-in-a-year-137712">2,200 deaths, 32,000 hospital admissions, 15.7 billion dollars: what opioid misuse costs Australia in a year</a>
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</p>
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<h2>What’s the take-home message?</h2>
<p>These two datasets measure different things at different time points using different methods.</p>
<p>The wastewater data found the average <em>volume</em> of methamphetamine had increased, but <em>consumption per 1,000 population</em> had decreased. This drop in consumption is in line with the survey, which found a drop in the percentage of people reporting methamphetamine use, the lowest in over a decade.</p>
<p>So is methamphetamine use in Australia rising or falling? Both sets of data actually suggest use is falling, even though you’d never know it from the recent headlines.</p>
<p>It’s a good demonstration of why we shouldn’t take data in isolation and why we need to consider a range of factors in interpreting data.</p>
<p>The last thing we want is sensationalised headlines, leading to the type of stigma that makes it harder for people who use drugs to ask for support.</p>
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<p><em>If you are worried about your own or someone else’s drug use or just want further information you can call the free and confidential National Alcohol and Other Drug Hotline on 1800 250 015 or contact <a href="https://www.counsellingonline.org.au">Counselling Online</a>. Both services are available 24/7.</em></p><img src="https://counter.theconversation.com/content/225657/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Nicole Lee works as a paid consultant in the alcohol and other drug sector. She has previously been awarded grants by state and federal governments, National Health and Medical Research Council and other public funding bodies for alcohol and other drug research. She is a Board member of drug checking organisation The Loop Australia. She is CEO at Hello Sunday Morning, which receives funding from the Australian government.</span></em></p>One report says methamphetamine use is rising. Another says it’s falling. So what’s going on?Nicole Lee, Adjunct Professor at the National Drug Research Institute (Melbourne based), Curtin UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2233702024-02-15T13:15:53Z2024-02-15T13:15:53ZSpice: the ‘zombie drug’ being found in some vape liquids<figure><img src="https://images.theconversation.com/files/575640/original/file-20240214-30-1pca5f.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C5000%2C3323&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Spice is the name given to a diverse group of drugs called 'synthetic cannabinoid receptor agonists'. </span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/man-preparing-new-synthetic-cannabis-drug-1422542375">Axel Alvarez/ Shutterstock</a></span></figcaption></figure><p>Five teenagers in London were hospitalised recently after smoking vapes containing the drug known as <a href="https://www.standard.co.uk/news/health/what-zombie-vapes-e-cig-children-spice-symptoms-b1138635.html">spice</a>. This incident is only the latest in what appears to be a <a href="https://news.sky.com/story/spice-vape-alert-after-children-collapse-in-greater-manchester-11764453">growing problem</a> in the UK with <a href="https://www.publichealth.hscni.net/news/spice-vaping-warning-issued-0">unregulated vape liquids</a>, especially those marketed as containing THC or cannabis. </p>
<p>Spice is a synthetic drug which originally came onto the recreational drugs market to mimic the effects of cannabis. But unlike cannabis, spice is far more dangerous due to its potency and the way it exerts its effects on the brain and body. It has even been nicknamed the “zombie drug” because of the <a href="https://www.nhsinform.scot/healthy-living/drugs-and-drug-use/common-drugs/synthetic-cannabinoids-spice/">debilitating effects</a> it can have – causing psychosis, loss of movement, vomiting or diarrhoea and even sometimes seizures.</p>
<p>This is why it’s so important for users to think carefully about what vape products they use.</p>
<h2>What is spice?</h2>
<p>First described in 2008, spice is not a single compound but the name given to a diverse group of drugs called <a href="https://pubmed.ncbi.nlm.nih.gov/26226849/">synthetic cannabinoid receptor agonists</a> (or SCRAs). While these lab-made drugs are designed to mimic the effects of cannabis, they tend to be far more unpredictable and harmful.</p>
<p>There’s currently no data on how these drugs are manufactured in clandestine laboratories thought to be located in China and India. But we do have some idea of how spice may be synthesised, based on academic experiments that have been published in <a href="https://www.frontiersin.org/articles/10.3389/fchem.2019.00321/full">peer-reviewed journals</a>. The purpose of such experiments is to understand how spice is made and any impurities it might contain, which in turn helps forensic scientists compare with real-world samples to identify drug trafficking routes.</p>
<p>Many different drugs may be classified as spice. Some versions are structurally very similar to those found in herbal cannabis and cannabis resin, while others share only partial structural similarities with the THC molecule itself (the psychoactive compound in cannabis). These drugs interact with cannabinoid receptors (which are primarily located in the brain) in order to exert their effects. Hundreds of synthetic cannabinoids have now been <a href="https://www.emcdda.europa.eu/publications/edr/trends-developments/2022_en">identified in Europe</a>. </p>
<p>The drug is commonly sold in bags containing dried plants onto which a <a href="https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1556-4029.2012.02207.x">solution of the drug</a> has been sprayed. Once the plant material is dry the drug can be smoked with tobacco. The pure drug can also be <a href="https://analyticalsciencejournals.onlinelibrary.wiley.com/doi/abs/10.1002/dta.2767">mixed with vaping liquids</a>.</p>
<h2>What makes spice harmful?</h2>
<p>Studies have shown that the compounds contained in spice act on both types of cannabinoid receptors that the body has. They also bind far more strongly to them than compared to cannabis, heightening the effects of the drug. </p>
<p>These effects are further compounded by the fact that after SRCAs have been metabolised by the body, their by-products can then bind to the cannabinoid receptors. This further <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3945037/">increases the effects</a> of the drug rather than reducing them. Normally, once the body has metabolised the drug it would be cleared from the system.</p>
<p>Those who use spice repeatedly can <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4582439/">develop a tolerance</a> to it, requiring more to achieve the desired effect – ultimately putting them at higher risk of harm.</p>
<h2>How does spice affect users?</h2>
<p>Synthetic cannabinoid receptor agonists were initially explored as experimental drugs to <a href="https://www.tandfonline.com/doi/full/10.31887/DCNS.2007.9.4/nkogan">alleviate suffering</a> related to a variety of conditions – including pain, anorexia, muscle spasms and glaucoma. </p>
<figure class="align-center ">
<img alt="Two teens vape." src="https://images.theconversation.com/files/575641/original/file-20240214-18-ixc7k.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/575641/original/file-20240214-18-ixc7k.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/575641/original/file-20240214-18-ixc7k.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/575641/original/file-20240214-18-ixc7k.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/575641/original/file-20240214-18-ixc7k.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/575641/original/file-20240214-18-ixc7k.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/575641/original/file-20240214-18-ixc7k.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">Vaping liquids which claim to contain cannabis may actually contain spice.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/vape-teenagers-young-cute-girl-sunglasses-1400130692">Aleksandr Yu/ Shutterstock</a></span>
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<p>But because of their chemical structures, these drugs bind more strongly to cannabinoid receptors than the drugs found in cannabis. Their <a href="https://www.drugwise.org.uk/wp-content/uploads/Spice-info-sheetv1.3-Interactive-national.pdf">psychotropic effects</a> are also far stronger than cannabis and can last much longer.</p>
<p>Many people use spice in the hopes of experiencing effects similar to those caused by cannabis. But spice can instead cause a long list of unpleasant side effects. These include dizziness, inability to move, heart and breathing problems, seizures and even mental health problems (including anxiety attacks, paranoia and suicidal thoughts). Damage to the kidneys and gastrointestinal problems have <a href="https://www.drugwise.org.uk/wp-content/uploads/Spice-info-sheetv1.3-Interactive-national.pdf">also been reported</a>. </p>
<p>It isn’t possible to predict who will suffer which of these side effects, but all spice users are at risk.</p>
<h2>Is spice a growing problem?</h2>
<p>It’s difficult to gauge the size of the spice problem in the UK because of how hard it is to obtain accurate information about illicit drug taking. </p>
<p>One report suggests that in Manchester, <a href="https://www.bbc.co.uk/news/uk-england-42621649">95% of homeless people</a> were using the drug in 2017. It is also known that the drug is being <a href="https://analyticalsciencejournals.onlinelibrary.wiley.com/doi/abs/10.1002/dta.2767">smuggled into prisons</a> soaked onto paper – through letters, for example. This makes it difficult to detect the drug during screenings. One investigation even found that <a href="https://www.theguardian.com/society/2023/jan/31/urgent-action-needed-rise-prison-deaths-uk-researchers">nearly half</a> of male prison deaths that happened between 2015-2020 in England and Wales were due to Spice.</p>
<p>There is also an increasing number of reports in the press of vape liquids being laced with spice – leading public health authorities to <a href="https://www.publichealth.hscni.net/news/spice-vaping-warning-issued">issue warnings</a>.</p>
<p>There are now calls to make young people more aware of the dangers of spice and using certain types of vape liquids. Two identically labelled packets may not contain the same drug, or indeed the same amount. It’s also impossible to know what may be contained in vaping liquids.</p><img src="https://counter.theconversation.com/content/223370/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Michael Cole receives funding and "in kind" support from the European Union and a number police forces and forensic science organisations around the world to carry out research.
</span></em></p>Spice has been nicknamed the ‘zombie drug’ due to the debilitating effects it can cause.Michael Cole, Professor of Forensic Science, Anglia Ruskin UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2212112024-01-22T04:20:02Z2024-01-22T04:20:02ZWondering how to talk to your teen about drugs? Start the conversation early, be honest and avoid judgement<figure><img src="https://images.theconversation.com/files/570276/original/file-20240119-17-qdcgr3.jpg?ixlib=rb-1.1.0&rect=12%2C12%2C8231%2C5475&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/teenage-girl-sharing-problems-her-mother-2278735419">Halfpoint/Shutterstock</a></span></figcaption></figure><p>With several <a href="https://www.theguardian.com/australia-news/2024/jan/13/mdma-overdose-nine-people-hospitalised-after-melbourne-music-festival-had-severe-hyperthermia">drug overdoses</a> already this festival season, and recent news of <a href="https://www.anu.edu.au/news/all-news/anu-chemists-make-australian-first-discovery-of-three-new-recreational-drugs">three new recreational drugs</a> identified by the drug checking service in Canberra, many parents of teenagers will be wondering how they can keep their kids safe from harmful drugs.</p>
<p>It’s <a href="https://www.theguardian.com/society/2022/oct/19/canberra-pill-testing-service-discovers-new-unknown-drug-similar-to-ketamine">not the first time</a> CANtest, Canberra’s fixed site drug checking service, has identified new drugs circulating. Worldwide, <a href="https://www.unodc.org/res/WDR-2023/WDR23_Exsum_fin_SP.pdf">more than 1,000</a> new drugs have been released on to the illicit market in the past 15 years.</p>
<p>Because illicit drugs are unregulated, there’s no quality control or restrictions on sales, like there is, say, for alcohol or medicines. Manufacturers can add whatever substances they like and sell their drugs as anything. Data from <a href="https://www.cahma.org.au/services/cantest/">CANtest</a> shows illicit drugs often contain substances other than the expected drug.</p>
<p>The age group most likely to have used an illicit drug recently is <a href="https://www.aihw.gov.au/reports/illicit-use-of-drugs/national-drug-strategy-household-survey-2019/contents/summary">young adults in their 20s</a> (30.6%), but <a href="https://www.aihw.gov.au/reports/illicit-use-of-drugs/national-drug-strategy-household-survey-2019/data">nearly 22% of teenagers</a> have tried an illicit drug in their lifetime. The key is to start talking to teens well before they encounter these substances so they’re well prepared.</p>
<h2>First, don’t panic</h2>
<p>The good news is most teenagers don’t use illicit drugs and the majority of those who do only do so <a href="https://www.aihw.gov.au/getmedia/54f66117-e846-4de0-a874-e5f5eee57214/aihw-phe-270-4-Illicit-use-of-drugs-tables.xlsx.aspx">occasionally</a>, and <a href="https://www.aihw.gov.au/getmedia/54f66117-e846-4de0-a874-e5f5eee57214/aihw-phe-270-4-Illicit-use-of-drugs-tables.xlsx.aspx">don’t come to serious harm</a>. Drug use among teens in Australia has actually been <a href="https://www.aihw.gov.au/getmedia/54f66117-e846-4de0-a874-e5f5eee57214/aihw-phe-270-4-Illicit-use-of-drugs-tables.xlsx.aspx">in decline</a> for more than two decades.</p>
<p>Still, some do, and using illicit drugs is risky, <a href="https://theconversation.com/history-not-harm-dictates-why-some-drugs-are-legal-and-others-arent-110564">primarily because they’re illegal</a> and you don’t know what you’re getting.</p>
<p>Children are <a href="https://www.sciencedaily.com/releases/2015/12/151210093313.htm">heavily influenced</a> by their parents’ attitudes when it comes to alcohol and other drug use. While some parents worry discussing drugs might encourage drug use, open communication generally, and specifically in discussing drugs, has been associated with <a href="https://www.tandfonline.com/doi/full/10.1080/09687637.2016.1221060">lower rates of drug use</a>.</p>
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Read more:
<a href="https://theconversation.com/how-hard-is-it-to-say-no-to-drugs-111536">How hard is it to say 'no' to drugs?</a>
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<h2>Maintain an open dialogue</h2>
<p>Conversations about drugs can start at an early age. Talking early means a young person already has well-formed attitudes before the influence of their peers kicks in. Even before they get to school you can be talking to them about using medicines safely.</p>
<p>As children become teenagers, they’re exposed to more news and information online. You can use current events, like the recent festival overdoses, as a catalyst for raising the issue.</p>
<p>Find a time to talk when you’re both clear-headed, you’re somewhere private and you have plenty of time. In the car can be a good place.</p>
<figure class="align-center ">
<img alt="A teenage boy talking with a man outdoors." src="https://images.theconversation.com/files/570295/original/file-20240119-16-me8ll1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/570295/original/file-20240119-16-me8ll1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/570295/original/file-20240119-16-me8ll1.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/570295/original/file-20240119-16-me8ll1.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/570295/original/file-20240119-16-me8ll1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/570295/original/file-20240119-16-me8ll1.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/570295/original/file-20240119-16-me8ll1.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">Find the right time to talk.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/father-gesturing-talking-teenager-son-park-1817278340">LightField Studios/Shutterstock</a></span>
</figcaption>
</figure>
<p>Ask questions, listen to what your teen has to say, and resist the urge to lecture. We know honest information works best. <a href="https://theconversation.com/ex-ice-users-lecturing-school-kids-isnt-the-answer-to-preventing-drug-use-64753">Scare tactics</a> and exaggeration are generally unhelpful and may make teens more curious about trying drugs.</p>
<p>For example, claims they will become addicted after using a drug once or that using drugs causes instant and irreversible brain damage are not credible to teens, and they’re likely to ignore them.</p>
<p>Ask what they know about the topic and what their thoughts are. Then give them the facts in a non-judgemental way. Talk about the reasons some people choose to use drugs, and about the risks. </p>
<p>Avoid glorifying drug use, such as talking about fun times you’ve had using drugs in the past. Some parents think this makes them more credible, but it also potentially communicates a permissive attitude to drugs.</p>
<h2>Emphasise personal responsibility</h2>
<p>If your teen is worried about peer pressure or standing out from their friends if they don’t want to use drugs, it can be helpful to run through a few scenarios with them. What would they say if someone asked them if they wanted to try MDMA?</p>
<p>Emphasise personal responsibility and the importance of making independent decisions, and help them make contingency plans if someone is applying unwanted pressure. This could include seeking out friends at a party who don’t use drugs, planning how to exit, or calling a parent.</p>
<p>It’s absolutely OK to set and be clear about your expectations around drug use, but try not to make threats. Saying things like “if you use drugs you’re on your own” is unhelpful because if they get into trouble they may not feel they can call for help.</p>
<figure class="align-center ">
<img alt="One young person hands a bag of white pills to another." src="https://images.theconversation.com/files/570296/original/file-20240119-27-p5mi1g.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/570296/original/file-20240119-27-p5mi1g.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/570296/original/file-20240119-27-p5mi1g.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/570296/original/file-20240119-27-p5mi1g.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/570296/original/file-20240119-27-p5mi1g.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/570296/original/file-20240119-27-p5mi1g.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/570296/original/file-20240119-27-p5mi1g.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">Your teen could be worried about peer pressure.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/unrecognizable-high-school-students-dealing-drugs-2177001531">Halfpoint/Shutterstock</a></span>
</figcaption>
</figure>
<h2>Take a harm reduction approach</h2>
<p>Sometimes though, no matter what you do, some young people will want to experiment. Risk-taking is a natural part of adolescence and young adulthood.</p>
<p>Make sure they know how to respond in an emergency. Consequences from illicit drugs such as toxicity <a href="https://theconversation.com/how-does-mdma-kill-109506">can often be reversed</a> if treated early enough, so make sure your teen knows if they or their friends use something and start feeling unwell that they should get medical help straight away. It’s better to get help and not need it.</p>
<p>At festivals there’s always a medical tent. Ensure they know to call 000 if there is no immediate medical help available and they should disclose what has been taken. Police are not usually called to drug emergencies.</p>
<p>Make sure they feel like they can call you for advice or to pick them up and that they won’t be interrogated or berated. It’s much better if you can talk to them later about what they learnt from the incident.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/should-i-give-my-teen-alcohol-just-a-sip-the-whole-can-or-none-at-all-190234">Should I give my teen alcohol? Just a sip, the whole can, or none at all?</a>
</strong>
</em>
</p>
<hr>
<p>If you know your teen is occasionally using recreational drugs or is intending to, or their friends are, you can be more direct with harm reduction information.</p>
<p>Let them know it’s possible to get <a href="https://theconversation.com/novel-drugs-are-leading-to-rising-overdose-deaths-in-victoria-drug-checking-services-could-help-215791">drugs checked</a> in some places to see what’s in them.</p>
<p>If they can’t, make sure they know they should just take a small amount first to see how a drug affects them. It’s best to take a quarter or half initially to make sure there are no adverse reactions, and <a href="https://wearetheloop.org/crush-dab-wait">ideally wait</a> at least 45 minutes before talking more. It can take up to an hour or more to feel the effects of MDMA.</p>
<p><a href="https://adf.org.au/reducing-risk/polydrug-use/">Mixing drugs</a> with alcohol or mixing multiple drugs, including prescription medicines, significantly increases the risk of something going wrong and should be avoided.</p>
<p><em>If you need advice you can call the National Alcohol and Other Drug Hotline on 1800 250 015. The <a href="https://adf.org.au">Alcohol and Drug Foundation</a> has a range of helpful information about drugs and their effects.</em></p><img src="https://counter.theconversation.com/content/221211/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Nicole Lee works as a paid consultant in the alcohol and other drug sector. She has previously been awarded grants by state and federal governments, National Health and Medical Research Council and other public funding bodies for alcohol and other drug research. She is a Board member of drug checking organisation The Loop Australia.
</span></em></p>The good news is most teenagers don’t use illicit drugs, and the majority of those who do only do so occasionally and don’t come to serious harm.Nicole Lee, Professor at the National Drug Research Institute Curtin University (Melbourne based), Curtin UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2206082024-01-15T13:37:47Z2024-01-15T13:37:47ZKush: what is this dangerous new west African drug that supposedly contains human bones?<figure><img src="https://images.theconversation.com/files/568481/original/file-20240109-30-g2zjue.jpg?ixlib=rb-1.1.0&rect=31%2C31%2C2971%2C1963&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/close-african-man-smoking-joint-588753893">DeanP/Shutterstock</a></span></figcaption></figure><p>A new drug called kush is <a href="https://www.channel4.com/news/kush-a-drug-sometimes-mixed-with-human-bones-is-ravaging-sierra-leone#:%7E:text=Kush%20is%20a%20mysterious%20new,the%20drug's%20cocktail%20of%20ingredients">wreaking havoc in west Africa</a>, particularly in Sierra Leone where it is estimated to kill around a dozen people each week and <a href="https://www.telegraph.co.uk/global-health/terror-and-security/kush-synthetic-drug-addiction-epidemic-west-africa/#:%7E:text=But%20it's%20not%20just%20Sierra,the%20region%20are%20now%20addicted.">hospitalise thousands</a>. </p>
<p>The drug, taken mostly by <a href="https://www.telegraph.co.uk/global-health/terror-and-security/kush-synthetic-drug-addiction-epidemic-west-africa/#:%7E:text=But%20it's%20not%20just%20Sierra,the%20region%20are%20now%20addicted.">men aged 18 to 25</a>, causes people to fall asleep while walking, to fall over, to bang their heads against hard surfaces and to walk into moving traffic.</p>
<p>Kush should not be confused with the drug of the same name found in the US, which is a mixture of <a href="https://www.houstoniamag.com/news-and-city-life/2016/08/so-what-exactly-is-kush-city-council-is-asking-ice-house-september-2016">“an ever-changing host of chemicals”</a> sprayed on plant matter and smoked. Kush in Sierra Leone is quite different; it is a <a href="https://www.telegraph.co.uk/global-health/terror-and-security/kush-synthetic-drug-addiction-epidemic-west-africa/#:%7E:text=Kush%20first%20emerged%20in%20Sierra,under%20%C2%A3400%20a%20year">mixture</a> of cannabis, fentanyl, tramadol, formaldehyde and – according to some – ground down <a href="https://www.youtube.com/watch?v=fKc3SDBoFtA">humans bones</a>.</p>
<p>It is mixed by local criminal gangs, but the constituent drugs have international sources, facilitated no doubt by the internet and digital communications. </p>
<p>While cannabis is widely grown in Sierra Leone, the fentanyl is thought to originate in clandestine laboratories in China where the drug is manufactured illegally and shipped to west Africa. Tramadol has a similar source, namely illegal laboratories across Asia. Formaldehyde, which <a href="https://www.justice.gov/archive/ndic/pubs11/12208/index.htm#:%7E:text=Embalming%20fluid%20is%20a%20compound,resulting%20in%20a%20prolonged%20high.">can cause hallucinations</a>, is also reported in this mixture. </p>
<p>As for ground human bones, there is no definitive answer about whether or not they occur in the drug, where such bones would come from, or why they might be incorporated into the drug. Some people say that <a href="https://www.channel4.com/news/kush-a-drug-sometimes-mixed-with-human-bones-is-ravaging-sierra-leone#:%7E:text=Kush%20is%20a%20mysterious%20new,the%20drug's%20cocktail%20of%20ingredients">grave robbers</a> provide the bones, but there is no direct evidence of this. </p>
<p>But why would bones be incorporated into the drug? Some suggest that the sulphur content of the bones causes a high. Another reason might be the drug content of the bones themselves, if the deceased was a fentanyl or tramadol user. </p>
<p>However, both are unlikely. Sulphur levels in bones are not high. Smoking sulphur would result in highly toxic sulphur dioxide being produced and inhaled. Any drug content in bones is orders of magnitude less than that required to cause a physiological effect.</p>
<h2>Where is the drug found?</h2>
<p>The drug is reported in both <a href="https://www.telegraph.co.uk/global-health/terror-and-security/kush-synthetic-drug-addiction-epidemic-west-africa/#:%7E:text=Kush%20first%20emerged%20in%20Sierra,under%20%C2%A3400%20a%20year">Guinea and Liberia</a>, which share porous land borders with Sierra Leone, making drug trafficking easy. </p>
<p>Kush costs around five leones (20 UK pence) per joint, which may be used by two or three people, with up to 40 joints being consumed in a day. This represents a massive spend on drugs and illustrates the addictive nature of the mixture, in a country where the annual income per capita is <a href="https://tradingeconomics.com/sierra-leone/gdp-per-capita#:%7E:text=The%20Gross%20Domestic%20Product%20per,percent%20of%20the%20world%27s%20average.">around £500</a>.</p>
<p>The effects of the drug vary and depend on the user and the drug content. Cannabis causes a wide variety of effects, which include euphoria, relaxation and an altered state of consciousness. </p>
<p>Fentanyl, an extremely potent opioid, produces euphoria and confusion and causes sleepiness among a wide range of other side-effects. Similarly, tramadol, which is also an opioid but less potent than fentanyl (100mg tramadol has the same effect as 10mg morphine) results in users becoming sleepy and “spaced out” – disconnected from things happening around them. </p>
<figure class="align-center ">
<img alt="Blisterpacks of tramadol pills" src="https://images.theconversation.com/files/568482/original/file-20240109-27-4m2gnf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/568482/original/file-20240109-27-4m2gnf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=345&fit=crop&dpr=1 600w, https://images.theconversation.com/files/568482/original/file-20240109-27-4m2gnf.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=345&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/568482/original/file-20240109-27-4m2gnf.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=345&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/568482/original/file-20240109-27-4m2gnf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=434&fit=crop&dpr=1 754w, https://images.theconversation.com/files/568482/original/file-20240109-27-4m2gnf.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=434&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/568482/original/file-20240109-27-4m2gnf.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=434&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Kush can contain tramadol, an opioid.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/pain-killer-capsules-called-tramadol-hcl-789515359">Saowanee K/Shutterstock</a></span>
</figcaption>
</figure>
<p>The danger of the drug is twofold: the risk of self-injury to the drug taker and the highly addictive nature of the drug itself. A further problem is the need to finance the next dose, often achieved through prostitution or criminal activity.</p>
<h2>Joining the ranks of existing polydrugs</h2>
<p>Kush is another example of polydrug mixtures of which forensic scientists are becoming increasingly aware. Another tobacco and cannabis-based drug, <a href="https://www.sciencedirect.com/science/article/pii/S037907381830481X">nyaope</a>, otherwise known as whoonga, is found in South Africa. This time the tobacco and cannabis are mixed with heroin and antiretroviral drugs used to treat Aids, some of which are <a href="https://www.scielo.org.za/scielo.php?pid=S0038-23532021000600018&script=sci_arttext">hallucinogenic</a>. </p>
<p>A further polydrug, <a href="https://mg.co.za/article/2002-07-05-high-on-the-white-pipe/">“white pipe”</a>, a mixture of methaqualone (Mandrax), cannabis and tobacco, is smoked in southern Africa. These drugs are inexpensive and provide an escape from unemployment, the drudgery of poverty, sexual and physical abuse, and the effect, in some cases, especially in west Africa, from having been a child soldier. So what can be done about these drugs? </p>
<p>The effectiveness of legislation alone is questionable, and many of those who attend the very limited rehabilitation centres return to drug use. Perhaps what is required is an integrated forensic healthcare system where legislative control is backed up by properly resourced rehabilitation centres coupled with a public health and employment programme. What changes are made in response to this epidemic remains to be seen.</p><img src="https://counter.theconversation.com/content/220608/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Michael Cole receives funding and "in kind" support from the European Union and a number police forces and forensic science organisations around the world to carry out research. </span></em></p>A new polydrug is destroying lives in west Africa.Michael Cole, Professor of Forensic Science, Anglia Ruskin UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2205172024-01-12T16:12:10Z2024-01-12T16:12:10ZFour street drugs that could pose the biggest threat to UK public health in 2024<figure><img src="https://images.theconversation.com/files/569021/original/file-20240112-25-j3jcoe.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C4025%2C3017&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Xanax pills</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/muncie-indiana-united-states-june-5-1416893333">gremlinworks/Shutterstock</a></span></figcaption></figure><p>As with fashion and music, illicit drugs go through peaks and troughs of popularity. There are popular staples, such as cannabis, and more disruptive and transient substances, such as <a href="https://theconversation.com/meow-hear-this-mephedrone-is-a-curious-khat-2164">mephedrone</a>. As with <a href="https://youtu.be/Ja2fgquYTCg?si=AjGVwuw92NiEPnMS">clothing fashion</a>, the drugs that most people are able to buy are <a href="https://www.emcdda.europa.eu/publications/eu-drug-markets_en">determined by</a> the choices of designers, manufacturers and logistical operations, rather than consumers. </p>
<p>Predicting how the UK drug market may change in 2024 relies not only on recent trends in drug use but also on international developments. Geopolitical events in <a href="https://geographical.co.uk/news/myanmar-becomes-worlds-biggest-producer-of-opium">south-east Asia</a> or <a href="https://www.bbc.co.uk/news/world-latin-america-67912242">South America</a> are just as important as organised crime activity in cities such as London or Liverpool. We suggest that there are four types of drugs that will be of increasing concern in 2024. </p>
<h2>1. Opioids</h2>
<p>Heroin sold in the UK is primarily sourced from opium grown in Afghanistan. Any change in the <a href="https://theconversation.com/afghanistan-what-the-conflict-means-for-the-global-heroin-trade-165995">production and distribution</a> of opium has a direct effect on the <a href="https://theconversation.com/nitazenes-synthetic-opioids-more-deadly-than-fentanyl-are-starting-to-turn-up-in-overdose-cases-212589">UK heroin market</a>. </p>
<p>After seizing power in 2022, the Taliban announced a clampdown on opium farming in Afghanistan. While other growing regions have <a href="https://www.unodc.org/roseap/en/2023/12/southeast-asia-opium-survey-report-launch/story.html#:%7E:text=Bangkok%20(Thailand)%2C%2012%20December,Asia%20released%20in%20Bangkok%20today.">increased production</a>, this has not been at the level of the Afghan crop. </p>
<p>Large stockpiles of opium and heroin stored along trafficking routes have depleted. 2024 will see the impact of this. </p>
<p>The estimated number of people who use heroin has <a href="https://www.gov.uk/government/publications/opiate-and-crack-cocaine-use-prevalence-estimates/estimates-of-opiate-and-crack-use-in-england-main-points-and-methods">increased</a> over the past decade, with an estimated 341,032 current users in England. </p>
<p>This is a highly profitable market, and suppliers are adaptable and nimble in responding to changes like these. As a consequence of the shortfall in Afghan heroin production, new, highly potent <a href="https://www.bmj.com/content/383/bmj.p2421">synthetic opioids</a> have already emerged to fill the gap. These include the group of synthetic opiates known as <a href="https://theconversation.com/nitazenes-synthetic-opioids-more-deadly-than-fentanyl-are-starting-to-turn-up-in-overdose-cases-212589">nitazenes</a>, which have contributed to the <a href="https://theconversation.com/generation-x-hardest-hit-as-drug-deaths-rise-yet-again-in-england-and-wales-220064">record levels</a> of drug-related deaths recorded in 2023 in the UK. </p>
<p>Increased market penetration of these drugs could lead to a big rise in deaths in 2024. Worryingly, <a href="https://www.bbc.co.uk/news/uk-england-manchester-67777938">misselling</a> as other products and unintentional contamination of other non-opioid drugs could increase the harms further. Government and treatment services must act now to prepare for an increase in the supply of these drugs, as the costs of not doing so might lead to a <a href="https://www.sciencedirect.com/science/article/pii/S0955395923003614?via%3Dihub">“nightmare scenario”</a>. </p>
<h2>2. Cocaine</h2>
<p>Cocaine has never been purer, more affordable and more available to those <a href="https://www.theguardian.com/commentisfree/2023/dec/23/coke-consumption-uk-millennials-generation-x">who want it in the UK</a>. While <a href="https://www.ons.gov.uk/peoplepopulationandcommunity/crimeandjustice/articles/drugmisuseinenglandandwales/yearendingmarch2023">levels of use</a> have been relatively stable over the past 20 years, <a href="https://theconversation.com/generation-x-hardest-hit-as-drug-deaths-rise-yet-again-in-england-and-wales-220064">deaths and hospitalisations</a> have increased due the nature of the product on the market and increases in the frequency and length of use. </p>
<p>Unlike other class A drugs, such as heroin, there are few effective treatments, and users tend to be more socially integrated. This means that they are less likely to come into contact with police or present to treatment services. </p>
<p>They may not identify themselves as having a drug problem, despite the effect it may be having on their lives. When disposable income continues to be squeezed as it is in the current cost of living crisis, powder cocaine (as opposed to crack cocaine) is a drug that will continue to provide good “value for money”. Sadly, we predict yet another rise in poisonings and hospitalisations in 2024.</p>
<figure class="align-center ">
<img alt="Older man snorting coke." src="https://images.theconversation.com/files/569019/original/file-20240112-29-ke6q5v.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/569019/original/file-20240112-29-ke6q5v.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=401&fit=crop&dpr=1 600w, https://images.theconversation.com/files/569019/original/file-20240112-29-ke6q5v.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=401&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/569019/original/file-20240112-29-ke6q5v.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=401&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/569019/original/file-20240112-29-ke6q5v.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=504&fit=crop&dpr=1 754w, https://images.theconversation.com/files/569019/original/file-20240112-29-ke6q5v.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=504&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/569019/original/file-20240112-29-ke6q5v.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=504&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Cocaine users tend to be more ‘socially integrated’.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/old-male-writer-smoking-cigarette-2284921057">Elnur/Shutterstock</a></span>
</figcaption>
</figure>
<h2>3. Ketamine</h2>
<p>Ketamine has been used in medicine as an anaesthetic for many years, and more recently as an <a href="https://theconversation.com/how-antidepressants-ketamine-and-psychedelic-drugs-may-make-brains-more-flexible-new-research-216025">antidepressant</a>. Taken recreational at lower doses, the drug <a href="https://www.talktofrank.com/drug/ketamine">induces</a> feelings of detachment and happiness. </p>
<p>This is another drug that has become increasingly <a href="https://bjgp.org/content/73/727/87">popular</a> because it is cheap, fast-acting and easy to get hold of. </p>
<p>Around <a href="https://news.sky.com/story/student-died-after-taking-ketamine-now-her-mother-wants-to-address-naivety-among-parents-13039959">3.8% of young people</a> (aged 16 to 24) report having used the drug. This has been steadily rising over the past decade. Police report that the weight of <a href="https://www.gov.uk/government/statistics/seizures-of-drugs-in-england-and-wales-financial-year-ending-2022/seizures-of-drugs-in-england-and-wales-financial-year-ending-2022">seizures</a> of ketamine that they made increased sharply from 187kg in 2021 to 1,837kg in 2022. Drug seizures are often used as a proxy for estimating levels of supply.</p>
<p>A range of problems can develop for those using ketamine in higher doses or over a longer period, ranging from mental health problems to <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4544340/">incontinence</a>. An overdose of the drug can prove to be fatal.</p>
<p>As with most illicit drugs, combining ketamine with alcohol <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9323326/">increases</a> health risks. Sadly, it is the norm for people to use more than one drug at a time – including alcohol.</p>
<p>Given the widespread availability and <a href="https://www.timeout.com/uk/nightlife/how-ketamine-became-britains-go-to-party-drug">affordability</a> of ketamine in the UK, its use will continue to rise in 2024. Use is concentrated among younger people, many of whom won’t be aware of its potential for harm until it’s too late. </p>
<p>As with cocaine, there has been a distinct lack of health messaging, advice and support for people who use ketamine. Some youth organisations that have tried to do this have faced unhelpful <a href="https://www.thetimes.co.uk/article/how-ketamine-became-the-uks-hidden-campus-killer-9mp3pm6ht">national media backlash</a>. </p>
<h2>4. Benzodiazapines</h2>
<p>Benzodiazepines, more commonly known by brand names such as Valium and Xanax, have proved to be popular and dangerous in equal measure. While medical prescriptions have <a href="https://www.england.nhs.uk/2023/03/opioid-prescriptions-cut-by-almost-half-a-million-in-four-years-as-nhs-continues-crackdown/">fallen</a> in recent years illicit <a href="https://www.ons.gov.uk/peoplepopulationandcommunity/crimeandjustice/articles/drugmisuseinenglandandwales/yearendingmarch2023">demand</a> and supply has not. </p>
<p>Although doctors have been <a href="https://www.nice.org.uk/sharedlearning/benzodiazepine-hypnotics-deprescribing">encouraged</a> to reduce prescriptions for benzodiazepines, the black market has filled the gap in demand. Unlike legitimate supply, the illicit market has no quality control or reliable information on strength – both of which lead to deaths.</p>
<p>The rapid rise in deaths from <a href="https://www.sciencedirect.com/science/article/abs/pii/S0955395921004308">these drugs</a> in Scotland shows regional differences both in the use of drugs and the risks they pose. Reversing this trend in use and fatalities will prove to be difficult in 2024 as there are few signs of a change in demand for, or supply of these drugs.</p>
<h2>Can we prevent drug harms?</h2>
<p>It is not possible to entirely prevent all the harms relating to drug use and the drugs market, but they can be reduced. 2024 may see the emergence of new drugs or new ways of taking them, but what won’t change will be the continuation of more than 20 years of increasing drug-related harm. </p>
<p>In a year of a general election in the UK, there is the danger that drugs policy will be used for political point scoring – signalling to the electorate how tough on crime one party is, or how soft on crime their opponents are. Whatever the outcome of the election, unless there is a clear commitment to long-term investment in responses to drug use, new records will be set in drug-related deaths.</p><img src="https://counter.theconversation.com/content/220517/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Harry Sumnall receives and has received funding from public grant awarding bodies for alcohol and other drugs research, and consultation fees from (international) not-for-profit organisations, and government Ministries for consultation work. He is an unpaid member of the Scientific Advisory Board of the Mind Foundation.</span></em></p><p class="fine-print"><em><span>Ian Hamilton does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Synthetic opioids called nitazenes are ones to watch in 2024.Ian Hamilton, Honorary Fellow, Department of Health Sciences, University of YorkHarry Sumnall, Professor in Substance Use, Liverpool John Moores UniversityLicensed as Creative Commons – attribution, no derivatives.tag: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">
<figcaption>
<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>
</figcaption>
</figure>
<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>
<figure class="align-center ">
<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">
<figcaption>
<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>
</figcaption>
</figure>
<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/2195992023-12-12T03:46:44Z2023-12-12T03:46:44ZPlanning to use drugs at a festival on a scorching summer day? Here’s why extreme heat might make MDMA riskier<figure><img src="https://images.theconversation.com/files/565079/original/file-20231212-29-chp7fb.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C5176%2C3453&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/crowds-enjoying-themselves-outdoor-music-festival-184911032">Monkey Business Images/Shutterstock</a></span></figcaption></figure><p>Sydney and other parts of Australia have just experienced <a href="https://news.sky.com/story/australia-temperatures-in-sydney-climb-to-nearly-40c-as-authorities-issue-bushfire-warnings-13027266">a significant heatwave</a>, with temperatures reaching highs of well over 40°C. In Sydney in particular, the extreme heat has coincided with a bustling schedule of <a href="https://www.canberratimes.com.au/story/8453863/crowds-bake-at-sydney-concerts-as-mercury-soars/">live music events</a>, attracting large crowds despite the sweltering conditions.</p>
<p>Drug experts <a href="https://www.abc.net.au/news/2023-12-09/nsw-heat-drug-overdose-festival-deaths/103205522">raised concerns</a> ahead of the sold-out Epik festival which took place at Sydney Olympic Park on Saturday, cautioning revellers against the dangers of taking illicit drugs in extreme heat.</p>
<p>Reports have since emerged that <a href="https://www.abc.net.au/news/2023-12-10/nsw-sydney-epik-music-dance-festival-drug-hospitalisations/103211208">four festival patrons</a> were taken to hospital for reasons relating to drugs. </p>
<p>While illicit drug use is dangerous no matter the circumstances, extremely hot weather may make it even more risky.</p>
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<em>
<strong>
Read more:
<a href="https://theconversation.com/5-reasons-why-climate-change-may-see-more-of-us-turn-to-alcohol-and-other-drugs-217894">5 reasons why climate change may see more of us turn to alcohol and other drugs</a>
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<h2>Drug use at festivals</h2>
<p>We know the use of recreational drugs is common at live music events such as festivals. Studies have shown people who frequently <a href="https://harmreductionjournal.biomedcentral.com/articles/10.1186/s12954-017-0205-7">attend music festivals</a> and dance events tend to have <a href="https://substanceabusepolicy.biomedcentral.com/articles/10.1186/1747-597X-6-18">more experience with illegal substances</a> than their counterparts who don’t attend these events. </p>
<p>Wastewater analyses <a href="https://www.sciencedirect.com/science/article/pii/S0048969718351490?casa_token=ZMgSdR0MnjYAAAAA:iseXbDHWCT8i4O4FqGUUrooAUleX9TXqSce89xbPVDjONBubOHB-rrpsCkHUl-if5m3DYgFW6Eg">have confirmed</a> the prevalence of drug use at music festivals.</p>
<p>In Australia and overseas, several live music events have been marred by tragedies linked to drug use. As recently as October, two men, aged 21 and 26, died following <a href="https://cityhub.com.au/two-men-die-from-suspected-drug-overdose-after-attending-sydney-music-festival/">suspected drug overdoses</a> at the Knockout music festival in Sydney. </p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1708729898116808711"}"></div></p>
<p>At these sorts of events, MDMA (or ecstasy) is among the <a href="https://www.tandfonline.com/doi/full/10.1080/15563650.2017.1360496?casa_token=qppYTfu_IBcAAAAA%3ANwXWLwMFiKcBWE0e8DIGu-97pJNnqynSjjiwYhg-gNDbOEcqhNI2MOccCvzszG4QCRewZhiDTPH_MQ">most commonly used substances</a>. And when taken during extreme heat, the risks could be much greater.</p>
<h2>MDMA and hot weather</h2>
<p>MDMA triggers the release of substances that interfere with our <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5008716/">temperature regulation</a>, leading the body to generate more heat than usual. This effect is known as hyperthermia (as opposed to hypothermia, when the body gets too cold). </p>
<p>This elevation in body temperature happens even if the person using drugs is not exerting themselves and not in a hot environment. In this context, the effect can still <a href="https://sunrisehouse.com/ecstasy-abuse/effects/">cause dehydration</a>.</p>
<p>However, the effects may be greater if a person is exerting themselves in hot, crowded settings. Studies have shown that on average, for a person who takes MDMA somewhere like a dance club, their body temperature can increase by <a href="https://www.sciencedirect.com/science/article/abs/pii/S0376871611003577">more than 1°C</a>.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/taylor-swifts-brazil-concert-was-hammered-by-extreme-heat-how-to-protect-crowds-at-the-next-sweltering-gig-218341">Taylor Swift's Brazil concert was hammered by extreme heat. How to protect crowds at the next sweltering gig</a>
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<p>In extreme cases, a sharp increase in body temperature <a href="https://www.nih.gov/news-events/news-releases/mdma-can-be-fatal-warm-environments">can lead to</a> organ failure and even death. </p>
<p>Extreme heat may compound the hyperthermia induced by taking the drug. A <a href="https://www.jneurosci.org/content/34/23/7754.short">study in rats</a> showed a moderate dose of MDMA that is typically non-fatal in cool, quiet environments can be fatal in rats exposed to conditions that mimic the hot, crowded settings where people often use the drug.</p>
<figure class="align-center ">
<img alt="One person passing a small packet of pills to another person." src="https://images.theconversation.com/files/565081/original/file-20231212-15-71opww.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/565081/original/file-20231212-15-71opww.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/565081/original/file-20231212-15-71opww.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/565081/original/file-20231212-15-71opww.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/565081/original/file-20231212-15-71opww.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/565081/original/file-20231212-15-71opww.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/565081/original/file-20231212-15-71opww.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">Taking MDMA interferes with the body’s temperature regulation.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/drug-dealer-selling-ecstasy-pills-addict-1331364980">Impact Photography/Shutterstock</a></span>
</figcaption>
</figure>
<h2>What now?</h2>
<p>Illicit drugs pose significant dangers to people who use them at music festivals and elsewhere. </p>
<p>Meanwhile, with climate change, we are set to face <a href="https://www.climatechange.environment.nsw.gov.au/impacts-climate-change/weather-and-oceans/heatwaves">more frequent and intense</a> heatwaves in the future. So it’s important to better understand how the weather might intensify the risks of drug use. </p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/testing-festival-goers-pills-isnt-the-only-way-to-reduce-overdoses-heres-what-else-works-118827">Testing festival goers' pills isn't the only way to reduce overdoses. Here's what else works</a>
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<p>The principles of harm reduction recognise that, despite our best efforts to educate people about the risks associated with substance use, some people will continue to experiment with drugs at music festivals. So it becomes essential to minimise potential harms through evidence-based strategies, such as <a href="https://harmreductionjournal.biomedcentral.com/articles/10.1186/s12954-017-0205-7">pill testing</a>.</p>
<p>Harm reduction messages play a vital role in educating music festival attendees about the dangers of drug use, especially in hot conditions. These messages must encourage seeking medical help without fear of repercussions, staying hydrated, taking regular breaks, and wearing appropriate clothing for sun protection. Public officials, event organisers, families and friends can all contribute to spreading these messages, though attendees also need to exercise personal responsibility.</p>
<p>Messaging should also stress the importance of patrons looking out for their friends, highlighting everyone has a role in maintaining a safe environment at these events.</p>
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<em>
<strong>
Read more:
<a href="https://theconversation.com/its-extremely-hot-and-im-feeling-weak-and-dizzy-could-i-have-heat-stroke-215084">It's extremely hot and I'm feeling weak and dizzy. Could I have heat stroke?</a>
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<img src="https://counter.theconversation.com/content/219599/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Dr Milad Haghani receives funding from the Australian Research Council (Grant No. DE210100440). </span></em></p><p class="fine-print"><em><span>Dr Pegah Varamini has received funding from the National Breast Cancer Foundation, Therapeutic Innovation Australia (TIA), Pipeline Accelerator Grant, SPARK Oceania, Tour de Cure, Sydney Catalyst, Controlled Release Society, and Australian Pain Society. She is a lecturer and the head of Breast Cancer Targeting & Drug Delivery laboratory at the University of Sydney Pharmacy School. Pegah is affiliated with the World Health Organisation as a scientific advisor within the Global Breast Cancer Initiative and is the Co-Chair of NanoPharma cluster within NanoHealth Initiative at the Sydney Nano Institute.</span></em></p>Taking MDMA can raise our body temperature higher than it should be. Extreme heat may compound this effect.Milad Haghani, Senior Lecturer of Public Safety & Disaster Risk, UNSW SydneyPegah Varamini, Senior Lecturer in Pharmacy and Pharmacology, Head of Breast Cancer Targeting and Drug Delivery Laboratory, University of SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2164392023-12-11T04:27:58Z2023-12-11T04:27:58ZWe’re on track to eliminate hepatitis C, but stigma remains and reinfection is a risk<figure><img src="https://images.theconversation.com/files/564715/original/file-20231211-21-yubjnt.jpg?ixlib=rb-1.1.0&rect=244%2C325%2C5794%2C3630&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/back-view-man-standing-looking-through-2136042105">Shutterstock</a></span></figcaption></figure><p>Hepatitis C is a preventable but potentially life-threatening blood-borne virus. It primarily affects the liver and, if untreated, can lead to <a href="https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/cirrhosis-of-the-liver">cirrhosis</a> (scar damage) and cancer. </p>
<p>When direct-acting antivirals for hepatitis C arrived in 2016, they were described as a <a href="https://www.smh.com.au/politics/federal/turnbull-government-to-spend-1-billion-on-hepatitis-c-miracle-cures-for-all-20151219-glrib0.html">game changer</a>. They <a href="https://www.penington.org.au/wp-content/uploads/2022/07/The-Bulletin-April-2021.pdf">cured</a> chronic hepatitis C in <a href="https://www.nature.com/articles/510043a">more than 95% of cases</a>. So Australia adopted the World Health Organization’s target to <a href="https://www.nature.com/articles/510043a">eliminate hepatitis C</a> by 2030.</p>
<p>More than <a href="https://www.abc.net.au/news/2016-12-05/hep-c-drugs-australias-most-expensive/8094188">a billion dollars</a> has been invested in adding direct-acting antivirals to the Pharmaceutical Benefits Scheme, making treatment accessible to anyone covered by Medicare. By the end of 2022, <a href="https://unsw-primo.hosted.exlibrisgroup.com/primo-explore/fulldisplay?vid=UNSWORKS&docid=unsworks_modsunsworks_84935&context=L">about 60%</a> of people living with hepatitis C had been treated. </p>
<p>That’s a remarkable public health achievement. Life-changing for many and for some, literally life-saving. But what is life like for this growing group of people after they’ve been cured? And where are we still lagging in our efforts to combat hepatitis C?</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/explainer-the-a-b-c-d-and-e-of-hepatitis-54739">Explainer: the A, B, C, D and E of hepatitis</a>
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<h2>Cure doesn’t always eliminate stigma</h2>
<p>The most common way of picking up hepatitis C in Australia is by sharing injecting equipment. As injecting drugs is widely disapproved of, and illegal in most parts of Australia, this has huge implications for people with hepatitis C. </p>
<p>The <a href="https://journals.sagepub.com/doi/10.1177/1357034X09347221">stigma associated with injecting drugs</a> means people with hepatitis C can experience persistent discrimination – in relationships, at work, and other settings. Research suggests <a href="https://www.unsw.edu.au/content/dam/pdfs/unsw-adobe-websites/arts-design-architecture/ada-faculty/csrh/2021-06-Stigma_Indicators_Monitoring_Project_Summary_Report.pdf">more than half</a> of people with hepatitis C experienced discrimination in a 12-month period. </p>
<p>Such discrimination happens <a href="https://academic.oup.com/cid/article/57/suppl_2/S51/394838">most commonly in health care</a>, when doctors, nurses and others health-care professionals become aware of someone’s hepatitis C status. This <a href="https://www.sciencedirect.com/science/article/pii/S1326020023001784?via%3Dihub">can include</a> withholding treatment, <a href="https://theconversation.com/mental-distress-is-much-worse-for-people-with-disabilities-and-many-health-professionals-dont-know-how-to-help-187078">diagnostic overshadowing</a> (when workers attribute physical symptoms of illness to mental health issues), rude or unwelcoming behaviour, and excessive infection control like double-gloving. This may lead some people to avoid seeking medical care entirely.</p>
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<img alt="GP talks to female patient" src="https://images.theconversation.com/files/564712/original/file-20231211-21-7k618h.jpg?ixlib=rb-1.1.0&rect=27%2C9%2C6132%2C4091&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/564712/original/file-20231211-21-7k618h.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/564712/original/file-20231211-21-7k618h.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/564712/original/file-20231211-21-7k618h.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/564712/original/file-20231211-21-7k618h.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/564712/original/file-20231211-21-7k618h.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/564712/original/file-20231211-21-7k618h.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">Some health providers act differently when finding out about a patient’s history of hepatitis C.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/close-young-female-general-practitioner-gesturing-1917303137">Shutterstock</a></span>
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<p>Our recent research <a href="https://mh.bmj.com/content/early/2023/07/13/medhum-2023-012653">found</a> direct-acting antivirals do not necessarily cure these forms of stigma and discrimination. If medical records show a person has a history of hepatitis C, some health-care workers change the way they treat that person. </p>
<p>Their manner can change. The treatments they offer might change – for example, whether they will provide access to painkillers. Sometimes people are treated as if they are infectious, or as if they still have the virus when they don’t.</p>
<h2>The law can reinforce stigma and discrimination</h2>
<p>Laws and legal practices have been slow to respond to new treatments.</p>
<p>In insurance law, for instance, having once had hepatitis C has been considered a risk to insurance providers. This means affected people <a href="https://opal.latrobe.edu.au/articles/journal_contribution/Insurance_discrimination_and_hepatitis_C_Recent_developments_and_the_need_for_reforms/22091411">may not be</a> approved for travel, health or life insurance. Or, their premiums may be much higher, potentially pricing them out of the market and limiting their ability to travel, access health care or plan for their financial futures. </p>
<p>We would expect to see practices change with more effective treatments. But insurance practices and the actuarial data that insurers use is <a href="https://opal.latrobe.edu.au/articles/journal_contribution/Insurance_discrimination_and_hepatitis_C_Recent_developments_and_the_need_for_reforms/22091411">lagging</a> behind medical developments. </p>
<p>This is just one example of how laws and legal practices can exacerbate stigma and discrimination for people with a history of hepatitis C. Our <a href="https://opal.latrobe.edu.au/articles/report/Hepatitis_C-related_stigma_and_discrimination_in_a_post-cure_world_Summary_report_of_project_findings_and_recommendations/23909613/1">research found</a> this also occurs in <a href="https://journals.sagepub.com/doi/full/10.1177/09646639221115698">criminal law</a>, privacy law, <a href="https://www.tandfonline.com/doi/full/10.1080/1535685X.2023.2221950">social security and migration law</a>.</p>
<h2>People in prison are being left behind</h2>
<p>Prisons have high rates of injecting and <a href="https://theconversation.com/direct-acting-antivirals-can-cure-hepatitis-c-and-prisons-are-now-leading-efforts-to-eliminate-the-virus-182854">hepatitis C transmission</a> has historically been high. </p>
<p>While Australia has had <a href="https://www.sydneycriminallawyers.com.au/blog/australia-pioneered-drug-harm-reduction-and-must-continue/">a good track record</a> on reducing some harms associated with drug use in prisons, there is at least one <a href="https://www.hepatitisaustralia.com/news/renewed-calls-for-needle-syringe-programs-in-prisons-ahead-of-international-drug-users-day">glaring omission</a>: prisons don’t have access to a needle and syringe programs to ensure that people who use drugs can access sterile equipment. This means it’s much harder to prevent the transmission of hepatitis C and other blood-borne viruses in prisons.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/sterile-needles-can-stop-the-spread-of-disease-in-prisons-heres-how-3644">Sterile needles can stop the spread of disease in prisons – here's how</a>
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<p>Yet <a href="https://www.health.gov.au/resources/collections/national-strategies-for-bloodborne-viruses-and-sexually-transmissible-infections?utm_source=health.gov.au&utm_medium=callout-auto-custom&utm_campaign=digital_transformation">current national hepatitis C policy</a> says harm reduction should be available in prisons. And the <a href="https://www.penalreform.org/resource/standard-minimum-rules-treatment-prisoners-smr/">Mandela Rules</a> – which are a set of international human rights principles – state that prisoners should receive the same standard of health care as those in the wider community.</p>
<p>Without sterile injecting equipment for people in prisons, people who have been cured of hepatitis C are at risk of reinfection. And Australia is less likely to eliminate hepatitis C. </p>
<h2>Elimination demands more than just treatment</h2>
<p>The world is watching as Australia tries to be one of the first countries in the world to <a href="https://www.health.gov.au/sites/default/files/documents/2022/06/fifth-national-hepatitis-c-strategy-2018-2022.pdf">eliminate hepatitis C</a>. The final national hepatitis C health strategy is expected to be released before the end of 2023. </p>
<p>But the number of people coming forward for treatment has <a href="https://unsw-primo.hosted.exlibrisgroup.com/primo-explore/fulldisplay?vid=UNSWORKS&docid=unsworks_modsunsworks_84935&context=L">dropped significantly</a>. Resources are being marshalled into <a href="https://pubmed.ncbi.nlm.nih.gov/34448668/">finding people</a>, and keeping the momentum going on elimination. </p>
<p>It is increasingly clear that we also need to direct resources to what happens “post-cure”, assuring people that stigma-free health care is available to them. We also need to tackle the laws, policies and practices that allow stigma and discrimination to linger in people’s lives. </p>
<p>Finally, we need to ensure people in prisons have access to sterile injecting equipment so they aren’t reinfected.</p><img src="https://counter.theconversation.com/content/216439/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Kate Seear receives funding from the Australian Research Council's Discovery Scheme (DP200100941) and the Future Fellowship Scheme (FT200100099).</span></em></p><p class="fine-print"><em><span>Dion Kagan, Emily Lenton, and Sean Mulcahy 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>Around 60% of Australians with hepatitis C have accessed treatment which usually cures the condition. But to eliminate the disease, we need to prevent re-infection and tackle stigma.Dion Kagan, Research Officer, Gender, Law and Drugs program, La Trobe UniversityEmily Lenton, Research officer, La Trobe UniversityKate Seear, Associate professor, La Trobe UniversitySean Mulcahy, Research Officer, La Trobe UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2125892023-09-25T16:24:23Z2023-09-25T16:24:23ZNitazenes: synthetic opioids more deadly than fentanyl are starting to turn up in overdose cases<p>The synthetic opioid fentanyl is well known for the many lives it has claimed – mainly <a href="https://www.cdc.gov/stopoverdose/fentanyl/index.html">in the US</a>, but <a href="https://www.statista.com/statistics/470910/death-by-fentanyl-drug-poisoning-in-england-and-wales/">elsewhere too</a>. Now, a less well-known class of synthetic opioids called nitazenes is starting to crop up in overdose cases, on both sides of the Atlantic. </p>
<p>Nitazenes have recently been the subject of a <a href="https://www.cas.mhra.gov.uk/ViewandAcknowledgment/ViewAlert.aspx?AlertID=103236">national patient safety alert</a> in the UK as a result of a spike in opioid-related deaths over the last two months, with several cases involving nitazenes. </p>
<p>Some drugs in the nitazene class are 100 times more potent than morphine – so about as potent as fentanyl. However, nitazenes may be more deadly.</p>
<p>A <a href="https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2808868?resultClick=3">recent study</a>, published in Jama Network Open, reported that people who overdosed on nitazenes typically needed two or more doses of the overdose-reversal drug naloxone, whereas those who overdosed on fentanyl typically only needed one dose.</p>
<p>Nitazenes were first developed by a Swiss company called Ciba Pharmaceuticals in the 1950s as a new type of potent painkiller (analgesic). But the drugs never made it to market. </p>
<p>It appears that chemists in clandestine labs have <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10361140/">pored over old research papers</a> looking for new synthetic opioids to make and stumbled across this class of deadly drugs. </p>
<p>These new synthetic opioids are illegal in the UK as they are covered under the <a href="https://www.legislation.gov.uk/ukpga/2016/2/contents/enacted">Psychoactive Substances Act 2016</a>, which bans all chemical compounds capable of producing a psychoactive effect in people. </p>
<h2>How do they work?</h2>
<p>Opioids act at sites in the brain, and elsewhere in the body, called mu-opioid receptors. These brain receptors, when activated, can relieve pain, and at high doses evoke feelings of euphoria followed by drowsiness.</p>
<p>Morphine, heroin and fentanyl all activate these mu-opioid receptors. However, fentanyl can do so at much lower doses than morphine or heroin – and some nitazenes can relieve pain at even lower doses than fentanyl. </p>
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<iframe width="440" height="260" src="https://www.youtube.com/embed/NDVV_M__CSI?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">What happens to you when you take opioids.</span></figcaption>
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<p>For example, a <a href="https://doi.org/10.1016/j.drugalcdep.2023.109939">study</a> in rats found that a nitazene called N-desethyl isotonitazene provided pain relief at a dose nearly ten times smaller than that needed for fentanyl, and around 1,400 times less than that for morphine, to see the same effect.</p>
<p>Not only do these drugs relieve pain and cause euphoria, they also suppress the respiratory system. That is, they reduce breathing, and this is the cause of death in opioid overdose. </p>
<p>N-desethyl isotonitazene causes <a href="https://doi.org/10.1016/j.isci.2023.107121">apnea</a> (where breathing stops) at about a third of the dose of fentanyl. It also takes much longer to recover normal breathing after N-desethyl isotonitazene (208 minutes) compared with fentanyl (67 minutes). One must assume, therefore, that some nitazenes may have the potential to be more deadly than fentanyl and heroin.</p>
<p>There are also issues with nitazenes being used as adulterants in other illicit drugs, such as <a href="https://www.nbcnews.com/health/health-news/fentanyl-stimulants-drives-fourth-wave-overdose-epidemic-us-rcna104953">cocaine</a>, benzodiazepines and <a href="https://www.talktofrank.com/drug/synthetic-cannabinoids">synthetic cannabinoids</a> (“spice”). Illicit drug users may be unwittingly taking opioids and need to be aware of the risk of respiratory depression.</p>
<p>Several nitazenes have been found in overdose cases recently, and the number of new drugs in this class (called analogs) emerging on the streets appears to be growing. However, the true extent of this drug’s penetration into the illicit market is <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10361140/#REF8">not known</a> as many testing facilities are not set up to test for nitazenes. </p>
<p>And it isn’t just nitazenes that we need to be concerned about. There are also new non-nitazene synthetic opioids, such as the <a href="https://doi.org/10.1016/j.forsciint.2023.111775">brorphine-like compounds</a>. As with nitazenes, these drugs have been found to be slightly more potent than fentanyl, and much more potent than heroin or morphine, in lab tests.</p>
<p>Mercifully, opioid overdose can be reversed with naloxone – which blocks the mu-opioid receptors and is very effective if given in time. </p>
<p>Public health agencies in the UK have highlighted the need to educate heroin users, and those who come into contact with them, about nitazenes and how to treat overdose with naloxone.</p><img src="https://counter.theconversation.com/content/212589/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Colin Davidson acts as an expert witness on psychoactive substances for the Defense Science Technology Labs</span></em></p>Nitazenes were developed as a powerful class of painkiller in the 1950s, but they were abandoned – until now.Colin Davidson, Professor of Neuropharmacology and Head of School of Pharmacy & Biomedical Sciences, University of Central LancashireLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2103162023-07-31T15:26:30Z2023-07-31T15:26:30ZOpioids and cocaine are a deadly combination – and ‘polydrug’ deaths are rising<figure><img src="https://images.theconversation.com/files/540138/original/file-20230731-251277-bhfjl1.jpg?ixlib=rb-1.1.0&rect=8%2C0%2C2987%2C1994&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/mans-hand-holding-on-palm-plastic-1056695408">DedMityay/Shutterstock</a></span></figcaption></figure><p>Drug deaths in the US involving both opioids and cocaine have increased dramatically in the past decade, according to a <a href="https://stacks.cdc.gov/view/cdc/129733">new report</a> from the Centers for Disease Control and Prevention (CDC).</p>
<p>Drug-related deaths associated with stimulants, such as cocaine, methamphetamine, amphetamine and methylphenidate, doubled between 2011 and 2021. And deaths associated with using both stimulants and opioids, such as heroin, morphine, fentanyl and methadone, increased by about sevenfold over the same period. The biggest increases have been seen since about 2019. </p>
<p>Cocaine and methamphetamine are stimulant drugs, whereas opioids, such as heroin and methadone, are depressants. This means that cocaine and methamphetamine will, among other things, make you euphoric and more alert with more energy, while heroin has the opposite effect. After an initial rush of euphoria, heroin users report a long period of drowsiness. </p>
<p>It is unclear why people take both types of drugs together. It is not thought that the euphoric effects are changed significantly by taking these drugs together, but cocaine may help with acute withdrawal from heroin. Another explanation is that, by taking both types of drug together, the user balances the stimulant and depressant effects of the drugs. Some medicated opioid abusers take stimulants for an alternative high or to counteract the sedative effects of their medication. </p>
<h2>Different mechanism</h2>
<p>These drugs work via different mechanisms. The stimulants work mostly by activating the brain’s dopamine system. Dopamine is a neurotransmitter, or chemical messenger, important in the brain reward system, so it is critical to both feeling joy and euphoria.</p>
<p>Heroin and similar drugs such as methadone or fentanyl work via the body’s opioid system. The brain and body have various proteins attached to cell surfaces involved in transmitting the opioid signals. The most relevant proteins here are the mu opioid receptors. These receptors are activated by opioid painkillers.</p>
<p>Unfortunately, it is easy to overdose on opioids such as heroin. Overdose can lead to respiratory depression and then respiratory failure. This is when there are long pauses between breaths, which become more like sighs and then a loss of consciousness followed by cessation of breathing. </p>
<figure class="align-center ">
<img alt="Heroin addicts nodding off" src="https://images.theconversation.com/files/540151/original/file-20230731-256057-j6pxbd.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/540151/original/file-20230731-256057-j6pxbd.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/540151/original/file-20230731-256057-j6pxbd.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/540151/original/file-20230731-256057-j6pxbd.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/540151/original/file-20230731-256057-j6pxbd.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/540151/original/file-20230731-256057-j6pxbd.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/540151/original/file-20230731-256057-j6pxbd.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">Opioids can cause respiratory depression.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/no-drugs-concept-man-woman-aids-533628886">Lipik Stock Media/Shutterstock</a></span>
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<p>The exact mechanism whereby opioids cause respiratory depression is unknown but probably involves opioid receptors found in the brainstem.</p>
<p>Cocaine and methamphetamine are less likely to kill you but are still dangerous drugs causing heart palpitations, increased blood pressure and increased risk of stroke. Methamphetamine is especially associated with dangerous <a href="https://www.tandfonline.com/doi/epdf/10.4161/23328940.2014.982049?needAccess=true&role=button">hyperthermia</a> leading to multi-organ toxicity. </p>
<p>Taking stimulants together with an opioid clearly increases your risk of drug-related death.</p>
<p>One reason that we may be seeing more drug-related deaths is due to the increased use of fentanyl. Fentanyl is a synthetic opioid that is <a href="https://www.drugs.com/medical-answers/fentanyl-compare-heroin-opiates-3569710/">50 times</a> more potent than heroin and 100 times more potent than morphine, with a faster onset of action. It is therefore more likely to lead to respiratory depression than other opioids, such as heroin or methadone. </p>
<p>Fentanyl is increasingly being used as an <a href="https://www.clinicaterapeutica.it/2022/173/1/11_DI_TRANA.pdf">adulterant</a> in street drugs, such as heroin. This is because it is cheap and very powerful, so only a small amount is needed to have a large effect.</p>
<h2>Europe’s problem too</h2>
<p>It is not just the US that is seeing a rise in so-called polydrug-related deaths. Data from the <a href="https://www.emcdda.europa.eu/publications/european-drug-report/2023/drug-induced-deaths_en">European Monitoring Centre for Drugs and Drug Abuse</a>) show that deaths from polydrug use, especially those involving opioids, are also increasing in Europe. The European data shows that it is mostly men who are dying and that older age groups are increasingly dying from drug taking. </p>
<p>Taken together, it can be seen that there may be a worldwide increase in polydrug-related deaths and in particular those involving both stimulants and opioids.</p><img src="https://counter.theconversation.com/content/210316/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Colin Davidson does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>The US has seen a huge rise in drug deaths in the past decade involving a stimulant and a depressant.Colin Davidson, Professor of Neuropharmacology and Head of School of Pharmacy & Biomedical Sciences, University of Central LancashireLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2079982023-07-24T14:47:10Z2023-07-24T14:47:10ZProdrugs: pills your body converts into an illicit drug can evade detection, but we don’t know how big the problem is<figure><img src="https://images.theconversation.com/files/534827/original/file-20230629-21-yyrva0.jpg?ixlib=rb-1.1.0&rect=7%2C0%2C4985%2C3323&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/young-woman-having-psychedelic-trip-hallucinations-2168132723">Blackday/Shutterstock</a></span></figcaption></figure><p>Drug traffickers have found a way to trick enforcement agencies by using one of the most potent tools our bodies have: our metabolism. Welcome to the world of prodrugs. </p>
<p>Prodrugs are substances that can only cause an effect after being broken down by enzymes in the digestive system or other chemical reactions in the body. While they have legitimate pharmacological uses (<a href="https://www.nature.com/articles/nrd2468">between 5% and 7% of approved drugs fall under this category</a>), their <a href="https://www.jstage.jst.go.jp/article/yakushi/140/11/140_20-00124/_article/-char/ja/">use</a> as street drugs is a relatively new phenomenon. </p>
<p>Most illicit drugs work by <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC80880/#:%7E:text=Drugs%20of%20abuse%20are%20able,over%20this%20mesolimbic%20dopaminergic%20pathway.">interacting with specific brain cell receptors</a>, stimulating or blocking the release of chemicals called neurotransmitters. They last for a short time before being transformed into inactive or less active chemicals, which are then eliminated from the body, usually in urine. </p>
<p>For prodrugs, however, a small part of the molecule needs to be removed or substituted before it can act on those receptors. This is done inside the body by natural processes. <a href="https://en.wikipedia.org/wiki/ALD-52">ALD-52</a> (1-acetyl-LSD), for example, is a prodrug that is converted by the body into LSD after the removal of two carbon and one oxygen atom.</p>
<p>Although some <a href="https://www.sciencedirect.com/book/9781483232966/the-hallucinogens">reports</a> indicate that ALD-52 has been around since the 1960s, it was first officially detected in <a href="http://www.emcdda.europa.eu/system/files/publications/4724/TDAN17001ENN_PDFWEB.pdf">2016</a> by the authorities in France. The UK government was quick to list this prodrug as a controlled substance <a href="https://www.legislation.gov.uk/uksi/2014/3276/article/2/made#text%3DALD-52">as early as 2014</a>, even though there were no reports of drug seizures or known harms. Since then, many other prodrugs <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/1556-4029.14268">have been identified</a>.</p>
<p>Seizure of LSD prodrugs, such as ALD-52, increased at the height of the <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8411784/">COVID pandemic in Italy</a>. Japanese authorities have been dealing with an increasing number of <a href="https://www.sciencedirect.com/science/article/abs/pii/S2352007822003675">similar LSD prodrug compounds</a>. And in Brazil, the <a href="https://www.sciencedirect.com/science/article/pii/S0379073822003279?casa_token=JAgmG-7fCD8AAAAA:HxfcYkSS4FVopGgc-lTolrwF39sibU0oX4M1VqvKsrW07Kpqxx0-tAlgStAJvUDzkpwZoT61NP-Q#bib24">first reports</a> of these LSD prodrug were made in 2022.</p>
<p>The party drug GHB also has a <a href="https://www.gov.uk/government/publications/assessment-of-the-harms-of-gamma-hydroxybutyric-acid-gamma-butyrolactone-and-closely-related-compounds">prodrug equivalent</a>. It is called GBL (gamma-butyrolactone). </p>
<p>The UK introduced tougher controls for GBL – which is usually sold as a cleaning agent – <a href="https://www.gov.uk/government/publications/circular-0012022-reclassification-of-ghb-and-related-substances/circular-0012022-reclassification-of-ghb-and-related-substances">in 2022</a>. Following strong recommendations from the government’s Advisory Council on Misuse of Drugs, GBL is now classified as a class B drug, alongside cannabis and ketamine.</p>
<p>For stimulants, it is known that some commercially available drugs can be converted in the body into amphetamines and may be <a href="https://journals.sagepub.com/doi/abs/10.1177/0269881109103113">abused</a> for their potentially psychoactive effects - which justifies the strict control in their prescription. </p>
<p>Drug traffickers have also developed ways to mask illegal MDMA (ecstasy) by adding a small molecule that can be removed by chemical reactions or in the stomach through contact <a href="https://analyticalsciencejournals.onlinelibrary.wiley.com/doi/10.1002/dta.2059">with gastric acid</a>.</p>
<h2>Hard to detect</h2>
<p>A major problem with prodrugs is they are difficult to detect. Police forces need <a href="https://wires.onlinelibrary.wiley.com/doi/full/10.1002/wfs2.1486">reference samples</a> to compare the drug with, or advanced equipment to discover its molecular structure. Since the list of these compounds is not known and minute chemical changes can lead to different patterns to be analysed, these new drugs are easy to miss. It also explains why many have only appeared in police reports in the past decade.</p>
<p>For biological samples (such as blood, urine or saliva), there is another difficulty. Since the prodrugs must be converted inside the body before they become active, they are, in effect, <a href="https://onlinelibrary.wiley.com/doi/10.1111/1556-4029.14268">absent</a> in cases of lethal overdoses, as the substance that causes harm and death is the product of that transformation. So telling apart prodrugs from the more classical components they are converted into is an obstacle. While the overall effects leading to death would be the same, appropriately identifying which drug was originally used can help indicate trends for illegal sales, use and availability.</p>
<p>For GHB prodrugs - namely GBL and 1,4-butanedione - lawmakers have been progressively including them in stricter and more specific legislation. But for LSD prodrugs, in many countries it falls under a grey area. While France, Japan and the UK have nominally included ALD-52 and 1p-LSD in their controlled substances laws, in the US and Canada they have to be proved to be an analogue – that is, they possess a similar molecular structure and can cause the same effects – or they are not covered by current law.</p>
<figure class="align-center ">
<img alt="Dog sniffing a suitcase at the airport" src="https://images.theconversation.com/files/538327/original/file-20230719-15-7nkpc7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/538327/original/file-20230719-15-7nkpc7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=409&fit=crop&dpr=1 600w, https://images.theconversation.com/files/538327/original/file-20230719-15-7nkpc7.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=409&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/538327/original/file-20230719-15-7nkpc7.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=409&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/538327/original/file-20230719-15-7nkpc7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=514&fit=crop&dpr=1 754w, https://images.theconversation.com/files/538327/original/file-20230719-15-7nkpc7.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=514&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/538327/original/file-20230719-15-7nkpc7.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=514&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Without a reference sample, prodrugs can be hard to detect.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/officer-dog-checking-suitcase-airport-closeup-1538486276">New Africa/Shutterstock</a></span>
</figcaption>
</figure>
<p>In the UK, new psychoactive substances are <a href="https://www.gov.uk/government/publications/forensic-early-warning-system-fews-annual-report/annual-report-on-the-home-office-forensic-early-warning-system-fews-2021-to-2022">defined as</a> either a compound controlled by the Psychoactive Substances Act 2016 or a compound controlled by the Misuse of Drugs Act (post-2008). However, to be included in the Psychoactive Substances Act 2016 there has to be evidence of causing psychoactivity - defined as those compounds that can affect mental functions, such as <a href="https://www.who.int/health-topics/drugs-psychoactive#tab=tab_1">cognition, mood and emotions</a>. </p>
<p>Psychoactivity can also be determined by laboratory <a href="https://www.cps.gov.uk/legal-guidance/psychoactive-substances">testing</a>. Drugs are incubated with a small number of cells and researchers measure whether they bind to proteins on the surface, which are called receptors. Many prodrugs, however, will not bind to the receptors before they are converted. Where a substance is not listed in the legislation as controlled, and laboratory tests (for molecular similarity or binding to receptors) are required, there’s more room for in-court dissent.</p>
<p>Even if such seizures are infrequent and do not reach the numbers for more commonly used drugs, such as cocaine, cannabis or heroin, their appearance in the illegal market should serve as a warning sign of potentially changing trends in the illicit drug market. </p>
<p>There are potentially unknown effects – in intensity and duration – but also difficulty in prosecuting people who supply these prodrugs. With one new psychoactive substance reaching the illegal market roughly <a href="https://www.unodc.org/res/wdr2022/MS/WDR22_Booklet_4.pdf">every week in 2021</a>, the sheer diversity of drugs on the market has been indicated as one of the <a href="https://www.emcdda.europa.eu/publications/european-drug-report/2023/drug-situation-in-europe-up-to-2023_en">main challenges</a> for toxicologists and forensic chemists.</p><img src="https://counter.theconversation.com/content/207998/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Julio de Carvalho Ponce does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>The problem with prodrugs is we don’t know how big the problem is because they are so hard to identify.Julio de Carvalho Ponce, Lecturer in Forensic Science, University of WinchesterLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2047832023-07-04T21:51:22Z2023-07-04T21:51:22ZScaling up community drug-checking services in B.C. could help respond to the overdose crisis<figure><img src="https://images.theconversation.com/files/535609/original/file-20230704-27-lyamti.jpg?ixlib=rb-1.1.0&rect=30%2C105%2C4986%2C3083&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Drug checking is a harm reduction practice that provides chemical analysis of substances. Fentanyl test strips help drug users ensure that substances are free of dangerous fentanyl. </span> <span class="attribution"><span class="source">(AP Photo/Carlos Giusti)</span></span></figcaption></figure><p>British Columbia is in the midst of an enduring drug overdose crisis that continues to claim hundreds of people every year with no end in sight. With a <a href="https://www2.gov.bc.ca/assets/gov/birth-adoption-death-marriage-and-divorce/deaths/coroners-service/statistical/illicit-drug.pdf">significant rise in deaths over the last seven years</a>, innovative responses are urgently needed.</p>
<p>Among these responses is community drug checking, which continues to gain traction in both public health practice and research. Drug checking is a harm reduction practice that provides chemical analysis of substances. This is not only to inform harm reduction for people who use, buy and sell drugs (<a href="https://doi.org/10.1186/s12954-021-00545-w">and those who support them</a>), but also to monitor the supply for emerging trends that inform both the community and policymakers about the state of the unregulated supply, <a href="https://doi.org/10.1016/j.drugalcdep.2022.109427">which remains volatile, unpredictable and dangerous</a>. </p>
<p>As researchers providing drug checking on Vancouver Island, we see value in exploring new ways to deliver this service to reach more people who use drugs, at a scale required to address the current crisis.</p>
<h2>Drug checking in global perspective</h2>
<p><a href="https://doi.org/10.1111/add.15734">While drug checking has been around since the 1990s</a>, it remains an underused intervention that is often limited in both scope and scale. However, innovations in <a href="https://doi.org/10.3390/ijerph191911960">how and where the service is provided</a>, as well as <a href="https://doi.org/10.1016/j.drugpo.2022.103611">technological advancements within analytical chemistry and instrumentation</a>, are helping to overcome these limitations.</p>
<p>Internationally, groups like the <a href="https://www.drugs-test.nl/en/about-dims/">Drug Information Monitoring System</a> in the Netherlands have been pioneering drug checking and continuing to inform drug-checking research and practice internationally. </p>
<p>While services in some countries remain beholden by archaic <a href="https://doi.org/10.1016/j.drugalcdep.2022.109425">prohibitory legislative environments that challenge the legality of drug checking</a>, others are finding success in embedding drug checking within novel legal frameworks, <a href="https://doi.org/10.1108/DHS-03-2022-0016">like the legalization of drug checking in New Zealand</a>.</p>
<h2>Drug checking in Canada</h2>
<figure class="align-right ">
<img alt="A person's hand seen using a fentanyl test strip to test a dose of heroin in a small container" src="https://images.theconversation.com/files/535606/original/file-20230704-29-rsezno.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/535606/original/file-20230704-29-rsezno.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=624&fit=crop&dpr=1 600w, https://images.theconversation.com/files/535606/original/file-20230704-29-rsezno.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=624&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/535606/original/file-20230704-29-rsezno.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=624&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/535606/original/file-20230704-29-rsezno.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=784&fit=crop&dpr=1 754w, https://images.theconversation.com/files/535606/original/file-20230704-29-rsezno.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=784&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/535606/original/file-20230704-29-rsezno.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=784&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">A drug user places a fentanyl test strip into a mixing container to check for contamination, using a fentanyl test strip.</span>
<span class="attribution"><span class="source">(AP Photo/Bebeto Matthews)</span></span>
</figcaption>
</figure>
<p>In Canada, drug checking has its origins in the festival and rave scene as a grassroots bottom-up response to the harms of an unregulated market. <a href="http://michelow.ca/doc/drug-checking-guide-online-v1.pdf">The oldest drug-checking project has provided critical services at Shambhala Music Festival in Salmo, B.C.</a> for the last two decades. </p>
<p>The success of drug checking in festival settings for <a href="https://doi.org/10.17269/s41997-018-0126-6">lowering potential harms and highlighting broader trends</a> is now <a href="https://doi.org/10.1186/s12889-021-11243-4">increasingly being evaluated as a response to the overdose crisis</a> in B.C. and <a href="https://drugchecking.cdpe.org/">other parts of the country</a>. </p>
<p>Drug checking alone is not enough to curb the dramatic increase in drug toxicity deaths in the province and nationally. However, some of its strengths include <a href="https://doi.org/10.1108/DHS-01-2022-0005">generating evidence of trends</a> within the drug supply, as well as evidence for its effectiveness as a harm-reduction measure. It can also be <a href="https://doi.org/10.1080/09687637.2022.2087487">incorporated into other harm reduction programs and methods</a>, including safe supply.</p>
<h2>Substance: The Vancouver Island drug-checking project</h2>
<p>Our <a href="https://substance.uvic.ca/">research-based service in Victoria, B.C.</a> has spent the last five years developing and evaluating drug-checking service models while conducting robust multi-disciplinary research in the fields of social work, chemistry, computer science and public health. This research provides evidence to support services that <a href="https://doi.org/10.1186/s12954-020-00373-4">respond to the unique needs of people accessing drug-checking services</a>.</p>
<p>On the chemistry side, our research <a href="https://doi.org/10.1002/jrs.6133">evaluates and improves analytical technologies and methods, and boosts their effectiveness in detecting fentanyl and other adulterants</a>. Public health research highlights <a href="https://doi.org/10.1186/s12889-021-11243-4">how drug checking goes beyond individualistic responses to act within community, market and policy arenas</a>. This research supports services that <a href="https://doi.org/10.1186/s12954-020-00373-4">respond to the unique needs of people accessing drug-checking services</a>.</p>
<h2>Vancouver Island’s unique model of drug checking</h2>
<p>In responding to the challenges of scaling up drug-checking services, <a href="https://doi.org/10.1108/DHS-01-2022-0005">we developed a unique distributed drug-checking model</a> to increase the reach of these services. </p>
<p>This model aims to fill in gaps in service delivery for diverse communities that are vulnerable to the unregulated drug supply. It also highlights the importance of multidisciplinary research and service design that draws critical insight from multidisciplinary fields to better inform drug-checking services. </p>
<figure class="align-center ">
<img alt="A window with a logo in a circle reading Substance, est. 2018, surrounded by paper hearts with handwritten messages." src="https://images.theconversation.com/files/535630/original/file-20230704-21-fkqtxb.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/535630/original/file-20230704-21-fkqtxb.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=360&fit=crop&dpr=1 600w, https://images.theconversation.com/files/535630/original/file-20230704-21-fkqtxb.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=360&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/535630/original/file-20230704-21-fkqtxb.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=360&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/535630/original/file-20230704-21-fkqtxb.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=452&fit=crop&dpr=1 754w, https://images.theconversation.com/files/535630/original/file-20230704-21-fkqtxb.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=452&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/535630/original/file-20230704-21-fkqtxb.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=452&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Substance’s distributed model provides a hybrid, easy-to-use drug-checking program that blends immediate portable drug-checking technologies for timely harm reduction with more comprehensive lab-based technologies that provide greater accuracy of drug composition.</span>
<span class="attribution"><span class="source">(Substance)</span>, <span class="license">Author provided</span></span>
</figcaption>
</figure>
<p>Drawing on a network that enables the collection of samples in various locations and communities, our distributed model provides a hybrid, easy-to-use drug-checking program. The program blends immediate portable drug-checking technologies for timely harm reduction with more comprehensive lab-based technologies that provide greater accuracy of drug composition. </p>
<p>Through the use of <a href="https://doi.org/10.1186/s12954-023-00764-3">specialized spectrometers and test</a> strips distributed at various sites and connected to a central server and database, drug analysis can be done remotely within our central hub. These results get looped back to service users distributed across Vancouver Island who also have the opportunity to receive further analysis at a later time using a lab-based method called <a href="https://doi.org/10.1111/dar.13370">paper spray mass spectrometry</a>.</p>
<p>This model responds to the unique challenges of providing critical harm reduction across geographical locations and within different communities. Through the distributed model, we continue to evaluate what works best for whom in <a href="https://theconversation.com/why-the-drug-poisoning-crisis-in-b-c-wont-be-addressed-by-the-new-decriminalization-policy-199239">the context of an ever-changing drug supply and policy landscape</a>. </p>
<p>Most consumables in Canada have quality controls that help inform purchasing and consumption decisions. People who use drugs and those who support them deserve the same. It is long past time that we respond to the enduring crisis to the magnitude it deserves. </p>
<p><a href="https://doi.org/10.1186/s12954-022-00727-0">Drug checking everywhere for everyone</a>: is it possible? It is certainly a worthwhile goal with life-saving potential, and we will continue working to achieve it.</p><img src="https://counter.theconversation.com/content/204783/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Bruce Wallace received funding from Health Canada, the Canadian Institutes of Health Research, the Social Sciences and Humanities Research Council, Vancouver Foundation, and the Island Health Authority. </span></em></p><p class="fine-print"><em><span>Dennis Hore received funding from Health Canada, the Natural Sciences and Engineering Research Council of Canada, and the Canadian Institutes of Health Research.</span></em></p><p class="fine-print"><em><span>Piotr Burek does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Most consumables in Canada have quality controls that inform purchasing and consumption decisions. People who use illicit drugs deserve the same. Drug checking provides that harm-reduction service.Piotr Burek, Master of Arts student, Social Dimensions of Health Program, University of VictoriaBruce Wallace, Professor, School of Social Work, University of VictoriaDennis Hore, Professor, Chemistry, University of VictoriaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2007122023-02-28T07:43:46Z2023-02-28T07:43:46ZPill testing is coming to Queensland. Here’s what can we learn from programs overseas<figure><img src="https://images.theconversation.com/files/512579/original/file-20230228-1889-sef6zp.jpg?ixlib=rb-1.1.0&rect=16%2C176%2C5537%2C3549&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://unsplash.com/photos/C6ni9uAva5I">Lukas Bato/Unsplash</a></span></figcaption></figure><p>Queensland will become the second Australian jurisdiction to offer pill testing. While the timeline is yet to be announced, once up and running, Queenslanders who use illicit drugs can have them checked to see what they actually contain before taking them. </p>
<p>This is likely to reduce the risk of people overdosing on both unexpected and high potency substances, as well as reducing illness and death from harmful additives and mixtures. </p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1629286883305099265"}"></div></p>
<p>While making the announcement, Queensland’s health minister acknowledged the groundwork of my colleagues and I in the ACT, where we’ve provided <a href="https://www.harmreductionaustralia.org.au/wp-content/uploads/2018/06/Pill-Testing-Pilot-ACT-June-2018-Final-Report.pdf">successful</a> festival-based testing at the Groovin’ The Moo in 2018 and 2019, and a fixed-site service since 2022. Independent evaluations conducted in Canberra, and unusual in this research space, <a href="https://medicalschool.anu.edu.au/files/ACT%20Pill%20Testing%20Evaluation%20report.pdf">clearly demonstrate</a> a benefit. </p>
<p>Queensland’s move aligns the state with a growing international norm. In fact, the evidence to support such services has existed for decades. </p>
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Read more:
<a href="https://theconversation.com/what-is-drug-checking-and-why-do-we-need-it-in-australia-51578">What is 'drug checking' and why do we need it in Australia?</a>
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<h2>What are other countries doing?</h2>
<p>There are as many ways to provide drug checking services as there are countries providing them. They can be broadly divided into:</p>
<ul>
<li><p><strong>onsite or festival-based services</strong>, that generally test at the point of consumption, with lightweight and rapid turnaround equipment</p></li>
<li><p><strong>fixed site services</strong>, to which consumers are usually required to travel. They frequently offer more accurate and detailed analysis, but that takes a little more time.</p></li>
</ul>
<p>Either of these models can be incorporated into broader early warning or monitoring services, where data is collated and emerging trends and novel drugs can be identified. </p>
<p>The Netherlands has been offering a system since the late 1990s. It has now grown to a national monitoring system that <a href="https://www.trimbos.nl/wp-content/uploads/sites/31/2021/09/af1677-the-drugs-information-and-monitoring-system-dims.pdf">extends over 30 sites</a>. Drug checking services have been rolled out in other countries around the world, including <a href="https://kosmicare.org/">Portugal</a>, <a href="https://energycontrol-international.org/">Spain</a>, Mexico, <a href="https://checkit.wien/drug-checking/">Austria</a>, <a href="https://ccsa.ca/drug-checking-working-group">Canada</a>, <a href="https://www.health.govt.nz/our-work/regulation-health-and-disability-system/drug-checking">New Zealand</a> and some parts of the United Kingdom. </p>
<p>Canada offers <a href="https://datac.ca/shambhala-festival-leads-canada-with-drug-checking/">onsite</a> and fixed site testing. The latter is used in Toronto, with samples <a href="https://drugchecking.cdpe.org/about/">transported</a> from collection sites to analytical sites. In British Columbia, in the middle of a deadly fentanyl epidemic, both onsite and fixed site services have <a href="https://drugcheckingbc.ca/">saved lives</a> by identifying <a href="https://www.abc.net.au/news/2022-12-31/deadly-drug-found-during-pill-testing-in-canberra/101819004">samples tainted by</a> not only fentanyls but also products like <a href="https://nida.nih.gov/research-topics/xylazine">xyalzine</a> and <a href="https://www.health.nsw.gov.au/aod/public-drug-alerts/Pages/heroin-found-to-contain-nitazenes.aspx">nitazenes</a>.</p>
<p><a href="https://www.drugfoundation.org.nz/info/being-safer/party-drug-checking/">New Zealand</a> has recently amended legislation to permit both festival testing and pop-up sites.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/after-the-last-summer-of-terrible-drugs-its-time-to-make-nzs-temporary-drug-checking-law-permanent-165612">After the last 'summer of terrible drugs' it's time to make NZ's temporary drug checking law permanent</a>
</strong>
</em>
</p>
<hr>
<p>Ireland <a href="https://www.hse.ie/eng/services/news/media/pressrel/hse-reports-results-ireland-first-back-house-drug-testing-pilot.html">conducted</a> its first pilot at the Electric Picnic festival last year. Meanwhile, I was involved in establishing a <a href="https://www.wedinos.org/about-us">Welsh</a> program which permits the delivery of small samples of drugs to the analytical service from the consumer by ordinary mail. <a href="https://itsnotgov.org/regulation/drug-safety/ecstasydata-dot-org/">Ecstasy Data</a> in the United States does the same.</p>
<p>The combination of onsite testing, fixed site testing and monitoring provides the greatest coverage of drug intelligence, much in the same way that different levels of flu-tracking allows us the best analysis of what lies in store, and is circulating. This allows services to <a href="https://www.emcdda.europa.eu/topics/drug-checking_en">detect</a> and <a href="https://www.independent.co.uk/news/world/europe/superman-ecstasy-pill-fatal-heart-netherlands-trimbos-dutch-holland-a7373086.html">issue warnings</a> about harmful substances that are circulating. </p>
<p>The United States Center for Disease Control (CDC) <a href="https://filtermag.org/cdc-drug-checking/">has recommended drug checking</a> as a way of monitoring the fentanyl crisis in that country. Any future CDC in Australia should strongly consider incorporating such surveillance in its remit.</p>
<figure class="align-center ">
<img alt="Women at a festival at the back of the crowd" src="https://images.theconversation.com/files/512583/original/file-20230228-1648-110fn1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/512583/original/file-20230228-1648-110fn1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=401&fit=crop&dpr=1 600w, https://images.theconversation.com/files/512583/original/file-20230228-1648-110fn1.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=401&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/512583/original/file-20230228-1648-110fn1.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=401&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/512583/original/file-20230228-1648-110fn1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=504&fit=crop&dpr=1 754w, https://images.theconversation.com/files/512583/original/file-20230228-1648-110fn1.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=504&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/512583/original/file-20230228-1648-110fn1.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=504&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Some pill testing occurs at pop-up festival sites, others have fixed locations.</span>
<span class="attribution"><a class="source" href="https://unsplash.com/photos/pOXHU0UEDcg">Aranxa Esteve/Unsplash</a></span>
</figcaption>
</figure>
<h2>So what system is best?</h2>
<p>In the ACT, we’ve been allowed to design our service around the needs of the patron, and we find face-to-face services are the <a href="https://pilltestingaustralia.com.au/trans-tasman-charter/">best way</a> to engage with consumers. </p>
<p>But other jurisdictions might find that difficult, and may need to modify their service to address external constraints placed upon them, such as not having available equipment on site, or the concerns of local law enforcement in endorsing such an approach. </p>
<p>Some places permit the tests to be conducted by non-chemists. </p>
<p>But in the ACT we use graduate chemists, who are also involved in <a href="https://www.churchilltrust.com.au/project/to-visit-leading-international-drug-checking-services-to-rapidly-improve-the-analytical-chemistry-capabilities-in-australia/">developing and improving</a> the program. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/pill-testing-really-does-reduce-the-risk-of-harm-for-drug-users-181778">Pill testing really does reduce the risk of harm for drug users</a>
</strong>
</em>
</p>
<hr>
<p>The Netherlands has applied the best service possible for the Netherlands, and certainly one of the best in the world, with a process that is proven, and well trusted by the population it serves.</p>
<p>But this is not a service that would necessarily lend itself to the federal structure of Australia, or our historical apprehension to pragmatic discussions about drugs and drug use. </p>
<p>None of these approaches are necessarily better or worse than another – they have been developed to suit the environment in which they operate. The best service for Australia will be an Australian service. And there may well be differences in what that will be, between jurisdictions. </p>
<h2>What do we know about the Queensland system so far?</h2>
<p>While it’s not clear how the Queensland service will work, or how many testing sites there will be, there are some hints it might be a little different to the ACT’s drug checking service, CanTEST. </p>
<p>At the Queensland press conference, health authorities explained the testing process under consideration would take between 45 minutes to an hour. </p>
<p>In Canberra, our analysts conduct a number of tests, including an <a href="https://youtu.be/zWjgsZ4lt-4">FTIR analysis</a> as an initial test, fentanyl test strip analyses where indicated, and UPLC PDA against ten known compounds for quantitative analysis. That all takes around ten minutes – and all in front of the patron. </p>
<p>Times for the patron can vary, depending on the number of attendees at any time, but the analytical time is pretty constant. The patron is encouraged to stay and engage with the process, and even the chemists, who have become very adept science communicators. </p>
<p>The longer time reported might be associated with a different choice of testing equipment, or the use of external analytical facilities, such as private analytical laboratories for offsite testing, like the Toronto model.</p>
<h2>What about other states and territories?</h2>
<p>Queensland’s adoption of pill testing is likely to prompt other states and territories to follow. Queensland played a long political game, never fully ruling out the process, while stating it required further evidence. </p>
<p>With such adamant opposition elsewhere, it is difficult to see what the end-game for other jurisdictions will be. </p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1630167185036288000"}"></div></p>
<p>But there is no future scenario in which pill testing will become less necessary, or less in demand. Twenty years after John Howard’s “tough on drugs” strategy, the appetite of young Australians for illicit drugs seems undiminished, and the nature of those drugs is more dangerous than ever. </p>
<p>The road forward will now necessitate experts and academics alike easing politicians out of the corners they’ve found themselves backed into, as a consequence of adopting the rhetoric of a dated proxy “war on drugs”. It’s a hard road, but one on which the young people, and the parents of young people, across Australia now expect their governments to travel.</p><img src="https://counter.theconversation.com/content/200712/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>David Caldicott has been the recipient of an NH&MRC Partnership Grant.
He is the Clinical Lead for Pill Testing Australia and CanTEST.</span></em></p>There’s a lot we don’t know about how Queenslanders will be able to get their pills tested in future. But here’s how other countries do it.David Caldicott, Senior lecturer, Australian National UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1992392023-02-06T20:53:55Z2023-02-06T20:53:55ZWhy the drug poisoning crisis in B.C. won’t be addressed by the new decriminalization policy<p>On the same day that British Columbia began a new era in drug policy with the <a href="https://www2.gov.bc.ca/gov/content/overdose/decriminalization">decriminalization of simple possession of some drugs</a>, the province’s chief coroner provided a <a href="https://www2.gov.bc.ca/gov/content/life-events/death/coroners-service/statistical-reports">devastating update</a> about the number of lives lost to illicit drugs during the previous year. </p>
<p>On Jan. 31, 2023, B.C. began a <a href="https://www2.gov.bc.ca/assets/gov/overdose-awareness/decriminalization_factsheet.pdf">three-year pilot project</a> under which simple possession of some drugs (opioids, methamphetamine, cocaine and MDMA) can no longer lead to criminal prosecution or even seizure of the drugs by police. The policy applies to possession of up to 2.5 grams of substance for personal use.</p>
<p>While a major step in the right direction, decriminalization does nothing to tackle what is fuelling the drug-poisoning crisis: the makeup of a toxic and unregulated drug supply. </p>
<p>In fact, imposed carry restrictions of 2.5 grams could theoretically lead to unintended consequences as drugs become more potent to fit within legal limits. </p>
<p>The stated goal of the decriminalization policy change is to <a href="https://theconversation.com/decriminalizing-drug-use-is-a-necessary-step-but-it-wont-end-the-opioid-overdose-crisis-162497">remove the stigma associated with drug use</a> to encourage people to seek help when they need it. </p>
<p>While the effects that decriminalization may have on the stigma of drug use remain to be seen, what it won’t affect is the toxicity of the drug supply that is killing thousands of Canadians each year.</p>
<h2>Inconsistent and unreliable drug supply</h2>
<p>Chemical analysis of drugs (such as from <a href="https://drugcheckingbc.ca/video/">drug checking</a> or police investigations) can tell us what is circulating in the supply, but <a href="https://www2.gov.bc.ca/assets/gov/birth-adoption-death-marriage-and-divorce/deaths/coroners-service/statistical/illicit-drug-type.pdf">toxicology results</a> from those who have died from overdoses tell us what is actually causing death. </p>
<p>These data sources describe how increases in adulteration of drugs with fentanyl analogues, <a href="https://theconversation.com/benzo-dope-may-be-replacing-fentanyl-dangerous-substance-turning-up-in-unregulated-opioids-164286">benzodiazepines</a> and animal tranquilizers like <a href="https://substance.uvic.ca/blog/xylazine/">xylazine</a> are driving the drug poisoning crisis. </p>
<p>Fentanyl has been the main opioid sold on the unregulated market for several years. It is typically sold mixed into other powders like caffeine or sugars to make a final product. </p>
<p>Drug supply monitoring has shown that fentanyl concentration in these powders sold on the street can range from zero to nearly 100 per cent, with a standard sample in B.C. being <a href="https://drugcheckingbc.ca/wp-content/uploads/sites/2/2023/01/Drug_Checking_BC_Nov_20224.pdf">around 10–15 per cent</a>. </p>
<p><a href="https://doi.org/10.1093/aje/kwab129">Research conducted in Vancouver</a> has described how fentanyl concentration in these samples was somewhat consistent between 2018 and early 2020, with variability between samples even decreasing over that period. What that may speak to is producers of fentanyl reaching a sort of “sweet spot” that satisfies their customers. People who sell drugs have described how they <a href="https://doi.org/10.1016/j.drugpo.2020.102845">listen to feedback</a> from their regulars and adjust the product to meet their customers’ needs. </p>
<p>However, following the start of the COVID-19 pandemic, <a href="https://epiresearch.org/wp-content/uploads/2022/06/2022-Abstract-Book.pdf#page=77">variation in potency between fentanyl samples rose dramatically</a>, leading to further unpredictability. These changes to the fentanyl supply around the spring of 2020 coincided with rates of drug poisonings previously not seen in the province. </p>
<p>Under B.C.’s decriminalization framework, possession for personal use caps at 2.5 grams of substance. While 2.5 grams may be more than enough MDMA for a night out, it may not be enough heroin to last a single day for someone who has a high opioid tolerance. People who use drugs say that to abide by these limits, they will be forced to make <a href="https://vancouver.citynews.ca/2022/05/31/bc-decriminalization-drugs/">more frequent, smaller purchases.</a> With the drug supply as volatile and unpredictable as it is, every new purchase puts someone at risk. </p>
<h2>Legal limit may affect potency</h2>
<p>Since we know that the drug supply is dynamic, it raises a question: Will the imposed legal carry limit of 2.5 grams result in increased potency of fentanyl to fit within the new 2.5-gram threshold? </p>
<p>Increases in average potency of fentanyl has been <a href="https://www.inhsu.org/resource/fentanyl-concentration-in-drug-checking-samples-and-risk-of-drug-related-mortality-during-an-illicit-drug-toxicity-crisis-in-vancouver-canada-a-time-series-analysis/">shown to be linked to increased drug poisonings</a> in the same geographic area. If the unregulated fentanyl market adjusts to fit more active ingredient into a smaller package, there will be downstream effects on people lives. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/508487/original/file-20230206-31-5cy44g.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Cropped image of a person holding a hand-lettered sign reading 'Every death is a drug policy failure'" src="https://images.theconversation.com/files/508487/original/file-20230206-31-5cy44g.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/508487/original/file-20230206-31-5cy44g.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/508487/original/file-20230206-31-5cy44g.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/508487/original/file-20230206-31-5cy44g.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/508487/original/file-20230206-31-5cy44g.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/508487/original/file-20230206-31-5cy44g.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/508487/original/file-20230206-31-5cy44g.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"></a>
<figcaption>
<span class="caption">An advocate holds a sign at a demonstration in Victoria in April 2022. Decriminalization alone may have little effect on drug deaths without changes to the addiction treatment system.</span>
<span class="attribution"><span class="source">THE CANADIAN PRESS/Chad Hipolito</span></span>
</figcaption>
</figure>
<p>The provincial and federal governments have <a href="https://www.theglobeandmail.com/canada/british-columbia/article-federal-minister-promises-data-on-impact-of-decriminalization/">committed to a data-driven approach</a> to decriminalization. Ongoing drug supply monitoring will help public health professionals characterize what changes occur to the unregulated drug supply as a result of the policy change. Yet the act of decriminalizing drugs for personal use does not have any direct effect on the cause of the ongoing poisoning crisis. </p>
<p>The <a href="https://news.gov.bc.ca/releases/2023PSSG0008-000109">consensus among experts</a> has consistently pointed to unpredictable drugs from an unregulated supply and the absence of a functioning addiction treatment system. For those who want to seek treatment, the lack of available space leaves people waiting, once again left to rely on the toxic drug supply. </p>
<p>If B.C. is serious about confronting the leading cause of unnatural death in the province, it is going to take far more than decriminalizing simple drug possession. People who use drugs require an alternative to the toxic unregulated supply to not be risking their lives every time they use drugs. </p>
<p>Increasing access to a safer supply of drugs through a <a href="https://theconversation.com/safer-supply-of-opioids-saves-lives-providing-alternatives-to-toxic-street-drugs-177925">variety of formats</a> and providing meaningful funding for accessible treatment options are some examples of ways the province can take immediate steps to make an impact. </p>
<p>In the meantime, <a href="https://bc.ctvnews.ca/illicit-drug-death-toll-surpasses-2-000-in-b-c-for-a-2nd-consecutive-year-1.6253605">six more people will die today</a> from a drug poisoning in B.C. And another six will die tomorrow. How many more days can this go on?</p><img src="https://counter.theconversation.com/content/199239/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Samuel Tobias does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>As British Columbia begins a new era in drug policy, the drug poisoning crisis continues without an end in sight.Samuel Tobias, PhD Student, School of Population and Public Health, University of British ColumbiaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1920442022-12-19T09:58:11Z2022-12-19T09:58:11ZDrug deaths are rising and overdose prevention centres save lives, so why is the UK unwilling to introduce them?<p>In late 2020, a converted van appeared in central Glasgow. Inside were clean needles, sterilising equipment, mirrors, “sharps bins” for the disposal of syringes, and supplies of the overdose reversal drug <a href="https://nida.nih.gov/publications/drugfacts/naloxone">naloxone</a>. There were also boxes containing protein bars, tea, blankets and a defibrillator, as well as two chairs and tables where injections could be prepared.</p>
<p>The van had been converted, and was being driven, by Peter Krykant – an ex-outreach worker with his own history of homelessness and injecting drug use. Frustrated with the fact that no overdose prevention centre (OPC) had yet opened in the city <a href="https://www.nhsggc.org.uk/media/238302/nhsggc_health_needs_drug_injectors_full.pdf">despite calls from the local NHS</a>, he took the law into his own hands and, after a successful crowdfunding campaign, opened one independently.</p>
<p>OPCs are places where people can take illegally purchased drugs in a supervised environment, using clean equipment and with staff able to intervene in the case of an overdose. The first such centre opened in the Swiss capital Bern in 1986, and there are now <a href="https://www.google.com/maps/d/u/0/viewer?mid=17-5DJHbW9HnUQyDYo5XQF7R8dPuyEN2A&ll=40.90817195577131%2C2.8725385499999447&z=2">around 200 across the world</a> from Berlin, Paris and Geneva to Sydney, Vancouver and New York.</p>
<p>While the centres go under an array of different names including “drug consumption rooms”, “safer consumption sites” and “safe injecting facilities”, the essential concept – providing a safe environment for the use of risky, illegal drugs – remains the same. There have been no recorded overdose deaths within any of these centres since the first opened 36 years ago.</p>
<p>No such services exist in the UK, however. As <a href="https://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/deaths/bulletins/deathsrelatedtodrugpoisoninginenglandandwales/2021registrations">drug-related deaths continue to rise</a>, the debate over whether this should change has become increasingly heated – especially in Scotland, where drug mortality rates are among the <a href="https://www.bbc.co.uk/news/uk-scotland-58024296">highest in the world</a>. The <a href="https://doi.org/10.1016/S2352-3018(19)30036-0">largest outbreak of HIV in the UK in over 30 years</a> has been among people who inject drugs in Glasgow, Scotland’s largest city, and is ongoing. </p>
<p>Krykant’s unsanctioned Glasgow OPC operated for nine months. It oversaw <a href="https://www.sciencedirect.com/science/article/pii/S0955395922000901?via%3Dihub">894 injection events involving heroin and cocaine</a> and treated nine potentially fatal overdoses. Krykant describes its impact as “overwhelming”:</p>
<blockquote>
<p>I saw people move from groin injecting to injecting in less dangerous areas [of the body] due to having a warm and well-lit environment where they could take their time and not feel rushed. Myself and the other volunteers who helped run the service witnessed people feeling cared about for the first time. The service turned into a beacon of safety for many. We started supplying basic things like warm clothing, drinks and sanitary products. On one occasion, we bought a wheelchair for a person who had lost a leg.</p>
</blockquote>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/PPM_TOFMM-8?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
</figure>
<p>The Glasgow police largely tolerated the facility, although on one occasion <a href="https://www.dailyrecord.co.uk/news/scottish-news/drugs-activist-peter-krykant-charged-22897048">Krykant was cautioned</a> for refusing to let officers into the van while it was being used. And the media were fascinated: during its brief time of operation, reports about the van appeared in UK and international media including the <a href="https://www.nytimes.com/2020/11/21/world/europe/scotland-glasgow-drugs-van.html">New York Times</a>.</p>
<p>Due to health issues, Krykant reluctantly closed the facility in the summer of 2021. The van was donated to the <a href="https://transformdrugs.org/about-us">Transform Drug Policy Foundation</a> and now tours the UK, demonstrating what an OPC would look like in practice. Krykant believes it served a vital purpose in demonstrating that “it could be possible to set up and run OPCs within current frameworks”. He is still hopeful that a formal facility will be commissioned in the near future – but the UK government remains opposed to their introduction.</p>
<figure class="align-center ">
<img alt="Inside of ambulance converted as an OPC" src="https://images.theconversation.com/files/489119/original/file-20221011-23-c159bf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/489119/original/file-20221011-23-c159bf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=338&fit=crop&dpr=1 600w, https://images.theconversation.com/files/489119/original/file-20221011-23-c159bf.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=338&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/489119/original/file-20221011-23-c159bf.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=338&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/489119/original/file-20221011-23-c159bf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=424&fit=crop&dpr=1 754w, https://images.theconversation.com/files/489119/original/file-20221011-23-c159bf.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=424&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/489119/original/file-20221011-23-c159bf.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=424&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">The mobile OPC was stocked with clean needles, sharps bins and supplies of the overdose reversal drug naloxone.</span>
</figcaption>
</figure>
<h2>Campaigning amid controversy</h2>
<p>Pat Hudson is an emeritus professor of history at Cardiff University. In 2017, her son Kevin was found dead in a locked toilet in a department store in the Welsh town of Carmarthen. He was 32 and an experienced tree surgeon.</p>
<p>Kevin Hudson died of cardiac arrest and brain damage after injecting heroin. He had been battling addiction and was making progress, but died alone after the kind of accidental overdose that kills <a href="https://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/deaths/bulletins/deathsrelatedtodrugpoisoninginenglandandwales/2021registrations">thousands of people</a> in the UK every year. According to his mother:</p>
<blockquote>
<p>If Kevin had had somewhere safe to go in the town to inject, without fear of criminalisation or stigma and with a medically qualified person in attendance, he would certainly not have locked himself in a toilet where no one could reach him.</p>
</blockquote>
<figure class="align-center ">
<img alt="Pat Hudson and her son Kevin" src="https://images.theconversation.com/files/489130/original/file-20221011-16-2mkqj6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/489130/original/file-20221011-16-2mkqj6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=478&fit=crop&dpr=1 600w, https://images.theconversation.com/files/489130/original/file-20221011-16-2mkqj6.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=478&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/489130/original/file-20221011-16-2mkqj6.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=478&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/489130/original/file-20221011-16-2mkqj6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=600&fit=crop&dpr=1 754w, https://images.theconversation.com/files/489130/original/file-20221011-16-2mkqj6.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=600&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/489130/original/file-20221011-16-2mkqj6.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=600&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Pat Hudson with her son Kevin, who died of an overdose in 2017.</span>
</figcaption>
</figure>
<p>Hudson, a member of the campaign group <a href="https://anyoneschild.org/about/">Anyone’s Child: Families for Safer Drug Control</a>, is calling for OPCs to be introduced as a way of providing this kind of life-saving support. While first and foremost about saving lives, she says this is also about “providing medical and addiction advice for those seeking help”.</p>
<p>OPCs <a href="https://www.emcdda.europa.eu/system/files/publications/2734/POD_Drug%20consumption%20rooms.pdf">have been found to</a> successfully reduce the risk of blood-borne virus transmission, signpost clients to treatment services, provide advice on safer consumption, and reduce levels of public injecting and discarded needles. By creating a non-stigmatising environment, they can also attract people who might otherwise not come into contact with support services – or who previously had unhappy experiences in treatment.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/another-new-high-for-drug-deaths-in-england-and-wales-heres-what-needs-to-change-187548">Another new high for drug deaths in England and Wales – here's what needs to change</a>
</strong>
</em>
</p>
<hr>
<p><a href="https://www.gov.uk/government/statistics/substance-misuse-treatment-for-adults-statistics-2020-to-2021/adult-substance-misuse-treatment-statistics-2020-to-2021-report">More than 300,000 people</a> are thought to use opiates or crack cocaine regularly in England, of whom about half are in treatment. But even for those accessing such services, treatment can only help if they are kept safe and alive when they are using. For people such as Kevin Hudson, a lack of safe drug consumption spaces significantly increases the risk of death.</p>
<p>In December 2021, in response to record levels of drug-related deaths, the UK government <a href="https://www.gov.uk/government/news/largest-ever-increase-in-funding-for-drug-treatment">committed more than £700m</a> to improving treatment services in England and Wales – a desperately needed injection of money following years of disinvestment. But despite organisations such as the harm reduction charity <a href="https://cranstoun.org/who-we-are/">Cranstoun</a> signalling their intention to open OPCs when conditions allow, there are no plans for piloting such facilities in the UK government’s ten-year <a href="https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/1079147/From_harm_to_hope_PDF.pdf">drug strategy</a> for England.</p>
<p><strong>Deaths related to drug poisoning in England and Wales:</strong></p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/488535/original/file-20221006-7785-jjy784.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/488535/original/file-20221006-7785-jjy784.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/488535/original/file-20221006-7785-jjy784.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=344&fit=crop&dpr=1 600w, https://images.theconversation.com/files/488535/original/file-20221006-7785-jjy784.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=344&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/488535/original/file-20221006-7785-jjy784.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=344&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/488535/original/file-20221006-7785-jjy784.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=432&fit=crop&dpr=1 754w, https://images.theconversation.com/files/488535/original/file-20221006-7785-jjy784.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=432&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/488535/original/file-20221006-7785-jjy784.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=432&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>
<span class="attribution"><a class="source" href="https://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/deaths/bulletins/deathsrelatedtodrugpoisoninginenglandandwales/2021registrations">Office for National Statistics</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
</figcaption>
</figure>
<p>The UN’s International Narcotics Control Board has stated that OPCs are consistent with international drug control treaties, as long as they are part of a <a href="https://www.incb.org/documents/News/Alerts/Alert_on_Convention_Implementation_Feb_2018.pdf">wider system of drug treatment</a>. But under UK law, allowing the preparation of illicitly purchased drugs for ingestion <a href="https://www.release.org.uk/sites/default/files/pdf/publications/Drug%20Consumption%20Rooms%20-%20Briefing%20for%2017.01.18%20Westminster%20Hall%20debate.pdf">could be construed as illegal</a>.</p>
<p>As things stand, this means anyone operating an OPC could potentially be liable for prosecution. In 2016, Scotland’s largest NHS organisation, <a href="https://www.nhsggc.scot/about-us/who-we-are/">Greater Glasgow and Clyde</a>, recommended that an <a href="https://www.nhsggc.org.uk/media/238302/nhsggc_health_needs_drug_injectors_full.pdf">OPC be opened in Glasgow city centre</a> in response to the high rates of drug-related deaths and the emergence of an HIV outbreak, highlighting “widespread support [among] stakeholders from the target population, health services, and organisations representing drug users and their families”.</p>
<p>The lord advocate, Scotland’s chief public prosecutor, was asked to produce a “<a href="https://www.heraldscotland.com/news/17572581.lord-advocate-urged-provide-prosecution-immunity-drug-consumption-facility/">letter of comfort</a>” to guarantee such facilities would not be a subject for prosecution. This proposal <a href="https://publications.parliament.uk/pa/cm201919/cmselect/cmscotaf/44/4407.htm">was not successful</a> and the current lord advocate has stated she cannot make an activity unlawful, nor grant immunity from prosecution. However, in 2021 <a href="https://eur03.safelinks.protection.outlook.com/?url=https%3A%2F%2Farchive2021.parliament.scot%2Fparliamentarybusiness%2Freport.aspx%3Fr%3D13315%26i%3D120787&data=05%7C01%7Ct.s.parkes%40stir.ac.uk%7C7cb3733d11254427d68708dad0b179de%7C4e8d09f7cc794ccb9149a4238dd17422%7C0%7C0%7C638051757919369863%7CUnknown%7CTWFpbGZsb3d8eyJWIjoiMC4wLjAwMDAiLCJQIjoiV2luMzIiLCJBTiI6Ik1haWwiLCJXVCI6Mn0%3D%7C3000%7C%7C%7C&sdata=EZKjoU2K3xIoEC0%2B4o0QFXESUB0mrHKsJ%2Brw%2BZg0g1g%3D&reserved=0">she said</a> she “would be prepared to consider any such future proposal, but it would have to be specific and underpinned by evidence, and it would require fresh consideration”.</p>
<hr>
<figure class="align-right ">
<img alt="" src="https://images.theconversation.com/files/288776/original/file-20190820-170910-8bv1s7.png?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/288776/original/file-20190820-170910-8bv1s7.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=600&fit=crop&dpr=1 600w, https://images.theconversation.com/files/288776/original/file-20190820-170910-8bv1s7.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=600&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/288776/original/file-20190820-170910-8bv1s7.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=600&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/288776/original/file-20190820-170910-8bv1s7.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=754&fit=crop&dpr=1 754w, https://images.theconversation.com/files/288776/original/file-20190820-170910-8bv1s7.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=754&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/288776/original/file-20190820-170910-8bv1s7.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=754&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption"></span>
</figcaption>
</figure>
<p><strong><em>This story is part of Conversation Insights</em></strong>
<br><em>The Insights team generates <a href="https://theconversation.com/uk/topics/insights-series-71218">long-form journalism</a> and is working with academics from different backgrounds who have been engaged in projects to tackle societal and scientific challenges.</em></p>
<hr>
<p>In September 2021, the Scottish <a href="https://drugdeathstaskforce.scot/our-work/drug-law-reform/drug-law-reform-report-summary-of-recommendations-1/">Drug Deaths Taskforce</a> asked the Scottish government to “explore all options within the existing legal framework” that would enable OPCs to be piloted. Many Scottish MPs and MSPs have also called for action, with a <a href="https://www.pauljsweeney.com/membersbill">private members’ bill</a> currently being put through the Scottish parliament. And in January 2022, the UK Faculty of Public Health <a href="https://www.fph.org.uk/media/3412/fph_opc_statement-04-01-2022.pdf">published a letter</a> signed by every royal medical college calling on the UK government to “take steps towards funding [OPC] pilots … to save lives and reduce harm”. Scotland’s minister for drugs confirmed in June 2022 that a new proposal had been <a href="https://eur03.safelinks.protection.outlook.com/?url=https%3A%2F%2Farchive2021.parliament.scot%2Fparliamentarybusiness%2Freport.aspx%3Fr%3D13878%26i%3D125839&data=05%7C01%7Ct.s.parkes%40stir.ac.uk%7C7cb3733d11254427d68708dad0b179de%7C4e8d09f7cc794ccb9149a4238dd17422%7C0%7C0%7C638051757919369863%7CUnknown%7CTWFpbGZsb3d8eyJWIjoiMC4wLjAwMDAiLCJQIjoiV2luMzIiLCJBTiI6Ik1haWwiLCJXVCI6Mn0%3D%7C3000%7C%7C%7C&sdata=VV3ECoRBNbpb5j7FzjzIclDgLqpWWgzksvhHwEAIQEs%3D&reserved=0">submitted for consideration by the Crown Office.</a> </p>
<p>The UK government’s <a href="https://www.scottishdailyexpress.co.uk/news/politics/tory-mp-kit-malthouse-rejects-27006317">consistent refusal</a> to introduce legal reforms to protect OPC providers from the threat of criminal sanctions has set Westminster against the Scottish government, which views OPCs as an important tool in its broader <a href="https://www.gov.scot/policies/alcohol-and-drugs/national-mission/">public health-led response to drug harms</a>.</p>
<p>Recognising that a policy change in Westminster looks unlikely in the short term, the Scottish minister for drugs, Angela Constance, <a href="https://www.heraldscotland.com/politics/20168444.snp-ministers-give-persuading-uk-government-allow-safe-drugs-consumption-rooms/">said</a> the Scottish government is “leaving no stone unturned to deliver clinically and legally safe consumption facilities”. In contrast, according to Hudson, the UK government is “digging its heels in” because OPCs are seen as condoning illegal drug use. She explains:</p>
<blockquote>
<p>There is a public health crisis with drug mortality which must be tackled … There needs to be a change of mindset among politicians so that they see public health policies on illicit drug consumption as a vote winner. The general public are mostly ready for this – it would not be hard to sell.</p>
</blockquote>
<h2>What the evidence tells us about OPCs</h2>
<p><a href="https://vancouver.ca/people-programs/safe-injection-site-and-needle-exchange.aspx#:%7E:text=Insite%2C%20Vancouver's%20supervised%20injection%20site,the%20care%20of%20medical%20professionals.">Insite</a> was the first sanctioned and supervised injecting site to open in North America. Founded in 2003, it operates in the Downtown Eastside neighbourhood of Vancouver, a city that for decades has <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3665976/">experienced high levels</a> of homelessness, street injecting and drug-related deaths.</p>
<p>The Insite facility provides an array of booths, each with a table, mirror and waste bin. According to <a href="http://www.vch.ca/public-health/harm-reduction/supervised-consumption-sites/insite-user-statistics">2019 data</a>, there is space for more than 300 injections a day. People need not be registered and there is no form-filling on arrival. In almost two decades, there have been thousands of overdose events but no fatalities.</p>
<figure class="align-center ">
<img alt="Sterile booths for injections at the Insite OPC" src="https://images.theconversation.com/files/489118/original/file-20221011-20-j4ttyf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/489118/original/file-20221011-20-j4ttyf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=338&fit=crop&dpr=1 600w, https://images.theconversation.com/files/489118/original/file-20221011-20-j4ttyf.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=338&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/489118/original/file-20221011-20-j4ttyf.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=338&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/489118/original/file-20221011-20-j4ttyf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=424&fit=crop&dpr=1 754w, https://images.theconversation.com/files/489118/original/file-20221011-20-j4ttyf.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=424&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/489118/original/file-20221011-20-j4ttyf.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=424&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Vancouver’s Insite facility provides a safe space for more than 300 injections each day.</span>
</figcaption>
</figure>
<p>Insite also offers a key source of evidence on the effectiveness and impact of OPCs. A <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(10)62353-7/fulltext">2011 study published in the Lancet</a> found that, in the two years after Insite opened, the rate of overdose deaths within 500 metres of the facility fell by 35%, compared with 9% in the rest of Vancouver. More recently, <a href="https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1002964">a six-year cohort study</a> found that people who used Insite and other OPCs in Vancouver at least weekly were almost 50% less likely to die of any cause than other people regularly using drugs.</p>
<p><a href="https://www.emcdda.europa.eu/publications/pods/drug-consumption-rooms_en">Evidence</a> from Insite and other established OPCs shows that these centres reduce risky activities such as needle sharing while increasing engagement with health and treatment services. This led the <a href="https://www.gov.uk/government/publications/reducing-opioid-related-deaths-in-the-uk">UK government’s Advisory Council on the Misuse of Drugs</a> to call for them to be considered for the UK in 2016. </p>
<p>Similarly, a 2019 review of global evidence <a href="https://ukhsa.koha-ptfs.co.uk/cgi-bin/koha/opac-retrieve-file.pl?id=9ae9fae9b094afc8c0656db4bccd44d5">commissioned by Public Health England</a> found that OPCs were effective in reducing high-risk injecting behaviours, drug-related litter and ambulance callouts while increasing access to education and other forms of social support. This review also confirmed there was no evidence of increased crime in the vicinity of OPCs.</p>
<p>Over the three decades since the first facility opened in Bern, the number of lives saved in OPCs across the world is likely to be enormous. And crucially, people who use drugs <a href="https://pubmed.ncbi.nlm.nih.gov/32331859/">say they are likely to use OPCs</a> if they are made available.</p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/7gIyBMt2BEk?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">A tour of Vancouver’s Insite supervised injection facility.</span></figcaption>
</figure>
<h2>‘Absolute and utter hope’</h2>
<p><a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9180147/">Over a six-month period</a>, our research team spoke to senior figures throughout Scotland – from the government and the criminal justice system to local health and social care teams and charities – to explore their views on OPCs and what they saw as barriers to adoption. </p>
<p>We also spoke to <a href="https://harmreductionjournal.biomedcentral.com/articles/10.1186/s12954-022-00679-5">family members</a> of people who use drugs, most of whom were overwhelmingly supportive. Many suggested that OPCs could provide a lifeline where other interventions had failed – and above all, “hope, just absolute and utter hope” that their loved ones could be kept safe when facing their most difficult and dangerous moments.</p>
<p>Many were bewildered as to why OPCs had not been introduced already. One family member described a “lightbulb moment” when she found herself thinking: “I can’t believe we don’t do this as a humane society.” Another asked: “Why would we not want to keep everybody safe?”</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/scotland-wont-prosecute-personal-possession-of-class-a-drugs-but-outdated-laws-prevent-deeper-reforms-168333">Scotland won't prosecute personal possession of class A drugs, but outdated laws prevent deeper reforms</a>
</strong>
</em>
</p>
<hr>
<p>As well as recognising the lifesaving potential of OPCs, local decision makers highlighted their value in reducing levels of public injecting and discarded needles – often the main concern for the general public who, as one respondent put it, just “want rid” of drug problems in their area. Among decision makers and family members alike, OPCs represented a compassionate, non-judgmental approach to drug issues. They mattered not only because they could save lives, but because they stood for an alternative response to drug problems more broadly. As one family member put it: </p>
<blockquote>
<p>By creating these drug consumption rooms, what we are really saying is: “We have an issue as a society – and it’s our responsibility to look after these people.”</p>
</blockquote>
<p>Krykant, the pioneer of Glasgow’s mobile OPC van, sees this as a key point in understanding the full value of OPCs, concluding: “Although all data gathered is important, the human factor builds the most compelling case for implementation of these services.”</p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/rkxLv3Q5a2k?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
</figure>
<h2>So why the resistance to introducing OPCs?</h2>
<p>In June 2022, Alexis Goosdeel, director of the <a href="https://www.emcdda.europa.eu/about_en">EU’s leading illicit drugs authority</a>, described OPCs as “<a href="https://idpc.net/alerts/2022/06/supervised-drug-use-centres-key-to-reducing-harm-says-eu-expert">key instruments</a>” in reducing drug harms. Goosdeel’s comments reflect a broad consensus within the drug research community – but this view is not shared by everybody.</p>
<p>The UK government argues that evidence of the effectiveness of OPCs is not sufficient to justify their introduction. In part, as <a href="https://www.rand.org/pubs/working_papers/WR1261.html">one major review</a> noted in 2018, this is because “estimating the overall effect of [OPCs] on fatal and nonfatal overdoses is difficult”. </p>
<p>Preventing individual deaths does not automatically mean overall drug mortality rates will be reduced. Someone who has had an overdose reversed in an OPC may still suffer a fatal overdose later in another location. And OPCs often operate alongside other services such as the provision of take-home <a href="https://en.wikipedia.org/wiki/Naloxone">naloxone</a> and drug treatment services such as methadone, which <a href="https://jamanetwork.com/journals/jamapsychiatry/fullarticle/2780655">significantly reduce death rates</a>.</p>
<p>A <a href="https://content.health.vic.gov.au/sites/default/files/migrated/files/collections/research-and-reports/r/review-of-the-medically-supervised-injecting-room-june-2020.pdf">recent review of an OPC in Melbourne</a>, Australia, estimated that, of the 271 “extremely serious overdoses” that were treated in its first two years of operation, between 21 and 27 deaths were avoided. But again it is difficult to isolate the impact on drug deaths from other factors; <a href="https://onlinelibrary.wiley.com/doi/abs/10.1111/add.14747">some have argued</a> that a “heroin drought” skewed the initial results from Sydney’s Medically Supervised Injecting Centre.</p>
<figure class="align-center ">
<img alt="Interior of OPC in Copenhagen" src="https://images.theconversation.com/files/489120/original/file-20221011-12-6a2qut.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/489120/original/file-20221011-12-6a2qut.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=338&fit=crop&dpr=1 600w, https://images.theconversation.com/files/489120/original/file-20221011-12-6a2qut.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=338&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/489120/original/file-20221011-12-6a2qut.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=338&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/489120/original/file-20221011-12-6a2qut.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=424&fit=crop&dpr=1 754w, https://images.theconversation.com/files/489120/original/file-20221011-12-6a2qut.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=424&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/489120/original/file-20221011-12-6a2qut.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=424&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Copenhagen’s H17, which opened in 2016, is one of the world’s largest supervised injection facilities.</span>
</figcaption>
</figure>
<p>Taken alongside the practical difficulties of gathering data on people who are often hard to engage with, OPCs are <a href="https://onlinelibrary.wiley.com/doi/abs/10.1111/dar.12919">not practical or ethical</a> for the <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6235704/">randomised controlled trial</a> (RCT) or large-scale cohort evaluations that may be expected for other medical interventions – although <a href="https://academic.oup.com/ije/advance-article-abstract/doi/10.1093/ije/dyac120/6606118?redirectedFrom=fulltext">a recent French study</a> applied some of these methods and shown positive results. However, as a <a href="https://www.thelancet.com/journals/lanpub/article/PIIS2468-2667(22)00038-X/fulltext">recent Lancet commentary on OPCs pointed out</a>, “many public health interventions have been introduced without RCTs when their mechanism of action is clearly understood”.</p>
<p>Our study found that local decision makers are most concerned about whether OPCs are cost-effective compared with other interventions. Here, the question of how to interpret the available evidence – and decide what type of evidence is needed to justify investment – takes centre stage.</p>
<p>While the UK government points to a lack of RCT evaluations, local decision makers are more pragmatic. Although there was a recognition that politically, the evidence would need to be extremely strong to get the green light, it was felt that such evidence could be produced through pilots or studies from other countries, people with experience of drug use, and public perceptions. Most of those we interviewed in Scotland felt the available evidence was sufficient to move forward to implementation.</p>
<p>But anyone hoping to develop local evidence faces a Catch-22. Building evidence requires opening an OPC – yet this is blocked by the UK government on the grounds that the available evidence is insufficient. Without the reassurance of central government support or formal agreements with local police, many local authorities and service providers lack the confidence to go ahead.</p>
<h2>What do families and communities want?</h2>
<blockquote>
<p>[When] she is living with you and she wakes up and she’s shaking and she is dreadful, you can say: “Do you want me to take you to the consumption room?” Hope … that’s all you are left with in the end. Hope that one day they say: “I don’t want to live like this anymore.” (Mother of a person who uses drugs)</p>
</blockquote>
<p>Among the family members we interviewed, OPCs were attractive not only because of the evidence that they save lives, but because they gave new hope and the promise of greater dignity for their loved ones:</p>
<blockquote>
<p>[An OPC] lends itself to people being given just a bit of space to say: “Actually I would want to do something different here.” I think it’s the gap between what we say and what we do at a deeply compassionate level. It’s easier to blame and shame and stigmatise people and see them as less than human, rather than see them as your own son, daughter, niece, nephew or uncle.</p>
</blockquote>
<p>Communities affected by visible public drug consumption, however, often have different priorities. As a number of our participants pointed out, OPCs also need the support of these wider community members if they are to be successful.</p>
<p>In the past, community support for OPCs has often been strongest when large-scale drug scenes – such as emerged in parts of Germany and Switzerland in the 1980s and in Sydney in the 1990s – became a <a href="https://www.tandfonline.com/doi/abs/10.3109/14659891.2016.1143049">pressing social problem</a>. More recently, the dramatic rise in UK drug deaths has raised the political pressure for action. However, public concern over visible drug consumption, especially when many people find it threatening or morally wrong, does not necessarily translate into support for OPCs.</p>
<p><a href="https://www.sciencedirect.com/science/article/abs/pii/S0955395918302706">A US survey</a> found that many people believed money spent on OPCs would be better allocated to more conventional treatment and recovery programmes. Some community groups have expressed concern that OPCs would <a href="https://www.tandfonline.com/doi/full/10.1080/13698575.2017.1291918">create a “honeypot effect”</a>, not only attracting people using drugs but also dealers to the vicinity. However, <a href="https://www.sciencedirect.com/science/article/abs/pii/S095539592030195X?via%3Dihub">other research suggests</a> that if people hear stories about the experiences of people who use OPCs (or their families), rather than just being presented with statistics and data, then support increases.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/a-medically-supervised-injection-facility-matters-for-victoria-and-for-more-inclusive-mental-health-support-79761">A medically supervised injection facility matters for Victoria – and for more inclusive mental health support</a>
</strong>
</em>
</p>
<hr>
<p>When a proposal to open an OPC in the Richmond district of Melbourne was announced in 2017, there was widespread opposition from residents who feared it would encourage higher levels of drug use, increase crime, and attract more dealers to their areas. A <a href="https://www.parliament.vic.gov.au/file_uploads/Review_of_the_Medically_Supervised_Injecting_Room_June_2020_WsP785dN.pdf">later evaluation</a> found that, while a large number of deaths had been prevented and ambulance callouts had fallen by 25% near the facility, some local residents reported no perceived change to factors such as the number of discarded needles – and a degree of opposition to the OPC remained.</p>
<p>But this was in stark contrast to the experience in <a href="https://www.health.nsw.gov.au/aod/resources/Documents/msic-kpmg.pdf">Sydney</a>. In 2010, ten years after its OPC opened, the amount of street injecting reported by residents had halved, and there was a “considerable reduction” in reported levels of discarded needles in the vicinity – leading to high levels of local support. The Insite centre in Vancouver also continues to enjoy high levels of public support for similar reasons.</p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/Ms9CV2m59MA?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
</figure>
<p><a href="https://www.appgdrugpolicyreform.org/news/drugattitudespolling2022">In a recent UK-wide poll</a>, just under half the respondents supported OPCs and only 18% opposed their introduction. Yet for some sceptics, <a href="https://hansard.parliament.uk/commons/2018-01-17/debates/1681A3C1-E6A4-4E10-8E38-8B4B240D5B67/DrugConsumptionRooms">the basic principle of facilitating drug consumption</a> is wrong, especially without a clear requirement that visitors take steps towards recovery.</p>
<p>Under former prime minister Boris Johnson, the UK’s Conservative government argued that OPCs ran counter to their “tough” approach to drugs – not only enabling but even “<a href="https://www.bbc.co.uk/news/uk-scotland-scotland-politics-58092735">encouraging use</a>” (a claim not supported by any available evidence). Because it is much easier <em>not</em> to open an OPC, political inertia and institutional risk-aversion are always liable to prevent innovation.</p>
<p>Settling these controversies is about more than just appealing to evidence. <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/1745-9133.12566">Recent research</a> confirmed what, to a casual observer, may seem obvious: even what you call these centres makes a difference. The label “drug consumption room”, for example, garners less public support than “overdose prevention centre” because one sounds like a facility designed to enable drug use to take place while the other frames it as saving lives. Getting public clarity on what OPCs actually do is therefore critical.</p>
<p>That OPCs save individual lives is beyond dispute. But they do so by accepting that creating safer environments for otherwise high-risk forms of drug consumption can be the right thing to do in certain circumstances. For some people, that will never be an acceptable principle – and the high level of stigmatisation towards people who inject drugs <a href="https://www.sciencedirect.com/science/article/abs/pii/S0306460318307925">in political discussions</a> only serves to reinforce this view. For many others, however, it sits at the heart of a compassionate and effective approach to reducing drug harms. </p>
<h2>Will OPCs happen in the UK?</h2>
<p>While every participant in our research supported piloting OPCs in principle, almost all decision makers felt the power to give the green light lay elsewhere. In Scotland, the issue is seen to have been kicked around like a political football, while the UK government insists that OPCs are a distraction from other treatment responses and claims advocates view them as a kind of silver bullet (something our participants strongly disputed).</p>
<p>Despite <a href="https://transformdrugs.org/mda-at-50/parliamentary-support">many expert voices arguing</a> that after more than 50 years, a review of the UK’s primary drug legislation, the <a href="https://www.legislation.gov.uk/ukpga/1971/38/contents">1971 Misuse of Drugs Act</a>, is urgently needed, it seems unlikely that this act will be amended in the short term at least. Senior police authorities (such as regional police and crime commissioners in England), however, could agree to memorandums of understanding, guaranteeing that local police will not enforce the act in ways that prevent OPCs from operating. This would be possible without any change to primary legislation but relies on senior local leaders championing their case.</p>
<p>There is certainly growing support for OPCs in English regions such as the <a href="https://www.westmidlands-pcc.gov.uk/drugs-2/">West Midlands</a> that have pressing drug problems. Should regional police forces arrive at agreements to allow local adoption, there are organisations ready to create facilities and a considerable body of evaluation literature to support effective service designs. Importantly, there are also researchers in place to ensure that new services are rigorously evaluated.</p>
<p>OPCs can only ever be one part of society’s response to drug dependency and harm. But without the opportunity to pilot them locally in the UK, it will never be possible to assess what the scale of that contribution could be, or how many lives would be saved. In the face of a growing drug death crisis, the need for action is more urgent than ever.</p>
<hr>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/313478/original/file-20200204-41481-1n8vco4.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/313478/original/file-20200204-41481-1n8vco4.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=112&fit=crop&dpr=1 600w, https://images.theconversation.com/files/313478/original/file-20200204-41481-1n8vco4.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=112&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/313478/original/file-20200204-41481-1n8vco4.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=112&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/313478/original/file-20200204-41481-1n8vco4.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=140&fit=crop&dpr=1 754w, https://images.theconversation.com/files/313478/original/file-20200204-41481-1n8vco4.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=140&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/313478/original/file-20200204-41481-1n8vco4.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=140&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption"></span>
</figcaption>
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<p><em>For you: more from our <a href="https://theconversation.com/uk/topics/insights-series-71218?utm_source=TCUK&utm_medium=linkback&utm_campaign=TCUKengagement&utm_content=InsightsUK">Insights series</a>:</em></p>
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<li><p><em><a href="https://theconversation.com/liverpools-unsung-covid-heroes-how-the-citys-arts-scene-became-a-life-support-network-192776?utm_source=TCUK&utm_medium=linkback&utm_campaign=TCUKengagement&utm_content=InsightsUK">Liverpool’s unsung COVID heroes: how the city’s arts scene became a life support network
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<p><em>To hear about new Insights articles, join the hundreds of thousands of people who value The Conversation’s evidence-based news. <a href="https://theconversation.com/uk/newsletters/the-daily-newsletter-2?utm_source=TCUK&utm_medium=linkback&utm_campaign=TCUKengagement&utm_content=InsightsUK"><strong>Subscribe to our newsletter</strong></a>.</em></p><img src="https://counter.theconversation.com/content/192044/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>James Nicholls was previously chief executive officer of the Transform Drug Policy Foundation, which received funding from the Esmée Fairbairn Foundation to support research on overdose prevention centres (OPCs). He received funding from the Scottish government's Drug Deaths Taskforce for research on OPCs, and is currently a trustee of the harm reduction charity Cranstoun. </span></em></p><p class="fine-print"><em><span>Kirsten Trayner has been a lead author and co-author relating to OPC research in the UK, including the evaluation of the unsanctioned OPC in Glasgow featured in this article. She has received funding from the Scottish government for an unrelated project.</span></em></p><p class="fine-print"><em><span>Tessa Parkes received funding from the Scottish government’s Drug Deaths Taskforce research fund for a study on OPCs which is referred to in this article. She sits on the Scottish government’s National Drugs Mission Oversight Group and has received funding from a range of public and not for profit funders.</span></em></p>There are around 200 supervised injection facilities around the world but the UK government remains opposed to their introductionJames Nicholls, Senior Lecturer in Public Health, University of StirlingKirsten Trayner, Research Fellow, Glasgow Caledonian UniversityTessa Parkes, Professor of Substance Use and Inclusion Health, University of StirlingLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1826292022-05-10T12:06:06Z2022-05-10T12:06:06ZWhat is fentanyl and why is it behind the deadly surge in US drug overdoses? A medical toxicologist explains<figure><img src="https://images.theconversation.com/files/462077/original/file-20220509-18-ruua59.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C1024%2C683&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Only a small amount of fentanyl is enough to be lethal.</span> <span class="attribution"><a class="source" href="https://newsroom.ap.org/detail/OverdosesLosAngeles/9b9e2555c6654b1094d2be9f3ef43226">AP Photo/Jacquelyn Martin</a></span></figcaption></figure><p>Buying drugs on the street is a game of Russian roulette. From Xanax to cocaine, drugs or counterfeit pills purchased in nonmedical settings may contain life-threatening amounts of fentanyl.</p>
<p>Physicians like me have seen a rise in unintentional fentanyl use from people buying prescription opioids and other drugs <a href="https://doi.org/10.1016/j.drugalcdep.2022.109398">laced, or adulterated, with fentanyl</a>. Heroin users in my community in Massachusetts came to realize that fentanyl had entered the drug supply when <a href="https://www.bostonindicators.org/reports/report-website-pages/opioids-2018">overdose numbers exploded</a>. In 2016, my colleagues and I found that patients who came to the emergency department reporting a heroin overdose often <a href="https://doi.org/10.1080/15563650.2017.1339889">only had fentanyl present in their drug test results</a>.</p>
<p>As the Chief of Medical Toxicology at UMass Chan Medical School, I have <a href="https://scholar.google.com/citations?user=X55PT8EAAAAJ&hl=en">studied fentanyl and its analogs</a> for years. As fentanyl has become ubiquitous across the U.S., it has transformed the illicit drug market and raised the risk of overdose.</p>
<h2>Fentanyl and its analogs</h2>
<p><a href="https://doi.org/10.1016/j.jpain.2014.08.010">Fentanyl</a> is a synthetic opioid that was originally developed as an analgesic – or painkiller – for surgery. It has a specific chemical structure with multiple areas that can be modified, often illicitly, to form related compounds with marked differences in potency.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/462058/original/file-20220509-19-b5q65.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Diagram depicting various functional groups that can be substituted in fentanyl." src="https://images.theconversation.com/files/462058/original/file-20220509-19-b5q65.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/462058/original/file-20220509-19-b5q65.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=435&fit=crop&dpr=1 600w, https://images.theconversation.com/files/462058/original/file-20220509-19-b5q65.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=435&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/462058/original/file-20220509-19-b5q65.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=435&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/462058/original/file-20220509-19-b5q65.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=546&fit=crop&dpr=1 754w, https://images.theconversation.com/files/462058/original/file-20220509-19-b5q65.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=546&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/462058/original/file-20220509-19-b5q65.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=546&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Fentanyl’s chemical backbone (the structure in the center) has multiple areas (the colored circles) that can be substituted with different functional groups (the colored boxes around the edges) to change its potency.</span>
<span class="attribution"><a class="source" href="https://doi.org/10.1002/cpt.1418">Christopher Ellis et al.</a>, <a class="license" href="http://creativecommons.org/licenses/by-nc-nd/4.0/">CC BY-NC-ND</a></span>
</figcaption>
</figure>
<p>For example, <a href="https://pubchem.ncbi.nlm.nih.gov/compound/Carfentanil">carfentanil</a>, a fentanyl analog formed by substituting one chemical group for another, is 100 times more potent than its parent structure. Another analog, <a href="https://doi.org/10.1097/ADM.0000000000000324">acetylfentanyl</a>, is approximately three times less potent than fentanyl, but has still led to <a href="https://dx.doi.org/10.15585%2Fmmwr.mm6643e1">clusters of overdoses in several states</a>. </p>
<p>Despite the number and diversity of its analogs, fentanyl itself continues to <a href="http://dx.doi.org/10.15585/mmwr.mm6910a4">dominate the illicit opioid supply</a>. Milligram per milligram, fentanyl is roughly <a href="https://www.cdc.gov/stopoverdose/fentanyl/index.html">50 times more potent than heroin and 100 times more potent than morphine</a>.</p>
<h2>Lacing or replacing drugs with fentanyl</h2>
<p>Drug dealers have used fentanyl analogs as an adulterant in illicit drug supplies <a href="https://doi.org/10.1021/ac00235a790">since 1979</a>, with fentanyl-related overdoses clustered in <a href="https://doi.org/10.1111/j.1556-4029.2008.00669.x">individual cities</a>. </p>
<p>The modern epidemic of fentanyl adulteration is far broader in its geographic distribution, production and number of deaths. Overdose deaths <a href="https://dx.doi.org/10.15585%2Fmmwr.mm6634a2">roughly quadrupled</a>, going from 8,050 in 1999 to 33,091 in 2015. From May 2020 to April 2021, <a href="http://dx.doi.org/10.15585/mmwr.mm7050e3">more than 100,000 Americans</a> died from a drug overdose, with over 64% of these deaths due to synthetic opioids like fentanyl and its analogs.</p>
<p>Illicitly manufactured fentanyl is <a href="https://www.dea.gov/documents/2020/2020-03/2020-03-06/fentanyl-flow-united-states">internationally synthesized</a> in China, Mexico and India, then exported to the United States as powder or pressed pills. China also exports many of the precursor chemicals needed to synthesize fentanyl.</p>
<p>Additionally, the emergence of the <a href="https://doi.org/10.2196/24486">dark web</a>, an encrypted and anonymous corner of the internet that’s a haven for criminal activity, has facilitated the sale of fentanyl and other opioids shipped through <a href="https://www.npr.org/2018/05/24/613762721/deadly-delivery-opioids-by-mail">traditional delivery services</a>, including the U.S. Postal Service.</p>
<p>During the 2023 Asia-Pacific Economic Cooperation summit, U.S. President Joe Biden and Chinese President Xi Jinping reached an agreement to <a href="https://apnews.com/article/biden-xi-apec-san-francisco-58d11e7e3902955302182c2bc41430e0">combat fentanyl trafficking</a>.</p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/01QYV8nbHs0?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">Fentanyl is driving an increasing number of opioid overdose deaths.</span></figcaption>
</figure>
<p>Fentanyl is both sold alone and often <a href="https://theconversation.com/rat-poison-is-just-one-of-the-potentially-dangerous-substances-likely-to-be-mixed-into-illicit-drugs-163568">used as an adulterant</a> because its high potency allows dealers to traffic smaller quantities but maintain the drug effects buyers expect. Manufacturers may also add bulking agents, like flour or baking soda, to fentanyl to increase supply without adding costs. As a result, it is much more profitable to cut a kilogram of fentanyl compared to a kilogram of heroin. </p>
<p>Unfortunately, fentanyl’s high potency also means that even just a small amount can prove deadly. If the end user isn’t aware that the drug they bought has been adulterated, this could easily lead to an overdose.</p>
<h2>Preventing fentanyl deaths</h2>
<p>As an emergency physician, I give fentanyl as an analgesic, or painkiller, to <a href="https://www.mayoclinic.org/drugs-supplements/fentanyl-injection-route/description/drg-20075614">relieve severe pain</a> in an acute care setting. My colleagues and I choose fentanyl when patients need immediate pain relief or sedation, such as anesthesia for surgery. </p>
<p>But even in the controlled conditions of a hospital, there is still a risk that using fentanyl can <a href="https://doi.org/10.1073/pnas.2022134118">reduce breathing rates</a> to dangerously low levels, the main cause of opioid overdose deaths. For those taking fentanyl in nonmedical settings, there is no medical team available to monitor someone’s breathing rate in real time to ensure their safety. </p>
<p>One measure to prevent fentanyl overdose is <a href="https://www.cdc.gov/stopoverdose/naloxone/index.html">distributing naloxone to bystanders</a>. Naloxone can reverse an overdose as it occurs by blocking the effects of opioids.</p>
<p>Another measure is increasing the availability of <a href="https://nida.nih.gov/publications/research-reports/medications-to-treat-opioid-addiction/how-do-medications-to-treat-opioid-addiction-work">opioid agonists</a> like methadone and buprenorphine that reduce opioid withdrawal symptoms and cravings, helping people stay in treatment and decrease illicit drug use. Despite the lifesaving track records of these medications, their availability is limited by <a href="https://www.statnews.com/2021/12/22/inflexible-methadone-regulations-impede-efforts-reduce-overdose-deaths/">restrictions on where and how they can be used</a> and <a href="https://www.npr.org/sections/health-shots/2021/11/08/1053579556/dea-suboxone-subutex-pharmacies-addiction">inadequate numbers of prescribers</a>.</p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/zWe_lPniEq4?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">Naloxone can rapidly reverse an opioid overdose.</span></figcaption>
</figure>
<p>Other strategies to prevent overdose deaths include <a href="https://doi.org/10.1097/adm.0000000000000555">lowering the entry barrier</a> to addiction treatment, <a href="https://www.cnn.com/2021/12/01/health/fentanyl-test-strip/index.html">fentanyl test strips</a>, <a href="https://doi.org/10.1007/s11904-017-0363-y">supervised consumption sites</a> and even <a href="https://doi.org/10.1192/bjp.bp.114.149195">prescription diamorphine (heroin)</a>. </p>
<p>Despite the evidence supporting these measures, however, <a href="https://www.ncbi.nlm.nih.gov/books/NBK541389/">local politics and funding priorities</a> often limit whether communities are able to give them a try. Bold strategies are needed to interrupt the ever-increasing number of fentanyl-related deaths.</p>
<p><em>This article was updated on Nov. 16, 2023 to note developments regarding fentanyl at the Asia-Pacific Economic Cooperation summit.</em></p><img src="https://counter.theconversation.com/content/182629/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Kavita Babu receives research support from the National Institutes of Health, Centers for Disease Control and Prevention, the National Highway Traffic Safety Administration, the Massachusetts Department of Health Bureau of Substance Abuse Services and royalties from UptoDate.</span></em></p>Fentanyl’s wide availability in the drug supply has led to an increase in unintentional overdoses. While prevention strategies are available, limited availability stymies their use.Kavita Babu, Professor of Emergency Medicine, UMass Chan Medical SchoolLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1671002021-09-16T12:11:03Z2021-09-16T12:11:03ZOxyContin created the opioid crisis, but stigma and prohibition have fueled it<figure><img src="https://images.theconversation.com/files/421389/original/file-20210915-17-1lvjamv.jpg?ixlib=rb-1.1.0&rect=6%2C12%2C997%2C597&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">People around the world mourned loved ones on International Overdose Awareness Day on Aug. 31, 2021.
</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/edmontonians-pose-wooden-crosses-with-roses-on-news-photo/1234986137?adppopup=true"> NurPhoto/Getty Images</a></span></figcaption></figure><p>The <a href="https://theconversation.com/how-the-purdue-opioid-settlement-could-help-the-public-understand-the-roots-of-the-drug-crisis-166701">highly contentious</a> <a href="https://www.npr.org/2021/09/01/1031053251/sackler-family-immunity-purdue-pharma-oxcyontin-opioid-epidemic">Purdue Pharma settlement</a> announced Sept. 1, 2021, comes at a pivotal time for the U.S. overdose crisis: 2020 was the worst year on record, with over <a href="https://www.cdc.gov/nchs/nvss/vsrr/drug-overdose-data.htm">93,000 Americans</a> losing their lives to fatal drug overdose. The drug overdose epidemic, now more than two decades long, has claimed the lives of <a href="https://www.cdc.gov/opioids/data/index.html">more than 840,000</a> people since 1999. Current estimates suggest that some <a href="https://www.rand.org/content/dam/rand/pubs/research_reports/RR3100/RR3140/RAND_RR3140.pdf">2.3 million people</a> in the U.S. use heroin and <a href="https://www.drugabuse.gov/drug-topics/opioids/opioid-overdose-crisis">1.7 million people</a> use pharmaceutical opioids without a prescription. </p>
<p>Since 2016, I’ve <a href="https://gc-cuny.academia.edu/EmilyCampbell?from_navbar=true">studied the overdose crisis</a> with an eye to understanding its roots as well as its ramifications. As a <a href="https://www.holycross.edu/academics/programs/sociology-and-anthropology/faculty/emily_b_campbell">sociologist</a>, I came to this area of research in my own quest for meaning, as each year brought more funerals of former classmates and friends. What I found was an increasingly dangerous drug environment for people who use drugs, often exacerbated by policies not founded in research and by attitudes that harm those affected.</p>
<h2>How prohibition fuels dangerous markets</h2>
<p>Research shows that <a href="https://doi.org/10.1016/j.drugpo.2017.05.050">the illicit drug market adapts</a> to both demand and drug enforcement efforts. </p>
<p>The first consequence of increased demand is that drugs become <a href="https://doi.org/10.1016/j.drugpo.2007.11.016">cheaper over time</a>. For example, the price of heroin and cocaine have been falling for decades. Political economists explain that demand, coupled with globalization, increases efficiency and competition. The result is that there are more drugs on the illicit market, which in turn lowers prices. </p>
<p>Second, as a response to drug prohibition, <a href="https://doi.org/10.1016/j.drugpo.2017.05.050">drugs become more potent</a>. A stronger product in a smaller package is easier to transport and harder to detect. The American overdose crisis has become <a href="https://doi.org/10.1016/j.drugpo.2017.05.050">a case study</a> in the devastating interplay of demand and prohibition. </p>
<p>OxyContin was released in 1996 and <a href="https://doi.org/10.2105/AJPH.2007.131714">mass-marketed as a revolutionary intervention</a> in the medical treatment of pain. Purdue Pharma, its maker, <a href="https://www.nytimes.com/2007/05/10/business/11drug-web.html?smid=url-share">knowingly downplayed</a> its addictive potential. As an opioid and central nervous depressant, <a href="https://doi.org/10.1300/J069v23n04_01">OxyContin has effects</a> similar to those of morphine or heroin. Not surprisingly, studies show that prescription patterns of opioids from 1999 to 2008 were <a href="https://pubmed.ncbi.nlm.nih.gov/22048730/">directly linked to a surge in overdose deaths</a>.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/420692/original/file-20210913-27-4nizsn.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Pill bottle and pills of OxyContin prescription-only pain medication" src="https://images.theconversation.com/files/420692/original/file-20210913-27-4nizsn.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/420692/original/file-20210913-27-4nizsn.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=428&fit=crop&dpr=1 600w, https://images.theconversation.com/files/420692/original/file-20210913-27-4nizsn.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=428&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/420692/original/file-20210913-27-4nizsn.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=428&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/420692/original/file-20210913-27-4nizsn.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=538&fit=crop&dpr=1 754w, https://images.theconversation.com/files/420692/original/file-20210913-27-4nizsn.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=538&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/420692/original/file-20210913-27-4nizsn.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=538&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Oxycontin prescription-only pills were aggressively promoted to primary care physicians as a safe and effective pain control method for patients.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/oxycontin-pills-oxycodone-hydrochloride-prescription-only-news-photo/563590877?adppopup=true">Lawrence K. Ho/Los Angeles Times via Getty Images</a></span>
</figcaption>
</figure>
<p>As concern over opioid overdose grew, doctors’ prescribing practices <a href="https://doi.org/10.1007/s11013-016-9496-5">came under scrutiny</a>. In 2010, Purdue Pharma replaced the original OxyContin with an <a href="https://doi.org/10.1001/jamapsychiatry.2014.3043">“abuse deterrent” formulation</a> that was more difficult to crush and inhale. As a result, many people who were addicted to OxyContin turned to heroin, which was <a href="https://doi.org/10.1162/rest_a_00755">cheaper and easier to get</a>. This spurred a surge in heroin-related fatal overdoses, which is often termed the <a href="https://doi.org/10.1016/j.drugpo.2019.01.010">second wave of the overdose crisis</a>.</p>
<p>The growing market for heroin paved the way for the <a href="https://doi.org/10.1016/j.drugpo.2017.06.010">introduction of fentanyl</a> into the illicit U.S. drug market. Fentanyl, a drug used in medical settings for severe pain, is <a href="https://www.drugabuse.gov/publications/drugfacts/fentanyl">50 times more potent than heroin</a>. From the standpoint of efficiency for shipping and trafficking, fentanyl is easier to transport and sell than heroin. Fentanyl’s entry into the illicit drug market, in particular in combination with heroin, <a href="https://doi.org/10.1016/j.drugpo.2017.06.010">led to a doubling and tripling </a>of overdose deaths around 2012 to 2013. </p>
<p><a href="https://journals.lww.com/co-psychiatry/fulltext/2021/07000/the_rise_of_illicit_fentanyls,_stimulants_and_the.4.aspx">Since then, fentanyl</a> <a href="https://doi.org/10.1016/j.drugpo.2021.103353">has contaminated</a> the U.S. illicit drug supply: It is often found in not just heroin but cocaine, MDMA – commonly known as Ecstasy – methamphetamine and counterfeit prescription pills. The result is that most people <a href="https://doi.org/10.1016/j.drugpo.2019.07.008">do not know the potency or contents</a> of what they are using. </p>
<p>As the overdose crisis evolves, <a href="https://doi.org/10.1007/s40615-021-01007-6">communities of color</a> in particular have experienced a surge in fatal overdoses – deaths that are often preventable. And most recently, COVID-19 supply chain disruptions led people to use whatever was available, causing <a href="https://ajph.aphapublications.org/doi/abs/10.2105/AJPH.2021.306256">a surge in overdoses</a> from drug mixing. </p>
<h2>Barriers to treatment</h2>
<p>Too often, people who use drugs are bombarded with messages that are not supported by research and that deepen the harm. </p>
<p>Public health officials and community leaders urge people to seek treatment and highlight that recovery is within reach. Yet, roughly 70% of people who seek treatment are <a href="https://www.rcorp-ta.org/sites/default/files/2020-06/Improving-Access-to-Evidence-Based-Medical-Treatment-for-OUD_FINAL.pdf">unable to access it</a>. <a href="https://doi.org/10.1080/10826084.2017.1363238">Barriers to treatment</a> include health care costs, lack of available treatment options and social stigma. Research also demonstrates that some people are not ready for treatment or <a href="https://doi.org/10.1080/10826084.2017.1310247">do not want to be sober</a>.</p>
<p>Sobriety is touted as the ultimate goal for people who use drugs. Yet research shows that addiction is a <a href="https://doi.org/10.1038/s41386-020-00950-y">recurring brain disease</a>, and relapse is highly likely. Most people who use drugs do so in a <a href="https://www.ucpress.edu/book/9780520293472/hurt">sporadic way</a> that features bouts of controlled and uncontrolled use as well as sobriety. It is also well documented that fear of arrest and shame encourages people to hide their drug use in ways that <a href="https://doi.org/10.1080/10826084.2020.1790008">increase their risk</a> of a fatal overdose. This is because when people use alone, there is no one there to call 911 or perform CPR should an overdose occur. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/420698/original/file-20210913-23-1llv382.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Woman holding up phone with image of brother and son who died after taking fentanyl-laced drugs" src="https://images.theconversation.com/files/420698/original/file-20210913-23-1llv382.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/420698/original/file-20210913-23-1llv382.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=431&fit=crop&dpr=1 600w, https://images.theconversation.com/files/420698/original/file-20210913-23-1llv382.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=431&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/420698/original/file-20210913-23-1llv382.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=431&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/420698/original/file-20210913-23-1llv382.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=541&fit=crop&dpr=1 754w, https://images.theconversation.com/files/420698/original/file-20210913-23-1llv382.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=541&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/420698/original/file-20210913-23-1llv382.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=541&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Laurie Restivo’s brother, David Restivo, 47 (left on phone image), died from fentanyl-laced heroin, and her son, Jason Fisher Jr., 25 (right), died from fentanyl-laced cocaine.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/fentanyl-overdose-restivo-johnson-laurie-restivo-displays-a-news-photo/1315873058?adppopup=true">Reading Eagle/MediaNews Group via Getty Images</a></span>
</figcaption>
</figure>
<p>In terms of effective treatment, <a href="https://doi.org/10.1176/appi.ps.201300256">medically assisted treatments</a> are considered the gold standard for opioid use disorder, yet they are still <a href="https://doi.org/10.1111/jrh.12328">underutilized</a>. <a href="https://doi.org/10.1001/jama.2021.1741">Buprenorphine</a> is an opioid with a “ceiling effect,” meaning it does not intoxicate like morphine or heroin but instead satiates an opioid craving. Buprenorphine assists people in transitioning away from uncontrolled use and mitigates physical cravings. People who are prescribed it are often able to work, attend therapy and regain enjoyment of day-to-day life. </p>
<p>Nonetheless, buprenorphine’s availability <a href="https://doi.org/10.1002/pds.4984">varies widely by state</a>, and people of color are <a href="https://doi.org/10.1377/hlthaff.2020.02261">persistently underprescribed</a> this lifesaving medication. Methadone has been used as a treatment for opioid use disorder since the 1950s, yet it is persistently <a href="https://doi.org/10.1007/s11606-018-4801-3">hard to access</a> long term. Researchers point to the <a href="https://doi.org/10.1080/08897077.2019.1640833">ongoing role of stigma</a> in the underuse of both of these medications. </p>
<h2>Better paths forward</h2>
<p>Public health officials, harm reduction activists and concerned citizens across the U.S. are working to secure <a href="https://doi.org/10.1097/01.NPR.0000534948.52123.fb">safer injection sites</a> where people can use drugs in the presence of medical staff. Such sites facilitate the prevention of fatal overdose by assuring an adequate and timely medical response and open a pathway for further health care and addiction-related treatment. In response to the pandemic’s strains on inpatient care facilities, <a href="https://doi.org/10.1016/j.jsat.2021.108552">take-home methadone</a> availability was expanded in new ways – a change that some treatment experts <a href="https://doi.org/10.1016/j.jsat.2020.108246">hope will be permanent</a>. </p>
<p>For people who use drugs, the <a href="https://doi.org/10.1016/j.jhealeco.2019.01.001">potency and contents of their drugs are often unknown</a>. <a href="https://doi.org/10.1016/j.drugpo.2018.10.001">Drug-checking programs</a> allow people to inspect the <a href="https://doi.org/10.1016/j.drugpo.2018.09.009">contents of their drugs for fentanyl</a> at home with a simple test strip. Such programs have recently gained traction with <a href="https://www.cdc.gov/media/releases/2021/p0407-Fentanyl-Test-Strips.html">federal support</a>. States also continue to expand <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5049966/">access to naloxone</a>, an overdose reversal nasal spray that is simple to administer. People who use drugs or have loved ones who use drugs are encouraged to receive training on how to administer naloxone and to carry the nasal spray on them. </p>
<p>Those who argue for a <a href="https://doi.org/10.1503/cmaj.201618">safer supply</a> and <a href="https://doi.org/10.1016/j.socscimed.2021.113986">decriminalization of drugs</a> point to success abroad. <a href="https://www.rand.org/content/dam/rand/pubs/working_papers/WR1200/WR1263/RAND_WR1263.pdf">Heroin-assisted treatment</a> is shown to be effective in keeping people away from an unpredictable drug market, thus lowering the risk of overdose. Germany’s use of <a href="https://doi.org/10.1111/j.1360-0443.2008.02185.x">heroin-assisted treatment</a> improved patients’ physical and mental health while dramatically reducing illicit drug use. In the early 2000s, <a href="https://doi.org/10.1177/2050324516683640">Portugal decriminalized</a> all drugs in response to consistently having the highest fatal overdose rates in Western Europe. With diversion of funds away from prohibition to education and treatment, Portugal saw a drop in overall drug use and now boasts among the lowest fatal overdose rates in Western Europe.</p>
<p>Americans are the world’s <a href="https://doi.org/10.1111/add.14234">largest consumers</a> of drugs and consistently have among the highest rates of opioid and cocaine dependence globally. In <a href="https://gc-cuny.academia.edu/EmilyCampbell?from_navbar=true">my own research</a>, I’ve found that people often describe drug use as a battle between sobriety and death. But the heartbreaking surge in accidental, fatal overdose deaths tells a much more complex story. Ignoring the evidence will surely cost many more lives.</p>
<p><em>If you or someone you care about has a substance use disorder and wants help, you can call SAMHSA’s National Helpline: 1-800-662-HELP (4357). Immediate emotional support is available from the National Suicide Prevention Hotline 800-273-8255.</em> </p>
<p>[<em>Get our best science, health and technology stories.</em> <a href="https://theconversation.com/us/newsletters/science-editors-picks-71/?utm_source=TCUS&utm_medium=inline-link&utm_campaign=newsletter-text&utm_content=science-best">Sign up for The Conversation’s science newsletter</a>.]</p><img src="https://counter.theconversation.com/content/167100/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Emily B. Campbell 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>False narratives about drug addiction and policies that are not supported by research are deepening the overdose epidemic in the US.Emily B. Campbell, Visiting Assistant Professor of Sociology, College of the Holy CrossLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1635682021-08-16T12:29:11Z2021-08-16T12:29:11ZRat poison is just one of the potentially dangerous substances likely to be mixed into illicit drugs<figure><img src="https://images.theconversation.com/files/415548/original/file-20210810-17-n2r4rx.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C2121%2C1412&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Impurities are often added to recreational drugs to mask poor quality.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/midsection-of-man-holding-cocaine-royalty-free-image/1076137624">Sebastian Leesch/EyeEm via Getty Images</a></span></figcaption></figure><p>Over 150 people in Illinois started <a href="https://doi.org/10.1056/NEJMoa1807652">bleeding uncontrollably</a> after using <a href="https://www.drugabuse.gov/publications/drugfacts/synthetic-cannabinoids-k2spice">synthetic cannabis-based products</a> – including fake marijuana, Spice and K2 – that contained the rat poison brodifacoum in March and April 2018. By the end of July 2021, these banned products were still being sold in <a href="https://www.usatoday.com/story/news/nation/2018/07/20/fda-warning-synthetic-marijuana-rat-poison/802585002/">10 states and the District of Columbia</a>, resulting in hundreds of severe bleeds and several deaths.</p>
<p>Illicit drug use was responsible for <a href="https://ourworldindata.org/illicit-drug-use#direct-deaths-drug-overdoses">an estimated 166,613 deaths worldwide in 2017 due to overdose</a>. The increased risk of disease and injury associated with illicit drug use caused an <a href="https://ourworldindata.org/illicit-drug-use#indirect-deaths-drug-use-as-a-risk-factor-for-premature-death">additional estimated 585,348 premature deaths</a>. And it’s impossible to tease out whether people were harmed by the drugs themselves or by the myriad impurities added to them.</p>
<p>I am a <a href="https://scholar.google.com/citations?user=lWAD9d8AAAAJ&hl=en">clinical pharmacologist</a> and guest editor for a <a href="https://doi.org/10.1002/jcph.1921">special supplement</a> in the Journal of Clinical Pharmacology on commonly abused substances. I also <a href="https://doi.org/10.1002/jcph.1860">surveyed the research</a> in 2021 on what’s known about illicit drug adulteration. The research is clear: Adding impurities to, or adulterating, illicit drugs is a longstanding and widespread practice with harmful consequences. </p>
<h2>You seldom get what you pay for</h2>
<p>Drugmakers <a href="https://doi.org/10.1002/dta.220">include other ingredients for a few reasons</a>, whether to cut costs by bulking up their product with cheaper nonactive ingredients or to achieve particular effects by adding other drugs to mask poor product quality or imitate the desired effect of the drug itself.</p>
<p>Prior to the 2000s, drugs including cocaine and heroin were being “cut,” or diluted, with <a href="https://doi.org/10.1002/jcph.1860">inactive ingredients like sugars</a> to enlarge supply and increase profits. Since then, buyers of cocaine and heroin products frequently receive a cocktail of adulterants that mimic the product’s intended effects or mask side effects due to poor quality.</p>
<p>For example, the active ingredient of ecstasy, MDMA, is what produces the product’s intended effects. However, a 2004 study assessing ecstasy tablets from drug seizures at raves found that <a href="https://doi.org/10.1007/s00213-003-1712-7">20% of the products contained no MDMA</a>, and dosage varied widely in products that did. Cheaper and more dangerous <a href="https://doi.org/10.1002/jcph.266">stimulants and psychedelics</a> like <a href="https://doi.org/10.1002/jcph.742">synthetic bath salts</a> and LSD are frequently swapped for MDMA without alerting the buyer.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/415555/original/file-20210810-17-1rzlf8u.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Five ecstasy tablets on a white background." src="https://images.theconversation.com/files/415555/original/file-20210810-17-1rzlf8u.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/415555/original/file-20210810-17-1rzlf8u.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/415555/original/file-20210810-17-1rzlf8u.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/415555/original/file-20210810-17-1rzlf8u.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/415555/original/file-20210810-17-1rzlf8u.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/415555/original/file-20210810-17-1rzlf8u.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/415555/original/file-20210810-17-1rzlf8u.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"></a>
<figcaption>
<span class="caption">Some drugs are so adulterated that they contain little to none of the active ingredient that buyers seek.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/ecstasy-pills-royalty-free-image/508919350">portokalis/iStock via Getty Images Plus</a></span>
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<h2>Drugs added to intensify effects</h2>
<p><a href="https://doi.org/10.1111/1556-4029.13968">Over 70% of cocaine products</a> contain <a href="https://doi.org/10.1038/clpt.2010.156">levamisole</a>, a drug for worm infections that increases the intensity and duration of stimulant effects. It was <a href="https://doi.org/10.1016/j.psym.2013.02.012">banned in the U.S. in 1999</a> because it <a href="https://doi.org/10.1111/1556-4029.13968">suppresses red and white blood cell production</a> and increases the risk of life-threatening infections and anemia. These side effects are seen at doses over 150 milligrams, and <a href="https://doi.org/10.1111/1556-4029.13968">35% of seized cocaine products in the U.S.</a> exceed that level.</p>
<p>Other additives are commonly added to cocaine to intensify effects. <a href="https://doi.org/10.1016/j.ijcard.2011.06.105">Aminorex</a>, a stimulant and appetite suppressant, was <a href="https://doi.org/10.1016/j.ijcard.2011.06.105">withdrawn by the FDA in 1972</a> after it caused a number of <a href="https://go.gale.com/ps/i.do?id=GALE%7CA181301396&sid=googleScholar&v=2.1&it=r&linkaccess=abs&issn=1082801X&p=AONE&sw=w&userGroupName=anon%7E1f297428">pulmonary hypertension</a> cases that resulted in heart failure and death. Similarly, <a href="https://doi.org/10.1001/jama.291.2.216">caffeine</a> is <a href="https://jppres.com/jppres/pdf/vol8/jppres19.638_8.2.146.pdf">frequently added</a> to intensify the adrenaline rush. While safe when taken alone in lower doses, higher doses of caffeine in combination with other stimulants can induce <a href="https://doi.org/10.1001/jama.291.2.216">seizures and heart rhythm problems</a>.</p>
<p>For heroin, <a href="https://doi.org/10.1111/j.1556-4029.2007.00648.x">veterinary anesthetic xylazine</a> is commonly added to intensify its relaxing effect. And <a href="https://doi.org/10.1111/j.1556-4029.2007.00648.x">fentanyl is increasingly being used as a substitute</a>. Because fentanyl is <a href="https://www.statnews.com/2016/09/29/why-fentanyl-is-deadlier-than-heroin/">50 times more potent</a> than heroin, a smaller amount of total product can produce similar effects. But adding even just a slightly larger amount of fentanyl than expected can easily result in an overdose.</p>
<h2>Covering up adulteration and poor manufacturing quality</h2>
<p>Manufacturers also add impurities to compensate for lost effects due to adulteration. Anesthetics like <a href="https://doi.org/10.1111/1556-4029.13968">lidocaine and benzocaine</a> are added to adulterated products to reproduce the tingling sensation on the gums or tongue that drug dealers look for to assess cocaine quality. While these anesthetics are FDA approved, they can cause seizures and heart rhythm problems with the wrong dose.</p>
<p>A similar technique is used for heroin. Manufacturers commonly add <a href="https://doi.org/10.1007/s11606-012-2089-2">malaria drug quinine</a> to mimic heroin’s bitter taste and the initial drop in blood pressure when it’s administered.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/415553/original/file-20210810-19-922ggf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Three pairs of hands holding packets of drugs." src="https://images.theconversation.com/files/415553/original/file-20210810-19-922ggf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/415553/original/file-20210810-19-922ggf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/415553/original/file-20210810-19-922ggf.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/415553/original/file-20210810-19-922ggf.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/415553/original/file-20210810-19-922ggf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/415553/original/file-20210810-19-922ggf.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/415553/original/file-20210810-19-922ggf.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"></a>
<figcaption>
<span class="caption">Adulterants may be added to mimic the expected effects of a particular drug.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/drug-grams-and-tabs-royalty-free-image/482857483">KatarzynaBialasiewicz/iStock via Getty Images Plus</a></span>
</figcaption>
</figure>
<p>Poor heroin production also creates a lot of impurities that can cause <a href="https://doi.org/10.1002/jcph.1860">severe chills and pain at the injection site</a>. To get around these side effects, manufacturers frequently add antihistamines like Benadryl and pain relievers like Tylenol. The pain reliever metamizole, which was recalled in 1977 for health risks, is sometimes used instead of Tylenol.</p>
<h2>The double-edged sword of field testing</h2>
<p>Adulterants can lead to dangerous side effects. But because additives aren’t disclosed to the buyer and most of them have been banned by the FDA, clinicians might not recognize or even suspect that an adulterant is the cause of a patient’s symptoms. </p>
<p>While consumer-based methods to test for drug impurities may help, they aren’t foolproof. Volunteers at music festivals in the 2010s offered <a href="https://www.hopkinsmedicine.org/news/media/releases/on_site_ecstasy_pill_testing_services_may_reduce_user_risks_at_concerts_and_raves">MDMA purity testing</a> so attendees could decide whether they wanted to use the drugs they had. If they were injured, attendees could alert emergency personnel about potential adulterants they were exposed to. Unfortunately, over 40% of the adulterated samples were missed by those field testing kits and discovered days later only with sophisticated laboratory equipment.</p>
<p>With illicit drugs, the difference between what you believe you are buying and what is actually in the product can be the difference between life and death. If you are suffering from drug addiction, <a href="https://www.samhsa.gov/find-help/national-helpline">resources are available</a> to help you manage your addiction and achieve sobriety.</p><img src="https://counter.theconversation.com/content/163568/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>C. Michael White 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>In an effort to reduce costs, drugmakers and dealers often cut, or adulterate, recreational drugs with substances that have been banned by the FDA.C. Michael White, Professor of Pharmacy Practice, University of ConnecticutLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1639532021-07-08T14:59:15Z2021-07-08T14:59:15ZTreat illegal drug use as health issue, says UK government review – here’s why<figure><img src="https://images.theconversation.com/files/410356/original/file-20210708-23-1es550t.jpg?ixlib=rb-1.1.0&rect=0%2C13%2C4601%2C3435&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Changing attitudes towards drug problems could lead to better prevention and treatment.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/holding-hands-helping-drug-addict-teenage-652604278">Orawan Pattarawimonchai/ Shutterstock</a></span></figcaption></figure><p>The scale of the illicit drug trade in the UK is immense. Last year, the <a href="https://www.gov.uk/government/publications/review-of-drugs-phase-one-report">first part</a> of an independent review of the drugs trade found the market in the UK was estimated to be worth £9.4 billion a year – with the health, social and criminal damage from this industry costing society an estimated £19 billion annually.</p>
<p>The review was conducted by <a href="https://www.cam.ac.uk/women-at-cambridge/profiles/carol-black">Dame Carol Black</a>, a medical practitioner and researcher who was previously the government’s national director for health and work. Her first report revealed that around 3 million people used illicit drugs in England and Wales in 2020. These numbers are staggering, especially when considering that drug-related deaths have risen to <a href="https://theconversation.com/drug-deaths-in-england-and-wales-rise-for-eighth-consecutive-year-145498">record numbers</a> in England and Wales for the past eight years. </p>
<p>The <a href="https://www.gov.uk/government/publications/review-of-drugs-phase-two-report">second part of the review</a>, which has just been published, makes a number of recommendations for how the government can best tackle drug problems in the UK. Black makes a total of 32 recommendations, covering all aspects of drug policy, from preventing drug problems through to evaluating the effectiveness of treatments.</p>
<p>Some of the main recommendations include:</p>
<ul>
<li>Setting up a “drugs unit” that would put leadership and accountability for drugs policy, prevention and treatment into one central government department.</li>
<li>Providing funding for “peer mentors” in job centres to encourage drug addicts access to employment support.</li>
<li>Creating a fund to research which measures work best at changing the behaviour of recreational drug users.</li>
<li>Providing money to local authorities for drug services to ensure resources are given to those who need them.</li>
</ul>
<p>Given the scale of the drug trade in the UK and the number of people using illicit drugs, it’s obvious that <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(21)01588-9/fulltext">investment and reform</a> need to take place. But to ensure these changes do happen, one of the biggest recommendations Black makes is that we need to stop continuing to frame problem drug use as a <a href="https://www.unodc.org/unodc/en/treaties/index.html">criminal activity</a>. </p>
<p>Instead, problem drug use needs to be approached in the same way as other chronic health problems, such as diabetes or cancer. Treating drug addiction like other health problems would mean patients would be provided with help from skilled health workers – such as nurses, social workers and psychiatrists – rather than workers and volunteers that are <a href="https://www.gov.uk/government/publications/review-of-drugs-phase-two-report/review-of-drugs-part-two-prevention-treatment-and-recovery">sometimes untrained</a>. </p>
<p>But treatment for drug problems hasn’t been a <a href="https://www.bbc.co.uk/news/uk-england-44039996">priority</a> for the UK government for years – with spending and budgets for services and treatments reduced severely. This hasn’t been helped by the fact that many still view drug addiction as a <a href="https://www.gov.scot/publications/public-attitudes-towards-people-drug-dependence-people-recovery-research-findings/">personal choice</a>. But this isn’t necessarily true, as many different experiences – <a href="https://journals.sagepub.com/doi/full/10.1177/0033294118764918?casa_token=YpsRfGMw5A4AAAAA%3AzNgC1lDcjVVwBcnFSTsK2a_L-zRryGXoRmIOANiKVEFzXeE-JfdEkqcM05rZkYBmOhf49WGdklyukiA">such as trauma</a> – can lead to a person developing problems with drugs. This shows us that, in many cases, drug problems are intertwined with health and mental health problems.</p>
<figure class="align-center ">
<img alt="Used drug syringes on the pavement outdoors." src="https://images.theconversation.com/files/410364/original/file-20210708-27-pi4gaj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/410364/original/file-20210708-27-pi4gaj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/410364/original/file-20210708-27-pi4gaj.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/410364/original/file-20210708-27-pi4gaj.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/410364/original/file-20210708-27-pi4gaj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/410364/original/file-20210708-27-pi4gaj.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/410364/original/file-20210708-27-pi4gaj.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">Stigma often keeps people from seeking treatment they need.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/needles-alley-dirty-syringes-left-public-1209583678">AP Group of Photographers/ Shutterstock</a></span>
</figcaption>
</figure>
<p>Research shows that the stigma from framing drug use as a criminal issues – rather than a health issue – can put people off <a href="https://www.thelancet.com/journals/lanhiv/article/PIIS2352-3018(21)00130-2/fulltext">seeking treatment</a>. In some cases, this delay can be fatal, as treatment is an effective way of reducing drug-related deaths. Timely treatment can also reduce the <a href="https://www.thelancet.com/journals/lanhiv/article/PIIS2352-3018(21)00130-2/fulltext">spread of infections</a> such as HIV and hepatitis by providing sterile needles and syringes to those who are injecting drugs.</p>
<p>Viewing drug use as a criminal issue also means <a href="https://www.rsph.org.uk/static/uploaded/68d93cdc-292c-4a7b-babfc0a8ee252bc0.pdf">less funding</a> is invested into research on viewing effective treatments for these problems. Traditionally, investment has gone into research investigating the link between drugs and crime. Investing in research that explores the health aspects of problem drug use could lead to positive outcomes, such as finding targeted interventions that can minimise harm. </p>
<p>Framing drug use as a criminal issue has also seen funding put into treatments that mainly seek to reduce criminal activity associated with <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5608072/">drug dependency</a>. As such, many treatment services have become unintentionally “opiate centric”, as they mainly <a href="https://www.nationalelfservice.net/mental-health/substance-misuse/nice-one-is-nhs-guidance-on-substance-misuse-fit-for-purpose/">provide support</a> for those with problems due to heroin, which are associated with crime. This again has been driven by a policy and resource focus which seeks to reduce crime but doesn’t reflect the range of drug problems that people present with. </p>
<p>But with the use of other drugs increasing – including <a href="https://www.bbc.co.uk/news/newsbeat-49766047">cocaine</a> and <a href="https://www.tandfonline.com/doi/abs/10.1080/09687637.2018.1478948">cannabis</a> – a growing number of people are presenting to services with problems other than heroin. By investing almost solely in providing support and treatment for those with opiate problems, people experiencing issues with other drugs may not receive the kind of help they need. Investing in research to develop evidence-based treatments for all drug problems is urgent.</p>
<p>Perhaps the most pressing need to move drug policy to health services is the <a href="https://theconversation.com/drug-deaths-in-england-and-wales-rise-for-eighth-consecutive-year-145498">record number</a> of drug-related deaths. <a href="https://www.sciencedirect.com/science/article/pii/S0740547218302939?casa_token=DuxmafMPUB4AAAAA:SjxMsjMI6pxqheRvXzW2WUPoAlIaFVwhDiZ1sOcmdtxcKasDX23XYkljSbZWmCw8mY1CNbZO1IwY">Improving the access to and quality of treatment</a> not only helps keep more people in treatment, it also reduces the potential for relapse – ultimately reducing drug-related deaths. But so far, policymakers have <a href="https://www.gov.uk/government/news/acmd-tells-ministers-drug-related-deaths-will-continue-to-rise-if-treatment-programmes-are-not-maintained">ignored this advice</a> on reducing avoidable deaths. Providing services to people outside of treatment – such as access to housing and employment – may also help people break the cycle of problem drug use. </p>
<p>It’s <a href="https://blogs.bmj.com/bmj/2020/10/16/ian-hamilton-drug-related-deaths-are-not-spread-equally-in-our-communities/">no coincidence</a> that since cuts were imposed on treatment services a decade ago, drug-related deaths started to rise and reach a new record. If attitudes toward drug problems are changed, and greater investment put into developing more effective treatments that people struggling can access, more people may be able to recover successfully.</p><img src="https://counter.theconversation.com/content/163953/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Ian Hamilton does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>A recent report outlines how the government can reduce the harm caused by the illicit drug trade.Ian Hamilton, Associate Professor of Addiction, University of YorkLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1577092021-04-06T05:29:46Z2021-04-06T05:29:46ZDrugs could soon be decriminalised in the ACT. Here’s why that would be a positive step<figure><img src="https://images.theconversation.com/files/393486/original/file-20210406-17-n21fl.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C1000%2C667&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Shutterstock</span></span></figcaption></figure><p>In February this year, Labor backbencher Michael Pettersson introduced a <a href="https://www.legislation.act.gov.au/b/db_63822">private members bill</a> to remove criminal penalties for possession of small amounts of some illicit drugs in the Australian Capital Territory.</p>
<p>This might seem like a radical step to some, but researchers and health professionals have been <a href="http://www.globalcommissionondrugs.org/wp-content/uploads/2016/11/GCDP-Report-2016-ENGLISH.pdf">calling for this reform for some time</a>.</p>
<p>Most Australians support decriminalisation and a <a href="https://theconversation.com/more-australians-back-legalising-cannabis-and-57-support-pill-testing-national-survey-shows-142720">less punitive</a> approach to drug use.</p>
<p>The bill is currently before a <a href="https://www.parliament.act.gov.au/parliamentary-business/in-committees/committees/select-committee-on-the-drugs-of-dependence-personal-use-amendment-bill-2021/inquiry-into-the-drugs-of-dependence-personal-use-amendment-bill-2021">parliamentary committee</a> that will look at the evidence and submissions from professionals, people who use drugs and the general public, and will report back in October this year.</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1338350568130088962"}"></div></p>
<h2>How will decriminalisation work?</h2>
<p>Drug decriminalisation is not the same as legalisation. Decriminalisation means it’s still illegal, but you may get a fine, rather than a criminal charge. In this case, the proposal is for decriminalisation of use and possession only. Manufacturing and selling will still be a criminal offence.</p>
<p>Possession of cannabis has already been decriminalised in the ACT since 1992. Pettersson also introduced a bill that <a href="https://theconversation.com/home-grown-cannabis-to-be-legal-in-the-act-now-what-124268">came into effect in 2020</a>, which went one step further. It allowed adult residents in the ACT to legally grow and possess small amounts of cannabis for personal use.</p>
<p>Possession of cannabis has also been decriminalised in South Australia and the Northern Territory for nearly 30 years.</p>
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<em>
<strong>
Read more:
<a href="https://theconversation.com/more-australians-back-legalising-cannabis-and-57-support-pill-testing-national-survey-shows-142720">More Australians back legalising cannabis and 57% support pill testing, national survey shows</a>
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<p>If the new legislation passes, possession of small amounts of a limited number of illicit drugs will no longer be a criminal offence. They will be decriminalised, like cannabis was between 1992 and 2020 in the ACT.</p>
<p>If someone is found in possession of illicit drugs, and the amount is under the “personal possession limit”, they risk a civil fine of 1 penalty unit ($160). The <a href="http://www6.austlii.edu.au/cgi-bin/viewdoc/au/legis/act/consol_act/doda1989169/s169.html">current criminal penalty</a> is a maximum fine of 50 penalty units ($8,000) or two years of imprisonment or both.</p>
<p>This means people who use drugs can avoid a criminal record if they pay the civil penalty within prescribed time period — a little like a speeding fine.</p>
<p>The proposed personal limit for possession is 0.5 grams of MDMA, 0.002 grams of LSD, and two grams of cocaine, amphetamines, psylocibin and heroin. These are much lower levels than the current definitions of “personal use” in the ACT.</p>
<h2>Why decriminalise drugs?</h2>
<p>Australia’s <a href="https://www.health.gov.au/resources/publications/national-drug-strategy-2017-2026">official national drug policy</a> includes reducing harms from legal and illegal drugs. Efforts to reduce harms from illicit drugs are severely hindered because possession and use is a criminal offence.</p>
<p>The legal status of some drugs has more to do with <a href="https://theconversation.com/history-not-harm-dictates-why-some-drugs-are-legal-and-others-arent-110564">history</a> than risk of harm. In fact, some of the major harms from using illicit drugs are because they are illegal.</p>
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<em>
<strong>
Read more:
<a href="https://theconversation.com/history-not-harm-dictates-why-some-drugs-are-legal-and-others-arent-110564">History, not harm, dictates why some drugs are legal and others aren't</a>
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<p>One of the biggest harms from illicit drug use is having a criminal record for possessing small amounts of a drug for personal use. Most people who use illicit drugs do so very occasionally and only in small amounts, and are <a href="https://theconversation.com/health-check-what-makes-it-so-hard-to-quit-drugs-69896">not dependent nor do they need treatment</a>. A criminal record can have a long-lasting negative impact on a person’s future, including on their career and their ability to travel.</p>
<p>Making them a criminal offence also means there is a lot of stigma attached to using these drugs. We know stigma makes it harder for people to seek help when they need it.</p>
<p>There are <a href="https://ndarc.med.unsw.edu.au/blog/australias-recreational-drug-policies-arent-working-so-what-are-options-reform">no clear benefits</a> from criminalisation of illicit drugs. In the justice system, a large amount of time and money is spent on addressing drug-related offences. Former Australian Federal Police Commissioner Mick Palmer has <a href="https://www.smh.com.au/politics/federal/after-33-years-i-can-no-longer-ignore-the-evidence-on-drugs-20120606-1zwpr.html">noted</a>: “drug law enforcement has had little impact on the Australian drug market”. There’s <a href="https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1745-9125.2002.tb00959.x">no evidence</a> criminalisation has reduced use of illicit drugs.</p>
<p>Decriminalisation significantly reduces the involvement of the justice system and allows existing resources to be better used to support treatment for people who need it, or to focus justice system efforts elsewhere.</p>
<p>Evaluation of drug decriminalisation in other countries, <a href="https://academic.oup.com/bjc/article-abstract/50/6/999/404023?redirectedFrom=fulltext">such as Portugal</a>, has found it increases the number of people accessing alcohol and drug treatment and does not result in increased drug use.</p>
<p>In the Northern Territory, South Australia and ACT, cannabis use did not increase when decriminalisation was introduced 30 years ago. <a href="https://www.aihw.gov.au/reports/illicit-use-of-drugs/national-drug-strategy-household-survey-2019/contents/summary">Rates of use</a> are no higher than other states. This suggests there are more benefits than risks to decriminalisation.</p>
<p>Recently, the state of Oregon in the United States decriminalised all drugs for personal use following <a href="https://theconversation.com/oregon-just-decriminalized-all-drugs-heres-why-voters-passed-this-groundbreaking-reform-150806">a vote</a> by residents.</p>
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<em>
<strong>
Read more:
<a href="https://theconversation.com/oregon-just-decriminalized-all-drugs-heres-why-voters-passed-this-groundbreaking-reform-150806">Oregon just decriminalized all drugs – here's why voters passed this groundbreaking reform</a>
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<p>More and more jurisdictions are moving towards this approach. Decriminalisation of illicit drugs is the natural conclusion to decades of research on drug-related harms.</p><img src="https://counter.theconversation.com/content/157709/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Nicole Lee works as a consultant in the alcohol and other drug sector and a psychologist in private practice. She has previously been awarded funding by Australian and state governments, NHMRC and other bodies for evaluation and research into drug prevention and treatment. She currently holds grants and tenders from the Australian Government, and several state and territory governments. She is a member of the Australian Government's Australian National Advisory Council on Alcohol and other Drugs, a member of the board of directors of Hello Sunday Morning and volunteers with The Loop Australia.</span></em></p><p class="fine-print"><em><span>Jarryd Bartle is a consultant to the alcohol and other drug sector</span></em></p>Decriminalisation of illicit drugs is the natural conclusion to decades of research on drug-related harms.Nicole Lee, Professor at the National Drug Research Institute (Melbourne), Curtin UniversityJarryd Bartle, Sessional Lecturer, RMIT UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1466372020-10-02T10:27:02Z2020-10-02T10:27:02ZMisinformation about illicit drugs is spreading on social media – and the consequences could be dangerous<figure><img src="https://images.theconversation.com/files/361345/original/file-20201002-14-1733wvb.jpg?ixlib=rb-1.1.0&rect=33%2C11%2C7315%2C4891&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">For man, social media is the only place they get their news.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/closely-image-woman-making-online-purchase-427841167">GaudiLab/ Shutterstock</a></span></figcaption></figure><p>We’re all familiar with the term “<a href="https://theconversation.com/fake-news-why-people-believe-it-and-what-can-be-done-to-counter-it-70013">fake news</a>” and have probably witnessed the speed at which these stories can circulate on social media. Fake news stories can be about almost any topic, but increasingly misinformation about illicit drugs is becoming common. But the consequences of such false information can be dangerous – even deadly. </p>
<p>There tends to be a high level of interest about drug use myths on social media, driven in part by curiosity, but also fear of the unknown as some <a href="https://www.independent.co.uk/news/long_reads/drug-panics-overdose-spice-monkey-dust-krokodil-mental-health-a8541036.html">new and bizarre threat is reported</a> – but often without any evidence to back up the hysteria. Some of this interest will be amplified by algorithms used by social media platforms, which <a href="https://www.theverge.com/2018/12/4/18124718/google-search-results-personalized-unique-duckduckgo-filter-bubble">tailor content</a> based on user search history. </p>
<p>However, this misinformation is also further spread by mainstream media news outlets that pick up on the popularity and <a href="https://www.independent.co.uk/news/uk/home-news/krokodil-purple-drank-world-s-10-most-deadly-street-drugs-a6719541.html?utm_content=Echobox&utm_medium=Social&utm_source=Twitter#Echobox=1600876508">publish stories</a> repeating the false information. Misinformation on social media is also easy to access, engaging, and may be shared by friends and family, making it appear more trustworthy. And, for many people, <a href="https://www.ofcom.org.uk/about-ofcom/latest/features-and-news/half-of-people-get-news-from-social-media">social media</a> is the only place they get their news. </p>
<p>Dangerous synthetic drugs are common subjects of misleading “fake” news spread on social media. Given their potential dangers, it’s understandable that many people are concerned. This misinformation could be harmful, especially to those who may take the drug. </p>
<p>One such example is the <a href="https://www.drugabuse.gov/drug-topics/trends-statistics/overdose-death-rates">deadly drug fentanyl</a>, an opiate that can be anywhere between <a href="https://www.drugabuse.gov/publications/drugfacts/fentanyl">50 to 100 times stronger</a> than morphine. A myth that you can overdose even by <a href="https://www.youtube.com/watch?reload=9&v=61bvi22uOrA">touching a small amount of this drug</a> spread on social media – and was even perpetuated by the United States Drug Enforcement Administration, which claimed that <a href="https://www.dea.gov/press-releases/2016/06/10/dea-warning-police-and-public-fentanyl-exposure-kills">touching or inhaling</a> airborne fentanyl could be deadly. As this warning was issued by a government department, many people took this misinformation seriously. It spread quickly and widely on social media even after the medical community <a href="https://link.springer.com/article/10.1007/s13181-020-00762-y">agreed</a> that overdose due to fentanyl skin contact is impossible.</p>
<p>Researchers tracked the <a href="https://www.sciencedirect.com/science/article/pii/S0955395920302851?dgcid=coauthor">spread of information</a> about fentanyl between 2015 and 2019 by using a media analysis tool which was able to track the number of fake news articles created on and spread by social media, and could also track the number of potential views by looking at article shares. They found that erroneous information had a reach 15 times greater than correct information. Some of this included the myth about how touching the drug could be toxic. Most of this misinformation about fentanyl originated from Facebook posts created in Texas and Pennsylvania, and potentially reached 67 million people. </p>
<figure class="align-center ">
<img alt="Social media icons on smartphone." src="https://images.theconversation.com/files/361348/original/file-20201002-19-1thvlqt.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/361348/original/file-20201002-19-1thvlqt.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/361348/original/file-20201002-19-1thvlqt.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/361348/original/file-20201002-19-1thvlqt.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/361348/original/file-20201002-19-1thvlqt.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/361348/original/file-20201002-19-1thvlqt.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/361348/original/file-20201002-19-1thvlqt.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">Misinformation about fentanyl was spread mainly on Facebook.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/corby-united-kingdom-january-27-2019-1296085084">Erhan Inga/ Shutterstock</a></span>
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<p>While fentanyl use might not be common, this sort of misinformation could have dangerous consequences. For example, a person might not help someone who has overdosed if they believe any physical contract with them – even to administer chest compressions – could cause them harm, too. </p>
<p>Other synthetic drugs, including <a href="https://www.scielo.br/scielo.php?script=sci_arttext&pid=S0104-12902020000200301&lng=en&nrm=iso&tlng=en">Krokodyl</a> and “spice” (a type of synthetic cannabis) have also triggered widespread misinformation. Krokodyl has been <a href="https://medicalxpress.com/news/2019-06-krokodil-russian-flesh-eating-drug-rare.html">portrayed</a> on social media as a chemical which can eat your flesh, even after only one use. Spice, on the other hand, has <a href="https://www.washingtonpost.com/news/morning-mix/wp/2015/06/16/the-new-drug-that-causes-users-to-rip-off-their-clothes-and-attack-with-super-human-strength/">been described</a> in the media as a drug that causes users to rip off their clothes as if it’s given them “superhuman” strength. </p>
<p>While it’s unlikely someone would take a drug knowing it causes severe damage, the idea of using something to gain extraordinary physical strength might entice potential users. In both instances, this information was wrong, but that didn’t stop them from <a href="https://www.forbes.com/sites/jacobsullum/2014/01/10/krokodil-crock-how-rumors-of-a-flesh-eating-zombie-drug-swept-the-nation/#6d42a7017127">going viral</a> on social media.</p>
<p>It is often the young or naive that are victims of misinformation about some new drug or using a drug to achieve an effect. This is illustrated in a recent case when information about the <a href="https://www.fda.gov/drugs/drug-safety-and-availability/fda-warns-about-serious-problems-high-doses-allergy-medicine-diphenhydramine-benadryl">antihistamine Benadryl</a> was circulated on social media. Users reported that consuming this drug caused hallucinations and would challenge each other to take the drug, sadly at least <a href="https://www.salon.com/2020/09/30/benadryl-challenge-claims-the-life-of-one-teen-as-tiktok-claims-to-have-already-banned-the-videos/">one person died</a> as a result.</p>
<p>Beyond these extreme examples, it’s also becoming routine to see misinformation on social media about drugs such as cannabis. In particular, claims being made about <a href="https://news.usc.edu/164317/cannabis-health-social-media-bots-fake-claims/">cannabis-based medicinal products</a>, which suggest that everything from pain to terminal cancer can be cured. These are made despite the lack of research and evidence that support these assertions. Tragically this type of <a href="https://www.pharmout.net/fda-crackdowns-false-claims-cannabis-cbd-medicine-advertisements/">misinformation</a> offers false hope to people who are often at a very vulnerable point in their life. These false claims are harmful in themselves, but could be really damaging if people choose to stop traditional medical intervention and use these products in the belief that their health will improve.</p>
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Read more:
<a href="https://theconversation.com/how-to-spot-fake-news-an-experts-guide-for-young-people-88887">How to spot fake news – an expert's guide for young people</a>
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<p>Misinformation about illicit drugs may also make them sound <a href="https://www.tandfonline.com/doi/full/10.3109/09687637.2016.1149148?casa_token=y5PyrnQ69GAAAAAA%3A26eZqU53akkE6sqehlEObdLmNltBtXOMPVFYKqA_MIrU6shFcsCfs5HhkTdIDvOMP1CLjqGZ3afxczc">more appealing</a> to people who aren’t risk adverse. For them the appeal is in the risk that the drug poses. Widely circulated fake news may even be the reason they try these types of drugs to begin with.</p>
<p>Finding ways of reducing this type of misinformation is important to prevent any dangerous consequences. Social media platforms have an important role to play in regulating information – should they choose to. Educating people in how to spot fake news, and <a href="https://www.pshe-association.org.uk/curriculum-and-resources/resources/drug-and-alcohol-education-%E2%80%94-lesson-plans">better education</a> for young people in schools about drugs may also prevent the further spread of such harmful misinformation. </p>
<p>We need to accept that there will always be interest in drugs and that false information about them will accompany that curiosity. Social media platforms have the ability to mitigate misinformation, but they may not have the will if an action threatens their commercial interests. So young people and their families are left to separate fact from fiction as they try to reduce the potential risks some drugs pose.</p><img src="https://counter.theconversation.com/content/146637/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Patricia Cavazos-Rehg receives funding from National Institutes of Health and the Substance Abuse and Mental Health Services Administration</span></em></p><p class="fine-print"><em><span>Ian Hamilton does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Social media makes it easy to spread ‘fake news’.Ian Hamilton, Associate Professor of Addiction., University of YorkPatricia Cavazos-Rehg, Professor of Psychiatry, Washington University in St LouisLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1438742020-08-10T12:23:50Z2020-08-10T12:23:50ZRise in fake benzodiazepines in the UK may put people at risk of serious harm<figure><img src="https://images.theconversation.com/files/351977/original/file-20200810-24-1hdnlq9.jpg?ixlib=rb-1.1.0&rect=18%2C0%2C4007%2C3024&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Fake benzodiazepines (including diazepam and alprazolam – better known as Xanax) could cause serious harm.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/january-26-2020ogden-utah-usa-alprazolam-1650256819">PureRadiancePhoto/ Shutterstock</a></span></figcaption></figure><p>Counterfeit, or “fake”, <a href="https://www.statnews.com/2019/05/07/stopping-murder-counterfeit-medicine/">medicines</a> are a <a href="https://www.theguardian.com/science/2019/mar/11/fake-drugs-kill-more-than-250000-children-a-year-doctors-warn">growing problem</a> worldwide, from antimicrobials to cancer treatments. <a href="https://www.who.int/news-room/fact-sheets/detail/substandard-and-falsified-medical-products">They are</a> are designed to look exactly like the real thing, but typically contain the wrong type or amount of active ingredient, which may cause serious harm, illness or premature death.</p>
<p>In the UK, there’s been a <a href="https://publichealthmatters.blog.gov.uk/2018/07/30/alprazolam-xanax-what-are-the-facts/">concerning rise</a> in the use of counterfeit benzodiazepines, among young people and those are already dependent on drugs. Public Health England has even issued a <a href="https://www.cas.mhra.gov.uk/ViewandAcknowledgment/ViewAlert.aspx?AlertID=103075">rare warning</a> about drugs sold as <a href="https://www.drugwise.org.uk/benzodiazepines/">benzodiazepines</a>, including diazepam, temazepam, and alprazolam (better known as <a href="https://theconversation.com/xanax-how-does-it-work-and-what-are-the-side-effects-94594">Xanax</a>).</p>
<p>Benzodiazapines are prescribed around the world for anxiety, depression and even epilepsy. However, Xanax can only be obtained illicitly in the UK as doctors are unable to prescribe it. Drugs like these are also used by young people <a href="https://www.vice.com/en_uk/article/ne4mvb/how-british-teens-got-hooked-on-xanax">recreationally</a>.</p>
<p>Fake benzodiazapines can produce a similar effect to the real thing. However, incorrect dosages may cause drowsiness, which could potentially lead to unconsciousness. Many people may also see these drugs as being low risk, or may rely on their friends – rather than medical opinion – on how many pills they should take. Unfortunately many fake benzodiazepines aren’t safe – and the strength of the dosage often isn’t known until it’s too late.</p>
<p>Toxicological and chemical analysis has shown that some of these counterfeit medicines <a href="https://www.cas.mhra.gov.uk/ViewandAcknowledgment/ViewAlert.aspx?AlertID=103075">contain dangerously high</a> doses of benzodiazapines, or even novel substances such as flubromazolam, flualprazolam and etizolam. These chemicals are related to benzodiazapines in that they cause a similar effect but can present a greater risk of toxicity due to their side-effect profile. </p>
<p>The main risks from taking these drugs is overdose, either because the user doesn’t realise how strong they are or they combine them with alcohol. Like benzodiazapines, alcohol is a <a href="https://www.tandfonline.com/doi/abs/10.1081/CLT-120002887">respiratory depressant</a>. Using them together increases the chances of breathing difficulties or even death.</p>
<p>Deaths following exposure to these drugs have been rising in recent years among all age groups. In <a href="https://www.gov.uk/government/publications/novel-benzodiazepines-prevalence-and-harms-in-the-uk">Scotland</a>, novel substances were responsible for 85% of the 792 deaths from benzodiazepines in 2018. Analysis has also shown that drugs bought as <a href="https://bnf.nice.org.uk/drug/diazepam.html">diazepam</a>, and packaged to look like legitimate medicines, contained completely unrelated substances. One sample even contained the anaesthetic drug <a href="https://theconversation.com/ketamine-the-illicit-party-psychedelic-that-promises-to-heal-depression-115697">ketamine</a>. </p>
<figure class="align-center ">
<img alt="A Xanax box and tablets." src="https://images.theconversation.com/files/351978/original/file-20200810-22-1tbm1hi.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/351978/original/file-20200810-22-1tbm1hi.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/351978/original/file-20200810-22-1tbm1hi.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/351978/original/file-20200810-22-1tbm1hi.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/351978/original/file-20200810-22-1tbm1hi.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/351978/original/file-20200810-22-1tbm1hi.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/351978/original/file-20200810-22-1tbm1hi.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">Fake versions are packaged and sold as the real thing.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/genevaswitzerland-0303-xanax-pills-anxiolytic-antidepressant-1415011127">LMWH/ Shutterstock</a></span>
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<p>Benzodiazapines used to simply be stolen from pharmacies and <a href="https://www.bbc.co.uk/news/uk-northern-ireland-40658649">pharmaceutical manufacturers</a> and sold on the streets or purchased from bogus online pharmacies. But there’s now a <a href="https://www.emcdda.europa.eu/publications/joint-publications/eu-drug-markets-report-2019_en">sophisticated international market</a> in these illicitly synthesised alternatives, many of which can easily be <a href="https://www.bbc.co.uk/news/resources/idt-sh/fake_xanax_the_uks_largest_ever_dark_net_drugs_bust">purchased in bulk</a> from the internet, and distributed via local drug markets. </p>
<p>People also obtain these types of drugs from <a href="https://theconversation.com/instadrugs-new-research-reveals-hidden-dangers-when-young-people-use-apps-to-buy-illicit-substances-110319">social media apps</a> or the dark web. People may believe they’re buying a licensed medicine online, while unwittingly consuming a significantly higher dose or a harmful substitute. There’s no quality control in illicit drug manufacturing. </p>
<p>It’s currently unknown how many people have required hospitalisation or died as a result of these fake medicines. However Public Health England doesn’t typically issue <a href="https://www.gov.uk/government/publications/issuing-public-health-alerts-about-drugs">drug alerts</a> unless cases have been rising, or particularly harmful substances have been detected. </p>
<h2>Illicit use</h2>
<p>Many people may find these drugs appealing as they’re easy to access and cheap. Typically, tablets <a href="https://www.bbc.co.uk/news/resources/idt-sh/fake_xanax_the_uks_largest_ever_dark_net_drugs_bust">won’t cost</a> more than a couple of pounds and are easy to access online. People may also believe these fake medicines are safer than other types of illicit drugs, as they may think they’ve been through quality control. And given that taking medicine <a href="https://www.sciencedirect.com/science/article/pii/S0277953616303938?casa_token=-9FLpiawTj4AAAAA:3tYJIMoVjRIs70eqmib61RHpsK4jTPEK1HjlAw1cxR3OJfCZQrKZ7dOQmbS2bRguMQ5imhd2PYYj">is so normalised</a> in our society, this can create a perception of low risk and even benefit. </p>
<p>Perhaps of more concern is that these <a href="https://www.vice.com/en_uk/article/ne4mvb/how-british-teens-got-hooked-on-xanax">fake medicines appeal</a> to those who experience mental health problems <a href="https://journals.lww.com/co-psychiatry/fulltext/2009/01000/Current_use_of_benzodiazepines_in_anxiety.16.aspx?casa_token=qgaXylV0utMAAAAA:xSTnvszeVY8Elu7EUBqqkoRA1I6levJ6l2aN_URLsQ7FA2BMxWGJEXBqnqQ0suNBcy8tYLFUXMczzWnEPApY83ppcsmS1yo">like anxiety</a>. Despite efforts to <a href="https://www.time-to-change.org.uk/category/blog/talking-about-mental-health">reduce the stigma</a> of mental illness, some people will be too ashamed or anxious to seek help, and may self-medicate using these illicit medicines.</p>
<p>These drugs are also more readily accessible than the professional support that these people need. There are no long <a href="https://epi.org.uk/publications-and-research/access-to-child-and-adolescent-mental-health-services-in-2019/">waiting times</a> or invasive assessments with professionals that need to be navigated before treatment is even offered. Users know they can source a temporary quick-fix solution to the way they feel in a matter of hours – while they may wait eight weeks on average for a specialist appointment in the UK, if <a href="https://epi.org.uk/wp-content/uploads/2020/01/Access-to-CAMHS-in-2019_EPI.pdf">they’re referred</a> at all.</p>
<p>Despite promises by the NHS <a href="https://www.kingsfund.org.uk/blog/2019/10/mental-health-staff-shortage">to prioritise</a> mental health treatment and reduce waiting times, access to these services is still challenging. Rates of mental illness have been <a href="https://theconversation.com/the-uk-doesnt-spend-enough-on-the-mental-health-of-young-people-we-found-out-why-124315">rising</a>, but it’s still no easier to get treatment. It’s unsurprising that some young people are trying to find their own solutions.</p>
<p>The rise of illicit or fake benzodiazepines shows this is a growing problem in the UK. Without important changes to the UK’s mental health services, many people could continue to be harmed by fake medicines.</p>
<p><em>If you need someone to talk to or need specialist support for substance use, please visit <a href="https://youngminds.org.uk/">Young Minds</a>, <a href="https://www.talktofrank.com/get-help/find-support-near-you">Talk to Frank</a>, or <a href="https://www.crew.scot/drug/xanax-alprazolam/">Crew 2000</a>.</em></p><img src="https://counter.theconversation.com/content/143874/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Harry Sumnall receives and has received funding from public grant awarding bodies for alcohol and other drugs research.</span></em></p><p class="fine-print"><em><span>Ian Hamilton does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Young people may be at particular risk.Ian Hamilton, Associate Professor, Addiction and Mental Health, University of YorkHarry Sumnall, Professor in Substance Use, Liverpool John Moores UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1421522020-08-04T12:17:50Z2020-08-04T12:17:50ZMarijuana fueled Colombian drug trade before cocaine was king<figure><img src="https://images.theconversation.com/files/350268/original/file-20200729-19-qmd65z.jpg?ixlib=rb-1.1.0&rect=0%2C8%2C5403%2C3580&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">A marijuana trafficker practicing his aim in the Guajira, epicenter of Colombia's first drug boom, in 1979.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/colombia-marijuana-dealer-practising-shooting-his-gun-on-news-photo/96345506?adppopup=true">Romano Cagnoni/Getty Images</a></span></figcaption></figure><p><em>The <a href="https://theconversation.com/us/topics/research-brief-83231">Research Brief</a> is a short take about interesting academic work.</em></p>
<h2>The big idea</h2>
<p>Long before Pablo Escobar’s Medellín cartel got rich supplying Americans with cocaine in the 1980s, Colombia was already the United States’ main source of illicit drugs – specifically, marijuana. That’s the takeaway of my new book “<a href="https://www.ucpress.edu/book/9780520325470/marijuana-boom">Marijuana Boom</a>.” </p>
<p>This debunks the popular notion of Escobar as the <a href="https://theconversation.com/pablo-escobar-and-the-legacy-of-drug-warfare-in-latin-america-21061">pioneer of Colombian drug trafficking</a>. Rather, it was some of Colombia’s <a href="https://colombiareports.com/la-guajira/">most marginalized people</a> who changed the course of their nation.</p>
<p>Back in the 1970s, peasant farmers from the Sierra Nevada de Santa Marta – a remote and mountainous region of Colombia’s Caribbean coast – began shifting from banana, cotton and coffee production to marijuana cultivation. When this population again pivoted to growing <a href="http://oaji.net/articles/2020/2336-1580845587.pdf">coca leaf for processing into cocaine</a> in the 1980s, they set Colombia on a course to become the <a href="https://www.businessinsider.com/colombia-top-cocaine-producing-countries-record-production-2017-3">illicit drug capital of the Americas</a>. </p>
<h2>Why it matters</h2>
<p>This research upends other old tropes about the drug trade, including the idea that it’s <a href="https://www.washingtonexaminer.com/drug-dealing-is-a-violent-crime">inherently violent</a>. </p>
<p>Colombia’s marijuana economy operated relatively peacefully until the Colombian and U.S. governments in 1978 launched <a href="https://www.scholars.northwestern.edu/en/publications/a-traffickers-paradise-the-war-on-drugs-and-the-new-cold-war-in-c">a militarized campaign to eradicate marijuana crops and increase drug interdictions</a>. Traffickers retaliated, giving rise to the now familiar “war on drugs”-style dynamic of escalating conflict. </p>
<p>My research also disproves the <a href="https://franciscothoumi.com/wp-content/uploads/2016/10/Drogas-Ilegales-Econom%C3%ADa-y-Sociedad-en-Los-Andes.-Francisco-E.-Thoumi-2002.pdf">long-held academic consensus</a> that illegal drug markets emerge in remote areas where the state has insufficient presence. </p>
<p>I find Colombia’s marijuana boom was actually an unintended consequence of state-led efforts to economically develop Colombia. Throughout the 20th century, Colombia worked to build its <a href="https://nyupress.org/9780814799345/bananas-and-business/">banana export sector</a>, create <a href="https://archive.org/details/cottonindustryof113port/page/n5/mode/2up">a cotton belt</a> to supply Colombian textile factories and to <a href="https://www.cambridge.org/core/books/agrarian-question-and-the-peasant-movement-in-colombia/410CEB610724F8514ED2B1928689A125">redistribute land</a>. By the 1970s, Colombia was expanding international trade, particularly with the U.S.</p>
<p>These changes made some rural Colombians rich but, my research shows, impoverished peasant farmers in the Sierra Nevada de Santa Marta. People who’d grown legal commodity crops saw opportunity in exporting an illegal one to the United States: marijuana.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/350275/original/file-20200729-27-mm04gx.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Two armed officers search three men with their hands up" src="https://images.theconversation.com/files/350275/original/file-20200729-27-mm04gx.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/350275/original/file-20200729-27-mm04gx.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=411&fit=crop&dpr=1 600w, https://images.theconversation.com/files/350275/original/file-20200729-27-mm04gx.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=411&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/350275/original/file-20200729-27-mm04gx.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=411&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/350275/original/file-20200729-27-mm04gx.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=517&fit=crop&dpr=1 754w, https://images.theconversation.com/files/350275/original/file-20200729-27-mm04gx.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=517&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/350275/original/file-20200729-27-mm04gx.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=517&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Police search suspected marijuana growers in the Guajira, Colombia, 1980.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/armed-police-searching-suspected-marijuana-growers-near-news-photo/3271093?adppopup=true">Timothy Ross/Hulton Archive/Getty Images</a></span>
</figcaption>
</figure>
<h2>What still isn’t known</h2>
<p>My book recounts how and why people in northern Colombia used their farming experience to grow and export marijuana. But it doesn’t detail their next transition, from <a href="https://verdadabierta.com/los-anos-de-hernan-giraldo-en-la-sierra-nevada-de-santa-marta/">marijuana to cocaine</a>. </p>
<p>In southern Colombia, academics have documented how Pablo Escobar’s generation of traffickers <a href="https://www.dukeupress.edu/between-the-guerrillas-and-the-state">financed new settlers to grow coca leaf</a>, the base ingredient in cocaine, in the 1980s. We just don’t know how cocaine simultaneously supplanted marijuana as the staple drug crop of the peasant economy up north. </p>
<h2>How I do my work</h2>
<p>This began as a personal quest to understand the country of my childhood. My father is from the Sierra Nevada de Santa Marta area, where marijuana once boomed. </p>
<p>Some of my research was archival, conducted in Colombia and the U.S. But much of it was done on the ground. I began collecting testimonials in northern Colombia in the early 2000s, during Colombia’s <a href="https://theconversation.com/search/result?sg=5ff52dde-56c1-4bd3-94a9-5a94fe3f99e9&sp=1&sr=1&url=%2Fwhy-only-now-after-51-years-war-is-ending-in-colombia-48563">52-year armed conflict</a>. Paramilitary forces controlled the area. The war ended in 2016. But armed groups, including cartels, still operate there.</p>
<p>[<em>Deep knowledge, daily.</em> <a href="https://theconversation.com/us/newsletters/the-daily-3?utm_source=TCUS&utm_medium=inline-link&utm_campaign=newsletter-text&utm_content=deepknowledge">Sign up for The Conversation’s newsletter</a>.]</p>
<p>To stay safe while studying an industry that uses cash and violence to keep its affairs clandestine, I relied on friends and family, who helped me establish contacts and identify information sources. I also kept my questions focused on the defunct marijuana business – not the active cocaine trade. </p>
<p>This focus helped me avoid reproducing what historian Luis Astorga calls “<a href="https://openlibrary.org/books/OL896105M/Mitologi%CC%81a_del_narcotraficante_en_Me%CC%81xico">the mythology of the narcotrafficker</a>.” There are no Pablo Escobars in my book – just everyday Colombians who seized on their country’s growing commercial ties to <a href="https://www.rand.org/pubs/research_reports/RR3140.html">the world’s largest drug market</a> – the United States – to launch a global business.</p><img src="https://counter.theconversation.com/content/142152/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Lina Britto 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>Step aside, Pablo Escobar. New research shows it was poor farmers who helped turn Colombia into the world’s largest drug producer when they started growing and exporting pot in the 1970s.Lina Britto, Assistant Professor of History, Northwestern UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1376082020-05-04T19:50:43Z2020-05-04T19:50:43ZThe darknet – a wild west for fake coronavirus ‘cures’? The reality is more complicated (and regulated)<figure><img src="https://images.theconversation.com/files/332232/original/file-20200504-83730-e9qxp9.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C4345%2C2721&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Shutterstock</span></span></figcaption></figure><p>The coronavirus pandemic has spawned <a href="https://www.sbs.com.au/news/fake-coronavirus-vaccines-and-repurposed-drugs-are-being-sold-on-the-dark-web">reports</a> of unregulated health products and fake cures being sold on the dark web. These include <a href="https://www.france24.com/en/20200427-french-police-seize-14-000-face-masks-bound-for-black-market">black market PPE</a>, illicit medications such as the widely touted “<a href="https://www.theguardian.com/world/2020/apr/06/hydroxychloroquine-trump-coronavirus-drug">miracle</a>” drug <a href="https://decrypt.co/24802/dark-web-vendors-are-selling-face-masks-for-bitcoin">chloroquine</a>, and fake COVID-19 “cures” including blood supposedly from <a href="https://www.abc.net.au/news/2020-04-30/blood-recovered-coronavirus-patients-dark-web-passive-vaccine/12199324">recovered coronavirus patients</a>.</p>
<p>These dealings have once again focused public attention on this little-understood section of the internet. Nearly a decade since it started being used on a significant scale, the dark web continues to be a <a href="https://theconversation.com/dark-web-not-dark-alley-why-drug-sellers-see-the-internet-as-a-lucrative-safe-haven-132579">lucrative safe haven</a> for traders in a range of illegal goods and services, especially illicit drugs. </p>
<p>Black market trading on the dark web is carried out primarily through darknet marketplaces or <a href="https://journals.sagepub.com/doi/pdf/10.1177/1748895813505234?casa_token=yBIwwCagNiMAAAAA:9OWxEytBtLbudsRKv0nmTr6qLFmiEwBiqUfpvrgotiGrcN03RBb_V_mmSr_LLACrs_QDDvmufa2gMBo">cryptomarkets</a>. These are anonymised trading platforms that directly connect buyers and sellers of a range of illegal goods and services – similar to legitimate trading websites such as eBay. </p>
<p>So how do darknet marketplaces work? And how much illegal trading of COVID-19-related products is happening via these online spaces? </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/dark-web-not-dark-alley-why-drug-sellers-see-the-internet-as-a-lucrative-safe-haven-132579">Dark web, not dark alley: why drug sellers see the internet as a lucrative safe haven</a>
</strong>
</em>
</p>
<hr>
<h2>Not a free-for-all</h2>
<p>There are currently more than a <a href="https://darknetlive.com/markets/">dozen darknet marketplaces in operation</a>. Protected by powerful encryption technology, authorities around the world have largely <a href="https://idp.springer.com/authorize/casa?redirect_uri=https://link.springer.com/article/10.1007/s10611-016-9644-4&casa_token=HsGOAAiu-GMAAAAA:1GFH2-Imgd-Br1tEBfyenyQhTmxBSQcKf7TGHGrUaoRPp6GYU6TqL6gp8HjHG6W2iyflofpcLMWKBJnI08s">failed to contain their growth</a>. A steadily increasing proportion of illicit drug users around the world report sourcing their drugs online. In Australia, we have one of the world’s <a href="https://www.abc.net.au/news/2018-06-01/australian-concentration-of-dark-net-drug-dealers/9824954">highest concentrations</a> of darknet drug vendors per capita.</p>
<p>Contrary to popular belief, cryptomarkets are not the “lawless spaces” they’re often presented as in the news. Market prohibitions exist on all mainstream cryptomarkets. Universally prohibited goods and services include: hitman services, trafficked human organs and snuff movies. </p>
<p>Although cryptomarkets lie outside the realm of state regulation, each one is set up and maintained by a central administrator who, along with employees or associates, is responsible for the market’s security, dispute resolution between buyers and sellers, and the charging of commissions on transactions. </p>
<p>Administrators are also ultimately responsible for determining what can and can’t be sold on their cryptomarket. These <a href="https://www.emerald.com/insight/publication/doi/10.1108/9781838670306">decisions are likely informed by</a>:</p>
<ul>
<li>the attitudes of the surrounding community comprising buyers and sellers</li>
<li>the extent of consumer demand and supply for certain products</li>
<li>the revenues a site makes from commissions charged on transactions</li>
<li>and the perceived “heat” that may be attracted from law enforcement in the trading of particularly dangerous illegal goods and services. </li>
</ul>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/illuminating-the-dark-web-105542">Illuminating the 'dark web'</a>
</strong>
</em>
</p>
<hr>
<h2>Experts delve into the dark web</h2>
<p>A <a href="https://www.aic.gov.au/publications/sb/sb24">report</a> from the Australian National University published last week looks at several hundred coronavirus-related products for sale across a dozen cryptomarkets, including supposed vaccines and antidotes. </p>
<p>While the study confirms some unscrupulous dark web traders are indeed exploiting the pandemic and seeking to defraud naïve customers, this information should be contextualised with a couple of important caveats.</p>
<p>Firstly, the number of dodgy covid-related products for sale on the dark web is relatively small. According to this research, they account for about 0.2% of all listed items. The overwhelming majority of products were those we are already familiar with – particularly illicit drugs such as cannabis and MDMA. </p>
<p>Also, while the study focused on products listed for sale, these are most likely listings for products that either do no exist or are listed with the specific intention to defraud a customer.</p>
<p>Thus, the actual sale of fake coronavirus “cures” on the dark web is likely minimal, at best. </p>
<h2>A self-regulating entity</h2>
<p>By far the most commonly traded products on cryptomarkets are illicit drugs. Smaller sub-markets exist for other products such as stolen credit card information and fraudulent identity documents. </p>
<p>This isn’t to say extraordinarily dangerous and disturbing content, such as child exploitation material, can’t be found on the dark web. Rather, the sites that trade in such “products” are segregated from mainstream cryptomarkets, in much the same way convicted paedophiles are <a href="https://www.judcom.nsw.gov.au/sentencing-trends-21/">segregated from mainstream prison populations</a>.</p>
<p>Since the outbreak of the coronavirus, dark web journalist and author <a href="https://www.theguardian.com/books/australia-books-blog/2018/mar/22/the-darkest-web-exploring-the-ugly-world-of-illegal-online-marketplaces">Eileen Ormsby</a> reported some cryptomarkets have quickly imposed bans on vendors seeking to profit from the pandemic. For instance, the following was tweeted by one cryptomarket administrator:</p>
<blockquote>
<p>Any vendor caught flogging goods as a “cure” to coronavirus will not only be permanently removed from this market but should be avoided like the Spanish Flu. You are about to ingest drugs from a stranger on the internet –- under no circumstances should you trust any vendor that is using COVID-19 as a marketing tool to peddle tangible/already questionable goods. I highly doubt many of you would fall for that shit to begin with but you know, dishonest practice is never a good sign and a sure sign to stay away.</p>
</blockquote>
<p>So it seems, despite the activities of a few dodgy operators, the vast majority of dark web traders are steering clear of exploiting the pandemic for their own profit. Instead, they are sticking to trading in products they can genuinely supply, such as illicit drugs. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/what-is-the-dark-web-and-how-does-it-work-63613">What is the dark web and how does it work?</a>
</strong>
</em>
</p>
<hr>
<img src="https://counter.theconversation.com/content/137608/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>James Martin receives funding from the Australian Institute of Criminology and the National Health and Medical Research Council. </span></em></p>These online spaces are more regulated than many media reports would have you believe. And the vast majority of dark web traders are steering clear of exploiting the pandemic.James Martin, Associate Professor in Criminology, Swinburne University of TechnologyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1355562020-04-15T08:34:21Z2020-04-15T08:34:21ZDrug use may increase the risk of coronavirus. Here’s how to reduce the harms<figure><img src="https://images.theconversation.com/files/327922/original/file-20200415-153313-1nu37qb.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C1000%2C667&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/he-handrolled-marijuana-closeup-552107188">Shutterstock</a></span></figcaption></figure><p>People who use illicit drugs, whether they are dependent or use them occasionally, are potentially at increased risk of harm during the coronavirus pandemic.</p>
<p>The coronavirus is too new to know the exact interaction with illicit drugs. There has been no peer reviewed research yet, and we don’t know how many people who have contracted the virus also use drugs.</p>
<p>However, we can estimate some of the possible impacts from what we know generally about drugs, their effects on the body, and how people use them, including in times of increased stress.</p>
<p>Regardless of your views on illicit drugs, reducing the harms from drug use during the pandemic will improve the well-being of people who use them, and those close to them. Reducing harms will also help avoid additional pressure on the health system.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/coronavirus-how-long-does-it-take-to-get-sick-how-infectious-is-it-will-you-always-have-a-fever-covid-19-basics-explained-132963">Coronavirus: how long does it take to get sick? How infectious is it? Will you always have a fever? COVID-19 basics explained</a>
</strong>
</em>
</p>
<hr>
<h2>Who are we talking about?</h2>
<p>Around 2.5 million Australians (or 12.6% of people aged 14 or over) <a href="https://www.aihw.gov.au/reports/illicit-use-of-drugs/2016-ndshs-detailed/contents/table-of-contents">said they used an illicit drug</a> in the previous 12 months. Cannabis was by far the most common, followed by cocaine and ecstasy.</p>
<p>Most use only a handful of times a year; around <a href="https://theconversation.com/health-check-what-makes-it-so-hard-to-quit-drugs-69896">10% are dependent</a>.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/three-charts-on-who-uses-illicit-drugs-in-australia-110169">Three Charts on who uses illicit drugs in Australia</a>
</strong>
</em>
</p>
<hr>
<h2>In stressful times, drug use tends to increase</h2>
<p>People are more likely to take <a href="https://www.aihw.gov.au/reports/illicit-use-of-drugs/2016-ndshs-detailed/contents/table-of-contents">illicit drugs</a> (and drink <a href="https://theconversation.com/coronavirus-its-tempting-to-drink-your-worries-away-but-there-are-healthier-ways-to-manage-stress-and-keep-your-drinking-in-check-134669">alcohol</a>) during times of stress. So it’s not surprising that, with isolation, boredom and financial worries, some people might increase their use of illicit drugs.</p>
<p>People who use drugs in response to stress are <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2696937/">more likely</a> to become dependent on them. For people who are already dependent, stress is related to <a href="https://www.ncbi.nlm.nih.gov/pubmed/17915078">relapse</a> to drug use after treatment.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/coronavirus-its-tempting-to-drink-your-worries-away-but-there-are-healthier-ways-to-manage-stress-and-keep-your-drinking-in-check-134669">Coronavirus: it's tempting to drink your worries away but there are healthier ways to manage stress and keep your drinking in check</a>
</strong>
</em>
</p>
<hr>
<p>Illicit drugs have also been linked with <a href="https://theconversation.com/alcohol-and-drug-use-exacerbate-family-violence-and-can-be-dealt-with-69986">domestic and family violence</a>. </p>
<p>It’s a complex relationship between the two, but illicit drugs may interact with current stress, unemployment and spending long periods together in lockdown to further <a href="https://theconversation.com/coronavirus-and-domestic-terrorism-how-to-stop-family-violence-under-lockdown-135056">increase the risk</a>.</p>
<h2>Why are people who use drugs at increased risk?</h2>
<p><strong>Immune system</strong></p>
<p>Illicit drugs, like alcohol, reduce immune function and increase <a href="https://academic.oup.com/femspd/article/47/3/330/506577">susceptibility to infections</a>. The more you use the <a href="https://academic.oup.com/femspd/article/47/3/330/506577">greater the impact</a> on your immune system.</p>
<p>So people who use drugs are more at risk of getting, and having complications from, COVID-19.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/what-does-it-mean-to-be-immunocompromised-and-why-does-this-increase-your-risk-of-coronavirus-135200">What does it mean to be immunocompromised? And why does this increase your risk of coronavirus?</a>
</strong>
</em>
</p>
<hr>
<p><strong>Lung problems</strong></p>
<p>Inhaling, vaping or smoking drugs (like <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5072387/">cannabis</a>, <a href="https://www.ncbi.nlm.nih.gov/pubmed/12234652">heroin</a> and <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6601696/">methamphetamine</a>) can directly cause lung damage. </p>
<p>Some drugs can also affect the lungs indirectly. For example, methamphetamine <a href="https://www.ahajournals.org/doi/10.1161/ATVBAHA.119.312461">reduces blood flow</a> to the lungs and heroin <a href="https://www.drugabuse.gov/publications/research-reports/heroin/what-are-medical-complications-chronic-heroin-use">depresses breathing</a>.</p>
<p>The coronavirus also <a href="https://theconversation.com/how-does-coronavirus-kill-130864">weakens the lungs</a> so people who use drugs may be more vulnerable to lung complications from COVID-19.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/how-does-coronavirus-kill-130864">How does coronavirus kill?</a>
</strong>
</em>
</p>
<hr>
<p>People who have a lung disease are also at more <a href="https://www.ncbi.nlm.nih.gov/pubmed/15296619">risk of overdose</a> from some illicit drugs, such as heroin.</p>
<p>So if you contract COVID-19 and your lungs are affected, if you then use illicit drugs you potentially increase the risk of drug-related complications, such as overdose.</p>
<p><strong>Chronic health problems</strong></p>
<p>People with long-term drug problems are at <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5373082/">greater risk</a> of chronic diseases, such as heart disease.</p>
<p>People with additional <a href="https://www.bmj.com/content/368/bmj.m1198">chronic health problems</a> are more likely to die from COVID-19.</p>
<p><strong>Risks from sharing drugs</strong></p>
<p>Some drugs are commonly shared. For example, a cannabis joint or bong is sometimes shared between a group of people. </p>
<p>As COVID-19 is <a href="https://www.health.nsw.gov.au/Infectious/alerts/Pages/coronavirus-faqs.aspx">spread from person to person</a> through small droplets from the nose or mouth, sharing drugs and equipment can increase the risk of contracting the virus.</p>
<h2>Changes in supply, production, price</h2>
<p>There are a number of possible impacts of coronavirus-related changes to <a href="https://theconversation.com/how-coronavirus-is-changing-the-market-for-illegal-drugs-134753">supply</a>, including changes to drug availability and price.</p>
<p>A near-total shutdown of our borders may <a href="https://theconversation.com/how-coronavirus-is-changing-the-market-for-illegal-drugs-134753">reduce</a> the availability of both <a href="https://www.acic.gov.au/sites/default/files/illicit_drug_data_report_2017-18.pdf?v=1564727746">imported drugs</a> and the chemical precursors needed to make them locally.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/327924/original/file-20200415-153298-bmlh2d.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/327924/original/file-20200415-153298-bmlh2d.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/327924/original/file-20200415-153298-bmlh2d.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=384&fit=crop&dpr=1 600w, https://images.theconversation.com/files/327924/original/file-20200415-153298-bmlh2d.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=384&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/327924/original/file-20200415-153298-bmlh2d.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=384&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/327924/original/file-20200415-153298-bmlh2d.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=483&fit=crop&dpr=1 754w, https://images.theconversation.com/files/327924/original/file-20200415-153298-bmlh2d.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=483&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/327924/original/file-20200415-153298-bmlh2d.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=483&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">As flights are cancelled, illicit drugs and the chemicals to make them locally may be harder to import.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-illustration/close-international-airport-board-panel-all-90904352">Shutterstock</a></span>
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Read more:
<a href="https://theconversation.com/how-coronavirus-is-changing-the-market-for-illegal-drugs-134753">How coronavirus is changing the market for illegal drugs</a>
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<p>We might expect a reduction in supply to lead to an <a href="https://ndarc.med.unsw.edu.au/sites/default/files/ndarc/resources/Bulletin%206.pdf">increase in price</a>, which then tends to reduce demand. So, some people who use illicit drugs occasionally may decide to reduce or stop their use when it gets too expensive, or they may switch to more readily available drugs made locally.</p>
<h2>How to reduce your risk</h2>
<p>If you are able to, it is safest to stop using drugs during the current pandemic. If you continue to use drugs there are a number of things you can do to reduce your risk of harm.</p>
<ul>
<li><p><strong>Stay as healthy as possible</strong> Eat well, drink plenty of water and get regular exercise. If you don’t feel well for any reason, see a doctor. The healthier you are the less likely you will get and have complications from COVID-19.</p></li>
<li><p><strong>Wash your hands, packaging and equipment</strong> Wash your hands before and after handling drugs, <a href="https://theconversation.com/can-i-get-coronavirus-from-mail-or-package-deliveries-should-i-disinfect-my-phone-134535">the packaging</a> it came in, money or anything that has come from outside your home. Use warm water and soap, and wash for at least 20 seconds.</p></li>
<li><p><strong>Don’t share</strong> Don’t share joints, bongs, pipes or injecting equipment because you increase the risk of contracting COVID-19.</p></li>
<li><p><strong>Have someone check in on you</strong> It’s never advisable to use drugs alone. So during distancing and isolation, make sure you have someone to check in on you (remotely).</p></li>
<li><p><strong>Change route of administration</strong> If you normally inhale, smoke or vape your drugs, given the impact of coronavirus on lungs, consider an alternative way to use them if possible. Ingesting is safest.</p></li>
<li><p><strong>Withdrawal</strong> If you use illicit drugs regularly, reduced supply may mean you experience some withdrawal symptoms. Most people with mild dependence can safely withdraw at home, but if you have been using frequently (for example, daily) for several months or more, you may need supervised withdrawal. Talk to your GP or a drug treatment service who can advise whether home withdrawal is possible. If you or someone you are with begins to hallucinate, seems disoriented or loses consciousness while undergoing withdrawal, call triple zero immediately.</p></li>
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<p><em>If you’re worried about your own or someone else’s drug use, you can get help <a href="https://www.counsellingonline.org.au">online</a> or by phoning the National Alcohol and other Drug Hotline on 1800 250 015.</em></p>
<p><em>You may also be eligible to access one of the new temporary <a href="https://www.health.gov.au/resources/publications/covid-19-national-health-plan-primary-care-package-mbs-telehealth-services-and-increased-practice-incentive-payments">telehealth</a> services. Talk to your GP to find out more.</em></p><img src="https://counter.theconversation.com/content/135556/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Nicole Lee works as a consultant in the alcohol and other drug sector and a psychologist in private practice. She has previously been awarded funding by Australian and state governments, NHMRC and other bodies for evaluation and research into drug prevention and treatment. She is a member of board of directors of Hello Sunday Morning.</span></em></p><p class="fine-print"><em><span>Jarryd Bartle works as a consultant in the alcohol and other drug sector.</span></em></p>People who use illicit drugs are at increased risk during the coronavirus pandemic. But minimising that risk will improve their well-being and help avoid additional pressure on the health system.Nicole Lee, Professor at the National Drug Research Institute (Melbourne), Curtin UniversityJarryd Bartle, Sessional Lecturer, RMIT UniversityLicensed as Creative Commons – attribution, no derivatives.