Hard News by Russell Brown

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Hard News: Labour's medical cannabis bill and a new Drug Harm Index

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  • Rich of Observationz,

    eventually didn’t feel I could usefully respond to its requirement to score each drug

    And I don’t see how many people could do so, in an objective fashion.

    The only way you could do it would, as a specialist in the field, be to sit down and do a literature survey of mechanistic and epidemiological research and produce measurements of “harm” for each substance (along with an idea of the uncertainty in your estimate), rather as Cochrane do for medical drugs and interventions.

    Which would take some time and involve payment, I suspect.

    Otherwise, you’re just hunting for anecdata.

    Back in Wellington • Since Nov 2006 • 5550 posts Report Reply

  • Alfie,

    While ignoring alcohol and tobacco and lumping synthetic cannabinoids in with cannabis shows poor judgement in an academic study, I’m more than a little surprised by table six on page 21 which records 32 (presumably NZ) deaths per year from cannabinoids.

    Seriously? I’ve always understood that nobody has died from smoking cannabis. In the whole world. Ever. Do I have that horribly wrong, or has the author of the study played fast and loose here?

    Here’s the stats for all 2013 deaths in the US. The usual suspects like cardiovascular disease and motor vehicle accidents are well represented. But scroll down to the bottom of that table and you’ll see cannabis deaths total a nice, round zero.

    Norml’s figures reinforce this view.

    Around 50,000 people die each year from alcohol poisoning. Similarly, more than 400,000 deaths each year are attributed to tobacco smoking. By comparison, marijuana is nontoxic and cannot cause death by overdose.

    The HuffPost also concludes "…not a single person has ever died from a weed overdose."

    I understand that some people who die may have traces of cannabis in their system, but it is duplicitous to suggest that was the main cause of the death. Forgive me if I lack knowledge in this area, but the author’s approach seems rather disingenuous in this regard.

    Dunedin • Since May 2014 • 1435 posts Report Reply

  • Rich of Observationz,

    Depends on what you mean by "die". There are those (represented heavily in the nuclear industry) that consider that unless you're on the ground twitching within minutes of being exposed to their substance, then no foul.

    OTOH, it seems unlikely that inhaling any kind of smoke from burning organic material is going to do your lungs any good - possibly Norml feel that smoke particles from weed have been blessed by Ras Ta Whari and float in and out of ones lungs harmlessly, but the less poetically aligned might disagree.

    Not to say that weed should be illegal, but that people should have a realistic view of what it might do.

    Back in Wellington • Since Nov 2006 • 5550 posts Report Reply

  • Bart Janssen,

    I can see why you'd leave out alcohol and tobacco, essentially you avoid a fight with both those lobby groups and there are other organisations dealing with those already.

    Auckland • Since Nov 2006 • 4458 posts Report Reply

  • Ian Dalziel,

    ...didn’t feel I could usefully respond to its requirement to score each drug

    Can you get them all at the same place?
    :- )
    But seriously, without personal experience of each drug and its effects on you or others around you, where could you start to 'rate them' on 'harms' of any sort...

    I understand that some people who die may have traces of cannabis in their system, but it is duplicitous to suggest that was the main cause of the death.

    There a case in the states where a college kid bought legal 'hash cookies' and ate more than the recommended amount and ended up jumping off a balcony?
    see: http://www.thecannabist.co/2014/04/02/denver-coroner-man-fell-death-eating-marijuana-cookie/8519/

    Christchurch • Since Dec 2006 • 7943 posts Report Reply

  • Alfie, in reply to Ian Dalziel,

    …ate more than the recommended amount and ended up jumping off a balcony?

    So the cause of death was almost certainly injuries caused by the fall. Or at least the bit at the bottom where he stopped falling. If the kid had instead downed a bottle of Jack Daniels, I wonder if that would be counted on official stats as an alcohol-related death?

    There’s a reason there is no maximum dosage for cannabis… it’s almost impossible to overdose because people fall asleep well before reaching any lethal amount. That’s why I’m questioning the 32 NZ deaths mentioned in the report. It sounds like complete nonsense to me.

    Unless they were caused by synths, in which case that's a major flaw in the report.

    Dunedin • Since May 2014 • 1435 posts Report Reply

  • Alfie,

    Silly question... who is the report's author, Dr Michael McFadden of the "McFadden Consultancy". Google doesn't turn up anything in NZ for either the man or the company.

    Dunedin • Since May 2014 • 1435 posts Report Reply

  • Moz, in reply to Bart Janssen,

    I can see why you'd leave out alcohol and tobacco

    Plus it makes the graphs easier to draw, no need for a break in the axis or a log scale.

    The whole "cause of death" thing is complex. Still, better here than in the US where "death associated with cannibis use" probably means "shot by a cop".

    Sydney, West Island • Since Nov 2006 • 1229 posts Report Reply

  • Ianmac,

    A way back the massive tobacco industry realised that cannabis was a threat. So they organised and paid for "research", the results of which were presented to the American Drug Agency. They decided that the research was sound and declared cannabis to be a banned drug. So now many decades later it is very hard for a Government to backtrack. In the meantime Phillip Morris has had the advantage of little competition.

    Bleneim • Since Aug 2008 • 135 posts Report Reply

  • Russell Brown, in reply to Alfie,

    Silly question… who is the report’s author, Dr Michael McFadden of the “McFadden Consultancy”. Google doesn’t turn up anything in NZ for either the man or the company.

    He's Australian :-)

    Auckland • Since Nov 2006 • 22830 posts Report Reply

  • B Jones, in reply to Alfie,

    it’s almost impossible to overdose because people fall asleep well before reaching any lethal amount.

    No problem, so long as you're not driving, or flying a hot air balloon, or boating, or walking along a country road at night. Something doesn't need to be toxic to be dangerous.

    Did anyone here know that Alex Renton's treatment has been written up as a case study? Cannabidiol oil in the treatment of super refractory status epilepticus. A case report. The abstract looks interesting, and if you're really keen you can pay US$30 for the full article.

    Wellington • Since Nov 2006 • 976 posts Report Reply

  • Tze Ming Mok,

    Okay what. A survey of twelve people. Fine, it's a pilot.

    I suppose he was looking more for proof of concept for the Index itself. Thus, it's admirably transparent of the report to admit that Nutt the Wise had experts rank sixteen indicators of harm for each drug in the UK research. Compared to two for each drug in this NZ survey. The very low response rate might suggest that the other NZ experts thought this was a bit of a shit survey/Index too.

    Still, not completely without value as you say, but the sample size is unavoidably amusing.

    SarfBank, Lunnin' • Since Nov 2006 • 154 posts Report Reply

  • Tze Ming Mok,

    What's interesting is the attempt to cross-validate expert survey DHI findings (n=12) with estimated harm costs of the drugs, most of which cannot be validated by anything else. It's sort of like: "Here's some soft and imprecise data - how does it match up to another set of soft and imprecise data?" Answer: 'reasonably'? Compared to what? There's just no yardstick; and we don't know which is the more valid measure: estimated dollars or the 'blunt instrument'. You can appreciate the effort though. Perhaps if this DHI instrument becomes widely used and generates a large amount of data (which seems to be the intent here, and also I would guess is the rationale behind it being so basic as this would ensure its easy takeup by frontline professionals), it could become much less soft as a measure - though of course, more potentially skewed by social attitudes rather than evidence-based opinions.

    SarfBank, Lunnin' • Since Nov 2006 • 154 posts Report Reply

  • Alfie,

    This report reaches the MSM and its figures (based on n=12) become fact.

    Dunedin • Since May 2014 • 1435 posts Report Reply

  • BenWilson, in reply to Alfie,

    If the kid had instead downed a bottle of Jack Daniels, I wonder if that would be counted on official stats as an alcohol-related death?

    It probably should be. Harm resulting from (or at least associated with) cannabis impairment should certainly be recorded. But I agree that it should be carefully separated from harm caused by the cannabis itself. I'm pretty sure it's still true that no one has actually overdosed on it. But, as Rich notes, there are other physical harms short of death, and it's hard to see how inhaling smoke particles and all the hot gases surrounding combustion couldn't be at least a little bit harmful. Under a legal framework this is instantly soluble, of course. It is easy to get portable (pocket sized) vaporizers, and they would probably be the most convenient way to have inhalable cannabis, if the little capsules with liquid product in them were legal to make in large volume and sell here.

    I do always find it interesting, though, in this kind of analysis, all the pains that we go to enumerate and measure harms, when so little effort is put into quantifying the other side of the equation, against which this so clearly counterbalances. The "goods" that come from enjoying recreational drugs could definitely be quantified in a very similar way, and we could make a much more informed decision about that tradeoff as a result. At a policy level AND at a personal level. But instead, all these goods are simply collected under the one good (personal choice) and assumed to be equal. Then we are left scratching our heads and wondering why it is that there is such a strange disparity in the usage of drugs of approximately equal harm.

    We're so far down the mentality of considering only the one side of the utilitarian equation, that many would struggle to even see that there are goods at all, and could even consider those goods to be harms. "It's addictive!! People love it too much. That's just wrongs!!". "An establishment made money!! They must be evil!!". I think this leads to a very warped understanding of what is driving drug use, and therefore also a very weak understanding of how to mitigate the harms.

    I know it's quite a stretch to go evaluating any of the upsides of, say, P. But the fact that they do exist is a big part of the reason for the drug's popularity. We should have data on them. Then we can form a much more realistic picture of what is going on. We should at least know what it is that users think is good about it, even if we want to disagree with them about whether that is, in fact, good.

    Auckland • Since Nov 2006 • 10650 posts Report Reply

  • Ian Dalziel,

    This might have already been noted / posted:
    http://www.theguardian.com/society/2016/mar/30/legal-highs-ban-uk-delayed-concerns-law-enforceable-psychoactive-definition

    The (British) government’s blanket ban on legal highs that was due to come into effect on 6 April has been postponed for at least a month, the Home Office has said.
    The Psychoactive Substances Act, which has reached the statute book, has been delayed following claims that its current definition of a psychoactive substance is not enforceable by the police.

    Christchurch • Since Dec 2006 • 7943 posts Report Reply

  • tussock,

    Haha, wait, they want us to arrest people for selling tea and coffee?

    Since Nov 2006 • 610 posts Report Reply

  • Steve Barnes, in reply to Alfie,

    figures (based on n=12) become fact.

    However, when looked at by individual, cannabinoids cause the least personal harm at $9900 each year per dependent user

    We must assume, of course, that these figures are accurate to greater than 90%, otherwise they would have rounded that figure to $10,000.... wouldn't they?
    9900/12=825 so therefore 12 people spent $825 each on pot. Is that how it works?

    Peria • Since Dec 2006 • 5521 posts Report Reply

  • Rich of Observationz, in reply to Ian Dalziel,

    I'd think the same might apply here (much as it's apparently possible to escape a fine for public drinking if your lawyer demands evidence that the substance you were imbibing was in fact alcoholic).

    Back in Wellington • Since Nov 2006 • 5550 posts Report Reply

  • BenWilson, in reply to Steve Barnes,

    Is that how it works?

    I'm still trying to get my head around how it works, by reading it. It seems to turn harm into dollars in order to get a number that we think we can understand. So for example:

    The most recent government estimate for the value of a human life is $3,948,300, based on a
    willingness
    -to-pay study conducted by the Ministry of Transport (2014).

    A similar number is used for disablement caused by drugs. I have no idea how they calculate "years of life lost through disability". But that's what's being added up.

    Willingness to pay seems to be used to calculate the cost to family and friends caused by drugs too. Willingness to pay for treatment of the drug user.

    The cost of taxes that couldn't be collected on the illegal business seems to be evaluated as a harm here. I don't really follow how this is justified since the proviso of all these harm calculations is "how much less harm there would be if the drugs never existed". But in the lost revenue case, there would be no business to tax, so surely that can't be counted as a true harm?

    Then there's losses caused by acquistive crime. That might actually have a meaningful dollar value, but there's a very long bow drawn linking cause and effect here. It is possible that drugs cause people to steal. It's also possible that thieves are just more likely to take drugs, being people who care even less than usual about the law.

    Whether you think the dollar values really equate to the idea of harm is up to you. If you do, then you might righteously ask about the other side of the ledger. This is the expenses sheet, now show us the incomes. Then we can work out the profit/loss.

    But no such analysis is forthcoming. Show me a 54 page document detailing the positive side of drug use, with expert opinions and a literature review, so we can interpolate some funny money of our own and claim that the social good from drugs is actually 2 billion, and we actually made 200 million out of them. Ain't gonna happen. Harm reduction ideology doesn't work that way. It puts this humungous emphasis on putting numbers around one side of the story. The other side, it just isn't there. It's like no one sane ever took drugs. Ever.

    Auckland • Since Nov 2006 • 10650 posts Report Reply

  • linger,

    It’s like no one sane ever took drugs.

    By definition, for those believing the hype of campaigns like the classic “This is your brain. This is your brain on drugs. Any questions?”

    Meanwhile on BBC Radio 4, broadcast 7 April 2016: Psychadelic Science

    Jamie Bartlett asks if new research into psychedelic drugs will lead to them being accepted as mainstream medical treatment – or whether their controversial history will prove insuperable.

    Currently available for streaming, but no download (yet).

    Tokyo • Since Apr 2007 • 1928 posts Report Reply

  • BenWilson,

    Medical usage would be interesting to know, of course. But the positive side would be much wider than that. It would be a self evaluation of anything good about the drug that they could think of.

    Rate from 1-5 (1 = totally ineffective, 5 = very effective)

    "Helped break down social barriers"
    "Increased my enjoyment of a night out"
    "Kept me alert and awake on the job"
    "Helped me sleep"
    "Gave me insight for an artwork I was making"
    "Made me feel good"
    "Reduced my pain"
    "Reduced the symptoms of cold and flu"
    "Gave me energy"
    "Made me feel awesome for several days after"
    "Contributed to my popularity"

    Calculate in dollars:

    Profits from sales
    Savings from reduced expenditure on alternative drugs, such as alcohol.

    If we actually punch in this side then maybe we might understand why people do take the particular drugs they do, and what prohibition potentially costs.

    Sure, it's funny money. So is the Harm Index. They could, however, be funny money in the same units.

    These questions are obviously just a start at how such thinking could work. Not a 54 page document from earnest scholars paid for by the government at the behest of many lobby groups. Just an idea from someone who sees how broken you can make the idea of Utilitarianism if you just cut it in half.

    Auckland • Since Nov 2006 • 10650 posts Report Reply

  • BenWilson,

    It should be reasonably obvious that the minor goods I note are mostly much smaller than the harms they could be set against. However, they might occur with far higher frequency. For every instance of an alcohol induced harm, there could be hundreds of alcohol induced goods. If you're going to do a cold calculus that seriously tries to say that a human life is worth $4 million, then we should perhaps be allowed to offset that by $4 million in profits from sales, savings, and all of the minor enjoyments of the hundreds of thousands of people (per death) who used alcohol but didn't die. Then we might have a better handle on why the majority of the population still thinks alcohol should be legal. And a framework under which we can reasonably compare it to other drugs.

    Auckland • Since Nov 2006 • 10650 posts Report Reply

  • linger, in reply to BenWilson,

    Nor are the harm/benefit calculations for different drugs in any way independent. You note reduction of alternative drug use; but the interactions can be even more systematic. For example, take the proposed use of psilocybin to help people quit smoking. Twice as effective as any standard treatment, apparently, though there are huge caveats concerning the small sample size and nonrandom selection of individuals for study.

    Tokyo • Since Apr 2007 • 1928 posts Report Reply

  • Russell Brown, in reply to BenWilson,

    Rate from 1-5 (1 = totally ineffective, 5 = very effective)

    "Helped me write that song"

    This was my argument when Peter Dunne was still a drug prohibitionist but characterising the gambling industry levy as an "envy tax". How many awesome records did pokies help the Beatles make?

    Auckland • Since Nov 2006 • 22830 posts Report Reply

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