Hard News by Russell Brown

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Hard News: Sorting out our thinking on drugs

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  • BenWilson,

    debunk, what is that database used for practically? Is it to actually administer emergency treatment, or for the purposes of future research and maybe policy making? Or both?

    I ask because the former seems like a very hard ask. Virginia's experience in the A&E mirrors my own, the one time I had to take someone who was in a bad way on synthetic stuff to hospital. They didn't really care what it was that he had - he even had the actual packaging with him, and they scarcely glanced at it. They were more concerned with the usual triage procedures - checking the vital signs, asking about the symptoms, making a decision whether to even do anything at all (considering that in an A&E there are quite often competing concerns, other people with much more serious needs than just to lie down and be monitored for a few hours). I went along mostly on the off-chance that if he took a serious turn for the worse, I'd feel obliged to tell them that there's a good chance with this particular guy that the synthetics he's holding aren't the only drugs he's taken today, and I could probably have guided them about what to look for. It wasn't needed. Nor was it asked for. Nor would I have violated his privacy by telling them anything about it, unless the need suddenly seemed very urgent.

    And the experience was quite illuminating. In cases of potentially toxic overdosing, the hardest part for the medical staff (who are in the first place typically triage nurses, then doctors later) is to ascertain any kind of truth about what's actually been ingested. When it comes to exotic rare concoctions, which have potentially been mixed inside the patient into even rarer crossovers, there's very little evidence for them to go on as to what chemicals they might try as an antidote. That's even if the packaging does actually contain the truth. If it's serious enough, and the patient is looking like they're getting worse, I'd think they would do their own blood analysis, rather than trusting anything the patient, or anyone with them, would say. Because they have to know how the drugs are affecting this particular person right now. And that might manifest in different things for different people. Or even just different foods they ate that day.

    I guess what I'm saying is that sound medical decisions are typically based on huge trials. Isolated points of evidence for individual reactions aren't going to form the basis of decisions that doctors would want to take, unless they really had nothing else to go on, and the patient is steadily worsening.

    I'm not even vaguely saying what Virginia is asking about is a bad idea. It's a very good idea. I'm just asking about the motivation. It would seem to me to be excellent evidence to inform the world about the effects of various chemicals.

    Auckland • Since Nov 2006 • 10650 posts Report Reply

  • steven crawford, in reply to Craig Young,

    I could never get my head around smoking dope as any kind of medication, rather than just being a recreational drug. But breaking it down and extracting useful compounds, Is more tangible. CBT seems to be a promising anti psychotic. And could well reduce the anxiety created by the THC. So, for lots of ailments where medications derived from marijuana are useful, the THC is not only not required, it would compromise the treatment.

    That’s not to negate what you have said about HIV treatment. I saw the results of decriminalize marijuana for ” medical” use in California. And what I can report, anecdotally, is that kids might not want to smoke granddads drugs because it really isn’t all that cool anymore.

    That legal alloy house shown on Campbell Live is dissimilar to a methadone clinic, but without any mental health professionals present. In California, if you want to get dope, you will need to get a health certificate. I wonder how many doctors would hand one out, that allows somebody with a history of psychotic episodes to buy pot. More precisely a strain that contains high THC but low CBT.

    Atlantis • Since Nov 2006 • 4411 posts Report Reply

  • BenWilson, in reply to steven crawford,

    I could never get my head around smoking dope as any kind of medication, rather than just being a recreational drug.

    I can see why some people would want that, but presumably either pills or a vaporizer would be a better way to have it. It would only make sense to me for people who are already smokers. Then they could mix it into their tobacco. Not sure though, whether that might be even more unhealthy, considering that dope hits are usually held in longer, and you'd be doing that with tobacco smoke, potentially increasing the harm from that.

    Auckland • Since Nov 2006 • 10650 posts Report Reply

  • debunk, in reply to BenWilson,

    Read the article on the "evidence" and how difficult the whole area is

    www.theguardian.com/society/2013/apr/26/hidden-dangers-of-legal-highs

    No-one will do "trials" of these psychoactives because there are too many and changing too fast according to the market. I will see what I can find about this unit and the database - tho if its used by police and health sector must be useful for identification of substance type and therefore possible treatments?

    "Really, if you'd said even 10 years ago that you;d be able to buy tryptamines on the high street who'd have believed you?" said Ramsey wearily." Times have changed.

    "In comparison with regular drugs, there is hardly any data on the harm these drugs do."

    New Zealand • Since Aug 2012 • 105 posts Report Reply

  • Sofie Bribiesca, in reply to BenWilson,

    This is absolutely how I feel, you articulate it so well Ben. In my experience, if you feel like you could be dying, one gets pretty honest pretty quickly with the professionals and in my experience o'seas ,Professionals have seen similar signs present time and time again so there is the monitoring and checking vital signs first and what one ingests does not compromise that which anyone can receive in A an 'E. They are duty bound to help you in order of most serious at the front.
    As an aside, I haven't taken synthetic cannabis, but I have had, I would say, a lot of experience with and around many other drugs. Marijuana is a brilliant pacifier and encourager for such conditions as general pain and chemo and a friend uses it for MS, but not for everyone. It is the individuals circumstance and the type of medical problem that has occurred and I have been advised from health professional of the considered benefits of bud . They have all suggested a vaporiser which I find truly professional in that my situation has deemed it worthy of a mention. Once a Doctor got through to me in trying to suggest I consider some prescribed medications that I was weary of by saying "Sofie, let's face it, you have tried just about every other illegal drug, how but giving these blood pressure tablets a try too." I laughed and thought, yes my blood pressure is more of his expertise than mine. I now take them for life.

    ETA. It has always been my choice to take whatever drugs I have (except when in Hospital in a coma) and I have always excepted there may consequences and to be honest, I think most people who take drugs know that one day they might not like, know about or care about the outcome. That's life.

    here and there. • Since Nov 2007 • 6796 posts Report Reply

  • BenWilson, in reply to debunk,

    No-one will do “trials” of these psychoactives because there are too many and changing too fast according to the market.

    I understand. So this database is essentially attempting to keep track of effects in the field. It's a very poor substitute for controlled trials, but it might still be the best thing available, and definitely a whole lot better than nothing.

    Auckland • Since Nov 2006 • 10650 posts Report Reply

  • BenWilson, in reply to Sofie Bribiesca,

    In my experience, if you feel like you could be dying, one gets pretty honest pretty quickly with the professionals

    You do, but only if you're actually conscious at the time. But on the flip side, if you don't feel like you're dying, are you going to tell them that you used P earlier? You're already in some paranoid freakout, and are probably wondering if they might tell the police, who would only have to search your car to find your stash and paraphernalia, and you'll be in big trouble. So what goes down on the report is that patient has taken synthetic shit #21235908365749, and is experiencing paranoid delusions and elevated heart rate. Nothing about how they took synthetic shit #21235908365749 to take the edge off a bender on P, which they began when they woke up hungover as hell from drinking far too much booze the night before, and caught a cold and had a horrible running nose but can't buy effective cold relief medication.

    ETA: Oh and the P might not have been particularly pure. Supply issues meant that the dodgy dealer had slipped 50% synthetic #09385732458 in there too, which is P-like in effect, but of course, has completely unknown side effects.

    Auckland • Since Nov 2006 • 10650 posts Report Reply

  • Russell Brown, in reply to debunk,

    “In comparison with regular drugs, there is hardly any data on the harm these drugs do.”

    So what does that imply? We should just give up and let the black market rip? We should re-evaluate the better-understood "old" illicit drugs, like LSD and MDMA? We should try and weed out the the most risky of the novel substances? We should ban all psychoactive substances?

    You've posted that link alf a dozen times now and not really said what you think it implies for public policy.

    Auckland • Since Nov 2006 • 22830 posts Report Reply

  • Ian Dalziel, in reply to BenWilson,

    Nothing about how they took synthetic shit #21235908365749 to take the edge off a bender on P, which they began when they woke up hungover as hell from drinking far too much booze the night before, and caught a cold and had a horrible running nose but can’t buy effective cold relief medication.

    Reminds me of a Stanislaw Lem Book - The Chain of Chance (Katar)
    <spoiler alert>

    During the investigation, it becomes apparent that certain innocent chemicals can be combined into a strong depressor, a kind of chemical weapon. ... He discovers the industrial sources of the chemicals, and demonstrates how random chance chemical reactions led to the string of deaths.

    Christchurch • Since Dec 2006 • 7943 posts Report Reply

  • Russell Brown, in reply to BenWilson,

    I ask because the former seems like a very hard ask. Virginia’s experience in the A&E mirrors my own, the one time I had to take someone who was in a bad way on synthetic stuff to hospital. They didn’t really care what it was that he had – he even had the actual packaging with him, and they scarcely glanced at it.

    Here's one example why that's a dangerous thing to do in the modern world.

    One symptom of an overdose of MDPV ("bath salts") can be elevated heart rate and hypertension. One standard treatment for those symptoms is beta blockers. Unfortunately, that treatment could kill someone who's taken MDPV. In the words of the Michigan Department of Community Health:

    Avoid using beta-blockers to treat ANY degree of elevation in blood pressure as this may cause an unopposed peripheral alpha-adrenergic effect and dangerous, dramatic paradoxical surge in blood pressure.

    This is also a really big problem for users who may already be on blood-pressure drugs. Sure, they shouldn't be using MDPV in the first place, but it's entirely possible they're getting it in the guise of something more benign.

    Auckland • Since Nov 2006 • 22830 posts Report Reply

  • BenWilson, in reply to Russell Brown,

    Yes, and my understanding is that MDPV is a drug that has an effect much like P, but with a much more rapid decline in response, leading to redosing becoming imperative. Hence the tendency towards overdose.

    It could easily be used by a P dealer who wanted to cut product due to an urgent need for cash. In the long run the users would know it wasn’t P, but if they took some of it with the dealer before the sale, they could be fooled. Anecdotally, I’ve even heard that it’s initial effect is even speedier than P, so they could think they’d had a lucky score of some amazingly pure P (not that this would be rational, I don’t think P works like that at all, whatever Breaking Bad might have implied).

    Auckland • Since Nov 2006 • 10650 posts Report Reply

  • debunk, in reply to Russell Brown,

    Dr Ramsey's opinion implies that, for the proposed "clinical trials," these will not be possible with a randomised treatment regime, so how are sellers going to do proper assessments as the Act requires? What will be compared with what? There are just too many unknown unknowns here to measure anything properly. It is an article that rewards careful reading.

    It also points out, as you have found with A&E, that the medical fraternity do not know what to do because they don't know what they are "treating"..as Ramsey says "There simply aren't the resources to risk-assess everything, and I don't know if there's even the appetite to do it."

    New Zealand • Since Aug 2012 • 105 posts Report Reply

  • BenWilson, in reply to debunk,

    That's not really answering Russell's question. He wanted to know what you think this means NZ should do.

    My answer to that, as Russell ascertained, was that I think the current rules are far too strict, and that things should be relaxed. But that's caveated by "starting with the least harmful currently prohibited substances first". In other words, I think dope should be legalized, at the very least.

    If that is not on the table, then I really don't think it makes much difference at all what we do. Eventually, following the logic of our PSA, we will eventually ban all psychoactive substances, and be back to square one, having solved essentially nothing, other than that one direction for policy did more harm than good, namely trialing unknown substances on that segment of our own population that wants to smoke dope but doesn't want to get busted, or doesn't have a dope connection. Which is a lot of our kids, and a surprising number of adults.

    On the stimulants side it could even be worse. To be completely consistent, I think in the long run decriminalizing the biggest ones of those follows much the same logic, but this country is a long, long way from being able to accept that idea. We might get closer if we could ever dare to allow cannabis to be legalized, so that we could actually see what happens. But the harm from strong stimulants can be so much greater than from dope that I'm not even sure how that could be approached. However, I'm pretty sure that banning all these chemicals is just causing people who really want a P effect to just take P. From some gang, probably.

    Auckland • Since Nov 2006 • 10650 posts Report Reply

  • debunk, in reply to BenWilson,

    Follow the USA re marijuana, as I said earlier and for stimulants we already have lots of Ritalin available on prescription (which students in UK are using for supposed cognitive enhancement as well as stimulant effect) and the benzodiazapines are old drugs well researched and cheap on script too (eg valium). I don't know. But the approach here is going to end in a lot of unnecessary harm (eg strokes, heart attacks, kidney failure, brain damage) before the process is decided. It is not possible to do clinical trials (unethical for a start) and banning on reported effects is, in my view, going to set up legal battles which are already quite unfair too often in the ACC Court, depending on what counsel claimants can afford if any, and the attitude of the specialists. NZ medicine does not generally run on the "evidence" in ACC but rather on medical opinion, and unfortunately that is the path this dispute is heading down. My opinion. What if Russell's friend had had a stroke and lost speech, movement etc. Who would be blamed? These are the questions we need to think about. The businesses selling this product will have lots of cash and legal firepower at hand, unfortunately. Dr Ramsey uses two tissue samples to test these drugs - one for heart response and one for brain - according to this article (laboratory rats). But research on animals has been banned?

    New Zealand • Since Aug 2012 • 105 posts Report Reply

  • Rich of Observationz, in reply to Russell Brown,

    Beta-blockers are a largely obsolete treatment for ordinary hypertension - only indicated for angina risk, nowadays.

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

  • debunk,

    Re Beta-blocker for Legal High side effect...

    A&E client could apply for "treatment error" then from ACC?

    New Zealand • Since Aug 2012 • 105 posts Report Reply

  • steven crawford, in reply to BenWilson,

    I can see why some people would want that, but presumably either pills or a vaporizer would be a better way to have it. It would only make sense to me for people who are already smokers. Then they could mix it into their tobacco. Not sure though, whether that might be even more unhealthy, considering that dope hits are usually held in longer, and you’d be doing that with tobacco smoke, potentially increasing the harm from that.

    I think you might have misunderstood the point. What I am trying to point out is that cannabis can not be a medication in its raw form. some strains have high THC low CBD which will course anxiety. As I was saying in my last comment, CBD is being trialled as an anti psychotic. It's not about the smoking or eating. It's about getting the correct dose and it's about applying science.

    As for the dispensing of synthetics, as seen on TV, It might be a good idea to have medical people and social workers at the dispensaries. because I think our problems are somewhat greater than the actual substances them selves. There might be a bit of the old socio economic involved.

    Atlantis • Since Nov 2006 • 4411 posts Report Reply

  • debunk, in reply to steven crawford,

    "DIspensing"
    Probably contrary to the Act assuring competence and ethical behaviour by registered health professionals ..(can't recall name of it)..do no harm etc

    New Zealand • Since Aug 2012 • 105 posts Report Reply

  • BenWilson, in reply to steven crawford,

    What I am trying to point out is that cannabis can not be a medication in its raw form.

    I give you that it's a much less precise thing when smoked as a plant. But whether that means it can be a medication or not? Pretty much a semantic distinction.

    It is possible to grow it with differing amounts of THC or CBD, depending which you want. But yes, it would be clearer what chemical you were getting if that chemical were actually extracted and delivered in a purer form.

    Auckland • Since Nov 2006 • 10650 posts Report Reply

  • steven crawford, in reply to BenWilson,

    give you that it’s a much less precise thing when smoked as a plant. But whether that means it can be a medication or not? Pretty much a semantic distinction.

    Semantic? Would using the word pharmaceutical make more sense to you? If you are medicating a serious illness like schizophrenia, should we just use plants , or should we extract the useful compounds.

    Atlantis • Since Nov 2006 • 4411 posts Report Reply

  • debunk, in reply to Rich of Observationz,

    What would you have recommended?

    New Zealand • Since Aug 2012 • 105 posts Report Reply

  • steven crawford, in reply to debunk,

    “DIspensing”
    Probably contrary to the Act assuring competence and ethical behaviour by registered health professionals ..(can’t recall name of it)..do no harm etc

    I am starting wonder why the hell I am contributing to these discussions.

    Look, methadone is dispensed by pharmacists and the scripts are written by doctors in this country. It's called harm reduction.

    Atlantis • Since Nov 2006 • 4411 posts Report Reply

  • debunk,

    That's because methadone is a treatment ... not the same as selling a recreational drug not on script ..drugs have to well tested and approved by Pharmac (quality control, safety) to be prescribed and dispensed.

    New Zealand • Since Aug 2012 • 105 posts Report Reply

  • Ian Dalziel, in reply to debunk,

    approved by Pharmac

    Which could soon be seriously compromised by the TPPA

    The Trans Pacific Partnership Agreement (TPPA), currently under negotiation, could remove much of Pharmac’s power, and put it in the hands of international drug companies – something that should concern us all. Additionally it will limit key health strategies to address health hazards arising from tobacco and alcohol use.

    Christchurch • Since Dec 2006 • 7943 posts Report Reply

  • steven crawford, in reply to debunk,

    That’s because methadone is a treatment … not the same as selling a recreational drug not on script ..

    OK, so can you see how these "recreational" drugs are not actually recreational for the people who have said they are addicted to some of the products? and that the law makers are trying to figure out how to deal with problem dispensaries.

    Got any ideas how to solve these problems?

    Atlantis • Since Nov 2006 • 4411 posts Report Reply

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