That opinion piece reads equally well if you replace Ecstasy with RTDs and MDMA with alcohol.
Not just Mr Schep
The long-term effects of MDMA use also merit attention. I've been looking at some literature on that. But that's a whole other post ...
But it's not hard to see why emergency doctors like Quigley would see it as a better option than most other things that could turn up in a pill:
Quigley was saying on Back Benches recently that, for every 100 alcohol related incidences in ER on a weekend night that he deals with, there may be just 1 case of a drug related incident.
Having tuned in (late start recording) late to Damian and Wallace's show, it appeared that there was a group on MDMA under Quigley's watch. I was astounded (and pleased to see) that this was allowed to happen. I couldn't determine if it was true but I suspect if anyone could do it ,Damian could. Does anyone know if it was true?
Behind a paywall, but the summary of this comprehensive 2009 UK [meta?] study is intriguing.
The study that is raising most concern over long-term MDMA effects is this one from last year: Depression, impulsiveness, sleep, and memory in past and present polydrug users of 3,4-methylenedioxymethamphetamine (MDMA, ecstasy)
I read the full report and it did seem to me to have some problems with self-selection, ie: that the largely employed and professional ex-MDMA users would be much more likely to go through the bother of replying to a newspaper ad and volunteering for the study if they already felt that had problems with sleep or cognition. There's also no record of how heavy or frequent past use was, which is unfortunate given that other studies have found those factors have a strong bearing on long-term effects.
The UK Advisory Council report the story refers to is here.
This is relevant (emphasis mine):
An extensive systematic assessment of observational data on the recreational use of MDMA by Rogers et al. (2009) examined studies that compared MDMA users versus poly-drug users and MDMA users versus drug-naïve controls with separate analyses for current MDMA users and ex-users. The review found that there was a small but consistent negative effect of ‘ecstasy’ on cognitive and psychomotor function across a large number of controlled observational studies (over 100). The authors considered these effects tended to be ‘small’ in magnitude, noting that the mean scores of ‘ecstasy’-exposed cohorts were commonly still in the ‘normal range’. Former ‘ecstasy’ users frequently showed deficits that matched or exceeded those seen among current users. The statistically significant differences reported were most apparent on memory domains and on focused but not sustained attention. Self-rated measures of performance gave bigger effects than objective measures, which suggests a degree of self-concern in those volunteering for research studies. The authors of the report suggest that such measures could bias research findings (Rogers et al., 2009).
The MDMA findings are rather different from those of studies of methylamphetamine and cocaine users where impulse control, planning and attentional (rather than memory) processes are affected, often to a pronounced and clinically relevant degree (Volkow et al., 2001a and b).
If you drink two bottles of spirits (which contain about three times as much alcohol as the wine) you might well wind up dead of alcohol poisoning.
For sure. And if you consumed pure alcohol you'd be lucky if you survived a single glass.
To de-criminalize any of the drugs in question, you have to put forward a reasoned scientific case for harm minimization. In order to do that, you have to acknowledge the harm done by drugs in general and, therefore, acknowledge that alcohol is by far the most harmful drug in our society. So, logically, you need to impose more restrictions on alcohol and there is your stumbling block. Not only are many people philosophically opposed to that, you will also have dozens of alcohol industry lobbyists off to visit the minister to explain why that is a bad idea.
It'd be great if you could legislate for the sensible majority, who don't drink to excess, who don't abuse a legal mind-altering alternative, who drive sensibly, who follow the instructions on the bottle, etc etc. But it's also useful to have some crash barriers in place for the small but apparently irreducible minority who aren't sensible.
What sort of regulation would work for MDMA, do you think? It would need to deal with the people apparently addicted to synthetic cannabinoids when they were legal. MDMA isn't particularly addictive, but neither is sugar, and we're struggling with that. Gambling too. There's a black market in relatively non addictive prescription pain killers, which suggests that regulation isn't 100% there either. What would work, and how would you define "work" anyway? Fewer psychoactive ED admissions? Fewer alcohol ED admissions if people switch? No increase in hyponatremia, hyperthermia, depression etc? It might not work very well if all you did was switch people from alcohol to alcohol plus MDMA. Would that be a sufficient improvement from alcohol plus whatever the hell else is around, or do we expect some corresponding reduction in booze? That's a whole other kettle of fish.
alcohol is by far the most harmful drug in our society.
Only because it's legal and therefore the most prevalent. And, in moderation, for most people, it's totally harmless.
Opening up the legal market for other drugs will also attract industry lobbyists for those drugs. For instance, a former pot campaigner in the U.S. was on Nights with Bryan Crump a while ago, explaining how decriminalisation has failed to account for this.
Commercial operators use good old fashioned brand campaigns to generate a whole generation of customer addicts.
For sure. And if you consumed pure alcohol you'd be lucky if you survived a single glass.
"The year before, an Intourist guide had taken a group of Americans into the taiga and laid out an even more splendid lunch but had forgotten to turn the bottle. After many toasts with warm tea to international friendship, mutual respect and closer understanding, the guide poured glasses of nearly frozen, almost congealed vodka and showed his guests how to drink it in one go. “Like this,” he said. He tipped the glass, drank it and fell over dead. What the guide had forgotten was that Siberian vodka was nearly two hundred proof, almost pure alcohol, and would still flow at a temperature that would freeze the gullet and stop the heart like a sword. Just the shock was enough to kill him. It was sad, of course, but it was also hilarious. Imagine the poor Americans sitting around their campfire, looking at their Russian guide and asking, “This is a Siberian picnic?” ".
- from 'Polar Star', by Martin Cruz Smith
Would you care to outline a third option? Given that prohibition has so very, very clearly utterly failed.
What would work, and how would you define “work” anyway? Fewer psychoactive ED admissions? Fewer alcohol ED admissions if people switch? No increase in hyponatremia, hyperthermia, depression etc? It might not work very well if all you did was switch people from alcohol to alcohol plus MDMA. Would that be a sufficient improvement from alcohol plus whatever the hell else is around, or do we expect some corresponding reduction in booze? That’s a whole other kettle of fish.
All perfectly reasonable questions. For now, I’d be happy with a more enlightened attitude to onsite testing at festivals and the like and a public information system like WEDINOS in Wales.
You don’t want to make a potentially harmful substance available in a way that encourages use. On the other hand, the use of party drugs has been mainstream for 20 years – it’s what people do at festivals and dance parties. The Drug Foundation says around 180,000 New Zealanders have used Ecstasy (or something like it).
But driving out the “original” party drugs has only made things less safe. In addition to the bad experiences reported in the Dom Post and my MoS story recently, there are incidents like this:
The emergence of the NBOMe group of drugs has doctors and nurses at Christchurch Hospital worried, with one of the men now in intensive care with kidney and cardiac complications.
The four men, in their 20s, had taken the synthetic LSD at a party in the city last night and quickly became agitated and confused.
Police were called after they were involved in a violent disturbance and had to be restrained before they were taken to Christchurch Hospital’s emergency department.
One of the men suffered kidney and cardiac complications and remained in a serious but stable condition in the cardiothoracic intensive care unit.
In the years before Operation Ark shut down a huge analogues operation, there was a real problem with mephedrone among kids in Auckland.
My guess would be that more MDMA use would equal fewer problems with alcohol. By contrast, one of the big problems with the then-legal piperazines was that they facilitated binge drinking. On the upside, they don’t appear to have outright killed anyone. But, then, there have been only three MDMA-related deaths in the three decades it’s been available in New Zealand.
It is really complex. I’d just like people to be safer.
They've predicted a massive mental health epidemic of depression from the abuse of MDMA for twenty years. However, this seems inconsistent with the lack of observational evidence to support it - AKA The Fermi paradox.
I fear the munter-factor would spoil it for everyone.
Yay! Legal drugs, let's see how many we can take, wash them down with Red Bull and Vodka shots. That chick looks like she could do with one dropped in her drink etc. etc.
It's a pity because there is real merit in the idea.
They’ve predicted a massive mental health epidemic of depression from the abuse of MDMA for twenty years. However, this seems inconsistent with the lack of observational evidence to support it – AKA The Fermi paradox.
True. There may be long-term (and even irreversible) effects, but they don't seem to be showing up at a clinical level.
The global reach of the legal highs industry has been laid bare by a UN study that shows new psychoactive substances – as they are officially called – being reported for the first time in countries as far afield as Peru and the Seychelles.
The annual report of the UN’s office of drugs and crime, published on Friday, says that the number of legal highs “with a negative health impact” being marketed around the world increased by a further 20% to 541 substances, up to last December.
The reasons Quigley might favour such a course are outlined in my what’s-in-the-pills story for the New Zealand Drug Foundation’s Matters of Substance magazine, which sparked the current media interest in the topic.
The other problem with all of these studies is that it's not really a question of MDMA's long term effects, but of the long term effects of whatever was in the pills that were in circulation at the time. This assumption that ecstacy === MDMA is really problematic and needs to stop.
It's not like there's this big pool of people who have only taken MDMA and maybe alcohol for 20 years. As the title suggests, MDMA users are polydrug users (whether they chose to be or not). And guess what, doing lots of random drugs is bad for you.
Sure, testing drugs is a good move. There are many things we can do to make the current situation less bad.
However, I think that it’s got to the point where we need to accept that prohibition is not just a bad idea, but morally wrong in a fundamental way. We shouldn’t be dignifying the persecution of drug users by suggesting that it is a failed public health measure. It is and always has been a politically motivated act of repression.
It is not a policy question akin to seatbelt laws, or how we go about funding hospitals, or what sort of anti-natal care we should provide. Drug prohibition is justified with similar logic, and is motivated by similar political forces as racial segregation or the prohibition of sodomy.
Could you expand on that, Daniel, as I'm not sure I follow. There's an aspect of puritanism to any drug debate, but I'd be very surprised if the majority of people who have contributed to this issue were motivated by anything other than trying to reduce the amount of preventable harm going on, in whatever way seems best to them.
B, It’s a long story, and it’s a historical story. (See below for a book and video dealing with the history)
I think you’re right, most of the people involved mean well. I also think many see the situation as hopeless and go along with the status quo because to not do so would threaten their positions of power. (There are a lot of former heads of state, former police officers, and former government misters calling for an end to prohibition)
But that doesn’t mean that prohibition is moral. It doesn’t mean that drug users are not suffering repression. In the 1960’s in Australia, well meaning people believed that the best thing to do with Aboriginal children was to forcibly adopt them. They were well meaning, but they had a false (in this case, racist) view of the world. They did immeasurable harm and committed shameful acts as a result. It is this sort of situation (though far less horrible) that I think we’re dealing with. History has framed of the debate, and the history is one of racism, political repression and moral panic.
Prohibition does great harm. This harm could be justified only if it were extremely successful or if the alternative were truly dire. We deprive people of their freedom for an act that only directly affects them. We create a situation where people overdose, take drugs they wouldn’t otherwise, and are subject to personal violence. This is an extreme thing. It does not fit within any concept of a democratic, liberal society.
A great general book that covers how the current debate has nothing to do with public health is “Drugs without the hot air” by David Nutt. He is doesn’t take the same position as I do (he’s firmly in the public health camp) but he goes through the history very well and presents it far better than I could. (He’s famous for getting fired from a British government post for arguing that MDMA is safer than horse-riding.) The organisation he works for has a website here: http://drugscience.org.uk/
This video is pretty good too: http://www.ted.com/talks/ethan_nadelmann_why_we_need_to_end_the_war_on_drugs
Thanks for that clarification. I think your point risks getting lost if you're trying to compare forced relocation of children and other racist policies to prohibition. There's a real difference between policies designed to change people's behaviour and policies designed to wipe out a cultural identity or preserve a social hierarchy. People in the main choose which drugs they consume, and those choices are affected by the legal and social environment, they're not inborn.
Of course, prohibition can be deployed in ways that preserve social hierarchies and damage cultural identities - there's a well-known ethnic disparity in arrests for drug possession. But that's not an indictment on prohibition itself, just its implementation.
When I was in London 1997~2000 people who took a lot of pills seemed to take more and more. It was’t uncommon for some folk to take 3 (over more) in a night. Of course no one really knew the potency but they obviously felt that they needed more than the average punter. More quality, certainty and monitoring would be so good. Imagine if people in a club could wear wrist bands to indicate what they had taken, they could even have the time recorded.
Thanks for that clarification. I think your point risks getting lost if you’re trying to compare forced relocation of children and other racist policies to prohibition. There’s a real difference between policies designed to change people’s behaviour and policies designed to wipe out a cultural identity or preserve a social hierarchy.
You'd be surprised. New Zealand's first real drug laws were consciously targeted at immigrant Chinese workers, whose opium use had become a matter of public alarm.
In the US, the story is even starker. Drug laws there were essentially born out of racism – against immigrant Chinese, blacks and Mexicans – and their impact still falls sharply along racial lines.