Hard News: Sorting out our thinking on drugs
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BenWilson, in reply to
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.
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BenWilson, in reply to
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.
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Russell Brown, in reply to
“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.
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Ian Dalziel, in reply to
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.
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Russell Brown, in reply to
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.
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BenWilson, in reply to
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).
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debunk, in reply to
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."
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BenWilson, in reply to
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.
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debunk, in reply to
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?
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Rich of Observationz, in reply to
Beta-blockers are a largely obsolete treatment for ordinary hypertension - only indicated for angina risk, nowadays.
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Re Beta-blocker for Legal High side effect...
A&E client could apply for "treatment error" then from ACC?
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debunk, in reply to
"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 -
BenWilson, in reply to
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.
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debunk, in reply to
What would you have recommended?
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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.
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Ian Dalziel, in reply to
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.
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Steven
I think the whole situation is a mess and if any of these products are proved "safe" the retail outlets should not have been set up first ..as a sole trader think it's unfair for small businesses for starters to be encouraged to get stock (however toxic it may or may not be), rent premises etc and then be closed down on medical whim. Also unfair on consumers because product seems to be very addictive and then it could be cut off on medical/Ministry whim. Whole situation is poorly managed, and is going to cost taxpayers/health system big time ..I see them as shops selling product and not "dispensaries because like mental health don't see advantage in medicalising the situation. Favour US moves myself (and Australian states like ACT where can grow a couple of plants..visited a friend and long time cannabis consumer there doing just that very happily in the suburbs). Maybe NGO like Drug Foundation could set up some sort of specialised drop in centres away from A&E which suspect make stress worse ..tho not familiar with what services they offer ..have helped local ACC claimants in the past for a GP and can see claims coming up with side effects .. tho not for me to deal with..ACC very tricky these days. -
debunk, in reply to
Just referring to overdue change in attitude towards cannabis in the US ..will broaden and has to be an improvement!
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perhaps recreation is
becoming 'wreck creation'
and dispensary leads
to 'dissed penury' ?...but I'm only exploiting words
not people's dreams/fears... -
debunk, in reply to
and Legal High dispensaries leading to 'diss order' and 'dis tress' ?
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Russell Brown, in reply to
Beta-blockers are a largely obsolete treatment for ordinary hypertension – only indicated for angina risk, nowadays.
No, lots of people are on two-factor treatments for hypertension -- an ACE inhibitor and a beta blocker.
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Are you diss-ing the situation?
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Russell Brown, in reply to
Colorado, has a different system that we are yet to see unfold. It might go down the same path that our alcohol laws have. Advertising it will make you into something you are never going to be if you use to much of the product.
Colorado's up and running. I wrote a feature article about Colorado and Washington State's move to legalisation here. Colorado has the advantage of having already had a very sophisticated system for managing medical marijuana -- there's a bar code for every seedling.
California's med-pot system is all but legalisation -- it's very loose. I wouldn't be comfortable with quite the degree of commercialisation we're now seeing in Colorado and Washington.
The interesting thing is that the Psychoactive Substances Act is in a number of ways quite similar to the systems in those states. Most of what you'd need for the regulated sale of cannabis is in it.
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Russell Brown, in reply to
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)
Ritalin's quite a popular party drug here too. It makes far more sense to use it than to mess about with pills and powders of unknown providence.
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Ian Dalziel, in reply to
...of course Colorado had Hunter S. Thompson to push the envelope on extreme use - which must have helped skew data and perceptions (literally in his case) and shift the centre of opinions past a tipping point...
interestingly, well cryptically,
Gonzo also shows NZ in the Goo...
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