Pubdate: Sun, 22 Jun 2014
Source: Observer, The (UK)
Copyright: 2014 Guardian News and Media Limited
Author: Adam Winstock
Note: Adam Winstock is a senior lecturer at King's College London and 
a consultant psychiatrist and addiction medicine specialist for the 
NHS. He was talking to Mark Townsend
Page: 33


We need an honest dialogue in this country that accepts that drugs 
can be incredibly dangerous but also that there are ways that people 
can use them that moderate their risk of harm.

We need to start being able to help people do that in ways that are 
not hypocritical or driven by the tiny proportion of people that are 
in treatment.

I work with that minority, and for those people drug use is not a 
choice. Patients in drug clinics do not use heroin for pleasure, yet 
the majority of people who use drugs do use them for pleasure. We can 
help those people make smart decisions.

In the past, the national guidelines have been along the lines of 
"don't take them, they're harmful - they kill you". It would be 
really nice to start a narrative with users that gave them 
information about drugs that was more meaningful.

The government must have the information it needs to make guidelines, 
and its communications department must ensure that drug users are 
given information that is meaningful.

But the elephant in the room is the truth that it's pleasure that 
drives drug use - guidelines that fail to acknowledge this will mean 
people will not pay attention to them.

This year the Global Drug Survey came up with guidelines for the 
safer use of eight drug groups, including cannabis and MDMA. 
Essentially, these are the strategies you can take that will reduce your risk.

One of the fundamental problems with guidelines on drugs is the 
widely variable purity of drugs. If we take MDMA, for example, you 
might have guidelines that say that one pill of 75mg of MDMA taken 
less than monthly is associated with a very low risk of longterm 
harm, and in terms of short-term risk  unless you were one of those 
incredibly unlucky people who have a very unusual reaction - would be 
associated with a very low risk.

As you increase the frequency of MDMA use to every two weeks, you 
start to increase the negative effects and the risk of longer-term 
effects increases.

It's as simple as "more drugs, more often, more harm". At some level 
the guidelines would be like cigarette health warnings, in that 
there's no level of drug use that is probably without risk at all, 
but there is a level at which - if you stuck to it - your risk in the 
long term would be very slim.

Of course, we would also need to highlight the contextual factors 
around drug use that also increase risk, such as avoiding driving, 
whether users are taking medication, and avoiding drinking excess 
alcohol. The government doesn't do this very well at the moment.

I think that the drug-using population is ready for this, and the 
internet means that you can get the information out; a perfect storm 
of interesting information and the means of mass communication.

One real problem is that drug policy has to match a country's 
culture. There's something about the UK in terms of our capacity to 
understand moderation. Maybe it's because we're such an intolerant 
society that we've never been able to educate around moderation.
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MAP posted-by: Jay Bergstrom