Drug Science Policy and Law

Published by SAGE Publications
Online ISSN: 2050-3245
Publications
Fifteen years ago when Portugal decriminalized the consumption of all narcotic drugs and psychotropic substances it was both a bold and a desperate move to curb the drug problem that the country faced at the time. In this paper, I analyse the Portuguese drug policy, its historical foundation, its success and its possible future.
 
Adulteration poses additional unknown risks to the health of people who use illicit drugs. In this study, we sought to determine the extent and nature of adulteration of ‘MDMA’ in circulation at English summer music festivals in 2021, following Brexit, COVID-19 lockdowns and various regulatory changes overseas. At three festivals in 2019 and 2021, 1648 surrendered substances were analysed with Fourier-transform infrared spectroscopy and colourimetric reagents in a mobile laboratory as part of a harm reduction project. Form, mass, appearance and main psychoactive component were recorded. Analytical results were compared to a parallel self-report survey with 1124 attendees at the same events, as part of the annual English Festival Study. In 2019 and 2021, 417 and 377 samples strongly resembling MDMA (e.g. ecstasy tablets) were tested. Detection of MDMA in such samples decreased from 93% to 55% between the two years. Whilst virtually absent in 2019, synthetic cathinones and caffeine each constituted approximately one fifth of 2021 samples. 4-Chloromethcathinone (4-CMC), 3-methylmethcathinone (3-MMC) and N-ethylbutylone (eutylone) were the most prevalent cathinones detected. In both years, >35% of survey respondents reported use and/or intention to use MDMA on the fieldwork day; ≤1% reported cathinone or caffeine use, suggesting their consumption was predominantly unintentional. The sharp rise in synthetic cathinone prevalence in the summer 2021 UK market coincided with a unique combination of events including Brexit and the reopening of nightlife after 16 months of lockdowns, months ahead of other European nations. Echoing similar periods over the past decade, the cathinone hydra reared its head to satisfy the buoyant demand for MDMA at a time of scarcity, through substitution with substances legally obtainable in the Netherlands at the time of data collection. Alerts issued on social media led to >360,000 engagements, demonstrating extensive public engagement with illicit market monitoring and harm reduction advice.
 
3,4-Methylenedioxymethamphetamine (MDMA), also known as ecstasy, was first synthesized in 1912 but first reached widespread popularity as a legal alternative after the much sought-after recreational drug 3,4-methylenedioxy-amphetamine (MDA) was made illegal in 1970. Because of its benign, feeling-enhancing, and nonhallucinatory properties, MDMA was used by a few dozen psychotherapists in the United States between 1977 and 1985, when it was still legal. This article looks into the contexts and practices of its psychotherapeutic use during these years. Some of the guidelines, recommendations, and precautions developed then are similar to those that apply to psychedelic drugs, but others are specific for MDMA. It is evident from this review that the therapists pioneering the use of MDMA were able to develop techniques (and indications/counterindications) for individual and group therapy that laid the groundwork for the use of MDMA in later scientific studies. In retrospect, it appears that the perceived beneficial effects of MDMA supported a revival of psycholytic/psychedelic therapy on an international scale.
 
Context In recent years there has been an increase in the availability of ‘novel psychoactive substances (NPS)’ or ‘legal highs’. In turn, there is concern as to the risks these compounds pose as compared to those posed by traditionally misused substances such as illicit diamorphine (heroin), methadone, cocaine, and amfetamines. Methods We reviewed deaths where opiates/opioids, stimulants, hypnosedatives, hallucinogens, or volatile substances were mentioned on the death certificate in England and Wales, 1993–2016 as recorded on the Office for National Statistics drug poisoning deaths database. Deaths were analysed by year of registration of death, age, sex, intent, drug(s) involved, and the presence of alcohol (ethanol). Results There were 68,347 drug-related deaths in England and Wales (includes both licit and illicit substances), of which 15,457 were either coded as, or had mention of, drug dependent/non-dependent substance abuse on the death certificate. Opioids, particularly diamorphine/morphine and methadone, featured in most deaths. Diamorphine/morphine-related deaths (17,402) increased from 155 in 1993 to 981 in 2001, and then remained relatively stable until 2010 (791). Thereafter, annual numbers of deaths fell to 579 in 2012, but have since increased to 1,209 (2016). Deaths in the age group 20–29 years declined from 46% (1993), to 13% (2016), whereas in those aged 40–49 years the percentage of deaths increased from 13% (1993) to 33% (2016). Methadone was mentioned in 7,894 deaths (1993–2016). Annual numbers of such deaths increased from 206 to 437, 1993–7, then declined, but have since increased, reaching 413 in 2016. As to age, a similar pattern as to diamorphine/morphine-related deaths is apparent. Annual numbers of deaths involving cocaine (1993–2016: 3,342), reached 235 in 2008, declined, but have since increased (2011: 112, 2016: 371). Annual numbers of deaths involving methylenedioxyamfetamine/ methylenedioxyethamfetamine/ methylenedioxymetamfetamine (‘ecstasy’) (1993–2016: 853), have also increased steadily in recent years (2010; 8, 2016: 65). There were relatively few mentions of ‘novel stimulants’ (1993–2016: 386) on death certificates and such deaths have declined in recent years (2015: 88, 2016: 57). Mephedrone was most frequently mentioned (122), as was para-methoxyamfetamine/ para-methoxymetamfetamine (88). Conversely, although synthetic cannabinoids were mentioned infrequently (1993–2016: 37), such deaths have increased recently (2015: 8, 2016: 26). Conclusions Illicit diamorphine (heroin) and methadone continue to be the principal drugs of abuse involved in fatal poisonings in England and Wales. The increase in such deaths in recent years has been largely due to an increase in deaths amongst older users, although the role of potent synthetic opioids such as carfentanil is a cause for concern. Overall, stimulants and related compounds have been implicated in an increasing number of deaths annually. The impact of the plethora of NPS that have appeared in recent years on fatal poisonings may have been mitigated by legislation.
 
The Misuse of Drugs Regulations 2001 (MDRs) create exemptions to the offences of possession, production, supply, and administration of controlled drugs (CDs), which are necessary to allow healthcare professionals to treat patients without rendering themselves liable to prosecution for various offences under the Misuse of Drugs Act 1971. As the scope of healthcare in the UK grows to include extended roles for an increasing number of professions, so must the law be amended to allow for these. The MDRs were poorly drafted in their original form, and this has been compounded by twenty years of equally poor amendments, leading to a degree of inaccuracy and ambiguity that is no longer acceptable. These regulations both lack internal consistency, and fail to align with the Human Medicines Regulations, such that neither healthcare professionals, their regulators, nor their representative bodies agree on either the spirit or letter of the law. There are fewer than 30 active regulations in the MDRs, of which more than half contain ambiguities originating from poor drafting. While these could be clarified by a further series of amendments, the time is right to learn from previous mistakes and start over afresh.
 
Khat leaves originate in East Africa and the Arabian Peninsula and are chewed socially for their psychoactive properties. The main constituents of khat, cathinone and cathine, are illegal substances in most of Europe, including the UK, which reclassified khat as a Class C drug in June 2014. Case reports of khat-induced psychosis and dependence are not supported with robust scientific studies, and evidence for a causal relationship is lacking. Cross-sectional population studies reveal that khat abuse is affected by a range of susceptibility factors, such as psychological trauma; this has been experienced by many khat users, due to civil war and/or migration. Most studies on animal models of khat-induced dependence or psychosis use its psychoactive ingredient, cathinone, rather than khat extract. However, the unique chewing method of khat diminishes its addictive potential due to slow and prolonged absorption. Furthermore, the effects of the other constituents present in khat leaves are not well understood. While there are multiple criteria for banning a drug, this review considers the scientific evidence regarding two frequently mentioned criteria: dependence potential and psychosis. It concludes that further investigation, which takes into account susceptibility factors, is required to justify such intervention.
 
Background Criminal justice system involvement has been associated with health issues, including sexually transmitted disease. Both incarceration and sexually transmitted disease share associations with various social conditions, including poverty, stigma, and drug use. Methods United States state laws (including Washington, D.C.) regarding drug possession and consequences of drug-related criminal convictions were collected and coded. Drug possession policies focused on mandatory sentences for possession of marijuana, crack cocaine and methamphetamines. Consequences of drug-related convictions included ineligibility for public programmes, ineligibility for occupational licences and whether employers may ask prospective employees about criminal history. We analysed correlations between state sexually transmitted disease rates and percentage of a state's population convicted of a felony. Results First-time possession of marijuana results in mandatory incarceration in one state; first-time possession of crack cocaine or methamphetamines results in mandatory incarceration in 12 (23.5%) states. Many states provide enhanced punishment upon a third possession conviction. A felony drug conviction results in mandatory ineligibility for the Supplemental Nutrition Assistance Program and/or Temporary Assistance for Needy Families in 17 (33.3%) states. Nine (17.6%) states prohibit criminal history questions on job applications. Criminal convictions limit eligibility for various professional licences in all states. State chlamydia, gonorrhoea and syphilis rates were positively associated with the percentage of the state population convicted of a felony ( p < 0.05). Conclusion While associations between crime, poverty, stigma and health have been investigated, our findings could be used to investigate the relationship between the likelihood of criminal justice system interactions, their consequences and public health outcomes including sexually transmitted disease risk.
 
This narrative review describes the background to the introduction of the UK Psychoactive Substances Act 2016, and developments since the Home Office review of the Act in 2018. It discusses the challenges when measuring illicit drug proliferation, and triangulates the impact of the Act by using data from multiple public sources. It looks at both the direct impacts of the Act, and indirect impacts on other forms of drug use, and identifies the discrepancy between politically expedient legislation and real-world harm reduction.
 
Graph showing the number of respondents reporting about changes to their colour blindness following recreational psychedelic use. Experienced means respondents reported improved colour blindness, not experienced means respondents did not report improved colour blindness.
Graph showing the number of times certain drugs were cited to improve colour blindness symptoms. The 'other' category includes substituted 2C family drugs and novel substituted tryptamines. Some respondents listed multiple drugs. LSD: lysergic acid diethylamide.
It is well documented that psychedelic drugs can have a profound effect on colour perception. After previous research involving psychedelic drug ingestion, several participants had written to the authors describing how symptoms of their colour blindness had improved. The Global Drugs Survey runs the world’s largest annual online drug survey. In the Global Drugs Survey 2017, participants reporting the use of lysergic acid diethylamide or psilocybin in the last 12 months were asked, We have received reports from some people with colour-blindness that this improves after they use psychedelics. If you have experienced such an effect can you please describe it in the box below, say what drug you took and how long the effect lasted. We received 47 responses that could be usefully categorised of which 23 described improved colour blindness. Commonly cited drugs were LSD and psilocybin; however, several other psychedelic compounds were also listed. Some respondents cited that the changes in colour blindness persisted, from a period of several days to years. Improved colour blindness may be a result of new photisms experienced in the psychedelic state aligning with pre-existing concepts of colour to be ascribed a label. Connections between visual and linguistic cortical areas may be enhanced due to disorder in the brain’s neural connections induced by psychedelics allowing these new photisms and concepts to become linked. This paper provides preliminary data regarding improved colour blindness accompanying recreational psychedelic use which may be further investigated in future iterations of the Global Drugs Survey or in a stand-alone Global Drugs Survey-managed psychedelics survey.
 
There is growing concern that the majority of modern research may be comprised of false findings, which is partly attributed to unacceptable flexibility in data analyses. Here this issue is considered in the literature suggesting that MDMA (3,4-methylenedioxymethamphetamine) may be associated with neurocognitive deficits. Research suggests that increased exposure to ecstasy is associated with decreased performance on some neuropsychological tests. This claim is supported by the fact that “heavier” users often perform worse than “light” users on neurocognitive tests. However, most studies use different criteria for defining what is considered a “light” or “heavy” ecstasy user. Here the literature was systematically reviewed to compare the criteria used across studies which compare light and heavy ecstasy users. Out of the 19 studies reviewed nine unique points of dichotomization were found. In many cases, heavy users in one study would have been considered light users in another study and vice versa. Most studies (n = 11) did not explain how or justify why a particular criterion was chosen. Only eight studies provided justifications for why they chose a particular criterion and the reasons were often misleading. There are many methodological issues which bring into question the validity of research suggesting MDMA is the cause of neurocognitive deficits. Methodologists have demonstrated that it is unacceptably easy for researchers to report significant findings where no relationship exists, which may have been the case in some studies reporting on the neurocognitive deficits found in ecstasy users.
 
All new drugs targeting or influencing the central nervous system (CNS) must be screened for Drug Abuse Liability (DAL) prior to license approval by the FDA. Drug discrimination, self-administration, and drug dependence potential study designs are three core behavioral assays proposed in the 2017 FDA Guidance to Industry on Abuse Liability Testing for submission to the agencies for review at the time of the NDA submission. There are no international or federal drug control agency requirements for which animal species to use and selection of the test parameters for the sex, strain, age, dose range, study duration, systemic drug exposure thresholds or positive comparators to use in the conduct of these studies. In pre-IND and pre-NDA discussions with sponsor representatives, it is the FDA that has placed the financial burden on the industry to conduct these studies in both sexes in, what appears to be, a direct conflict with the intent of the Animal Welfare Act (1996). There is no single drug-of-abuse that is self-administered exclusively by one sex and there are no differential schedule controls placed on any drug substance based on any sex- or gender-based pharmacokinetic parameter. These nonclinical assays used for drug control scheduling actions should be conducted in only one sex unless there is a strong indication that sex is an important factor in the therapeutic use of the new drug or the mechanism of action.
 
The objective of this paper is to examine definitions of the terms “drug,” “drug use, “drug abuse,” and “addiction” to determine if the most commonly consumed foods in America are similar or consistent with drug use, abuse, and addiction. The methodology consists of reviewing published studies in the “food addiction” literature to determine if any consensus on the issue is achieved. Further, the author analyzes research on harms (including illness, death, medical costs and productivity losses) of illicit drugs, licit drugs, and foods. The author finds evidence that some food consumption is consistent with drug use and drug abuse, and that food addiction is real. Further, the harms caused by the unhealthy foods we eat dwarf those caused by crime and illegal drugs combined. Based on the data, the author suggests we reprioritize what we believe to be dangerous and “criminal” as well as rethink the “war on drugs.”
 
In this article, we compare how five jurisdictions (the USA; UK; Canada; New Zealand; and Australia) balance the disparate objectives of preventing the misuse of drugs and allowing their legal use for medical purposes. The statutory law underpinning each country’s method of categorising drugs depicts distinctive outlooks from the different jurisdictions, as each works towards these same goals. In examining how each country’s legislation deals with controlled substances, initial consideration will be given to whether drugs are categorised once only, or twice: once for dealing with their criminal misuse; and again for ensuring their safe medicinal use. In effectively dealing with criminal activities associated with drugs of abuse, Australia’s system of imposing penalties based on the quantity of a drug possessed, rather than on its grouping with other drugs of a broadly similar type offers the most flexibility. In terms of managing the legitimate use of such drugs, however, it is perhaps the least flexible of the four jurisdictions operating parallel systems of categorisation. The greatest level of flexibility is offered by Canada and the UK, which have functionally very similar protocols in this respect.
 
Drug addiction is a historical issue in Vietnam. Although Vietnam has a long history as a producer of opium poppies and crossroads for the illicit drug trade, it is now has some of the most stringent drug laws in the world. Vietnam has shown some success in reducing the production, trade, and transportation of narcotics. There has also been a shift in the attitudes of lawmakers and government authorities toward viewing drug abuse as a health problem rather than a social vice. Educating and encouraging citizens to collaboratively reduce drug use has also proven effective. However, despite these changes, the number of people who use drugs has increased in recent years. The US, too, has also experienced an increase in illicit opioid use. The Trump administration declared opioid addiction a public health emergency and has established goals to address the crisis. The results of these efforts have also been uneven. This article reviews Vietnam’s efforts to tackle its opioid epidemic, with the goal of identifying areas where Vietnam’s approach to opioid addiction may be improved. A brief overview of efforts by the U.S. government, an important foreign partner for Vietnam in the control of illicit opioids, serves to demonstrate the difficulty of treating opioid use in different political systems.
 
Alcohol use during the day is common amongst British MPs and Parliamentary staff even when Parliament is in session. MPs are frequently under the influence of alcohol when deciding on important bills, potentially affecting their judgement. Lobbying from the alcohol and the tobacco industries is rife in Parliament. What hope is there to change alcohol and tobacco policy in a more rational and healthy direction if the companies responsible for their harms are corrupting the political process in this fashion? We propose recommendations in line with the standards required for doctors.
 
Criminal offenses committed by individuals receiving health-related measures (HRM) or in prison ( 2 (8) ¼ 33.873, p < 0.001). Dichotomization: people in HRM were significantly more often convicted for offenses 1–3 (n ¼ 64, 66.7%) than those in prison (n ¼ 82, 36.0%, 2 (1) ¼ 25.722, p < 0.001, OR ¼ 3.6). There was no significant difference in the legal categories between the treatment modalities, outpatient (OP) and inpatient (IP) treatment (p ¼ 0.959). Missing categorization data (IP, OP) are marked by the white box with black boundaries. ***p < 0.001. HRM: health-related measures; IP: inpatient; OP: outpatient; OR: odds ratio.  
Characteristics
Differences between the HRM-population in out-and inpatient treatment 
In Austria, judges can offer quasi-compulsory treatment options (in- and outpatient settings) as an alternative to impris- onment for drug-related delinquencies. A standard assessment of medical, psychological and legal data on the imple- mentation of health-related and legal interventions in Austria was applied in 96 opioid-dependent individuals (10.4% female) undergoing quasi-compulsory treatment, receiving health-related measures. Additional data from the official prison registry were collected (data of 228 imprisoned individuals sentenced for drug-related crimes; 14.5% female) to gain comparable information to in- and outpatient health-related measure groups. Health-related measures were offered significantly more often to individuals charged with solely narcotics possession and/or trade, whereas imprisonment was filed significantly more often when concomitant property or violent crimes were committed in addition to drug pos- session/dealing (p < 0.001). Both cohorts had high prevalences of previous convictions (health-related measure 84.4%, prison 93.9%). The majority of patients in health-related measures suffered at the time of investigation from severe depression (62.5%), anxiety disorders (58.3%) and had a high loading of suicidal ideation (45.8%). Women showed a higher prevalence of affective disorders (p 1⁄4 0.042), with higher administration rates of psychopharmacological medica- tion (p 1⁄4 0.045), whereas male offenders scored significantly higher in violent behaviour (p 1⁄4 0.004). Inpatients showed a significantly higher burden of comorbid disorders compared to outpatients and reported a higher need for psychiatric treatment and legal counselling (all p < 0.001). The inpatient sample had a longer duration of opioid use (p 1⁄4 0.024), a higher lifetime prevalence of intravenous drug use (p < 0.001) and a higher rate of hepatitis C infections (p 1⁄4 0.012). Results confirm that imprisonment is sentenced to a vast extent for severe crimes, and health-related measure is well accepted among judges. However, based on patients’ high loading of previous convictions and alarmingly high burden of comorbidities, quality improvement and assurance in health-related measure are required when patients have their first contact with the criminal justice system. Continuous focus on applying diversion procedures is also required to reduce societal costs.
 
A 49-year-old woman was diagnosed with an ER + , PR-, HER2 + , BRCA- invasive ductal carcinoma which progressed metastatically to include bone, liver, and lymph node involvement. Standardised care included a 26-month treatment period with targeted chemotherapy and a ketogenic diet. The patient also began a course of cannabinoid-based therapy, consisting initially of a titrated high-dose protocol of mixed cannabidiol (CBD) and d9-tetrahydrocannabinol (THC) chemotypes, as well as psilocybin-assisted psychotherapy at macro and intermittent micro-doses. At the end of the five-month treatment period PET/CT investigations revealed no evidence of metastatic disease and chemotherapy was withdrawn. A one year follow up CT investigation concluded no evidence of residual or recurrent disease. A recurrence of disease was noted at 18 months follow up. Over these 18 months the cannabis regimen was titrated down to 60% of the initial protocol. This was subsequently increased to the initial dosing protocol following detection of recurrent disease and this titration occurred over a 10-month period where it remained stable. 16 months following the detection of recurrence of disease, favourable results were observed in the patient with evidence of receding cancer progression. Over the last 15 years there has been a considerable body of in-vitro and in-vivo evidence supporting the anti-neoplastic properties of cannabinoids and more recently psychedelics. Indeed, growing anecdotal and real-world evidence is reported of the therapeutic effect of cannabinoids and psychedelics in reducing both tumour proliferation and aiding as a palliative medicine to treat pain and psychological distress associated with cancer and chemotherapy. The data presented here indicate the potential therapeutic utility of such adjunctive pharmacological interventions in an individual with metastatic breast cancer.
 
This systematic review investigates whether clinical trials of psilocybin support criterion number three of the drug's schedule I designation: There is a lack of accepted safety for use of the drug or other substance under medical supervision. Data were collected by using the PubMed database and conducting a search on November 24, 2021, with the search term psilocybin and applying the clinical trial filter. Only primary reports on the sole administration of psilocybin by a medical professional were included for analysis, excluding trials wherein psilocybin was not administered, trials wherein psilocybin was exclusively co-administered with other drugs, articles that were not clinical trials, and articles that were repeat analyses of already included trials. 52 included publications were closely examined for reports of adverse events, drug tolerability, and drug safety. Zero of these articles reported psilocybin to be unsafe, while 27 of the included trials suggested that psilocybin is safe to administer under proper medical supervision.
 
Hangovers represent a major source of distress to the individual and a huge source of economic loss to society. Hangovers and their associated problems have been recognised for thousands of years in both Western and Eastern cultures but only in recent years has there been any scientific research into their mechanisms and treatments. This small review contrasts Chinese and Western approaches to the question of hangovers. We also give an overview of recent research into the mechanisms that may underpin it, which may suggest new approaches to prevention or treatment of hangovers.
 
Trends in drugs use during the last year. Total population, from 12 to 65 years old. Source: Villatoro-Velazquez et al., 2012. 
Trends in drugs use during the last year
Recently, there has been a more profound political debate in Latin American countries around the possibilities of legal regulation and decriminalization of currently controlled drugs, particularly cannabis. This debate is a complex one that deals with a growing drug trade towards North America and Europe, as well as oversaturated judicial and health systems across Latin America. Mexico's role in the production and/or distribution of controlled drugs has been recognized for many years, but only recently has Mexico’s own problematic use of drugs, especially in the cities of the northern and southern borders, been raised as an issue. Drug policy in Mexico has a long history, which can only be understood in its political and economic contexts and its relations with the United States. Mexican drug policy is stipulated in several legal documents such as the Constitution, the General Health Law and specific Official Mexican Standards, amongst others. In these documents possession, use and sale of drugs are considered illegal, but in case of some drugs like cannabis, cocaine, opium, heroin, MDA, MDMA, Meth (crystal), and LSD, the maximum amount that an individual may possess for personal use is stipulated. Currently, there are controversies in Mexico regarding exempting the use of certain drugs (especially cannabis) for medical indications as well as increasing the maximum amounts under which possession is deemed for personal use whilst reducing the penalty in case of personal use in small doses.
 
Benefits vs. risks of medical cannabis.
Main code families in order of frequency of occurrence.
Despite the legalisation of cannabis based medicinal products (CBMPs) in the UK in November 2018, today there remains a scarcity of NHS prescriptions, and many patients continue to face unsustainable financial costs to acquire their medicines. Following on from our previous quantitative study highlighting the effectiveness of CBMPs to treat severe intractable childhood-onset epilepsy, for the present study, we used a narrative, open-ended approach to interview parents/carers of these patients. 11 families were interviewed to understand their current situation in more depth, and to contextualise the previous findings. Although these families have found CBMPs to be the most effective treatment for their child’s condition, access to these medicines remains severely restricted, causing serious challenges in their day-to-day life. Participants discussed a broad range of issues associated with medical cannabis. These included the regulation and policy surrounding medical cannabis, the anger and desperation related to these policies, and the benefits and harms of it. Evidently, the benefits of medical cannabis for these patients far outweigh any associated risks. Many of the issues raised in our study go beyond the science of medical cannabis per se. Rather, they are political issues, related to the wider issue of trust and power in society, and associated challenges of the doctor and patient relationship. The findings highlight the importance of including patients in decision-making about their medical plans and the value that should be given to their reported outcomes and wishes. We conclude by offering implications for further research and for policy making so that these families, and others like them, can finally receive the medications they so urgently require without crippling financial costs.
 
Underground psychedelic-assisted psychotherapy has persisted in Europe despite the banning of the substances LSD and MDMA in the 1960s and 1980s, respectively. This article describes the work of a Zurich-based psychotherapist providing individual and group psycholytic psychotherapy, whose practice persisted for several years before she was arrested in 2009. The article provides commentary on the psychopharmacological, moral, ethical and legal issues of this case and discusses these issues in the context of the growing medical research of psychedelic substances as mainstream treatments for psychiatry.
 
Participant characteristics.
Background Scientific and anecdotal evidence suggest that whole plant cannabis extracts are effective in reducing seizure frequency in individuals with a range of epileptic etiologies. We report a case series of 10 individuals using CBMPs in the UK to treat their conditions. Methods In this retrospective study, we report on patients (aged 2-48) with severe, intractable, childhood onset epilepsies using combined cannabinoid therapy. Carers of patients provided details through the charity ‘End our Pain’ and these data were subsequently analysed. Our primary objective was to assess changes in monthly seizure frequency pre and post initiation of CBMPs. We also report on previous and current AED, CBD:THC daily dose, quality of life and financial costs associated with CBMP private prescription. Change in monthly seizure frequency were assessed using a Wilcoxon Signed-ranks test. Results Of the 10 patients enrolled in the study there was an 97% mean reduction in monthly seizure frequency post initiation of CBMPs which was statistically significant (Z = 0, p < 0·01). We showed a reduction in AED use following initiation of CBMPs from a mean of 8 (±5·98) to 1 (±1·05). All patients were using either Bedrolite or Bedica (Bedrocan International) as their CBMP. Individual daily doses of THC ranged from 6·6mg – 26·5mg and for CBD, 200 mg – 550 mg. Average monthly cost of CBMP was £1816·20. Interpretation Our findings suggest a combination of CBD and THC based products are effective in reducing seizure frequency in a range of epileptic conditions. We highlight the inefficacy of the healthcare system in supporting these patients who bare great personal and financial burdens. We encourage specialist physicians and relevant bodies to permit greater ease of access of these medications to those patients where efficacy has been shown.
 
Unlike the recent global trend of a decline in the prohibition of the use of Cannabis sativa for recreational and medical uses, Barbados and other small island states in the Caribbean have maintained their prohibitive legislation and policies on the use of the herb. A negative social construct of the use of cannabis and its effects in the consciousness of many in the Caribbean have contributed to the maintenance of the prohibitive policies towards the use of the herb. This article highlights the negative societal construct of the herb and its impact on the youth as two critical factors limiting the implementation of medical marijuana laws. It conceptualises a possible policy framework that would address this issue by enabling a phased implementation of the use of medicinal products from marijuana in the management of selected conditions from an evidence-based vantage point. Barbados would need to evaluate the mechanisms under current prohibitive legislation and create amendments to allow for an incremental approach on the use of the plant or products thereof for medicinal purposes in light of societal concerns. The policy framework should result in discreet enforceable mechanisms to facilitate and monitor the importation and development of efficacious and safe medicinal products for prescribing to authorised patients throughout the island’s healthcare system.
 
Subcodes and codes used to develop the four themes.
There is increasing research to suggest that certain Schedule 1 drugs, most notably psychedelics, can be effective in treating a range of mental health disorders. However, due to several practical, financial, and bureaucratic barriers, there is a lack of large-scale trials into their efficacy. This study aimed to explore the barriers, and any facilitators, to undertaking Schedule 1 research through examining the different positions Schedule 1 and other controlled drug researchers place themselves in, and the impact this has on their experiences.
 
The potential of psychedelic drugs in the treatment of mental health problems is increasingly being recognized. However, relatively little thrust has been given to the suggestion that individuals without any mental health problems may benefit from using psychedelic drugs, and that they may have a right to do so. This review considers contemporary research into the use of psychedelic drugs in healthy individuals, including neurobiological and subjective effects. In line with findings suggesting positive effects in the treatment of mental health problems, such research highlights the potential of psychedelic drugs for the enhancement of wellbeing even in healthy individuals. The relatively low risk associated with usage does not appear to align with stringent drug laws that impose heavy penalties for their use. Some policy implications, and suggestions for future research, are considered.
 
Mean human right scores (1: strong disagreement, 10: strong agreement) for each of the five substances according to gender (53 males, 52 females).
Calculated deaths per 100,000 consumers per year.
Mean scores (1: not at all harmful, 5: very harmful) of the perceived harm of the five substances according to 105 survey participants.
Likert-style scale human right results for each of the five drugs according to gender.
Background Contemporary research indicates that the legal classifications of cannabis (Schedule 2, Class B), 3,4-methylenedioxymethamphetamine (MDMA) (Schedule 1, Class A) and psilocybin (Schedule 1, Class A) in the United Kingdom are not entirely based on considerations of harm and therapeutic utility. The legal classifications of the substances discussed are typically determined by legislators such as Parliament and, therefore, may be a reflection of the views or perceived views of the general public. Objective The aim of the study was to provide an indication of the underlying psychology regarding the legislated sale of alcohol, tobacco, cannabis, MDMA and psilocybin in pharmacies according to a UK general population sample. Methods A sample of 105 UK nationals was selected for the survey. Participants were asked questions on perceived relative harm of the five substances. After viewing contemporary information on reported relative harm and therapeutic applications, the participants were asked questions related to using the pharmacy retail model for the sale of the substances discussed. Participants who opposed the substances being sold primarily in pharmacies were asked to explain their rationale according to a predetermined list of options for each of the five drugs. Participants were also asked whether they consider it a human right to be legally permitted to consume the substances. Results The participants' perceptions of relative harm (tobacco > MDMA > psilocybin > alcohol > cannabis) were not in agreement with the relative harm reported in the literature (alcohol > tobacco > cannabis > MDMA > psilocybin). Principal objections to the currently illicit substances being legally available in pharmacies include it sending the wrong message; it feels wrong; it is too dangerous; disliking the smell of cannabis; disapproval of the people; and not liking the idea of people using psychoactive drugs for entertainment or to have mystical/religious experiences. Overall, the participants determined that being legally permitted to consume the substances discussed is an issue of relevance to human rights. A majority of the male participants concluded that being legally permitted to consume alcohol, tobacco, cannabis and Psilocybe mushrooms is a human right in contrast to the majority of female participants who solely considered alcohol consumption to be a human right. Conclusions The data suggest that the legal classifications may not simply be based on considerations of harm. Misperceptions of the dangers, biases and non-health-related aversions likely contribute to the continuation of policies that do not reflect the state of scientific research.
 
Context In recent years, due to an alarming increase in the number of opioid-related overdose fatalities for White, Non-Hispanics in rural and suburban communities across the United States, they have been considered as the face of this epidemic. However, there has also been a staggering rise in the number of opioid overdoses in urban, minority communities, which have not been thoroughly addressed by the literature. Methods We reviewed deaths where opioid-related substances were reported as the leading cause of death to the Centers of Disease Control Multiple Cause of Death database from 1999 to 2017. Deaths were analyzed by year, State, drug type, and race and ethnicity. Results There were 399,230 total opioid-related deaths from 1999 to 2017 amongst all ethnic groups in the U.S. During this timeframe, approximately 323,939 total deaths were attributed to White, Non-Hispanics, while 75,291 were attributed to all other ethnicities. Examination of opioid-related overdose death data by ethnicity reveals that while White, Non-Hispanics have experienced the largest numbers of opioid-related overdose deaths in the U.S with up to 37,113 deaths occurring during 2017, there has also been a sharp rise in the number of opioid-related overdose deaths for minorities. opioid-related overdose deaths for Black, Non-Hispanics climbed from 1130 deaths in 1999 to 5513 deaths in 2017, while opioid-related overdose deaths for Hispanics climbed from 1058 in 1999 to 3932 in 2017. According to the Centers for Disease Control and Prevention, over the past 19 years, age-adjusted opioid-related deaths for Hispanics have climbed from 3.5 overdoses per 100,000 in 1999 to 6.8 overdoses per 100,000 in 2017. However, greater increases have been reported for Blacks during the same 19-year timeframe with age-adjusted rates of 3.5 overdoses per population of 100,000 in 1999 to 12.9 overdoses per population of 100,000 in 2017. Conclusion While Opioid-related overdoses have overwhelmingly plagued rural and suburban White, Non-Hispanic communities, there has been a surge in the number of deaths in Black and Hispanic Minority communities in recent years. Although there have been significant increases in the number of opioid-related overdose deaths in Black and Hispanic communities, the media narrative for this epidemic is often portrayed as a White, Non-Hispanic rural and suburban crisis. As a result, intervention strategies and policies have failed, both, to assess the severity of the problem in minority communities and to offer culturally sensitive preventative and treatment solutions. In this paper, the impact of the opioid epidemic on Black and Hispanic minority communities will be presented. Racial disparities in the U.S. Government’s current approach to an epidemic, which plagues rural and suburban White America, will be compared to its past criminal justice response to drug pandemics in urban minority communities. Culturally sensitive policy considerations and recommendations that can be used to, both, mitigate and offer treatment options for the opioid epidemic in these minority communities will also be addressed.
 
What seemed impossible 50 years ago is today becoming a reality as ‘soft drugs’ such as cannabis are being decriminalized and accepted for their calming effects as well as their legitimate medicinal properties. Several countries have now made the possession of cannabis legal, with others considering this, while the coffee shops in the Netherlands have been supplying cannabis in different forms for many years. It is now the turn of kava to be re-evaluated, to see whether there are properties in this plant that might be readily substituted for more conventional and harmful drugs, for instance tobacco and alcohol. However, as highlighted by Norton and Ruze (1994), kava like cannabis, has an enduring reputation that still makes it difficult for many to accept. Kava has been mythologized as an illicit alcohol, highly addictive, and causing physical harm. When examining the history of kava use in traditional contexts and considering the evidence now available, it is possible to demythologize this characterization. Looking at the potential benefits, it is time to re-brand kava, not only on the grounds as a relaxant, but in possessing life enhancing medicinal properties and as an alternative to alcohol, understanding that will be beneficial to policy makers, doctors and pharmacists.
 
Recreational drug use in Canada is not uncommon, but as with most societies, illegal drug use carries harsh penalties resulting in a criminal record when an individual is successfully prosecuted. Popular drugs of use in Canada include ecstasy, cannabis (including some synthetic cannabinoids sold as ?Spice? and ?Incense?) and several emerging psychoactive ?legal highs?. Surprisingly, Canada is a major manufacturer and exporter of the popular club drug ecstasy, with criminal gangs organising the synthesis and distribution of this club drug worldwide. Over the last 18 months, there has been much interest in and use of alternatives to ecstasy due to contamination of ecstasy during synthesis. One particular contaminant, paramethoxymethamphetamine (PMMA), has resulted in several deaths. Other alternatives include piperazines and mephedrone analogues. With regard to cannabis, some is home grown within people?s properties, but there is also large-scale cultivation in British Columbia where the climate is more temperate. With the introduction of corporate drug screening, there is increasing use of synthetic cannabinoids to avoid detection of marijuana use. This article discusses the problems and trends of synthetic drug use in Canada and reflects on the limited education available to youth in this regard.
 
Summary of responses from participants about cannabis causing them problems.
There is growing recognition of the potential utility of medical cannabis as a harm reduction intervention. Although used for this indication in other countries, there is an absence of UK clinical guidelines that supports such an approach. We administered a short survey to gain a better understanding of the potential role of medical cannabis by 39 people who were currently using illicit cannabis and accessing a specialist substance misuse treatment service. It was identified that 36 (92.3%) respondents found that cannabis positively impacted upon their physical and/or mental wellbeing and 56.4% reported that they used less of other substances which are known to be more harmful as a result. Therefore, while we acknowledge the small sample size, given the notable potential positive impact that medical cannabis could have as a harm reduction intervention, we propose that the use should be trialled within a specialist drug treatment setting.
 
The prosecution of cannabis-presence driving offences (in the absence of any behavioural evidence of impairment) is ultimately based on the assumption that there is a tight causal relationship between positive toxicology for cannabis and impairment. The main purpose of this review is to examine the evidence for that relationship. We show that most experimental studies have failed to elicit statistically-significant cannabis-induced impairments for many of their possible outcomes. And many studies failed to demonstrate any impairment at all in regular users of cannabis (because of the development of tolerance). We argue that selective reporting by researchers, editors and the media has created the false impression that the evidence for cannabis-induced impairment is strong and consistent. Human beings are ‘over-engineered’ for the psychomotor skills required to drive safely. A benchmark level of cannabis-induced impairment is therefore required to distinguish unproblematic from ‘real-world’ impairment. The conventional benchmarks of statistical significance, effect size and BAC-equivalence are shown to be inadequate. However, a benchmark in terms of 30 years of normal cognitive aging has good face validity. The recent use of cannabis is indicated toxicologically by the presence of delta-9-tetrahydrocannabinol (THC) in blood or oral fluid. Evidence is provided that most THC-positive drivers are not impaired, and certainly not meaningfully impaired. It follows that the justice of stand-alone cannabis-presence driving offences must be questioned.
 
The use of khat (Catha edulis) has been associated with a large number of physiological and societal harms, leading to calls for it to be controlled in the UK. The evidence of these harms is often equivocal, limited by confounding factors, or entirely anecdotal: high-powered, quality-controlled studies are lacking. Regardless, the body of relevant literature indicates that the once socially-regulated use of khat has been eroded. Some individuals have developed excessive consumption patterns, either using khat daily or in binge-sessions, though daily consumption is not necessarily problematic per se. The majority of users seem to use khat in moderation, where the associated harms appear low. For excessive users, harms associated with khat are greater, particularly relating to mental health. Social harms also seem to be largely related to excessive khat use rather than khat use itself. Even in cases of excessive khat use, however, causal relationships between chewing and harms have not been described. More research is required to establish the role of khat in liver disease, coronary problems, cancers of the digestive tract and incidents of domestic violence. Studies should consider the likeliness that certain users are more vulnerable to developing patterns of excessive khat use due to an interwoven set of factors such as social health determinants and pre- and post-migration experiences.
 
Background The supply chains addressing the global demand for major recreational drugs are hardly addressed due to international contracts, particularly the UN Single Convention on Narcotic Drugs. Currently applied regulatory changes have several disadvantages ranging from political tensions to the neglect of ecological aspects. The aim of this study is to show some implications associated with a transformation of the recreational drug market that is focused on self-supply of different categories of drugs. The concepts of "farmability", the feasibility to cultivate relevant plants and fungi, and "pharmability", the feasibility to refine materials to drugs by chemical synthesis, purification etc., are addressed. Methods 68 drug experts were invited to fill out an online survey on the feasibility of self-supply of different categories of drugs. The online survey was a five-point Likert scale and had seven questions. Results 26 experts (38.2%) responded to the online questionnaire. Cannabinoids were considered easy to cultivate/manufacture, depressants and psychedelics were ranked with moderate difficulty, opioids and stimulants were regarded as difficult to cultivate/manufacture, and empathogens/entactogens and dissociatives were ranked very difficult. The study found that some controlled substances, in particular cannabis, could be decriminalised without the need for a commercial market. However, some drug categories, such as dissociatives and empathogens/entactogens, would require the establishment of professional manufacturers. Psychedelics and depressants are ranked in between. Conclusion Different drugs are associated with different cultivation and/or manufacturing steps with contrasting difficulty levels. Those differences are likely to shape use prevalence to more accessible and safer drug markets which also decrease the involvement of organised crime groups. Hence, when decriminalising the possession of drugs for personal use, it is therefore recommended to allow also for personal cultivation or cultivation within social clubs. This is particularly relevant for drugs with moderate to high farmability but also if pharmability is sufficiently high.
 
Although there are great regional differences, smokable forms of cocaine (crack, free-base, paco, etc.) are a drug complex associated with often harmful and problematic drug use patterns. While strategies based on drug prohibition did not eradicate the consumption of smokable cocaine forms, prohibition itself led to many harmful effects, such as criminalisation, stigmatisation, unpredictable smokable cocaine forms quality and hardly any safer-use education. While there are many positive insights from heroin-assisted treatment programs with regard to heroin users, there are no comparable programs for problematic users of smokable cocaine forms. Smokable cocaine forms are challenging due to their different pharmacology and particularly their short duration leading to often many administrations per day. In this manuscript a device for a heroin-assisted treatment-like program for problematic users of smokable cocaine forms is suggested. This device is a cocaine-e-cigarette which could be prescribed to problematic users of smokable cocaine forms to reduce the risk of lung damage, exclude potentially harmful adulterants, limit intake (by formulation and/or technical settings) and also to bring users of smokable cocaine forms into the medical system to address comorbidities and risk factors, for example cardiovascular conditions, insomnia, depression, etc. This manuscript describes basic functionality and general specifications of a cocaine-e-cigarette as a medical device treating people with respective cocaine use disorder when cessation and substitution are not considered an option.
 
Lifetime psychedelic substance use has previously been linked to nature relatedness and pro-environmental behaviour. Yet, participants’ responses to the self-report measures in these studies may have been affected by stereotypical associations or confirmation bias. We therefore re-examined this link by measuring three pro-environmental dependent variables: nature relatedness, concerns about climate change, and objective knowledge about climate change. Additionally assessing lifetime experience with 30 psychoactive substances, we collected an international convenience sample for an online survey ( n = 641), Controlling for age, educational attainment, and covariation in substance use indicators, psychedelic use (primarily the use of psilocybin) predicted objective knowledge about climate change directly, and indirectly via nature relatedness. Further, it predicted concern about climate change indirectly via nature relatedness. The results suggest that the relationship of psychedelics with pro-environmental variables is not due to psychological biases, but manifests in variables as diverse as emotional affinity towards nature as well as knowledge about climate change.
 
Objective To examine the relative changes in opioid overdose mortality rates between states that have and have not adopted naloxone co-prescribing laws. Methods We performed a synthetic control analysis. National Vital Statistics data for the years 2012–2018 were analysed, and five states with naloxone co-prescribing laws were examined: Arizona, Florida, Rhode Island, Vermont, and Virginia. Opioid overdose-related deaths were identified through cause-of-death ICD-10 codes. Results Our pooled analysis for all opioid-related deaths showed no significant changes in opioid-related mortality rates in treated states, post naloxone co-prescribing law adoption (−0.05; 95% CI: −0.43, 0.33). Rates of other and unspecified narcotic-related mortality rates in Rhode Island were found to have decreased post-law adoption (−0.13; 95% CI: −0.25, −0.00). Conclusions These findings suggest that naloxone co-prescribing laws were not associated with changes to overall opioid overdose mortality rates, post-law adoption, during the study period. However, Rhode Island did see a decrease in other and unspecified narcotic-related mortality rates post-law adoption. This is perhaps due to the comprehensive nature of the state's law. As overall rates of naloxone co-prescribing remain low, interventions to enhance naloxone prescribing and distribution may be necessary for co-prescribing laws to impact opioid-related mortality rates.
 
Interview coding tree. Note: Identified codes are from interviews with drug treatment and mental health professionals (n = 8).
Common topics identified during interview.
Background Opioid-related deaths are at record levels in the UK and contribute to over half of all drug-related deaths. The prevalence of psychiatric disorders within people who uses substances is known to be considerably higher than the general population, yet only 4% of people accessing treatment are thought to receive integrated care for coexisting conditions. This study aimed to explore perspectives on treatment for people with substance use disorders and coexisting psychiatric problems. Methods Face-to-face semi-structured interviews with community drug workers, specialist nurses, prescribing administration worker and one clinical psychologist were conducted. Deductive analysis of three preconceived themes (i.e. reasons for substance use, treatment provision, the role of medication) was conducted. Results There was agreement between drug treatment professionals and mental health professionals for the complexities for being in treatment for people who use substances. An expectancy of prolonged periods of abstinence from drug and alcohol use before psychological treatment would be initiated leading to relapse was reported. Individual judgements of practitioners, stigmatisation and fear of people who use substances and organisational barriers often meant psychological help was unavailable which contributed to a reliance on medication, against national clinical guidance which was known by only one interviewee. Conclusion The UK drug treatment and mental health services should review the pathways to ensure that national guidelines are followed so that people who use substances are not excluded from accessing psychological therapies. Data from the coronavirus pandemic indicates heightened psychiatric problems, where illicit drug use may escalate as a means of self-medication leading to further increases in drug-related deaths.
 
The Global Commission on Drug Policy launched a report on The world drug (perception) problem, countering prejudices about people who use drugs, which includes remarks on the avoidance of stigmatizing terminology. Although many aspects of the report are helpful in moving the field forward, the report itself is full of stigmatizing terminology and ill-defined terms.
 
Set and setting is a term which refers to the psychological, social, and cultural parameters which shape the response to psychedelic drugs. The concept is considered fundamental to psychedelic research and has also been used to describe nonpharmacological factors which shape the effects of other agents such as alcohol, heroin, amphetamines, or cocaine. This paper reviews the history and evolution of the concept of set and setting from the 19th-century Parisian Club des Hashischins, through to 1950s psychotomimetic research on nondrug determinants of psychopharmacology, the use of extra-drug techniques by psychedelic therapists of the 1950s, and the invention of the concept of set and setting by Leary. Later developments and expansions on the concept of set and setting are discussed, and the term of collective set and setting is suggested as a theoretical tool to describe the social forces which shape individual set and setting situations. The concept of set and setting, it is argued, is crucial not only for psychedelic research but also for advancing drug research and developing more effective drug policy.
 
Comparison of lifetime and past year drug usage (UNDOC, 2017).
Percentages of PDU per drug.
Lifetime, past year and past month drug use (%).
Percentages of users with PDU (%).
This paper reviews the literature on problem drug use, aiming to answer the question ‘what percentages of drug users are problem drug users?’ We look at the conceptualisation of problem drug use, and related concepts such as addiction and dependence. While conceptually distinct, definitions vary, and terms are often utilised interchangeably in the literature. Because of the heightened controversy and recurring moral panics (often without factual basis) related to illicit drugs as compared to the licit drugs, we focus primarily on the use of the former. We summarise previous research findings on percentages of problem drug user in general as well as for the most commonly used illicit substances more specifically. Results show that the majority of drug use is episodic, transient and generally non-problematic. The majority of people who have used various drugs in their lifetime have not done so in the past year. Only a minority become problem drug users. Appreciating the limitations of current research, further research avenues are outlined and implications for policy making are provided. If most drug use is indeed non-problematic it implies the need for policy changes with a heightened focus on the development of improved risk communications and other harm reduction strategies. There is a need to move away from the narrative of ‘the problem drug user’ which is in many ways still prevalent in informing policy making. Incorrect perceptions of drugs and people who use drugs should be countered by providing evidence-based, transparent and easily accessible information. This is essential to change public attitudes towards and remove stigma of people who use drugs.
 
The drug policy in the Philippines is written as the Comprehensive Dangerous Drugs Act of 2002 or Republic Act 9165. Unlike drug policies in other countries, the law includes policies on drug testing. Aside from mandatory drug testing for specific situations, the law states further that two testing methods should be employed—a screening test, and a confirmatory test to be performed if the former yields a presumptive positive result. Over 1000 drugs of abuse screening laboratories are scattered all over the Philippines, but only seven can perform confirmatory testing using either gas chromatography-mass spectrometry (GC-MS) or liquid chromatography-mass spectrometry (LC-MS) technologies. In the last 30 years, more sophisticated analytical technologies like liquid chromatography-tandem mass spectrometry (LC-MS/MS) and high-resolution mass spectrometry such as liquid chromatography-quadrupole time-of-flight mass spectrometry (LC-QTOF/MS) have been developed not only to confirm what has been detected on screening tests, but also to determine the presence of new psychoactive substances that are not usually detected in drug screening. New matrices are also being utilized for the detection of drugs. The drug testing policy in the Philippines will have to keep up with the changing drug trends and drug testing innovations in the world to truly address the current administration's war on drugs. With the adoption of new drug testing methods using modern analytical platforms, the cut-offs used for drug testing interpretation should be updated.
 
Methamphetamine was reclassified as a Class A drug in New Zealand in 2003. This meant harsher sentences for people convicted of its manufacture, importation or supply. Despite this, the number of convictions for methamphetamine-related offending continued to increase. In 2019, the New Zealand Court of Appeal agreed to review the sentencing of people convicted of methamphetamine offences on the grounds that some sentences were disproportionately severe. This resulted in a guideline judgment which lowered penalties for offences involving small amounts of methamphetamine (up to 5 grams). Community-based sentences replaced imprisonment as the lower bound of the starting point for sentence calculation. The Court of Appeal highlighted that the presence of addiction, mental health problems or social disadvantage should be taken into account as potential mitigating factors in sentencing. The Court accepted that these factors diminished moral culpability and reduced the deterrent impact of prison sentences. In this article we review the law and policy background to the New Zealand Court of Appeal proceedings, and discuss the reasoning behind the Court’s judgment.
 
The UN General Assembly Special Session on drugs held in April 2016 has been organized by the international drug control entities, but has confirmed the inclusion of other UN agencies in the global debates on drugs. Out of these, WHO and UNDP have played a major role in linking drug policy with the priorities of protecting human rights and promoting sustainable development. In May 2017, the leadership of both agencies will change. This letter reviews the aspiring leaders of these agencies’ positions on drug policies through existing literature, providing more clarity on their past or current commitment to the issue of drug policy and harm reduction stakeholders.
 
This paper investigates options available to policy makers responding to the challenges of drug use in modern society, focussing on the UK. It investigates the failings of prohibition policy that has driven historic reactions to drugs, drug use and drug users globally, nationally and locally. This policy paradigm has been largely destructive and counter-productive and has led to a whole host of health and social problems. The authors have approached their investigation from a public health perspective, free from moral biases that have driven many policy initiatives until now. Many countries and regions of the world are rejecting prohibition as they move towards public health models in opposition to criminal justice responses, and this trend is continuing. Four policy models are examined; prohibition as the status quo; extension of prohibition to include alcohol and other drugs; decriminalisation; legalisation and regulation of all drugs. Each of these policy options are contested; none have universal support. However, given careful consideration, this paper proposes that our only way out of the public health and criminal justice crises that have been driven by drug policy globally is to adopt the more contentious option of legalisation and regulation of all drugs commonly used non medically.
 
Presence and severity of alcohol hangover symptoms. 
Background The purpose of this study was to examine whether drinkers would change their alcohol consumption behavior if an effective hangover treatment became available. Methods An online survey was held among Dutch students, aged 18–30 years, who recently had a hangover. Participants were asked (1) whether they would buy an effective hangover treatment if it became available and (2) whether using such a product would increase their alcohol consumption. In a follow-up survey, the same participants could clarify their answers in detail. Results A total of 1837 subjects completed the survey: 69.9% of the participants indicated they would buy an effective hangover treatment if available, 8.1% answered “no”, and 22.1% did not know. Only 13.4% stated that using such a treatment would increase their alcohol consumption. The majority of 71.6% stated it would not increase their alcohol consumption and 15.1% did not know. The follow-up survey was completed by N = 471 participants, of which 11.9% stated consuming more alcohol, 70.3% reported not to drink more alcohol, and 17.8% did not know. Motives for not consuming more alcohol were “The risk of having a hangover does not influence my drinking behavior” (24.2%), and “alcohol is a harmful substance” (20.3%). Discussion Social drinkers second the need for an effective hangover treatment. However, according to the vast majority of them, the availability of an effective hangover treatment would not result in an increase of alcohol consumption.
 
Background Recreational drug use is a major cause of disease, injury, physical and mental impairment and death in developed countries such as the United Kingdom and the United States. Alcohol, tobacco, cannabis, 3,4-methylenedioxymethamphetamine (MDMA) and psilocybe mushrooms are recreational drugs with capacity to cause harm. Cannabis, MDMA and psilocybin have reported therapeutic applications. Objectives The primary purpose of this study was to determine which of the three types of vendor (pharmacy, shop and the black market) are perceived to be the most suitable for selling the substances discussed according to a general population sample. Methods A sample of 105 UK nationals was selected for the survey. Participants were presented information regarding reported relative dangers of alcohol, tobacco, cannabis, MDMA and psilocybin and potential therapeutic applications. Participants were then asked to review harm reduction strategies. Results It was found that participants concluded that pharmacists with available NHS support from GPs and mental health workers are the most suitable vendors of cannabis, MDMA and psilocybin as opposed to regulated shops or the black market (p < 0.001). There was a high level of support for selling cannabis in pharmacies both for therapeutic use and for harm reduction purposes with a mean score of 7.0 out of 10. Participants (60) with a university education were found to be more in favour of the substances being sold primarily in pharmacies (alcohol 5.6, tobacco 6.7, cannabis 7.6, MDMA 6.5 and psilocybin 6.5) than participants (45) with no university qualification (alcohol 5.0, tobacco 4.8, cannabis 6.3, MDMA 5.0 and psilocybin 5.1). Conclusions The data suggest that the university-educated participants are supportive of treating recreational drug use as a health issue with GPs, mental health workers and pharmacists taking on roles.
 
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Ido Hartogsohn
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Emily K Bloesch
  • Central Michigan University
Jacob S. Aday
  • University of California, San Francisco
Torsten Passie
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Melissa Kwende
  • Texas Southern University