Oslo David Nutt FMedSci

Transcription

1 Curbing use of the most harmful drugs by providing safer alternatives Oslo 2017 David Nutt FMedSci Professor of Neuropsychopharmacology Imperial College London Visiting Professor at the Open University UK and Maastricht University NL Chair drugscience.org.uk

2 How prohibition leads to more harm Examples: Opium à heroin Cannabis à synthetics (spice) Cocaine à crack LSD/psilocybin à nboms etc Safrole (MDMA) à PMA Heroin à synthetics AH7921 and fentanyls

3 An example of wrong policies Prosecution of cannabis users è

4 Synthetic cannabinoids = Opening Pandora s box Because cannabis is illegal and users are prosecuted and prisoners are tested è (logically) seek legal alternatives è Massive use in prisons

5 Synthetic cannabinoids = Opening Pandora s box The rise and rise of Synthetic Cannabinoids Some prisons estimate up to 75% of inmates now using spice regularly despite their now being illegal More potent more harmful - much less well understood

6 And the homeless...

7 Rise of PMA/PMMA deaths in UK Number of deaths Novel psychoactive substances PMA Number of drug-related deaths where selected substances were mentioned on the death certificate, England and Wales

8 PMA is sold as ecstasy i.e. MDMA MDMA PMA

9 Production of MDMA (ecstasy) Safrole MDMA From sassafras oil

10 Alternative precursors à different products Safrole Seizure of massive quantity of safrole in Thailand in 2008 à reduction in supply of MDMA So underground chemists turn to other precursors such as aniseed oil With disastrous consequences MDMA PMMA Anethole PMA PMMA From aniseed oil

11 PMA and PMMA Not typical stimulants Slow onset of actions à overdose Block monoamine oxidase inhibitor so can get serotonin syndrome à hyperthermia, brain and muscle damage and death An example of how the war on drugs leads to collateral deaths.

12 Safer stimulants? BZP for metamfetamine (New Zealand experiment) Mephedrone for cocaine/amfetamines Other cathinones for MDMA Methiopropamine etc

13 Scare stories over mephedrone à ban Mephedrone = methylcathinone also known as Meow meow M-cat Drone

14 The remarkable impact of mephedrone to reduce UK stimulant deaths

15 Relative harms of stimulant drugs Relative harm

16 Proven harm reduction approaches = Less harmful alternatives To legal drugs Ecigs/vaping for tobacco cigarettes To illegal drugs Buprenorphine & methadone for heroin For recreational cannabinoids Cannabis for synthetic cannabinoids

17 So why not these? An alternative to alcohol? Nitrous oxide Alcosynth Less harmful stimulants? Mephedrone or other cathinones for cocaine/amfetamine Methoxetamine for ketamine?

18 Nitrous Oxide UK discovery Priestley and Davy In 200 years no deaths Used by Coleridge, Southey for poetic inspiration Millions of women for childbirth And Prince Harry

19 Why young people use nitrous oxide THEN Strong...Sun and fast newspaper pleasurable effect hysteria over soccer players Rapid recovery, over in mins, so back in control à Clamour to ban under the Psychoactive Substances Act à so lower risk of assault than when drunk for hours Safer to drive home à Invent new term = hippy crack slang inferring No as hangover harmful as less the loss most of work harmful time form of cocaine Less toxic to the body Less addictive

20 The two sides of nitrous oxide in footballers Bad? Good? Because of this hysteria NITROUS OXIDE now ILLEGAL in UK under the 2016 Psychoactive Substances Act Sellers à prison Sterling Good? Shaw Bad?

21 Ketamine Tolerance & Dependence with repeated use + bladder damage/ functional brain changes Recreational use à Class B in UK à methoxetamine = safer alternative probably à media hysteria à ban of all possible alternatives even if much safer than ketamine

22 Saving the world from drink? Alcohol è 4 million premature deaths per year many in young people Neuroscience can give us a safer synthetic alcohol New Scientist 2006 The Scientist Jan 2011 But would this now be legal in the UK? Do you want it Norway?

23 The underpinning principle? John Stuart Mill In a freedom loving society no conduct by rational adults should be made criminal unless it is harmful to others.

24 Thanks and questions? Buy this for your kids/parents/politicians All proceeds to DrugScience charity