Wales on Drugs I: Drugs & Modern Wales

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This mini-series cover drugs policy and drug policy reform in Wales including:
current laws (this part), reasons people take them (Part II), the drugs market and how it’s supplied (Part III), how Welsh public services deal with drugs (Part IV), whether prohibition works and public attitudes towards drugs (Part V) and – controversially – addressing why drugs haven’t been legalised or decriminalised and setting out how they could be (theoretically) and what that might mean (Part VI).

Drugs: The ScienceTo start, it’s worth looking at how recreational drugs work.

Firstly the drug has to get into the body and blood supply. Recreational drugs can, as you all know, be smoked, ingested, inhaled, “inserted” or injected, making their way to the circulatory system either directly (in the case of injection), via the lungs or via the digestive system.

Then, they cross the blood-brain barrier, which acts as a selective filter for substances in the blood in order to protect the brain and nervous system from infections and damage. This often makes it difficult to treat brain diseases using conventional medicines. Any drug that does manage to cross becomes what’s known as a psychoactive drug.

The real story of how drugs work lies in the junction between nerves (synapse). Nerves aren’t one long single strand from the brain or spinal cord, but are broken up into shorter lengths. Nerves transmit signals from each other using chemicals called neurotransmitters. Each neurotransmitter carries a different type of message.

Recreational drugs can:

  • stimulate neurotransmitter release, mimic them or make it easier for a nerve to receive them (agonists).
  • suppress their release or make it harder for a nerve to receive them (antagonists).
  • have properties of both (agonist-antagonists)
  • block neurotransmitters from being produced, reabsorbed into the nerve or received (inhibitors).

The side-effects of taking a drug depend upon the chemistry of the drug itself and which neurotransmitters and receptors are targeted.

For example, the neurotransmitter dopamine plays a part in the brain’s “reward system”, producing a natural high or rush in order to increase sensitivity and encourage the behaviour that produces that reward. So drugs that overstimulate the production and transmission of dopamine – like amphetamines and cocaine – imitate or amplify this natural reward system. Drugs that inhibit dopamine, like some anti-psychotic medicines, will have an opposite calming effect.

The active ingredients of recreational drugs are, therefore, important in treating common illnesses despite the stigma attached to using drugs for recreational purposes.

For example, amphetamines are used to treat things like ADHD and narcolepsy, while active ingredients of cannabis (cannabinoids) have been shown to ease symptoms of multiple sclerosis and glaucoma.

To demonstrate this further, opioids are agonist-antagonists that mimic morphine – a powerful painkiller. One common opioid prescribed on the NHS to treat chronic pain and terminal diseases is diamorphine. You probably know it by its other name: heroin.

Drugs: The Types

There are several broad categories of recreational drugs:

 

Stimulants – These cause an uplift in activity, whether that’s mental activity, concentration, physical endurance or alertness. Some commonly consumed legal stimulants include caffeine, as well as nicotine from tobacco. Controlled and illegal stimulants include amphetamines, MDMA (aka ecstasy), cocaine, khat, methamphetamine and methadrone (aka meow-meow). Stimulants can have strong withdrawal symptoms, producing a noticeable “crash”after taking them – which often prompts users to seek them out again. They also put strain on the cardiovascular system due to increases in blood pressure, are linked to violence (cocaine) and psychosis, while tobacco has well known lethal side effects after prolonged use.

Hallucinogens/Euphoriants – Often dubbed psychedelic drugs, these cause an altered state of consciousness and hyper-awareness. They lift moods, causing very strong hallucinations and dream-like visions. Common hallucinogens include nitrous oxide (aka. laughing gas), ketamine, Salvia divinorium, psilocybins (aka magic mushrooms), LSD, DMT and mescaline. The side effects depend on which drug is used, but there are very few known side effects from hallucinogens like LSD. Their use could, however, cause temporary psychosis, lead to personality changes, cause “flashbacks”, or result in a user unwittingly putting themselves in danger.

Depressants/Sedatives – These have the opposite effect to stimulants and are used to reduce arousal and activity. They relax muscles, lower blood pressure, reduce social anxiety and cause drowsiness. Alcohol is the most commonly-used legal depressant, while controlled depressants include barbiturates, cannabis, benzodiazepines and GHB. Alcohol has numerous side effects of its own, but one obvious side effect of depressants is….depression….as well as increased risk of accidents when operating machinery. Also, smoking cannabis has been linked to bronchitis (here), but causes far less damage to the lungs than tobacco (here).

Opioids – A sub-group of depressants. As noted earlier, these are primarily used as painkillers. Some prescription opioids include morphine itself, oxycodone, tramadol, methadone (used to treat heroin addiction) and codeine. There are also street drug opioids which aren’t common here like krokodil. Heroin is perhaps the most famous, and arguably the most dangerous, recreational drug in terms of addiction and physical harm. The side-effects from all opioids can be vicious and include digestive problems, skin problems, inability to function and a high risk of death from overdose.

Inhalants – They aren’t so much recreational drugs in the traditional sense, but inhaled fumes from chemicals and solvents. They cause hallucinations and effects similar to alcohol or cannabis. Because of the inherent risks of poisonous fumes, some inhalants can kill instantly. As chemical and solvents are completely legal, and often cheap, they’re readily accessible to anyone at any time.

Anabolic steroids – These mimic testosterone, making it easier to develop muscle mass. They’re often used as a growth hormone or in gender reassignment, so don’t work in exactly the same way as other drugs (i.e. by affecting neurotransmitters). They’re heavily-linked to body dysmorphia in men, bodybuilding and cheating in sport – particularly baseball in the United States. Anabolic steroids are a controlled Class C drug, but are available on prescription. Side effects include heart enlargement, kidney problems, male impotence, depression, aggression (aka “roid rage”) and gynecomastia (male breasts). In women, the problems include developing male secondary sexual characteristics (like extra body hair and a deeper voice), clitoris enlargement and increased libido.

Drug abuse in Wales (Parts III & IV)

On the whole, recreational drug use is decreasing, though the UK has some of the highest rates of substance misuse in Europe – regardless of whether that includes alcohol or not. In the 12 months to September 2013, there were more than 30,000 referrals to treatment for substance abuse in Wales (pdf). In July-September 2013, 60.1% of referrals were for alcohol abuse, and 39.9% for controlled substances (illegal drugs).

Men are significantly more likely to be referred to treatment for drug abuse (72.9%), though for alcohol, the gap between men and women is narrower, with men making up 61.6% of referrals.

In 2012, 131 people in Wales died directly as the result of illegal drug misuse – the highest rate per 1million people (45.8) in EnglandandWales, and accounting for 8.8% of all drug-related deaths in EnglandandWales (Table 7). In 1993, when the statistics started, Wales had one of the lowest mortality rates at 11.3 deaths per million. 241 people died from both legal and illegal drug abuse (Table 1). Deaths from drug abuse are, like referrals, also significantly more common amongst men.

Drugs: The Law (Part V)

In 1961, the Single Convention on Narcotic Drugs (pdf) restricted the international trade and production of several listed drugs – except under licence. The UK Government brought in the Misuse of Drugs Act 1971 to comply with this treaty – and other international initiatives – in order to restrict narcotics and help distinguish between recreational drugs and controlled medicines.

Technically-speaking, the act of using drugs isn’t illegal; but possession (having them on your person/in your home), supply (drug dealing and trafficking) and production are all illegal. This, in practice, makes drug abuse illegal as you would commit an offence by obtaining them. Despite claims to the contrary, drug possession is still a serious criminal offence in the UK.

In the UK, drugs are placed into three classes to determine punishments for possession, production and supply, based on advice given by the Advisory Council on Misuse of Drugs (ACMD).

 

  • Class A – (Heroin, cocaine, magic mushrooms, ecstasy….) – Up to 7 years imprisonment for possession, up to life imprisonment for supply or production, including unlimited fines.
  • Class B – (Cannabis, amphetamines, codeine, barbiturates….) – Up to 5 years for possession, up to 14 years for supply or production, with unlimited fines.
  • Class C – (Anabolic steroids, GHB, ketamine [for now]….) – Up to 2 years for possession, up to 14 years for supply or production….with unlimited fines.

The UK Government can issue temporary banning orders for drugs which don’t fall into any class, granting police the power to confiscate them – carrying a prison sentence of up to 14 years for supply or production.

This has become more relevant due to the increasing problem of “legal highs” – chemicals that have similar effects to other narcotics but are new (or old) enough to escape drug classification, therefore openly-sold in “head shops” – which are unregulated and unlicensed.

The drug category system – especially the position of cannabis – has caused controversy.

Cannabis was downgraded to a Class C drug in 2004 based on ACMD advice, but then re-categorised to a Class B drug in 2009. More recently, it’s been recommended ketamine moves from Class C to Class B.

The former chair of the ACMD, Prof. David Nutt, was sacked by then Labour Home Secretary Alan Johnson, after claiming politics was playing a greater role deciding drug classification than scientific evidence. The ACMD also called for a downgrading of ecstasy but was ignored, while attempts by Alan Johnson’s eventual successor, Jacqui Smith, to get Prof. Nutt to apologise for a critical article (which he eventually did) were widely mocked by scientists.

Drugs: The Politics

Drug laws are one of the largest areas not devolved from Westminster – even to Scotland, where it’s a reserved matter. In Wales’ case it extends to controls on medicines, which are functions of the National Institute for Health and Care Excellence (NICE). Those controls have, however, always been devolved to Scotland in the form of the Scottish Medicines Consortium.

As community safety and health are devolved, the Welsh Government and National Assembly have responsibilities in this area – they just can’t change the law. Substance misuse in devolved politics is, therefore, approached as a health and social justice issue rather than one of criminal justice.

Current Welsh Government policy is driven by the Substance Misuse Strategy 2008-2018 (pdf). The plan has four key themes:

 

  • Preventing harm – This encompasses drugs education, raising awareness of advice services, making people aware of things like how much alcohol they’re drinking and encouraging parents and carers to influence their childrens’ choices.
  • Support for substance abusers– This includes outreach programmes, drug rehabilitation, working with young offenders and making sure substance misuse services are joined up.
  • Protecting families of substance abusers – This includes identifying the causes of substance misuse in families and intervention in those families where appropriate.
  • Reducing the availability of illegal substances – Although criminal justice isn’t devolved, this includes working with trading standards to limit the alcohol sales to children via the licensing system, as well working with authorities to clamp down on drug dealing.

In addition, DAN 24/7 is the Welsh Government-backed 24-hour bilingual helpline and website for information relating to substance abuse, including alcohol.

Last year, the Welsh Government and Public Health Wales launched WEDINOS, where the public and authorities can send suspected drugs or legal highs they find to a laboratory for testing, helping figure out what’s in them and ways to reduce their use.

This caused controversy, as the Welsh Conservatives claimed it could allow drug dealers to “test the purity of their produce”. Coincidentally, today Darren Millar AM (Con, Clwyd West) told the Assembly he received evidence the system was being used by steroid abusers.

In a 2012 UK Drugs Commission Poll of 31 Assembly Members (pdf p7) :

  • 67% of the AMs questioned believed the UK’s current drugs policies weren’t working. Only 14% agreed.
  • 63% believed drugs was too controversial a topic to have an objective discussion on.
  • 67% believed drugs policy should be driven by evidence and research.
  • AMs were more evenly split on whether Wales should have powers over drugs – 44% in favour 48% against.
  • 33% believed possession of small amounts of illegal drugs should be decriminalised, while 50% disagreed.

In terms of specific policies, Plaid Cymru supports the legalisation of cannabis for medicinal use, and in 2010 called for a wider debate on drugs laws based on scientific evidence.

The Liberal Democrats have called for the decriminalisation of drug use, and the effective legalisation of cannabis. This also has support amongst some Labour MPs – perhaps most (in)famously Paul Flynn MP (Lab, Newport West). The EnglandandWales Green Party also supports the decriminalisation of both cannabis and possession of small amounts of currently illegal drugs.

AMs clearly believe there are problems with the current approach to drugs, but some are all too willing to play up to the cameras – as we saw with the WEDINOS “scandal” and in Assembly debates. Or, they avoid the topic altogether, despite it being something that affects every part of Wales. As is typical here, despite having reservations on current policy, many don’t want to take responsibility over it. To an extent you could call that moral cowardice.

After leaving numerous sensationalist headlines and hatchet jobs in its wake, nobody wants to touch the drugs debate – a notable exception being the South Wales Argus. So I’ll have to do it.

Regardless of whether those inside the Bay Bubble agree with what’s coming over the next fortnight – I suspect, as usual, this will be a wasted effort – for even contemplating doing this I risk trashing everything I’ve done here to start a “discussion based on evidence and research” they’re too scared to have.

Part II asks (and attempts to answer) the question, “Who takes drugs, and why?”