‘Legal High’

China spearheaded last month a resolution at the WHO to relegate the much-used anaesthetic ‘Ketamine’ into the Schedule I of the 1971 Convention of Psychotropic substances.

Most probably China is having a tough time controlling abuse of that low-cost Ketamine by her citizens.

It is at present readily available for anaesthetic use; surely drug addicts are finding in it a ready psychotropic haven. But most countries,specially the less developed, will oppose that Chinese push because Ketamine is a very useful drug in difficult, emergency operation conditions, specially in remote regions, where even the common analgesics such as Morphine and Pethidine may be difficult to obtain. Placing Ketamine in the 1971 Schedule 1 of the WHO means a sure disappearance of that much-needed drug from the medical armamentarium. So anaesthetists worldwide are opposed to the Chinese request.

All this is happening whilst synthetic recreational drugs are being legalized in New Zealand! In many countries synthetic drugs are available on the streets where they are part of an illegal money-spinning industry playing havoc with the users’ life in the same manner the old hard drugs heroine, amphetamine and cocaine have been doing. In fact, our own Parliament had proposed to strengthen our laws against drug abuse, especially illicit synthetic drugs, also known as ‘legal high’ or ‘designer drug’ — which are invading our market.

Proliferation of synthetic drugs may threaten our social stability. A modern approach to counter such a difficult challenge is necessary. In the olden days, it was part of the culture to use recreational drugs in countries like China and India, but they were restricted to adults. However, our present-day concepts of democracy, freedom of movement and market forces have amplified the problem – and made all sorts of recreational addictive substances available, and worse, even to very young persons. Our social fabric is thus under growing threat of being destabilized.

New Zealand ‘experiment’

Geographically New Zealand is well out of the way of the narcotic trail, like the Golden Triangle in South East Asia; and that’s why its residents have taken to synthetic drugs like the well-known Mephedrone – nicknamed ‘Meow Meow’.

New Zealand is being watched by other countries, as it is about to carry pioneering work into legalizing the use of ‘Legal High’. It will continue to criminalize the old drugs, but new legislations will be voted to control the newer drugs, and to tackle impending problems following such legislation. (The paradox is that naturally occurring drugs will be banned, but synthetic ones will not!). It is said that it is not just an experiment, but rather a pragmatic approach to modern social problems. These ‘legal highs’ will be produced by pharmaceutical companies under strict scientific control and will undergo clinical trials as common medicinal drugs do. The idea is to separate modern hard drugs from criminality and pass laws to regulate for safer ones. Of course, it will be available over the counter, taxed and regulated.

Prohibition ineffective

Across the world, some 300 million people are on illicit drugs in spite of prohibition. For the past 40 years, some one trillion dollars have been invested into fighting drug abuse in the USA alone. And the battle is far from won, in fact the drug problem is on the increase.

Finland first introduced prohibition laws against alcohol in 1919; USA in 1920, but both had to repeal that law 13 years later. Illicit drinking was doing more harm than good. In India, prohibition or no prohibition, poor people filter varnish solution to separate the alcohol for consumption, resulting in hundreds of deaths sometimes. And that’s how most countries end up legalizing alcohol (and cigarette), hoping to limit collateral damage.

Prohibition is ineffective, counterproductive, and expensive, and of no use, but many of us are conscious that legalizing the product also opens up the door to extreme abuse and medical problems. So countries like the Netherlands, Portugal, Uruguay, Bolivia and other South American countries are already legalizing marijuana – as the Colorado and Washington states in the USA have done, to face up to the negative effects of prohibition. But they are also enacting laws to allow the use of some synthetic drugs not really on scientific grounds.

In late 1990 Benzylpiperazine (BZP) was introduced in NZ as an alternative to Amphetamine; soon some 5% of New Zealanders were on it, but by 2008 it was banned because of many severe adverse effects. New designer drugs like Mephedrone came on the market, yet again it had to be banned. And as supply keeps chasing demand, the vicious cycle is hard to break. The Europeans have reported that in 2009 there were 24 designer drugs on the market. In 2010 that list climbed to 41 and by 2012 it was 73. To beat the market at its game of supply and demand, the UK Parliament enacted a new ‘Emergency Scheduling” law whereby, when a new drug is on the street, there is no need to go through Parliament to outlaw it. And the manufacturers responded by manufacturing new molecules ‘as fast as possible, and sell as much as possible in the shortest of time’. This cat and mouse game goes on. Even in Australia, an ‘analogue law’ was passed that would ban any new drug that was a near copy of an old molecule, but it was interpreted differently by underground manufacturers, as a license to produce newer molecules!

After trying the above two laws, which were a failure, New Zealand wants to have a new approach. They are aware that prohibition of old recreational substances is already a hard procedure, so prohibiting new designer drugs, coming out every week, will be harder still. So why not have new laws to allow free use of these substances as long as they are safe?

Thus in NZ the two Houses of Parliament have given the green light to these new laws, whereby drugs of ‘low risk of harm’ will be allowed, but limited to individuals above 18 and not sold where alcohol is already on sale. But what could constitute ‘low risk of harm’? Neuropsychopharmacologist David Nutt of Imperial College, London, thinks that it is time to address that ‘evidence based policy’ problem. A harmful drug is one which causes ‘harm to the individual, to society and has an addiction value — and by these criteria … alcohol comes on top of the list, followed by heroine and cocaine (The Lancet).

Nutt hinted to the NZ lawmakers that their law must imply that the newer low risk designer drugs should be less harmful than alcohol, at which the New Zealanders shuddered and giggled. Another new criterion was proposed: the new drugs should be less than half as harmful as alcohol. That new law must also supply a possibility to tackle post-sale problems, hence the idea of having a surveillance program. Again a scientific approach is being contemplated to gauge the safety of the new designer drug. As for the criteria to be used, Nutt suggested that it will have a score 1 if it causes vomiting, mild pain and restlessness; 2 if it causes cramps, hallucinations and unconsciousness; 3 if coma, paralysis and deafness are observed. And the moment competent authorities report a total score 2 after sales of 200,000 units, the new drug is removed from the market (New Scientist).

A Lot of Doubt

NZ hopes to limit social damage by introducing these new laws, but some experts have their doubts. Most of the time when severe adverse effects or death were reported it was noticed that more than a single product had been used; the users had had fun by combining different drugs, more so with alcohol. So the experts are pessimistic about the success of the NZ novel approach. An individual would like, as most of us, to experiment with the highest climax he can reach. Now and then most of us want the maximum of happiness, of money, of fun, of leisure and vacation (it does tickle our brain or our psyche). So what could prevent him, the drug user, to aspire to the maximum of ‘kick’, of psychedelic experience and hallucinations, to explore the outer reaches of his brain? And so he ‘designs’ all sorts of cocktails of drugs to test his brain; except that sometimes he crosses over and ends up in the morgue.

A 2008 WHO report said that more restrictive laws across the world had not diminished drug use. The Netherlands and Portugal, after liberalizing marijuana in the 70s, have not noted an increase in the percentage of users; there is even a drop in negative health problems connected with drug addiction.

However, we must concede that different governments in different parts of the world have different constraints to pay heed to. As usual, geography, history, social context, political and religious ideology play a role in determining the policy of the government vis-à-vis addiction. In democracies, where freedom is the ultimate pursuit (hence we talk of ‘recreational substances’!), there is a tendency to accommodate drug users, while in theocracies there is no choice than applying rigid, moralistic laws.

In huge and vast countries, where the porous frontiers are difficult to control, the problem of drug smuggling is acute, while in small island states – where control should have been easier – different laws are being passed to prohibit the addictive drugs. Even in NZ, in 2006 about 15% of people were taking the legal high BZP; in 2009 prohibition brought that rate to 3.2 %. Still the New Zealanders want a different policy to reduce the rate further; it seems that their new laws are living up to that promise!

In Mexico some 50,000 people have lost their lives in recent years due to involvement in drug traffic; so Mexicans may view their problem differently. Yet most of us may still hesitate about what the solution should be: the ravages of alcohol and nicotine are a daily reminder that legalization or decriminalisation of recreational substances could yet be another step to undermine our social well-being. ‘Global drug prohibition took 80 years to construct: will not post prohibition take as long?’ (New Scientist)

In 2016 the UN will have another special assembly to address the problem of drug abuse and its policy for drug control. We truly hope it will find a just and fair solution.

* Published in print edition on 17 April  2015

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