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Theme: Healthcare systems
Carlotta Ceccarelli
A UK drugs reform charity called ‘Transform’ has recently sparked a tricky discussion for the UK government, through the release of their book ‘How to regulate Stimulants’. The book has gained it’s credibility through its preface, written by Helen Clark, the former prime minister of New Zealand. Their main argument is that the battle against organised crime of narcotics has been lost, they claim that there needs to be an approved system to license the distribution of these drugs legally in UK pharmacies, and it needs to happen soon. With reference to this book, I will be simplifying their ideas concerning the prohibition of hard drugs, highlighting their proposed regulation models for substances such as MDMA and cocaine.
Previously, in my article ‘The Road to Medical Marijuana’, I discussed the legislation of psychoactive components of marijuana that have been proven to work therapeutically. However, this was taking into account that cannabis is relatively low-risk. In many societies, MDMA and cocaine are an entirely different cultural space. Not only are their public reputations harsh, but their health risks are even harsher. Cocaine and MDMA are drugs that are getting more potent everyday, the little information available about their purity makes them impossible to be used safely. Since 2011, the number of stimulant-related deaths in England and Wales have been increasing, reaching record numbers of over four thousand deaths in 2019. The regulation of stimulants are planned to occur in Pharmacies. Pharmacists, as we know them now, are licensed professionals who dispense written prescriptions to patients (amongst other tasks). They are responsible for selling ‘over-the-counter’ drugs, which are generally low-risk and do not need a medical prescription from a doctor. As of today, a prominent involvement pharmacists have with a targeted prescription is the distribution of methadone. The tendency for this product to end up on the illegal market is high, therefore pharmacists have to keep a close eye, as patients prescribed to this drug are usually opioid recovering addicts. The idea of pharmacists being used for non-medical reasonings raises questions, will their role slowly move away from established medical dispensing? Will pharmacists adopt a care taking role for drug addicts?
MDMA is the abbreviation for MethyleneDioxy-MethylAmphetamine, a compound that's structural formula looks like this:
It is very commonly known as ‘ecstasy’ or ‘molly’, and has been popular in parties all over the globe. Its recreational effects are lasting and tend to make users feel intimate and extra empathetic. They are produced in the shape of small colourful pills, made to look a lot like candy. MDMA is illegal so the chance of getting a good dosage is unclear, it is very easy for one to get an unexpectedly strong dose which may lead to unintended consequences and danger. The unsafe measures of this drug justify the strict control and availability in proposed regulation models. In terms of preparation, MDMA would be available only in capsule form, encased for multiple advantages. Firstly, it is more hygienic and the dose can be controlled perfectly compared to crystalline powder. Secondly, the start of psychoactive effects can be moderated more easily in terms of time, it is more reliable in the speed of onset. The pharmacist vendor would sell them a small pack of 4-5 pills, in total equating to around 120-150 milligrams of MDMA. In order to prevent stockpiling and further distribution for reselling, the supply will be intended for single-use only. In addition to this, the option of user-specific doses would be made available. To reduce harm, the purchaser could attend a consultation to tailor their ‘prescription’ for different circumstances. In the illegal markets, MDMA is usually classed as ‘high value for money’, people are willing to spend money (more than necessary to produce) for their needs. This alternative would cost an average of 40 pound a pack, an economical option that is, without a doubt, much safer for the consumer.
Cocaine on the other hand, is a stimulant derived from a “Khoka” bush instead of a laboratory. The leaves of the bush have been used as pain relief for thousands of years, by the South American indians of the Amazon basin (including my ancestors from Venezuela!). There is a range of coca products, including forms such as flours that do not have any stimulant effects. Cocaine hydrochloride has a high melting point, it isn’t smoked up well, so many opt to snort the substance or inject it into their blood in a solution form. Cocaine has it’s set of major risks, including addiction and the possibility of being overdosed. With similar effects there is also crack cocaine, a cooked up version of cocaine hydrochloride, heated up with ammonia. This type of cocaine has a lower melting point and can therefore be smoked, the effects are more intense and its complications tend to be so too. Cocaine is popular for making users feel euphoric, confident and particularly energetic. The regulation of cocaine is predicted to be much more complex than the regulation of MDMA. This is due to the countless number of ways it could be distributed, there are other ways that are not mentioned here including the chewing of unprocessed coca leaf, pasta bases and much more. It is also already quite cheap and widely available, making controlling the substance even more difficult. Pharmaceutical grade cocaine would be 100% pure but reduced with non-toxic agents, because as you can imagine, 100% pure cocaine would result in a huge exposure to risks. Cocaine would be made as a nasal spray with a calibrated single-dose of around 20 milligrams, as it is a healthier form of ingestion compared to snorting. Unlike MDMA, cocaine is ranked the ‘worst value for money’, pharmaceutically produced cocaine would be dramatically cheaper depending on the local region. For those who choose to snort, a gram a month would be administered at a maximum for each person.
What was emphasised in this book is that there is no perfect solution. More effort and money will be used if providing only information and advice is continued, there are alternative options to help prevent consumers from putting themselves in danger. As the president of Mexico once said: “Ultimately, the choice is simple. We can hand control to governments or to criminal organizations. There is no third way.”.
If you would like to read more information about the topics that I mentioned above, visit this link containing the book referenced ‘How to regulate Stimulants’ by Transform.
Glossary:
Preface: An introduction to a book, typically stating its subject, scope, or aims.
Narcotics: A substance used to treat moderate to severe pain. Narcotics are like opiates such as morphine and codeine, but are not made from opium.
Hard drugs: Drugs that are seen to be more dangerous and more likely to cause dependency such as heroin and crack cocaine.
Psychoactive: Affecting the mind.
Potent: Having great power, influence, or effect.
Prescriptions: An instruction written by a medical practitioner that authorizes a patient to be issued with a medicine or treatment.
Methadone: A powerful synthetic analgesic drug which is similar to morphine in its effects but less sedative and is used as a substitute drug in the treatment of morphine and heroin addiction.
Opioid: A compound resembling opium in addictive properties or physiological effects.
Recreational: Relating to or denoting activity done for enjoyment when one is not working.
Capsule: A small case or container, especially a round or cylindrical one.
Consultation: A meeting with an expert, such as a medical doctor, in order to seek advice.
Overdosed: Take an overdose of a drug, overuse leading to potential risk.
Euphoric: Characterized by or feeling intense excitement and happiness.
Nasal: Relating to the nose.
Calibrated: Correlated with those of a standard.
Ingestion: The process of taking food, drink, or another substance into the body by swallowing or absorbing it.
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