Advice is that "less is more" EDITOR,-A Richard Green and Guy M Good- win rightly point out that ... more Advice is that "less is more" EDITOR,-A Richard Green and Guy M Good- win rightly point out that the risk of long term consequences of neurodegeneration associated with the use of ecstasy (3,4-methylene- dioxymethamphetamine) may be greater than the risk of death from acute toxicity.' Having reviewed the compelling evidence linking ecstasy with neurotoxicity in animals, they omit what is perhaps the strongest indication of neurotoxicity in humans. A universal finding of descriptive studies of users of ecstasy is that the first ecstasy tablet is the best and that with subsequent use the desired effects decline and side effects increase.24 As ecstasy is pharmacologically active for only a few hours and even frequent users usually limit their use to weekends, neurotoxicity seems a more likely explanation than tolerance through neu- roadaptation. Even newsgroups on the Internet that promote the use of ecstasy are now debating not whether it causes serotoninergic nerve cell damage but whether the result is detrimental, inconsequential, or even beneficial, with general advice to users being that "less is more" and "more than one tablet once a month is an overdose.
Abstract The purpose of this study was to identify and assess patterns of use and problems associ... more Abstract The purpose of this study was to identify and assess patterns of use and problems associated with prolonged heavy use of cannabis. The strategy for doing so involved comparing heavy long-term users with light long-term users. Considerable variation in the ...
Ninety-two cocaine users were interviewed in Scotland. Most were middle-class nasal users, also u... more Ninety-two cocaine users were interviewed in Scotland. Most were middle-class nasal users, also used other drugs and generally gave cocaine a positive rating. One half of them had at some time used cocaine more than once a week. For some, this period lasted some months, when as much as 30 'lines' of cocaine were used per day of cocaine use. More of these heavy users reported adverse effects of cocaine than was the case for light users. Nonetheless, most heavy users had reduced their use by themselves to the point that their current cocaine use was no different from that of light users. Possible explanations for this apparently spontaneous reduction are discussed.
This paper investigates options available to policy makers responding to the challenges of drug u... more 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; n...
This paper reports qualitative data about violence and trauma amongst drug injectors in Scotland,... more This paper reports qualitative data about violence and trauma amongst drug injectors in Scotland, collected using a life story method with 55 drug injectors currently in recovery. It focusses on different types of violence and trauma that occurred whilst using drugs. Stories told of very severe and repeated traumas often involving extreme violence. One motive for escalating and continuing drug use was avoidant coping to deaden the emotions and thoughts regarding these traumas. Many traumas were due partly to the criminal drug milieu, so respondents were in a vicious cycle of using opiates and other sedative drugs to cope with the consequences of being involved in a lifestyle of using, supplying and obtaining illegal sedative drugs. Drugs were used as a dynamic method of self-medication or avoidant coping to cope with life in a criminal milieu. Traumatic events were more often described as worsening the lifestyle than as being motives for quitting. Amongst the traumas recounted were ...
Objectives. This longitudinal study focused on 126 long-term heroin users who had never been in s... more Objectives. This longitudinal study focused on 126 long-term heroin users who had never been in specialist treatment for use of any drug. The primary aim of the study was to assess whether this ‘hidden’ population resembled heroin users identified with drug treatment agencies, or alternatively, to test whether heroin could indeed be used in a controlled, non-intrusive fashion for an extended period of time. Design and methods. Recruitment was achieved through chain-referred purposive sampling methods, and data was collected through two semi-structured interviews. 67% of participants were re-recruited for follow-up. Results. Participants had levels of occupational status and educational achievement comparable to that in the general UK population, and considerably higher than typically found in heroin research. At the conclusion of the study, six participants had entered treatment. While there was evidence of intensive risky patterns of drug use among the sample, there was equal evide...
Abstract The purpose of this study was to identify and assess patterns of use and problems associ... more Abstract The purpose of this study was to identify and assess patterns of use and problems associated with prolonged heavy use of cannabis. The strategy for doing so involved comparing heavy long-term users with light long-term users. Considerable variation in the ...
Nmethyl-1-(3,4-methylenedioxyphenyl)-2-butanamine) instead of ecstasy. Mixtures of these substanc... more Nmethyl-1-(3,4-methylenedioxyphenyl)-2-butanamine) instead of ecstasy. Mixtures of these substances with ecstasy as well as with unrelated drugs such as amphetamine, caffeine, and I-phenylethylamine are also encountered. In addition, tablets have been found to contain other, less common, ring substituted amphetamines instead of ecstasy. These analogues may well differ in their neurotoxic potential. Finally, there have been reports of mixtures of ketamine and ephedrine, as well as other substitutes such as mixtures of lysergide (LSD) and amphetamine or of lysergide and ephedrine, being sold as ecstasy. This diverse pharmacological content of tablets may go some way to explaining the variety of symptoms reported among and within users. Not only does it mean that users are exposing themselves to unknown long term effects but it leaves researchers with a problem. Neither the user nor the researcher can be certain what the ingested tablet contained until later analysis. Adverse symptoms, both short and long term, will depend on the interaction between the drug and the individual, which cannot be safely predicted.
Advice is that "less is more" EDITOR,-A Richard Green and Guy M Good- win rightly point out that ... more Advice is that "less is more" EDITOR,-A Richard Green and Guy M Good- win rightly point out that the risk of long term consequences of neurodegeneration associated with the use of ecstasy (3,4-methylene- dioxymethamphetamine) may be greater than the risk of death from acute toxicity.' Having reviewed the compelling evidence linking ecstasy with neurotoxicity in animals, they omit what is perhaps the strongest indication of neurotoxicity in humans. A universal finding of descriptive studies of users of ecstasy is that the first ecstasy tablet is the best and that with subsequent use the desired effects decline and side effects increase.24 As ecstasy is pharmacologically active for only a few hours and even frequent users usually limit their use to weekends, neurotoxicity seems a more likely explanation than tolerance through neu- roadaptation. Even newsgroups on the Internet that promote the use of ecstasy are now debating not whether it causes serotoninergic nerve cell damage but whether the result is detrimental, inconsequential, or even beneficial, with general advice to users being that "less is more" and "more than one tablet once a month is an overdose.
Abstract The purpose of this study was to identify and assess patterns of use and problems associ... more Abstract The purpose of this study was to identify and assess patterns of use and problems associated with prolonged heavy use of cannabis. The strategy for doing so involved comparing heavy long-term users with light long-term users. Considerable variation in the ...
Ninety-two cocaine users were interviewed in Scotland. Most were middle-class nasal users, also u... more Ninety-two cocaine users were interviewed in Scotland. Most were middle-class nasal users, also used other drugs and generally gave cocaine a positive rating. One half of them had at some time used cocaine more than once a week. For some, this period lasted some months, when as much as 30 'lines' of cocaine were used per day of cocaine use. More of these heavy users reported adverse effects of cocaine than was the case for light users. Nonetheless, most heavy users had reduced their use by themselves to the point that their current cocaine use was no different from that of light users. Possible explanations for this apparently spontaneous reduction are discussed.
This paper investigates options available to policy makers responding to the challenges of drug u... more 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; n...
This paper reports qualitative data about violence and trauma amongst drug injectors in Scotland,... more This paper reports qualitative data about violence and trauma amongst drug injectors in Scotland, collected using a life story method with 55 drug injectors currently in recovery. It focusses on different types of violence and trauma that occurred whilst using drugs. Stories told of very severe and repeated traumas often involving extreme violence. One motive for escalating and continuing drug use was avoidant coping to deaden the emotions and thoughts regarding these traumas. Many traumas were due partly to the criminal drug milieu, so respondents were in a vicious cycle of using opiates and other sedative drugs to cope with the consequences of being involved in a lifestyle of using, supplying and obtaining illegal sedative drugs. Drugs were used as a dynamic method of self-medication or avoidant coping to cope with life in a criminal milieu. Traumatic events were more often described as worsening the lifestyle than as being motives for quitting. Amongst the traumas recounted were ...
Objectives. This longitudinal study focused on 126 long-term heroin users who had never been in s... more Objectives. This longitudinal study focused on 126 long-term heroin users who had never been in specialist treatment for use of any drug. The primary aim of the study was to assess whether this ‘hidden’ population resembled heroin users identified with drug treatment agencies, or alternatively, to test whether heroin could indeed be used in a controlled, non-intrusive fashion for an extended period of time. Design and methods. Recruitment was achieved through chain-referred purposive sampling methods, and data was collected through two semi-structured interviews. 67% of participants were re-recruited for follow-up. Results. Participants had levels of occupational status and educational achievement comparable to that in the general UK population, and considerably higher than typically found in heroin research. At the conclusion of the study, six participants had entered treatment. While there was evidence of intensive risky patterns of drug use among the sample, there was equal evide...
Abstract The purpose of this study was to identify and assess patterns of use and problems associ... more Abstract The purpose of this study was to identify and assess patterns of use and problems associated with prolonged heavy use of cannabis. The strategy for doing so involved comparing heavy long-term users with light long-term users. Considerable variation in the ...
Nmethyl-1-(3,4-methylenedioxyphenyl)-2-butanamine) instead of ecstasy. Mixtures of these substanc... more Nmethyl-1-(3,4-methylenedioxyphenyl)-2-butanamine) instead of ecstasy. Mixtures of these substances with ecstasy as well as with unrelated drugs such as amphetamine, caffeine, and I-phenylethylamine are also encountered. In addition, tablets have been found to contain other, less common, ring substituted amphetamines instead of ecstasy. These analogues may well differ in their neurotoxic potential. Finally, there have been reports of mixtures of ketamine and ephedrine, as well as other substitutes such as mixtures of lysergide (LSD) and amphetamine or of lysergide and ephedrine, being sold as ecstasy. This diverse pharmacological content of tablets may go some way to explaining the variety of symptoms reported among and within users. Not only does it mean that users are exposing themselves to unknown long term effects but it leaves researchers with a problem. Neither the user nor the researcher can be certain what the ingested tablet contained until later analysis. Adverse symptoms, both short and long term, will depend on the interaction between the drug and the individual, which cannot be safely predicted.
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