Can safer drug use being more enjoyable drug use? The Global Drug Survey Highway Code and almost 80,000 people say ‘yes’.
As the world creaks ever closer to examining whether current drug laws are the best way to minimize the population and individual health impact of substance use it is worth giving a moment’s thought to what advice we could give to users to assist them in minimizing harm. Because even if drugs become regulated they will not be without the risk of harm. And to date, the world has a poor track record in providing harm reduction information on the world’s most popular drug – alcohol. As our research this year showed, most of the 65,000 drinkers who took part in GDS2014 were either unaware of, or pay no attention to national drinking guidelines. The challenge has always been how do you engage people who use drugs in a conversation about harm associated with their use? One difficulty is that you will be having different conversations with different users and the harms they are exposed to will vary widely. The second is that problem use sits on a spectrum from acute toxicity and the risks associated with intoxication related behaviours that everyone who uses drugs is at risk of, to longer term physical complications and dependence that are issues for only minority (5-20% depending on the drug). Predictors for problem use are myriad. While some are constitutional, for the vast majority of people the major risks associated with drug use can be significantly curtailed by adopting certain strategies to minimize risk. But conversations about reducing risks and harm are just not that sexy.
The term harm reduction has been a watch word, nay a mantra for those with common sense in the drug and alcohol field for 30 years. From needle exchanges and methadone to giving out naloxone to injecting heroin users and nicotine patches to try and help people smoke less, its adoption worldwide has saved millions of lives. The fact some people still have a problem with harm reduction and think such actions promote drug use in the face of overwhelming research based evidence saddens me. These people have what is known as ‘evidence resistance’ a virulent and surprisingly potent strain of embedded ignorance. Anyway I never had a problem with promoting reduction of harm. I thought I would never be on anything other than safe ground with this concept, until I started running the Global Drug Survey. I began receiving e-mails. Apparently some people thought I was a drug harm obsessed doctor. They said – why don’t you ask us questions about pleasure? So we did. Following GDS2013 we came up with the Net Pleasure Index, which based on tens of thousands of responses weighing up the good, the bad and the ugly things about different drugs, rated MDMA, LSD and Magic mushrooms as the nicest drugs on balance and alcohol and tobacco as the worst.
Pleasure and drugs went to together naturally and it seemed lots of people had given lots of thought to how to get pleasure from their drugs. In fact compared to harm, pleasure was a rather engaging topic for people who used drugs. And so we wondered what the relationship was between harm reduction and pleasure. We looked around to see if we could find out what people actually did to keep themselves safe. GDS had seen 100s of lovely cards and posters and adverts over the years advising people on safer drug use. But we could not find much research of what people actually did. And there was nothing on how these strategies impacted on drug pleasure. Common sense suggested that if harm reduction strategies took all the fun out of drugs they would not catch on. So we thought we better look into it.
As part of GDS2014 we asked people from around the world to vote on the harm reduction approaches they usually adopted when they used the following drugs: alcohol, cannabis, MDMA, stimulants, ketamine, psychedelics, GHB and new drugs for the first time. For each strategy we asked them if they usually (>50% of the time) did it; we asked them to score it out of 10 for how important it was in reducing the risk of harm and finally to tell us whether using that strategy increased the pleasure they got from that drug, decreased it or had no effect. So we did we find? Well put simply, the vast majority of the strategies adopted by people to reduce harm had either have a neutral or positive effect upon their drug experience. Safer drug use is more enjoyable drug use. It like saying pizzas are good for your diet except it appears to be true.
Are guidelines that talk about the pleasure associated with the consumption going to prove to be an effective approach to help people reduce their risk associated with drug use? I am not sure. But for me the findings confirmed what I already knew, that not only is it OK to talk about drug related pleasure but that it is an absolute necessity if you want to engage people who like using drugs in a dialogue about safer drug use. The early feedback we have received it that people love the GDS Highway Code. If anyone fancies researching the impact of it please feel free to contact me. Until then I am really pleased that I can now start conversations about reducing harm with many of the people I see as a doctor knowing I can sell drug related pleasure as a happy bonus to the harm reduction strategies I suggest.
The Global Drug Survey Highway Code ‘the first guide to safer drug use voted for by people who use drugs’ is available free at www.globaldrugsurvey.com/highwaycode.