The NHS this week announced the opening of the UK’s first ever club drug clinic to treat the increase in users with problems with newer drugs mephedrone, ketamine, GHB and GBL whose effects are harder to deal with.

Opening in Chelsea and Westminster Hospital the clinic hopes to give advice, and treatment to the many young people who have developed damaging drug habits n substances that are less well catered for by established addiction treatment centres. More importantly the centre can also be used to conduct valuable research into the long term effects of drugs that the world has very little experience of. The increase of drug derivatives has meant that although many of the new designer drugs work on the same types of receptors in the brain, the ways in which they are metabolised, the sub-classes of receptors they hit and the ways in which the drugs interact with the rest of the body can be wildly different from their parent compound.

GHB and GBL are a classic example of the after effects of criminalisation. GHB was used in the rave scene of the 1990’s, low doses caused euphoria and enhanced the effects of other drugs. In 2000 use of the drug rose dramatically with 3% of clubbers having tried it in 1999 and 26% a year later. It was also used in a number of high profile date-rape cases and was banned in 2003. Very quickly users turned to the legal GBL, this is a precursor to GHB and is metabolised into the active form in the cells of the users. However the properties of GBL mean that it is absorbed far faster into cells than its parent so paradoxically has a stronger onset than the drug it is broken down to making it far more dangerous. Some users of the drug have to resort to a 24/7 dosing regime to avoid the crippling and sometimes life threatening withdrawal symptoms. GBL itself was criminalised in 2009. 1,4 butanediol and GVL represent other legal, yet more toxic GHB precursors that have been found used as recreational drugs.

Ketamine was developed in the early 60’s when looking for a better anaesthetic than PCP. It was rolled out on American troops in Vietnam as it reduced pain, didn’t suppress breathing like opiates and there were no allergic reactions. It has remained a popular medical tool since, if you are involved in a car crash you will likely be given ketamine by the paramedics, although this will be a purified isomer that causes less of the hallucinatory effects associated with recreational use. The problems with the drug only become apparent with long term, high dose use. When users take over a gram of the drug a day the body becomes unable to efficiently remove it, the drug reaches a high concentration in the bladder and causes permanent damage.

Mephedrone was first synthesised in 1929 but was largely ignored until its re-discovery in 2003. Within 4 years online retailers of the drug had set up shop and began distributing vast amounts of mephedrone across the world, bypassing drug control laws by selling it as a “not for human consumption” plant fertiliser. By 2009 many in the UK had cottoned on to the huge profits that could be made selling the drug, buying a kilogram could reap a profit of £7,500, suddenly the UK was swamped with mephedrone. Use spiked massively as many young people were attracted to the legality and low price, for a while making it a popular “entry level” narcotic. After the British press falsely reported a number of deaths were caused by mephedrone, (most had a number of other drugs in their system or were involved in traffic accidents) the government banned the substance. Use dropped but remained at a steady rate as the criminal underworld began to respond to the demand.

The problem with criminalising drugs to prevent their use is that it ignores the most basic principles of economics. The demand for mind altering drugs is relatively inelastic, and will remain about constant from generation to generation. Governments find this very hard to tackle as it requires education and treatment and there is a lot of political capital to be had in appearing to be “hard on drugs”. What results is campaigns like “just say no” which brands drug use as a one way ticket to a life of criminality and death soon afterwards. Anyone with a brain can see through the propaganda and the whole message is invalidated. Treatment for addiction is also difficult as the average tax-payer hates spending money on such wasters.

What is easier for the government to target is the supply of drugs. When a huge shipment of cocaine is stopped from entering the UK, with demand stable, price goes up and purity goes down. For the average recreational user the drop in purity means that their drug is more likely to be cut with other drugs or adulterants meaning more deaths and hospital admissions. The addicts, whose only aim in life is to get their dose, now need more money to support their habit, which leads to robbery, burglary and prostitution. The extra cash in the hands of dealers and organised criminals can be re-invested in buying guns and financing major crime. In the crowded drugs market-place any arrest and seizure of drug shipments causes a gap in the market which is quickly filled by other smugglers and dealers.

These effects were seen immediately after the banning of mephedrone, the price nearly doubled and the drug previously known for its purity began to be cut with other substances. The supply network of the drug proved very sophisticated, it quickly became apparent that retailers had been planning on the drug being made illegal and had actively been stockpiling derivatives. Days after bans kicked in across Europe the same retailers began selling A3A, MDAI, naphyrone and others taking advantage of the media coverage around the ban to maximise their sales. In survey done after the ban 75% of the people with experience of the drug said that they continued to use it.

Criminalisation of drugs obviously has its problems, but I’m not so sure legalisation is the solution either. The problem comes when you think about what would happen to demand after drugs became legal. If the demand remained constant or at least only slightly then the savings made in not having to deal with drug related crime, gang war and being able to dedicate police forces to more productive work would far outweigh the medical and social care costs. However there is the danger that drug usage would rapidly spiral out of control and the cost of treating all the addicts would nullify any gains. I guess its a difference of opinion.

What certainly isn’t helpful is their attitude that drugs are one hundred percent bad for you. It ignores the many potential benefits, like recent research into ecstasy derivatives that kill breast cancer cells or treatment of Post Traumatic Stress Disorder with MDMA. Did you know that paracetamol’s analgesic effects are due to its metabolism in the body to AM-404 which increases the amount natural cannabinoids in your brain?

It is a shame that politicians are so liable to stamp down on any progressive drug policy out of instinct, or else they might consider listening to scientists and sociologists to actually help drug users instead of using the law punish them to the extent where more drugs are the only way they’ll forget their problems.

And a little extra reading:

Club drug clinic opens its doors - Sarah Boseley for The Guardian

Supplement on drug recovery - National Treatment Agency for Substance Misuse for The Guardian

Supply Side Drug Policy: Will it ever work? - Robert Stonebraker

Photo by Flickr user Valerie Everett.