One of the most important things when taking drugs of any sort is to be well educated on their possible risks and complications and to use that information to make your use as responsible and safe as possible. Unfortunately, much of what we’re taught about drugs from school or public education campaigns is fear-based or in support of abstinence rather than education and harm reduction, reducing the accessibility of credible information about drugs.

This week, I decided to share some important harm reduction information for MDMA usage. This substance is quite widely used among college and university students. I’ve written about its therapeutic benefits in the past, but it’s important to also talk about its risks.

One of the difficulties in discussing MDMA use is that, in many cases, people have no certainty that what they’re taking is in fact MDMA. For example, it’s not uncommon for methylone or MDA to be sold as MDMA or for other stimulants to be mixed with it. This is one of the things that makes purchasing drugs from someone at an event and taking it that night dangerous—you have no opportunity to verify the identity of what you’ve purchased.

To verify the identity of your drugs, it’s recommended that you purchase a testing kit. This is a collection of solvents that can be dripped onto a small sample, and the resulting colour change will help you in identifying the substance. You can purchase testing kits from DanceSafe, a harm reduction organization made up of members of the electronic music community.

Before taking a full dose for the first time, it’s recommended that you first take a quarter dose (approximately 20-30 mg), sometimes called an “allergy test.” The reason for this is that a portion of the population has a deficiency in a liver enzyme involved in processing MDMA and other drugs. This is called “fatty liver disease” and often goes undiagnosed. The impaired metabolism of MDMA results in far stronger effects at dosages that are normal for others and the likelihood of overheating or overdose is increased.

Pure MDMA is a rather safe substance with a significantly better safety profile. than alcohol, tobacco, or cannabis. Nonetheless, important points to discuss surrounding the risks of MDMA include overheating, dehydration and overhydration. Deaths and serious harm resulting from MDMA use are quite rare in proportion to how much it is used. Overdoses can and do occur, but many complications of MDMA use are often due to preventable situational factors such as not having taken breaks to cool off or drinking too little (or too much) water.

Keep up-to-date with drug policy developments by subscribing to the IDPC Monthly Alert.

A guide to MDMA harm reduction

Drug mules were barely out of the UK news in 2013. First the “Peru two”, Melissa Reid from Scotland and Michaela Connolly from Ireland, were arrested attempting to leave Lima with just under 12kgs of cocaine. They claim they were coerced into carrying drugs by a gang they fell in with while on holiday in Ibiza.

Then, in August 2013 Lindsay Sandiford’s appeal against the death sentence was rejected. She was arrested in Bali in May 2013 with just under 5kgs of cocaine. She also claimed that she was forced to carry drugs due to coercion and threats of violence against her family. She is currently on death row and will have one year in which to apply for clemency.

Neither Lindsay Sandiford, nor Melissa Reid and Michaela Connolly are “typical” alleged drug mules (if there is such a thing) - the majority of those arrested with drugs at national borders are men, whose arrest seldom attracts national attention. Everyone who researches drug trafficking finds accounts of coercion and threats yet this is the exception rather than the norm. In fact most become involved voluntarily, motivated by poverty and financial difficulties.

Keep up-to-date with drug policy developments by subscribing to the IDPC Monthly Alert.

Five myths about drug mules and the death penalty

2015 is looking like it could be a watershed year for global health. As the United Nation’s millennium development goals come to fruition, and we move towards a post 2015 sustainable development goals model, there will no doubt be much reflection on where we’ve collectively succeeded—and failed.

There has been much talk in recent years about the beginning of the “end of AIDS,” and we certainly have seen incredible successes, such as the roll-out of antiretroviral drugs (ARVs) to some 14 million people. This has transformed HIV from a death sentence into a chronic and manageable disease—for those on treatment.

However, we’d do well at this juncture to reflect on a parallel but very different reality. Some 20 million people still do not have access to ARVs and so many of them are from the populations most affected: men who have sex with men, sex workers, transgender people, migrants, and people who inject drugs.

We are failing all of these people, but the clearest case of our inability to implement tried and tested science is that of people who inject drugs.

We have known for three decades that in settings where comprehensive harm reduction interventions—such as methadone, buprenorphine, and needle and syringe programmes—have been implemented, HIV rates among people who inject drugs are low—in some cases negligible. This was the primary reason that injection driven HIV epidemics in cities such as London, Glasgow, New York, Sydney, Amsterdam, and Berlin were avoided when AIDS first surfaced in the early 1980s.

Leading on harm reduction after 2015

The aim of the centres, where users are given clean needles to use in a supervised environment, is to get drug addicts into treatment while keeping the streets safe for the general public.

The idea was proposed 16 months ago by the former Lord Mayor Oisin Quinn, but was quickly shot down on the basis that it is illegal to possess banned substances.

However, the Herald can reveal that the Ana Liffey Drug Project and the Voluntary Assistant Scheme (VAS) of the Bar Council of Ireland have been working together since last summer on draft legislation which would finally allow for the operating of the centres.

Radical legislation to allow for supervised injecting centres for heroin users in Ireland

The conclusions of a recent report from Release and the London School of Economics and Political Science into the enforcement of drug laws in England and Wales are blunt and make for depressingly familiar reading:

Black and Asian communities have lower rates of illegal drug use than the white majority.

, enforcement of drug laws is unfairly focused on these communities.

Black and Asian people are stopped and searched for drugs at a much higher rate than white people.

Black people are subject to harsher sanctions for drug possession offences.

The report is based on analysis of official statistics provided by the MoJ and the Metropolitan police for 2009/10. and is written by Niamh Eastwood, Director of Release and Michael Shiner and Daniel Bear from the LSE.

Drug laws drive racism in the justice system

Drugreporter has for some time now been hearing rumours of the possible decriminalisation of drug use in Slovakia. Unlike the Czech Republic (the country with which it was previously joined, famous for its liberal drug policy) this central-European country has until now remained one of the shrinking number of EU countries which punish simple drug possession with imprisonment.

Slovak media have reported on the proposed decriminalisation of illicit substances several times over the past two years. According to this news, the new law would end imprisonment for possession of small amounts of illicit drugs. Possession of small amounts would instead become a simple misdemeanour. This would apply to all substances presently listed as illicit.

Slovakia heading towards full decriminalisation

The International Doctors for Healthier Drug Policies (IDHDP) is deeply concerned about the proposed scheduling of ketamine. This would cause considerable harm by greatly restricting its availability, especially in the developing world.

Ketamine is a uniquely useful anaesthetic, particularly in settings where even the most basic western medical facilities are unavailable as in much of the developing world. This notwithstanding, China has proposed scheduling ketamine under the UN drug treaties which would restrict its availability. Despite the World Health Organisation’s (WHO) advice against this scheduling, countries coming together for the UN Commission of Narcotic Drugs’ (CND) meeting in Vienna (9-17 March) will decide on 13 March whether or not to schedule ketamine. Scarcity or unavailability of ketamine risks a global crisis in essential surgery

As the Swiss delegation in Vienna pointed out last Monday “millions of surgical interventions are done with ketamine every year. Obstructed liver, birth defects, cancer, acute abdominal conditions, burns, industrial injuries and traffic accidents are among some of the emergencies where ketamine is used.”

Ketamine is the only anaesthetic, which can be used in regions where the power supply is often interrupted. When this happens, oxygen and ventilation equipment do not work. Ketamine is administered intravenously or intramuscularly in places where these full facilities are not available or in emergencies case if the patient is not prepared for anaesthesia with inhalants. Ketamine provides very good analgesia and can also be used as a sedative for physically painful procedures in emergency departments and emergency surgery in field conditions (such as in war zones).

Medical doctors agree that ketamine is a very safe anesthetic. Dr Chris Kinchin (England) recalls that he used ketamine regularly while working as an anaesthetist in the UK during the late 1970s. He always found it to be very effective as it did not tend to compromise the airway in the same way as conventional anaesthetics. “Restriction of its use could well mean that more dangerous forms of anaesthesia might have to be used in developing countries”

Dr Dinesh Ch Goswami, Secretary cum CEO, Guwahati Pain and Palliative Care Society (India) reminds us that ketamine is used in North East India for anaesthetic purposes and also for control of neuropathic pain. He urges member states to not schedule ketamine.

Ketamine is also a key medicine to treat patients who have a history or risk of opioid-dependence. Dr. Alex Wodak AM, Emeritus Consultant, Alcohol and Drug Service, St Vincent's Hospital (Australia), states that by using ketamine (as a coanalgesic) in surgical cases, say involving multiple fractures, or in painful conditions such as osteomyelitis, it allowed Australian doctors to improve pain relief with lower doses of opioids. This reduces the risk of opioid side effects including drowsiness, constipation and dependence. This was useful in all patients but particularly patients with a long history of injecting heroin (or other opioids) and severe dependence. Patients with say, septic arthritis as a complication of injecting, are similar.

Ketamine is also the main stay in veterinary anaesthesia and wild-life conservation. Veterinarians apply it like human physicians, but also (using a dart gun) to immobilize dangerous animals like a rabid dog. In the same way it is used in wild-life conservation for hanging a collar band with a transmitter on elephants and other animals.

Many rural areas of developing countries have already suffered from the restrictive availability of morphine leading to millions of people dying in agony from chronic illnesses. As Willem Scholten PharmD MPA, IDHDP board member, points out “Scheduling ketamine will leave them with no alternative anaesthesia for essential surgery, and will further deepen the already acute global crisis of surgery.”

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