UK drug policy

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dyqik
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Re: UK drug policy

Post by dyqik » Wed Sep 08, 2021 12:01 pm

Bird on a Fire wrote:
Wed Sep 08, 2021 9:44 am
It seems like the roots of the US's opioid epidemic were largely to do with its healthcare model. Deliberate promotion of excessive prescription by Purdue and others, doctors financially incentivised to prescribe them, general laissez-faire (lack of) oversight.
AIUI, this is correct. In addition, there's also the US work and benefits model, which essentially doesn't allow paid time off to recover from injuries unless you're in a white collar salaried job. Then there's the balkanization of contract physical work like construction (where sometimes everyone is an independent contractor) means that there's effectively very little health and safety regulation for a lot of blue collar workers, as well as a general attitude of toughing out injuries and not being able to get to a doctor unless it's an emergency room case.

There's also the fact that there are way more chiropractors than physical therapists, with medical licences and the ability to take what health insurance there is for post injury care.

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Re: UK drug policy

Post by Millennie Al » Thu Sep 09, 2021 2:16 am

Bird on a Fire wrote:
Wed Sep 08, 2021 9:44 am
Even if recreational opioids were legalized, I don't think anyone would suggest that doctors should be encouraging patients to take them willy-nilly.
Obviously not. But drugs prohibition has had a severly distorting effect on prescribing. If you could get recreational drugs in the local supermarket as easily as alcoholic drinks, doctors would have no need to worry about having to be a gatekeeper, so they could prescribe whatever works best for the patient without worrying they were faking symptoms to get drugs and without the patient having an incentive to sell their drugs.

The original prohibitionist stance meant that people in pain were denied effective treatment due to fears of addiction. Addressing that by increasing prescription rates moved the problem elsewhere, but didn't fix the fundamental problem, which is the prohibition.
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Re: UK drug policy

Post by Woodchopper » Thu Sep 09, 2021 7:41 am

Millennie Al wrote:
Thu Sep 09, 2021 2:16 am
Bird on a Fire wrote:
Wed Sep 08, 2021 9:44 am
Even if recreational opioids were legalized, I don't think anyone would suggest that doctors should be encouraging patients to take them willy-nilly.
Obviously not. But drugs prohibition has had a severly distorting effect on prescribing. If you could get recreational drugs in the local supermarket as easily as alcoholic drinks, doctors would have no need to worry about having to be a gatekeeper, so they could prescribe whatever works best for the patient without worrying they were faking symptoms to get drugs and without the patient having an incentive to sell their drugs.

The original prohibitionist stance meant that people in pain were denied effective treatment due to fears of addiction. Addressing that by increasing prescription rates moved the problem elsewhere, but didn't fix the fundamental problem, which is the prohibition.
The likelihood of people becoming addicted is a concern. But as far as I’m aware the main public health reason for restrictions on access to opioids is the risk of accidental overdoses.

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Re: UK drug policy

Post by tom p » Thu Sep 09, 2021 8:06 am

Woodchopper wrote:
Thu Sep 09, 2021 7:41 am
Millennie Al wrote:
Thu Sep 09, 2021 2:16 am
Bird on a Fire wrote:
Wed Sep 08, 2021 9:44 am
Even if recreational opioids were legalized, I don't think anyone would suggest that doctors should be encouraging patients to take them willy-nilly.
Obviously not. But drugs prohibition has had a severly distorting effect on prescribing. If you could get recreational drugs in the local supermarket as easily as alcoholic drinks, doctors would have no need to worry about having to be a gatekeeper, so they could prescribe whatever works best for the patient without worrying they were faking symptoms to get drugs and without the patient having an incentive to sell their drugs.

The original prohibitionist stance meant that people in pain were denied effective treatment due to fears of addiction. Addressing that by increasing prescription rates moved the problem elsewhere, but didn't fix the fundamental problem, which is the prohibition.
The likelihood of people becoming addicted is a concern. But as far as I’m aware the main public health reason for restrictions on access to opioids is the risk of accidental overdoses.
Yes, both are significant issues.
The therapeutic window with many opioids is far less than with alcohol.
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Re: UK drug policy

Post by shpalman » Thu Sep 09, 2021 9:48 am

Woodchopper wrote:
Thu Sep 09, 2021 7:41 am
Millennie Al wrote:
Thu Sep 09, 2021 2:16 am
Bird on a Fire wrote:
Wed Sep 08, 2021 9:44 am
Even if recreational opioids were legalized, I don't think anyone would suggest that doctors should be encouraging patients to take them willy-nilly.
Obviously not. But drugs prohibition has had a severly distorting effect on prescribing. If you could get recreational drugs in the local supermarket as easily as alcoholic drinks, doctors would have no need to worry about having to be a gatekeeper, so they could prescribe whatever works best for the patient without worrying they were faking symptoms to get drugs and without the patient having an incentive to sell their drugs.

The original prohibitionist stance meant that people in pain were denied effective treatment due to fears of addiction. Addressing that by increasing prescription rates moved the problem elsewhere, but didn't fix the fundamental problem, which is the prohibition.
The likelihood of people becoming addicted is a concern. But as far as I’m aware the main public health reason for restrictions on access to opioids is the risk of accidental overdoses.
But didn't we get here via a link which said that deaths by overdose were increasing?
molto tricky

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Re: UK drug policy

Post by IvanV » Thu Sep 09, 2021 1:50 pm

tom p wrote:
Thu Sep 09, 2021 8:06 am
... but if I try and drink myself to death, I'll puke it all up first
Is it a lucky feature of being Tom P that you are have a self-protection system against dying of acute alcohol poisoning? Unlike the
530 people who died of acute alcohol poisoning in the UK in 2018?

I've been very aware of the risk of alcohol poisoning since a fellow school student I was sharing a room with on a school choir tour got hold of a half litre of whisky and drank most of it very quickly, and now appeared to be in a very bad way. There's 20 units in half a litre, so he'd had at least 16 in less than an hour. I came into the room just as some others were separating him from the rest of the bottle and were wondering if it was safe to keep this situation concealed from the teachers. Fortunately we did immediately go and get the teachers, who sought the medical attention he needed.

According to the NHS advice on alcohol poisoning, you are at severe risk of developing alcohol poisoning beyond just 12 units. So if you have more than about 300ml of 40% spirits in your house, or equivalent, you have the materials on hand to give yourself acute alcohol poisoning.

I suppose I have the lucky feature that I don't like feeling drunk and so usually stop well before any short term ill-effects.

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Re: UK drug policy

Post by tom p » Thu Sep 09, 2021 2:08 pm

IvanV wrote:
Thu Sep 09, 2021 1:50 pm
tom p wrote:
Thu Sep 09, 2021 8:06 am
... but if I try and drink myself to death, I'll puke it all up first
Is it a lucky feature of being Tom P that you are have a self-protection system against dying of acute alcohol poisoning? Unlike the
530 people who died of acute alcohol poisoning in the UK in 2018?

I've been very aware of the risk of alcohol poisoning since a fellow school student I was sharing a room with on a school choir tour got hold of a half litre of whisky and drank most of it very quickly, and now appeared to be in a very bad way. There's 20 units in half a litre, so he'd had at least 16 in less than an hour. I came into the room just as some others were separating him from the rest of the bottle and were wondering if it was safe to keep this situation concealed from the teachers. Fortunately we did immediately go and get the teachers, who sought the medical attention he needed.

According to the NHS advice on alcohol poisoning, you are at severe risk of developing alcohol poisoning beyond just 12 units. So if you have more than about 300ml of 40% spirits in your house, or equivalent, you have the materials on hand to give yourself acute alcohol poisoning.

I suppose I have the lucky feature that I don't like feeling drunk and so usually stop well before any short term ill-effects.
You're right.
I should have put "probably" in there. As happened to me many times when I was young and foolish.
Seriously, though, given the number of drinkers in the UK (a quick googling suggests 70% of >18s have drunk alcohol in the past year, which translates as ~48 million people) the risk of death by acute alcohol poisoning is approx. 1.25 in 100k.
When you consider how many students and twenty-somethings drink ludakrisly excessive amounts repeatedly, that's pretty low.
ETA: I should say that 12 units, or 6 pints, would have been a warm-up for me at one point.

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Re: UK drug policy

Post by Bird on a Fire » Thu Sep 09, 2021 3:38 pm

12 units is only 4 pints of 5.2% beer/cider. I wouldn't want to operate machinery or owt after that point but it'd hardly be "acute poisoning". Unless you inject it or something I guess.

Presumably discussion of therapeutic windows needs to consider individual tolerance. AIUI the highest risk of overdose comes when former users relapse and take their former standard dose, not realising that their tolerance has since declined massively.
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Re: UK drug policy

Post by JQH » Thu Sep 09, 2021 5:10 pm

Isn't there also the issue of street drugs being of highly variable quality. So if your drug of choice normally contains 10% Active Ingredient but you get hold of some that is (unknown to you) 30% the risk of ODing is much greater.
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Re: UK drug policy

Post by tom p » Thu Sep 09, 2021 6:20 pm

both of the above posts are true.
Therapeutic windows in medicine definitely do consider the dose per kg and potential tolerance, which is why opioids really are more risky than booze and why there's a good reason they are, and should always be, more controlled.
Most non-opioid drugs, however, I think should be legalised, in the main. Dose controlled, age controlled and taxed.

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Re: UK drug policy

Post by Millennie Al » Fri Sep 10, 2021 1:21 am

tom p wrote:
Thu Sep 09, 2021 6:20 pm
both of the above posts are true.
Therapeutic windows in medicine definitely do consider the dose per kg and potential tolerance, which is why opioids really are more risky than booze and why there's a good reason they are, and should always be, more controlled.
Most non-opioid drugs, however, I think should be legalised, in the main. Dose controlled, age controlled and taxed.
If you're worried about overdose, you should be worried about paracetamol, which can cause harm at levels very close to the common theraputic dose of 4g in 24h - especially where the dose is sustained over many days. But that's freely available in supermarkets.
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Re: UK drug policy

Post by tom p » Fri Sep 10, 2021 7:37 am

Millennie Al wrote:
Fri Sep 10, 2021 1:21 am
tom p wrote:
Thu Sep 09, 2021 6:20 pm
both of the above posts are true.
Therapeutic windows in medicine definitely do consider the dose per kg and potential tolerance, which is why opioids really are more risky than booze and why there's a good reason they are, and should always be, more controlled.
Most non-opioid drugs, however, I think should be legalised, in the main. Dose controlled, age controlled and taxed.
If you're worried about overdose, you should be worried about paracetamol, which can cause harm at levels very close to the common theraputic dose of 4g in 24h - especially where the dose is sustained over many days. But that's freely available in supermarkets.
I'm afraid that this is not entirely accurate.
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Re: UK drug policy

Post by Woodchopper » Fri Sep 10, 2021 9:33 am

Also, as far as I know, paracetamol isn’t used recreationally.

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Re: UK drug policy

Post by tom p » Fri Sep 10, 2021 1:09 pm

Woodchopper wrote:
Fri Sep 10, 2021 9:33 am
Also, as far as I know, paracetamol isn’t used recreationally.
I suppose one might argue its use for hangovers counts as recreationally, or at least as a post-hoc facilitator of recreational mild alcohol overdosing.

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Re: UK drug policy

Post by Gfamily » Fri Sep 10, 2021 1:28 pm

tom p wrote:
Fri Sep 10, 2021 1:09 pm
Woodchopper wrote:
Fri Sep 10, 2021 9:33 am
Also, as far as I know, paracetamol isn’t used recreationally.
I suppose one might argue its use for hangovers counts as recreationally, or at least as a post-hoc facilitator of recreational mild alcohol overdosing.
I know of one family where the teenagers put the paracetamol in the 3 litre bottles of cider before they started.
They were sent-feral, but good people, just a bit stupid totally ignorant of the risks.
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Re: UK drug policy

Post by IvanV » Fri Sep 10, 2021 1:38 pm

tom p wrote:
Fri Sep 10, 2021 7:37 am
That's why in the UK pack sizes are limited to 16, so that someone has to deliberately want to use paracetamol to top themselves
Wondering why the last one I got had 32, I discover...

Pack size available on open shelf is limited to 16.

You can get a pack of 32 from the pharmacy counter. And that's been temporarily increased to 100 during the pandemic.

I think the 12 units comment on alcohol poisoning is more relevant if it's spirits you are on, rather than more voluminous fare. Such as Dylan Thomas mentioned in Under Milk Wood, the "seventeen pints of flat, warm, thin, Welsh, bitter beer" that Cherry Owen had at the Sailors Arms, plainly a reference to his own drinking feats at Brown's Hotel in Laugharne.

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Re: UK drug policy

Post by tom p » Fri Sep 10, 2021 1:50 pm

IvanV wrote:
Fri Sep 10, 2021 1:38 pm
tom p wrote:
Fri Sep 10, 2021 7:37 am
That's why in the UK pack sizes are limited to 16, so that someone has to deliberately want to use paracetamol to top themselves
Wondering why the last one I got had 32, I discover...

Pack size available on open shelf is limited to 16.

You can get a pack of 32 from the pharmacy counter. And that's been temporarily increased to 100 during the pandemic.

I think the 12 units comment on alcohol poisoning is more relevant if it's spirits you are on, rather than more voluminous fare. Such as Dylan Thomas mentioned in Under Milk Wood, the "seventeen pints of flat, warm, thin, Welsh, bitter beer" that Cherry Owen had at the Sailors Arms, plainly a reference to his own drinking feats at Brown's Hotel in Laugharne.
True about the units being more relevant with spirits (after all, Thomas' last words were reputedly "I've had 18 straight whiskies...... I think that's the record."); however they, of course, have an immediate physical impact that inhibits imbibing by most people, unlike stronger opioids. My mouth would have no idea if I was taking 5mg codeine or 150mg oxycontin, which is another reason why opioids are more dangerous than alco-ma-hol

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Re: UK drug policy

Post by Opti » Fri Sep 10, 2021 2:18 pm

Anecdote alert: From me, a serious multi-drug user during the late 60's to late 70's.

Before the Misuse of Drugs Act 1971, drugs were a smallish sub-culture. There was no-one selling to kids, to get drugs you had to make an effort to get an 'in'. You had to be vetted as trustworthy.
Heroin was available, but only if you got someone's excess from their script. If you got a habit by that route, you could also get a script from a doctor or from a clinic. There were a few in London. If you wanted coke, you had to know someone - or someone who knew someone who worked at the Peruvian Embassy. Weed or hash came mostly from young travellers you knew coming back from producer countries. Or some bloke you'd got trusted by round Ladbroke Grove or other select areas. Acid was ubiquitous. It was a very self-contained scene.
Junkies generally quit after 5-6 years. But managed to hold down responsible jobs. Mostly.

Then came said Act. If you had a smack habit you had a real problem. Months waiting for consultations to end up being given a reducing dose of Methadone. Which wasn't what people were addicted to, nor what they wanted.
The War on Drugs.
Then a massive black market emerged, there was 'brown' on the street, fewer pharmaceuticals available from chemist break-ins, the lot.

Probably just coincidental, mind.

There was also a spectacular News of the World shock article in maybe 1966,67 about the terrible world of popular musicians and the stuff they got up to. Which to me sounded like fun.
Time for a big fat one.

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Re: UK drug policy

Post by Woodchopper » Fri Sep 10, 2021 3:14 pm

Gfamily wrote:
Fri Sep 10, 2021 1:28 pm
tom p wrote:
Fri Sep 10, 2021 1:09 pm
Woodchopper wrote:
Fri Sep 10, 2021 9:33 am
Also, as far as I know, paracetamol isn’t used recreationally.
I suppose one might argue its use for hangovers counts as recreationally, or at least as a post-hoc facilitator of recreational mild alcohol overdosing.
I know of one family where the teenagers put the paracetamol in the 3 litre bottles of cider before they started.
They were sent-feral, but good people, just a bit stupid totally ignorant of the risks.
Fair enough, but still, people aren’t doing paracetamol as a form of recreation. It’s more that it facilitates it.

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Re: UK drug policy

Post by nezumi » Sat Sep 11, 2021 8:23 am

Opti wrote:
Fri Sep 10, 2021 2:18 pm


There was also a spectacular News of the World shock article in maybe 1966,67 about the terrible world of popular musicians and the stuff they got up to. Which to me sounded like fun.
Funnily enough, I too was persuaded to do drugs by anti-drug propaganda. It was a Rik Mayall video - "Out of my Head". Brilliant watch if you haven't seen it.
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