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Can Safer Drug Use Be More Enjoyable Drug Use?

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The results of the world's biggest drug survey (Global Drug Survey 2014) came out on April 14. The Huffington Post was our U.S. partner in GDS2014 and as they share our findings with you we wanted to add a few thoughts of our own. Three little pieces on drug policy, social norms and alcohol and the first one here on harm reduction and pleasure.

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 paid no attention to their national drinking guidelines. The challenge has always been how do you engage people who use drugs or alcohol for pleasure in a conversation about the harm associated with their use?

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 the 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 emails. 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, whichwas based on tens of thousands of responses weighing up the good, the bad and the ugly things about different drugs. It ranked 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 hundreds of lovely cards and posters and adverts over the years advising people on safer drug use. But we could not find much research on 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 percent 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 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.

Now I am not daft enough to think that any set of guidelines or precautions can make the use of drugs or alcohol completely safe from the risk of problems. And problems there are. From acute toxicity and the risks associated with intoxication related behaviors that everyone who uses drugs is at risk of, to longer term physical complications and dependence that are issues for only minority of users (5-20 percent 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. Maybe talking about pleasure is what we need to do?

Will guidelines that talk about the pleasure associated with the consumption of drugs 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 from GDS2104 and the Highway Code 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 is 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. Bargain!

The Global Drug Survey Highway Code, "the first guide to safer drug use voted for by people who use drugs" was published on April 14, 2014 and is available free here.