Time magazine warns "The World's Most Horrifying Drug May Have Claimed Its First U.S. Victim." The horror of this "new" drug, "krokodil," is that it "eats the skin" of those who use it.
Why would anyone use drugs with all their risks, let alone an untested new drug or a drug that reportedly "eats their skin?" Because the reasons that people use drugs are important to them. People use drugs to get high for various reasons (i.e. to feel good, to forget their troubles, to seek the "truth" or the "divine," for excitement or adventure, or to relieve boredom).They use drugs to ward off "dope sickness" (i.e. prevent withdrawal symptoms). They use drugs to enhance their performance of some task (such as studying, flying an airplane or driving a truck for many hours, or hitting homeruns). And people use drugs to fit in socially (to feel relaxed with strangers or to accommodate peer pressure). However, federal, state and international law recognize "medical use" as the sole legitimate reason one can use a drug (other than tobacco, alcohol and caffeine). These non-medical reasons are compellingly important to the tens of millions of Americans who use drugs knowing that their drug use is against the law and harshly punished. Laws and treaties that limit the legal manufacture of drugs only for medical purposes results in all non-medical drug use being more dangerous because it is unprotected by government or market-based regulation and inspection. Now New Zealand is changing that approach.
The dangerous drug du jour, "krokodil," is a version of desomorphine being made informally in Russia. It is a fast acting narcotic derived from codeine which is extracted from opium poppy. Desomorphine is reported to be 8 to 10 times more potent than morphine.
Codeine is common in over-the-counter medications in Russia, and therefore is readily available to be informally processed into desomorphine using a recipe that requires highly toxic chemicals. The manufacturers' failure to completely remove those chemicals makes the impure compound very dangerous, hence the lovely name, "krokodil." There are lots of reasons to get high in Russia, and those addicted to opiates, always one dose away from becoming "dope sick," have little market power to insist on unadulterated illegal drugs. Of course, all over the world illegal drug laboratories that are run by addicts or criminals are usually low-tech affairs, and product purity is rarely achieved.
For the first part of the twentieth century, the number of drugs available was limited. But by the 1960s, as drug use expanded, the numbers of drugs grew rapidly to include many synthetic drugs, amphetamines and LSD being the best known. When the U.S. Congress adopted the Controlled Substances Act, it banned dozens of obscure compounds, and an entirely new international treaty on "psychotropic substances" was opened for ratification in 1970. In the years since, headlines have trumpeted the imminent hazards of super-dangerous "new" drugs: "ice," "Nazi crank," "Special K," club drugs, "skunk," Salvia, "K2," "Spice," "bath salts," and now, "krokodil." In January 1984, recognizing the inadequacies of so many of the drugs available to get high, Huey Lewis and the News released a catchy hit tune, "I Want a New Drug" that went gold and was a radio hit. A new drug, aside from providing a pleasurable high without unwanted side effects, is not one of the compounds tested for in a drug test that may be required of those persons in the military, on probation or parole, or applying for a job. The wide prevalence of drug testing is a powerful incentive for non-medical drug users to try something new.
In a zeitgeist that fears drugs, "new" drugs are especially scary. On October 12, 1984, President Ronald Reagan signed a law to ban new drugs on an emergency basis. I drafted the language of that law as assistant counsel to the House Crime Subcommittee that spring (Sec. 3 of H.R. 5656, House Rept. 98-835; enacted in Sec. 508 of the Comprehensive Crime Control Act of 1984, P.L. 98-473 (21 U.S.C. 811(h))). The new law was inspired by the paralysis and deaths caused by a botched (and therefore contaminated) new way to produce a synthetic opiate. In retrospect, it is ironic that the new law had nothing to do with crack cocaine, the production of which was rapidly spreading in the U.S. as a new way to make cocaine base.
As a tool to protect the public from the risks of drugs not being used for medical purposes, the prohibition model has not worked well -- for old drugs or new ones. In 1985, the first application of the new power to ban new drugs targeted a drug patented in 1914! The drug, prosaically called ADAM, was practically unknown in America. But as headlined by Time magazine, "Crackdown on Ecstasy," (June 10, 1985), this "new" drug, MDMA, seemed to be exactly what Huey Lewis and the News had been singing about.
Today MDMA is often called "molly," but what is sold as "molly" in dormitories, on the street and at music festivals is nearly universally contaminated, if not wholly lacking in MDMA. The deaths at festivals this summer were attributed to "molly" but the actual toxicology has been irrelevant to the news reports. What the media called "overdoses" were rarely that -- they were outright poisonings by unregulated chemicals pumped out of criminal laboratories around the world. Clearly, unregulated and untested "molly" is a danger to young people.
The drug testing industry reports that in 2012, marijuana was detected more than twice as frequently as the second most frequently detected drug-type, amphetamines. Many of the tens of millions of persons who use marijuana non-medically and face drug tests are tempted to experiment with ostensibly marijuana-like chemicals to both get high and pass the test. These chemicals have no safety testing in humans. While marijuana is not harmless, at least there is an enormous scientific and cultural understanding of how it works and how to minimize its harmfulness. There is no equivalent knowledge for the chemicals marketed as "K2" or "Spice" and disingenuously labeled "Not for human consumption" which contributes to the growth in reported drug-related hospital visits.
The emergence of these drugs -- with a high inferior to that of marijuana and preferable to it solely for being undetectable without special expensive tests -- is another tragic consequence of prohibition. As Congress did in 1984, New York, Louisiana, Virginia and other states are predictably creating new criminal penalties on sale and possession of the new substances. The Obama administration said it is educating the public on the harms of these substances and cooperating in writing new legislation.
However, the nation of New Zealand, facing these problems as well, is now trying a different approach. Because of its relative isolation in the south Pacific and its small population (4.43 million, a little larger than Kentucky, a little smaller than Louisiana), criminal cartels have not had much interest in supplying "conventional" illegal drugs such as heroin or cocaine to New Zealand. Domestically produced drugs, such as methamphetamine, are relatively more common than in other countries. New Zealand had more meth lab raids than any country other than the U.S. and Ukraine.
To address the problems of illegally produced drugs used non-medically, New Zealand is attempting a less prohibitive approach. The government developed the Psychoactive Substances Act" which took effect in July 2013 "to help protect the health of, and minimize harm to, individuals who use these substances." The government will license the production and sale of psychoactive drugs for other than medical purposes.
This new law is rooted in a public health paradigm called "harm reduction." A Psychoactive Substances Regulatory Authority will authorize the sale of drugs for non-medical purposes after determining a drug to be "low-risk" and non-addictive. To sell or manufacture products, licenses must be obtained by this regulatory body. Furthermore, advertising is limited, and a strict age limit, for sale and possession, of 18 and older is imposed. All active ingredients, and any health warnings, must be displayed prominently, alongside the phone number for the local poison control center. Already the law is reported to have reduced the number of outlets selling psychoactive substances from three or four thousand down to 110.
While the legislation will not solve the problems of addiction and overdose with respect to opiates (since non-medical use of them remains illegal), it will substantially limit the risks of poisoning and overdose in the use of the psychoactive compounds which are approved for distribution. Information developed to meet the regulatory requirements will educate the public, first responders, and treatment personnel about the new drugs that are being consumed. Every licensee under the Act is charged with promptly reporting any notice of adverse reactions from the use of the approved psychoactive substances. When people choose to consume synthetic drugs non-medically, they will have confidence that there have been studies of the risks and confidence that the purity of manufacture has been confirmed by government inspection. More profoundly, the government approval and licensing of approved psychoactive products for non-medical purposes is a new legal approach. At last a legislature has enacted a drug law in order to carry out the proper first priority of any drug law: protecting the drug users.
Those who want new drugs -- ones that are low risk -- are advised to keep an eye on what products are approved by New Zealand's Psychoactive Substances Regulatory Authority. And all of us should keep an eye on whether the legalization of non-medical use of psychoactive drugs can be carried out in a manner that protects public health.