I went to a talk by Rick Doblin, the head of the Multidisciplinary Association for Psychedelic Studies, who has bachelor’s in psychology and a PhD in public policy. MAPS’s main project is the use of MDMA combined with talk therapy to treat post-traumatic stress disorder in a small number of sessions.

Doblin had some interesting things to say about strategy. He pictures a progression in treatment groups from the most politically valuable to the least:

• Veterans of Iraq and Afghanistan Wars, police and firefighters
• Sexual assault victims
• Terminal cancer patients
• Couples therapy (the original therapeutic use of MDMA)
• Individuals doing self-therapy for emotional issues or spiritual enlightenment (this will effectively require full legalization)

Doblin thinks MDMA is cognitively simpler than hallucinogens and therefore easier to use in therapy. The idea is to get it accepted by the therapeutic community and then introduce other psychedelics. And then once drugs have a history of safe therapeutic use we can start talking about legalization.

The DrugMonkey blog had a lot of criticism of the lack of rigor in MAPS’ initial exploratory testing. Now that they’re seeking US Food & Drug Administration approval, their experimental design has been beefed up:

• MAPS has developed a specific talk therapy protocol to be used with the MDMA. Therapy sessions are recorded and then scored by observers for adherence to the protocol.
• They’re comparing between patients who randomly receive one of three different doses: 25 mg, 75 mg and 120 mg. And then giving low-dose patients the opportunity to repeat the intervention with a higher dose.

The great comment (slightly edited) below was made on BoingBoing in response to this security fog warning:

This is actually just one component of a larger security scheme.

The fog contains a debilitating chemical, 3,4-Methylenedioxymethamphetamine.

At the same time that the fog is dispensed, the building lights flash on and off to attract the attention of nearby security patrols. Grids of lasers sweep through the area, to pinpoint where in the fog the perpetrators are.

Meanwhile, incredibly loud, pulsating music plays from hidden speakers to disorient the intruders and prevent them from communicating. A recorded voice instructs the intruders to put their hands in the air (to show law enforcement that they are unarmed) and then repeats the command: “get down, get down, get down”.

Evidence-based drug policy should discourage use of dangerous, highly-addictive drugs. But the War on Drugs has provided economic incentives for the discovery and marketing of stronger drugs:

• opium → heroin
• cocaine → crack
• speed → meth

This continues with the growing popularity of desomorphine as a heroin substitute in Russia.

Opioid replacement therapy is an example of steering existing addicts to safer drugs; it is usually done with methadone in Canada, although other opiates are used elsewhere and there are good arguments for prescribing medical-grade heroin instead of a substitute drug. There is some evidence that cocaine users voluntarily switched to mephedrone until it was banned in the UK.

Drug policy should also prevent drug users from using the more dangerous drugs in the first place. New drugs and recipes are distributed using the network for existing drugs, and a diversified product line makes drug dealing more economically viable. Given the failure of prohibition, safer drugs, like marijuana, opium, coca leaves, mephedrone and speed, should be legalized with appropriate regulation (more on that in another post). Benefits include:

• fragmenting the organized black market
• discouraging legal drug users from gatewaying to dangerous still-illegal drugs
• bring abusers of the newly legal substances into the open where they can be treated
• reduce incentives for discovering new drugs
• reduce issues in opium- and coca-exporting countries

Yesterday was the 90th anniversary of the repeal of prohibition in BC (by referendum). Fans of alcohol in Vancouver celebrated by getting drunk and having a riot. And that, precisely, is why I think prohibition was good policy.

Alcohol is a hell of a drug with a significant cost to society. Heavy alcohol use has a higher direct health cost than most other drugs and alcohol is unique in its ability to cause injuries, particularly motor vehicle accidents. Because of its legal status, alcohol has free reign to cause domestic breakdown and poor job performance.

The problems with prohibition are that:

• it was not implemented consistently: many speakeasies continued to operate and the wealthy could easily access smuggled alcohol
• it was implemented only through regulation: the government did not make an effort to convince people to lower their demand for alcohol both before and after the ban
• no substitutes were available

The last two points get at the crux of the problem: alcohol is both traditional and vital to our culture. Successfully banning alcohol would require widescale cultural change, cultural engineering if you will. Given that many cultures throughout history have practiced intoxication, it seems that humans might have an inherent desire that would be easier to satisfy with a safer alternative drug than suppress completely. David Nutt, the ex British drug czar, is working on an alcohol substitute based on benzodiazepines (eg: Valium).

I believe that reducing alcohol abuse is an important public goal that the government should be willing to use radical means to achieve.

Well, not new, but new to me. It’s one of those brutally atheist-socialist-existentialist ones:

I’ve been following the Charlie Sheen saga with half an ear. My lay take on this is that he is incredibly sick and, unfortunately, has the means and mouthpiece to psychically, violently explode, publicly across the worldwide media.

Imagine if you were fevered to the point of hallucination and then were interviewed on national television. If someone cut together clips of all your craziest locutions and worst-lit photos how sane would you appear?

What I’m saying is: remember that the media is profiting of the public destruction of a specific human being here. They’re running a carnival freak show for people to point and laugh at as did Victorian insane asylums.

My watchword in the Sheen saga is compassion, and I take it all with a healthy dose of respect for the editorial distortion power of media. Here’s Drew pop-psych opinion (he’s not a psychologist):

Some researchers at UBC have brought Canadian media’s attention to the fact that Google search results in the US are rigged. The US National Institute of Health, a government agency, has a deal with Google to place their pages of drug information at the top of searches. Google displays the NIH hit as an “organic” result, below the AdWord results for that search.

This particular issue is unlikely to undermine many users’ confidence in Google’s results. AdWords results are still featured higher, so a side-effect of this policy is a transfer of wealth from pharmaceutical companies to Google. The Institute of Health’s pages are not always up-to-date, because updates to them must be submitted through some bureaucratic maze.

The UBC researchers found that on Google Canada, the top hits for brand names tend to be the websites of US pharmaceutical companies while generic names get Wikipedia. Wikipedia’s information on drugs is often incomplete, although the actual research paper is more optimistic about Wikipedia’s quality improving than the Canadian journalists summarizing it.

My take is that the Institute of Health is messing with the Internet and could be considered to be vaguely censoring*. The correct government policy is to pour resources into improving the Wikipedia articles. Wikipedia is the market leader for providing unbiased information, so using Wikipedia to inform the public is a form of alternate service delivery. The government doesn’t even need a contract because Wikipedia’s already open to government input and can serve as a platform for engagement with other active stakeholders.

How would Wikipedia change if it became important for providing public services? The government could donate to the Wikimedia Foundation to make sure the lights stay on. Government editors could vote for government representatives on the Board of Trustees and start influencing Wikipedia’s editing policies to work in their favour.

* Not that there’s anything wrong with censoring drug companies in the public interest: I want peace, order and good government, not free speech.

One of the bennies of partying in Ottawa: last night a policy analyst at Health Canada told me salvia is on the road to becoming scheduled, but you still have like a year to shatter your reality on it, over-the-counter.

I’ve been looking for bits of this article to copy, but it’s all pretty golden. Here’s the leading contradiction, but it just gets better (in the sense that it lays out my political views exactly):

Bob Ainsworth, the MP for Coventry North East, who previously served as a drugs minister in the Home Office and as defence secretary, has claimed that the war on drugs has been “nothing short of a disaster” and that it was time to study other options, including decriminalising possession of drugs and legally regulating their production and supply.

His comments were met with dismay by the party leadership, while fellow backbencher John Mann claimed that Ainsworth “doesn’t know what he’s talking about”.

I must comment on this part though:

“Legalisation fails to address the reasons people misuse drugs in the first place or the misery, cost and lost opportunities that dependence causes individuals, their families and the wider community.”

They’re not addressed in jail either, and jail adds to “the misery, cost and lost opportunities”.

And I love that the call for “a grown-up discussion” in the article is met with ad hominems.

Ok, I’ll stop now.

David Nutt was the chair of the Advisory Council on the Misuse of Drugs, which is supposed to make the British government’s drug policy evidence-based. He got fired from this post after publishing a paper arguing that ecstasy was less dangerous than horse riding and then making a speech criticising the government’s entire drug classification scheme. Other experts on the Advisory Council resigned alongside Nutt and set up the Independent Scientific Committee on Drugs.

The disfunction of the government Advisory Council was confirmed this year when the ecstasy analog mephedrone took off in Britain. (It was automatically illegal in Canada and the US because our drug laws have analog provisions.) The UK Home Secretary announced that he would make mephedrone illegal as soon as the Advisory Council made their report (ie: waiting for the Council’s rubber stamp, not their recommendations).

As Jack posted, the Independent Committee has done a more sophisticated ranking than Nutt’s previous study. The previous study didn’t include weightings of different factors, which is why I used the raw data to develop my own rankings. This study divides cocaine and crack, and amphetamine and methamphetamine, which is much more useful for these preparations that hold significantly different positions in our society.

The study only assess harm, not benefits (alcohol scores well on the previous selfish scale). Aspects like crime, economic cost, international damage and loss of relationships are based on the current legal status in Britain, not the potential under legalization or decriminalization. This is intended as a criticism of current drug policy – it’s not a complete analysis for setting new policy.

It’s easier to separate out the personal and social harm in this scatterplot:

The raw data isn’t available, but if you stare hard enough at this composite bar graph you might figure something out (CW = cumulative weight):

(The Lancet converts all images to JPG. )