Hard News by Russell Brown

Know Your Stuff’s Jez Weston has just tweeted this explanation of why the result is being announced now, rather than at the time of detection:

I did the Fentanyl testing at a festival a while ago, but we had to wait to publish to hide which festival it was. This is frustrating. We want to provide timely warnings. Still earlier than everyone else though.

To explain: the legal risk for event organisers under Section 12 of the Misuse of Drugs Act means that they can’t publicly acknowledge testing on their premises. Announcing the result immediately would have outed the event at which it was derived, so it had to be delayed.

This is another example of the risk posed by the law it stands.

At least MDMA proper may have psychotherapeutic benefits for trauma relief if certain clinical trials pan out overseas, but we do need to rationalise our MOD Act when it comes to harm reduction, harm magnitude and severity and risk minimisation. If the problem is adulterated MDMA, and the aforementioned clinical trials show the efficacy of intervention, a medical MDMA legislative reform campaign may be our next avenue.

If the problem is adulterated MDMA

Not generally adulterated – usually just a completely different substance than it was sold as.

But Know Your Stuff has been detecting what appear to be deliberately deceptive mixtures intended to confound tests.

These will fool the reagent test kits people can buy – it takes the spectrometer to detect them.

This whole millennia drug culture concerns me. I am responsible for guidance and wisdom toward millennial teenager.

Things used to be a lot simpler, put it that way.

One of my favourite "quirks" of the current legislation is the rating of fentanyl and its analogues. Heroin is Class A, fentanyl which is 100 times as potent is Class B and carfentanyl which is 50 times as potent as fentanyl and 5000 times as potent as heroin is Class C as it is a fentanyl analogue.

The obvious differences in the class rating of a drug and its risk index really stand out in this case.

Hi Steven, Wendy Allison from KnowYourStuffNZ here. While we try to stay involved in discussions where we can, we are all volunteers and have full time jobs, and as you can imagine today has been quite busy for us already. If you have any questions, please fire away but we can't guarantee a speedy response.

We are quite happy to pour compliments on Russell - he is awesome and his grasp of the issues is streets ahead of the majority of folks commenting in this field.

(Hi, I did the testing as a volunteer with KnowYourStuffNZ, lead by Wendy Allison. I've a day job, so I'll answer now on my lunchbreak and can answer further questions this evening.)

Steven's question about teenagers is a common one. I don't think that drug culture is terribly different now - every generation had its drugs. What's different is that there's more information about risks and how to stay safe, more choice of substances, and a more realistic public debate abut drug use. So that's all positive.

I'd say that every teenager is going to do stupid shit. That's part of growing up, you make mistakes and you learn from them. I broke plenty of bones coming off bikes while learning my limits. The goal isn't to get kids through that stage without mistakes. It's to make sure that the cost of the mistakes is bearable, that the pain is short term, that bones heal, and that there are no long-term health or legal consequences..

Drugs have two specific factors. The first is that the legal risk is out of all proportion to the health risk. A conviction can seriously mess up your education and career. That's a reason for staying away from drugs.

The second is that the health risk is hard to quantify, because the substances may be unknown. Testing is a solution here. As Russell said, if you've got MDMA then 100 mg isn't that dangerous to your health, in comparison to a night on the booze. If that MDMA is n-ethylpentylone and you take 100 mg, then that's three or more doses and you're at substantially more risk.

Teenagers can be a weird combination of smart and stupid. KnowYourStuffNZ tested a lot of drugs for a lot of people this summer. We don't talk about our clients, but I'll just say that some of the younger people (18+) were the best informed, had clearly done their research, had already tested their substances, and came to us to confirm their tests. They knew their stuff. Some of the older people this summer... did not.

So I suggest treating teenagers like we treat our clients - openly, honestly, and with trust. They are people who want information, who want to balance risk and safety, and who will ultimately make their own decisions.

Thanks Steven, the needle exchange model is the one most apt to apply to what we’re doing. They also began with ‘ethical non- compliance’ that produced evidence which demonstated its value.

Hopefully it won’t take the government 20 years to catch up this time.

This may be a dumb question, but what's the incentive for suppliers to insert fentanyl into their "products"? Given how lethal it is the risk of killing their market is so high that I'm wondering where the benefit is.

The illicit drug market is global. Economics + distance would be my guess. But it is just a guess.

It’s a sad irony that just as the harm reduction approach is about to gain critical mass a new set of drugs comes along to complicate things.

Harm reduction was based on the fact that drugs in themselves were essentially harmless - at least for all except a very small number.

But the new drugs are actually harmful. P and synthetics are poisons destroying lives. It’s not a moral panic.

The hope is that decriminalising the more traditional drugs will result in displacing the new poisons but it could be the genie can’t be put back. It may also take firm disincentives to manufacture and supply, ie long prison time, that haven’t til now been part of the harm reduction paradigm.

Amphetamine use in NZ has been stable for about 8 years. It is a moral panic, and part of the reason for that is that the marginalisation of methamphetamine and its users means that problematic meth use is now centred in poor communities – and we all know that everything poor people do is something to panic about.

Meanwhile Fentanyl is a very useful drug for anaesthesia and is quite safe when administered under supervision in accurately measured doses. It’s when its misrepresented as something else in a market with no quality control that deaths occur.

Neither of these drugs are poisons any more than other drugs, and the harms associated with them are a direct result of the lack of regulation in illicit markets. The solution to this is not more punishment – that method has had 45 years to work and has failed spectacularly to reduce use or harm.

KnowYourStuffNZ would like nothing better than to be put out of business by a better system, one that includes legal purchase, quality control, and labelling, and doesn't pretend that prohibition had ever worked.

KnowYourStuffNZ would like nothing better than to be put out of business by a better system, one that includes legal purchase, quality control, and labelling, and doesn’t pretend that prohibition had ever worked.

But not all drugs have the same minimal harm. People working in acute health settings do fear for their safety because of heroin but because of P.

There are anti-social people out there willing to make money out of destroying other peoples’ lives. There’s other people who fall into trouble because of circumstance.

Things used to be a lot simpler, put it that way.

Yeah, about the only thing my peer group had to worry about was being sold cheap and nasty speed masquerading as Ecstacy.

Obviosly, it was a bit more complicated than that, but we didn't generally have to worry about stopping breathing.....

As you are suggesting long prison time as a 'solution' to an alleged problem with methamphetamine, it would be good if you could demonstrate how harsher punishments for supply of methamphetamine has reduced the harm associated with the drug in other countries.

It would also be good if you could explain how emergency department staff fearing for their safety warrants ratcheting up prohibition and its punishments for methamphetamine, but not, say, for alcohol.

Finally, please consider how it's possible for a drug like methamphetamine to be administered to children in the US (Desoxyn) while being demonised in NZ, alongside contemplation of the correlation between the marginalisation of a drug and its users, and the harm associated with the drug.

Prohibition is not, and has never been, a solution, regardless of the dangers associated with specific substances. We need to do better.

Well yes, but I’ll bet they also get the decks clear when someone shows up having any other psychotic episode, that’s part of any other illness. Tim Harding, CEO of Care NZ says methamphetamine addicts are relatively easy to manage. They generally sleep in off.

By clear the decks I take it you mean health professionals taking measures to prevent serious physical harm. Meth psychosis is somewhat different to psychosis caused by mental illness. The risks to others are often far higher, deescalation techniques usually don’t work and psychosis from mental illness isn’t caused by someone selling harmful substances for a profit.

I don’t think Care NZ have much experience with acute meth detox.

What you have quoted doesn’t indicate Tim Harding having any direct experience of acute meth withdrawal.

I’ve seen it and it’s essentially quite a few days of living hell. If you’re lucky that hell might get replaced by the somewhat lesser hell of acuphase. Anyone contemplating doing meth might want to look up the side effects of that as it could be the next drug they encounter.

People do not just sleep off a meth binge.

I have no problem with heroin or marijuana or exstasy or a number of other drugs. Their intrinsic harm is low. Some drugs are different. Pethadine is different enough to heroin to make the case for its legalisation more problematic. It has a shorter half life.

It maybe too late but making available low risk drugs may crowd out the high risk ones.

I think there is an argument for the value of access to lower risk drugs as a potential means of directing people away from higher risk ones. However, there will always be those who seek out the higher risk ones, and in my view that use is much less likely to be damaging if it happens in the light of day rather than in dark marginalised corners.

And of course no discussion of risk is complete if we don't give alcohol a mention. Especially in terms of ER visits and violence towards others.

These could be a bit off because they're from memory, but I think it's about 8% of regular meth users that end up on the problematic use spectrum. For alcohol is about 16%, for heroin about 24% . So really, while meth damage is the sexy topic right now, in context I don't think singling out meth contibutes to overall harm reduction in any useful way.

Helen Clark supports festival drug assays and supervised injecting rooms: http://www.nzherald.co.nz/nz/news/article.cfm?c_id=1&objectid=12017963