Table of Contents
Preface xi
Chapter endnotes ix
URLs and web links ix
Acknowledgements ix
Chapter 1 Why I had to write this book 1
Who this book is for 7
Chapter 2 Is ecstasy more dangerous than horse riding? 10
Comparing horse riding with ecstasy 11
"Equasy" 14
What is ecstasy? 15
Does ecstasy kill? 16
What are the other harms of ecstasy? 18
Ecstasy becomes a media crusade 18
Ecstasy: a moral issue 22
Why measuring drug harms frightens politicians 24
A cautionary tale: how the UN made the harms of ecstasy much worse 26
Chapter 3 How can we measure the harms done by drugs? 37
Evidence-based comparison of harms 37
Sixteen different sorts of harm 39
Multi-criteria decision analysis 43
The panel of experts 44
Which drugs did the expert panel consider? 46
Rating the drugs 47
Weighting the scores 49
Results 51
Limitations of the model 52
Media & government reaction to the report 53
Analysis in Europe, Canada & Australia 54
A new drug classification scheme based on harms 55
Reviewing a drug's Class? The case of ketamine 57
Chapter 4 Why do people take drugs? 62
Chemicals in the human brain 62
A typical day without drugs 64
What is a drug? 65
1 Opioids - opium, heroin, methadone, buprenorphine, codeine 66
2 Stimulants or "uppers" - cocaine, amphetamine etc 68
3 Depressants or "downers" - alcohol, benzodiazepines, GHB 69
4 Psychedelics - LSD, mushrooms, ayuesca/DMT, peyote/mescaline etc 69
Less-easily classified drugs 70
A typical day on drugs 72
A brief history of drug use 73
Why do people take drugs? 76
Maximize benefits, minimize harms 80
Chapter 5 Cannabis, from the medicine of Queens to public enemy number one? 84
Cannabis as a fibre (hemp) 85
Cannabis as a drug 85
What are the benefits of cannabis? 86
What are the harms of cannabis? 89
Methods of taking cannabis - its "routes of use" 91
Is skunk more harmful than hash? 93
The world-wide campaign against cannabis 93
Medicinal cannabis use today 98
Is it right to criminalize cannabis? 100
Why are cannabidiol cocktails available in London but not New York? 105
Chapter 6 Synthetic cannabinoids - the problem of "spice" 114
Chapter 7 If alcohol were discovered today, would it be legal? 119
How the drinks industry influences alcohol policy 122
How can we reduce the harm done by alcohol? 133
Conclusion 140
Chapter 8 "Meow meow" - should mephedrone have been banned? 146
What is mephedrone and why is it called plant food? 147
The harms of mephedrone 149
Why was mephedrone banned? 150
The designer drug problem 152
Alternative approaches to new drugs 154
The very least we ought to know 155
Conclusion 157
Chapter 9 What is addiction? Is there an "addictive personality"? 168
Addiction in history 169
The brain mechanisms of addiction 171
What is tolerance and why does it occur? 176
Withdrawal and craving 177
Diagnosing addiction 179
Is there an "addictive personality"? 182
Protective factors - why some people don't get addicted to drugs 184
Conclusion 185
Chapter 10 Can addiction be cured? 193
Psychological treatments 195
Pharmacological substitutes 197
Other pharmacological treatments 199
Heroin and its effects 200
Why do people take heroin, and why can't they stop? 201
Using heroin to treat heroin addicts 202
Advantages and disadvantages of methadone treatment 203
Buprenorphine - a better solution? 205
Evaluating treatments and defining government drugs policy 206
The Portuguese experiment - legal changes 209
Preventing addiction 211
Conclusion 212
Chapter 11 Cocaine - from chewing to crack 217
Routes of use and main associated harms 217
Why are drugs used in different forms? 219
Kinetics and dynamics of addiction 219
From chewing to crack: the history of cocaine 220
Why is crack twice as addictive as cocaine? 225
Conclusion 227
Chapter 12 Why was smoking banned in public places? 232
The 2007 ban on smoking in public places in the UK 232
What is tobacco? 233
What are tobacco's harms and benefits? 234
How do we know that smoking causes lung cancer? 237
Why is smoking so addictive? 239
Public-health responses and industry resistance 242
Did the UK 2007 smoking ban work? 244
Freedom of choice to smoke? 246
Conclusion 248
Chapter 13 Vaping and snus - to vape or not to vape? 257
Snus 260
Chapter 14 Prescription drugs; the US opioid crisis 263
The US opioid crisis 263
What are benzodiazepines and how do they work? 268
Antidepressants and SSRTs 272
Painkillers 275
The pharmaceutical industry and science 276
The mental health epidemic 278
Informed consent 280
Conclusion 281
Chapter 15 Can drugs improve physical and mental performance? 285
Drugs to increase muscle and power 285
Other drugs in sport 289
Drugs for calmness in sports 291
Improving mental performance - cognition enhancers 291
Conclusion 297
Chapter 16 Psychedelics, and their use in treating depression 300
How do psychedelics work? 300
The discovery of LSD 301
LSD and psychiatry 303
Set and setting 304
LSD leaves the laboratory 305
What are the harms of LSD and psychedelics? 307
What are the benefits of psychedelics? 309
The renaissance of psychedelic research 311
Should scientists take LSD? 312
Magic mushrooms and other psychedelics 314
Why were magic mushrooms banned in the UK? 316
Conclusion 317
Chapter 17 The War on Drugs, and drugs in war 321
The other "war on drugs" 321
The aims of the War on Drugs 325
1 Has the War on Drugs reduced supply? 326
2 Has the War on Drugs reduced demand? 329
3 Has the War on Drugs minimized harm? 330
Why are we still at war? 338
What are the alternatives? 339
Chapter 18 NPS - novel psychoactive substances 351
Why do we have NPS? 351
The Poppers rebellion 355
Spice (synthetic cannabinoids) 357
Conclusions 360
Chapter 19 The future of drugs 362
Genetic sequencing 362
What are the risks of genetic sequencing? 365
Treating addiction 366
Learning and unlearning in addiction 368
New drugs research 369
The Brain Science, Addiction and Drugs Foresight programme 371
What sort of future do we want? 375
Can we put science into policy-making? 376
Chapter 20 What should I tell my kids about drugs? 384
Young people and drugs 384
Talking to your children about drugs 385
1 Alcohol and tobacco are drugs 385
2 All drugs can potentially cause harm as well as pleasure 386
3 Start telling your kids about drugs from an early age 386
4 Never inject 387
5 Don't use solvents 387
6 Don't take drink and drugs at the same time 387
7 A criminal record could rain your career 388
8 Find good sources of advice 389
9 If you do take drugs (including alcohol and tobacco) be clear why 389
10 If you do get into trouble with drags, get help quickly 390
11 Make sure drugs don't interfere with your schoolwork 391
Useful websites 395
URLs referenced in the text 395
Index 396
