The Courier-Mail - QWeekend - - FRONT PAGE - Story Michael Slezak

I’ve tried prob­a­bly 150 dif­fer­ent psy­choac­tive chem­i­cals,” the man with the Is­raeli ac­cent tells me over the phone. “So to me sim­ply as Dr Z, the man is a math­e­ma­ti­cian who used to de­sign sleep­ing pills for a ma­jor phar­ma­ceu­ti­cal com­pany. The drugs he de­signs these days are more likely to keep you awake. His most fa­mous cre­ation is mephedrone, or “meow fa­mous le­gal high.

Drugs like mephedrone usu­ally slip onto the mar­ket via shad­owy un­der­ground net­works. Dr Z will­ing hu­man guinea pigs from the on­line “psychonaut” com­mu­nity. But this clan­des­tine sys­tem may soon be a thing of the past. Dr Z is now test­ing a num­ber of drugs in rig­or­ous phar­ma­ceu­ti­cal labs and cost­ing hun­dreds of thou­sands of dol­lars.

The tri­als are the re­sult of a rad­i­cal shake-up in drug pol­icy in New Zealand. Last July, its govern­ment passed a law that will al­low new recre­ational drugs to be sold openly as long as they meet cer­tain safety stan­dards. Be­fore long, Dr Z hopes his drugs will be on sale there, along­side al­co­hol and tobacco – taxed, reg­u­lated and en­tirely le­gal. This doesn’t mean NZ is le­gal­is­ing all drugs; far from it. Ex­ist­ing il­le­gal drugs won’t change their sta­tus. Nev­er­the­less, the law is a de­ci­sive break with pro­hi­bi­tion, a pol­icy that has had a stran­gle­hold on in­ter­na­tional drug en­force­ment for more than 50 years.

Other coun­tries, too, are break­ing ranks on pro­hi­bi­tion, leading some to claim that the en­tire ex­per­i­ment could pro­vide some an­swers to the long-run­ning and bit­ter ar­gu­ments about whether ban­ning drugs pre­vents or causes ter­ri­ble harm.

If pro­hi­bi­tion’s aim is to pre­vent people from tak­ing drugs, it isn’t very suc­cess­ful. In 2011, an es­ti­mated 300 mil­lion people world­wide took il­le­gal drugs, up 18 per cent on 2008. Even the world’s top drug en­forcers strug­gle to put a pos­i­tive spin on this num­ber. “We have to ad­mit that, glob­ally, the de­mand for drugs has not been sub­stan­tially re­duced,” wrote Yury Fe­do­tov, ex­ec­u­tive di­rec­tor Crime, in last year’s World Drug Re­port.

to some es­ti­mates, the United States has spent $1 tril­lion on do­mes­tic drug law en­force­ment over the past 40 years, only to see a rise in drug use. Since 2006, 50,000 people have died in Mex­ico’s drug wars. To some, these fail­ures sim­ply demon­strate that pro­hi­bi­tion hasn’t been pur­sued vig­or­ously enough.

it or not, the de­mand for drugs can­not be stamped out, and there will al­ways be people will­ing to sup­ply them. Where drugs are il­le­gal, the sup­pli­ers highly sus­pect. It is surely bet­ter, say the re­form­ers, to set up a sys­tem that di­vorces drugs from crim­i­nal­ity and al­lows con­trolled ac­cess to com­pounds that are known to be rel­a­tively harm­less. NZ’s rad­i­cal new law will be the clos­est thing yet to a test of that claim.

That’s not to say the coun­try is de­lib­er­ately Its mo­tive is largely prag­matic. Pos­si­bly be­cause NZ has a long­stand­ing prob­lem with new psy­choac­tive sub­stances – com­monly called to take off there was BZP (ben­zylpiper­azine) in the late 1990s. It was mar­keted as a safe and le­gal al­ter­na­tive to am­phet­a­mines, and by 2008 more than 5 per cent of adults re­ported tak­ing it in the pre­vi­ous year – more than twice as many as had used il­le­gal am­phet­a­mines.

The NZ Govern­ment ini­tially turned a blind eye, but banned BZP in 2008 af­ter re­ports of se­ri­ous was even­tu­ally banned, only to be re­placed by is now rou­tine: a new drug ap­pears; it is sold legally un­til the au­thor­i­ties spot it and ban it; then an­other drug takes its place and the cy­cle starts over again.

The game of cat-and-mouse is spi­ralling out of con­trol. In 2009, Euro­pean au­thor­i­ties re­ported 24 new syn­thetic drugs. In 2010 there were 41; else­where around the world. These drugs cater to all sorts of tastes. Many are syn­thetic ver­sions of cannabis. Oth­ers are am­phet­a­mine-like stim­u­lants, ec­stasy sub­sti­tutes or hal­lu­cino­gens. Some are phar­ma­ceu­ti­cals that never made the grade.

tried to break the cy­cle by in­tro­duc­ing “emer­gency sched­ul­ing”, which means new drugs can be tem­po­rar­ily banned with­out re­course to the nor­mal par­lia­men­tary rig­ma­role. Oth­ers, – any chemical that is struc­turally sim­i­lar to an ex­ist­ing il­le­gal drug.

New Zealand tried both those ap­proaches with lit­tle suc­cess, says James Dunne, a drug-law has worked for le­gal high man­u­fac­tur­ers. Emer­gency sched­ul­ing just ac­cel­er­ates the cat-and-mouse game, he says. The re­sult is the sale of drugs that have barely been tested. “It sends the wrong in­cen­tives to man­u­fac­tur­ers – de­velop some­thing that’s hard to iden­tify and sell as much of it as you can as fast as you can.”

to chemists”, says Dunne.

“When you say that these chem­i­cals are struc­turally sim­i­lar, you’re also say­ing oth­ers aren’t – and [thus] point­ing the way for fu­ture drugs.”

PRO­HI­BI­TION WAS HARD ENOUGH IN A WORLD where gov­ern­ments knew what drugs to ban. Now, in a world where new drugs ap­pear ev­ery week, it seems al­to­gether im­pos­si­ble.

While the rest of the world is crank­ing up the tread­mill, NZ has de­cided to get off. Last year, the Psy­choac­tive Sub­stances Bill passed both houses of par­lia­ment with only a sin­gle dis­sent­ing voice.

Read­ing the bill to par­lia­ment, as­so­ciate health min­is­ter Peter Dunne ex­plained that pro­hi­bi­tion sim­ply couldn’t keep up with the turnover of new drugs. “Scores of prod­ucts with un­known ef­fects this reg­u­la­tory void,” Dunne said. “This pro­lif­er­a­tion of poorly un­der­stood chem­i­cals and their wide­spread use should con­cern us all. So we need an en­dur­ing so­lu­tion.”

The de­tails of his pro­posed so­lu­tion are still a lit­tle hazy, though some ba­sic rules have been set. The most im­por­tant is that drugs won’t be al­lowed on the mar­ket un­less they have a proven means and how it will be de­cided are a work in progress. Drugs also won’t be sold to un­der-18s, at con­ve­nience stores, or any­where al­co­hol is also on sale. La­bels with in­gre­di­ents and health warn­ings will be manda­tory. Ex­ist­ing il­le­gal drugs won’t be le­galised, but Dunne says this could be done later.

A new author­ity charged with im­ple­ment­ing the regime is still work­ing out the other de­tails. The law is ex­pected to come into full ef­fect as soon as the end of this year, once safety tests are com­pleted. Mean­time, NZ is in a half­way house. When the law was en­acted last July, le­gal highs that had been on sale for at least three months could ap­ply for tem­po­rary li­cences; 46 were ap­proved and six re­fused, based on an as­sess­ment of risk. Re­tail­ers also had to ap­ply for li­cences to con­tinue sell­ing those drugs. From an es­ti­mated 3000 out­lets, the author­ity granted 110 li­cences.

Un­til the new regime goes “live”, there are many unan­swered ques­tions about how it will op­er­ate. The big­gest is how to de­cide which drugs are suit­able for sale. Ex­actly what con­sti­tutes “low risk”? For the past 15 years, David Nutt, a neu­ropsy­chophar­ma­col­o­gist at Im­pe­rial Col­lege Lon­don, has been try­ing to an­swer that ques­tion. His ap­proach takes into ac­count harm to in­di­vid­u­als, the risk of ad­dic­tion, and so­cial dam­age. “You come to a sen­si­ble bal­ance,” says Nutt. “You look at the big­ger pic­ture.” By this reck­on­ing, the most harm­ful drug is al­co­hol, fol­lowed by heroin and crack co­caine, ac­cord­ing to med­i­cal jour­nal The Lancet.

harms is only half the prob­lem. The next step is de­cid­ing where to draw the line. Nutt li­aised with the NZ reg­u­la­tors on this ques­tion. “I told them they should set the thresh­old as less harm­ful than al­co­hol, but they laughed and said that’s too harm­ful,” Nutt says. He now sug­gests “half as harm­ful as al­co­hol” would make sense.

Wher­ever the line is set, the next chal­lenge is how to prove a drug is on the right side of it. Dr Ste­wart Jes­samine, head of Med­safe, NZ’s ver­sion of the US Food and Drug Ad­min­is­tra­tion, says the ini­tial re­quire­ment will be sim­i­lar to the “phase 1” safety data phar­ma­ceu­ti­cal com­pa­nies must pro­vide be­fore they can do large-scale clin­i­cal tri­als. Af­ter that, the key to safety will be sur­veil­lance. If a drug starts to cause more harm than ex­pected, Med­safe will be able to fur­ther re­strict its sale or ban it com­pletely. An in­terim ver­sion of this sys­tem has al­ready been in­tro­duced. Any neg­a­tive ef­fect re­ported to a hospi­tal or poi­sons hot­line is ranked in one of three cat­e­gories. Mild re­ac­tions, such as rest­less­ness, mild pain or vom­it­ing, are given a score of 1. Cramp, un­con­scious­ness or hal­lu­ci­na­tions score 2; coma, paral­y­sis or deaf­ness score 3. Any prod­uct that ac­cu­mu­lates a score of more than 2 per 20,000 units sold is taken off the mar­ket.

In this way, Jes­samine says the risks can be stud­ied, con­trolled and com­mu­ni­cated to users, and laws ad­justed ac­cord­ingly. There will be no need for man­u­fac­tur­ers to con­stantly dream up new drugs. Con­sumers who want to stay on the right side of the law won’t be forced to give up a le­gal high they know works for them and try a new, pos­si­bly more dan­ger­ous one. NOT EV­ERY­BODY SEES THIS AP­PROACH AS a panacea. Foren­sic tox­i­col­o­gist Dr Keith Bed­ford, un­der NZ’s old sys­tem, points out that it fails to take into ac­count people’s ten­dency to mix drugs with al­co­hol or other recre­ational sub­stances.

That’s some­thing the coun­try has seen be­fore. Many of the people who had se­ri­ous re­ac­tions sev­eral drugs, says Bed­ford. He works for ESR, the com­pany that does all of the NZ Govern­ment’s foren­sic tox­i­col­ogy work, and has seen a lot of the tox­i­col­ogy data.

Pub­lished stud­ies back up Bed­ford’s claim. A 2010 study by Dr Chris Wilkins, head of the il­le­gal drug re­search team at Massey Univer­sity in Auck­land, found that 86 per cent of BZP users al­co­hol, but also cannabis and ec­stasy. “I think, un­for­tu­nately, they’ll get some nasty sur­prises that their low-risk prod­uct is used in com­bi­na­tions,” Wilkins says. “That’s some­thing that’s hard to model in ad­vance.”

Sim­i­lar ad­verse drug re­ac­tions have been spotted else­where. In 2012, for ex­am­ple, the Euro­pean Mon­i­tor­ing Cen­tre for Drugs and Ad­dic­tion re­ported that 21 people had died af­ter tak­ing an am­phet­a­mine called 4-MA. But if you look at the re­ports, in each case 4-MA was com­bined with other drugs. Bed­ford sug­gests the safety test­ing ought to in­clude com­bi­na­tions, at least with al­co­hol. But ac­cord­ing to Jes­samine, that’s not likely to hap­pen: “It’s much more likely that they’ll be re­quired to in­clude ad­vice about not en­gag­ing in those be­hav­iours on the packet.”

Dr Z sup­ports the new law, but he also wor­ries about people mix­ing drugs. On be­half of a group of le­gal high man­u­fac­tur­ers, he is co­or­di­nat­ing stud­ies of an MDMA ana­logue called 5-MAPB. “It’s a good drug, it’s fun,” he says. “So people will start drink­ing on it.” But he warns that the struc­ture of the chemical sug­gests that mix­ing it with al­co­hol would be very risky. “People could hap­pens? The news­pa­pers will re­act. The whole ‘dan­ger­ous’ and it will never be heard of again.”

As these is­sues are dealt with, in­ter­na­tional ex­perts are watch­ing, some hop­ing the re­sults will demon­strate that an al­ter­na­tive to pro­hi­bi­tion can work. “This comes at a time when drug pro­hi­bi­tion is col­laps­ing,” says Dr Alex Wo­dak, re­cently re­tired di­rec­tor of the Al­co­hol and Drug Ser­vice at St Vin­cent’s Hospi­tal in Syd­ney, and for­mer head of the In­ter­na­tional Harm Re­duc­tion As­so­ci­a­tion. “The long de­bate is now over and the po­lit­i­cal phase has started. More and more people are re­al­is­ing that drug pro­hi­bi­tion is get­ting harder and harder to de­fend, and the taboo has been bro­ken on dis­cussing al­ter­na­tives.” Wo­dak says the out­come is a groundswell in coun­tries look­ing for al­ter­na­tives.

fully le­galise cannabis. Phar­ma­cies are al­lowed to


sell 40 grams a month to in­di­vid­u­als, people can grow up to six plants them­selves, and “cannabis clubs” can grow up to 99. Other Latin Amer­i­can coun­tries are dis­sent­ing too. In 2011, Bo­livia with­drew from the 1961 Sin­gle Con­ven­tion on Nar­cotic Drugs and re­joined last year with the raw source of co­caine. The pres­i­dents of Gu­atemala and Colom­bia are both call­ing for pro­hi­bi­tion to end.

In 2012, a sum­mit of the Or­ga­ni­za­tion of Amer­i­can States – an in­ter­na­tional or­gan­i­sa­tion of 35 coun­tries from across the Amer­i­cas and the Caribbean, in­clud­ing the US – re­sisted US pres­sure to duck the is­sue, and dis­cussed al­ter­na­tives to the war on drugs. Last year it re­leased an op­tions paper that in­cluded le­gal­i­sa­tion as one pos­si­ble way to go. Within the US it­self, two states – Colorado and Wash­ing­ton – have le­galised cannabis. Bri­tain’s Deputy Prime Min­is­ter, Nick Clegg, has also come out in sup­port of a de­bate about pro­hi­bi­tion.

These ef­forts are likely to snow­ball, says Wo­dak. Af­ter cannabis was le­galised in Colorado and Wash­ing­ton, pub­lic sup­port for cannabis le­gal­i­sa­tion all over the US jumped to 58 per cent, favour. “Other US states will fol­low,” Wo­dak says. “All this is com­ing about be­cause it is now in­escapable that global drug pro­hi­bi­tion has been in­ef­fec­tive, coun­ter­pro­duc­tive and very ex­pen­sive.” But it won’t hap­pen overnight, he pre­dicts. “Global drug pro­hi­bi­tion took about 80 years to con­struct, so I would not be sur­prised if the post-pro­hi­bi­tion pol­icy also takes a while to build.”

Wo­dak fore­sees the NZ ap­proach will have ob­vi­ous con­tra­dic­tions, with rel­a­tively un­known syn­thetic cannabis be­ing le­gal while nat­u­ral cannabis is still banned, de­spite be­ing well-stud­ied. But syn­thetic drugs are a good place to start since ban­ning them is par­tic­u­larly prob­lem­atic, he says.

NZ’s laws may be giv­ing the world a glimpse of what a post-pro­hi­bi­tion era will look like. “It’s just re­duce the harm caused by pro­hi­bi­tion,” Wo­dak says. “It’s a good ex­am­ple of the start of ev­i­dence-based pol­icy,” adds Nutt.

In 2016, the UN will hold a spe­cial as­sem­bly to re­view its ap­proach to drug con­trol. Nutt is hop­ing in­ter­na­tional mo­men­tum against pro­hi­bi­tion will lead to a change of heart, and he’s push­ing NZ to lead the meet­ing. The US will un­doubt­edly ex­ert pres­sure to main­tain a hard James Dunne. “There would have to be some fancy foot­work to ex­plain how Colorado and Wash­ing­ton le­gal­is­ing the sale of mar­i­juana is okay but Uruguay do­ing it is not.” He notes the Kiwi ap­proach at­tracted a lot of in­ter­est at meet­ing. And to­gether with South Amer­ica, and to a lesser ex­tent Europe, there will be

Ul­ti­mately, whether the rest of the world fol­lows NZ’s lead de­pends on the re­sults of its ex­per­i­ment. And say­ing no to pro­hi­bi­tion, even in a limited way, might not be risk-free. Ev­i­dence sug­gests pro­hi­bi­tion has some­times re­duced drug use in NZ. When Massey Univer­sity’s Chris Wilkins stud­ied le­gal highs in NZ in 2006 while BZP was still le­gal, he found 15 per cent of people had tried a le­gal high in the pre­vi­ous year. By 2009 – a year af­ter it was banned – he found that

The rea­sons aren’t clear. Wilkins says it might highs hadn’t yet gained pop­u­lar­ity. But there was an in­di­ca­tion that pro­hi­bi­tion was also turn­ing users off: 30 per cent of people who stopped us­ing BZP gave the ban as a rea­son. That raises the ques­tion of whether mak­ing drugs le­gal would en­cour­age people who would other­wise ab­stain, or prompt cur­rent users to take more. If the BZP study is in­dica­tive of what might hap­pen, NZ could be in trou­ble, says Wilkins. “If the preva­lence of le­gal high use tripled, you might end up with more to­tal prob­lems even if the prod­uct was low harm,” he points out.

Whether that will hap­pen isn’t clear. When the Nether­lands lib­er­alised con­trol of cannabis in the 1970s, there was no ma­jor rise in cannabis use. When Por­tu­gal de­crim­i­nalised per­sonal use of all drugs, drug use stayed about level, but the

And look­ing around the world, there seems to be no di­rect cor­re­la­tion be­tween stricter drug laws and de­creased con­sump­tion, at least ac­cord­ing to a 2008 World Health Or­ga­ni­za­tion study. Some re­searchers say NZ’s law is al­ready hav­ing pos­i­tive ef­fects. “Since the bill was en­acted we’ve seen fewer hospi­tal ad­mis­sions and emer­gency pre­sen­ta­tions as­so­ci­ated with the use of syn­thet­ics,” says Dr Paul Glue, head of psy­cho­log­i­cal medicine at Dunedin School of Medicine.

Wilkins says the NZ ex­per­i­ment will “stand or fall” depend­ing on whether people re­place bad drugs – co­caine, heroin, and maybe even al­co­hol – with the safer ones, or sim­ply take more drugs. There is some ev­i­dence that le­gal­is­ing mar­i­juana in the US cor­re­lates with a re­duc­tion in heavy drink­ing among 18- to 29-year-olds. Whether Ki­wis will swap booze for pills is still a huge un­known.

Wilkins has ap­plied for fund­ing to study this cru­cial ques­tion and has set up an in­ter­na­tional re­search group so the world can learn from his coun­try’s bold ex­per­i­ment. “Here is a pos­si­bil­ity of a big pub­lic health gain on the one hand, or a re­ally big pub­lic health dis­as­ter on the other,” he says. “But there will be no-one more ex­cited than

High hopes …( above left) Uruguayans who marched in favour of le­gal­is­ing mar­i­juana won suc­cess last year; (above) a pock­et­ful of de­signer dreams may soon be re­al­ity in NZ.

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