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Global Drug Survey: An interview with the founder

The Global Drug Survey is the largest of its kind in the world. The research seeks information about people's experiences of drug use, regardless of the legal status of the substance, so that data can be collected and shared with the public.  

95bFM reporter Pearl spoke to Adam Winstock, a London based consultant psychiatrist, addiction medicine specialist and founder of the Global Drug Survey, about what he hopes to achieve with the research project. 

Pearl: So the survey has been running for about 6 years. Are there some massive changes that have come out of the data that you've been noticing?

Adam: Yeah, absolutely. I mean, we were lucky - we started just as the world of drugs was about to change forever. So the three big things we've been able to track have been 1) the appearance of Darknet markets, such as the Silk Road, and people being able to access good quality drugs online without going through street dealers. More and more people are buying drugs on the Darknet, and whether or not people buy drugs on the Darknet reflects the country's drug policy. So for example, in Sweden and Norway, huge numbers of people buy drugs on the Darknet compared to a country like Portugal, where you can just buy drugs on the street. Interestingly, New Zealand has really low levels of buying drugs on the Darknet, and I think that's because you have such tight borders and such a tight working relationship between your police and your postal services.

The second change would obviously be the huge increase in the number of new drugs that have appeared around the world. We've been tracking the appearance and impact of drugs, like synthetic cannabis products, over the last 5 or 6 years, and I think one of the biggest findings we've been able to share is synthetic cannabis products, which were obviously huge in New Zealand, just aren't nice. The risk of turning up to emergency department on synthetic cannabis products is at least 30 times higher than natural high potency cannabis. Also, the risk of you running into problems like dependence and withdrawal is way higher. So if I look at what New Zealand did with its attempts at regulation, it was such a brave thing to do, but I think you probably tried to regulate the wrong drug.

The third thing, and it probably hasn't hit New Zealand in the same way, is the huge reemergence of high quality and high dose MDMA pills, which has caused lots of problems across Europe and the UK, where people are ending up taking way too much. And the reason I guess this hasn't hit New Zealand is one of the things New Zealand tops the Global Drug Survey in every single year, is that you have the most expensive cocaine and MDMA in the world by a factor of at least 5.

P: Yeah, and I think also for us it’s a geographical thing, we're so so far way from the hubs of those drugs that it's A) impossible to get anything through our border security, but also the sheer feat of transporting over that much mileage is ridiculous and with such a small population I don't think that people -

A: It's not worth the effort.

P: Yeah exactly.

A: You're exactly right, but the consequence of that is New Zealand has other problems that you don't see elsewhere, you know. The best source of quality pharmaceuticals is prescription drugs for a lot of people, which is why you see high rates of prescription opiate misuse, tramadol use, benzo use, and why we also see lots of people cooking up their own sort of drugs, whether that's crystal meth or poppy seed tea. I think New Zealand's geographical isolation protects it from some things but increases its use of other substances, I mean people use what's available, and of course, there's alcohol and weed.

P: What are the main objectives of the survey? Would you say its addiction treatment or reducing harm? Or both?

A: It's absolutely reducing harm. So my day job is an addiction psychiatrist. I work with people whose lives have been ruined by drugs, but the truth is, 90% of people who use drugs will never see somebody like me. But it doesn't mean to say those people don't need good advice and good information to help them use drugs more safely, and the Global Drug Survey is actively trying to fill that gap. Because government's aren't really interested in the kind of hidden masses of drug users, they're interested in people who commit crime, die, overdose or go to jail. What Global Drug Survey is about is everyone else.

P: Are there specific objectives in each survey in terms of what you want to know? Are you adapting the survey every year?

A: Yeah, there's a core bit of survey that’s about prices, and who ends up in accident and emergency etc., and then every year we look at things that are particularly interesting that year. So this year we're looking at 4 things. We're looking at cannabis legalisation, so we're asking cannabis users around the world, "how would you like to see cannabis regulated in your country?", and that's really important. Secondly we're going to look at cannabis as medicine in the real world, if you're using it, what condition you have, how often do you use, the side effects. The third thing is drug vaping, so people think that the only drugs you can vape are sort of nicotine and cannabis. That's not the case, so we're looking at other drugs that people are using. And then the fourth thing is a little section of psychedelics, so we're looking at the issue of people microdosing LSD and mushrooms to improve creativity and work performance, we're looking at people's use of ayahuasca, and finally we're trying to understand what people mean when they have a "bad trip". Psychedelics get a bad name because of this idea of a bad trip, and the truth is, there is a big difference between someone having a difficult experience, and having a bad trip.

Part of the reason people are exploring psychedelics as treatment for difficult emotional conditions like depression or PTSD is that it can allow people to process difficult emotions that can ultimately transform how they think about things.

P: Yeah, I've definitely noticed that discourse popping up in the media a lot this year about using LSD to treat PTSD, and using MDMA, and it almost felt like a bit of a revival with people trying to find alternative solutions to their problems. I was also wondering, because I did notice in the survey, there was a question about oral contraception. Is that something you look at every year or is that new this year?

A: No. So one of the other things we've been able to highlight over the past couple of years is that women are more vulnerable to ending up in emergency departments after using MDMA than men. I mean young women are 2 to 3 times more likely to end up in hospital and we're trying to figure out why. It's probably got something to do with estrogen and other hormones affecting women differently, but we also thought we better try find out whether or not it might be something to do with people taking oral contraceptives. That's because what we want to do is we want to advise young women that if you want to do MDMA, it might make a difference where you are in your menstrual cycle as to whether or not you're going to have a good time. It might mean that being on the pill can increase or decrease your risk, we simply don't know. And it's really difficult to do that research unless you can get access to 30 or 40,000 MDMA users, but we can. So yeah, well-spotted - that's a really important thing we're trying to find out this year.

P: Yeah definitely, I think it's really important because you have people reading trip reports and getting advice from random personal experiences they read on the internet, and that's kind of 50/50 you know?

A: Yeah I think you're right. There's a difference between one person's experience and the experience of 50,000 people. And I guess we're trying to give people an idea of the ranges of experience, but also what the real risks are. So 90% of people when they end up in accident and emergency after taking MDMA have taken other drugs. We know that people who do MDMA more than every other month are more likely to mix with ketamine, crystal and coke, and they're more likely to end up in emergency rooms. So we can turn around to people and say, “if you want to reduce your risk, don't use more than every 4 or 8 weeks, don't mix with lots of alcohol, don't mix with coke and really importantly, if you follow these simple bits of advice, you're also more likely to have a better time”. Cause I think that's the other thing Global Drug Survey understands and accepts, is that pleasure drives drug use, not the avoidance of harm.

P: Definitely. I guess this is so broad, but what would you like to see be done either domestically or globally to reduce drug harm? What do you think are sort of the key things that need to happen?

A: I think definitely honesty is the best policy. And so the first thing I would want to see - this is on the back of a big nightclub in London, Fabric, being shut down because of MDMA deaths, and recently being allowed to be re-opened, but with really punitive rules, effectively going zero tolerance for drugs - when in fact what I'd like to see is legislation from the police and licensing that would be applicable to night clubs, pubs, people who run festivals, and the legislation would be that if you're going to run a large event where people are drinking and likely to take drugs, it would be mandatory for you to have information on your website about how to use drugs more safely. You will have your staff not just trained in the responsible service of alcohol, you will have your staff trained in how to recognise and respond to risk related drugs, and  that should be put down in law.

And the reason that's so important is that there's lots of places to get good information about drugs, Global Drug Survey, Erowid, TripSit, whatever. But lots of people don't bother, and if you had all of that information there on all the big sort of club websites, promoter websites, venue websites, people would go, "oh yeah - I'm waiting 2 minutes for my ticket to download, I'm going to go get a little bit of information". That's kind of what I'd like to see. And I think I'd like to see governments being a little bit more honest. I understand changing drug laws is difficult, it's politically a bit risky, there can be some backlash. But at least for governments to go “look, even though drugs are illegal at the moment and we're looking at how things might change, we want to protect the people and so what we're now happy to do is start having an honest dialogue with you”. It's just being honest with people.

The idea that you can ban drugs, and that's the only way of reducing drug related harm, is just not true. It's outdated, it doesn't work. So, just start treating your population like adults. You know, people who use drugs, and who want to have fun -  they don't want to ruin their lives or anyone else's.

You can listen to the full interview Pearl did with Adam here.