Volteface Voices

VOICES

SCIENCE Exploring opportunities for innovation in healthcare and research

PEOPLE How drug policy impacts businessmen, doctors, police and students

CULTURE Tracing the influence of drugs in society

OUR TEAM FOUNDER

Paul Birch DIRECTOR

Steve Moore

EDITORIAL

Henry Fisher Calum Armstrong

CREATIVE DIRECTOR

Alastair Moore

Abbie Llewelyn

DESIGN

George McBride

Aline Aronsky

Lizzie McCulloch

CONTRIBUTORS Mi ke B ar nes

Ian Bir rel l

Ezr i C arleb ach

A hig h ly ex p er i en c e d c on su lt ant n e u rol o g i st ,

Former d e puty e d itor of t h e Ind e p end ent ,

A w r iter, l e c turer, and c onsu lt ant , E z r i is

over the l ast 3 0 ye ar s , Profes s or Bar n es h a s

Bi rrel l i s a l s o an a c c l ai me d j ou rna l i st and

a ls o a Fel l ow of t h e Roya l S o c i e ty of Ar t s and

b e en d e di c ate d to t he d e vel opm ent of n e u ro -

work e d a s a sp e e c hw riter for D av i d C ameron

t h e Institute of Inter na l C ommuni c ati on.

l o g i c a l rehabi l it ati on t hrou g hout t he U K and

du ri ng t h e 2 0 1 0 el e c ti on c amp ai g n.

inter n ati on a l l y.

Abi Mi l l ar

Max D a ly

A lex Proud

A f re el an c e j ou r n a l ist w ho sp e ci a l is es i n

A j ou rna l i st and aut h or sp e c i a l i si ng i n

E ntre prene ur and found er of t h e Prou d

me di cine an d p ol i c y, Abi’s w r iting has fe a -

s o c i a l af f ai rs and i l l e g a l d r u g s, Ma x i s a l s o

Group, w h i c h inc lu d e s g a l l er i e s , nig htc lubs ,

ture d in a nu mb er of Bu sin es s publ i c ati ons,

a fe atu re d c olu m ni st for Vi c e, i n a d d iti on

c ab are t venu e s and re st aur ants around L on-

inclu ding Futu re Ban k ing an d C E O Mag a -

to b ei ng t h e c o - aut h or of Narc omani a : How

d on, Al ex a ls o w r ite s a we ek ly c olumn in Th e

z in e.

Brit ai n G ot Ho ok e d on Dr u g s.

Tel e g r aph .

R os Stone

Nei l Wo o ds

Har r y Wa l lop

Ros ha s s er ve d as D ire c tor of C om mu n i c a -

C h ai rman of L EAP U K and a former u nd er-

Har r y is a c onsumer j our na list , fe ature w r it -

ti ons at t he B e ck l e y Fou n d ati on a l ongsi d e

c over Dr u g s D e te c ti ve S erg e ant , Nei l i s a l s o

er, c olumnist and bro a d c a ster. He is a ls o t h e

w riting for Ta l k ing D r u gs , T he L on d on i st

t h e aut h or of t h e re c ent l y publ i sh e d memoi r

aut h or of ‘C onsume d : How We Buy C l a s s in

an d Ps y mp o si a.

G o o d C op, Bad War .

Mo d er n Br itain’.

A lex Ste war t

A lex King

Mona Zhang

A former s er v ing p ol i c e of f i c er w it h t h e

Al ex i s a j ou rna l i st , h e w rite s re g u l arl y for

A Ne w Yor k-b a s e d w r iter fo c using on d r ug

Me trop olit an Pol i c e S er v i c e w it h ex ten si ve

Hu c k Ma g a z i ne and L itt l e Wh ite L i e s.

p oli c y and c u lture, Mona is a ls o th e e d itor of d ai ly c annabis ne wsl e tter Word on th e Tre e.

ex p eri enc e of t he w ar on dr u gs , A l ex is n ow a journa l ist an d tel e v isi on pres enter.

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EDITOR’S LETTER

Ste ve Mo ore

V

olteface was launched a year ago to change the public debate about drug policy in the UK. It had become stale. All over the world Governments are moving beyond failed policies of prohibition but here in the UK a fudging of the myriad issues dealing with the supply and distribution of illicit drugs prevails with deleterious consequences.

The chasm between the official rhetoric and the lived reality of so many is widening all the time.

Whether it is in clubs, inside prisons, at music festivals or on our streets, drugs are everywhere yet we have no control or regulation of the supply of drugs, capricious policing of the criminality associated with illegal markets and variable levels of treatment for those who require help.

This state of affairs has led to a record number of drug deaths, the facilitation of a huge organised crime racket and to has left tens of thousands of parents anxious about their children’s drug use and not knowing where to turn for helpful advice.

At the same time millions of Britons continue to love drugs and the emotional state they elicit.

If Volteface stands for anything it is this: we want to promote an honest and open public debate about our passion for drugs and how best to ensure that people who consume them can do so as safely as possible; that those who abuse their use get the help they need and that some of the most vulnerable people in society - our children and the poorest - are not exposed to the criminality that occupies the space left by under-regulation and light touch law enforcement.

For too long the poles in the drug debate have been characterised by people being seen as 'hard' or 'soft' on drugs.

Volteface is neither soft nor hard on drugs. Instead, we are, and we will continue to strive to be, honest and intelligent about drugs. We won't shirk the tough challenges that drug use generates, nor will we romanticise it, but we will be unflinching in our desire to formulate policies that promote individual wellbeing and reduce societal harm.

These are the Volteface Voices.

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CONTENT

14 30 40 58

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THE OVER-MEDICTED POPULATION

The culture of medicine is littered with institutional bias, false theories and misinformation. The result is massive overprescription, with serious implications for patients.

TRIPS AND TRAPS

Psychedelic drugs are poised to be the next major breakthrough in healthcare. The results are encouraging, but a difficult road lies ahead for future research.

PRIMING THE POT

Meeting the most influential legal cannabis supplier in the US provides compelling insights into the future trajectory of a nascent industry.

DRUGS CRISIS IN OUR PRISONS

Investigating the downward spiral of inactivity and drug abuse gripping the nation’s prisons.

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WHAT’S IN A WORD? INVENTING THE DRUGS PROBLEM

In America in 1987 there was a government sponsored anti-drug campaign called ‘This Is Your Brain on Drugs’.

It was based around a short public information film that showed a man cracking an egg (“this is your brain” he told viewers) into a hot frying pan (“this is drugs” he said, pointing at the pan). As the egg sizzles, he brings the pan up to the camera and says: “This is your brain on drugs. Any questions?” (continued on next page)

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O

ne of the main questions people did have about this film was what drugs he was talking about. Was the frying pan an LSD tab? Was it a giant spliff, a bag of cocaine or heroin-filled syringe? No-one could work it out. But it didn’t matter. In the minds of the anti-drug campaigners, ‘drugs’ were in fact a singular entity, an amorphous bag of illegal ‘stuff’ that fried your brain like an egg.

The final stage of the construction of the modern drug concept was a crucial one: the “decoupling” of one group of intoxicants – alcohol and tobacco – from the others, during and shortly after the First World War, culminating in the Dangerous Drug Act in 1920.

Yet there was a time, not long ago, when ‘drug’ was not a word associated with death, villains and frying pans. Up until the late Victorian era, a drug was just a medicine you picked up from your local pharmacy or doctor to make you feel better. There were alcoholics, coke injectors (like the fictional sleuth Sherlock Holmes) and opium vendors, but no one labelled ‘drug addicts’ or ‘drug dealers’. There was no singular label for a substance that you took to get you high, let alone one that was illegal to buy.

As it happens, Derrida has an interesting take on this one, again expressed during his magazine interview in 1989. He accepted that the division between alcohol and tobacco and ‘drugs’ was not down to matters of health.

So he wondered, what do we hold against the ‘drug’ user? His answer: the act of inauthentic pleasure.

Why were some substances thrown in the bad, ‘drugs’ corner, while others were allowed to thrive in the light of day?

“Something we never, at least never to the same degree, hold against the alcoholic or the smoker: that he cuts himself off from the world, in exile from reality, far from objective reality and the real life of the city and the community; that he escapes into a world of simulacrum and fiction.

But in a matter of three decades, the word drugs had taken on a whole new meaning. By 1900, for example, Arthur Conan Doyle had decided to scaleback his hero’s habit at a time, according to drug historian Mike Jay, when “the image of such drugs was changing fast”. The transformation of the word ‘drug’ is the subject of a new paper written by Professor Toby Seddon, head of Manchester University’s school of law, in which he points out that the journey of the word drug – from its innocent origins to its highly loaded meaning today – not only played a crucial role in the war on drugs, but could be the key to ending it.

“We disapprove of his [the illicit drug user] taste for something like hallucinations drugs make us lose any sense of true reality. In the end, it is always, I think, under this charge that the prohibition is declared. We do not object to the drug user’s pleasure per se, but we cannot abide the fact that his is a pleasure taken in an experience without truth.”

Derrida touches a nerve. But Seddon concludes that the main driver behind this “decoupling” was a more practical one: the targeting of substances being used by members of society deemed social deviants at the time, specifically ethnic minorities and the lower classes. Soon these were the substances that were to became known as ‘drugs’, whose buyers and sellers were soon to be transformed into criminals and over time jailed in their millions across America.

Seddon begins Inventing Drugs: A Genealogy of a Regulatory Concept by taking a bird’s eye view of the word. He quotes the French philosopher Jacques Derrida, who said in 1989: “There are no drugs in nature the concept of drugs is not a scientific concept, but is rather instituted on the basis of moral or political evaluation.”

He’s right. The modern meaning of ‘drugs’ is a social construct based on the fears and prejudices of people living over a century ago. Seddon admits early on: the purpose of his paper is to “destabilise” this concept, to expose the root that is shackling us to an outdated system of laws. Otherwise he says, “moving beyond prohibition is impossible”.

In reality, the clampdown on this new, corralled group of substances labelled ‘drugs’, became a clampdown on specific groups of people. Racism provided the momentum behind a new fervour for “anti-cocainism”: freed black slaves in the southern American states, once plied with cocaine to make them work longer, were chased down for taking the same substance, now an abhorrent ‘drug’, in their spare time. While white Americans got pissed on a booming alcohol industry, the authorities equated cocaine with “uppity southern blacks”, race riots and interracial drug parties.

Seddon has done some genealogical excavating and it’s interesting stuff. He traces the first use of the word ‘drug’ (as a substance taken to alter one’s psychic state), back to a New York physician called Lewis Mason in 1887 who told a conference on inebriety in London that some people had a “natural tendency to stimulating and narcotic drugs”. Suddenly the new drug buzzword is everywhere. It gets name-checked in medical journal reports on ether addiction in Berlin, opium intoxication in China, ganja use in Bengal and the smoking of bhang in Cairo. There are some positive mentions of the effects of ‘drugs’, but the word is usually linked to negative things: narcotic “enslavement”, the drugging of others and being a bad thing for the economy.

In San Francisco and London’s East End, the authorities saw opium as a narcotic weapon, used by Chinese men to corrupt white women. Portrayed as potions of the undesirables, opium and cocaine were soon consigned to the metaphorical and physical drug den. “The sustained connection of the consumption of particular psychoactive substances with disliked or feared minority groups was a key element in the final assembly of the drug concept,” says Seddon.

With the First World War over, the focus on both sides of the Atlantic turned to defending society from internal threats. As Seddon describes in his paper: “Drugs, or more precisely the people who used them, were now seen as the ‘enemy within’. The creation of a raft of new drug laws in the

By the end of the nineteenth century, says Seddon, the new concept was thriving. “The notion of a drug no longer solely referred to a medicine but now had a secondary meaning, associated with vice and addiction, with criminality and danger, and with colonial and international trade interests.”

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Original photo by Arturo Espinosa

Jacques Derrida

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A New Vice: Opium Dens in France, 1903

The Madhouse , 1815

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attitudes, but they are not immutable. The mythical world of people once called drug peddlers and dope pushers, thrill seekers and drug abusers, junkies and scagheads, is fading, it just sounds stupid and old fashioned, even for the tabloids now. And with less intoxicating labels, people are viewed with a different eye. It is not too unrealistic therefore to think that as we remove the invented line between bad drugs and good drugs, then it becomes easier to make policies based on individual substances rather than a mysterious assembly of pills and potions that made up the brain-addling frying pan of the 1980s.

first three decades of the twentieth century, banning heroin, opium, cocaine and cannabis, was seen as an apt solution to address the perceived dangers presented by social deviants and their drug taking. Alcohol and tobacco became big business, yet the substances marked ‘drugs’ were banished to a moral and legal dark side, all equally as bad, all leading down the same slippery slope to hell.

A clear line was drawn, between good and evil, black and white, drug and non-drug. While those who used ‘drugs’ were morally deviant, people who used alcohol and tobacco, while occasionally scarlet faced, riddled with gout and afflicted by lung and heart disease, were upstanding members of society. Lurid newspaper tales encouraged them to look down on their fellow, corrupted citizens, the narcomaniacs and drug peddlers, the lowest of the low.

In fact Seddon predicts that, like the lexicography of drugs, drug prohibition itself will turn out to be a momentary state, a ‘transitory period in human affairs’.

“Genealogy tells us that the modern notion of a drug is itself deeply embedded in the prohibition paradigm and implicated in its continuing survival,” concludes Seddon. “It will only be when the ‘false self-evidence’ of the drug concept is shaken hard enough that it falls apart, that we will finally see the arbitrary boundaries between intoxicants drawn a century ago disappear like markings ‘drawn in sand at the edge of the sea.”

Royal Copeland, President of the Board of Health for New York City told the New York Times in 1919, “in the underworld of New York you will find 10,000 drug addicts, and every crime of violence committed you may know has been perpetrated by one of them.” A year later Dr Donald Murray, MP for the Western Isles, warned parliament of a “great evil in the social structure of our country habits learned, developed and practiced, especially in the bigger towns, amongst certain sections of the population.”

The civil war and the ignorance created by the new drug concept is still in place today. While there have been great efforts to help people addicted to drugs, the people who use and sell them are still stigmatised, scapegoated and duly banged up. In America, the links between the drug war and ethnic minorities is well established. Globally, for decades, the war on drugs has become a legitimised tool to oppress and execute undesirables.

Words by Max Daly

The fragility and artificiality of the invented ‘drugs’ bag has unravelled in the last decade. In Britain the government was forced to delay the start of its Psychoactive Substances Act 2016 for seven weeks because it got lost in a philosophical and scientific hall of mirrors trying to work out exactly what constituted an ‘illegal’ drug and indeed, what a ‘psychoactive drug’ was in the first place. The expanding market in psychoactive lifestyle drugs, such as the legal stimulant modafinil, has further blurred the old lines.

But there is a way out of this entanglement. The concept that got us into this mess offers a way out of it, says Seddon. The drug label must be broken up into its constituent parts if individual substances are to be addressed properly. Dealing with a rag tag of ‘drugs’ is like dealing with a vast array of mental health problems marked with derogatory catch-all terms like ‘lunacy’ or ‘mad’.

“If we wish to create a new regulatory regime for the psychoactive substances we currently term ‘drugs’,” says Seddon, “we need first of all to construct them differently as regulatory objects. We need to consider, for each type of substance, what type of market do we wish to see?”

When substances are singled out and removed from the drugs bag, such as cannabis in Colorado or heroin in Switzerland, there is progress. Arguably the biggest success of Portugal’s decriminalisation policy has come about not because of the blanket policy regarding possession of all drugs, but because of the specific, unique attention paid to helping the users of one drug, heroin.

The term ‘drugs’ to describe a vast array of substances that just happen to make you high has enabled politicians and the media to lump them together in a way that is entirely negative. As Seddon has shown, it has coloured the way society acts towards the people who use them. Words can influence

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THE OVER-MEDICATED POPULATION

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Doctors are misinformed, patients are misled and millions of people are taking medication with no benefit for them.

It also means that most of the new drugs produced in the last 20-30 years have been near copies of existing drugs, with just tiny alterations, meaning that the clinical advantages of these drugs over what was already available is minimal. A Barral report on all internationally marketed drugs between 1974 and 1994 found that only 11% were truly innovative and multiple independent reviews since then have also concluded that around 85-90% of all new drugs provide few or no clinical advantages to patients. On top of this, many of these drugs also have serious side effects, which have a negative impact on people’s health.

More than one billion prescriptions are dished out in the UK each year, which is 2.7 million per day or 1,900 every minute, an increase of nearly 2/3 in just a decade. And the increasingly widespread use of prescription medication can have some serious consequences.

Most people are aware that the over-prescription of antibiotics has unfortunately led to the development of resistant strains of bacteria and many people are campaigning for more restrained prescription of antibiotics.

However, an interview with Aseem Malhotra, a London-based cardiologist, reveals that the problem is by no means limited to antibiotics; in fact, there is a worrying trend in the over-prescription of drugs for all sorts of ailments, leading to ever increasing costs of side effects. He explains that this is due to misinformation at all levels in the system, from how research into drugs is funded, to how it is reported in academic journals, to how drugs' pros and cons are presented to patients.

Biased reporting in medical journals Another serious issue in the chain, that Malhotra points out, is bias in the reporting of drugs research. Firstly, there is a publishing bias whereby only the “success stories” even see the light of day, but even within these supposed “success stories” there can be misleading information. For example, the reporting of risk can mislead a reader, which is seen even in well-respected journals like The Lancet, the BMJ and JAMA. Between 2006 and 2009, around 1/3 articles published in the three aforementioned journals had mismatched framing, which means that they report the benefits of a drug in relative risk (large numbers), whereas they report harms in absolute risk (small numbers). For example, take a drug that reduces your risk of getting heart disease from 10 in 1000 to 5 in a 1000 – it would be reported in relative risk as a 50 percent reduction. However, the drug also increases your chance of getting intense muscle pain from five in 1000 to 10 in 1000, but this side effect would be reported in absolute risk, as an increase of 5 in 1000, so 0.5 percent increase.

Malhotra, who trained as an interventional cardiologist, practices in London and is a former consultant clinical associate to the Academy of Medical Royal Colleges. Last year he became the youngest member to be appointed to the board of trustees of health think tank The King’s Fund. He has campaigned for years on a number of issues including transparency in healthhcare, fighting excess sugar consumption and criticising the focus on total cholesterol and use of statins. He spoke to us about what he calls “an epidemic of misinformation” that has led to people undergoing unnecessary treatments.

The BBC programme The Doctor Who Gave Up Drugs has recently brought the issue of prescription drugs back into the limelight, highlighting how prescription of drugs has increased massively in the last five years especially, for example, prescription of painkillers (up by 25%) and antidepressants for teens (up by 50%). It also presents the alternative to this, one that Malhotra is also endorsing and led on, that other treatments such as lifestyle interventions like diet and exercise can be just as effective, if not more so, than drugs. It is important to take a holistic approach to health, but the culture of medicine at the moment means that people simply want a miracle pill to solve all their problems, or “a pill for every ill” as Malhotra called it.

This is an obvious misrepresentation, yet it is permitted and used extensively in trusted journals. These are then used as marketing tools by the pharma companies, who pay for reprints of the journal. Doctors trust these journals and very rarely question what they say and their recommendations for patients will reflect this. For Malhotra: “The best way I can give quality care to my patients is to have complete transparency”, which means he has started telling patients the absolute risk involved with the drugs on offer and he reports that they are often underwhelmed by the benefits of these drugs when given this information.

Bias in funding for drugs research

These medical journals have also been found to print “bad data”. For example, a study investigated Riveroxaban as an alternative for Warfarin, a widely-used anticoagulant. It concluded that this drug had the benefit that, unlike with Warfarin, the blood does not have to be regularly checked. This is a major inconvenience avoided for patients, so the NHS spent around £50 million on this new drug. However, an investigation by the BMJ uncovered that a device used in the randomised controlled trial that justified the NICE guidelines recommending the drug, a key measuring instrument had been faulty, which casts doubt on the whole trial. Even though this

So let’s look at the issues that Malhotra brings up with what he calls “a collective system problem”. Firstly, there is bias in the funding of drugs research. A great deal of funding comes from pharmaceutical companies who stand to gain a profit from the industry. The way they make the most profit is to create drugs that can be used by the largest number of people for the longest amount of time, which clearly means that they aren’t necessarily funding research that is the most beneficial to patients.

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painkiller to help with joint pain, but this drug has a side effect of churning up their stomach, so they take another drug to settle their stomach. However, the most “unnecessary” medications according to Malhotra are the so-called “preventative medicines” like statins. Statins only slightly reduce the risk of heart attack and have been shown to cause Type 2 diabetes in 2% of patients.

has all come out, doctors up and down the country will still be prescribing this drug to patients because releasing an investigation in a journal does not guarantee that every doctor will both hear of this and change their behaviour accordingly, as ultimately doctors still follow NICE guidelines, which take a while to change.

The conflicts of interest in research can even result in serious scientific fraud and manipulation of statistics. GlaxoSmithKline paid the largest fine in US history for fraud, $3 billion, in 2012 specifically for illegally marketing drugs, misreporting and hiding data on harms. However, during the period covered by the settlement they made $25 billion in profit from the drugs. No one went to jail, no one went out of business and the cycle continues. And within academic institutions, even when fraud is revealed, often no one is punished. People are extremely unwilling to speak out against ‘Big Pharma’ because that is how their research is funded and they are scared that if they speak out they will lose this funding. Malhotra summarised: “Doctors are unwittingly becoming part of a system where side effects are underreported and institutions are funded by pharma so people don’t speak out when they should.”

The other issue with preventative medicine is that it is detracting from the importance of lifestyle choices. People think that they can take a pill such as one to lower cholesterol and that means that they can eat an unhealthy diet as they are ‘covered’ by the pill. The reality is that a cholesterol-only pill is probably not giving much benefit to them and eating burgers and chips every day will cause them serious harm, so they are getting a net harm from this attitude. In general, lifestyle is sorely overlooked, partly because GPs only have 10 minutes with each patient and it is easier to prescribe a pill than it is to explain the importance of healthy diet and exercise, and partly because people just don’t want to hear it. However, Malhotra says: “When you actually tell people the truth about how beneficial lifestyle is against medication they are amazed.”

The problem with over-medicating

Part of the solution to this crisis of over-medication is to actually actively take people off their medication, as seen in The Doctor Who Gave Up Drugs, as well as being careful when starting someone on a medication.

Sometimes when people have been taking a drug for a long time they become accustomed to how it makes them feel; they don’t even realise that the reason they are feeling fatigued, depressed etc is because of the drug.

When they stop taking it sometimes they suddenly feel a new lease of life without the side effects bringing them down. Malhotra claims that this is the case with statins. He said: “The original data suggested that only 1 in 10,000 people get any significant side effects, which is an absolute joke… in my view its at least 1 in 5 that will at some point experience a side effect that interferes with quality of life.”

This leads us on to the next point to address, which is – what is so wrong with over-medicating? Well, adverse side effects of prescription drugs are now having a serious impact on the healthcare system, with about a quarter of hospital admissions of the elderly being due to negative reactions to prescription drugs. FDA figures in 2014 indicated that in the US there were about 123,000 deaths due to adverse side effects of prescribed medication that year, a number that tripled in a decade, and there were around 800,000 serious disabilities caused. This is likely due to the fact that when drugs go through clinical trials they are usually tested on the young and fit, with only one drug at a time. Many elderly people are frail and taking multiple drugs at once, which can interact against each other. The chemical compounds used in these drugs are all very complicated and may interact with each other in unpredictable ways, but these are not comprehensively tested in trials, because it would be impossible to test every combination.

This means that patients are essentially guinea pigs when taking multiple drugs at once.

Antidepressants are also being prescribed more and more and whilst this is in part due to greater awareness around mental health, it is also because therapy is more expensive, so it is easier for GPs to simply prescribe a drug to help people suffering from mental illness. However, it is important to also consider and properly weigh up possible non-pharmacological interventions like cognitive behavioural therapy, or even something like a support group, as each person is different and antidepressants may not work for them. This is most likely to be true for people whose illness stems from a trauma or something in their past that needs to be addressed by talking about it and cannot get better without resolving their issues.

What’s more, new drugs are being brought out all the time so we cannot know what the long term side effects of these will be or how they will interact with other drugs. And often the side effects of drugs are combated with… simply taking more drugs. For example, a patient may take a sturdy

"Doctors are misinformed, patients are misled and millions of people are taking medication with no benefit for them."

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Transparency in health care

Considering the impact of lifestyle is important both individually for patients’ health but also in terms of public health initiatives to improve the health of the population. In fact, most of the increase in life expectancy seen in modern times has been due to public health interventions. Around 25 of the 30 years' improvement in life expectancy has been due to things like safe drinking water and sewage disposal, safer workplace environments, washing hands, smoke-free buildings, seatbelts in cars etc. Most of the further 5 years have been down to emergency treatments such as antibiotics for infections.

This brings me on to how information is being portrayed to patients when deciding what treatments they receive. If people are not receiving the correct information on treatments, they cannot make informed decisions about their own health. And this is not just limited to prescription drugs either – people are currently undergoing surgeries that may not even be necessary.

For example, when a patient is having a heart attack they will undergo surgery to save their life and the odds for this being the beneficial course are very good. However, when it comes to heart surgery (stenting) for stable coronary heart disease it is a different story. Whilst 1/3 of people with heart disease in the UK will undergo stenting for stable angina, this procedure will not prevent a heart attack or prolong life. It does help to relieve symptoms, although usually these can also be relieved with the appropriate use of drugs without the need for an invasive operation in which there is a 1 percent chance you will have a heart attack, a stroke or die. However, the most troubling aspect of this is that 88 percent of patients, when asked, thought they were having the procedure to prolong their life and prevent a heart attack, which is does not do.

However, this is not where the companies make their money – preventative medicine like statins is where the profit lies. And whilst public health interventions have clear benefits they are not given the attention they deserve – but Aseem Malhotra is fighting against that. He is one of the original founding members of Action on Sugar which aims to reduce people’s sugar intake by educating people on the effects of sugar and he also endorsed the sugar tax.

So to answer the question ‘what is wrong with overmedicating?’ – on top of the issue of side effects we have the inconvenience of taking a pill every day, possible interactions with other drugs, cost for the NHS, the attitude that taking a drug means that a change in lifestyle is not necessary, possible dependence on the drug, possible bias in reporting of research meaning the side effects are more significant than you may be aware of (I could go on). And either way, the issue is largely about transparency and giving the patient the right to make an informed choice on their health.

This means that the true nature of the procedure is not being accurately and comprehensively explained to the patients. Perhaps if they knew that the only benefit was symptom relief they would still want the operation, but perhaps not. What is important is that they get the informed choice. This is not just limited to cardiology either – the same can be said for orthopaedics and many other areas. Malhotra told us how multiple orthopaedic surgeons had told him that that is they had the same problem as some of their patients, they would not have chosen to undergo the treatment that they themselves had performed.

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There are many patients in the UK and abroad that are taking medications with little or no benefit that could be causing harmful side effects. In the US, about 1/3 of all healthcare activities bring absolutely no benefit to the patient. Whilst this is likely worse than over here because theirs is a commercialised system and based even more on activity over results than it is here, we still have a massive problem to address. If we take a step back and have a more sensible distribution of resources, where we divert attention away from drugs that cause side effects and just bring patients back to the doctor, we can focus on elements that would really benefit people like providing better social care.

This is partly due to a culture of doctors wanting to be seen to be ‘doing something’, but also the way in which people and hospitals are paid. Whilst here in the UK there is a “payment by results” system, there is also an element of “payment by activity” as allocation of funding to certain hospitals are affected by what procedures are carried out at those hospitals. This gives an incentive for institutions to carry out many procedures, even if it is against their better judgement.

Despite this plethora of issues relating to drugs research and the communication of the facts, there is very little written in the media about such things and where it does it tends to simply perpetuate the perception and culture about more pills being necessary. One example which breaks away from this trend is a campaign by the Academy of Medical Royal Colleges, which Malhotra was lead author on in a research paper published in the BMJ, called ‘Choosing Wisely: Winding back the harm of too much medicine’, which was covered relatively successfully in the media. It encouraged patients to ask questions such as “How much benefit am I getting?”, “What are the alternatives?” and “What happens if I do nothing?”. It also encouraged doctors to try and revaluate their practice and only use interventions that are fully supported by the evidence.

A more idiosyncratic approach to medicine is also warranted; every individual is different and has different priorities. Some people may hear the truth about certain drugs and still want to take them and other may hear it and want to keep well away. It is about giving people the information and the choice to make their own decisions about their health.

Words by Abbie Llewelyn

HOW CANNABIS LEGALISATION CAN HELP REMEDY SOCIAL INJUSTICES

Social justice is one of the key arguments for legalisation. But even in states with legal cannabis, racial disparities in arrests remain. One example is public consumption, which no legal cannabis state currently allows – of course, it is people of colour who bear the burden of arrests. In Colorado, the racial disparities in youth cannabis arrests became even worse after legalisation.

In 1992, Amir Varick Amma was sentenced to 25 years to life in prison on drugs charges. Convicted of two non-violent drug felonies, he was unfortunate to be sentenced under the Rockefeller drug laws – resulting in a harsh sentence typically reserved for murderers.

After drug law reforms were passed in New York in 2004 and 2009, a judge reduced Amma’s sentence. He was released after spending 19 years behind bars.

But recently, local governments in the U.S. have been approaching legalisation with these facts in mind, and developing policies in hopes of remedying the injustices of the ‘war on drugs’.

Finding work with a criminal record is no easy feat, and Amma was dismayed to find himself shut out of America’s burgeoning cannabis industry.

Most cannabis programmes contain some sort of provision that bars convicted drug felons from applying for a license.

Oakland, California made headlines in May when the city council passed an “Equity Permit Programme,” the first of its kind in the nation. Instead of barring those who have been convicted of cannabis crimes, the city will give priority to residents who have been recently convicted of a cannabis offence, or live in one of several police beats chosen for their high levels of cannabis arrests.

“Now that it’s becoming socially accepted, they’re trying to keep us out of the industry,” said Amma. He now works as an organiser at All of Us or None, advocating for the rights of currently and formerly incarcerated individuals.

Council member Desley Brooks added the equity amendment to the larger medical cannabis programme, which was passed in a unanimous vote.

But the programme is not without its critics.

For those with criminal convictions for actions that are now sanctioned by state governments, “the only thing they can do is become a consumer,” said Amma. “That’s not right.”

“The actual text of the ordinance is a little controversial for procedural reasons,” said Stefan Borst-Censullo, a criminal defence attorney and medical marijuana advocate. “People are struggling to figure out how it’s actually going to be facilitated. But there’s a powerful intent behind what [Brooks] did.”

Four U.S. states have legalised recreational use of cannabis, and 25 states have a medical cannabis programme. On the global stage, this makes the U.S. one of the more progressive countries on cannabis policy. But for the nation that basically created the ‘war on drugs’ as a way to disrupt black communities, simply legalising it does not solve the racial and social inequities that prohibition helped to create.

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While many advocates questioned the practical implications of such a programme, all praised the motivation behind it.

“I’m very proud of what Oakland has done, their rationale for making those steps are completely just,” said Jesce Horton, co-founder of the Minority Cannabis Business Association (MCBA). “We’ll determine whether that [programme] is the best way to go once we see it in motion,” he said.

Amma offered his cautious support for the amendment as well: “We have to support it because at least it’s doing something,” he said. But he pointed out that the Oakland police beats included in the programme are being gentrified, and many of those who the programme is designed to help have likely moved out of the neighbourhoods.

Supernova Women, an organisation promoting women of colour in cannabis, has been pushing the city council to increase the number of police beats included in the programme. The city will consider adding additional neighbourhoods in September.

“The programme is great… but you’re seeing a multi-generational impact of the war on drugs,” said Sunshine Lencho, an attorney and co-founder of the organisation. “It should include families of the incarcerated.”

Lencho also thinks the programme should not be based on the type of conviction, and applicants should be evaluated on an individual basis. “You haven’t captured everybody if you only include the non-violent offender,” she said.

There is increasing attention paid to policies like Oakland’s. Horton, who has served on governmental task forces in Oregon, said that there does seem to be a political will to push such policies. “The majority of people that I’ve come into contact with in the city and state are for it,” he said.

In June, Ohio legalised medical marijuana through its legislature, which will allow patients with certain qualifying conditions access to the drug. Ohio’s

medical cannabis programme had an interesting provision: at least 15 percent of licenses must go to businesses owned by those from economically disadvantaged groups: African Americans, Latinos, Asians, and American Indians.

“Fifteen percent is limiting,” said Yulian Shtern, an attorney at the law firm Abrams Fensterman. “That’s always going to be the argument for the quota system. Does it go far enough?” he said. “I think the goal is right.”

While some experts have questioned the legality of such a provision, none of the attorneys interviewed for this article agreed.

ly need a more global view of this issue to see how we can address it.”

For policy makers at a local level who do want to ensure fair access to a new industry, there are a few things to consider.

Track communities of colour. “This is how we understand where the problems are and how to improve,” said Horton. The MCBA is currently working with UC Berkeley on a survey to that end. “We don’t really know what is really out there. Are people actually applying? Are they not getting assistance after they apply?”

“I think there’s been a fair amount of trying to figure out how to [allocate jobs and licenses] while towing a legal line,” said Brian Vicente, a Colorado-based attorney.

Another way to collect data is to require the local government to collect and report information on applicants. “Being required to report that data can flag potential discriminatory practices early on,” said Lencho.

Vicente was one of the authors of Colorado’s legalisation measure. “Looking back, that’s one thing that I wish we would’ve addressed more clearly – allowing impacted communities to benefit from the industry,” he said.

Representation on governmental committees. “This is the single most important aspect to assuring equitable rules,” said Horton. Diversity is key when governments are writing the rules that establish an industry.

At the end of the day, while legalisation measures can help address racial and social inequities, it’s not going to solve the underlying problems of an unfair criminal justice system.

Include a racial impact statement. “Every hearing that I go to I ask them to incorporate racial impact statement,” said Amma. “How come these new laws don’t have any racial impact statement in them? [It’s] one thing that can show the ramifications of these policies.”

“I do think that making an equity amendment is an important first step in understanding the landscape of the industry and ensuring some kind of economic fairness in accessing the industry,” said Elizabeth Kase, an attorney at Abrams Fensterman. “[But] this is a bigger picture discussion. It’s an unfortunate result of real or perceived racism that exists between law enforcement and those who are targeted in an imbalanced fashion.”

“I think only the federal government can really address [the bigger picture],” said Shtern. Recently, there has been more attention paid at the federal level to criminal justice reforms – notably President Obama’s clemency initiative. “But ultimately we real-

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Right to appeal. If an individual is denied a cannabis license, he or she should have the right to appeal that decision. “The right to appeal any administration decision around your application adds transparency,” said Lencho.

Words by Mona Zhang

Volteface Voices

A TENDERLOIN TALE

It was June 2015, and I was headed to San Francisco for a conference.

I decided to add a few extra days to catch up with friends and spend some time in the city. A couple of weeks before the conference, the organisers invited me to devote the first afternoon to a session where conference delegates offer pro bono support to a local non profit. They sent me a list of organisations seeking help, and one name leapt off the page. I remember thinking, nobody will want to help them. Maybe I should. It was the National Council on Alcoholism and Drug Dependence, Bay Area (NCA-BA). And I was wrong, of course, because a colleague from Italy and two from Canada also volunteered. So the four of us sat down with Fay Zenoff and independent development consultant Yuki Mosher for the afternoon, to discuss NCA-BA’s plans for a rebrand and associated strategic communications. It was fun. We all got on well, and Fay and Yuki left with a rewritten vision and mission statement, an outline plan for the rebrand, and suggestions for keeping stakeholders informed and engaged.

I no longer drink alcohol.

It’s something I need to explain, because it’s something I don’t fully understand. This is a relatively recent thing, I should add. I have been dry for sixteen months, after nearly 50 years of… not being dry. My earliest exposure to alcohol came in a religious context. At my parents’ Passover table one year – I must have been five or six – I discovered that the sweet wine used in the service produced a dizzying sensation that was at once both frightening and funny. After that, I looked forward to the sips and small cups that punctuated Sabbath and festival observance, and which, with the benefit of hindsight, served as the nursery slopes of (much) more copious drinking as an adult.

In my first career, as a peripatetic double-bass player, alcohol was the sea in which we all swam. From my decade of small-time rock’n’roll rambling I remember only one musician who didn’t drink at all, and plenty who did little else. I don’t judge. I didn’t need anybody’s permission when I drank, and long after I had settled down with a family and a career in corporate communications I saw no contradiction between that settling down and the constant rhythm of the glass. Which, as Andy Fairweather Low once sang, is stronger than the rhythm of life. Or it can be.

The glass dances to many rhythms, and the crooked timber of humanity has mastered and misused them all in ways that reflect the specificities of each timbrous time and place.

I arranged to visit Fay at her office in the Tenderloin district after the conference, to discuss communicating the rebrand with her staff and governing board. She emailed me directions, adding “Happy to meet you somewhere if you have any hesitance about walking in the neighbourhood.” Hesitance hadn’t occurred to me. I once strolled from Baltimore’s tourist-friendly Fell’s Point area to the downtown church where Edgar Allen Poe is buried, oblivious to the fact that I was crossing streets notorious for their homicide rates. And I hadn’t read articles like the Quora page headed ‘How dangerous is the Tenderloin, really?’ (The answers are mixed, and feature the words ‘sketchy’ and ‘funky’.)

This is how it sounds in the Tenderloin…

Fay Zenoff’s office sits on the sixth floor of a building on Market Street, between 7th and 8th Streets at the UN Plaza, in San Francisco. Until recently, she shared the building with the Art Institute of California, whose students grapple with gaming technology, fashion, visual design and a host of other creative interests as they pursue, the Institute’s website says, “problems to be solved. And futures to be formed”. Fay’s concerns are surprisingly similar, given that her organisation is apparently of a quite different nature. As Executive Director of the Center for Open Recovery, Fay is a leader in the recovery advocacy movement, a movement with a tradition that dates back at least eight decades but whose provenance and progress are not as well-known as they should be.

So I struck out that Thursday morning along Market Street, amidst the sunshine and bustle of summertime shoppers and tourists, finding my way to the Art Institute without trouble. After talking with Fay and meeting some of her team, Fay offered to take me on a brief walking tour of the area. As we set off, she told me about the 79 liquor stores that inhabit just 44 Tenderloin blocks, describing the programme her organisation runs to persuade storekeepers to move liquor to the back of the store and put fresh fruit and vegetables near the counter, along with free leaflets from NCA-BA on healthy eating. A classic ‘nudge’ policy, it encourages some of the many single-occupancy dwellers within

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would be unthinkable to incarcerate cancer sufferers, instead of caring for them. Yet that’s exactly what we do to many problematic drug users.

The costs of such punitive fantasies acted out as policy are staggering.

In the United States alone some $350 billion a year is consumed by responses to drug and alcohol addiction, through lost productivity, health care demands, and criminal justice costs. Of that sum, just two per cent is used for prevention or harm reduction. It is not because the Federal government deems this a good use of public resources, but because public perception has largely represented addicts and alcoholics as moral failures, with a rich vocabulary of pejorative and insulting terms that trap people in disease and deceit. And as the author William Cope Moyes tells Greg Williams, in the latter’s absorbing 2014 documentary The Anonymous People, “public perception drives public policy.”

the Tenderloin to think a little more carefully about what they put into their bodies. It’s effective, but just a small part of the services Fay and her staff offer to those coping with the consequences of drug- and alcohol-related problems.

As we walked, we saw people in variously distressing situations; homeless and hungry, high on drink and drugs, some lying unconscious (or worse) in the street. And each may as well have been wearing a placard stating ‘this is my fault’, because that is how their predicament is so often regarded by others. As my initial reaction to the name National Council on Alcoholism and other Drug Dependence shows, I was far from immune to such prejudice. But the little time I spent with Fay helped me to realise that this is the attitude that perpetuates so much of the misery. Because as problem drug users, these people are prey to unscrupulous dealers and other criminals; while as sufferers in need of treatment, they are frequently denied the basic care that others with less stigmatised illnesses take for granted.

This is why Fay Zenoff wanted to rebrand NCA-BA; to reframe its role, as she told me recently, in a way that ended nearly six decades of a focus “on prevention and treatment, not sustaining recovery.” The rebrand did not signal a move away from the original purpose of founder Margaret ‘Marty’ Mann. Far from it. As one of the first women to join Alcoholics Anonymous, Marty Mann was a tireless campaigner for recovery not recrimination, and for openness not opacity (while respecting the validity of the original 12-step value of anonymity). Creating the Center for Open Recovery represents another step on the road to advocacy’s triumph over discrimination, a testament to the fact that recovery from addiction is possible, and a promise that eventually the stigma will end.

Others like me. The support available in my recovery from cancer has been excellent, and unconditional. Even after five years of remission I have access to a wide range of physical and psychological care to help me cope with life after treatment. But it hasn’t always been like that.

As Siddartha Mukherjee recounts in The Emperor of All Maladies: A Biography of Cancer, a breast cancer survivor in 1950s America wanted to set up a support group for women. She rang the New York Times to place an ad in the classified pages. After a pause, the clerk told her “I’m sorry, Ms. Rosenow, but the Times cannot publish the word breast or the word cancer in its pages.” We might scoff now at attitudes like that, but we have sought to impose the same silence on the victims of other diseases in the last fifty years, notably HIV/AIDS, and addiction.

I did not return from San Francisco vowing to abstain. It just happened.

But whether it was the sights and sounds of the Tenderloin, or the facts and figures of addiction, or the fundamental justice of the case for open recovery, it seems self-evident now that someone’s addiction is no more cause for persecution than was my cancer, and that access to the means of recovery is a right, regardless of the nature of the illness. Does any of this explain why I no longer drink? Maybe. Whatever the case, I am proud to be associated with the millions who are living in recovery, and to share the hope of recovery for millions more.

It begins with language. In Illness as Metaphor, Susan Sontag brilliantly skewers the verbal images that generate the “punitive or sentimental fantasies” which characterise language about certain illnesses. In the 1970s, when she wrote the book, cancer was still considered such a taboo that many physicians lied to their patients, only sharing their diagnosis with the patient’s closest relatives. Compare that with today’s wall-to-wall TV coverage of Stand Up 2 Cancer campaigns. And it

Words by Ezri Carlbach

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Volteface Voices

HOW DO WE STOP LONDON'S NIGHTLIFE DYING A DRUG-RELATED DEATH? The closure of Fabric after two people died from taking ecstasy has Alex Proud thinking about what statisticians call "avoidable causes of death."

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Avoidable causes of death are things like car crashes, falls off ladders, choking on peanuts, accidental poisonings and yes, drug-related deaths. Last year, there were 2,479 deaths which involved “drug misuse” – that is, the use of illegal drugs. By way of comparison, this figure is a bit bigger than the number of deaths caused by traffic accidents (around 1700) and a lot bigger than the number of deaths caused by water and drownings (just under 400). However, it is much, much smaller than the number of deaths relating to alcohol (over 8,000, not including alcohol as a contributory factor in accidents).

So what happens when there are other accidental deaths? The recent Camber Sands tragedy, where five men drowned, was instructive. The beach did not close, but there were calls for more lifeguards. That was it. With booze-related deaths, we have the usual hand-wringing that we should do more to make people drink less, and little more. With traffic deaths, everyone shrugs. Cars are convenient and fun, and a few dead pedestrians are a price worth paying.

And then we have drugs and clubs. Here, the venue where the two men died has been summarily closed down. Lest we forget, Fabric was a club which was routinely held up as a model of best practice. Of course, the club itself had nothing to do with the two men taking drugs. Their group of friends bought the pills into the club concealed in their clothing. The men then purchased the drugs from their friends in the club. Later, they died. One of them died outside the club, one inside.

So the club must close. But not the beach. Or the supermarket. Or the road. If I took drugs and walked into a shop and then died, should the shop be held responsible? Of course not. If I’m texting while driving and kill someone entirely blameless and unconnected, is the road closed? No. But clubs and pubs get shut down. They are held to a uniquely and arbitrarily high standard.

I was at the Fabric hearing. It was particularly interesting listening to Councillor Poole, a member of the licensing committee who is also a governor at Pentonville Prison. He was talking (at some length) about the need for strip searches, which struck me as both bizarre and rather incompatible with a free society. Ironically, in 2014, Pentonville was slammed in a surprise inspection for the easy availability of drugs; there have also been five suicides there in two years. So it would seem that clubs are also held to a higher standard than prisons.

Anyway, let’s move on. It is a fact that people take drugs and are going to continue doing so. Moreover, the group that takes the most drugs is the group that is likeliest to be in clubs. According to the 2015 crime statistics, illegal drugs are used every day by 220,000 adults in England and Wales and every week by a further 800,000 people. Overall 20% of the 20-24 age group will have taken drugs once in the last year.

The obvious solution would be to legalise drugs. Like many people (and many drug experts) I believe that the war on drugs is a dismal failure and that, if you were truly serious about reducing the harm they do, you’d take them off the streets and regulate them. If you look at countries such as Portugal (and even the United States, with weed) real life supports this view.

But I also know that politicians are terrified of the tabloid press, especially the Daily Mail and that, as the Brexit vote shows, right-wing papers remain a force to be reckoned with. Sadly, drug legalisation, which could so easily be a done deal by now, probably won’t happen for 20 years.

So let’s deal with the world as it is, not as we’d like it to be. And the good news here is that we can solve the clubs and pubs and drugs problem without legislation. We can, dare I say it, come up with a classic British fudge that actually works rather well.

As I see it, there are three parties here. The first is the nightclub owners. The second is the councils.

And the third is the police. The way the system is set up at the moment is very adversarial. It pits the police against club owners. I don’t blame the police for this. They’re put in a position where they’re asked to go in hard and their findings are not subjected to sufficient scrutiny.

What I’m suggesting is that we do away with the current hearings. It’s a system where clubs are put on trial and the presumption is guilty and the penalty is closure. It’s unfair on the clubs, but also unfair on councils and the police because it forces them to be the bad guys.

Instead let’s agree a voluntary process which is much more consultation-based. And, let’s make the aim of the process to work constructively to save lives, not punish clubs and find scapegoats.

For our part, club owners would do everything possible to reduce drug use and, crucially, everything possible to prevent drug-related deaths.

We would do our best to educate our customers.

Many clubs have huge mailing lists and enormous social media presence on platforms like Facebook and Twitter. So we’d use these to get the message out about drugs and their effects. Here I’d suggest a pragmatic two pronged approach. The first is to tell people that drugs are not a good thing. You don’t know what you’re getting. They’re illegal. They feed other crimes. They can damage your health and they can kill you.

But again, to deny people take drugs is nonsense and to believe that we can stop people taking them entirely is also nonsense. So, we’d educate customers about drug safety. We’d talk about the perils of combining different drugs. The problems that can occur when you mix drugs with alcohol. What quantities are generally agreed to be safer. Who to talk to if

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you think you might have a drug problem. And what to do if you’ve taken drugs in a club and get in trouble.

We’d also commit to train all our staff to spot the signs of drug use and, just as importantly, the signs of someone who has taken drugs and run into problems. Furthermore, we’d undertake to train 50% of our staff in first aid for drug-related problems. And we’d agree that any venue over a certain size should have equipment like defibrillators.

Finally, we’d do everything we could, short of strip searching people, to prevent people from bringing drugs into clubs. And because we’d all be working together, we’d be very open to any reasonable suggestions from police and councils to make clubs safer places.

All we’d ask for in return is a fair hearing and to be treated like partners, rather than the enemy. We’d like a commitment not to close clubs that have played by the rules and a focus on avoiding future tragedies, rather than being hung out to dry whenever anything goes wrong. I firmly believe this can happen. Once we start seeing the results we get from working together, we’ll want to do it more, not less. It would be genuinely fantastic to all be working together for safer clubs.

As I say, it’s a bit of a fudge, but it’s a sensible way forward to create a system that functions better for everyone without an act of Parliament. I also believe that it’s something we have to do, because nightlife is so important to the UK. Councils – and governments would do well to remember that we’re not just a bunch of unruly DJs and badly behaved kids who are a thorn in London’s side. The UK’s clubs are serious part of the economy – and we’re worth £55bn a year.

Our value goes far beyond this though. British nightlife is an essential part of our brand as a nation. It’s a huge draw for tourists in their 20s and 30s. And it has a halo effect that goes far beyond clubbers.

People in their 50s come to London (rather than, say, Vienna) because it’s a cool city with an edge. They may not come to go clubbing, but the clubs are very much part of the reason they visit.

Kill London’s clubs and you kill part of what makes London great. I don’t believe this is what the police and councils want. But unless we change the system, our capital’s nightlife may die an entirely avoidable drugs-related death.

Words by Alex Proud

Note: Fabric is set to open January 2017, following talks with Islington Council

Volteface Voices

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Volteface Voices

LEGITIMISING THE LOVE DRUG FOR COUPLES THERAPY In earlier decades, MDMA was used to boost empathy and improve communication skills. There has been a recent resurgence of interest in the therapeutic uses of the drug for couples.

of the UK’s most strictly classified illegal substances? Not when it’s all in the name of psychological research. Monika and Lars are one of 10 couples who have been supplying qualitative data to Katie Anderson of London South Bank University, as part of her PhD project: “MDMA: the love drug.”

In the low ethereal glow of a hotel bathroom, the dopamine flows. Two pairs of eyes meet across the bubbles, and serotonin streams like sunlight into the 5-HT receptors of the brains behind them. Oxytocin, and a shared sense of elation spreads through both bodies. Monika and Lars are more in love than ever, and they’re on MDMA.

I caught up with Katie after she’d presented her preliminary findings at this year’s International Conference on Psychedelic Research, and here’s what I learned: she has coined the term the “MDMA bubble”, a dynamic which takes the form of a kind of protective casing a couple enters into together as they embark on their high. Having researched MDMA users more generally for her MSc dissertation, Katie was captured by the idea that some of its key effects, openness and empathy, are “the perfect conditions for romance – for crafting a relationship.”

She has always seen MDMA as unique in providing a high accompanied by such a strong sense of connectivity: “the couple in the bathtub were experiencing a particular kind of ego dissolution.” Like the kind reported in the recent LSD Beckley/Imperial LSD studies, where “the normal sense of self is broken down and replaced by a sense of reconnection with themselves, others and the natural world”? “Yes, exactly! But they enter this space together.”

Talking about it three years later, they dive animatedly into the sheer romantic joyfulness of the memory. He embellishes her recollections; she picks up the ends of his sentences. “There was nothing between us,” they explain, “it was like we were merged.” As they gush in their keenness to convey the importance they both place on that particular MDMA experience, there’s something oddly reminiscent of the video series of Ann and Alexander (Sasha) Shulgin, discussing their shared drug-taking episodes in the living room at Beckley Park.

Famed for their chemical synthesis, self-trials and beautifully penned experiential treaties on hundreds of psychoactive compoundes, the Shulgins share anecdotes on a visit to fellow psychedelic researcher Amanda Feilding. Like Monika and Lars, they can be seen encouraging threads of the conversation through squeezes of their hands, lovingly correcting one another, finishing each other’s thoughts.

Describing exactly the same chemical coalescence Monika and Lars experienced in the bathtub, Sasha, who was famously dubbed ‘The Godfather of Ecstasy’ wrote of an MDMA experience with Ann that, “underneath it all is the feeling that we both belong here, just as we are, right now”

And how happy were the couples to talk, in general, about MDMA? “There was a range of attitudes, and degrees of openness – most couples were happy talking about their MDMA use with friends, but not with family or at work. None were involved in drug policy or advocacy etc., so there were different levels of comfort.” The interviews were semi-structured, meaning that they took the form of free-flowing conversations, punctuated by some staple questions and activities. As part of the interview process, participants brought four or five items (photos, keepsakes, words) that were reminiscent of their experiences.

But, doesn’t a normal couple, one that isn’t internationally celebrated for self-experimentation like the Shulgins, feel a teeny bit weird retrospectively fleshing out the minutiae of such an intimate moment for the eager ears of a third party (dictaphone in hand), particularly when that moment involves MDMA, one

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In addition to couples therapy, MDMA can be useful as treatment for social anxiety and post-traumatic stress disorder.

partner that he felt could prove “too good to be true.” However, along with many of the other couples, his recollections after the experience reflect a residual but enduring sensation of increased closeness. Like traces left by soap bubbles, most of the couples emerge from the cocoon of the MDMA experience noticing that their relationships are brighter and better than before. Katie evaluates these longer-lasting positive changes as being as “real” as any other relationship dynamics, despite having originated from taking MDMA.

The relics of romance included a brightly patterned hula hoop and a set of photos from a party photobooth, indicating that the festival atmosphere and its paraphernalia is complimentary, even conducive, to these romantic moments of intimate closeness.

Another interview activity involved the couples ranking the importance of their MDMA experiences in relation to other crucial events within their personal relationship timelines. Despite their wide range of differences in ages, financial circumstances and career choices, everyone agreed that they’d had a positive shared experience of MDMA, and that there is something uniquely special about the shared experience of taking it together, in love. Eight out of ten ranked their MDMA memories alongside the more archetypal fixtures of the amorous trajectory, like getting married and the birth of their children. (An emphasis which tellingly echoes Prof Roland Griffiths’ findings when he conducted a survey on the life-changing potential of psychedelics as part of the Johns Hopkins Psilocybin Research Project, in which a third of users attributed the highest degree of significance to having tripped on magic mushrooms within their lifetime.)

In their seminal editorial; MDMA, politics and medical research: have we thrown the baby out with the bathwater? Beckley Foundation collaborators Dr Ben Sessa (University of Bristol) and Prof David Nutt (Imperial College London) lament the fact that MDMA was made illegal by “single-minded politicians” in order to prevent an epidemic of people “writhing on the dancefloor,” and assert that MDMA-as-a-medicine has wrongly been “caught in the crossfire of the war on drugs.”

The jurisdiction has, for several decades, interrupted vital research into MDMA as a psychiatric tool. Sessa has more recently, and more viscerally, spoken out on social media against the blinkered political tendency to conflate the clinical administration of MDMA with recreational use when they should be clearly differentiated, asking whether cardiac surgeons writing papers on optimising the safety of medical procedures,

Does MDMA ever create feelings from scratch? Katie mentions one volunteer, Nick, wondering if the heightened level of connection to his

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Volteface Voices

similar in one respect: they were recruited from MDMA/drugs subreddits, and RollSafe; online communities dedicated to sharing tips about illicit drug taking, and how to indulge in it, in relative legal and medical safely. Katie recalls being overrun with applicants, but that there was something special about the final ten: “the couples ultimately who took part in the study were all there because – if they wanted to make the time commitment and were brave enough to open up – MDMA was in some way important within their relationship, and they had something important to say.”

would be hypothetically be obliged to nod to it, “if there was some weird recreational pursuit in which some people performed open heart surgery on their kitchen tables with rusty instruments” … Point made.

But, even at variable street-level purity and separated by a canyon from clinical conditions, it is remarkable that MDMA deepened interpersonal connections between 90% of Katie’s interviewed couples. These results indicate MDMA’s empathetic properties are so potent that, against the odds of the adulteration it incurs on the illegal market, and despite it being taken in a recreational climate, the potential benefits of MDMA are trickling determinedly into a proportion of couples’ lives and improving their relationships. In the context of our current drug culture, these results are surprising, but they befit MDMA’s singularly benign historic trajectory as a substance that initially entered the psychiatric arena in the 1950s after having been found so incapable of producing any emotional effects other than compassion that the US Army deemed it to have no military use.

These are people who are trying to protect themselves as best they can, arming themselves before they drop with whatever information they can find. Before Sasha’s death, the Shulgins decided to disseminate their collected information about MDMA and other drugs for free: as it was illegal, they had to rely on the rave culture, “interested amateurs” – their purpose was to make sure that what had been discovered about the pharmacology and transformative properties of drugs “cannot be exterminated now.” The couples in Katie’s study are just such amateurs as the Shulgins wished to benefit. By researching and discussing their MDMA experiences online, they are sustaining an important legacy.

Other than Monika and Lars, who shared a bubble bath, what did the rest of the serotonin-crossed lovers get up to during their highs? The anomaly within the research sample was one couple who “loved taking MDMA and going out to gigs,” but their experiences were “never deep, or life-changing.” More interestingly, nine out of ten couples found themselves indulging, unintentionally or intentionally, in MDMA’s therapeutic conversational properties. So is MDMA masquerading as a party drug, whilst offering these couples something much more beneficial? Katie finds one of her interviewees’ stories particularly symbolic in this regard; they dropped MDMA to dance, but inadvertently succumbed to its propensity to be therapeutic: “suddenly we were talking on the couch for the entire night.” About half the couples planned to take MDMA in a social setting, but then felt a desire to peel away from the party for some one-on-one conversation, inadvertently entering the “MDMA bubble” and plumbing new depths of their abilities to compassionately confide.

Although some of the experiences described by the couples indicate strongly therapeutic effects, a crucial distinction between MDMA therapy and recreational use is “that after 40 years of MDMA research, there has not been a single, serious adverse reaction,” following a clinically-administered dose of MDMA (Sessa, TEDx, Uni of Bristol, 17.45).

All “ecstasy deaths” and associated media hysteria are born out of our current recreational culture, in which prohibition makes safety impossible because, we’re in “the land of the blind,” grappling with assumptions and unknown adulterants, as Volteface’s Policy Editor Henry Fisher observed after testing festival goers’ drugs with The Loop. The samples of “MDMA” taken by The Loop when they tested punters’ drugs at The Secret Garden Festival this July revealed that unregulated pills could contain anything from a lethally strong dose of MDMA, to concrete!

In his biting analysis of Fabric’s closure in August this year, David Nutt points out that “tragic deaths” are often caused by more toxic MDMA substitutes such as PMA and PMMA, which make their way into the hands of clubbers when the real deal is in short supply. Furthermore, a lack of regulation over the potency of MDMA and insufficient harm reduction measures form a potentially fatal combination. This makes accidental overdoses, such as suspected for the two 18-year-olds who died after going to Fabric, all the more likely.

Emily and Dan “took MDMA for fun” initially but recall how this resulted in a mutual admission of infidelity. Despite it being “the worst stuff you could hear,” Dan recounts that, “it was as though every word she was saying made me love her even more.” Admitting infidelity during their MDMA experience helped the couple to reach a point of total honesty, such that, after a breakup, they felt able to heal the schism and return to the relationship secret-free. This sense of feeling secure within the drug-fuelled conversation no matter what negative memories or topics come up is the basis of MDMA’s use in psychotherapy, and was replicated by other interviewees: “one person’s going to be really honest and the other person’s going to listen and accept…I think that’s actually a very safe environment to chat through stuff”. For other couples, the use of MDMA to reach a state of conversational openness and mutual self-acceptance was deliberate. Mark and Jenny describe their use as “therapeutic” and walk through the streets of their city for hours “just dealing with all the issues that we have and just flowing with conversation”.

Katie feels that MDMA can be “demonised and derided” in the mainstream media, and that the unlucky few for whom adulterated, black-market doses of the drug prove fatal are all-too-often made to stand for users as whole, framing recreational drug use as incompatible with a functioning society. The current propensity of Brits to blunder around in the dark ingesting unknown substances adds, unfairly, to the notoriety of “MDMA”, which is used by a sometimes unscrupulous media as a blanket term for its more toxic substitutes. This reaffirms our drug culture where talking about drug-taking is taboo, drug-testing in the UK has only just become a possibility and has taken years of hard work and careful planning to organise, and most safety measures involve hearsay and guesswork.

A lasting impression that Katie has taken from her interviews is that there’s “no typical MDMA user.” Users were a wide range of ages and took MDMA in a variety of settings: from the traditional club/festival venues to exploring urban and natural environments. As qualitative research into recreational MDMA use is so unwillingly funded, and consequently so rare, she feels privileged to have been allowed glimpses into “so many worlds.” But the vast majority of her interviewees were

One important thing to note is that all of the couples were only concerned with the illegality of MDMA at the beginning of participating in Katie’s research. Having sussed her out as a non-judgemental inter-

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no long-term adverse effects into the academic discourse. And she’s valiant for setting out to do this in a climate which is such a far cry from the pre-prohibition perception of MDMA, which, before the “war on drugs,” enjoyed a spell as a mainstay in couples therapy.

viewer, collecting their subjective experiences with the spirit of an explorer, they focussed entirely on the way taking MDMA together had provided them with a unique platform to explore aspects of their relationships, upholding the Shulgins’ intentions that MDMA be shared and experienced and enjoyed safely regardless of its legality.

And, in step with Katie’s psychological research, MDMA in couples psychotherapy itself is making a comeback: in August 2016, a couple took part in the first experiential treatment session of a new trial of MDMA-assisted conjoint therapy for PTSD, conducted by the Multi-

According to the 2016 Global Drug Survey results, UK clubbers take the most MDMA per night (up to half a gramme), so Katie is doing vital work bringing the droves who take MDMA every week in the UK with

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I was worried it was just a chemical romance ...

disciplinary Association for Psychedelic Studies, monitored by Julie Holland, M.D. Both the partner experiencing PTSD, and their significant other took MDMA, reaching a clinically-controlled, psychotherapeutically superintended version of Katie’s “MDMA bubble”; a safe space in which they can emotionally explore together, and begin, within the context of their relationship, to heal the PTSD-suffering partner’s trauma.

data about the positive experiences that can and do result from the recreational use of MDMA into the academic and social discourse - is vital. She is documenting the fact that a significant proportion of the population are currently seeking out these MDMA experiences regardless of its Class A status and corresponding dangers.

Research like Katie’s makes it increasingly impossible for politicians to legitimately continue to ignore the non-problematic drug using proportion of the population. It also undermines the prohibitionists when they peddle the idea that MDMA-related deaths are a consequence of MDMA itself, rather than a consequence of the fact that there are no quality controls or instructions to accompany illegally-sold MDMA, and undercuts the oversimplified portrayal of drug use itself as intrinsically bad, incapable of producing effects like the ones Katie records.

Since MDMA was made illegal, its therapeutic potential, the “baby” of Sessa and Nutt’s treatise has spent years confined to the dancefloor, its potency dimmed by adulterants.

By confining the drug to the rave scene and blotting out its medical value, the mainstream media has functioned as a smoke machine, obfuscating the “disco biscuit” in a haze of notoriety and mystery. But, as Katie’s research shows, more and more ravers are stumbling out of the smog and accessing glimmers of MDMA’s stifled healing properties.

If MDMA could be sold officially in the UK, those who want to try it would be able to purchase it from a shop, at standardised purity, with safety and dosage instructions, and could more reliably enjoy the transformative bonding experiences of the “MDMA bubble.” As the country with the biggest appetite for it, this is the future we have to work towards.

Most clubbers’ nightlife careers feature the odd, pivotally important memory of an emotionally-laden, and strenuously gurned, heart-to-heart. But the “baby,” the therapeutic potential of MDMA, has limited applications whilst it remains stuck in the rave scene. The fact that Katie’s couples have had the luck to buy substances that perform like MDMA, and have taken them in the right set and setting to access the drug’s famous therapeutic benefits, show that these properties have not been destroyed, no matter how risky it has become to try to access them. On the contrary, Katie’s findings - and particularly the fact that she sourced most of the couples that provided them from harm-reduction forums - suggest that there is a demand within the recreational community for a safer means of exploring the therapeutic effects of MDMA: the “baby” has been sitting on the side of the dance-floor, teething tetchily on slobbery glow stick, for long enough. Surely it’s time to give it a legally-regulated leg-up into the bathtub?

Words by Rosalind Stone

I’m not positing the MDMA experiences Katie documents as an ideal to pursue: all clinical researchers of psychedelics take great care to distinguish their results from any experiences achieved through recreational drug use. (Think Dr. Robin Carhart-Harris’s qualification, after leading the recent Beckley/Imperial trial of psilocybin as a treatment for depression that, “I wouldn’t want members of the public thinking they can treat their own depressions by picking their own magic mushrooms. That kind of approach could be risky.”)

But while Katie’s findings may not be ideal (from a risk-perspective), the research she is doing - bringing qualitative

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TRIPS AND TRAPS Psychedelics Seek Legitimacy in the World of Modern Medicine

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or anyone tracing the fortunes of psychedelic research, the last few years have been a whirlwind ride. Once considered a great hope for psychiatry, this line of enquiry came to an abrupt end in the 1960s – a casualty of anti-hippie sentiment and the ‘war on drugs’. More recently, though, we seem to have come full circle, with a new wave of scientists and thinkers picking up where their predecessors left off.

In 2005, the British medical press saw its first editorial on psychedelic therapy in decades. This was followed by a symposium at the Royal College of Psychiatrists and a major international conference. Since then, dozens of studies have got underway, attempting to determine whether the likes of LSD, psilocybin, MDMA and ketamine might have uses beyond the recreational.

Most recently, a study into psilocybin for depression, led by Dr Robin Carhart-Harris at Imperial College London, made headlines across the world. The findings, published in The Lancet Psychiatry in May, suggested not only that psilocybin was safe to use, but that it could offer hope for treating depression where standard treatments have failed.

While these results have been heralded as a major breakthrough, the researchers themselves have counseled caution. As a small, proof-ofconcept study, with only 12 participants, the trial can’t be taken as anything more than a starting point.

The same applies to, say, the finding that ayahuasca stimulates the birth of new brain cells, or that LSD-assisted psychotherapy might reduce anxiety from terminal illness. If any of these drugs are to be approved for therapeutic uses, they will first need to undergo large clinical trials, complete with a placebo group and double blinding.

“There are suggestions of efficacy here that require a better-controlled, more rigorously done and bigger study that scrutinises that efficacy,” Carhart-Harris explains.

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Photo by Alan Rockefeller

Unfortunately, given the legal standing of these substances, this will be far from an easy ride. While a rigorous, multi-stage trial is par for the course in drug development, psychedelic researchers are uniquely disadvantaged in getting this off the ground. No matter how encouraging their early results, they have a long and labyrinthine road ahead.

As a result, researchers have been forced to find more creative sources of funding, ranging from anonymous benefactors to government grants to charitable organisations. Others have noted a new wave of entrepreneurial interest, which could conceivably gather momentum in the years ahead.

For Dr Ben Sessa, a Bristol-based psychiatrist, researcher and writer, the principal roadblock is simply money.

One major player in this field is the Beckley Foundation, a UK-based NGO that helps set up research and allocate funding. Its Beckley / Imperial Research Programme has not just led to the psilocybin for depression trial but also the first ever neuroimaging study with LSD, as well as an upcoming study into how DMT affects brain function.

“I’d like to say that we’ve come a long way and we’re moving into a period of great acceptance, but these studies are still difficult and costly and lengthy,” he says. “This applies to any human pharmacology study, but most of that research is sponsored by the pharmaceutical industry, and there’s no pharma industry money here.”

Beckley's science officer, Anna Ermakova, is tasked with assessing the studies that apply for sponsorship. She says that as the evidence base grows stronger and stigma decreases, government grants may well become easier to obtain.

Sessa has been involved with the research revival from the outset, both as a doctor and as a research subject. Since 2009, when he became the first person in 33 years to be legally administered a psychedelic drug in the UK, he has worked on most of the UK-based studies in the field.

He is currently setting up two clinical studies in MDMA-assisted psychotherapy, one for PTSD and the other for alcoholism.

“The Medical Research Council, which is the biggest sponsor in the UK of biomedical research, funded the psilocybin for depression study, and I think this is going to happen more in the future,” she remarks.

Unfortunately, even pending this kind of boost, the cash pool is only likely to run so deep. In a cruel twist of the knife, these hard-to-fund studies are far more expensive than they need to be.

As he sees it, pharma companies have no real incentive to fund psychedelic research. Drugs of this nature are not under patent, meaning anyone would be able to make them with the right licenses. Usage patterns, too, put a dampener on profitability: since patients would only receive two or three doses in total, large quantities would not be required.

Take the psilocybin for depression trial, which cost a steep £1,500 to dose each person. According Prof David Nutt, who worked on the study, the equivalent figure in a ‘sane world’ might only be £30.

“Getting ethics approval was quite drawn out and difficult, and then the biggest delay was around getting the drug,” says Carhart-Harris.

“You might think that would have been quite trivial, but there are only a small number of companies around the world that even synthesise psilocybin, let alone make it to GMP [good manufacturing practice] standards.”

“Most psychiatric drugs, like SSRIs, are maintenance therapies – you take them day in, day out, sometimes for years, and they mask the symptoms,” says Sessa. “But MDMA or psilocybin therapy is, if I dare use the word, somewhat curative, so there’s no product there for the pharma industry. Why would they throw tens of millions of dollars at this product when there’s very little profit to be made from its use?”

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and LSD are incredibly useful in psychiatry, and they’re virtually inert physiologically – there have been no recorded deaths from toxicity. As a pharmacologist I look beyond what the government arbitrarily calls legal or illegal, and I look at the relative benefits of the compound.

When you do that, it’s a very frustrating arena in which to work.”

Scheduling Conflicts The issue here is that psilocybin – along with LSD, MDMA and even cannabis – is classed as a Schedule 1 substance, which means it has no recognised medical uses. Whereas cocaine and heroin are Schedule 2 (i.e, they have a currently accepted medical use, and can therefore be more easily investigated), psychedelics are subject to extraordinarily tight restrictions.

Light at the end of the tunnel?

Currently, only one manufacturer in the world produces psilocybin for trial purposes, to the tune of £100,000 per gram. Factor in the cost of a Schedule 1 drug license (around £5,000), and it’s easy to see why researching psilocybin costs five to ten times more than researching heroin.

Whether the scheduling will change is a question in point – Sessa maintains that drug laws have a notoriously fraught relationship with evidence, whereas Rucker feels that our best hope lies with the United States. If the US scheduling system changes (perhaps as a result of the highly emotive MDMA study currently underway for PTSD), there could be a domino effect in which other countries follow suit.

“Only four institutions in the UK have licenses to deal with schedule 1 substances, whereas pretty much every hospital can handle opiates,” says Ermakova. “The license lasts about eight weeks and you have to keep reviewing it, so it involves a lot of bureaucratic procedures, and a lot of money.”

For the time being, researchers have little choice but to accept the state of play. And while it would be a stretch to describe their mood as sanguine – Sessa, for one, has no qualms in expressing his anger – all the experts I spoke to for this piece were hopeful about the long-term prospects.

For many researchers, this situation is not just absurd – it’s a classic catch 22. You can’t do the relevant studies because the drugs have ‘no medical uses’, and you can’t determine any medical uses because it’s so hard to do the studies.

Carhart-Harris is looking to build on his depression study via a largescale randomised control trial (RCT). He points out that, as the evidence accumulates, more and more people are likely to become interested in these substances’ potential, perhaps clearing some of the obstacles to drug development.

Dr James Rucker, a psychiatrist and honorary lecturer at the Institute of Psychiatry, Psychology and Neuroscience at King’s College London, worked with Carhart-Harris on the psilocybin for depression trial.

In 2015, he wrote a letter to the British Medical Journal opining that the current scheduling needs to change.

Ermakova feels that, while medical usage is at least a decade away, the stigma is at last beginning to lift.

“The Daily Mail ran an article on the psilocybin study with a very positive spin,” she points out. “That’s astonishing, that a newspaper like the Daily Mail would ever write anything positive about drugs.”

“It was written because of the frustrations we had with trying to use the drugs – we’d used up all the money going through the Government’s regulatory processes,” he explains. “The article was surprisingly well received, probably because I was asking for something quite reasonable. I wasn’t saying it should be decriminalised, just that it should be rescheduled to the same classification as heroin and cocaine. All that practically means is it’s easier for hospitals to store it, and easier for us to do research.”

Sessa agrees that attitudes are changing, albeit slowly. Mainstream media outlets, he says, are drifting towards the terminology of "prohibition", implying that the parallels with prohibition era America are perhaps becoming harder to ignore. For now, though, he concedes his job is "hard work".

“I’ve chosen a very difficult time to do this,” he says. “In ten years it’ll be easier because once this first raft of studies are all in, then the government-based bodies or big research companies will be more likely to back future research.”

As his editorial explained, there is no evidence to suggest that psychedelic drugs are habit forming, little evidence to indicate that they are harmful in controlled settings, and a large body of evidence to suggest they could have therapeutic uses.

Rucker agrees. Psychedelic research excites him in part because it is new, a rarity in a field that hasn’t changed much since the introduction of Prozac. Over the next few years, he is hoping to develop trials alongside Carhart-Harris and David Nutt, recruiting patients from the Maudsley Hospital who have so far proven difficult to treat.

“These drugs had been used in psychotherapy since the mid 1940s, through the 50s and the 60s, and they were pretty safe in those medically controlled contexts,” says Rucker. “But the drugs had diffused into the American counterculture, and it appears that one way for Richard Nixon to gain control of the anti-war movement was to make psychedelics illegal.”

Its very novelty, however, is what makes it so frustrating. Rather than coasting along on earlier efforts, researchers have no choice but to put in the grunt work.

Despite this background, Rucker feels there has never been much rationale for the drugs to be as restricted as they are.

“Long after the excitement from Robin’s trial dies down, it will be about getting through those months of badgering people, and making your case again and again to try to get the funding that you need,” he says.

“I think with passion and hope does come optimism, but there’s a lot of work to do, and you just have to plod away. It’s early days.”

“It’s true to say that in the recreational context there were isolated cases of LSD and psychedelics causing fairly severe reactions, but I don’t think that was necessarily commensurate with them being placed in Schedule 1. I think quite why they were placed there remains a mystery,” he says.

Sessa goes one step further, describing the current scheduling for psychedelics as "peculiar, skewed and arcane".

Words by Abi Millar

“We have a drug classification scheme that is not fit for purpose,” he says. “It’s not based on any science whatsoever. Drugs like psilocybin

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THE CANNABARONESS MOLLY MEACHER Baroness Molly Meacher is not your stereotypical cannabis legalisation campaigner. Smartly dressed in a tailored turquoise jacket and matching necklace, the 76-year-old life peer explains to me that she’s relatively uninterested in recreational uses of the drug.

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owever, she became convinced of its therapeutic benefits during her previous career as a social worker.

Meacher is optimistic that a new report by Professor Mike Barnes might play a pivotal role in changing UK policy on medical cannabis use. Her eyes light up with enthusiasm as she discusses the findings. “It’s the most thorough, professional and objective report on research into medical cannabis across the world,” she asserts. “It doesn’t go over the top, but it shows without any doubt that cannabis is a medicine. The evidence is strong for the alleviation of chronic pain, neuropathic pain. It may help someone who’s had an amputation, or who has cancer, multiple sclerosis or arthritis. It can also be used for insomnia, nausea, appetite loss and even anxiety. There’s good evidence that it helps those people.”

“I did social work because I was doing a lot of policy work on unemployment and poverty,” she reveals. “I thought ‘here I am, a middle class person who doesn’t know anything about the world really,’ and i wanted to understand what I was talking about.”

“I worked in mental health over many years and I would ask patients ‘why do you take cannabis?’ and they would tell me ‘because it makes me feel human’. They’d say ‘it may make my voice a bit worse, but it’s worth it because it just makes me feel so much better’. The thing that struck me was that these people were sick, but when they walked out of our hospital they would become criminals. What they were doing was a criminal act, but they were doing it for medical purposes, and I realised there was something terribly wrong.”

It’s true that similar evidence has already prompted many other countries to make policy changes. “Germany now has a bill going through to legalise cannabis and they estimate 800,000 people will benefit,” Meacher notes. “Italy has passed a similar bill. 11 countries in Europe now have access to medical cannabis, and 24 states of the US plus Washington DC. Canada has done the same, and most of Latin America never banned it.”

She entered the House of Lords in 2006 and was subsequently asked to put her name forward for a balloted debate. Unexpectedly, she was picked, so she settled on the topic of drug policy. When the debate happened it became clear that peers from across the house supported the need for reform. They formed the All-Party Parliamentary Group for Drug Policy Reform, which recommends the decriminalisation of drugs, and which Meacher has chaired since 2011.

She hopes the changing international context has also altered possibilities in this country. “I think people are more aware of the evidence now than they ever have been,” she suggests. “People read about other countries that have done it without problems. They travel around and they see, and slowly, slowly it’s got through to people. The End Our Pain campaign found that 68 percent of people support the legalisation of cannabis for medicinal use. This is the first time I have felt that drug policy reform is possible, in terms of legalising cannabis for medicinal use. I really believe that it’s possible.”

“When you talk to senior politicians, they’ll say the barrier is middle England,” she divulges. “They’re frightened of the newspapers and they’re frightened of the population. Because of the dialogue on drugs over the decades, and the UN convention, politicians are very scared of being seen as ‘soft’. Medical cannabis is a separate issue to recreational use, though. The arguments are completely different.”

The report by Professor Barnes suggests that different strains of cannabis are preferable for treating different conditions. Most important is the balance between the two main cannaboids THC and CBD. “That’s

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There’s more I want to ask, but Meacher is due to attend an event in her capacity as the chair of Dignity in Dying. She confides that her various commitments mean she sometimes barely has time to eat. Before she rushes off, I ask her if she can share a patient story that motivates her campaigning for medical cannabis. She thinks for a moment. “One case study in the report is a person who had a tumour, was in a wheelchair and had basically lost their sight. They began taking cannabis and can now walk quite a way without a wheelchair, and they have their sight back. Isn’t that incredible?”

why it’s so important that it’s legalised,” explains Meacher. “Herbal cannabis that is, I’m not talking about expensive medications like Sativex.

A whole range of cannabis products can be produced from high to low proportions of THC to CBD.” “There’s a lot of stuff about cannabis causing psychosis,” she continues, “but that’s because it’s purchased from illegal drug dealers who sell very high THC varieties of cannabis. That’s dangerous for people with psychosis, but if you take away the THC and just leave CBD it actually becomes an antipsychotic. I believe that THC is useful for people with spasms and epilepsy and so on. That’s obviously a very major medical judgement, because THC isn’t good for little children and people with their brain growing, but for people with Dravet syndrome, who have hundreds of epileptic fits a day, it might be the best thing for their brain.”

Perhaps noticing the hesitance flash across my face, she explains further: “The other thing about this is that there’s an endocannabinoid system in our brain. This is what Professor Barnes talks about, cannabis just enhances the mechanisms we have in our brains anyway. We know the system can have an effect on tumours, on pain, on seizures and so on – so we’ve got a theoretical basis for cannabis being this effective as well as the survey trials.”

Meacher is almost evangelical about the benefits of cannabis over many conventional medications used to treat the same illnesses. “Often, patients say that the side effects of the drugs they’re prescribed for these horrible, long term conditions make them feel worse than if they were taking nothing,” she contents. “For 90 percent of patients the side effects of cannabis were either nil or very mild. It’s actually far less dangerous than the alternatives.”

Her passion is infectious, but after we go our separate ways I consider her arguments in a more critical manner and find I still struggle to identify much to disagree with.

Words by Abi Wilkinson

She also touches on a benefit that could do more to change politicians’ minds than any amount of medical evidence. “We reckon about 1 million people with chronic conditions would benefit from the legalisation of cannabis for medical use in the UK,” she explains. “These people use vast amounts of NHS time, consultant time, registrar time, GP time, nursing time, hospital beds and expensive medications. The potential of cannabis to save the NHS large sums of money is surely huge. We need to do that research and find out how much we could save.”

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WHAT DOES RESCHEDULING CANNABIS MEAN? Most people will know that controlled drugs fall under different Classes (A, B or C) in the UK, but what far fewer people are aware of is that drugs are also classified under different Schedules, which restrict their availability, how they are used and whether they can be researched or prescribed. Here, Professor Mike Barnes explores what could be gained from rescheduling cannabis.

At the present time, cannabis is classified as a Schedule 1 controlled drug under the Misuse of Drugs Regulations 2001. This means that it is deemed “of no therapeutic value”. This is contrary to a significant volume of studies that demonstrate that various cannabis products do have a clear medicinal value, as has recently been illustrated in the report by myself and Dr Jennifer Barnes for the APPG on Drug Policy Reform, released in September.

The issue has been debated by several sovereign states and cannabis is now recognised as having medicinal value and is legal or decriminalised for medical usage in 28 US states as well as 39 other countries [at the time of writing].

The situation is further confused by the fact that Sativex (nabiximols) is a natural cannabis product containing equal proportions of the two main active chemicals, THC and CBD, and is classified as a Schedule 4 Part 1 drug under the same regulations and thus legally prescribable in the UK. A synthetic cannabinoid, nabilone, is also prescribable in the UK. Non-UK European citizens who have legally obtained cannabis in their own country may legally import cannabis for continuing personal medicinal use when they come to the UK, while UK citizens who legally obtain cannabis abroad may not do so.

Until October 2016 one of the main constituent substances in cannabis, CBD or Cannabidiol, which is not psychoactive, was legal to purchase in the UK. It is particularly of known medicinal value in anxiety and types of treatment resistant epilepsy in children.

In October 2016 the Medicines and Health Care Products Regulatory Agency (MHRA), which is an executive agency sponsored by the Department of Health, issued this statement:

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“We have come to the opinion that products containing cannabidiol (CBD) used for medical purposes are a medicine. Medicinal products must have a product licence (marketing authorisation) before they can be legally sold, supplied or advertised in the UK, unless exempt. Licensed medicinal products have to meet safety, quality and efficacy standards to protect public health.”

In other words, the MHRA now recognise that CBD could potentially have medicinal value, although this is dependent on manufacturers providing proof of its efficacy (the MHRA ruling has arisen due to manufacturers making claims of medicinal efficacy of their CBD products). Individuals, including young children with resistant epilepsy, will not be able to obtain CBD legally from January 2017 until the producers can satisfy the regulations for medicinal products, which will take some years.

Finally, there is now a solid scientific rationale for the efficacy of cannabis given the discovery in recent years of the human endocannabinoid system. This is known to play a key role in a variety of brain functions, including the modulation of pain, nerve growth and nerve protection, brain adaptability (plasticity) and aspects of memory. It is also involved in a number of metabolic, immune and endocrine functions and seems to play a role in tumour regulation.

Overall, the regulations covering cannabis and cannabis products are confused and contradictory.

Volteface Voices

Rescheduling The Misuse of Drugs Regulations 2001 define what circumstances it is lawful to possess, supply, produce, import and export controlled drugs. Drugs are divided into five schedules, with Schedule 1 containing those considered to have no therapeutic value and therefore cannot be lawfully possessed or prescribed – this includes cannabis. Drugs in Schedules 2 and 3 can be prescribed and supplied by pharmacists, doctors and anyone with a prescription – these include methadone. Schedule 4(i) can only be lawfully prescribed under prescription – this includes Sativex. Schedule 4(ii) drugs can be possessed as long as they are clearly for personal use – this includes steroids. Schedule 5 drugs are sold over the counter and can be legally possessed without a prescription.

It is possible to reschedule cannabis by Statutory Instrument. Primary legislation is not required. The logic would be to reclassify to Schedule 4(i) of the Misuse of Drugs Regulation 2001. This is the same category as the existing prescribable cannabis product – Sativex (nabiximols). This in turn would mean that cannabis becomes prescribable by doctor’s prescription.

Advantages of rescheduling:

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Removal from illegal purchase / supply: At the moment, there are between 30,000 and 1 million users of cannabis for medical purposes, as seen in the recent APPG report. All these users are acting illegally except for those who have a legal prescription for Sativex, which has a licence only for use in drug resistant spasticity in multiple sclerosis, and the few people prescribed nabilone for nausea or vomiting during chemotherapy. Rescheduling of cannabis would enable these people to legally access cannabis by doctor’s prescription. This would take vulnerable, and often disabled, people out of the criminal market. The disadvantages of obtaining cannabis from the criminal market are obvious and include personal risks involved in purchase, the uncertainty of the purity of the product and the risk of exposure to other addictive drugs.

Product Purity: Legal cannabis should be produced with stringent purity criteria. This is the case in most US States and European countries that have legalised it for medical use. This enables the consumer to be reassured about the safety and quality of the product.

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Diversity of product: Cannabis can be produced in a variety of forms, particularly with variations in the relative content of the psychoactive THC component and the non-psychoactive CBD component, as well other cannabinoids which may have medicinal effects. In the Netherlands, for example, the Bedrocan range of products come in 6 different varieties. It is clear that some people with different conditions respond better to a certain type of cannabis with a specific THC:CBD ratio and it is essential that different, pure, forms are available. Such control of product is not possible in the criminal market.

Alcohol reduction: There is evidence that if cannabis is more widely used medicinally then individuals consume less alcohol with consequent decrease in the adverse social consequences of alcohol usage.

Reduction of opioid-related deaths: The main alternative medications for pain (one of the best researched indications for cannabis) are the opioid drugs. Whilst these are effective for pain they are associated with significant side effects and each year many hundreds or people die from accidental or deliberate opioid overdosage. There have been no reported deaths from cannabis overdosage. Cannabis is known to be 'opioid sparing' and individuals can either stop or reduce their opioid medication giving rise to less risk of opioid side effects and less chance of death.

Research: There is some good quality literature regarding the efficacy and safety of cannabis but there are still many aspects which require further research. We need to understand which conditions are best helped by which type of cannabis product (such as those low or high in THC / CBD). We need to understand more about the short-term side effects and we need more knowledge about potential long term problems, such as the much-discussed risk of psychosis in those already vulnerable. This research is clearly facilitated by ability the prescribe cannabis and thus enter individuals into properly conducted studies.

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Suicide reduction: There is further evidence that use of cannabis in those with mental health vulnerability have a lower risk of suicide.

Finance: Legalisation of this market would enable the government to raise taxes on the suppliers (and on prescription charges to consumers). The income is estimated (by the Institute of Social and Economic Research) to be in the order of £0.5b to £1.25b if the cannabis market was opened for both medicinal and recreational use. If the reasonable assumption is used (End our Pain campaign) that one third of cannabis users are medicinal users then the tax income from medicinal legalisation would be in the range of £170m to £420m. In addition, there would be savings to the exchequer from less policing and court costs for prosecution of cannabis dealers and users, (estimate by ISER of about £300m from legalisation of the whole market). As a comparison, the State of Colorado was expected to raise $88m in 2015 from the legalisation of cannabis. Colorado’s population is about 10% of the UK.

Addressing potential disadvantages Some express concern about crime rates if cannabis is more readily available. The APPG report cites evidence from the US that “the legalisation of marijuana for medical purposes is not predictive of higher crime rates and may be related to reductions in rates of homicide and assault”. There is also no evidence of significant traffic accident risk and a meta-analysis of 66 studies has shown that crash risk was “statistically comparable to that associated with penicillin, antihistamines and antidepressants” (APPG Report). There is no evidence that legalisation leads to greater overall marijuana usage and indeed the risk of “leakage” into the recreational market is clearly minimised by a controlled and secure supply chain.

Conclusion The use of cannabis for medicinal purposes is common and the evidence that it is efficacious for several medical conditions is now strong. It is illogical to continue categorising the drug under Schedule 1 of the Misuse of Drugs Regulations. There are several advantages that would flow from rescheduling to Schedule 4(i). These advantages are mainly related to the compassionate need to stop criminalising genuine medical users but there are also a number of safety, research, and financial reasons for so doing with very few disadvantages.

Words by Mike Barnes

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PRIMING THE POT

During almost five years on the beat as a police officer, patrolling some of the roughest parts of London, Mike Abbott arrested dozens of people for drug offences.

As a young recruit he picked up people carrying cannabis on the street in areas such as Brixton, later participating in undercover operations against major suppliers and peddlers.

‘The stench of hash was becoming more prevalent,’ he said. ‘My job was to uphold the law and cannabis, like other drugs, was illegal.’

Three decades later, Abbott is a high-flying businessman. Yet given his background, there is a certain irony that his latest venture has seen him emerge as among the biggest legal cannabis dealers in the United States.

For this former member of the Metropolitan Police now runs Columbia Care, the largest player in the emerging market for medical marijuana in the United States. Sale of the drug for such purposes is now permitted in 28 of the nation’s 50 states.

Abbott’s fast-growing firm – set up with a friend and former colleague from Goldman Sachs – has opened dispensaries from small towns in Arizona to major cities such as Boston, Chicago and New York.

These outlets are sober in appearance. But the goods on sale would once have led to instant arrest by the firm’s boss: potent buds from marijuana plants, cannabis cookies crafted by some of the 211 staff and specialist inhalation equipment.

Supplies come from a string of high-tech greenhouses and warehouses.

The firm has thousands of plants growing in seven states, assisted by experts in more traditional forms of agriculture and scientists developing techniques to boost production.

Amid bold claims for the curative powers of the drug, demand is rising so fast that Columbia Care is rapidly expanding cannabis cultivation. It expects to grow more than fives times as many plants next year, producing at least ten tonnes of the crop to harvest for more than 200,000 patients.

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The success of Abbott’s three-year-old firm – already profitable despite tens of millions of pounds investment – underlines the astonishing pace of cannabis reform in the country that launched and for decades led the global war on drugs.

Another eight states balloted voters in November – three more for medical use and five, including California, questioning whether to join a quartet already backing legalisation. Seven of the eight ballots passed.

It is estimated sales in the Sunshine State alone could top $7bn a year.

As firms and investors rush to cash in on the ‘pot goldrush’, today’s critics are as likely to be hippies alarmed by ‘breadheads’ and commercialisation of the counter culture as they are to be conservatives worried about encouraging drug taking.

Abbott is focused on the medical market. Yet he argues his police experiences helped influence his unlikely change of direction, selling cannabis products to patients with conditions such as cancer, epilepsy and multiple sclerosis.

‘Why should people with a medical need risk being arrested?’ he said.

‘This allows them to go to a safe and regulated environment rather than a street dealer, avoiding a colossal waste of crucial resources and helping criminals.’

Certainly it is a long way from the days in 1983 when a school leaver from Liverpool joined London’s police force at a time of intense industrial and racial upheaval. ‘I loved serving with them but it was a very difficult period,’ recalled Abbott.

He found himself on the frontline of the miners’ strike as a member of the Special Patrol Group, bricks and bottles raining down on their heads as they protected men returning to work – and patrolling Brixton, where cannabis use inflamed tensions.

Bizarrely, he met his wife Jana on an undercover operation when he fell for the then student, who was enjoying an innocent drink in a Chelsea pub under police watch for suspected dealing.

Today the couple have three kids. The two oldest, both teenagers, asked their nine-year-old sibling last week what he would tell teachers at a new school if quizzed over what their father did. ‘I’ll tell them he makes medicines,’ came the response.

Yet Abbott, 52, admits most business friends thought he was ‘crazy’ when he told them he was entering the marijuana industry after a career in top-level finance that saw him work for banks and a hedge fund after leaving the police. Old pals from those days on the beat just made jokes about dope dealing.

One key person was supportive: his elderly father, a former hospital doctor, who told him that if he could collect data on any medicinal properties of marijuana then he would be doing a wider service to society.

It was Abbott’s business partner Nick Vita who first heard about a medical marijuana firm at a birthday party. He tracked it down and was impressed after giving cannabis cream to his mother, who found it alleviated her crippling rheumatoid arthritis.

The pair began as passive investors but now run the firm. Vita says he has never smoked pot; Abbott admits trying it a few times at university after leaving the police.

The fledgling firm made some mistakes at first such as hiring people who had grown illicit cannabis in basements. ‘It did not take long to realise the hippies were wrong for us,’ said Abbott.

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Today they use academics from the Mid West to advise on farming techniques and staff have been sent to study tulip growing in Holland.

Technicians test advanced lighting systems to speed plant growth and boost potency, while using a major pharmaceutical maker to formulate products.

I found security tight when visiting the firm’s New York production centre in a former Kodak plant near the Canadian border. Inside the first room a woman was carefully watering hundreds of female plants in varying stages of growth, each worth $5,000.

It was strange at first to wander round rooms filled with cannabis sprouting up under bright lights. But that feeling soon dimmed as I strolled past mesh baskets laden with drying buds and watched high-pressure machinery extract the precious oil for processing into tincture.

I estimated there were 2,500 plants at this single 50,000 sq ft centre, which opened in Rochester after Columbia Care won a licence last year to trade in New York. The site is being prepared already for fivefold expansion over several floors.

Another in Massachusetts cost $6m to open. It has 60 strains such as ‘California Dreaming’ and ‘Strawberry Amnesia’ growing in 8 ‘flowering rooms’, the pungent plants kept at constant heat and humidity with extra carbon dioxide pumped in to aid growth.

Afterwards I ate lunch in a local Rochester restaurant, then chatted to its middle-aged owner. When I explained my visit, she confessed that a relative had started obtaining cannabis for her to cope with insomnia caused by the menopause.

‘I don’t ask questions – I’m a businesswoman and a single mother,’ she said. ‘But it sends me straight to sleep with none of the grogginess from other medications.’

She is unable to access the drug in New York, which has strict regulations including a ban on leaf sales and only 10 permitted medical conditions signed off by doctors. This contrasts with Massachusetts that has a catch-all ‘debilitating’ qualification and leaf is sold alongside rolling papers and cookies; users there seemed far younger.

Elsewhere, medical tests to access the drug are so loose and easy to meet that they have come in for criticism for effectively decriminalising the drug for stoners.

Yet although it is 20 years since California became the first state to permit sale of medical marijuana, this is still a grey commercial environment since federal laws remain unchanged despite wide-ranging reforms at state level.

So it is illegal to transport the drug across state lines, tax laws are hazy, banks are reluctant to handle cannabis cash for fear of money-laundering charges and even insurance is difficult to obtain with just one European firm agreeing to provide cover.

A major processing company in California – licensed by authorities in San Diego – has just closed after raids by armed drug squad officers.

They used federal asset forfeiture laws to freeze and seize £1m in cash and cannabis oil cartridges.

In August, however, President Barack Obama loosened laws blocking research into marijuana. The move was seen as a significant step towards ending federal prohibition and comes as Canada prepares to legalise the drug.

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Recent polling found almost nine in ten Americans back the idea of people being allowed to use marijuana for medical purposes. A narrow majority support legal recreational use, although it remains controversial with 41 per cent still opposed.

Silicon Valley is also showing great interest. An investment fund founded by Peter Thiel, billionaire co-founder of PayPal, put money into the specialist firm behind Marley Natural while Leafly, a website for users, gets 8 million monthly visitors.

The burgeoning cannabis sector is reportedly the fastest-growing industry in the United States, with legal sales expected to climb 25 per cent to $6.7bn this year. Denver alone has 421 shops and commercial cultivation sites.

But there is still fierce debate over the consequences, with concern from parents over sales near schools and a sharp rise in cannabis-related emergencies in hospitals.

There are also suspicions criminal drug cartels, seeing profits fall from cannabis, are promoting harder drugs with more vigour. Studies have also linked regular use in adolescence to depression and schizophrenia.

This is astonishing expansion given that retail outlets for recreational use only started opening 36 months ago in Colorado. The first legal buyer in the US was an Iraq War veteran named Sean Azzariti, who suffered from post-traumatic stress.

Abbott aims to build a big pharmaceutical company based on cannabis, arguing that he operates in a different market to the recreational one emerging in parts of the US. ‘I’d love to bring some of the lessons we have learned here to Britain,’ he added.

The state now raises almost four times as much from cannabis tax as from alcohol.

There are indications of impressive results among people with genuine medical concerns – such as Fr Joe Quinn, a 63-year old Franciscan monk who used to obtain the drug from grandchildren of parishioners to curb agonising stomach pains.

Analysts ArcView Markets predicts the national market will more than triple in size by 2020, forcing traditional financial firms and investors to start to taking cannabis seriously.

Already celebrities such as rapper Snoop Dogg and country star Willie Nelson have backed weed-related ventures. Marley Natural, a startup funded by private equity cash, has launched branded products in the name of reggae icon Bob Marley.

Quinn suffers from a rare condition that led to seven major operations last year. ‘The other friars could hear my screaming from two floors below,’ he said. ‘It was like someone sticking a knife in your stomach – and the pain never went away.’

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She admits she did not tell friends for several months, such was the stigma. ‘Now I think we’re on to something major from the anecdotal evidence, although clearly we need more research,’ she said.

Quinn is allergic to conventional opiate-based pain relief – but found cannabis dulled the pain enough to snatch some sleep. He started secretly puffing on pipes in his bathroom before bed after discovering the drug following a tip from a friend.

She says she has seen patients get off opiates, seizures end for children with complex epilepsy and cancer patients given fresh lease of life. As one insider said, even if cannabis just boosts appetite and aids sleep that is often half the battle.

His 30 fellow monks soon found out but, seeing his distress, supported him. And the brown-robed priests proved a powerful lobby when there was debate over opening one of Abbott’s dispensaries nearby – even winning over the sceptical mayor, a recovering alcoholic who sometimes attended their church.

Reed’s most memorable case was a woman in her 30s suffering brain cancer whose weight had plummeted to seven stone and was preparing to go into a hospice.

When I visited the building beside the alleged birthplace of Benjamin Franklin, all the ‘patients’ visiting appeared to be young men.

One rotund tattooed man in his 20s told me he had attention deficit disorder; another spoke vaguely of ‘pain.’

She says the patient’s tumour shrank 40 per cent after taking cannabis, her weight rose and she was given several months extension of decent life. ‘I’m not saying it’s a cure but it can improve quality of life,’ said Reed.

Leaflets described the goods on sale: the strains available along with descriptions of their psychoactive contents, flavours, effects -‘happy’, ‘euphoric’ and ‘creative’ were typical – and uses, such as depression, pain, insomnia, sickness and stress.

Big claims for a drug more commonly associated with giggling student stoners. But they help explain why a former London copper has become perhaps the world’s least likely cannabis baron.

Although cannabis has long been thought to have medicinal qualities, Abbott’s company is careful not to over-claim while funding research projects. The average age of the 2,500 patients attending the more stringent New York outlet is 57.

‘Of course we want to build a profitable business,’ said Abbott as we travelled back from seeing thousands of his plants. ‘But I think we can also do a tremendous amount of good for people with serious health problems. That’s the real challenge.’

Chief pharmacist at the Manhattan dispensary is Tricia Reed, a softly-spoken Midwesterner. She joined the firm after becoming fed up doling out thousands of the highly-addictive opiate painkillers blamed for fuelling America’s heroin epidemic at a leading chemist chain.

Words by Ian Birrell

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HARRY POTTERS ON THE CANNABIS TOURISM TRAIL Harry Wallop navigates a cannabis tour in Denver, where the drug is a $34 million tourist attraction

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Plus, thousands of tourists each month cross state lines to smoke, chew, and ingest marijuana. There are even cannabis massages for those so inclined.

Interviewing someone when you are so high you can’t feel your own face, let alone hold a pen, is not easy, it turns out…

I had come to the home of Michael Eymer, a twenty minute drive out of Denver, to partake in a ‘Puff, Pass & Paint’ class. The idea was that I would join the painting class — recreating a Rocky Mountain nighttime scene in acrylics — while getting gently stoned with some fellow tourists who were making the most of the lawful marijuana in the state of Colorado.

I decided to join the crowds of visitors to see if the marijuana gold-rush was all it seemed, and how easy it was to get stoned.

My first stop in Mile High City is the tourism office, Visit Denver — a smart building in the downtown district, where the confusing status of marijuana in Colorado is immediately made apparent. The rack of leaflets for Colorado Attractions includes ‘Discover Colorado Wine’, ‘The Redstone Meadery’, ‘Colorado Hot Springs’, steam railways and art museums. But nothing about the many cannabis tours I had heard about.

Then, I would chat to Eymer, the chief executive of Colorado Cannabis Tours, about how the legalisation of cannabis has boosted not just the tourism industry, but Denver too, one of the fastest growing cities in America.

I start to ask the woman behind the desk, but she immediately does a friendly but firm ‘speak to the hand’ gesture. “You’ve said the magic word.”

However, either my jet lag, the altitude of America’s Mile High City or the fact I am a complete lightweight meant that after just half a dozen puffs, the room started to spin violently and one of the teachers, Leslie Moffatt, escorted me into the fresh air, as the floor lurched up and down.

I raise my eyebrows in bafflement.

“Marijuana,” she explains in a stage whisper and goes to get her manager, Chrystal, who gives me a dirty look as she emerges from her office.

She explains tersely that Visit Denver receives funds from the federal government; marijuana is illegal under federal law, she can’t discuss it with me.

I don’t remember much else, but my tape recorder kept running, capturing the heavy and desperate breathing of a man in the pit of despair, slumped in a deck chair.

At one point Leslie comments that I’ve turned very green.

On the street I try ‘Jason’, wearing a bright yellow uniform and manning an information booth on the pedestrianised 16th Street. He is initially suspicious, but once I assure him I won’t use his real name, he warms up and tells me that about 15 tourists a day ask him where they can buy marijuana. “They’re mostly middle-aged folk, who just want to give it a try,” he says.

Later, Michael hands me an apple. “You’ve got a real blood sugar low.

Eat that,” he tells me.

Eventually, I manage to lift the fruit, which to me weighs as heavy as a shot put, to my lips. The apple tastes both intensely sweet and sharp.

“What sort of apple is this?” I slur in amazement.

The younger crowd don’t need directions. They use a variety of smartphone apps, such as Weedmaps, Weedfinder or Leafly, an upmarket review site, where the writing is as pretentious as many wine critiques.

Space Cream, a new strain of marijuana, is described as having “an odor of citrus blossom, pine and hops, which blend into a creamy sweetness on the exhale.”

“It’s organic, man,” says Eymer.

I then vomit violently all over his front yard.

On November 8, four further US states voted to legalise cannabis for recreational use. They included the largest of them all, California, with a population of 39 million. To some this is a dangerous experiment on a gargantuan scale; to others, the necessary nudge needed to tip America into becoming a fully legalised cannabis market, opening up an industry that could be worth $100 billion a year, according to financial analysts at Ackrell Capital.

Leafly is owned by Privateer Holdings, a private equity firm based in Seattle, which raised $75 million last year in a round of funding — proof, if needed, that marijuana is starting to become big business.

Jason gives me a map and circles his favourite dispensaries, the licensed shops where you can buy the drug. He also gives me a leaflet, Denver: Know the Law, which reminds me I have to be 21, it is illegal to consume in public, I can only buy from a licensed establishment and I can not take marijuana out of the state. “Don’t even think about taking it on a plane,” he laughs. “You’ll be locked up.”

Colorado was the first state to vote in favour, back in 2012 and marijuana has been available to buy to anyone over the age of 21 since the start of 2014.

Drugs reformers are looking closely to see whether the policy of strict regulation in this state could provide the template for other places in the world. “The naysayers said it would be a disaster in Colorado,” says Paul Birch, who founded Volteface. “But the sky didn’t fall in.”

Most dispensaries are cash-only businesses, with ATMs for those who don’t have enough dollars. This is another corollary of the drug being legal statewide, but banned federally. Banks are regulated at a federal level and they have to prove their cash is coming from the legal cannabis trade. The result is that many banks refuse to give business accounts to marijuana growers and sellers.

Unlike The Netherlands, where the drug is grudgingly tolerated by the authorities, but not actually legal, in Colorado every single plant that is grown is tagged and monitored by the State, and, crucially, taxed.

The market brought in $34.4 million in tax receipts for the first seven months of this year, up 45 per cent on last year. That’s more than the Colorado taxman makes from alcohol and tobacco combined.

“It’s frankly ridiculous. Getting a bank account has been a nightmare,” says Eymer, the man whose front yard I vomited over. “I have other corporations set up that I run the money through.”

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The first hour of ‘puff, pass and paint’ is rather fun, probably because I don’t do any puffing. The teacher, Chris Eldert, 26, is less Joshua Reynolds and more Shaggy from Scooby Do. He’s wearing a bucket hat and a Hawaiian shirt. “You don’t have to follow me. You’re on own your own personal journeys,” he intones.

Nearly all the dispensaries have a security guard posted outside. I have to show my passport to one before I can enter Good Chemistry, on Colfax Avenue, which manages to look like a chic dental clinic from the outside and a moderately cool bar on the inside. A backlit board above the counter lists all the endless different strains available, listed by category: amplify, relax, relieve, sleep. Most have silly names such as Bruce Banner or Purple Alien Dawg, both $60 a quarter of an ounce.

In the class there is a New Zealand couple in their 50s, who don’t want to give their names. She is a teacher. There is also Benny and Claudia Berschied, both 32, from Minnesota, who are on their honeymoon and determined to spend every minute of it wasted. Benny works at Whole Foods. “I cut up the really expensive fruit. And some of the vegetables,” he tells me.

The majority of people are buying marijuana in its pure, dried flower, state to smoke in a pipe, but there are plenty of “edibles” — sweets and cookies infused with the stuff — on offer too.

Inside, I meet two sports promoters from North Carolina in Denver for a ski convention. “I can’t get over that this is just behind the Capitol Building,” said Donny, one of them, excitedly. “I think it’s awesome”

Claudia says: “We saw this class on YouTube. And I was amazed because I am a ceramic artist in my spare time. The idea of putting art with enjoying your pot was my idea of heaven.”

The two of them had spent $60 on some cannabis candy and an 1/8th of an ounce of weed. “We got here this morning and checked in our hotel, and our rooms weren’t ready. So we said, let’s go downtown and find a dispensary,” Donny said.

Chris, the teacher, admits he spends about $100 a month on weed and I ask him if he worries about the long-term effect on his brain.

“There hasn’t been enough research done on it. So, I’m going to rely on all the anecdotal evidence that there isn’t anything wrong with how much weed I smoke, that I’m going to be okay.” We both start to laugh at the flimsiness of his position. “That’s called optimism, my friend,” he says.

At the Native Roots dispensary the products are displayed under glass cabinets as if it were a pricey, but slightly naff, gift shop. There are prerolled joints for $9, as well as a bewildering array of different strains.

Joe, the sales assistant, tells me the most popular are the potent ones.

It’s only later that I discover regular smokers’ tolerance levels are so high, they puff away on stuff that can knock me out after a few drags.

Not long after, I have to be escorted from the room.

The next day is the main event: the cannabis bus tour. Because you can not smoke in public there are very few places you can actually consume your (legally bought) marijuana. So a number of companies have spotted a loophole: a bus counts as a residence.

I ask if the joints are mixed with tobacco, as they were when I was a student — the last time I smoked pot properly. It is a question that displays my naivety.

“We can’t legally sell tobacco-based products at all,” he says firmly. He recommends, considering I am staying in a non-smoking hotel, I try an edible. “I have chocolates, fruity taffies, caramel taffies, hard candies, gummies.”

Colorado Cannabis Tours is the biggest of all the companies, and some people warn me it’s a bit downmarket. There is a rival tour called Lighthouse Cannabis Project, where about one in three of the bus tours are non-smoking — for tourists who are genuinely curious, but either do not consume cannabis, or don’t want to do it with a bunch of strangers while getting travel sick.

I buy an apple caramel candy with 10mg of THC, the main active ingredient in cannabis. All products have to declare this figure as if they were a Pret a Manger sandwich divulging their salt content. He warns me: “We recommend 5 to 10mg for new users. And it can take 1 or 2 hours for the dose to play out. Start low, go slow.”

But the crowd who gather for the Colorado Cannabis Tours $99 fourhour trip at Cheba Hut sandwich shop are mixed.

The Berschied couple from the night before are there, already having consumed three candies, with blood-shot eyes. But there are also plenty of people in their 50s and 60s, most are regular users of cannabis. The youngest people I can find are Jon, with a Zorro moustache, and his girlfriend, Nikki 27. They are both real estate investors from Texas and there to celebrate Jon’s 31st birthday. Jon says: “I thought it would be a younger crowd.” Nikki, wearing Raybans and skinny jeans, says: “Yeah, I thought it would be a busload of degenerates. But it’s not.”

It was good advice. I wish I had heeded it.

Initially, I eat just a corner, maybe a third of the chewy sweet. But after an hour I feel nothing, so I go and buy a 10mg cookie from Good Chemistry and pop the whole thing in my mouth. Like all edibles, it has the distinct musty, almost compost, smell of marijuana, and comes in a child-proof sachet that requires fingers of steel to tear open.

This cookie did the trick. An hour later I am wandering around downtown with a tongue that feels like cotton wool, desperately searching for a bar of chocolate and some espresso to wake me up before my painting class. I am properly stoned and marginally alarmed when two cops in the 7Eleven look at me suspiciously, before I remember I haven’t broken any laws.

Cheryl, 49, is an executive from Pittsburgh, and looks like she’s on an office away day, wearing a Nike golf top, with her company’s logo stitched on the front. She asks me not to name the well-known corporation or her surname. “Most people I work with know what I’m doing here this weekend. Some people would judge it, some wouldn’t it. But I go to work sober, I do a fantastic job.”

I am only just sobering up by the time I arrive at Eymer’s clapboard house with a picket fence that screams Apple Pie Americana, even down to the doormat, which declares: ‘Come Back with a Warrant’.

She’s never been on any tour like this: “I’m so excited. Growing up in the 1980s, no one could imagine we’d be able to do anything like this. It was no joke, when I was young. It was all ‘just say no’.”

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The Lighthouse Cannabis Project, which runs the more upmarket tours, is owned by CID Entertainment, which specialises in promoting upscale hospitality and travel for concerts and music festivals such as Coachella.

It also organises the VIP packages for the Peppa Pig live tour in the US.

Most of the people I speak to are often drug-tested at work and admit they’ll have to be clever to ensure they do not get into trouble once they are back in their home state.

We sit on leather banquettes running along either side of the bus.

“We saw this as an opportunity for CID to leverage its high-touch, white-glove service, our experience of logistics in hospitality.”

“We’re going to have a lot of fun!” hollers Mia Jane, one of our young tour guides. We all cheer. “One thing on these tours I see is people don’t drink enough water. Remember, we are a mile above sea level so you need to keep hydrated,” she says.

Chavez, the glassblower, has another reason why he hopes California votes in favour. “I rather it was legalised in California so that my rent goes down in Colorado. I pay $1,300 a month for a one bedroom. It was $600 not long ago. It’s making it impossible for me to live here in the state.”

With that health and safety briefing over, she passes around some prerolled joints. The only businesses that can sell drugs are dispensaries, so no money changes hands. These are a “donation” from their sponsor, one of the main growers. Another rule, another loophole.

He is one of many locals who tells me about escalating rents, as people flood into the state and demand for housing outstrips supply.

Our first stop is Medicine Man, Denver’s biggest grower of marijuana, with an annual turnover of $18 million. Situated, on a light industrial estate, near Denver’s airport, the warehouse houses between 7,000 and 10,000 plants all growing under strong lights.

An estimated 3,737 homeless now live in Denver; plenty of them hanging out on 16th Street outside the Capitol Building, along the road from Good Chemistry. Activists say that’s a 10 per cent increase over the last two years. Some come for the legal highs, others just can’t afford a home.

Before we can inspect the growing tunnels, we have to listen to a detailed lecture on the propagation and cultivation of the cannabis plant.

There’s a lot of talk about Rhizotonic, NPK ratios, and PH levels. “What you’re looking for is 5.8 to 6.2, for hydroponics it needs to be 6.2 to 6.4”, our guide tells us.

True, weed is not the only reason for sky-high rents. The River North area, full of hip bars and street art, is home to many tech start-ups and Google has opened an office just up the road in Boulder. But as with most economic booms, there is invariably a group that gets left behind.

It’s like the most boring episode of Gardener’s World you can imagine.

Campaigners, however, believe the winners outweigh the losers. “Opponents said legalisation would hurt the economy and tourism, but that couldn’t be farther from the truth,” says Mason Tvert, from the Marijuana Policy Project, which campaigned for legalisation. He points out that 28,000 people are officially licenced to work in the State’s cannabis industry — all new jobs.

The crowd, most of whom are pretty high, are lapping it up. I ask Benny Berschied what he thinks: “It’s interesting, I’m just trying to absorb it all.” Are you too stoned to understand it? “I’m pretty stoned, but I feel good.”

We exit via the gift shop selling yet more marijuana. Back on the bus, a bong gets passed around. Up until then, I had not indulged for fear of repeating the previous night’s coma. I had memories from my student days — an era when Pulp and Radiohead were in the charts and Tony Blair promised us things could only get better — that these glass smoking contraptions were the quickest way to knock you out. But I was also aware that every other member of the tour group was halfway to becoming catatonic and I was not joining in.

Unsurprisingly, I can’t find anyone on the tour bus to disagree with him.

At the end of the tour, despite ingesting about five times the quantity I have, Cheryl is remarkably eloquent about how the right to get high is as an important freedom as the right to bear arms. “America isn’t a place, a flag, or an anthem. It’s an ideal; an ideal of freedom and equality.

Colorado is fighting and winning at bringing those ideals to life.”

For me, I just need a lie down.

Luckily, before the motion sickness from the bus and the Purple Haze from the bong makes me too queasy, we stop at a glassblowing workshop, which makes bongs and glass marijuana pipes. Most of my fellow tourists are too stoned to do anything other than gawp. Next to the till there is a tray of candy and chocolate bars for those who have an attack of the munchies.

As I leave to go back to my hotel, Eymer says: “Hey, you didn’t get sick today. You’ve learnt your limits. And that, my friend, is progress.”

The main glassblower is a heavily bearded Tim Chavez, who has a nice line in sardonic glassblower jokes — “What’s the difference between a glassblower and a pizza? A glassblower can’t feed a family of four.” We all laugh.

Words by Harry Wallop

If California votes in favour, how much will these businesses, heavily reliant on marijuana tourists, suffer?

Visit Denver refuses to say how many of last year’s record 78 million visitors to the state crossed state lines to get high. They say, correctly, Denver was already enjoying an uptick in tourism before the legislation came into effect.

Eymer says: “I’m not worried. Because I own CaliforniaCannabisTourism.com. I’m hoping it happens, in fact. It will give me five more states to build a business in. And Visit Denver is going to discover how many people were coming here exclusively for the cannabis.”

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Harry in Colorado

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Volteface Voices

SOUTHEND-ON-SPICE York Road is the epicentre of homelessness in the Essex seaside town of Southend. Walking east, away from the High Street, you’ll spot groups of guys huddling in the car park, an abandoned supermarket trolley full of clothes and the telltale pair of shoes hanging from the telephone wires. Sometimes you’ll catch odd-smelling fumes of Spice smoke being carried in the air.

Spice in the hope that others avoid what they’ve gone through.

Further down the street lies a support centre run by local homelessness charity HARP, which is often their first point of contact with the town’s rough sleepers. Inside, manager Neal McArdle explains that he’s had to deal with many service users suffering from the effects of Spice, from fits and hospitalisations to people running up and down the street possessed.

He pauses, and hangs his head in his hands.

“Historically, people haven’t seen Spice as an issue, like putting salt on your chips,” Neal says. “But that’s changing. With Spice people are starting to realise they have no idea what they’re smoking.”

In the corridor, Charlie, 20, nods his head in agreement. “It's like crack but a lot worse,” he says, revealing that he’s been hospitalised seven times due to Spice. “I wanted it so badly I punched a brick wall.”

Spice has become the misleading, catch-all term for a family of different psychoactive substances that have emerged since the mid-2000s. We’re now seeing the third generation of what scientists call Synthetic Cannabinoid Receptor Agonists (SCRAs).

Each evolution of the pharmacology has proven to be far more unpredictable, dangerous and addictive than herbal cannabis, with SCRAs responsible for multiple deaths and thousands of hospitalisations in the last year alone.

SCRA addiction is a growing epidemic among homeless people, in part due to its low price and ease of availability. Until the Government’s Psychoactive Substances Act or ‘legal highs ban’ came into effect in May 2016, it was sold over the counter at head shops, with brand names such as ‘Spice’ and ‘Black Mamba’, providing a cheap and legal alternative to cannabis. But while criminalising SCRAs appears to have cut down use among the general population, it has done little to restrict access for vulnerable groups, such as the homeless.

On the other side of Southend, Lewis, 19, and Chris, 20 are trying to put their lives back together at HARP’s halfway house in a white semi-detached Victorian house. Until they found the Restart programme, they were both on the streets, dealing with a number of issues, but addiction to Spice was sending them on an escalating downward spiral. The pair are the only people known by HARP to be in recovery, and they’re eager to share their experiences of

“[When I first smoked Spice] outside college, I thought ‘What’s this? I’ve got to have more,’” Lewis says. “I went to the shop later that day to buy more and from there I started to lose everything: my relationship, family members, education…”

“With weed and other drugs, I’ve never felt anything close to Spice. I just had to have more.”

No nationwide statistics exist for SCRA addiction among homeless people. However, Andrew, a Substance Misuse Co-ordinator at HARP, who works with Chris and Lewis, says it’s now a bigger problem for people under 23 than crack and heroin – but frustratingly little is known about its harmful effects or how to devise effective treatment strategies.

Chris and Lewis described withdrawal symptoms after an hour without smoking that could include sickness, mood swings or shaking. Their need to get more of the drug at whatever cost put them on the streets. From that point onwards, their usage went up dramatically as they struggled to deal with the pressures and insecurity of being homeless.

Both were alarmed by the psychological effects of smoking high quantities of Spice they saw in other homeless users, such as walking around like dogs, barking or hallucinating wildly. Lewis developed psychosis and attempted to jump from the roof of a car park.

“My worst experience was when I smoked four grams alone in a dark room,” Chris says. “I was seeing demons and they were touching me. It was terrifying.”

Despite a number of highly-publicised deaths, many people still see Spice as no more dangerous than herbal cannabis. Harry Sumnall, Professor in Substance Use at the Public Health Institute, suggests this simply isn’t the case. The high can be similar, but the pharmacology and toxicology of SCRAs means they should be considered a totally different drugs.

“We’re seeing a more diverse range of [harmful] effects and perhaps some serious conditions as a result of SCRAs like Spice that you wouldn’t see with herbal cannabis,” Harry explains.

People are primarily hospitalised due to changes in heart rate or panic attacks, which can occur with herbal cannabis too. But Spice is mostly responsible for more serious complications like heart attacks, strokes, and damage to the kidneys or liver. Psychi-

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atric symptoms including psychosis, paranoia and hallucination are much more likely from synthetic cannabinoids than herbal cannabis.

Both data and research on novel psychoactive substances (NPS), such as SCRAs are deficient. Yet, statistics from Public Health England for 2015/16 show that across the general population, numbers of people who sought treatment for issues related to SCRAs, such as support with addiction, rose significantly.

The Government’s ‘legal highs ban’ was intended to combat this, but Chris and Lewis explain that criminalisation has failed to reduce the availability of SCRAs to homeless people. They argue instead that the ban has increased the amount of adulteration to batches of SCRAs on the streets.

"From research into traditional illegal drugs, we know that always happens: availability rarely changes but the price increases and both the impurity and harmfulness of the product increases as well,” Harry explains.

However, due to the unregulated and unconventional nature of the NPS market, inconsistencies were rife, even before the ban, Harry explains. “Uncertainties about what's in the Spice products is not a new problem, it has always been an issue,” he says.

“Even with the branded, nicely-packaged products, it was never really clear to most users what they were smoking. Our analysis has shown that the actual content of those products varied enormously, even within particular named brands. You could never really know what the dose or potency was, but those risks might have increased with the introduction of the criminal market."

Lewis and Carl are happy to have put their experiences with Spice behind them and are slowly trying to rebuild their lives. But for the homeless community in Southend, and across the UK, government drug policy appears to be doing little to halt the growing problem of NPS addiction.

“Historically, we’ve seen that policies based on restricting supply have little impact on groups like the homeless, who have pre-existing relationships with and are targeted by dealers,” Harry says. “There’s a high profit margin, the ingredients for NPS are readily available and they are easy to make, which makes suppressing supply a challenge. Experience suggests the NPS ban won’t have much impact on highrisk populations, like the homeless, but then that has always been the way with drug laws.”

Words by Alex King Photos by Theo McInnes

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GOING COUNTRY Allegra Stratton presented a film on ITV News which reveals the scale of drug gangs exploiting teenagers for labour in the UK. We invited former undercover police officer and author Neil Woods to reflect on the film.

ITV news broke the story in September of a government report detailing the exploitation of children by drug dealing organised crime groups.

It was a well researched news story as ITV took the time to find, and speak to some child victims of this growing trend. However, as is the case with many news stories about drugs issues in our society, it never got to the full conclusion. Let me make it perfectly clear.

This situation has been caused by the increasing monopolisation of the illicit drug supply, and this in turn has been caused by policing drugs. The root cause is prohibition.

In basic economics it is understood that in any unregulated market, monopolies develop. This is certainly true in the world of illicit drugs. What needs to be more widely acknowledged and understood is that it is policing that helps build the monopolies. Consider the principle tactics used by police to tackle drugs organised crime, the use of informants, and the use of undercover work, such as that that I used to do. The perfect defence against both is terror. The gangster who are the most successful are those that can most successfully terrify the communities in which they exist. The world of small independent small time dealers, buying their supplies off whichever Firm offered the best deal, is gone. They were the low hanging fruit, whose business were easy prey to informants and the police.

What is left after decades of inner city drugs policing are collectives of brutal mutually supportive gangsters, all led by a mafia boss type of individual. They support each other by a commitment to playing the team game, and that is to maintain the reputation of utter ruthlessness and brutality. This is true in every UK city. They are the result of this urban Darwinian soup created by policing drugs.

The NCA state in their recent report into organised crime that the inner city urban street gangs are expanding their trade into county and seaside towns.

These city gangsters have jostled violently for position and consolidated their positions. I have seen this process in action from the street level over many years working undercover and studying intelligence. The city monopolies have been expanding their reach for many years, and are now taking advantage as ‘unconnected’ dealers are swept away. The larger groups even use the police system to get rid of lesser, unconnected

dealers, by ‘grassing them up’. The city Firms instantly become more successful because they are better organised and have learnt how to survive. The terror tactics are moving onto the counties. This has created the peculiar and unsettling situation that if you live in a county town, and the police celebrate a drug bust in the local newspaper, then this is the time to worry.

It’s the city monopolies that are filling these voids, and the never ending evolution of the drugs black market means that they will only get nastier.

The ITV news report states that in many cases it is vulnerable children that are being targeted in this market expansion process. They also point out that it also affecting children from a broad range of backgrounds.

There is mention of grooming and gifts, which of course goes on but they failed to mention the most important thing that connects these children to the crime communities; the drugs supply. Or more specifically the supply of cannabis.

Cannabis is intrinsic to the inner city areas that gangsters consider their heartland. It is in these areas that the youngest of children obtain and use the drug. I have witnessed how the drug gangs recruit and expand in these areas. A weight of cannabis is “laid on” to a customer, often as young as 13. He sells this on in one gram deals to his eager peers. He gains the kudos, and the spending money from this arrangement, and then his arrangement becomes regular. Over time he is tempted into the more lucrative trade of heroin and cocaine. As the report shows, this increasingly means taking part in the expansion of the monopoly by travelling and delivering drugs, but what the report doesn’t cover, is that this can also mean doing the inner city work. And this means learning to be brutal, and to follow the team ethos. This is where the next generation of gangsters is coming from. This is the where the young men of our city communities are being shaped.

The only way to take away this corrupting power from organised crime is to take the drug supply away from them. It is the policing of the drug supply that is empowering these expanding gangs.

The biggest blow that could be made to organised crime overnight would be to regulate the cannabis market. It is this market which is helping them corrupt our young, and facilitate the supply of other drugs. I have on several occasions debated this issue with pol-

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iticians and policy makers. So many times they have conceded that my evidence is compelling. On one particular occasion a fairly senior policy maker said to me “OK, I completely take your point. But tell me, why would we regulate cannabis now? Why not wait for a decades worth of evidence from Canada, who are about to do that” My answer to that is the same as the reason Canada voted for it. We need to protect our children from the drug, and the drug market.

Children have been used by criminal gangs to transport drugs across the UK via rail. Following the release of the NCA and the government report we now as a society need to accept that our drug policy does not work. We have to accept that our children are being put at more risk by the status quo.

It’s time to think of the impact on our communities and the risks to our young. It’s time to regulate.

Thankfully, there is a real shift in attitude towards this topic. There is increasingly more discussion on ‘how’ to regulate rather than ‘if’ we should. At the forthcoming Conservative conference there is an event on Monday 4th which seeks to further this discussion. I hope that any members of the Party considering attending the event will bear in mind the recent information about the scale of the problem. It’s time policy makers acknowledged the failures that have brought us to where we are, and started looking for solutions. We must not wait. It is now clear, the situation can only get worse and our children need protection now.

Words by Neil Woods

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Neil Woods, author of Good Cop Bad War

GOOD BOOK, BAD WAR A review of Good Cop, Bad War - the latest novel surrounding a new, eye-opening account of life as an undercover police officer amongst dangerous drug gangs.

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n Series One of David Simon and Ed Burns’ seminal television series The Wire, cops Kima, Carver, and Herc are sitting around, discussing how they fight the war on drugs on Baltimore’s streets.

Kima shakes her head, resigned to her colleagues’ aggressive approach, when Carver comes out with one of his most perceptive observations.

Carver: “Girl, you can’t even call this shit a war.”

Herc: “Why not?”

Carver: “Wars end.”

The war on drugs isn’t going anywhere soon and, indeed, runs the prevalent argument, why should it? Drugs blight people’s lives, the acquisitive crime committed by addicts to support their habit affects the community as a whole, and drugs are imported and dealt by genuinely

unpleasant individuals who use violence or threats of violence to control their criminal monopoly.

Neil Woods was on the frontline of that war for 14 years as an undercover police officer and his new book, Good Cop, Bad War details his efforts and his growing disenchantment with his ‘mission’. Woods took part in dangerous deployments to purchase drugs, helping to build intelligence and secure evidence that led to the conviction of many serious gangsters. His targets included Colin Gunn in Nottingham, the Birmingham-based gang the Burger Bar Boys, and a variety of lesser known but equally dangerous men and women across the country. And Woods is convinced that not only is the war on drugs un-winnable, but we should cease fighting altogether.

Good Cop, Bad War begins with his entry into the police, fired by a desire to protect society’s most vulnerable. The book proceeds, chapter by chapter, to detail his deployments across a range of cities, from Leicester and Northampton, to Nottingham and finally Brighton. The stories are gripping, full of detail, as you would expect from a man whose very safety, as well as the utility of his deployments, depended on remembering evidence; the prose zips along with real energy and avoids falling into a clichéd rehashing of former glories, showing instead a genuine sense of humour and a wry eye for an anecdote. And

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“This drug thing, this ain’t police work. No, it ain’t. I mean, I can send any fool with a badge and a gun up on them corners and jack a crew and grab bottles, but policing…I mean, you call something a war, and pretty soon everyone gonna be running around acting like warriors…

Soon, the neighbourhood you’re supposed to be policing, that’s just occupied territory. Soldering and policing ain’t the same thing.”

the chapters are peppered with characters, not just swaggering villains, but those caught up in the war on drugs as addicts, petty criminals, or young people sucked into a gang’s grasp.

It is among those people, the marginal and the damaged, where Woods’ perception of the war on drugs starts to change. He sees individuals whose lives have been shattered by fear, by violence, by a system that is focussed on punitive rather than remedial action. There is real pathos in Woods’ descriptions of these people and a desperation that the tactics he employed to get the job done often ended up exploiting and then further criminalising them:

Colvin’s point is that the philosophy of protecting a population suffers when a war mentality sets in, when everyone involved is an enemy. Information dries up, support for policing wanes, and the basic premise of the job itself is ruined. Woods makes exactly the same point in his book and goes further: “The war on drugs corrupts everything it touches… most painful to me, it corrupts the police. You can't ask an army to fight a war it isn’t meant for and doesn’t really believe in, day after day, without moral rot setting in.” Woods is talking here not just of the corruption he encountered in Nottingham and in the Greater Manchester Police, but also of the moral rot that saw officers in Brighton laughing and joking about a rise in addicts dying of overdoses; gallows humour is one thing, and a crucial mechanism for coping with stress for many officers, but a dead human being is still a dead human being, not one enemy fewer to worry about.

“It made no sense. I’d joined the police to protect the weak and vulnerable – and to fight against those who victimised them. Yet the most vulnerable people I had ever met were now being turned into criminals and sent to prison. If we were fighting a war, then these were the exact people we should be fighting to protect. And if we weren’t, then what were we fighting for at all?”

As Robert Peel noted when he set out his famous principles for policing in 1829, the police must “maintain at all times a relationship with the public that gives reality to the historic tradition that the police are the public and that the public are the police”. Occupying armies have no place in proper policing and nor does the exploitation of vulnerable people, however valuable the evidence secured from them. Perhaps more importantly, Peel also stated, “the test of police efficiency is the absence of crime and disorder, and not the visible evidence of police action in dealing with them”. This is the failure of the war on drugs in a nutshell: a lot of action, most of it thoroughly well intentioned, with little to no effect and, in some instances, increased harm to members of the public. This is the disillusionment that Woods details, painstakingly and with total credibility.

Gradually, it dawns on Woods that an escalation in police activity and the deployment of increasing numbers of covert officers, officers whose training and methods he helped create, simply creates smarter, more ruthless criminals. He likens the situation to the Cold War arms race, protracted, dangerous, and ultimately unwinnable.

Woods calculates that for all the convictions his work achieved, around 1000 years of prison time, he only stopped the drugs trade for around 18 hours. And, more importantly, his work had merely entrenched the newer, smarter gangsters, while also alienating or endangering the vulnerable addicts he wanted to help. As he says,

Finally, in Brighton, Woods has an epiphany, caused in part by the deaths of addicts by ‘hot shot’ at the hands of dealers and general police inertia around investigating these murders, that he can no longer fight this war the way it is heading. Woods initially continues within the police, gaining credibility and expert witness status, before leaving and becoming the chairman of LEAP UK, a body of former law enforcement officers who advocate ending the war on drugs. Woods now argues for the legalisation and regulation of the drugs trade, taking £7 billion out of the hands of dealers and redirecting an estimated £7 billion that police worldwide spend waging the war on drugs to other, more effective measures, including treatment.

“So, while I may have put a few of the [Burger Bar Boys] away for a while, I had done absolutely nothing to address the situation that actually gave them their power. And along the way, I had made a lot of vulnerable lives even more vulnerable.”

In series three of The Wire, Bunny Colvin, a major in the Western district of Baltimore’s police force effectively decriminalises drugs within a geographical area to allow the police to get on with what he feels is actual police work, serving and protecting a community by building trust and fostering relationships. He explains to Carver, by then a Sergeant, how the war on drugs has ruined policing.

Each chapter of Good Cop, Bar War builds Woods’ credibility as an expert on fighting the war on drugs and so when he comes to this conclusion, it is both a surprise and also thoroughly plausible. Woods did his time in the trenches and his book details it brilliantly, but one feels that the chapters to come are the ones he is most looking forward to writing.

Words by Alex Stewart

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DRUGS CRISIS IN OUR PRISONS Originally published in The Spectator

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his month Sam Gyimah, Minister for Prisons and Probation, had to explain the term ‘potting’ to the Justice Select Committee. For those of you unacquainted with the depraved state of our prisons, this is to throw faeces and/or urine over a prison officer. He never got round to explaining a ‘mambulance’.

Every day with alarming frequency sirens blare as an ambulance races to a prison to deal with another cardiac arrest, violent assault or attempted suicide of a prisoner high on one of many drugs generically referred to as ‘black mamba’ or ‘spice’.

Prisoners taken to hospital must be accompanied by two prison officers, leaving the wing the officers would otherwise be patrolling on lockdown with prisoners confined to their cell for the rest of the day. Those left on the wing expecting to attend treatment, education or work are out of luck.

Many of our prisons, particularly local men’s prisons, are regularly in lockdown for 23 hours a day.

This week’s report by HM Chief Inspector of Prisons on HMP Hindley stated that “most prisoners often spent less than half an hour out of their cell in a 24-hour period.” This is driving demand for drugs in prisons with inmates left bored, anxious, distressed and often mentally unstable. In Hindley 16% of prisoners had developed a drug problem since entering the prison.

More staff are needed to secure prisons but over the last 12 months 300 more officers have left the prison service than have been recruited despite earnest attempts by the National Offender Management Service to recruit more staff. This is fuelling the vicious cycle. As more staff leave, so drug demand goes up and as drug demand goes up, so too does the frequency of dangerous incidents which take up increasingly limited resources. This leaves the profession’s safety standards spiralling downwards, making it increasing less appealing to new recruits and experienced officers alike.

Prison wings which used to be patrolled by eight officers are now left to only two. This leaves officers making difficult decisions about whether to guard vulnerable prisoners or respond to an incident of violence. There is little to no time to do the proactive and labour intensive work of identifying and preventing prisoners from dealing drugs.

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To tackle the violence and instability caused by drug abuse and the market for drugs in prisons, Liz Truss launched the government’s White Paper on prison safety and reform, which the government lauds as being the ‘biggest overhaul of prisons in a generation.’

The Justice Secretary proposes to ratchet up the current, failed policies of utilising sniffer dogs and mandatory drug testing in an attempt to reduce the demand for, and supply of, drugs.

The chosen polices are the very same policies which precipitated the deadly transition in drug markets inside prisons from supplying cannabis to instead supplying spice. These drugs were sold by unscrupulous dealers precisely because they evaded the then mandatory drug tests and sniffer dogs.

Unfortunately there is no prospect of training drug dogs or developing tests fast enough to deal with this rapidly evolving market. It takes far longer to train new sniffer drugs or devise and implement new tests than it does to secure a bulk consignment of a new substance from labs in China which make a fortune trying to meet the insatiable international demand for drugs which can evade detection. A new psychoactive substance enters the European market at least every week. Attempts to keep pace with these innovators will always leave policymakers one step behind. Increased utilisation of these failed tactics will only incentivise suppliers to sell newer, less predictable and potentially more dangerous drugs.

As well as failing to stem supply, more importantly the proposed measures go no way to reducing the demand for drugs. The major drivers for drug use in prison are boredom and addiction. The answers must therefore be hard work and treatment. Inactivity and lack of attention are a breeding ground for vice and criminality. Overseeing busy prison routines and effective treatment is a labour-intensive endeavour with no quick-fix technological solutions. In order to bring about this reform we need a better staff to prisoner ratio. To do so means that the unpalatable and ineluctable truth is that we need to either substantially reduce the prison population or substantially increase prison funding. To do neither resigns our prisons to provide only temporary warehousing before spitting back out more drug addicts than entered.

Words by George McBride

Volteface Voices

HOW IS THE MOST SECURE PLACE IN OUR SOCIETY THE EASIEST PLACE TO GET DRUGS?

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Volteface Voices

VOLTEFACE POLICY REPORTS Digging deeper into the issues relating to drugs in our society.

Volteface delivers independent, fresh research, delivered with journalistic flair.

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Volteface Voices

The Tide Effect argues that cannabis legalisation and regulation is now inevitable and that the market-based approaches being developed in North America are the best way to protect children, eradicate criminality associated with illicit markets and promote public health.

High Stakes, An Inquiry into the Drugs Crisis in English Prisons examines the ramifications of the rise of novel psychoactive substances in prisons. The report concludes that the Government has failed to recognise the important policy implications of these new drugs. High Stakes presents five practical recommendations to reduce drug-related harms, improve prison security and reduce the demand for drugs in prison.

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THANK YOU We sincerely hope you have enjoyed reading our one year anniversar y edition.

Volteface would like to extend a special thanks to all our contributors and collaborators. Your exper tise has proved invaluable over this past year. The success of our events, magazines and policy repor ts are in great par t down to your effor ts.

To all our friends from across the worlds of culture, healthcare and policy, thank you for your patience and suppor t as we found our feet. A young, wide-eyed project such as ours relies upon the continued good faith from those around us, not to forget the goodwill of our friends and families - so our thanks to you.

To all those who challenge us with their divergent viewpoints, please continue to do so. We strive to maintain nuanced perspectives on the complex, engaging issues we wrestle with ever y day. Keep testing us - we like a challenge.

Lastly, we would like to offer our gratitude to all those who have taken the time to engage with Volteface over the course of this exciting year. Whether you have read our ar ticles, attended our events, or contributed to our debates, your engagement is the lifeblood of what we do, and we hope you stick with us on the road ahead.

Our thanks, The Volteface Team

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ABOUT Volteface is a policy innovation hub that explores alternatives to current public policies relating to drugs.

We cultivate fresh thinking and new ideas via our online and print magazine and an ongoing programme of private and public events.

We cover the policy and politics of drugs from the perspectives of science, health, lifestyle, culture, business and economics. Our ambition is to broaden the range of voices and perspectives to enliven and elevate this debate.

Volteface works with an array of par tners across civil society, business, media and government to foster public engagement, formulate new evidence-based policy ideas and as a thoughtful advocate for change. We are UK-based and focused whilst engaging with ideas and practice from across the world.

Contact us: info@volteface.me Read more: www.volteface.me Twitter: @voltefacehub

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