Recreational drug use: not a victimless crime

The problems of knife crime, often associated with drug gangs, have been highlighted by a blog in this journal prompted by a conference at the Royal Society of Medicine.

According to recent media reports, there is an increasing group of people who use drugs intermittently and are described as ‘recreational users’. Members of this group often think that they are committing no crime and that there are no victims of their activities. The class concerned is not usually defined and certainly transcends the definition that social scientists would use. They are often well educated and the ‘should know better class’ would be more accurate.

Recently, 76 people overdosed on a powerful synthetic cannabinoid in one night in the precincts of Yale University, USA.

It could be said that the crime element would disappear if the drugs were legalised, or if those who wished to use them could register to obtain supplies. The drugs would, presumably, be purer and doses would be known. Other than this, they would not be less harmful.

As detailed in an article, recently published in Trends, there are many victims of recreational drug use, including the users themselves. The genito-urinary tract, including sexual function, is particularly vulnerable to the commonly used ‘recreational drugs’.

Much the most damaging drug, at present, is the legal anaesthetic agent ketamine. Even quite small amounts cause bladder inflammation and urinary frequency, and with more frequent dosages the urinary tract is progressively destroyed and renal failure ensues. Fairly early in the process, the bladder becomes painful and users find that the best way to control the pain is to take more ketamine.

Doctors will know that cocaine is a vasoconstrictor. Even when taken locally, such as by sniffing, there are general effects. The most common and serious is to damage the placenta, with even one dose in the month of conception able to cause placental insufficiency. With further use in pregnancy, up to 14% of foetuses will have abnormal renal units. Although rare, dramatic complications such as renal failure from rhabdomyolysis, Fournier’s gangrene and difficult to control priapism, may occur with only a single dose.

Most drugs, but especially cocaine, cannabis and ecstasy impact sexual function. Most commonly, users become disinhibited. This can lead to unsafe sex with multiple partners and an increase in sexually transmitted disease. Both male and female sexual function is impaired by weaker erections, delayed orgasm and dyspareunia. Alcohol and tobacco compound the effects. Users compensate by using sildenafil and similar drugs. At least 10% of users come to associate sex with their regular drug of choice, so that one becomes dependent on the other.

Although this blog has briefly outlined the deleterious effects of recreational drug use on the user’s sexual function and genito-urinary tract, we would welcome further comment (professional, not personal) on how recreational drug use impacts other areas of the human body. What experiences and opinions have you had from patients? Is the abuse increasing and what can be done about it?

Comments (13) Add yours ↓
  1. Roger Kirby Professor of Urology

    Christopher Woodhouse (aka Lord Terrington) has posted an interesting and topical blog. Rather alarmingly Scotland’s drug-related death toll has increased by 27% over the past year to reach a record high of 1,187, putting the country on a par in terms of the fatality rate per capita with the United States, where synthetic opioids such as fentanyl have devastated drug-using populations.
    The death rate is now more than three times that of England and Wales, and has more than doubled since 2008, when there were 574 deaths. It is higher than any other EU country.
    According to the latest annual figures, published on Tuesday morning, most of the increase in fatalities was in the over-35 age-group, the so-called “Trainspotting generation” of ageing, long-term users, although there was also a rise in deaths among younger people.
    Heroin, methadone or codeine were implicated 86% of deaths. “Street” benzodiazepines, such as etizolam, which have flooded the market across the UK over the past few years, were implicated in 57% of the deaths.
    “Recreational” drug use can lead to mortality In addition to the very significant morbidity outlined by Christopher.

    July 29, 2019 Reply
  2. Cullehy Carson MD, FACS, FRCS Professor of Urology

    This is a very important issue in the US as there is an epidemic of drug use, especially opioids. This issue of overdose with recreational drugs is one that is close to our family as my wife’s nephew overdosed and died at age 23 ending a promising career and incredible artistic talent.

    The problem of recreational use in the US is being tried in the courts as the big Pharma are being fined heavily for their part in the supply of drugs that find their way into the illicit use. Interestingly, the worst of the problems ion the US are in rural communities. Clearly the large cities have problems, but smaller towns and communities are especially hard hit.

    Many believe that legalizing these agents, especially marijauana is the answer but the states that have legalized marijauna have seen no decrease in overdose deaths and are seeing new unintended consequences such as use by younger children, driving while high and problems with marijuana/alcohol combinations.

    In many US cities, police are equipped with injectable agents to reverse the opioid effects and many lives have been saved with this approach. Indeed, obtaining these agents by the public is possible in many communities to treat loved ones at risk for overdose.

    The solution for these issues is not clear but law enforcement is only one phase, There must be more community involvement and government funded treatment centers to treat and rehabilitate those with drug use problems.The US has a long way to travel in stemming the tide of recreational drug use, addiction and the tragedy of overdose.

    July 30, 2019 Reply
  3. Hannah Warren Core surgical trainee

    I have always been struck by the association between psychosis and cannabis use. Amongst the dozens of patients I have met during my medical career with acute mental health crises or psychosis (a psychiatry rotation at medical school that seemed to last for ever, and a busy London A&E), I recall only one in whom there was no history of cannabis use. While many in the general population consider cannabis a relatively ‘harmless’ drug or perhaps even a teenage right of passage, the association with life-changing psychotic episodes I have seen leave me forever fearful of its potential consequences. Anecdotal evidence, I agree, but the realisation was powerful enough for this otherwise very liberal individual to have a pretty intolerant attitude to drugs. While I accept there are major differences between the various cannabis products available on the street, lack of regulation means the consumer cannot know what it is they are consuming or how strong it is.

    August 1, 2019 Reply
    • Christopher Woodhouse Emeritus professor of adolescent urology

      Thank you Hannah. Anecdotal it may be, but I suspect that many others would have similar anecdotes to tell. In some users, the psychosis and other mental changes seem to appear in later life, in those who have been heavy users of cannabis, but have largely given up with maturity. A good part of the problem seems to be that users are completely convinced that there are no victims, least of all themselves.
      Christopher Woodhouse

      August 8, 2019 Reply
  4. Michael Kirby Professor

    My experience has mainly been with trying to sort out the sexual side effects of this behaviour, many of them will also have depressed sex hormones which are always worth checking.

    August 13, 2019 Reply
  5. Roger Kirby Professor of Urology

    Drug deaths in England and Wales have hit a record high, with about 84 people dying every week, new figures show.
    Ministers have been accused of “clinging to their failing policies on drugs” after data published by the Office for National Statistics (ONS) revealed there were 4,359 deaths related to drug poisoning, 56 a week from taking illicit substances, last year.
    The new figure is the highest number of deaths since records began in 1993. It also marks the highest annual increase, with deaths jumping by 16 per cent between 2017 and 2018. Opiates, such as heroin and morphine, continued to be the most frequently mentioned substance.

    August 16, 2019 Reply
  6. Roger Kirby Professor of Urology

    The number of live-in drug and alcohol rehabilitation services in England has fallen by a third in six years, confirming that as budgets fall, councils are sending fewer people to lifesaving residential rehabilitation centres.
    The OFfice of National Statistics figures show the male drug poisoning rate has significantly increased from 90 per million men in 2017 to 105 in 2018, while the female rate increased for the ninth consecutive year to 48 per million females in 2018. Two-thirds of the recorded deaths were related to drug misuse, accounting for 51 deaths per million people in 2018.
    Deaths involving cocaine doubled between 2015 and 2018 to their highest ever level, while the numbers involving new psychoactive substances, formerly known as “legal highs”, returned to their previous levels after halving in 2017. MDMA deaths are now also at their highest rate ever, at 1.5 per million. Between 2017 and 2018 there were increases in the number of deaths involving a wide range of substances.

    August 16, 2019 Reply
  7. Roger Kirby Professor of Urology

    Heroin addiction casts a deadly shadow over Britain. Fatalities involving the drug have doubled since 2011, and now stand at their highest level since records began. Behind the statistics lie stories of people dying in their homes, hospitals and in the streets, leaving children, siblings and friends behind. Vulnerable users continue to be jailed for possession, or for committing crime to fund their use, while increasingly powerful and violent organised crime groups exploit children to pump the drug into every part of the country.
    Britain’s “war on drugs”, which began nearly half a century ago, is failing. As drug users have entered prisons rather than treatment programmes, the cycle of addiction and crime has not just continued but taken an even tighter hold, with a boom in organised crime gangs now running supply lines from the cities into rural areas. So what is the answer to breaking the cycle? Where can we look for an alternative way to approach the issue?
    The answer could lie in Britain’s own past. In 1926, heeding the advice of medical experts, the Conservative Party began prescribing heroin, paid for by the taxpayer, to great success – with countries across the world following suit.
    Indeed, the policy continues today but on a far smaller scale. Hundreds of people across the UK are currently prescribed diamorphine, quelling their need for unpredictable and sometimes deadly street drugs and taking power away from increasingly violent organised crime groups. Surely this is the safest way ahead?

    August 23, 2019 Reply
  8. Michael Dinneen Urologist

    I welcome Prof Woodhouse’s blog, my own experience is both with the devastating effects on the bladders of some individuals associated with Ketamine abuse and sexual dysfunction associated with so called recreational drugs especially cocaine and cannabis. I strongly agree that there is no such thing as victimless crime when it comes to illegal drug use and would oppose blanket legalisation. With respect to the legalisation of medicinal cannabis I believe that the jury is still out, the recent Caldwell case in Northern Ireland highlights the complexities.

    September 1, 2019 Reply
  9. Roger Kirby Professor of Urology

    Class A drug use among young adults is at a 16-year-high, driven by increases in powder cocaine and ecstasy use, official estimates have revealed.
    Around 8.7% of adults in England and Wales aged 16 to 24 had taken a class A drug in the last year, equating to around 550,000 young people, the 2018/2019 Crime Survey for England and Wales (CSEW) shows.
    This is the highest recording since the 2002/2003 survey and Home Office statisticians said it was a “statistically significant” rise compared with the 2011/2012 survey seven years ago, when a previous decline in class A use reversed and started to climb back up.

    September 19, 2019 Reply
  10. Roger Kirby Professor of Urology

    The number of deaths of homeless people rose by a record 22 per cent last year in England and Wales. An estimated 726 people died in England and Wales in 2018 – nearly two a day. A very sad statistic.
    A key driver of the increase was drug poisoning, said Ben Humberstone from the Office for National Statistics, which published the figures. He said deaths from drug poisoning were up by 55 per cent since 2017, compared to 16 per cent of the population as a whole.
    Recreational drug use is not confined to the middle classes!

    October 2, 2019 Reply
  11. Roger Kirby Professor of Urology

    Ministers must consider decriminalising the possession of drugs, MPs have said in a new report that calls for “radical change” to the UK’s approach. The Health and Social Care Committee said the rate of drug-related deaths in the UK had risen to the scale of a public health emergency, and urged that any policy should focus on healthcare, not prosecution, with drug possession for personal use treated as a civil matter not a crime.
    Britain has some of the highest drug death rates in Europe. In 2018, 4,359 deaths were directly attributed to substance misuse in England and Wales – a 16 per cent increase in a year – while Scotland had a higher rate of drug-related deaths than any other EU country last year, after a 27 per cent increase brought the total to its highest level since records began 23 years ago.

    October 23, 2019 Reply
  12. Roger Kirby Professor of Urology

    The UK Parliament’s Scottish Affairs Committee has called for radical reforms to the UK’s approach to drug use demanding new laws to allow for the creation of so-called “shooting galleries” for drug users to safely get high. If the Westminster government was unwilling to do this it should devolve the powers to Scotland, the committee said.

    Its report also criticised the Scottish government for making the situation worse by cutting funding for some services and said it must do better if it is to demand more powers. MPs said the current approach of treating drug use as a crime was “counter-productive” and that decriminalising minor drug use would help users to get treatment and mean the government could focus on suppliers and drug dealers.

    November 4, 2019 Reply

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