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?