Article
Tell us about your drug use - legal and otherwise
Prescription drug abuse if rife, perhaps even at epidemic levels. That's why we really need a clearer picture of who is using what, and when and why. Please read about our drug use survey
In the US overdose deaths from prescription drugs are nearing epidemic levels. More people die from overusing prescription drugs than from heroin. Photograph: Alamy
It is fashionable and illicit drugs which tend to attract notoriety and media headlines and dominate public debate: cocaine, heroin, ecstasy and more recently, mephedrone and synthetic cannabis.
But a largely under-reported drug story, in the US and other developed nations, is that the drugs most likely to top overdose statistics (and currently causing the greatest ripples in public health circles) are in fact prescribed medications such as opioid pain-killers and sleeping tablets.
Prescription medicine abuse is rife, perhaps even at epidemic levels. The US has seen an unprecedented rise in drug-related overdose deaths (a tripling in the last decade) largely due to a massive increase in the abuse and misuse of prescription opioid drugs such as oxycontin, and sleep-inducing medications such zolpidem (Ambien) and Valium (diazepam-type drugs).
As the US physician David Kloth wrote recently:
"Prescription drugs now surpass motor vehicle accidents as the No 1 cause of accidental death in almost half the states in this country. Last year, nearly 30,000 Americans died from an overdose, with at least half of these deaths related to legally controlled substances that were misused, abused, prescribed incorrectly, or simply just in the wrong person's hands."
More people in the US die from an overdose of medications such as oxycontin than they do of heroin. Over one third of some 35-40,000 poisoning deaths each year in the US involve prescription opioids. These medications are sourced from individuals' own doctors, friends, drug dealers and, increasingly, online.
Efforts have been made to educate doctors to prescribe more carefully, and patients are increasingly warned of the risk of prescription medication dependence and overdose. But the advent of internet drug shopping is proving an additional challenge. Some towns may not have a local drug dealer, no one is that far away from a pharmacy or a computer terminal.
There has been, however, little population research on the extent of the use and misuse of these medications in the US or elsewhere. Surveys have often focused on high school students among whom abuse of prescribed stimulants and other prescribed medications is a recognised public health issue. There have been fewer studies exploring more widely how these drugs are acccessed (from doctors, dealers, the internet) or - and perhaps most importantly - the reasons why they are taken (other than for the stated medical purpose).
This is where this year's MixMag/Guardian online Drug Survey comes in. We are gathering valuable data on these vital drug use issues . We are not just interested in prescription drugs. We want to know people's experience of drugs of all kinds, from ketamine and cocaine to alcohol. What, we want to know, are the medical and social consequences of drug use? What happens in the real world when different people get caught in possession with different drugs?
With over 12,000 global responses including over 2,500 from the US, we have already - in a week - collected the largest ever data set on a number of key public health and drug specific issues. It is rapidly shaping up to be a hugely valuable and unique source of real people's attitudes towards and experience of drugs. Most studies don't ask the questions that make a difference to the people who use them: this survey does.
The survey is conducted by Global Drug Survey. Taking part in this survey and helping us reach our target of 15,000 people world-wide will help inform smarter decisions not only by people who use drugs but also by those draw up policy and write laws.
Because we receive no government funding we are free to ask what we think is important and ensure that the facts get shared with those who helped us gather the data. Our findings will be published exclusively by Mixmag and the Guardian in March 2012.
The survey is secure and anonymised. You can respond to the survey here. The survey takes 20-25 minutes.
• Dr Adam Winstock is an addictions psychiatrist and researcher in London, and founder of Global Drug Survey.
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User Comments
DWGism
30 November 2011 5:41PM
I'm a little disappointed that the article focuses so heavily on presumed misuse in the States, without mentioning that the backlash there means many people with severe chronic pain issues can now find it difficult to find a doctor willing to address their legitimate medical needs. Pain management is something very many GPs are ineffective at - I like my GP, she's supportive in managing my disability, but every time pain management comes up she wants to defer it to my specialist, even if it's something within a GP's normal remit. Nor is my experience unusual, I've talked to many other chronic pain patients facing similar issues. GPs are already reluctant to prescribe effective levels of pain control when needed and the last thing we need is to make that tendency worse.
It's perfectly valid to be concerned about drug abuse, but for many of us ready access to those same drugs means the difference between functioning and just surviving - it's vital that we don't throw out the baby with the bathwater.
mittfh
30 November 2011 5:51PM
I'm not on any prescription medication, but routinely take Cetirizine Hydrochloride and Beclometasone Diproprionate during summer months. I also admit to taking a daily dose of a 12% solution of ethanol and several doses of caffeine. I also have a serious addiction to dihydrogen monoxide and hydrogen hydroxide.
(For those unfamiliar with the compounds, they translate as in order: antihistamine, steroid - both hayfever remedies; wine, tea - but I'll leave you to guess the last two!)
Incurable
30 November 2011 5:57PM
I am ill with an incurable, highly painful neurological condition. I also have clinical depression. I take 2 kinds of antidepressants, 2 different Opiate-based painkillers, injections for head pain and a high-flow O2 tank. All of that is legal and apart from the O2, are rather dangerous and can kill if misused.
The only illegal drug I use, Cannabis, helps the pain almost as much as my prescribed Opiates. Yet, no matter how much Cannabis I smoke, the worst effect it has ever given me is oversleeping, munchies and slight brain fog if I have a bit too much. It won't kill me.
You see the pattern: the prescription drugs I take can be very dangerous. The Cannabis? Not so much.
It really is time this naturally-growing plant with many health benefits is legalised, taxed and sold like alcohol and ciggies. With legal controls, we could buy the strength we wanted and know 100% for sure what we are getting. Of course, strong strains *may* lead to mental illness in those whose brains are yet to be fully developed. But alcohol does the same, if not worse. Those under 18 should not be taking Cannabis or drinking anyway.
grendel65che
30 November 2011 6:14PM
It is sad that because of a very small percentage of abusers, the rest of society is saddled with additional unnecessary work to get what they need. But that is humanity, right? (At least for now...) Isn't that why we have locks on doors, only for the few abusers, the rest of us must constantly manage keys?
The really sad part of the drugs issue is that almost no one wants to work on the emotional and psychological issues that cause people to want to take drugs to "feel better". Being honest about why one "needs" cannabis or whatever should be the starting point. And I'm not talking about the very few with actual physical pain. I'd start the conversation with "So, what drives you to want to take this or that?"
TerribleLyricist
30 November 2011 6:20PM
Tragic story.
Meanwhile, the number of deaths caused by cannabis, ever, remains at . . . zero.
FreddyF
30 November 2011 6:23PM
Two people died from something that almost certainly wasn't MDMA (ecstasy) and it gets plastered all over the newspapers who then milk the story for all its worth to point the finger at MDMA with silly words like "linked to".
In other news Merck, the company that makes a pain killer called Vioxx have just been fined $950: "scientists at the FDA estimate that Vioxx caused between 88,000 and 139,000 heart attacks, probably 30%-40% of them fatal". Where has anyone seen this story reported? I saw it in Health Impact News Daily, hardly mainstream.
Conclusion? Two deaths due to a drug is a tragedy but 40,000 is a statistic.
Atomant77
30 November 2011 6:23PM
Michael Jackson's death is to Prescription Drugs what Freddy Mercury was to AIDS...
Personally I think that the banning of certain alternative remedies like herbal remedies and vitamines will lead to more prescription drugs for all. And why not? they make big, big bucks for Pharma Co.'s so they're here to stay.
I find that Cannabis helps me (and many others) greatly with a few things like sleep, appetite and to relax generally. As an Asperger's I do carry around a few symptoms with me, anxiety one of them. Even though I usually cope fine a death of a close one can be hard to get over. Anyway, I was prescribed Citalopram Citalopram for almost a year and having never been on AD's before didn't know what to expect. To be honest it worked,... far too well!, so much I did not worry about anything at all, and certain things in life DO need worrying about. Needless to say I came off them. I started using cannabis not just as a recreational drug (I had the odd joint in my youth) but as medicine when I learnt that:
Some research suggests that citalopram interacts with cannabinoid protein-couplings in the rat brain, and this is put forward as a potential cause of some of the drug's antidepressant effect
... I know I'm not a rat but learning that SSRI's work by interacting with the Cannabinoid receptors was good enough for me to give it a go,... and hey presto. A joint and I can feel at ease yet in control. Basically it works without any of the nasty side effects from SSRI's. I know two people with eating disorders who have started using it and what do you know, they are putting weight on. It is so obviously helpful that it is beyond belief that remains illegal Thing is, I'm aware that the worse thing that can happen to me for using Cannabis is a Criminal record for possession but if I was to ask a law enforcer why is it illegal, they could probably not give me an answer other than a tenuous link to schizophrenia. There is also this misconception of Cannabis being a gateway drug, ... it isn't ... tobacco and alcohol always come first.
Reading about medical Cannabis was a huge eye opener as I've got to learn how it came to be illegal after 5000 years of use and cultivation. Money of course, but I will leave that story to the inquisitive minds out there to find for themselves.
Atomant77
30 November 2011 6:27PM
The only illegal drug I use, Cannabis, helps the pain almost as much as my prescribed Opiates.
High 5!
tanukichan
1 December 2011 2:26AM
the survey could do with some expansion on medical use of certain drugs, why something like ketamine or cannabis is used and what conditions they are used for.
it felt very limited and presumed everyone filling it in was just using because they can.
i do take ketamine and i have a prescription for it, so its obtained completely legally but i couldnt find an option on the survey to state this.
if i could get hold of cannabis, i would, as i think it would greatly benefit in reducing the amount of pain i suffer daily, and is far safer than my ketamine use, given the minimum effective doses i need of ket are beyond anything i wouldve imagined.
i cannot sustain my use with my dosing changing everytime i use it, which is why i only take it if i have no other options.
TobySaunders
1 December 2011 3:20AM
The survey had some mistakes: it asked how often you use 'skunk' or 'weed'... Skunk is a specific strain of pot, but was used as a synonym for high grade pot... you might use an excellent strain, but not Skunk, so you would be lying to tick 'skunk'; it was a bad term. And 'weed' is, what? Low grade and middle grade pot? That's too vague also; it should have been 'high', 'mid', 'low' or 'higher' & 'lower' thc. There were many bizarre research chemicals, but basic hard drugs like opiates weren't there... I didn't see pain killers listed once on the survey, so I couldn't report my concern over friends using them. Finally, the survey asked of caffeine pills and energy drinks, but should have simply asked of caffeine; I am a caffeine user, but because what I use isn't in a pill or a sugary drink, I wasn't asked to report on use; that was a mistake.
-so, improvements for next time: correct cannabis terms, fewer weird research chemicals and more common hard drugs, correct caffeine terms
dirkbruere
1 December 2011 10:42AM
That survey is going to be almost worthless due to selection bias.
As for what I take, codeine and modafinil top the list. The former when I have a bad cough or cold in Winter. The latter for fun and work.
stevester
1 December 2011 3:27PM
Ive had 4 serious operations in the past 3 years and i get prescribed - 50mg Tramadol , Co-Codamol , 7 10mg Temazepan a week and 100mg Maxitram all to help me deal with pain and help me sleep - I have a stock pile of these drugs in my house ( unopened ) because i have choose to use cannabis as a natural pain killer instead as i was getting addicted to these legal drugs and they were damaging my stomach and liver - throwing up blood was one side effect , i have to take these pain killers of the NHS because if i didnt i would not get my Benefits while im having these operations as they would not believe im in pain if i refused the legal drugs . And thousands if not millions of people are doing what im doing and taking pain killers they are prescribed of a doctor that they have no intention of using because cannabis is a far better non addictive and safer medicine to help you cope with pain and get a great nights sleep . Now how many millions upon millions of pounds do you reckon this is costing the Government and NHS on top of the cost of prohibition in wasted medicine . If the Government would wake up and recognise cannabis as a safe medicine they would save millions of pounds that they could invest in other areas of the NHS as people like me could tell the truth and refuse these harmful addictive legal pain killers and register for a cannabis card of the NHS and buy our own legal cannabis medicine but sadly our MPs cannot see past their own wallets and are more interested in lining their own pockets from back handers from companies like GW Pharma who have permission of the British Government to grow 300 tonnes of skunk cannabis a year to make a medicine called Sativex that they charge an extortionate amount of money ( £11 a day ) for while our Government still say that cannabis has no medical value which is now a proven lie because I and millions like me are living proof of this FACT . And whats worse and an even bigger slap in the face is that Sativex is just cannabis made into liquid form then mixed with alcohol and is only prescribed to cancer and MS patients , and even they have to fight their local health service for it because its so dear and instead of fighting for it more and more people like myself just by herbal cannabis from drug dealers . The Government has backed the sick into a corner on this issue and its time things changed and our so called " leaders " need to start listening to the experts .
awinstock
1 December 2011 9:23PM
Dear DWGism. The backlash you talk about is a real concern. Fears about misuse, the development of escalating use and dependence or diversion to the grey market by a minority of users does lead to overly restrictive prescribing by some practitioners and a fear of prescribing adequate doses. Some simple steps can be taken in prescribing opioids in particular, to limit the risks of abuse while ensuring good pain relief (see article in BMJ 23 August and letter responses to it the month later). Issues of direct marketing and the use of opioids increasingly as a source of 'legal heroin' and for narcotic comfort in the US remain a serious issues. Doctors need better training in pain management especially in the prescription and monitoring of opioid medications , while the delivery of them as part of treatment needs to be transparent so both patient and doctor are aware of the others'concerns. Some may ned to improve their diagnostic skills, for example one of the greatest missed diagnoses in those with chronic pain is depression. Untreated pain makes depression worse and vice versa. Finally all these opioids are being prescribed by doctors - most sensibly and therapeutically and with the best of of intentions. But there are a tiny minority of 'doctor dealers' who need to be dealt with.......but that is another story.
awinstock
1 December 2011 9:32PM
Toby. Thanks for your feedback. We have had loads of constructive comments on how to make things better next year. Thanks to everyone for e mailing. Several people have got back to us on the issue of cannabis terminology ( our US cousins want the term 'bud' amongst other next year). There does seem to a wide spectrum of knowledge and understanding among people when it comes to different forms of cannabis- with marked transcultural differences. The variation in THC is so wide and man people would not know what they were smoking until they had smoked it! Next year we plan to use pictures to help more clearly differentiate between types. It would be great to have input from people on optimal terminology to use next year so we can ensure common understanding. Your other points are noted and we will address them in next year's survey. Thanks for your feedback - and next year i assure you taht we will modify our cannabis terms, add in a few more common drugs and as for coffee/tea/ etc well we are taking advice on that one.
awinstock
1 December 2011 9:51PM
Thanks for your response. You are right – this is not perfect. There are the inherent limitations of any study that use non-random self selecting samples. These limitations and others are discussed fully in Winstock et al 2001 and 2010 and McCambridge et al 2005 and 2006. However, we have previously shown that self-report studies among dance drug using populations may be a valid and effective tool for monitoring drug trends and detecting the appearance of new drugs. As with any study that explores patterns of drug use and effects that relies upon self report measures there is the possibility of recall and response bias which may especially in this group be compounded by the frequent concurrent consumption of other substances. We have made an effort to describe our sample by both broad demographics and other activities beside drug use. The wide geographical spread of our sample this year and the very large number (12,500 to date) will allow for some correction of our non-random selection process. Certainly our findings based on within group differences (heavy versus lighter users for example of a drug) and descriptions of comparative drug effects are valid because of the thousands of users who have contributed. We have already obtained the largest body of comparative data of the effects of synthetic v natural cannabis and in the description and progression of ‘k cramps. I think many of other findings will be robust and of interest. But your point about limitations is accepted. Every study has them. We accept that compared against gold standard public health surveillance system an approach such as ours does have has significant limitations, however early on in a drug’s use history it can be difficult for initial studies to adopt more a more rigorous approach. Having said all this – we are still on course to have conducted the largest survey of current drug use in the world so its not all bad.
rationallogical
3 December 2011 12:35AM
People would not be using so many dangerous drugs if small amounts of cannabis were a legal alternative to pharmaceuticals and alcohol. I cant hep but think that these large pharma and drinks corporations are lobbying effectively to keep exploiting their monopolies.
deludedemocrat
30 November 2011 5:31PM
I have PTSD I succumbed to it in 82 after many mis-diagnosis I was diagnosed in 99, since then I have taken many many different medications and multiple medications at any time. They still dont have my PTSD and several co-morbid conditions under control. I had a "reaction" to MAOI's which almost killed me, I was paralysed from the chest down, had liver and kidney failure and was delerious for five weeks, I was discharged from hospital still unable to walk. Gradually I regained the ability to walk, just as the SSD came to install stair lift etc.