If alcohol and cocaine are removed from society, 'all rates of violence will be halved'
If alcohol and cocaine were to be completely removed from society, all rates of violence will be halved, clinical toxicologists told The Malta Independent on Sunday.The Malta National Poisons Centre keeps a close eye on recreational drugs both locall
If alcohol and cocaine were to be completely removed from society, all rates of violence will be halved, clinical toxicologists told The Malta Independent on Sunday.
The Malta National Poisons Centre keeps a close eye on recreational drugs both locally as well as internationally in order to anticipate trends of intoxication.
Three of Malta’s top clinical toxicologists, and founders of the new Malta National Poisons Centre, Mark Lawrence Zammit, president-elect of the EAPCCT (European Association of Poison Centres and Clinical Toxicologists), Jeffrey Bonnici and Robert Chircop, both Emergency Medicine consultants with a special interest in toxicology, were approached by The Malta Independent on Sunday to provide insights into the current recreational drug situation in Malta. They were questioned on the most common recreational drugs such as cocaine, the newly-legalised cannabis plant as well as its synthetic cousins that lie in legal and medical grey areas. The experts also expressed their views on harm reduction testing and the truth behind date-rape drugs in Malta.
The toxicologists said that the Malta National Poisons Centre is “kept most busy” by drug and alcohol abuse which are a chief cause for admissions to Mater Dei Hospital, including to the Intensive Therapy Unit (ITU). They said that Malta remains generally “conventional” when it comes to drugs of abuse with users of the “big 5” drugs – cocaine, heroin, ecstasy, synthetic cannabis and “natural” marijuana – being 18 to 40 years of age.
a. Cocaine
They highlighted how popular cocaine is in Malta and how its effects are underestimated by those who abuse it.
They said that those who are brought in for care under its influence are known to be very abusive and aggressive towards healthcare personnel and sometimes even physical restraints or chemical sedation become necessary to ensure the safety of the staff and of the patients themselves.
They said that cocaine is a stimulant drug, which is known to increase aggression on its own, but when taken in conjunction with alcohol its effects are further increased. They said the result of using both cocaine and alcohol is also common and has even made it to the headlines, citing instances where these substances were involved in cases of violence and murder.
The toxicologists concluded that there is a large and robust body of research that found that should alcohol and cocaine be removed from society, all rates of violence will be halved.
b. Synthetic drugs
The toxicologists said that the illicit/recreational drug market functions just like any other economic market and is rapidly innovating to keep up with the supply resulting in new or variant drugs, especially synthetic ones. They said that the challenge is to keep up with these market trends locally and internationally, pointing out the “epidemic” of fentanyl in the US, for the sake of toxicovigilance.
They said that the approach of the healthcare system towards drugs cannot be proactive, due to a highly dynamic market where drugs, with a trend towards the synthetic type, may change chemical composition overnight. Instead, it must be quickly reactive, functioning in a response spanning days, as well as through risk mitigation from their monitoring of the international situation.
The toxicologists said that a good example for these new synthetic drugs is the current HHC fad and explained that when the natural cannabis plant is in-taken, THC is the chemical responsible for the high. They said that HHC (hexahydrocannabidol) is a synthetic chemical that closely resembles the THC (tetrahydrocannabidol) molecule, and so gives similar effects to cannabis while also being easy to manufacture. They said the crux is in the word “similar”, not “same” and emphasised that even though the chemicals are so similar, a small change in the molecule can have vastly different effects.
They said that while HHC may give a high which is perceived to be “better”, it is not produced by people who have researched it. It is not like a formal pharmaceutical product, which is properly studied over many years and undergoes clinical trials, authorised and closely monitored even post-marketing, at significant investment, they said. This lack of knowledge prompted the toxicologists to highlight the risks associated with using a drug that is poorly studied or regulated. The toxicologists also pointed out the trend of the online purchasing of apparently “legal” drugs labelled as plant food or incense. They said that there have been instances where what was “bought” online did not reflect what actually arrived, including drugs that are scheduled in this country. They added, however, that the legal technicalities are complex in this aspect and cautioned that what might be legal in the country/region where the drug is sold from, may not be legal in Malta and vice versa.
c. Cannabis
The toxicologists noted a significant increase in cannabis intoxications, despite being purportedly “safe” and recently legalised. They said that cannabis intoxications tend to present in Emergency with varied symptoms, including acute psychosis (a condition where the patient does not retain normal brain function), in addition to studies linking cannabis to psychosis from long-term use, as well as agitation and potentially cyclical (repeated) vomiting among other symptoms. The toxicologists said that psychosis is a serious problem as it makes the person uninhibited, disruptive and aggressive, leading to difficulties controlling the patient in the Emergency department and even making them a threat to society, for example when they drive under the influence.
They added that the treatment for cannabis poisoning is typically supportive, meaning treating the symptoms, but pointed out the cost burden it has on the healthcare system.
The toxicologists emphasised that when cannabis is combined with alcohol, moderation must also be exercised, since when mixed, these two substances often lead to loss of inhibition and dangerous situations, especially while driving.
On the other hand, they highlighted that natural cannabis, as a plant, does not typically have a consistent dosage with the same reasoning used for herbal remedies. They acknowledged the benefits of the recently set-up “cannabis clubs”, which supply lab-tested cannabis that states the accurate dose of THC present, but said there are still caveats in this, for instance the THC concentration might vary from plant to plant in the same field.
They also explained that there is much variation between people with regards to their reaction to the same dose of cannabis and that every individual’s reaction to cannabis is influenced by multiple factors including the dose taken, ambient setting, emotional state and other drug/s ingested, including alcohol.
They said that if someone feels abnormal symptoms following cannabis intake, they can call the Malta National Poisons Centre for advice, on 1774.
When asked whether there had been any collaboration between the Centre and the Authority for the Responsible Use of Cannabis (ARUC) thus far, they responded negatively. However, they reiterated their commitment to collaborating with all interested parties and their policy of fostering connections.
1. What is your opinion on drug testing for the purpose of harm reduction?
The toxicologists said that there is no one test to check all drugs and it simply doesn’t exist. They said that this is due to a matter of “diversity” and explained that to check for a drug’s content, a “standard” is needed, meaning a pure sample of the chemical/s present in all the types of drugs, in order to confirm their presence.
Furthermore, drug testing for harm reduction is possible in the right setting and when carried out by experienced and responsible people that are highly trained in the field, they said.
Ultimately, they said that they categorically believe that those who use recreational drugs are not criminals; however, they believe in the pursuit of “natural highs” through physical activities. They explained that “natural highs” are healthy and give both short- and long-term medical benefits while recreational drug highs might lead to both short- and long-term medical risks.
The toxicologists encouraged users to speak up about their usage, most importantly in the Emergency department, as it may save their life. They added that with the influx of new synthetic drugs, treatment of such patients in hospital is largely symptomatic as no antidote is available.
2. What is the situation in Malta with the so-called date-rape drugs?
In the first place, the toxicologists said that, luckily, this is not a significantly-reported problem in Malta.
They said that the bottom line for date-rape drugs in Malta is that they are very rare in their experience, however, they do receive many reports of false alarms.
They said that recently a story was going around on the media of an injected date-rape drug, called needle-spiking, prompting a trend of reports of people in distress after what they thought was a skin prick during a party. They added that these were all false alarms but pointed out that the media in general has to be cautious when reporting such cases.
Despite this, drink-spiking and “date-rape” drugs do exist and such cases would need to be investigated by the police and with the victims sometimes needing medical care.
They recommended that individuals who suspect they have been given substances without their knowledge or consent should notify venue staff and remain accompanied by a friend whom they should keep talking to. They added that it is advised not to let the spiking victim go home on their own or leave with a stranger. In an emergency it is advised to phone 112.
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