On 16th November 1995, school
girl Leah Betts died at her 18th birthday party. She and a friend –
like many 90’s teenagers - had decided to take ecstasy, a drug which they had
both taken before with no ill effects. Popular advice for ecstasy users at the
time was to drink plenty of water and to stay well hydrated to avoid
overheating, so when Leah started to feel unwell she followed that advice. Leah
continued to feel unwell, so, thinking she was dehydrated, she continued to
drink water. Unfortunately for Leah and her family this harm reduction advice was
misguided and her consumption of too much fluid led to the water intoxication
that ultimately killed her[i].
Leah’s death caused a moral panic and a media storm about
ecstasy, with many overlooking the actual cause of death and blaming the drug
itself. Bad advice and confusing messages were partly to blame for the actions
she took after ingesting the drug, and whilst Leah would undoubtedly have lived
had she not taken ecstasy that night, the popular harm reduction advice that
was in the public domain at the time was undoubtedly a contributing factor.
Since Leah’s death, what little official harm reduction advice
there is has been amended to reflect the dangers of both overheating and overhydrating:
‘Users
should take regular breaks from the dance floor to cool down and watch out
for any mates who are on it – they mightn’t realise they're in danger
of overheating or getting dehydrated…’
‘…However
drinking too much can also be dangerous…Users should sip no more than a pint of
water or non-alcoholic drink every hour.’
‘Ecstasy’, FRANK[ii]
With the rest of the ‘Ecstasy’ section of the FRANK website
emphasising either the associated illegalities or potential risks, it is clear that
there has actually been a shift away from harm reduction to prevention when it comes
to substance use education.[iii] Furthermore, the evidence seems to
suggest that despite many young people citing them as a source of information,
drug education initiatives such as the FRANK campaign fail to change behaviour.[iv]
 |
| A news report on the death of Leah Betts |
So what has happened to a ‘forewarned is forearmed’ approach
in the substance use agenda? Martin Barnes from Drugscope is concerned about
the lack of harm reduction knowledge among the current ecstasy-taking cohort:
“Much of that knowledge
[about reducing harm], for example, not increasing dosage and not allowing the
body to get over-heated is less known to many of the current generation of club
and festival goers. We need to find ways of reminding young people about this
type of information, not only in relation to ecstasy, but also to the many
other new drugs now available.”
Martin Barnes, quoted in the
Independent, August 2013[vi]
Both Harry Shapiro (also from Drugscope)
and Professor David Nutt (Imperial College) agree that there is a worrying
political shift away from harm reduction because the media have helped create
such a moral panic that the issue of substance use is now rooted in a culture
of fear rather than in providing effective and useful information to users.[vii]
Whilst harm reduction interventions such as needle exchanges and methadone
clinics are still used in the treatment of harder drugs, the ‘softer’
educational harm reduction approach and the associated safety benefits continue
to be overlooked due to the controversial, emotive and political nature of
substance use legislation.
 |
| 'Just say no' - FRANK campaign advert |
Current UK drugs policy has indeed seen a general shift
towards focusing on recovery and abstinence in recent years rather than on
damage limitation for substance users,[viii]
and the very mention of harm reduction as a tactic for tackling substance use
tends to send the more politically conservative into a moral spin as such
advice is seen to condone illegal and harmful activities. The “if you are going to do it, at least be
informed about it”[ix] approach to the so-called ‘war on drugs’
is frequently misinterpreted as condoning substance use, but if we accept that
prohibition has not eradicated these behaviours, the next logical step surely has
to be effective harm reduction advice. Moral panics and illegalities haven’t
stopped people taking ecstasy and other substances, so perhaps it is time to
educate people on how to stay safe, how to keep their friends safe, and on how
to reduce the potential harm involved in such activities. Settings in which
substance use tends to occur (such as festivals and nightclubs) should be free
to offer advice on safety without the fear of being seen to condone usage,
giving people the right information on how to manage dosage and dealing with any
associated concerns. Whilst we obviously don’t want to actively encourage drug
use, we do need to accept that certain behaviours exist in society, regardless
of whether they are either illegal or socially unacceptable.[ix] The challenge then shouldn’t be how we can
eradicate drug use, but how we can
ensure that harm reduction advice is freely available, easy for users to
understand and above all evidence-based; because the consequences of bad harm reduction advice can be as
devastating as having none at all.
[i] Henry,
J.A. (2000) Metabolic consequences of drug misuse. British Journal of Anaesthesia [online]. 85 (1), pp.136-142.
[iii] Measham, F.,
Williams, L. and Aldridge, J. (2011) Marriage, mortgage, motherhood: What
longitudinal studies can tell us about gender, drug ‘careers’ and the
normalisation of adult ‘recreational’ drug use. International Journal of
Drug Policy [online]. 22 (6),
pp.420-427.
[iv] Aldridge, J. (2008) A hard habit to break? A role for
substance use education in the new millennium. Health Education [online]. 108 (3), pp.185-188.
[vi]
http://www.independent.co.uk/news/uk/home-news/fresh-fears-over-ecstasy-substitute-pma-after-rise-in-deaths-8787783.html
[vii]
http://www.mixmag.net/feature/ecstasy-in-2015
[ix]
Truss and White. (2010). Ethical Issues in Social Marketing. In: French, J. (2010) Social
Marketing and Public Health: Theory and Practice [online]. Oxford University Press.
