 Poster: A snowHead
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Snow Hound,
Not entirely true that cocaine doesn't kill at normal doses. It acts as a profound vasoconstrictor and can lead to coronary vasospasm leading to a myocardial infarct (heart attack). Having seen a 23 year old with severe enough heart failure after her heart attack to need to be assessed for a heart transplant (3rd time using cocaine, otherwise completely fit and well previously) and a young man with a life threatening abnormal heart rhythm after a cocaine binge (VT with a rate of 220 requiring emergency cardioversion) I wouldn't class it as harmless even at "normal"usage. It is the largest cause of heart attacks in the under 40s in the US.
Also I've seen MDMA cause acute hyponatraemia after massive water intake. He ended up brain dead and an organ donor. I've also seen it cause serotonin syndrome leading to end stage renal failure needing long term dialysis, again in a young man. The significant side effects of these drugs are relatively rare but if they occur are devastating to both the unfortunate sod who took them and to their families. This is only for pure drugs, let along with poo-poo that most of them are cut with.
I'll leave them well alone I think.
Bert - intensive care doctor
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Obviously A snowHead isn't a real person
Obviously A snowHead isn't a real person
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BertIsfantastic,
You state that cocain doesn't kill at normal doses (I used 'moderate') and then go on to site two cases that were clearly overdoses. The examples you use regarding MDMA were also caused by mismanagement (hyponatreamia) and either likely overdose again or reaction with another substance such as a monoamine oxidase inhibitor (serotonin syndrome). You also don't mention heroin? I assume you administer opioids in safe doses to patients on a daily basis?
I'm no doctor and wouldn't disagree with you that these substances can be extremely harmful and sometimes fatal. My argument is that the current approach only increases the risks for those that do decide to take them. Would legalisation cause a massive uptake in drug use? I can't be sure but I don't think so.
Imagine this scenario: I want to try a particular drug so I take my passport or driving licence to a government licenced clinic and receive an information pack about said substance. One week later I return to the clinic and take a test on safe dosage, management, route of administration, reactions with other drugs etc. If I pass I sign a disclaimer and pay for a small amount of the substance in its pure form. The authorities would instantly know when recreational use crossed over into addiction. Yes there would still be a small black market (in high quality product) there would still be addiction but help and support would be more readily available and paid for out of the profits made by the clinics.
I know it's just a pipe dream (excuse the pun) but the 'war on drugs' has been won by criminals rather than the authorities and I feel that the current approach does more harm than good.
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Well, the person's real but it's just a made up name, see?
Well, the person's real but it's just a made up name, see?
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Also I've seen MDMA cause acute hyponatraemia after massive water intake
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Its the massive water intake not the MDMA that killed him. Hello Leah Betts? Everyone knows that drinking poo-poo loads of water kills you.
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You need to Login to know who's really who.
You need to Login to know who's really who.
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It's not a vote winner though and therein lies the reason our leaders will continue to ignore the advice of those they appoint to advise on such matters.
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Professor Nutts?
Unfortunately most of the population is actually pretty stupid and do need protecting from themselves. Huge swathes of the population don't have the capacity to assess evidence, have a reasoned discussion and draw their own conclusions on many subjects let alone one as contentious as 'drugs'.
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Anyway, snowHeads is much more fun if you do.
Anyway, snowHeads is much more fun if you do.
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You'll need to Register first of course.
You'll need to Register first of course.
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Snow Hound,
The cocaine in both of those circumstances was not an excessive amount, described by both patients as less than previously used. yes there may have been a higher percentage cocaine than used previously but as the whole thing is unregulated and it is up to the whim of drug dealers as to how much they cut it.
Whilst I agree the acute hyponatraemia is as a result of excessive water intake, and the patient had drunk a massive amount, there is some evidence to say that MDMA can cause SIADH which may have exacerbated the degree of hyponatraemia. The serotonin syndrome chap was on no other medication, we did question GP and family as to whether or not he was on anything such as an MAOI. He wasn't.
I do prescribe and administer opioids on a daily basis, in doses that I consider to be safe, although this is very different to what I might prescribe for outpatient use. Namely this is because in an ITU or theatre I can monitor and treat as appropriate, and it some cases use the expected effects of respiratory depression to my advantage. There is a significant difference between an anaesthetist using known doses of opioids for therapeutic benefit in a safe environment and injecting piles of smack/brickdust/warfarin/who knows what in some grotty shooting gallery. there is also increasing evidence to suggest long term opioid usage can lead to a degree of immunosuppression, yes a potentially small problem but unhelpful never the less.
I suspect that legalisation and regulation may reduce the impact of these substances but even then they are still potentially very dangerous compounds with idiosyncratic reactions a known problem. Some of dislike of these compounds is that i spend a reasonable amount of my working life dealing with the after effects, which isn't as much fun as you'd think.
bert
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| BertIsfantastic wrote: |
| Not entirely true that cocaine doesn't kill at normal doses....... I'll leave them well alone I think. |
That isn't really the point under discussion, which is whether the illegality of drugs does more harm than good. Illegality has a range of effects, from the restriction but not elimination of availability on the one hand, to the issue of people not knowing what they are actually consuming, the criminalisation of users and the creation of the career path from runner to dealer to drug baron which society might be better off without.
We could also think about why we have a society where so many don't want to be sober. And yes, I do like a drink.
Last edited by Then you can post your own questions or snow reports... on Tue 11-02-14 13:38; edited 1 time in total
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When I saw the title of this thread I assumed it would be about illegal booze after our trip to Borovets. We were warned several times not to drink the free shots in certain bars as they were known to be dodgy counterfeit vodka.
As for the drugs debate, the most dangerous things about drugs are the naive people who just class them all as 'drugs' and know that 'drugs are bad' like that silly women Jaquie Smith who just decided that she knew better than scientists who had conducted proper experiments into the dangers of them. People like this need properly educating about the subject and realise that it is the illegality that makes them impure and dangerous.
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You'll get to see more forums and be part of the best ski club on the net.
You'll get to see more forums and be part of the best ski club on the net.
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We were warned several times not to drink the free shots in certain bars as they were known to be dodgy counterfeit vodka.
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Really? Thats super bad!
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Yeah, although we weren't sure if it was just one barman slagging off another just so we stayed in his bar rather than move on, although to be fair to the guy he was very honest about all the other places and didnt have a problem recommending other bars just warned about the free shots in one or maybe two of them.
That whole resort is run by dodgy Russian mafia types though so wouldnt put anything past them
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snowHeads are a friendly bunch.
snowHeads are a friendly bunch.
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I was in Borovets back in the early 90s not long after they came out from behind the iron curtain, the dodgy Russian mafia types were there then too. I had thought they would be gone by now.
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And love to help out and answer questions and of course, read each other's snow reports.
And love to help out and answer questions and of course, read each other's snow reports.
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BertIsfantastic, out of curiosity, what constitutes massive water intake? As in litres per hour? Thanks.
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Clarky it is different amounts for different people, depending on size, weight, excersise, sweat production etc. However there was a case in the states a few years ago where a girl who entered a competition hold your wee for a wii, drank over six litres of water, ( 12 pints) in less than Three hours, she suffered a headache and later died. It was water intoxication that did it. Dancing and drinking lots and lots of water, can upset balance of sodium in the body and puts pressure on the kidneys.
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You know it makes sense.
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clarky999,
About 6-7 litres over the course of an evening. Wouldn't recommend it.
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Otherwise you'll just go on seeing the one name:
Otherwise you'll just go on seeing the one name:
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biddpyat, BertIsfantastic, thanks.
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Poster: A snowHead
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So water will kill you if you drink too much. How on earth is it still legal?
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Obviously A snowHead isn't a real person
Obviously A snowHead isn't a real person
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BertIsfantastic,
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| There is a significant difference between an anaesthetist using known doses of opioids for therapeutic benefit in a safe environment and injecting piles of smack/brickdust/warfarin/who knows what in some grotty shooting gallery |
Isn't that exactly the point? Legalise it, sell ( and tax ) clean gear. No more grotty shooting galleries and a bunch of very nasty people suddenly without income. Simple.
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Well, the person's real but it's just a made up name, see?
Well, the person's real but it's just a made up name, see?
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 snowhound, it is back to the usual too much of anything is bad. There was a song by the police once " everything gives you Cancer". It is so true because no matter what you do someone will tell you that it causes cancer. So I suppose too much of anything is bad for you.
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