Safer use limits

About this guide

Nobody takes recreational drugs to have a bad time. People take drugs to have fun and many people do. But sometimes they don’t and people can end up in all sorts of messed up places – sometimes for a night, very rarely, for life.

Global Drug Survey is interested in helping people use drugs more safely, regardless of their legal status. We do this by sharing what we learn from the hundreds of thousands of people who take part the world’s biggest drug survey, the annual Global Drug Survey. As part of our way of saying thank you to every one of the 102,000 people who took part in the Global Drug Survey 2015 we have created the world’s first ever guidelines that talk about safer drug using limits.

Guidelines exist for the world’s most dangerous drug, alcohol. These were developed to help people and healthcare professionals have some idea what different level of drinking might be associated with low risk, moderate risk and high risk of harm. They are based on evidence and when properly used can help people reduce their drinking. The problem is there aren’t really any sensible guidelines on how many drugs you could take in any space of time without running a high risk of ruining your life. In the UK, as elsewhere, the government line is effectively: “Do not take illegal drugs because they are all bad.” Which is helpful when politicians want to skirt questions about drug policy, but entirely redundant for anyone thinking of going ‘mental mental chicken oriental’ (AKA having ‘a bit of mad one’, ‘indulging in a night of drug-fuelled hedonism’) or even a chilled night in with their PlayStation and a bag of chips without doing themselves too much harm. I guess governments have no choice – they could hardly say a drug is illegal (because it’s very dangerous) and then say ‘look, actually if you don’t use too much X too often, not mix it with Y and make sure you don’t play with knives, go scuba diving or drive, then actually the risks of you running into serious harm if you use X is pretty low (not zero – it can never be zero)’.

And just for the record (and the lawyers) Global Drug Survey states categorically that the only way to avoid all harm from drug use is to not use them whatsoever (“no shit Sherlock”). However, it’s not a very practical goal for people who like to indulge in drugs that reroute their brain’s dopamine and serotonin traffic flows with stuff made by mother earth or in an underground Dutch (or Chinese) laboratory.

The reality is that the risks of experiencing harms from using drugs can actually be massively reduced for most people with the right set of advice. And we’ve spent the past few years crunching all that data from drug users around the world in an effort to settle on what that advice should be.

After the Global Drug Survey 2014 we came up with the Global Drug Survey Highway Code (HWC) the world’s first harm reduction guide voted for by ‘experts’ (people who like taking drugs and want to keep themselves and their community as safe as possible). The HWC has been downloaded over 70,000 times. It’s a collection of nine documents that give drug users rational, non-patronising tips on how to minimise harm and also what the effect of each strategy was on the pleasure people got from taking different drugs. For example: “The cannabis joint that gets you most stoned is the first one of the day. Using first thing in the morning leads to the development of tolerance and increases the risk of dependence. Leave your days free from cannabis – you’ll get more stuff done and get stoned on less cannabis in the evenings.” Sensible tips that will benefit your wallet and wellbeing.

For Global Drug Survey, the development of the Safer Use Limits guidelines is a natural follow up to the Highway Code. Using data collected from the Global Drug Survey 2015, we’ve come up with a number of guidelines aimed at raising people’s awareness of the level of risk that different patterns of drug use places them at over the next couple of years. We did this by asking respondents to rate (on a scale of 1 to 10) how the risk of harm from different drugs (including alcohol) is heightened with increasing levels of use. Risk here refers to the probability, range and severity of harm. The higher the score the more likely it is for a person to experience any harm, and the higher the score the more problems that person is likely to face and the more severe they are likely to be. We asked our respondents to think about the likelihood of a person experiencing harm over the next 1-2 years. By harm we mean anything that causes a person problems be it to do with their mental or physical health, their relationships and behaviours, their finances or their ability to work, study, or just do the things in life they want to do.

But before we get into the drug-by-drug breakdown here are five general things that you need to know (and probably do, but just in case here they are):

1. Young brains and drugs are not a good mix

There’s a huge amount of evidence that alcohol and drug use before the age of 18 can cause long-lasting impairments in your cognitive and emotional ability. Kids don’t screw up your brains. “Grow your brain before you start expanding it” Our guidelines are strictly for those over 18 years of age.

2. Guidelines don’t make drugs safe

By developing safer drug using limit guidelines for illicit drugs Global Drug Survey is not suggesting that drugs are safe. Quite the contrary in fact. Drugs can be very dangerous and Global Drug Survey is not suggesting guidelines will be a panacea to society’s drug problems. But as governments are starting to embrace population-based strategies to improve health and think more rationally about drug policy, having some common sense guidelines that allow people to reflect upon their drug use is a sensible thing.

3. We are all different

We accept there are also a few obstacles in creating catch-all safer use limits: purities vary; drugs are rarely taken in isolation of each other; the method of ingestion can affect the risk; people’s initial tolerance may vary depending on height and weight; and, finally, lots of people take drugs for lots of different reasons, so if you’re using them to cope with other issues you may be more susceptible to experiencing harm at a much lower level.

4. People with existing mental health conditions are much more vulnerable to drug/alcohol harms

If you have a underlying mental illness you are much more likely to develop drug related problems – both short-term ones, like getting anxious or paranoid, and long-term issues such as dependence. If you have a psychiatric illness and things are not getting better taking a rest from drink and drugs can help. This may allow the treatment you are on to work better and make it easier for you and your doctors to know what’s going on.

5. Other times to take care

If you are pregnant or trying to get pregnant avoid cannabis. If you have heart or lung conditions you might want to think about your use as well.

The safer drug use limits: basic principles

The risks associated with taking drugs are difficult to quantify and some are hard to protect yourself against. While some risks are unpredictable such as allergic reactions to drugs or accidents that occur under the influence, many drug associated harms are related to dose and mixing. In short, the more drugs you take and the more frequently you take them the greater the risks of harm.

Risk of harm = amount of drug x frequency of use
More drugs, more often, more risk.

Risk of harm = amount of drug x frequency of use x years of use
Of course some risks are cumulative, so the longer you use drugs for the more harm you expose yourself to.

Risk of harm = amount of drug x frequency of use x years of use x personal vulnerability
It is also the case that some people are more vulnerable to drug related risk that others (especially young people with developing brains, those with a family history of serious mental illness and people with existing mental health problems)

Risk of harm = increased by mixing drugs and/or alcohol.
This is especially the case with alcohol and cannabis where even small amounts of alcohol can increase THC levels and when it comes to driving the combination is really dangerous and one to avoid.

And as the High Way Code makes clear, the risks you expose yourself to when you use any amount of drugs can be reduced by adopting some common sense strategies that minimise some of the harms that can follow the use of any drug. And at the most simple level: less drugs, less often is equal to less risk of harm.

Life is never risk free and even rare occasions of very low-level drug use can increase your risk of harm.

The use of all intoxicants, legal or not, can impair your judgment. Which is why you do stupid things when you’re drunk, like eating sweaty mystery meat, actively posing for photographs with a vape pen or hiding a turd in the butter dish. Risky things can become more risky when you’re intoxicated. So definitely avoid driving a car, cycling, climbing up scaffolding, playing with knives or doing anything generally regarded as dangerous while you’re under the influence.

Despite these challenges and accepting the limitations inherent in any such undertaking, we are proud to offer the world’s first safer drug-using limits starting with cannabis. We suggest these are read in conjunction with the GDS Highway Code.

As ever we stress that the only way to avoid drug related harm is not to take drugs and that no level of intoxication with any substance can be considered drug free. Finally and most importantly GDS is keen to remind readers that the following guidelines simply represent GDS reporting on the combined opinions of tens of thousands of people who use drugs.

* The concept, design and development of Global Drug Survey’s Safer Drug Limits was led by Dr Adam Winstock with assistance from Professor Michael Lynskey.