You might have noticed that even though this is ostensibly an osteopathy blog, I venture off-piste quite regularly. This is partly as there is a wealth of innovation and research going on in related fields, which I think osteopaths should be aware of, but also as we have a marvellous opportunity to educate our patients. Not because we are omniscient beings, qualified to make judgements about patients’ choices in life – one patient told me a previous osteopath had told her, “I am surprised you let your children watch TV. I don’t”(!), – nor because we are gurus with access to secret wisdom and knowledge not possessed by our lesser-evolved patients, but because we bother to keep up to date with the latest ideas and research in the field of healthcare, and feel we have a duty to pass them on to our patients. We have patients in our rooms for long periods of time, much of our talking time is probably wasted in idle chitchat (speaking for myself here), and by keeping abreast of the latest findings in wider aspects of healthcare we can use this time to everyone’s advantage.
But I digress… I am merely giving the context for this blog, which is that I think we need to understand the enormous human propensity to use drugs, of which both cause and effect are a result of complex biopsychosocial factors. It is an area in which patients might need our understanding and knowledge. Fortunately David Nutt, a Cambridge-educated neuropsychopharmacologist, who used to be the Government’s Chief Advisor on drugs policy, has written a wonderfully clear and intelligent book, detailing current best research into drugs, and he has included a handy chapter on what to tell your children.
I am finally getting to the point
I urge you strongly to go and read David Nutt’s “Drugs: Without the Hot Air”, cover to cover, rather than read my truncated version of just one chapter, – it’s easy and fascinating reading. You’ll be able to bore your friends for weeks with facts: “heroin” was named for its “heroic” effects, and paracetamol would never be passed by the FDA today – but if you have not got the time or inclination, and you would like to know what to tell children about drugs, I have summarized his advice briefly here. This is a great thing to have read just so we know what to say to our own children, but it might also be useful to inform any patients who are parents, and even teenagers themselves. I can find teenagers in clinic at best monosyllabic and at worst mute, to the point it is hard to get an answer to basic questions such as “Where does it hurt?” or “How old are you?”, but if you do strike a rapport with someone at that tender age, it is good to know what line to take and what they could benefit from knowing.
Why talk to them and how?
- Delaying experimentation as long as possible is important. The first time you take a drug it has an unusually large effect on you, as you haven’t developed any tolerance to it. For a young, inexperienced person this can be even more powerful and lay down really positive memories that can lead to addiction. (A positive first experience of a drug is a strong predictor of addiction). If you use drugs in teenage years you are far more likely to use them as an adult.
- As every adolescent knows, they are immortal, so telling them about mortality rates is not helpful. However adolescents can also be self-conscious, vain and looking to attract a mate, so focussing on immediate downsides (bad teeth, bad breath or impotence from smoking, for example) is more effective.
- Every child is different, so talk in a way that you think will suit them. They will have a lot of misinformation from friends and the media so start young before those wrong ideas get too entrenched.
- Don’t shop them to the police if you find they are involved in drugs. David Nutt does not actually say this; he merely urges you to think carefully before doing so, but really! Every once in a while a frankly unbelievable story appears on the news that a young person, not yet launched in life, has ended up with a criminal record due to a parent panicking about some relatively minor teenage drug experimentation. By involving the police that child’s opportunities in life, not to mention their relationship with their parents, is damaged beyond all proportion to the actual offence or incident. Please hold your horses if you are tempted to do this and seek advice elsewhere first. I’d suggest the GP.
Points to discuss, lines to take, things they (and you) should know
- Alcohol and tobacco are drugs. Make sure children know that even though alcohol and tobacco are legal, they are still drugs and in a lot of ways are more harmful than illegal drugs. Emphasize that alcohol still carries considerable risks even if you are not an addict. Let them know how highly addictive tobacco is.
- All drugs can potentially cause harm as well as pleasure. There’s always a chance of an allergic reaction with any drug, and even if you’ve taken them before the setting can affect your reaction. If you buy off the street you don’t even know what you’re getting in terms of purity, ingredients, strength etc. I still remember the antifreeze-in-wine scandal, and that was sold by supermarkets, so goodness know what goes into street weed or cocaine.
- Start conversations when your kids are aged 6 or 7, as soon as the concept of drugs being used and discussed enters their consciousness. Be willing to discuss your own drug use – don’t pretend drinking and smoking are different, or you will lose all credibility as soon as they cotton on. Tell them how you weigh up the benefits and risks, and what you think is appropriate for yourself.
- Never Inject. Never, never, never. This should be a total no go area. It’s the most risky way to take drugs. Mention HIV and Hepatitis C, which will damage your health for life, much worse than the drugs, plus the very high risk of infection.
- Don’t use solvents.(butane, glue, aerosols, solvents) Young people get access to these easily so they are commonly used by adolescents. But don’t even try it once to muck around. One person a week dies doing this, mainly from SSDS (Sudden Sniffing Death Syndrome. Yes it’s real, I’m not making it up). One single session can instantly stop the heart. It’s highly dangerous to experiment with this: you’re basically playing Russian Roulette; another absolute no go.
- Don’t do drink and drugs at the same time. Alcohol can create new compounds when mixed with drugs (eg cocaine), which are more dangerous than either drug on their own. And if you use opioids with alcohol they can depress your breathing to the point of death. So never take ketamine, GHB, GBL, heroin or opioids if you are drinking. If you’re drunk your judgement is affected and you might take the wrong thing, or more than is safe, so beware.
- A criminal record could ruin your career. Most drugs are illegal and prosecution is a lottery. Some police officers will prosecute everyone they catch. You can’t assume that you’re safe even if you just have a small amount of cannabis on you. Hundreds of thousands of people every year end up with a criminal record or even go to jail. Dealing is taken very seriously and is likely to end up in court, and even passing small amounts to your friends counts as dealing. Never post pictures of yourself or friends doing drugs, and watch what you say online or in texts as it could be used as evidence against you.
- Find good sources of advice. e.g. obviously I am quite smitten with David Nutt’s book, or the associated website http://www.drugscience.org.uk. Don’t believe the media or your friends: they are often very badly informed and have their own agenda.
- If you do take drugs (including alcohol and tobacco) be clear why you’re doing it. Sometimes it is not for pleasure, but to deal with stress and anxiety. Liking alcohol might be a sign of an anxiety problem. (About a quarter of male alcoholics have an underlying anxiety disorder which could have been treated less harmfully with pharmaceutical drugs.) Be aware that liking cannabis might be an early indicator of schizophrenia. Also realize the power of peer pressure and encourage children to inform themselves rather than trust what their friends say about drugs.
- If you do use drugs, make sure they don’t interfere with your schoolwork. Make sure that if you do experiment, you keep the drug use separate from your school life. Don’t let it interfere with homework, attendance, or your state of attention at school (no hangovers on a school day!). Never have drugs in school: even small amounts of alcohol could get you suspended or expelled. Your choices and opportunities in life could be limited. Getting behind or getting in trouble at school could be the biggest and worst effect drugs could have on your life.
We might not be able to prevent children experimenting, but at least we can make sure they are informed about the risks, and we can act as a reliable source of information and let them know they can talk to us if they need. Good luck!