UPDATE: There have been significant changes to the Green Party Drug Group’s site following this post, as discussed here. Lots of links in this post are therefore broken. If you would like to see an earlier version of the site (similar to what I blogged about) you can look on archive.org.
When blogging about the Green Party of England and Wales’ health policy, we were accused of “quoting selectively” and “out of context”. I have therefore been looking over health-related aspects of Green policy more closely: in order to offer a broader view. One thing that stood out was their suggestion of various supplements to counteract some of the negative effects of recreational drug use, despite limited evidence for the supplements’ efficacy.
There are certainly evidence-based arguments in favour of the Green aim
to take the drug trade out of criminal control and [make] available in a legal environment
However, it is important to remember that recreational drug use (legal or illegal) comes with certain risks. An important aspect of a harm reduction approach to drug policy is that it works to accurately assess the risks and harms involved. Recommending pills which have not been shown to be effective, in order to treat some of the side effects of drug use, is not helpful.
The Greens take a surprisingly reductionist view of the mood changes that can be associated with ecstasy/MDMA use: focussing very much on the role of serotonin, despite criticisms of the ‘serotonin hypothesis’ in other contexts. The Greens suggest, if one is “feeling moody” and suspect this may be health-related, that:
If you haven’t got the time/inclination to exercise and improve your diet, both of which can have a gradual but marked positive effect on your general wellbeing, you can buy 5htp and tryptophan from health food stores, both of which increase your levels of serotonin to a constant and balanced level.
It is good that they mention diet and exercise (although I would argue that exercise can actually have a quite rapid impact on mood – with vigorous exercise providing a quick ‘lift’). However, the evidence for the use of 5htp and tryptophan is not convincing; I would also be cautious about reaching for a pill where lifestyle changes may be a better option.
The Greens are very optimistic about what 5-HTP can do:
What is 5-HTP used for?
There is a massive amount of evidence that suggests that low serotonin levels are a common consequence of modern living. The lifestyle and dietary practices of many people living in this stress-filled era results in lowered levels of serotonin within the brain. As a result, many people are overweight, crave sugar and other carbohydrates, experience bouts of depression, get frequent headaches, and have vague muscle aches and pain. All of these maladies are correctable by raising brain serotonin levels.
The primary therapeutic applications for 5-HTP are low serotonin states as listed below:
* Supporting healthy sleep patterns
* Providing building blocks for serotonin
* Promoting a regular sense of well being
The Greens are also quite positive about Tryptophan:
What is tryptophan?
Tryptophan (also known as L-Tryptophan) is an amino acid which is naturally present in the body and essential for human life. It is called “essential” because the body is not capable of producing it on its own, so we must ingest or consume it. Tryptophan is plentiful in protein foods like milk and bananas. Tryptophan is needed to produce serotonin, which is a hormone that regulates your mood, so tryptophan is very important for your emotional health.
We would – generally – be sceptical about ‘pill solves complex social problem’ stories. In the case of these particular pills, while there is some interesting research, there is not compelling evidence to support the claims made for them. For example, one might note the Cochrane review of 5-HTP and tryptophan for depression:
5-HTP (Hydroxytryptophan) and tryptophan have been examined to see whether these treatments are effective, safe and acceptable in treating unipolar depression in adults. The researchers reported that the symptoms of depression decreased when 5-HTP and tryptophan were compared to a placebo (non-drug). However, side effects had occurred (dizziness, nausea and diarrhoea). They also reported that tryptophan has been associated with the development of a fatal condition. More evidence is needed to assess efficacy and safety, before any strong and meaningful conclusions can be made. Until then, the reviewers propose that the use of antidepressants which have no known life threatening side effects remain more attractive. The review sets out the required methodology for effectively studying these substances in proper controlled studies.
I would not rush to these pills in order to achieve a quick mood lift. Alternative approaches such as exercise and lifestyle change seem rather better options.
The Greens also suggest a number of “Supplements to make tryptophan work better” which lack a good evidence-base:
* Vit B6
* Vit C
* Vit B3 a.k.a Niamicide (decreases irritability and increases your sense of humour)
I am not sure where to start with these, so will move onto melatonin. The Greens state that melatonin is
the all-natural nightcap
The Greens suggest the supplement to help with sleep. Once again, though, there is not the evidence to back up this suggestion: the evidence regarding melatonin is mixed, and more limited than one would like.
Other aspects of the Greens’ discussion of this supplement are also worrying. They ask
Is melatonin legal?
Yes. Melatonin has been available in the US for a few years. Unfortunately it is not available in Britain. People interested in buying it usually get it by mail order, or online.
Clearly, buying drugs mail order from abroad and/or online involves additional risks. It can be hard – for example – to judge whether a foreign website is reliable. The Greens also state that
There are also very active discussion boards about melatonin online and people have plenty of advice to give on how much to take.
There is a lot of discussion of supplements online – and lots of the advice offered is very, very bad. Referring users to such online discussions for treatment advice does not seem wise. A doctor or dietitian would be a far better option.
The Greens suggest three links on the topic of “HEALTH AND PARTYING”. Only one of these links covers the important topic of vitamins: offering a “comprehensive vitamin info source”. Sadly, this link leads to The Vitamins and Nutrition Center: a site provided by the makers of the Vitaplen supplement. They carry adverts for Vitaplen supplements, and recommend Vitaplen’s multivitamin. This is an important topic, and one would have hoped that the Greens could have suggested a better source to readers.
The Green Party have a responsibility to report the science accurately, and there is clearly a real demand for good-quality information. 476 of those who answered the Greens’ site survey (10%) said they came to the site for science info.
Recreational drug use carries risks. It is important that those who are using – or considering using – these drugs are educated in these risks. Making inflated claims for the role of supplement pills in ameliorating the negative effects of drugs is unhelpful. The rather unfortunate approach displayed here also raises broader concerns about the Green Party’s policy. The Green Party is letting down their readers and supporters here – many of whom say they want to read about the science – and doing a very poor job of arguing for their drug policy.