Drug Interactions - Are patients being put at risk?

Doctors are used to providing information on the risks and side effects of the medications they prescribe, but often patients are not informed of the interactions between their prescribed medication and any recreational drugs they are taking. Greta Friedlander and Jess Bradley investigate.

According to the 2005/06 British Crime Survey, just over a third of adults admit to using illicit drugs at somepoint in their lifetime, this figure increasing when considering just young people. Despite this, pharmaceutical companies and doctors often fail to provide information on the interactions of prescription drugs with illicit recreational drugs, where it is commonplace for information to be provided on a drugs interactions with alcohol.

We spoke to one student, Anne, who has been prescribed with a low dosage of Nortriptyline, a triclyclic anti-depressant. Anne is an occasional user of recreational drugs, and had not had any negative drug experiences prior to starting on her medication. Recently she decided to take some space cakes with a few friends and discovered an unexpected interaction with Nortriptyline, which had not been explained by her GP or within the information leaflet the medication came with. Anne describes her experiences below:

“I suffered nearly 24 hours of vivid hallucinations, which were far more intense than I have previously experienced on much stronger hallucinogenic drugs. I had vivid flashbacks, synaesthesia and paranoia, none of which I have never experienced on any other drugs. I spent the entire trip being terrified, the whole world became reduced to pixels of colour and I felt like the walls were moving in to crush me. At the start of my trip I watched TV for a while and believed all of the people on screen were people who I knew and were talking directly to me. I saw my own reflection and shadow trying to murder me. I had eaten space cakes a few times before, in similar quantities, and never experienced anything like this.”

“It hadn't occurred to me that my prescription drugs might interact with cannabis, although I had been avoiding alcohol on the GP's advice. I am now angry that I was not provided the information I needed by my doctor to make an informed decision about my drug use.”

Websites such as Erowid, which act as a depository for information on the interactions between different drugs and our bodies, have been created to meet the need of providing information on drug interactions in the absence of a coherent, unbiased information service by health professionals - a service which is lacking due to the drugs legal status. Many of these websites provide "trip reports", collections of experiences from drug users, which act as useful resources even though they are anecdotal in nature.

The lack of information provided to patients on the interactions between prescribed and illicit drugs is just one of many unintentional negative consequences of the drug prohibition - and one that particularly effects the most vulnerable patients.

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See also: Harm Minimisation, Self-Medication and Pleasure Maximisation (video)