Between 2013 and 2015 Doctor Fernando Caudevilla (aka Doctor X) offered free, individualised harm reduction advice to users of illicit drug markets on the deep web.
Establishing trust by providing access to his personal webpage and relevant information about his real identity and work, Doctor X quickly became a valuable resource. He answered over a thousand questions about drugs and health with common themes such as adverse drug effects, medical contradictions, pharmacological interactions with other illicit drugs and patterns for detoxification.
Working as a “normal doctor” by day, Caudevilla has a PHD in drug dependence and is a dedicated volunteer to Energy Control. This Spanish NGO focuses on the application of harm reduction interventions for recreational users. They offer drug testing services and analyse the contents of thousands of samples destined for personal use at festivals and clubs, as well as those that are sent into their lab by consumers. Through this work Energy Control aims to reduce the amount of drug related incidents.
Dreamland Magazine was lucky enough to speak with the good doctor this week.
Where did the idea for Doctor X come from?
I started working as a volunteer with Energy Control in 2000. Ecstasy was my main interest at this time, and mixing this with my profession as a clinic doctor, my colleagues gave me the nickname of “Doctor X”.
What drew you to study harm reduction strategies for recreational drug use?
I find this field particularly interesting and am excited by the possibilities offered by new technologies as tools for harm reduction.
I also see potential for there to be a shift in the way the medical field approaches drug use. Medicine is based on science and has helped improve the quality of life of people through methods such as vaccinations, antibiotics and surgeries. When it comes to (illegal) drugs however, the approach is often based on prejudice, morality and fear, which are not effective foundations for strategies to be built upon.
How do you balance this work with your job as a clinic doctor?
The work I did as Doctor X in crypto-market forums between 2013 and 2015 was financed by occasional donations in cryptocurrencies. While this work was not linked to Energy Control, it was based on their philosophies. In fact, most of my knowledge and experience is linked to my work in this organisation.
For several years now my main occupation has been working within Energy Control’s International Project. Most of my work related to the organisation is voluntary, sometimes we find funding but this is difficult in the field of harm reduction. Therefore I work part time in a primary care centre in Madrid, which gives me the freedom to dedicate time to the projects that I’m passionate about.
What is Doctor X’s main goal?
I regret that I am not brilliant enough to achieve a specific, significative goal. I try my best to contribute in a small way to shifting a failed drug policy towards one that is more respectful of public health and human rights. I truly believe that this will happen, sooner or later, as a result of the hard work being done by many experts across different fields.
Where do you think that the biggest gaps lie in relation to consumers knowledge of *safe drug use? (*we acknowledge that it is never 100% safe)
In my opinion, the lack of access to objective, science-based and non-moralistic information about drugs is one of the biggest problems.
There are various patterns of drug use, and they all involve different risk factors. Classical prevention, however, categorises all drug use as dangerous, which can prevent users being able to differentiate between risks which are real and severe and those that may be hypothetical, theoretical or anecdotal. As a consequence, health professionals and institutions are not considered trustworthy sources of information for drug users.
It’s also important to acknowledge that nothing in life is 100% safe. Let’s look at sex as an example. A monogamous relationship between two virgin people would be the definition of 100% “safe sex” – the only way to completely remove the risk of STI’s.
However nobody thinks that promoting monogamy and virginity is a realistic way to improve sexual health. In relation to drugs, however, the only approach accepted is “SAY NO TO DRUGS”. To achieve this objective, negative information about substances is exaggerated and deformed. Fear mongering is used as a key preventive tool and I believe this is highly ineffective.
You are very open about your work. How do you find working within an area that is controversial and triggering for many people?
I see drugs as having existed within almost all human civilizations, where they have been used for recreational, therapeutic or sacramental purposes. Drugs are a product of human culture. Drugs ARE culture. Of course they can cause issues, sometimes very severe ones but they are just not merely a collection of problems and fears to avoid. I think that “drugs” are as controversial or triggering as “sexuality” was one hundred years ago.
Have you been criticised for your work giving harm reduction advice?
Yes. I have been accused of being “part of the problem and not the solution”, “an enabler” and “breathtakingly irresponsible”. Fortunately, the scientific community has a different point of view and my work has been published in many research journals and international scientific congresses.
I feel that it is important to highlight that my work in harm reduction is focused on a very specific group: drug users or people at high risk of using drugs. Advising on the safest way to use cocaine is appropriate if I am talking to a cocaine user, but that same message would be counterproductive in a classroom of 13 year old students who have no contact with this substance. It’s all about context.
As a health professional why do you feel it is important to approach recreational drug use from the perspective of harm reduction instead of abstinence?
I believe that it’s essential to consider individual freedom. As people we do many things that are not necessarily healthy or safe, such as diving, travelling to exotic countries or riding a motorbike. However, you will not hear professionals trying to persuade people to stop these activities, instead they’ll offer strategies to reduce the likelihood of potential problems arising.
My approach to harm reduction of drugs works with the same philosophy. People who use drugs are obviously the group with the highest risk of having drug related problems. We need to offer specific solutions tailored to individual groups within our population that diminish these risks. This is what I hope to do through my work as Doctor X.
In Australia there is currently only one state where pill testing at festivals is legal. A common argument from those opposed is that “pill testing condones drug use”. Why do you believe that drug testing programmes are so important?
This kind of reasoning is as logical as claiming that fire extinguishers promote fire or condoms promote sex.
Law enforcement and international drug policies have been unable to achieve their goals in reducing the risks associated with drug use. It is important to remember that drugs are not in the hands of states or private corporations. They are distributed by criminal groups which makes adulteration or variability in dosage a significant risk for users. Drug checking programmes are therefore necessary to protect drug users health. However, I believe that these programmes need to be integrated in a global harm reduction strategy to be effective.
Our readers have expressed interest in the research surrounding Modafinil and its potential to inhibit the effectiveness of the contraceptive pill. Can you shed any light on the relationship between the two?
Modafinil accelerates elimination of contraceptive steroids, so alternative or additional contraceptive strategies should be used during Modafinil treatment and two months after finishing. On the other hand, the effects of Modafinil on human foetus are not well known and it is possible to expect some teratogenic effects. To the best of my knowledge, common recreational drugs do not affect contraceptive pills.