Heightened sense A critical perspective on drug prohibition

28Apr/120

An audience with Prof. Nutt

Prof. Nutt spoke to a small audience of students at ULU in March. Credit: RAWKU5 at sxc.hu

The former ACMD chair remains strongly critical of government policy

Drug prohibition is responsible for creating an epidemic of addiction, for the deaths of drug users and for holding back scientific research into the benefits of drugs.

That was the view of the former Advisory Council on the Misuse of Drugs chair Prof. David Nutt at a talk held at the University of London Union and hosted by Students for a Sensible Drugs Policy last month.

In his talk on 13 March, Prof. Nutt said that the near-total removal of prescribed diamorphine for heroin dependency created a greater addiction problem, as addicts recruited other users to help fund their own habits. He blamed prohibition for the lack of quality control that results in fatalities such as those at Alexandra Palace in late 2011, and added that not being able to use certain drugs to facilitate psychiatric treatment has led to further unnecessary deaths.

In the week preceding the talk, there had been media reports of the potential benefits of LSD for alcohol addiction, which the result of a metaanalysis of old work. “This was not a study – this is one example of how science has stopped since the 1960s,” he said. “What’s sad about it is it’s taken 42 years since the last trial to come to a conclusion about its value.”  He suggested that thousands of people who’ve died as a result of alcohol addiction might have been saved.

Prof. Nutt conducted the first psilocybin trial in the UK, and only the second in the world, which showed that the changes it causes in the brain are similar to those desired to alleviate depression. He’s now trying to develop an MDMA (ecstasy) trial for post-traumatic stress disorder, which is a problem in society but especially in the military. “Trauma produces dramatic changes in brain function,”. he said. “More US soldiers have died from suicide since coming back from war than died at the hands of the Taliban.”

He also claimed that Francis Crick and James Watson, the discoverers of the structure of DNA, had used LSD to help them think more creatively. “LSD was seen as a powerful tool for improving humankind – then the Vietnam War came along,” he said. He said that during wartime, the US government hadn’t wanted there to be an outbreak of freethinking, adding that in the UK, too, the Misuse of Drugs Act bans drugs not if they are harmful but if they pose a threat to “social order”.

Prof. Nutt was scathing about leaving the production of drugs to amateurs, suggesting that a high proportion of deaths from drugs were because people don’t know what they’re taking. “And I think that’s criminal,” he said. “The government is killing people. If people knew what they were doing there’s a good chance they will do it better and do it safer.”

He speculated that the deaths of clubbers at Alexandra Palace was because what they believed was ecstasy was most likely actually PMMA. He said that here were “two deaths that were completely avoidable if people knew what they were taking.”

Prof. Nutt praised the Swiss model of heroin-assisted treatment for addiction. “The issue of how you deal with heroin is an important one – now because the Tory government wants to redefine addiction as a lifestyle choice and remove treatment,” he said.

He claimed that in the 1960s, when the UK prescribed diamorphine for heroin addiction, there were only around 500 dependent users, most of whom had prescriptions. There had been a medical consensus that this was the best way to deal with addiction, but a political hostility to simply giving addicts drugs.

He added that this simply created a black market, which then expanded as new addicts were “recruited”. “We created the heroin market by getting rid of the policy of prescribing,” he said. Although there is still some prescribing it is less widespread and more difficult to access.

Prof. Nutt also spoke highly of the Netherlands’ drug policy as “rational”, adding that during his time on the ACMD, then Home Secretary Jacqui Smith forbade the group from talking to the Dutch. “You can see how it became difficult to pursue a proper scientific policy,” he said.

He told of his development of two comparisons of the relative harms of different drugs, first with the ACMD and then, after bening sacked, with the Independent Scientific Committee on Drugs. The second scale ranked alcohol as the most harmful due to its social impact, and was slammed by Peter Hitchens.

Attacks in the press were nothing new to him, having seen accusations that one of his children had been smoking cannabis, based on a photo taken from his son’s Facebook, and being routinely smeared as “Professor Poison”. “That’s actually demeaning not just of me but also of the people who take drugs,” he said.

Prof. Nutt seemed sceptical of the possibility of prohibition reducing drug use, stating that: “The simplistic solution of saying to people about ‘don’t use cannabis’ isn’t going to work, and locking people up isn’t going to work.”

He also claimed that the editorial stance of prohibitionist newspapers had softened recently, suggesting that “even Daily Mail readers” can recognise that the UK’s drug laws have been disastrous.

28Apr/122

One doubt

In the not-too-distant future, when drugs are regulated and it's harder for minors to get hold of cannabis, what do they do then?

They're not going to suddenly no longer want to get intoxicated. There will be no miraculous transformation, like Harry Enfield's 'Kevin the Teenager' metamorphosing from an obnoxious adolescent into an upstanding young man the instant he gets laid.

So what will they do instead? And will it be more harmful or less?

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18Apr/120

Property rights and wrongs

In the US, the aftermath of the Trayvon Martin shooting has seen growing concern about a Republican bill that would force states to recognise permits to carry a concealed firearm issued by any other state.

Similarly , one of the issues in the lead-up to the American civil war was that slavery was prohibited in the Northern states and widespread in the Southern states, with the initial intention that stopping the expansion of the vile practice would eventually cause it to wither and die. Opponents argued, however, that the government had no authority to prevent the transportation of any legally owned property across state borders.

What might then happen if any of the 50 states go ahead and decide to legally regulate marijuana, as, say, Colorado is considering?

The conflict between state and federal law in terms of which has primacy is interesting enough, but this could be more important still. If nothing else, Americans are known for loving their property rights – whether they're justified or not.

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11Mar/124

The Hitchens prebuttal

Hitchens advocates a minimum penalty of six months' hard labour for cannabis possession. Credit: Henrik Jonsson/istockphoto

Will the arguments in his forthcoming book hold up?

Peter Hitchens’s publishers, Continuum Books, have handily posted a contents list for his next effort, The War We Never Fought, on their website.

Although one should obviously never actually review a book without having read it1, one can still offer a pre-emptive rebuttal (prebuttal?) to the anticipated arguments. It's reasonable to expect these to be partly built on those previously made in his newspaper column and associated blog, and at several public debates over the past year or so:

1. It's my brain and I will fry it if I want to
Indeed it is, but I can’t help but suspect that Hitchens is going to argue differently, having assumed jurisdiction over millions of people’s bodies.

Whether on moral grounds or ‘for their own good’, the state has no more business telling people what chemicals one may put in one’s own body than they do in, for example, forbidding private sexual behaviour.

2. What about alcohol and tobacco then?
In response to observations about all the harm done by cigs and booze, Hitchens has rhetorically asked on several occasions how “the existence of two legal poisons could justify the legalisation of a third”. Easy: either intoxicating oneself, and risking harm to oneself, is inherently deserving of punishment or it is not. The specific drug used changes nothing. It’s unjust to allow one guy his preferred substance and punish another for his if the only difference is the chemical in question.

In a previous book, The Abolition of Liberty, Hitchens claimed that there really is a fundamental difference:

"While some people drink to get drunk, most do not, whereas nobody smokes cannabis for the taste. All of them smoke it to become intoxicated. And tobacco, while harmful, is hardly a powerful mind-altering substance."

The market share held by alcohol-free versions of beer, wine and whisky being so tiny, however, only shows that taste is far less important than the fact that alcohol is pyschoactive, if only mildly. Meanwhile the comment on tobacco only reveals that his opposition to other drugs is nothing to do with the harm that they might cause but based on a moral opposition to intoxication, of which more in a moment.

4. 'I went upstairs and had a smoke': The role of rock music
I envy Hitchens’s apparent obliviousness to ‘gangsta rap’, if not his inability to realise why self-characterised ‘rebels’ might want to glorify a taboo. (Hint: it’s because it’s taboo.)

A familiarisation with the idea of psychological reactance probably wouldn’t hurt either.

5. 'They'll do it anyway': The fallacy of harm reduction
They will. They do. And some of them die. An argument based on harm reduction was accepted in the debate on abortion, and it should be in the case of drugs too.

6. The misery of marijuana. The mental health consequences. The case of Henry Cockburn.
“Consequences” is overstating it a bit. One anecdote, however tragic, proves nothing. On any causal link between cannabis and schizophrenia, the science is ultimately inconclusive. One usually requires rather stronger evidence before depriving a man of his freedom.

Even if the link is genuinely causal, then thousands of cannabis users would have to be criminalised to prevent one case of schizophrenia. And prison is hardly a preferable alternative to declining mental health anyway.

Drug use is a remarkable exception to the usual limits on where the state may intervene to prevent people from doing themselves harm, rather than being the norm, and the difference in treatment is wholly unjustified.

8. Amsterdam versus Stockholm: Two advanced liberal states compared
One can prove just about anything by comparing just two carefully chosen examples. Worldwide, there is no simple correlation between how punitive a drug policy is and the level of drug use: other factors are more important.

9. The French connection: Is the heroin habit a crime or a sickness?
Whichever is more useful in allowing dependent substance users to function. Though I haven’t yet looked into this fully, treating them as criminals instinctively seems counterproductive.

10. Supply and demand: If drug dealers are evil why aren't drug takers also?
If operating a sweatshop is wrong, why isn’t working in one? If slavers are evil, why aren’t slaves also? What’s “wrong” got to do with it anyway? The criminal law is intended to protect people from others who would do them harm, not to regulate national moral standards. This isn’t Saudi Arabia, and many things that some might consider to be immoral are not against the law – adultery, the hoarding of wealth, supporting Manchester United...

If Hitchens thinks that drug use is wrong then he is welcome not to choose not to use drugs. But he has no right to force his own moral standards on anybody else.

11. The great surrender: The 1967 advertisement in The Times and the Wootton Report
Cannabis, apparently, is already ‘effectively decriminalised’, because the penalties for possession are at such a low level. Well, if that’s the case then actual legalisation need not see a significant increase in use.

12. Useful idiots: A catalogue of respectable establishments, persons and institutions who through laziness and ignorance have swallowed the propaganda of the drugs lobby
Quite aside from the unbridled arrogance of that contention, it’s also staggeringly hypocritical coming from Hitchens. At a public debate at King’s College, London in March 2011, former president of the Royal College of Physicians Sir Ian Gilmore suggested that prohibitionists must “have their head in the sand”. Hitchens was mightily offended, and threatened to walk out. In his tantrum he insisted that nobody should claim that they know more about the topic than anybody else. And yet here he is saying that all those who disagree with him are “idiots”, and are either idle or stupid or have been hoodwinked.

13. Is it too late? Can we prevent stupefying drugs from becoming as prevalent and acculturated as alcohol and tobacco?
No it isn’t; yes we can. Alcohol and tobacco are legal because, after centuries of integration, they’re part of our culture, not the other way around. Smoking has drastically declined with increasing regulation and public-health information – all without criminalising anybody.

The level of use of any particular drug is largely determined by culture and biology, and the effect of policy, in terms of a binary choice of legal or not-legal, is marginal. Having learned appropriate lessons from alcohol, of restrictions on advertising and so on, legally regulated drugs needn’t become any more culturally ingrained than they already are. We could legalise public nudity and few would choose to walk around with their swingers out; we could legalise incest and wouldn’t suddenly be inundated with twelve-toed children.

Hitchens seems to think that he alone has his thumb in the dike, and that only an escalation of prohibition can stem demand for drugs. He will likely repeat his astonishing call for a minimum sentence of six months’ hard labour for a second conviction of cannabis possession, even though mandatory minima for drug offences don’t work in countries where they have been tried, and the guarantee of a five-year prison term for handgun possession hasn’t removed illegal firearms from the streets of the UK.

14. Has your surgeon been tested for drugs? And your child's school bus driver? If the legalisers win what sort of society shall we become?
Give people responsibility and, by and large, they act responsibly. Again, most people aren’t going to suddenly take up hard drugs simply because they can. Surgeons and bus drivers rarely turn up to work drunk, so there’s no reason to think that they would be intoxicated with other drugs on the job just because they had more of an opportunity.

So the sort of society we’ll become is one that doesn’t imprison people who have done nothing that merits imprisonment simply in the hope that it will work out better for the rest of us. However much one might desire a drug-free society, that aspiration doesn’t justify locking up innocent people.

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Hitchens says that the UK has “never fought” a war on drugs, when what he really means is that it hasn’t been prosecuted as aggressively as he might wish. For this we should be thankful, for it amounts to nothing more than a crusade against people whose behaviour he doesn't like. It's hardly a sound basis for forming a national drug policy. But it will doubtless sell some books.
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1 Why yes, that is a plea to be commissioned to write a review.

23Feb/120

Should cats be banned?

Soft kitty, warm kitty... danger to society? Photo credit: gabirro at sxc.hu

The logic behind cannabis prohibition won't be applied to felophiles

In between the vapid tributes to dead celebrities and funny pictures of animals, one can learn a lot from Twitter.

I was unaware1 until last week, for example, that the parasite Toxoplasma gondii has been linked with schizophrenia.

It primarily affects rats and mice, whose brains it alters such that they're drawn to the smell of cats rather than becoming fearful. When a rat or mouse hosting a T gondius is eaten by a cat, the parasite can reproduce in the feline's stomach. It can therefore be transmitted via cat feces. As many as 30% of people are thought to have been infected at some point.

Now, one of the principal arguments in favour of continuing to prohibit cannabis is a similar association with schizophrenia. In neither case has a causal relationship been proven. But if the logic behind cannabis prohibition were to be consistently applied, then it would require a ban on cat ownership, with those flouting it subjected to punishment 'for their own good' and cat-breeders imprisoned for the good of society.

That's clearly not going to happen, because everyone loves cats while cannabis is a minority interest. As a rationale for government policy, it's as unscientific as it's unjust.

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And I'm afraid I can't recall who tweeted about it. Whoever it was: thanks.

18Feb/122

Counterfictional Trainspotting

There's better things than prohibition. Choose life. Credit: snazz_de at http://sxc.hu

How different would the story have been, given a regulated supply?

Proving that age restrictions on the purchases of certain products can’t always be 100% effective, I first saw Trainspotting long before I reached the 18 years that the law supposedly required.

Bar the usual “just say no” messages, the concept of hard drug use had barely entered into my consciousness, so it was rather revelatory. It’s now one of my favorite films. I’ve watched it dozens and dozens of times, including having it running in the background one afternoon earlier this month while penning something else for later – something that happens to mention counterfactual history. Which got me thinking.

The story, particularly if one includes its deleted scenes, is instructive in comparing the effects of prohibitionism with what we might hope and expect to occur with controlled regulation of dangerous drugs.

Consider, then, how different the characters’ outcomes could have been if they were not taking smack of unknown provenance in a variety of unsafe ways, but using a regulated supply of pure diamorphine, in a sterile fashion, with proper medical supervision.

Now, Trainspotting is not all misery and death, and in many places it’s an exceptionally funny film. A few directors had wanted to option the novel on which the film is based before Danny Boyle and John Hodges successfully pitched, but author Irvine Welsh recalls in the sleeve notes to the special edition that his initial cinematic suitors all “wanted to make a po-faced piece of social realism like Christiane F or The Basketball Diaries”. They were disappointed, and the resulting movie is far from one-dimensionally grim. But this examination necessarily requires a focus on the harms of prohibition.

So to recap for readers whose DVD players see a little greater variety:

As the film begins, Renton comes down from his latest high and spontaneously decides to get “off the skag”, by going cold turkey with no help other than a fistful of valium and an opium suppository. His sober life seems empty and depressing, and before too long he elects to get back on heroin: it takes about 12 hours.

After being arrested for shoplifting from the John Menzies newsagents on Edinburgh’s Princes Street, he receives a suspended sentence on the condition that he stick with the methadone rehabilitation programme that he’s entered. He fails: unable to to stand being around his friends and family and having used up all three doses in the morning, loneliness and withdrawal drive him back to longstanding dealer Swanney. His tolerance having declined, Renton’s usual order proves too much for him – fortunately his overdose doesn’t prove fatal, as he’s kindly left outside the local hospital’s emergency department by a taxi driver.

Later, in the first of two deleted scenes (#142 and #192), Renton is a visitor rather than the patient. Swanney, having tried to inject himself in the leg, has missed and pumped a syringeful of air into an artery. The leg is amputated. Plans to peddle just enough junk to set himself up for a comfortable life in southeast Asia go awry, and Swanney ends up homeless – and unrecognised even by his former mates as they idly hand over some change on the way to get their coach to London.

For most, this is the second leg of a return journey. The majority of the guys had recently come back to Edinburgh for the funeral of one of their number, the previously straight-laced Tommy. Grieving following his breakup with girlfriend Lizzy, he had asked Renton for an introduction to a new mistress, heroin. Amid the myriad unsafe practices common to Swanney’s less than sanitary setup, Tommy had contracted HIV, presumably from a shared needle, becoming a part of the shockingly high 50% of intravenously injecting 80s Edinburghians with, as Renton puts it, “shite for blood”. He dies of an Aids-related illness alone in a squalid flat, left there for days before anyone even notices.

Tommy’s is the second fatality of this story, at least in the film version. The first is Baby Dawn, daughter of Allison and, it is revealed, Sick Boy. Whether the cause is cot death or neglect isn’t entirely clear, but we might reasonably assume the latter given that the child’s mother is rarely sober enough to look after her.

Back onto the coach. The boys have come into £16,000 worth of gear and are off to punt it on to a guy Sick Boy knows in London. During the celebratory pub visit afterwards, Begbie, the group sociopath who doesn’t do drugs but does do people, viciously assaults a fellow drinker. When Renton makes off with the money in the middle of the night, Begbie trashes the hotel room in which they were all staying, attracting the police. Already on the lam after committing an armed robbery, he is presumably be arrested.

How different might a story such as this have been if it had taken place in a world with a better drug policy?

The first thing that would have to go would be the setting. Rather than a dank flat on a Leith housing estate, the characters now pass their days in a facility not so far from civilisation that it’s too much of a pain to get there and a return to Swanney’s is preferable, but just far enough from main residential areas to allay the locals’ largely unfounded fears of being up close and personal with ‘smackheids’.

This hypothetical facility has access to medical records of users who are registered as dependent. They know that Allison’s a mother, and social services get involved. She’s given a stark choice: get her addiction under control, or Baby Dawn goes into care. But better into care than left in a cot, face contorted and lungs static, dead before she’s had chance to live.

In this universe, Renton’s spontaneous decision to quit is not left to proceed unaided. He has access to a range of options: methadone, prescription diamorphine, psychotherapy. If he does return to heavy drug use after a break then there’s no chance of an overdose: he’s not being sold skag of unknown purity administered by an amateur, but a precisely controlled dose based on a carefully calculated estimate of his current tolerance level. In the event that someone does make a mistake, there’s a stock of opioid antagonists at hand to quickly counter the effects of the OD.

Similarly, because any and all injections are supervised by medically trained professionals, Swanney doesn’t mistakenly hit an artery and there’s no need to amputate his leg. And all this without Sick Boy licking any needles, too.

On this parallel Earth, when Tommy is dumped by girlfriend Lizzy and turns to the euphoria and detachment of heroin it’s not a simple case of handing a grubby banknote over to one of his mates. As he sits through a two-hour long mandatory induction at the medicalised out-of-town facility our new story again bifurcates, the alternative universe splitting into one in which he sticks with his decision and another in which he changes his mind. But even if it’s the former, the sterile conditions mean that he stays alive.

With addicts shunning street gear and the black market for heroin reduced to scraps, the four friends can’t illegally enrich themselves at the film’s close. Begbie perhaps escapes justice and Renton doesn’t have an easy getaway from the clutches of the mates that help to keep him down. Maybe he, Spud and the undead Tommy manage to get their lives together anyway, maybe not: it’s a tightrope.

Clearly this world would be far too dull to write a novel about. But there’s good reason for the Chinese to deem the idea of “living in interesting times” to be a curse. And Trainspotting is of course ultimately just a story, a work of fiction, and in this case a lens through which to view how a change in policy might affect a familiar set of made-up people and events. But the point of any piece of fiction is to illuminate the facts of the real world. And the fact is that the perverse incentives created by prohibition increase the harm done to drug users. There are thousands of real people just like Dawn, Swanney and Tommy, and prohibition, retained as a policy due to an unfounded fear of a surge in the number of drug users, is complicit in killing them.

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Update 21/2/2012 The original version of this post misspelled Allison's name on its final use. This has now been corrected.

4Feb/120

Drugs and unwanted pregnancy

Hospitals are cleaner than backalleys. Credit: Michal Koralewski

Abortion was legalised to reduce harm. Why not drugs?

Across the water, the Republican primaries continue. The names and faces change, but you can virtually guarantee that one thing will stay the same: that they will all take a position of what they term “pro life”, but which really means “anti abortion”.

DIY terminations may have been increasing over in the US recently, probably in reaction to increasingly tight restrictions that stay just the right side of Roe v. Wade, the Supreme Court decision that interprets the constitution as providing a right to abortion and prevents legislators from passing laws that ban it.

If the Grand Old Party (and doesn’t that sound ironically camp?) were to get their way and overturn the ruling, dangerous backstreet abortions would likely become a lot more common.

It’s precisely this problem that the legalisation of abortion in England and Wales in 1967 was aimed at tackling. According to the Telegraph’s obituary, the goal of Sir John Peel, the then-President of the Royal College of Obstetricians and Gynaecologists, “was to reduce the amount of disease and death associated with illegal abortion”.

Accurate figures for the level of death and disease are hard to come by. The Home Office reportedly estimated that in 1966 there were 100,000 illegal abortions carried out in the UK and around 40 resulting deaths. Now there are up to 190,000 legal, safe abortions and a smattering of illegal ones – educated guesses are around a few hundred per decade.

So English law has, for the past 45 years, accepted that making something illegal doesn’t make it go away, and that appropriate regulation can effectively reduce harm. But that principle is not applied universally, and the complexities of recreational pharmacology are still abdicated to amateurs.

This paper in the Annual Review of Law and Social Science suggests that “legalization will probably reduce average harm per use but increase total consumption”. The trick, then, is ensuring that the reduction in the harm per user outweighs the increase in use, so that total harm decreases.

Proper dosage- and quality-control just might prevent deaths such as that of this young man. If intravenous use is well supervised, that can reduce bloode-borne infections and limit the chances of accidental poisoning. Whatever the type of needle involved, the fatalities caused in each case are equally needless.

22Jan/122

Thinking of the children

Drugs can be bad for kids but prohibition is worse. Credit: Wesley Ferreira Oliveira

Essay collection examines the impact of drug policy on children and young people

Pleas to “think of the children” are rarely met with much actual thought at all. Particularly where drug policy is concerned, they’re more often followed by a repetition of received wisdom and unfounded assumptions. But not any longer.

Children of the Drug War is a collection of essays by academics, policy experts and campaigners examining the impact that a global “punitive and prohibitionist paradigm” has on children and young people all over the world. Edited by Damon Barrett of Harm Reduction International, it makes for occasionally grim, but always vital, reading.

The collection covers the frontline of trade and production, the disproportionate effects on ethnic minorities and the poor, the consequences for families, and the justifications commonly given for attempting to protect children via a policy of prohibition. It is a much-needed corrective to a common misconception: far from protecting children from the very real dangers of overdose or addiction, that policy places them at the very forefront of the harmful unintended consequences that it causes.

Writing about a 16-section anthology in its entirety would prove too long even for the theoretically infinite space afforded by the web. To bind the review in a nutshell, a seminar held at the London School of Economics in November focused on three chapters, therefore so will this blog.

That by University of Kent criminologist Jennifer Fleetwood and City University of New York graduate student Andreina Torres tells of the huge numbers of women in Ecuador who are separated from their children after being imprisoned for drug-trafficking offences.

They are massively overrepresented in the prison population, largely as a result of the country having worked to meet conviction targets imposed by the US in return for grant money. Low-level ‘mules’ make for easy targets. Many of these women are single parents, and the care system is inadequate, so their children have to be packed off to relatives or brought into prison with them. The result is collective punishment of a whole family for what is actually a fairly minor transgression by one member of it. Some of the stories related by Fleetwood and Torres, based on extensive fieldwork carried out within the prison system in 2007, are heartbreaking.

Steve Rolles from Transform, the drug-policy foundation, explains how regulation of production and trade would better protect children. He points out that restrictions on supply to children are easier to enforce than a universal prohibition, as well as commanding more popular support than widely ignored bans on drug use by adults.

Nor does prohibition make it harder for children to get hold of drugs if they want them, representing a total, abject failure of the declared aims of the war on drugs. Rolles cites a study by the US National Institute on Drug Abuse that found that 80–90% of children claim that cannabis is easy or very easy to access. He acknowledges also that limits on sales to minors would need to be enforced more strongly than those on alcohol are in the UK – he references a finding from Alcohol Concern that up to 15% of licenced premises regularly alcohol to children but only 0.5% have their licences subject to review.

The chapter by LSE criminologist Michael Shiner pragmatically addresses the limits of prohibition, acknowledging that it is impossible to achieve a drug-free world. He builds on the work of sociologist Jock Young, who said forty years ago that some amount of drug use is inevitable and the best tool to limit the harms involved is the drug subculture itself, and suggests that prevalence rates of the use of different drugs is down to the perception of how harmful they are.

Shiner concludes:

“We must take seriously both the limitations of the criminal law and the harmfulness of illicit drugs. In practical terms, this means accepting that the elimination of drug use is an impossible task and focusing instead on establishing a system of regulation that concentrates on reducing harm. What is required, in other words, is a more effective system of regulation than prohibition is able to provide.”

Rolles and Shiner’s chapters seem a good choice to have paired together at the LSE seminar. Between them they nicely expose the founding mythology of prohibitionism, futile in attempts to stamp out drug use and ineffective in protecting children. It is not, in other words, the only thing standing between us and a society too drugged-up to function. That there are better ways to minimise drug-related harms, without all the unintended consequences – lethally tainted product, gangsterism, depriving farmers of their livelihoods, and needlessly separating families.

The chapters of the book dealing with those harms, however, aren’t necessarily clear on where the line is between what is really caused by drug prohibition and what is simply caused by poverty. But then the web that the two factors weave is rather hard to untangle. Rolles acknowledged at the aforementioned seminar that legal regulation wouldn’t cure the problems of the poor world overnight, and that some sort of post-drug-war “Marshall Plan” would be required.

This certainly seems a better use of billions of dollars than continuing to pour money into funding the implementation of a discredited policy. For while the risks that drugs pose to children are great, the harms imposed by prohibition are worse.
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Children of the Drug War is available as a free download.

30Dec/110

Diamonds in and out of the rough

Dependent substance users are faced with being portrayed as stereotypes. Credit: Christian Martínez Kempin/ istockphoto

Behind every addiction, there's a person. Policy should be aimed at providing the best help for them.

There's an element among prohibitionists that views the use of some drugs as inherently immoral – and that can't seem to separate their hatred of the sin with that of the sinner.

It can only be this that is behind, for example, the decision of the US Congress to continue to ban federal funds being put towards needle exchanges – a shameful expression of fear and loathing that will needlessly cost lives. One can't help but recall the character of General Salazar in the film Traffic (based on Jesus Gutiérrez Rebollo) charmingly discussing Mexico's treatment strategies: “Treatment of addiction? Addicts treat themselves. They overdose, and then there's one less to worry about.”

Here in the UK, meanwhile, we have real-life moral-panicmongers like Peter Hitchens rhetorically asking how, if dealing drugs is wrong, then using them could possibly not also be wrong – a contention as patently absurd as reasoning that if it is immoral to operate a sweatshop then it must also be evil to toil in one for near-slave wages of pennies a day – and roundly dismissing the notion that those with drug addictions are in any way 'victims'.

Nor is this vitriolic, hateful element likely a minority given the widespread pejoratives used to refer to dependent substance users. Junkies. Smackheads. Dope fiends. The acceptable face of the language of prejudice.

But there's an obvious paradox here, in that if addicts are such vermin, then just who is prohibition aimed at helping in the first place? Only, it isn't helping them at all. And nor are they all bad people. Sure, some may have occasionally done bad things, but they're far from one-dimensional cartoon villains. Those who reflexively vilify drug users remind this blogger of, say, the kind of vociferous racists who have never even met anyone of a different ethnicity but are happy to pile opprobrium upon them regardless. Perhaps they should get out and speak to some of those they're demonising, and take the time to listen to their stories.

Stories, that is, like that of Jimi, who has experienced some of this prejudice first-hand. Growing up in Middlesbrough before finding employment as a residential social worker in Somerset at the age of 19, he used drugs recreationally and fairly harmlessly alongside his position of responsibility. But he eventually became addicted. “It’s essentially just drip, drip, drip,” he says. “I woke up a year later, thinking 'Oh my, what about this, every day for a year?'. I didn’t want to believe it, you know what I mean?”

Although from time to time he'd borrow money and fail to pay it back, he certainly didn't fit the tabloid profile of the thieving druggie. “I always used to tell myself 'I'm not a smackhead: I'm a heroin addict',” he says. After his own recovery, Jimi became involved with setting up a rehab centre back in his native north east, and was faced with a smear campaign and a shower of lies about its clients posting needles through neighbours' letterboxes. At a public meeting to discuss the issue he'd found that those opposing the centre displayed a mob mentality together but individually were, in the main, reasonable, decent people – much like those with addictions. “We could understand that that was coming from a place of misunderstanding and misapprehension,” he says. “And from years of seeing negative images on the TV and in the press, and all the ills of society being blamed on that sort. We knew that was coming from that place. We couldn't blame people for that. We thought, 'Well our job is to educate now; that's what we've got to do – not argue'.”

Or then there's Merseysider Thomas, a son of teachers, who grew up in a house filled with the sounds of Jimi Hendrix, Frank Zappa and Captain Beefheart and was as a consequence acutely aware of the power of drugs to alter the consciousness. It led to experimentation with, and then regular use of, acid, and, later, amphetamines. “I think initially it started off innocently, as I guess it does,” he says. “But, exploratory. That was definitely the aim, initially.”

Thomas used drugs clandestinely more or less daily from the age of 16 up to 18 or 19, and often couldn't sleep and experienced hallucinations. He then stopped for five years. “That was actually the best part of my life to be honest,” he says. “That was brilliant. But between real life and a girl it sent me back. I started drinking again. And after that day... It was bad timing. I was playing in a band at the time. We went to Swansea to record and I had been drinking in the van on the way over. By the evening I’d done valium and pills and ecstasy. Like, it was a very quick succession.” A heroin addiction later followed.

Thomas says that the only illegal activity in which he engaged during this time was scoring itself. Encounters with the law were rare, amounting to one single brief detention in the back of police van, largely because he “didn't look the type”. Amid multiple attempts at quitting, the threat of punishment wasn't particularly an incentive to do so. “You forget heroin’s an illegal substance after a while because you just do it without thinking,” he says. “The drug takes over people.” Eventually, the will to change overpowered the addiction, and Thomas is now settled with a partner and young child.

Across both the Atlantic and most of the continent that lies on the other side, Fabian grew up in one of the poorest parts of LA as the son of Mexican migrant workers just as the 1980s crack-cocaine epidemic hit. His parents found that the American Dream wasn't all it was cracked up to be, and a certain despair set in among the whole family. Fabian says that he turned to gangs and to drugs – first marijuana, later crack cocaine and PCP – as a means of coping. And because he felt like he had little to lose anyway. “Our environments also play into it,” he says. “So the best way we cope with it is to use a substance, which can be from marijuana to heroin to crack cocaine, to methamphetamine to anything that is suitable for the mind at the time. So that’s how I became a drug addict, to find ways of coping.”

Fabian was dragged deeper and deeper into the underworld lifestyle and ended up selling drugs himself, and being involved in gunfights. A fistful of arrests proved no incentive to change his ways, but after two suicide attempts borne of shame and ever greater hopelessness, he entered recovery and now works as a drug counsellor, trying to stop people from making the same mistakes as he did. “I’m not quick to judge because I see myself in the mirror every day,” he says. “If I have a 14-year-old kid and a mother in despair it immediately reminds me of my mother and her despair at the time I was 14.”

Faces and names
These are all people who have had problems, and perhaps sometimes caused them for others, rather than intrinsically being problems themselves.  In instances where trouble is made for others, for example by stealing, it's only because of the grip that drugs sometimes get of people – a shackle that they could not reasonably have predicted would take hold when they first began to experiment. Even with the most addictive drugs, those who become dependent are still a minority. And although self-inflicted (as are alcoholics' liver diseases or smokers' lung cancers) then once an addiction has rewired the brain then sating the beast by any means necessary is not fundamentally any different than, say, Disney's Aladdin lifting a loaf of bread in order to stay alive.

The point is that if dependent substance users are diamonds in the rough, the sole aim of policy should be to polish them up and enable them to shine. Telling them, implicitly or otherwise, that they're scum who deserve to be in prison is not useful. In many cases it will only reinforce an existing feeling of worthlessness.

Now, prohibition is, in theory, intended to prevent drug addiction from happening in the first place. It doesn't always work. More than this, it does precious little to help those who fall through the cracks, partly because it's so commonly necessary to dehumanise the other side in order to maintain support for a prolonged conflict.

Much the opposite sentiment to that of General Salazar is expressed at the end of Traffic, when Michael Douglas's drug czar concludes that: “If there is a war on drugs, then many of our family members are the enemy. And I don't know how you wage war on your own family.” Nor on other people's families, or their friends. On people who need a leg back up – not a slap down.

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19Dec/113

The substance tautology

Enjoying a drink and supporting the prohibition of other drugs is hypocritical. Picture credit: Stefan Gustafsson http://stefangustafsson.com/

The artificial difference in legal status between alcohol and other drugs is unjust and counterproductive

One evening towards the last throes of a pitiful summer, and you're approaching the run-down concrete expanse that you call... not ‘home’, exactly, but at least the place where you sleep and where most of your possessions are to be found. Before you get there you're accosted once again by the same man that has stopped you several times previously, seeking spare change but given short shrift. Perhaps in his 40s and perpetually dishevelled, he can occasionally be seen swilling cheap lager before 9am in the morning, or being forcibly ejected from the nearby off licence at night. Which is cause and which is effect here is, as so often, not easily determined, and drinking is just as likely to be a crutch to a combination of problems as it is to be the trigger of any of them.

Turning off the main road, you stop by the grocer's. Its owner, a friendly Turkish gentleman, is berating his friend for spending money on alcohol rather than on his children. The rather unfortunately named "Wine House" that apparently sees too much of his custom is three doors further up the string of shops that sit beneath current and former local authority housing. The tall man with the dreadlocks is absent from his usual position outside, missing from the spot where he spends night after night and most days too. This evening, for a change, there is no fog of weed-smoke in the shop doorway. As it turns out, he's in the next street making a phonecall and looking decidedly shifty – but harming nobody.

As brazen as they are, the crowd that hang around there are seldom – if ever – troubled by the law. The police station is only a few hundred yards away, but its inhabitants only come around here when they're called. This is not to say that the occurrence is infrequent, and the short stretch of pavement between the vendors of food and of booze is where, just a few days earlier, you overheard a different group of young men openly debating whether to forcibly relieve you of your phone.

In a rare piece of sensible prioritisation, the police have bigger problems to worry about here. There are real crimes to detect and enforce. Sometimes a van will show up to drag a local wrong 'un off to the station; more often still you hear the sirens' wails obeying Doppler and plummeting in pitch as police cars and ambulances race past the maw of the estate towards the town centre, sometimes to mop up after knife crimes, commonly pub brawls.

Of two drugs being used in close proximity, it seems, at least superficially, that it is the legal one that does the most damage. And, given the respective probabilities of harm, Dreadlocks is more likely to get lung cancer from the tobacco in his joint than develop schizophrenia due to the cannabis in them.

It sets you thinking.

You cast your mind back, first recalling that time early in the initial years of this millennium, in a nightclub in Wales, when you were pegged against the sides of a dancefloor as two barechested men settled their differences in the neanderthal way that alcohol encourages, before being unceremoniously removed by security staff.

And then further into the past, to the time when, in your early teens back in the north of England, you heard what turned out to be the local drunk beating seven shades out of his father, when you dutifully phoned the police and struggled for far too long to convince them that it wasn't a hoax call.

Or to all the occasions that you too have behaved badly, in youthful exuberance and under the disinhibiting influence of alcopops and cheap lager. And those times are many.

You’re savvy enough to know that booze-related harms tend to peak around this time of year, with a greater number of festive-season revellers not accustomed to drinking, so you sit on these reminiscences for a few months.

Central London meets at least some of its grim expectations, with an apparent outbreak of creativity in the form of that peculiarly British style of abstract pavement art that uses vomit as its medium. You have a stomach that is weak to the point of absurdity and the mere sight makes you gag, but you manage to fight your own reflexes.

Two days later, returning to the north east, you work on the write up of these ponderings while on a train that has been made a ‘dry’ service at the request of the British Transport Police because it was thought likely to be full of football fans (it isn’t), and, according to the train company’s email, banning the consumption of alcohol “is effective in reducing anti-social behaviour onboard”.

These are simply a smattering of instances that you can remember having noticed in which alcohol, and policy on the subject, happen to have intersected with your own life. Meanwhile, the accounts of the capital’s ‘booze bus’ from Drinkaware and from the BBC speak for themselves – as do the statistics.

In Scotland, 73% of murder suspects had been drinking. The homicide rate drops during recessions because people drink less. Alcohol is thought to be a factor in 10% of all ill health and premature death in Europe. Et cetera ad nauseam.

Regulate.
It’s becoming increasingly accepted that alcohol is under-regulated. One could readily make a case for minimum pricing or greater taxation, restrictions on promotions and advertising, and so on. But that’s as far as it would ever go.

Most of us can use alcohol responsibly, and it is so ingrained in our culture that we tolerate those who cannot, or will not. We are unlikely to accept being forbidden to share a bottle of wine with a meal, or a few beers after work on a Friday, simply because a minority of over-testosteroned young men like to get tanked up and hit each other, nor because some keeping pouring until their livers are blackened messes. And for those of us who do like an occasional drink, it would be rank hypocrisy to argue that others should be denied their own particular choice of substance.

But with illegal drugs, there is no official toleration even of the 90% who do use responsibly.  The point is that it is unjust for the criminal law to deal with two people differently, ignoring the one and punishing the other, if the only discernible difference between their actions is the specific chemical with which they choose to intoxicate themselves.

The difference in legal status is plainly nothing to do with an inherent difference in the harms that the two drugs cause, but on the socio-cultural view of them. Alcohol has been an essential part of life on these islands for centuries. Cannabis, to take one example, is a minority pursuit. The fundamental nature of policy is essentially based on a tautology: we accept alcohol because we accept alcohol; we don’t accept other drugs because we don’t accept other drugs. Therefore the freedom to drink is accepted despite its occasional downsides, whereas although cannabis is not especially dangerous its mere use is potentially punishable with imprisonment in an ineffective attempt at deterrence.

But there's more. Overall, the good must outweigh the bad. We must, as Churchill had it, have taken more out of alcohol than it has taken out of us.

The value of alcohol's benefit to society, as explained by economics blogger Tim Worstall, is equal to the amount we’re willing to spend on it:

“What is the benefit of booze? The pleasure that people get from boozing of course. How can we measure the value, in cold hard cash, of that benefit, that pleasure?

“The amount that people spend on booze of course. No one who thinks that 50p in their pocket is more valuable than a pint of cheap cider will exchange the 50p for the pint of cheap cider. Thus the pint of cheap cider which people do exchange 50p for must be worth more to that person than 50p.

“The value to, the pleasure gained from, the boozer of booze must be greater than the amount spent by the boozer on booze.”

According to the Institute of Alcohol Studies [pdf], the cost that drinkers imposed on the UK economy in 2004 was £15.4bn, while the total spent on booze was more than £40bn. So we’re quids in.

However those costs don’t fall equally, and we must render unto George Osborne that which is George Osborne’s. The share of the cost borne by the public sector was perhaps £9–12bn compared to exchequer revenue of just under £8bn – so there’s possibly a case for increased taxation.

Similar calculations can be applied to tobacco, against which the tide of public opinion has begun to turn, resulting in concurrent but not necessarily consequential increased restrictions and reduced levels of smoking. But for other drugs, because of the absence of regulation, the tax side of the equation is missing.

The Independent Drug Monitoring Unit has estimated that tax revenue from regulated sales of cannabis would amount to £0.3–1.5bn, excluding VAT and before taking into account the criminal-justice savings. With the introduction of appropriate restrictions on advertising and suchlike that are conspicuous by their absence with alcohol, any increase in actual use would likely be marginal, so the benefit of regulation in purely financial terms is clear.

But instead of this pragmatic approach, we are faced instead with prohibitionist moralising and policies based on culture rather than evidence. Not only is it unjust, it’s needlessly costing us money.