Are the potential harms of many drugs overstated?
Recent military action in Libya ostensibly began with the aim of enforcing a no-fly zone to prevent aircraft being used against civilians, but quickly escalated into targeting Colonel Gaddafi and other members of the ruling family.
Back in the 50s, the Korean War started with the aim of saving the South from invasion by the Communist North, but the objective spread to attempted reunion of the peninsula.
The war on drugs appears to have suffered mission-creep too.
The Misuse of Drugs Act refers to drugs "capable of having harmful effects sufficient to constitute a social problem". If causing a social problem is the criterion, the law should arguably only apply to heroin, crack cocaine, and alcohol. (Whoever included hallucinogens as socially harmful, let alone as class-A drugs, must've been tripping. Then again, in the Newspeak of drug policy, "controlled" drugs are those for which control has been ceded to gangsters, so maybe we shouldn't make too much of the language.)
Yet in the response to the release of the Global Drug Policy Commission's report the week before last, the Home Office declared that there would be no change in policy because drugs are "harmful".
Well, so are a lot of things. Life without any risk at all would be a very dull one indeed.
In the 1993 action film Demolition Man, Sylvester Stallone plays an over-testosteroned cop who is cryogenically frozen and wakes up in 2032 in an anemic Los Angeles in which anything vaguely fun, from meat to swearing to physical contact (including sex), has been made illegal. Stallone's new partner, Sandra Bullock, is aching for something interesting to happen and soon gets her wish in the form of a psychopathic Wesley Snipes, also released from cryo-prison. Meanwhile, a band of outlaws lives underneath the city with their own rules, surviving on rat-burgers and petty theft. Their leader rails against the safety-tyranny of the nanny city-state thusly:
"I want high cholesterol. I wanna eat bacon and butter and buckets of cheese, okay? I want to smoke a Cuban cigar the size of Cincinnati in the non-smoking section. I want to run through the streets naked with green Jell-O all over my body reading Playboy magazine. Why? Because I suddenly might feel the need to, okay, pal? I've seen the future. Do you know what it is? It's a 47-year-old virgin sitting around in his beige pajamas, drinking a banana-broccoli shake, singing 'I'm an Oscar Meyer Wiener'."
A life that is potentially risky but fun, versus a state-controlled diet and wall-to-wall puritanism. Beer and pizza, or tofu and boredom. This blogger knows which he'd choose.
Anyway, one supposes that the implication of current policy is that drugs that are currently prohibited are so much more dangerous than anything else that we must be forcibly protected from them with the threat of prison. But it's not necessarily the case.
Looking at the relative fatality rates, amphetamines are only very marginally more dangerous than driving. Owing to HIV, sex is more likely to kill someone than ecstasy is. A year's average cocaine use is less risky than a full-body CT scan, which can very occasionally cause cancer. (The lifetime chance of a regular male smoker getting lung cancer, on the other hand, is higher than that of taking the bullet if playing Russian roulette with a six-shooter.)
It's essentially impossible to overdose with cannabis at all, and the drug's risks are not mortal ones. So, much of the prohibitionist argument focuses on its alleged effects on mental health – as has been the case in the past week or so first with John Rentoul's wrong-in-every-paragraph column in the Independent on Sunday and then this piece of wibbling in parliament by Charles Walker MP.
(They also both somehow managed to miss the point that the easiest way to control the strength of the drug and to restrict access to children is via legal regulation. Street dealers don't ask for photo ID, and nor do they have much of an idea of what it is they're selling.)
Walker's argument, such as it is, is based on a few anecdotes and a debunked link between a particular gene and the influence of cannabis on incidence of schizophrenia. Rentoul's initially rested on one single anecdote, of the experiences of his colleague Patrick Cockburn with his son Henry, although he did provide a link to an actual scientific study in a follow-up blog post in which he managed only to dig himself into an even deeper hole.
The paper in the British Journal of Psychiatry to which Rentoul refers claims to have found a definite causal relationship. Smoking cannabis, they claim, increases the risk of psychotic disorders, although not on its own:
"Cannabis use appears to beneither a sufficient nor a necessary cause for psychosis. Itis a component cause, part of a complex constellation of factorsleading to psychosis."
However, the experiments it reviews were predominantly cohort studies, and it is difficult to definitively prove a causal relationship without conducting a randomised controlled trial, and particularly with the low level of elevated risk involved – this blog post by UCL pharmacologist Prof. David Colquhoun brilliantly explains why, in the context of red meat and colorectal cancer.
Other studies came to a different conclusion. Mikkel Arendt of Aarhus University in Risskov, Denmark found that episodes of psychosis following cannabis use were indicative of predisposition to mental-health problems, and the subjects of his research "would have developed schizophrenia whether or not they used cannabis". Meanwhile, the use of cannabis has increased over the past few decades while the prevalence of schizophrenia has not, which it ought to have done if it were actually caused by cannabis use.
The scientific evidence is ultimately inconclusive. It could be that cannabis causes schizophrenia, just as it could be that those already predisposed to schizophrenia are more likely to use cannabis – just as 80% of sufferers smoke tobacco for its calming effects.
Should cannabis then be banned just as a precaution? Ignore for a moment the assumption this entails, that it is the job of the state to decide an acceptable level of risk for the individual, and consider the actual strength of the putative effect.
The paper referenced by Rentoul showed a doubled risk of schizophrenia. A meta-study in the Lancet suggested an increased relative risk of 40%, or by 200% in the case of the heaviest users. (Compare: the increased risk of lung cancer for regular cigarette smokers is 2000%)
But double next to nothing and you're still left with very little. If the relationship really is causal, then the absolute increase in risk would be from around 1 case per 100,000 people to, at most, 2 per 100,000. So even if decriminalisation led to a doubling of the number of cannabis users in the UK from around three million to six million, there would only be an additional 30 cases of schizophrenia in the entire country.
Sure, this would be thoroughly horrible for those suffering from the illness, but it's hardly the apocalyptic scenario of voices in every head that prohibitionists would have us believe. As a policy tool, criminalising three million people to prevent 30 from becoming ill is a sledgehammer to crack a handful of nuts. Not only is prohibition hypocritical and counterproductive, it is a totally disproportionate response.
Update 14 June 2011: This post originally stated that the number of additional cases of schizophrenia would be 15. This has now been corrected.
People are not usually forcibly prevented from harming themselves, and drug use is the exception rather than the rule
As a follow-up to last week's post equating the present treatment of drug users with the historic treatment of gays, it's worth noting that unorthodox sex helped to define the boundaries of where one can consent to harm as recently as 1987.
It began with the investigation of a murder that never happened.
Greater Manchester Police launched Operation Spanner after coming into the possession of some pornography depicting gay BDSM activity. GMP's Gene Hunts, unable to determine what was actually going on, believed someone was being tortured and killed.
Finding everybody involved alive and well, the police and CPS decided to charge everybody anyway, initiating prosecutions for actual bodily harm.
The defence that the activities were all consensual, therefore no assault could have been committed, was rejected by the aptly named Judge Rant. After deciding to plead guilty, 16 defendants were given sentences ranging from fines to four and a half years in jail.
An appeal to the House of Lords in 1993 and to the European Court of Human Rights in 1997 both failed. In the former, the court cited the opinion of an 1882 case rejecting a defence of consent for bareknuckle boxing, with Lord Templeman adding that:
"In principle there is a difference between violence which is incidental and violence which is inflicted for the indulgence of cruelty."
Piercings or tattoos are fine, as the principal purpose is ornamental and the infliction of pain incidental. Standard boxing is okay too, since it's a regulated sport. Bareknuckle fighting and consensual sadomasochism are not – especially if the latter is homosexual, given that a few comparable cases involving straight sex have been determined to be perfectly legal. That old prejudice again.
So the established limits in which the state is allowed to interfere with someone's private life in order to stop them from harming themselves, or even from risking harming themselves, is in specific circumstances where the "self"-harm is actually being done by someone else. Or, of course, in cases of mental illness.
It's generally accepted that the "harm principle", by which authority may intervene with someone's liberty only to prevent harm to third parties and not to protect him from himself, applies only to those of sound mind.
Setting out the principle in On Liberty, JS Mill spoke of members of a "civilised community", language perhaps appropriate to his Victorian readers but less so today, when we are more likely to think of children and anyone otherwise incapable of making rational decisions, such as those suffering from certain mental illnesses.
But there is a paradox here. Consider the penalties. In the UK, someone who is mentally ill and deemed to be a risk to himself or others can be detained for involuntary treatment – if appropriate treatment is available. The period for which they may be detained is six months for the first two courses of treatment, or a year for subsequent ones.
Now, certain prohibitionists like to make much – too much – of the possible impact of cannabis on mental health. This, they say, is sufficient cause to ban the drug and punish its users "for their own good". Since it has been moved back up to class B, against expert advice, the maximum penalty for personal possession is five years' imprisonment.
The difference in penalty is staggering, and reveals the extent of prejudice against drug use. If one already has poor mental health and is a risk to oneself or others, maximum detention is only for a year, and as a patient. If one merely increases the risk of developing schizophrenia by 40% or so, it can result in detention for five years as a criminal. Punishment simply for risking one's own mental health is more severe than the restrictions on someone already suffering from a mental illness and at serious risk of doing harm to himself or others.
Serious addiction might arguably be considered a mental illness. Moderate and recreational use is not.
Other than cases of notifiable disease, where intervention is justified on the grounds of protecting others, these are the only circumstances under which an adult patient may be treated against his wishes. Even direct and deliberate acts of self-harm, such as cutting, cannot be forcibly prevented if determined not to result from mental illness. Otherwise, forcing treatment upon someone is considered to be an assault – even if they'll die without it.
Jehovah's Witnesses provide a useful, if obvious, example. Their faith requires them to refuse blood transfusions even if needed to save their life. Last year in the UK, a 15-year-old boy died after refusing a transfusion needed to treat injuries sustained in a car accident.
We may beg, plead and cajole them to receive treatment – but not compel.
Forcing someone to undergo a medical procedure and forbidding them from actively undertaking risky behaviour are both intrusive. The differences between compulsion to act and prohibition from acting are slight. Just as forced treatment is an assault, unjustified and exceptional restrictions on action ought to be considered wrongful imprisonment – bars and chains don't have to be made of steel to be just as real.
Instances where the risk of harm comes from the use of certain drugs are just about the only situation in which adults of sound mind are prevented from doing harm entirely to themselves.
Ultimately, however much prohibitionists might like to claim that their stance is based on evidence, there's no escaping that in reality it comes from prejudice – from finding drug use distasteful. It couldn't credibly be anything else, since forbidding drug use outright is an exception to the limits on intervention against self-harm rather than being the rule.
Most actions or pastimes that put one at risk are culturally accepted, and therefore legally permissible. Bareknuckle boxing, sadomasochistic (particularly gay) sex and drug use are taboo, and it is because of this, not any highminded notion of saving people from themselves, that they are prohibited. To pretend otherwise is a lie.
This post was edited at 1545 on 23 April. The 13th paragraph originally read "certain prohibitions" rather than "prohibitionists". This has now been corrected.