Article 13 - The real harms of Addiction
Address to the 2017 AGM of the Cape Town Drug Counselling Centre
(28 September 2017)
When I first became involved in the drug law reform movement a few years ago I discovered that I was extremely ignorant about the whole subject of drug use, addiction and the dynamics between drug use, the drug trade and local and international politics.
Once I began the process of educating myself I realised how ignorant both I, the public and particularly the medical profession is of the principal factors underlying drug use and the laws affecting that activity.
Initially drug use seemed to me to be a very complex issue but the more I looked into it the more I realised that it was in fact a fairly straightforward multi-factorial issue that could be easily understood when a only few underlying fundamental realities were appreciated.
So when discussing drug law reform I have found that it is vital to keep these universally applicable realities in mind, as they enable one to stand back and maintain a broad overview of the subject.
FUNDAMENTAL REALITY 1:
In spite of the worldwide War on Drugs there is widespread drug availability and use. It is easy to obtain drugs because they are so widely available. That is essentially why we are having this conversation. Because, if the drug laws were working children wouldn’t find it easier to buy cannabis and tik than alcohol. So to understand why this is the case and why we urgently need drug law reform we need to take a look at the rest of these fundamental realities.
FUNDAMENTAL REALITY 2:
There is sound archaeological and historical evidence to show that humans have always taken psychoactive substances. At any given moment in time a part of the human population has sought pleasure or relief by ingesting natural or synthetic psychoactive substances. The desire for drugs is in our genes. And sometimes even the drugs themselves can be found in a bankie hidden in our jeans.
FUNDAMENTAL REALITY 3:
Over 80% of people who sample a drug for the first time never use that drug again. Most people try drugs out of curiosity or peer pressure, not because a drug dealer forces them to. And the majority of them do not continue using that drug; either because the effects are not what they expected or are actually very unpleasant.
FUNDAMENTAL REALITY 4:
Of those who continue to use drugs on a regular basis fewer than 10% will develop substance use disorders. As is the case with alcohol use, by far the majority of people who use drugs regularly do not become addicted to them.
And this brings me to FUNDAMENTAL REALITY 5 and Darryl Gates, the chief of the Los Angeles Police Department in the nineteen seventies. Gates, who was a firm proponent and enforcer of Richard Nixon’s amped up War on Drugs, knew what he was talking about when he said, “All casual users of drugs should be taken out and shot”. ...Casual users not addicts. And he said this because he understood that it is the casual or recreational users of drugs, any drugs, who are the prime drivers of the drug trade. People with substance use disorders form the minority of drug users, just as alcoholics form only a small proportion of the liquor market.
Drug manufacturers, drug lords and drug pushers no more drive the drug trade than do wine farmers, beer makers and liquor outlets drive the liquor trade. They all supply a market that has been around forever- that is a proportion of the population that likes using psychoactive substances.
So, in theory, Darryl Gate’s distorted philosophy was quite correct - get rid of casual, recreational users and you get rid of a huge slice of the drug trade. And he fully appreciated that, although recreational drug use is prevalent in all socio-economic groups those in the middle and upper socioeconomic strata are seldom prosecuted for their infractions. While it is the lower socioeconomic groups that bear the brunt of the punitive drug laws.
FUNDAMENTAL REALITY 6:
Most of those who do develop substance use disorders have manageable psychosocial issues or mental illnesses. This is often the result of abuse, adverse childhood experiences or dire social circumstances. And it is these unfortunate members of society who, instead of being protected by the law and their fellow citizens, are scapegoated and trampled upon by both the criminal justice system and the criminal underworld itself.
And I am sad to say that the medical profession’s passivity on the drug law issue is not only doing very little to improve this dire situation but their inaction is actually making it worse.
FUNDAMENTAL REALITY 7:
Drug use in itself is a victimless crime. Unfortunately this fact is seldom at the forefront of drug policy reform discussions. And it really should be. Someone smoking, vaping or ingesting cannabis or any other illicit drug is doing no more harm than a person who has a beer when he comes home from work, a glass or two of wine with dinner and a post-prandial cognac. Illicit drug use per se is a victimless crime and therefore it shouldn’t be a crime at all.
And by extension, if drug use is a victimless crime, why should someone who makes a psychoactive substance and sells it to a person who wants that substance be committing a crime? Why is it a crime to grow and sell cannabis while it’s completely legal to brew beer, grow grapes, make wine and other alcoholic beverages and sell them? The making and selling of psychoactive substances per se is also a victimless crime.
The crimes occur when drugs are banned and their manufacture, sale and regulation end up in the hands of criminals. The USA Prohibition of alcohol in the nineteen twenties is the prime example whereby the ban of a psychoactive substance, in this case alcohol, caused a lot more damage than did alcohol itself.
In the same way the dreadful United Nations drug treaties have caused far more individual and social harm than have those banned drugs themselves. These treaties have had the unintended consequences of increasing drug use, accelerating the global rise in organised crime and a corresponding fracturing of societal structures around the world.
FUNDAMENTAL REALITY 8:
The legal regulation of cannabis and all other psychoactive drugs is the only workable holistic and humanistic drug policy framework.
There are two main reasons for this:
Firstly if you ban a drug for which there is a ready market you immediately increase the value of that drug and hand its production, potential tax revenues and control to criminals and corrupt factions within the criminal justice system. And to validate this irrefutable premise you need look no further than the current situation of cannabis versus that of alcohol. It’s really that simple.
Secondly, Prohibition means that those with substance use disorders are shunned by society and are forced to turn to crime in order to sustain their access to drugs. And if we agree that the majority of people who develop substance use disorders suffer with mental illnesses or have psychosocial problems then it’s easy to appreciate that it is precisely those unfortunate individuals who will bear the brunt of our draconian drug laws.
(A prime example of this is Foetal Alcohol Spectrum Disorder (FASD). This irreversible, condition that affects millions of South Africans is caused by the exposure of the foetus to alcohol.)
Before I get on to the harms of the drug laws themselves I would like to touch on the concept of harms within the context of health care. We often hear the much quoted old adage, “Above all, do no harm”. This, in itself, is a very noble ideal. But it is an unrealistic ideal. Because, we doctors do harm all the time. That’s because almost every health care intervention we use – whether it be prescribing a medicine, operating, carrying out an invasive diagnostic procedure or simply by deciding not to provide a particular treatment to a patient – usually carries with it some degree of harm or certainly the possibility of harm.
So when deciding on a treatment for virtually any patient we have to weigh up the potential harms vs. the potential benefits of the treatments we will offer that patient. And we do the same thing in the public health sphere. We recommend public health policy based on the probability that a particular intervention will benefit the majority of the population even if a small minority experience adverse effects of that intervention.
And that is why we should look at the drug laws – as a health and social issue rather than a criminal one. If we do that, then we can decide whether the interventions – the drug laws – do more harm than the actual health problem itself – in this case the adverse effects of drug use.
As all of you are well aware of the potential harms of drug use I am not going to cover that ground today. Instead I am going to talk about an aspect of the drug issue that is not emphasised enough - the harms and dangers of the drug laws themselves.
And to illustrate this I have used a template of a typical insert that you will find packed with any scheduled medicine – such as this one that can be found in a box of paracetemol tablets. The different categories...required for each medicine essentially give one an ideal of the benefits (indications) of the medicine versus the potential harms (contraindications, interactions and side effects) of each medicine.
So in order to illustrate the benefits of its benefits versus its harms I have created this mock package-insert of the Drug Trafficking Act that has the same headings as you will find in a normal package insert.
So now that we have read the Drugs and Drug Trafficking Act Of 1992 “package insert” do we really think that the benefits of this “medicine” justify its harms? I’m sure that you know what my answer is; but I’ll leave each of you to decide for yourselves whether the benefits of this intervention justify all the suffering and hardship that it causes.
- Written by Dr Keith Scott