Solutions Lab: Dealing with drugs
More than 30 years since its inception, the US-led ‘war on drugs’ has done little to slow the rate of drug dependence and misuse around the world, and even less to address the causes. Lauren Razavi speaks to five leaders in the field championing alternative approaches.
Richard Nixon famously declared war on drugs in 1971, while ideals of abstinence date back as far as 2,000BC. But this hardline approach, characterised by the US and taken up around the world, has done little to curb the fallout from an industry so often coupled with disadvantage and despair.
In its latest World Drug Report, the United Nations estimates that 246 million people – or one in 20 – between 15 and 64 years of age used an illicit drug in 2013. The UN also estimates that one in ten people who take drugs are ‘problem’ users: those who suffer from drug-use disorders or dependency. Almost half of these inject drugs, with an estimated 1.65 million of injecting users infected with HIV. In addition, an estimated 187,000 drug-related deaths are reported annually.
The effectiveness of the so-called ‘war on drugs’, which involves a combination of legislation, military aid and intervention to discourage illicit drug production, distribution, and consumption, continues to be disputed by a range of experts, from economists to psychologists. Many argue that the available data supports policies of decriminalisation and rehabilitation. For example, top judges in Mexico have declared that outlawing cannabis use is an infringement of human rights, and some US states have decriminalised cannabis for both medical and recreational use. Ireland is also considering decriminalising narcotics.
Portugal offers an example of successful decriminalisation and rehabilitation. One per cent of its population was addicted to heroin in 2000, alongside the highest rate of HIV among injecting users of any country in the EU. In 2001, a specialist panel of scientists and doctors recommended decriminalising drugs – everything from cannabis to cocaine. They suggested using the money spent punishing and imprisoning drug addicts to help them turn around their lives through residential rehabilitation, psychological support and job creation.
Fifteen years on, injecting drug use is down 50 per cent, and the number of drug-related deaths and AIDS rates among injecting users have dropped by around 80 per cent and 93 per cent respectively.
In Switzerland, a health-focused drugs policy based on policing, prevention, treatment and harm reduction has proven effective. Since introducing measures in 1994, including heroin-assisted therapies and supervised injection rooms, the country has saved significantly on law enforcement and health costs. Estimates suggest that the economic benefits of this approach were double the cost of its implementation.
The punitive approach to drug use also has negative impacts on communities that depend on the drug trade. A 2015 report by development charity Christian Aid condemned “a blind spot in development thinking” with regard to western governments’ drug policies. It highlighted the devastation foreign prohibition policies can cause in some of the world’s poorest countries and argued that pouring money into developing nations without addressing the extent and influence of the drug trade is hypocritical.
To gauge the potential for a solutions-based approach to drug issues worldwide, we spoke to five experts in the field.
Plant for Peace provides opportunities for farmers in some of the most troubled areas in the world, and acts as a bridge between communities and global industries. We emphasise the importance of giving people – particularly in Afghanistan, which supplies most of the world’s opium and heroin – a chance at positive income alternatives to the drug trade.
People within the drug trade need help to cut the roots of the problem and support to rebuild their society.
The approach is about more than coming up with ways to cut off the supply of illegal drugs to rich western countries. It’s about tackling the deep-rooted political and social problems that affect the countries that produce drug crops. The people on the ground, who are just trying to live their lives, have to come first.
Since Plant for Peace started in 2007, we have signed up 22,000 Afghan farmers to grow horticultural crops rather than opium. While farmers get around $4,000 (£2,810) per hectare for opium, they can make up to $6,000 (£4,215) per hectare for pomegranates.
The biggest problem for these farming communities is their lack of access to the international market. That’s why we’re creating partnerships with major retailers and food companies around the world.
By creating a vibrant and sustainable farming sector across Afghanistan, citizens have the chance to be positive members of society. It also allows the country to be characterised by more than its links to drugs, radicalisation and conflict.
Plant for Peace is an initiative designed to help rural communities and smallholder farmers in conflict and post-conflict territories worldwide.
Most people think that if somebody used heroin for a month, they’d become a heroin addict. The generally held belief is that the chemical mix in heroin is something that the body starts to physically need. Now if I was to get hit by a bus and break my hip, I’d be taken to hospital and given loads of diamorphine, or medical heroin. By the logic above, I should come out of the hospital addicted. But this phenomenon has been studied closely, and addiction rarely happens. Your grandma doesn’t have an operation then come out and try to score on the streets, right?
The ideas we have about addiction come from a series of experiments done in the early 20th century. Scientists took rats, put them in cages and gave them two water bottles. One bottle just contained water and the other contained water laced with either cocaine or heroin. In those circumstances, the rat almost always preferred the drug water.
But in the 1970s, a psychology professor named Bruce Alexander said: “Well, hang on a minute, we’re putting the rat in an empty cage. It’s got nothing to do except drink this water.” So he built a cage that contained everything a rat could want in life. The rats were then given normal water and drug water. They almost never used the latter, and none of them overdosed.
The lesson here is that the opposite of addiction is not sobriety – it’s connection. Social animals need connection and a healthy environment. When we are deprived of those, many of us will behave in dysfunctional ways.
Johann Hari is a freelance journalist and author of the book Chasing the Scream: The First and Last Days of the War on Drugs.
While advising the Guatemalan government on drug policy in 2013, I remarked that there was no hope of ending violence in Latin America without first opening the debate on regulating the coca/cocaine market. So I convened a soon-to-be-published report to tackle this taboo issue. It is the first time that this vital subject has been addressed by more than 25 experts.
Another of our reports develops best practice for regulation of substances such as cannabis, psychedelics and MDMA, and ways to analyse the outcomes of a move towards a regulated market. It is essential that drug policy is based on solid scientific evidence in order to protect health and reduce harm, and that it’s cost-effective. The current prohibition regime has led to horrific violence in producer countries, destabilising corruption in transit countries, and oppression of human rights in consumer countries.
However, there is hope. I believe we’ve reached a tipping point where the intellectual battle has been won and people realise that change has to happen. Around the world, the prohibition regime is crumbling. In addition to current policy discussions in Ireland and the actions of states in the US, Portugal has decriminalised drug use with incredible public health results, while the newly elected Canadian government has promised to legalise cannabis.
The Global Initiative for Drug Policy Reform promotes the academic analysis of drug policy and new data to inform discussion of national and international reform. Fielding is also the executive director of the Beckley Foundation, a charitable trust that promotes health-oriented, cost-effective and harm-reducing drug policy reform.
Through my 18 years as a psychiatrist, I’ve come to realise that the existing treatments for trauma, such as the combined use of SSRI (selective serotonin reuptake inhibitors) drugs as antidepressants to mask symptoms, and trauma-focused psychotherapy, which involves asking a patient to talk about their trauma, are only effective around 50 per cent of the time. This is because many people are just too damaged to approach their traumatic memories.
When combined with psychotherapy, MDMA allows a patient to engage with their trauma long enough to gain some understanding and perhaps resolution for what they’ve been through.
In terms of its safety, it is more appropriate to ask what the risk versus benefit ratio is. Every intervention in medicine — from a sticking plaster to cancer chemotherapy — carries risks and benefits. Is MDMA 100 per cent safe? No, but nor is paracetamol.
The risks of MDMA are minimal, and when you look at the very serious issues of suicide, drug addiction, self-harm and chronic mental health, all which exist around untreated post-traumatic stress disorder, the use of MDMA more than satisfies that ratio of safety versus risk.
We hope to demonstrate that, compared to a placebo, MDMA will safely reduce patients’ fear response so they will be less scared by their trauma. We’ll also show which parts of the brain are being affected in order to demonstrate our hypothesis about how MDMA works.
Dr Ben Sessa is a psychiatrist and author who wrote the Psychedelic Renaissance: Reassessing the Role of Psychedelic Drugs in 21st Century Psychiatry and Society.
The Jellinek clinic’s work focuses on two key areas: prevention and harm reduction. Our education programme, Unity, involves training volunteers — often drug users themselves — to inform fellow partygoers about how to use drugs such as ecstasy and cocaine more safely.
We also do a lot of research into what kind of drugs are actually being used. Sometimes politicians and the media are concerned about drugs that are not part of any broader trend, and therefore should not be a prevention priority.
We also educate school kids and encourage them to wait until they are at least 18 to try alcohol or drugs. Our focus is on keeping people safe.
We tested people’s drugs at nightclubs, parties and festivals in the 1990s, but encountered problems. First, because there were so many different pills circulating at the time, we could only identify around 20 per cent. Second, event organisers had to take measures to keep drugs out, but our presence suggested they were doing otherwise. These issues — and later, a change in prevention policy nationally — made us start testing from our office instead. The cost per test is between €80 and €150 (£61 and £115), but with financial support from the government today we offer testing for free or for €2.50 (£1.93) a pill.
People who have experience using drugs know that you don’t always get into trouble, so it is crucial to realise that simply telling people not to take them is ineffective. That’s why our goal is not to prevent drug use, but rather to ensure people who are using drugs don’t end up in hospital.
The Jellinek clinic is an addiction treatment and drug use prevention organisation based in the Netherlands.