vrijdag 26 oktober 2012

Drugs - without the hot air: Minimising the harms of legal and illegal drugs (David Nutt) [7]

There are other indirect health problems that result from this denial of healthcare to injecting drug users. Living in poverty for many years with low immunity and irregular or inadequate access to medication means that many of these people develop “TurBo-HIV”, contracting TB on top of the immunodeficiency virus. Many treatment programmes will only treat them for one health problem at a time, forcing them to choose between being treated for their addiction or for their TB. 

Since drug users’ lives are often chaotic anyway, being unable to receive holistic care means that they often move between different treatment programmes, stopping and starting courses of different sorts of medication – exactly the circumstances that cause viruses to mutate. The result is one of the highest rates of multidrug-resistant TB in the world, a hazard to health that extends beyond the users themselves, affecting Russian society at large. 

This situation could largely have been prevented if injecting drug users had been viewed as sick patients requiring medical help; instead, the attitude fostered by the War on Drugs was that they were immoral people deserving punishment.


Diverting attention from the dangers of alcohol and tobacco 

Each year, tobacco kills 5 million people across the world, while alcohol kills 1.5 million. By comparison, illicit drugs kill around 200,000 people between them. Even taking into account the much smaller populations who use these drugs, in many cases they are considerably less deadly.

Yet the levels of money and political will expended on trying to eradicate their use far exceeds the levels spent on public-health measures to reduce the harms of alcohol and tobacco. In addition, the small expenditure on reducing alcohol and tobacco consumption is counteracted by advertising from the drinks and tobacco industries which associate these drugs with health and beauty. 

Politicians often say that criminalisation is designed to “send a message” that the use of certain drugs is unacceptable because of the harm they cause to individuals and society. Unfortunately, the resultant message perceived by many millions of people around the world is that alcohol and tobacco are acceptable – and we all pay the price for that. Why are we still at war? 

After forty years, thousands killed, millions imprisoned, and $1 trillion spent (or $2.5 trillion depending on who you ask), we are still no closer to controlling either the supply- or demand-side of the illicit drug trade. Government interventions on the supply side are seen as a cost of business, like a tax rather than a serious threat; and the billions spent on DARE programmes and locking up users haven’t stopped the inexorable rise of drug use in most parts of the world. 

In its own terms, the War on Drugs has failed, and the evidence shows it was also the wrong strategy  for harm reduction. The intentional and perverse effects of the war have spread disease, held back medical research, brought the law into disrepute, and ruined the lives of millions. But still our politicians keep fighting, at least while they hold power. 

Mo Mowlam, who had been responsible for Tony Blair’s anti-drugs policies, called for full legalisation after she’d left politics in 2002. Former Home Secretary Bob Ainsworth spoke out about decriminalisation when safely out of the Cabinet and in opposition. Former presidents Bill Clinton and Jimmy Carter criticised the War on Drugs in a recent documentary. Jimmy Carter wrote an article entitled Call Off the Global Drug War in The New York Times, and in November 2011, along with many Nobel prizewinners, international statesmen, and other public figures, wrote a public letter entitled The Global War On Drugs Has Failed: It Is Time For A New Approach. And in 2002, an ambitious UK backbencher called David Cameron said in a debate in the House of Commons “drugs policy has been failing for decades”. 

Yet now that he’s Prime Minister, Cameron talks just as “tough on drugs” as every other politician, and Obama, while supporting having a more open debate on drugs policy, always takes pains to make it clear he himself is absolutely committed to prohibition.

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