Thursday 23 September 2010

What Happens When You Can’t Trust the Experts?

I have a general rule when it comes to drug policy … trust the experts. But what happens when the experts start dishing out anti-drug rhetoric reminiscent of our politicians?

This week, the Sydney Morning Herald published an article by 2 of Australia’s leading experts on drugs, Don Weatherburn and Wayne Hall. As I read through their article, I couldn’t help but notice some perplexing issues in their argument which prompted me to question my existing beliefs. Have I been wrong all this time? After some checking and careful consideration, I concluded that I wasn’t wrong at all but the article itself was flawed.

Interestingly, the title of the article is, Beating The Drug Trade Isn't About Black-And-White Solutions. It’s interesting because the authors go on to give an almost black-and-white argument against against any solution that may well end the drug trade. 

Don Weatherburn and Wayne Hall focus on 5 points which they claimed were key to the drug debate.

The war on drugs has failed because it's still easy to obtain illegal drugs
This is like arguing that the laws against drink driving have failed because thousands of people each year continue to drink and drive.

The purpose of drug law enforcement is not to make illicit drugs impossible to obtain. The primary justification for prohibition (and the enforcement activity that underpins it) is that it keeps illicit drug prices much higher than they would otherwise be. This, in turn, keeps illicit drug consumption and drug-related harm lower than they would otherwise be. The heroin shortage in 2000 showed us that higher drug prices do reduce levels of drug-related crime, morbidity and mortality. We ought, therefore, to be wary of any policy that reduces the cost of illegal drugs.

Apples and oranges - people are not addicted to drink-driving and any pressure to cease this practice will deter those who drink and drive. And occurrences of drink-driving have decreased considerably since we started educating the public to the dangers involved along with the police who regularly blitz the roads with booze busses and mobile patrols. But, for all the scare campaigns and billions spent on policing, drug use has increased ten fold since the 1970s. We are less likely to drive around drunk anymore because we are bound to get caught but since we started in earnest to police drugs, they are now cheaper, more available and stronger. In other words, the drink-driving strategies have worked but the "War on Drugs" has failed miserably by any standard.

The heroin draught argument needs some clarification. There was no “heroin draught” after 2000 but a return to the same levels before the heroin surge in 1997. The return to higher prices just cleaned out the recent and casual users who took it up when heroin was awash in the community. The hard core users remained.

The main point missed by Weatherburn and Hall, is the carnage caused by higher prices. Increasing prices for illicit drugs has clearly shown to cause more violence and crime. Addicts will commit crime to feed their addiction which is purely a result of high prices. If the purpose of prohibition is to increase prices and therefore reduce drug use and harm, then prohibition isn’t working very well.

If we legalise drug use and possession, more people will use illicit drugs
This argument sounds plausible because most people won't do something they know to be illegal.

However, the fact is that most studies of drug use decriminalisation find it has little effect on the prevalence of illicit drug use, except where the state turns a blind eye to drug supply (as happened a few years ago in the Netherlands).

There is a risk that decriminalising illicit drug use will increase consumption among existing dependent users. Since they account for most of the harm associated with illicit drug use, this is a matter for concern. Treatment, however, is almost certainly more effective than punishment in reducing drug consumption among dependent users.

Maybe the authors should have mentioned that most people who want to use drugs, do so already, regardless of the law. Saying that we should be concerned that decriminalisation raises the risk of dependant users increasing their consumption is odd when the next line states that treatment more effective than punishment. Sure, decriminalisation without increased treatment is probably a waste of time but why would any government leave out this important part?

The fact is, there is no evidence to suggest that removing or lowering penalties for drugs will increase drug use. The opposite is true. All the evidence points towards less drug use and more users seeking treatment.

If the state provided drugs to dependent users, the black market for drugs would collapse, thereby reducing if not eliminating drug-related crime
The main problem with this argument is that if the state did succeed in meeting a large portion of the demand for illicit drugs like heroin, the price of drugs on the black market could fall. This may encourage more people into the illicit drug market.

A second problem is that some drugs (such as amphetamines) have quite toxic mental health effects if used regularly. The state cannot be expected to offer toxic drugs to people just to avoid creating a black market.

A third problem is that medicalising a problem does not necessarily reduce crime and corruption. Witness the problems we are having with pharmaceutical opioids, such as oxycodone.

I am surprised that someone with as much knowledge as Don Weatherburn and Wayne Hall, have come up with these over simplified answers. This is the problem with most of the opposition to drug law reform - single solution responses. Legalising drugs does not mean selling heroin at the local 7-11 store. It would enable cheap, quality illicit drugs to be purchased safely from pharmacies with a prescription from a doctor. A black market would find it almost impossible to compete on price or quality. Anyone wanting drugs can do so with a visit to a doctor, removing most incentives for black market drug dealers. Since we already know that most people who want to use drugs already do so, there would be very little increase in new drug users. Also, drugs would become boring to our youth when the mystique is taken away. Like in Switzerland, the Netherlands and Germany - prescription heroin has changed the image of heroin to an old person’s drug. Seeing middle aged people line up for their daily shots at Heroin Assisted Treatment (HAT) clinics is not very sexy nor alluring to rebellious youth. Not only do these countries now have very low rates of new users but there are also fewer heroin dealers to get them started. 

Weatherburn and Hall argue that medicalising a problem does not necessarily reduce crime and corruption. This is part of the argument opposing legalisation because legal pharmaceuticals like Xanax, oxycondone, morphine etc. also have a huge black market as illicit drugs do. The glaring flaw is that these pharmaceuticals cannot be prescribed for addicts or recreational use. A better comparison would be alcohol as I am yet to hear about pubs fighting it out in the streets with guns for their share of the market. 

The other point raised by Weatherburn and Hall is that “some drugs (such as amphetamines) have quite toxic mental health effects if used regularly. and ”The state cannot be expected to offer toxic drugs to people just to avoid creating a black market”. The main drug of addiction - heroin - is non toxic and can be taken safely for decades. But that’s not the point. Users are taking these drugs anyway, which are almost always cut with contaminants. Swapping dirty street drugs with pharmaceutical quality drugs is a no-brainer. Feeling guilty is not an excuse to keep people using unregulated, contaminated chemicals when a clean alternative exists. The hard truth is, some people will use drugs regardless of the potential harms or the law. Weatherburn and Hall try to make this a moral issue where giving illicit drugs to existing users is somehow worse than sitting by and watching them hurt themselves by their own accord. 

But the strangest claim is that providing drugs to existing users is worse than the huge black market that prohibition has created. This is not science but the usual anti-drug rhetoric we should not expect from experts. How did they concluded that simply giving users a clean batch of what they would consume anyway is worse than the millions of people who have their lives ruined every year? Or the thousands who die or are injured from drug gang violence. Or the massive drug fighting budgets that could be used to wipe out global poverty? Or the hundreds of thousands who are incarcerated each year? 

Every kilo of illegal drugs we seize is one less on the streets
The problem with this argument is that drug traffickers can often make up for any losses they suffer by importing or supplying replacement drugs. The cost of seizures, moreover, is a lot less for them than it appears.

Police routinely state the value of drugs they seize in terms of their retail - street - cost as if this were the financial loss to the importer and distributor. But the cost of importing and distributing drugs is far less than the cost of consuming them. The effect of a drug seizure on the importer or the distributor's profit margin, therefore, is less than it appears. The profits for drug importers and distributors when they avoid detection are potentially huge.

They are correct on this point but should have gone further. With so much money being poured into customs, boarder protection and the policing of drugs, the authorities need to appear they paying their way. How often do we see or hear about some drug bust, often with pictures of the police in front of their prized stockpile of confiscated contraband? And how often do we hear that this bust will make a dent in the drug market. According to the police themselves, we only stop about 10-15% of all the drugs illegally entering Australia. Apart from raising the obvious issue about how futile this all seems, we have to wonder how they actually know it’s only 10-15%.

Treatment is more effective than drug law enforcement in reducing demand for illicit drugs.
This is perhaps the most misleading of all the arguments put forward about illicit drug policy.

It's a sad fact that many dependent drug users only seek treatment when the personal and financial cost of continued drug use gets too high. The financial cost is attributable in large part to prohibition. The personal cost includes trouble with police and the courts, which is one of the most commonly cited reasons for entering treatment. Coercing drug-dependent offenders into treatment is known to be effective in reducing drug use and drug-related crime.

What are the authors saying? It appears that they applaud the carnage caused by prohibition because it encourages users to seek treatment. Ruining people’s lives is a harsh way to help those with a drug problem and frankly, it’s disturbing that the authors don’t condemn it. They know better than anyone that coercing addicts into treatment might help some in the short term but unless they’re ready to give up drugs, it is a pointless exercise. The damage to people’s lives is one of the main arguments against our punitive drug laws. The big question is, why do we allow the lives of addicts to fall apart so they can be coerced into treatment?

Here is a quote from an earlier point made in the article, “Treatment, however, is almost certainly more effective than punishment in reducing drug consumption among dependent users”. Confused? To apply prohibition, you have to have a system involving punishment. But what if we took away the penalties (and the black market) where drug users could go through the addiction process under the supervision of medical experts? We could avoid the bulk of problems associated with drug use … the effects of prohibition.


The Move to the Mainstream
Don Weatherburn and Wayne Hall are not the only experts who seem to have softened their opposition to current drug policies. Over the years, there has been several cases of groups or individuals swapping their beliefs in evidence based science for a more government friendly, anti-drug approach. This is disappointing as more and more people realise the futility of our drug policies.

Australia’s official research group into drug use, the National Drug and Alcohol Research Centre (NDARC) was established at the University of New South Wales in May, 1986 and officially opened in November, 1987. It is funded by the Australian Government as part of the National Drug Strategy. Surprisingly, they were void of the government’s usual anti-drug rhetoric and if anything, gave plenty of evidence on why we should change our drug laws. But in 2007, the government expand NDARC with the dubious National Cannabis Prevention and Information Centre (NCPIC). Instead of following the strictly evidence only attitude of NDARC, NCPIC was headed up by a well known anti-cannabis zealot and returned us to the good old days of scare campaigns a.k.a. reefer madness. NCPIC is supposed to be an evidence based group like it’s sister-group, NDARC but including the word, prevention in it’s title must ring a few warning bells in the science community.

Another major worry is the appointment of NCPIC’s National Communications Manager, Paul Dillion. As the Media Liaison/Information Manager for NDARC, Paul was once known for his balanced views on our drug situation and his attacks on the media for their disgraceful reporting of drug issues. That seems to have been replaced with some sort of loyalty to pushing NCPIC’s agenda.

Although The Greens are not technically experts on drugs, they were one of the few political parties who supported an evidence based drug policy. While other parties might have mentioned evidence as part of their policies, The Greens actually modelled their drug policy on science, research and real evidence. Unfortunately, The Greens succumbed to the pressure involved in becoming a major political party and watered down their drug policy. Sadly, any political party wanting to be popular has to bow to public ignorance on drug related issues.

The same has happened in the UK where a coalition of conservative and progressive parties has seen The Liberal Democrats support a push for abstinence based treatment to replace substitution programs like methadone and the removal of welfare for drug addicts. Almost a complete polar position of their evidence based drug policy before they formed government.

It’s disappointing that in 2010, we are still pushing drug policies that wreak so much carnage although we now have decades of proof to show us our mistakes. But it’s even more disappointing that experts like Don Weatherburn and Wayne Hall are prepared to overturn their once logical assumptions for weak but popular views.

To read more analyse about the article in the Sydney Morning Herald, check out The Kings Cross Times.


Beating The Drug Trade Isn't About Black-And-White Solutions
By Don Weatherburn and Wayne Hall
September 2010

A combination of law enforcement and treatment is the key, write Don Weatherburn and Wayne Hall.

No sooner do signs emerge of another drug problem than we hear predictable calls to treat illicit drug use as a health rather than a crime problem. These calls mirror the rhetoric from supporters of an all-out war on illicit drug use.

Neither side in this debate sees any merit in its opponents' arguments. Both sides try to persuade you that we face a stark choice between investment in treatment and harm reduction or, on the other hand, prohibition and drug law enforcement.

Let's critically assess five of the arguments often put forward by both sides in this debate.

Argument number one is that the war on drugs has failed because it's still easy to obtain illegal drugs. This is like arguing that the laws against drink driving have failed because thousands of people each year continue to drink and drive.

The purpose of drug law enforcement is not to make illicit drugs impossible to obtain. The primary justification for prohibition (and the enforcement activity that underpins it) is that it keeps illicit drug prices much higher than they would otherwise be. This, in turn, keeps illicit drug consumption and drug-related harm lower than they would otherwise be. The heroin shortage in 2000 showed us that higher drug prices do reduce levels of drug-related crime, morbidity and mortality. We ought, therefore, to be wary of any policy that reduces the cost of illegal drugs.

Argument number two is that if we legalise drug use and possession, more people will use illicit drugs. This argument sounds plausible because most people won't do something they know to be illegal.

However, the fact is that most studies of drug use decriminalisation find it has little effect on the prevalence of illicit drug use, except where the state turns a blind eye to drug supply (as happened a few years ago in the Netherlands).

There is a risk that decriminalising illicit drug use will increase consumption among existing dependent users. Since they account for most of the harm associated with illicit drug use, this is a matter for concern. Treatment, however, is almost certainly more effective than punishment in reducing drug consumption among dependent users.

Argument number three is that if the state provided drugs to dependent users, the black market for drugs would collapse, thereby reducing if not eliminating drug-related crime. The main problem with this argument is that if the state did succeed in meeting a large portion of the demand for illicit drugs like heroin, the price of drugs on the black market could fall. This may encourage more people into the illicit drug market.

A second problem is that some drugs (such as amphetamines) have quite toxic mental health effects if used regularly. The state cannot be expected to offer toxic drugs to people just to avoid creating a black market.

A third problem is that medicalising a problem does not necessarily reduce crime and corruption. Witness the problems we are having with pharmaceutical opioids, such as oxycodone.

Argument number four is that every kilo of illegal drugs we seize is one less on the streets. The problem with this argument is that drug traffickers can often make up for any losses they suffer by importing or supplying replacement drugs. The cost of seizures, moreover, is a lot less for them than it appears.

Police routinely state the value of drugs they seize in terms of their retail - street - cost as if this were the financial loss to the importer and distributor. But the cost of importing and distributing drugs is far less than the cost of consuming them. The effect of a drug seizure on the importer or the distributor's profit margin, therefore, is less than it appears. The profits for drug importers and distributors when they avoid detection are potentially huge.

Argument number five is that treatment is more effective than drug law enforcement in reducing demand for illicit drugs. This is perhaps the most misleading of all the arguments put forward about illicit drug policy.

It's a sad fact that many dependent drug users only seek treatment when the personal and financial cost of continued drug use gets too high. The financial cost is attributable in large part to prohibition. The personal cost includes trouble with police and the courts, which is one of the most commonly cited reasons for entering treatment. Coercing drug-dependent offenders into treatment is known to be effective in reducing drug use and drug-related crime.

We don't have to choose between treatment and drug law enforcement. We can and should support both.

Dr Don Weatherburn is director of the NSW Bureau of Crime Statistics and Research and Professor Wayne Hall is the National Health and Medical Research Council Australia Fellow at the University of Queensland.

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