Fw: [drugnews] !!! ADDICTION: Informing America's policy on illegal drugs

Joshua Tinnin krinklyfig at myrealbox.com
Thu Jul 18 01:42:22 EDT 2002


Not *totally* on-topic (no specific ibo content), but worthy of note.

- jt

----- Original Message ----- 
From: "Peter Webster" <vignes at monaco.mc>

Date: Wed, 17 Jul 2002 09:50:20 +1000
From: Andrew Byrne <ajbyrne at ozemail.com.au
Subject: "Informing America's policy on illegal drugs: what we don't know 
keeps
  hurting us". US wisdom then commentaries in British journal.

For debate: Executive summary of the National Research Council's
report "Informing America's policy on illegal drugs: what we don't
know keeps hurting us".  Addiction (2002) 97: 647-652

Dear Colleagues,

Griffith Edwards, long-time editor-in-chief of the Addiction journal,
has written a lead piece explaining why he published this executive
report from the 'US National Research Council'.  'Addiction' and most
of its seven commentators seem to have missed the point that this is
an unscientific report of little relevance to the dependency field
beyond the US.  It represents the illogical and ineffective approach
taken by America for fifty years which is so clearly contrary to the
interests of its own citizens, not to mention some of its close
neighbours.

In short, Addiction seems to have found one of many American
reports saying that 'we need more research on drug use in young
Americans before we dare make any changes to drugs policy".  As
if to justify this, Edwards seeks comments from Reuter, Maynard,
Kandel, Weatherburn, Bammer, Kleber and Klingemann, mostly
prominent researchers!  It is hardly surprising that researchers
approve of more research!  But where are the comments from coal-
face clinicians, drug user representatives, administrators, police or
advocates for drug law reform, many of whom come from
impeccable conservative backgrounds.  Even a serious scientific
journal might consider such important interest groups occasionally.

Drug policy clearly should not remain frozen until more research is
done.  Even in England things are happening steadily, with cannabis
decriminalization, heroin prescription, improved methadone
treatment and needle services.  But the medical and research
experts seem to be the last to find out!  To Maynard's credit, he
states in his commentary that research should be done AFTER
certain policy changes are made, to see if they are beneficial.  This
is 'harm reduction' by definition.  However, he seeks more 'placebo
controlled studies', especially in prisoners denied treatment.  This
curious view may be partly due to the poor standard of methadone
treatment in the UK and doubts by some whether it actually
'works'.  He says that "UK reform cannot proceed without logic
and evidence . [changing the US] . current myopic and corrupting
policy framework".  But US policy rarely follows 'logic', being
largely based on punishment or a 'zero tolerance' approach.

Reuter points out that measuring the true cost of drug use is more
complex than just estimating gross quantities of drugs used, as
seems to be the current US policy aim.  Indeed, he goes on, neither
quantities nor prevalence of drug use can account for the 'violence,
corruption and disorder' associated with drug use and drug control.

Weatherburn intriguingly straddles the fence, saying 'it is
fashionable to decry America's [punitive] drug policy' but not
saying if he is part of the 'fashion'.  And this is a field which he
knows much better than most, or than he chooses to reveal.  I
cannot fathom why he calls inadvertent collateral damage from
policing "iatrogenic" (doctor-induced).

Bammer, Kleber and Kandel make various astute observations,
comments and suggestions.  Kleber's 'kernel' message is contained
in his final para, in a sentence with over eighty words and eight
commas!  To paraphrase his 'de Quincey'-style: 'nothing happens at
the top since so many still wrongly consider addiction self-inflicted'
(14 words!).  Only Klingemann, published last, points to the
profound myopia of the report and its lack of consideration of a
broader perspective beyond America such as heroin trials, criminal
nature of certain drugs and harm reduction as a policy.  These were
specifically excluded from consideration in this report.  The web
address is given as: www.nap.edu/catalog/10021.html  .

The reports authors are not given, nor its date.  However, three of
their number from the Department of Economics, Iowa University,
have replied to Reuter and Kleber while ignoring Klingemann and
Maynard.  Perhaps this is because the latter's arguments were
cogent and 'unanswerable'.

While the American government has resumed shooting down planes
suspected of being involved in drug importation, their own doctors
are prescribing amphetamine for children ... and Swiss, English and
other doctors are using heroin successfully for addiction treatment.

Edwards states: "Although American in origin, we believe that this
thoughtful statement is likely to be of wide international interest".
'Thoughtful'?  Can he be serious?  Coming from the country with
such a poor record of drugs policy!  And a report which apparently
does not espouse one single 'courageous' departure from the
ubiquitous policy of 'zero tolerance' in that country!

This whole exercise seems to ignore the major advances many
countries have made in the area of drug related harm.  In some
cases these problems have almost been wiped out at very little cost
(eg. overdoses in Switzerland; HIV transmission in Australia;
cannabis prosecutions in Holland).  And the report's' exclusions'
remove any hope of useful ways to improve the current American
approach.  Maynard eloquently calls it a "welfare system for
present-day criminals" just as "alcohol prohibition in the 1920s was
a social security system which supported Capone and the US
Mafia".

Editor Edwards asks readers to 'take the debate further ' by
submitting letters.  But Addiction appears to publish very little
correspondence arising from previously published articles - this
June edition contains none.  But under heading of letters, there are
3 apparently solicited but 'unannounced' commentaries (on cannabis
withdrawal review of Smith) plus a letter "from" the editor!  This
rambling apologia does everything but actually apologise, as it
possibly should, for "un-publishing" (!) an item from a decade ago
due to supposed undeclared tobacco sponsorship involving a
conference air-fare for a respected (and now deceased) Danish
researcher.

Comments by Andrew Byrne ..

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
    Dr Andrew Byrne,
    Medical Practitioner, Drug and Alcohol,
    75 Redfern Street, Redfern,
    New South Wales, 2016,
    Australia
    Tel (61 - 2) 9319 5524  Fax 9318 0631
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

"What was it that did in reality make me an opium-eater?
.... Pain was it? No, but misery. Casual overcasting of sunshine
was it? No, but blank desolation. Gloom was it that might have
departed?  No, but settled and abiding darkness. Total eclipse,
Without all hope of day!"

Thomas De Quincey. Confessions of an English Opium Eater.
The London Magazine, 1821.




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