Mental Health Matters: Innovative approaches to control drug issues (opinion)
Mental Health Matters
This is the third in a series of columns on illegal and legal drugs in a run-up to ballot questions in Nevada and California on the legalization of marijuana.
There is incontrovertible evidence that the War on Drug Use has been a catastrophic failure: We spend untold billions of dollars every year to eliminate illegal drugs, yet are paid back with more illegal drugs, more drug abuse, more drug addiction and more drug related deaths than ever.
We incarcerate more people for drug related offenses than every other country in the world and for longer periods of time. Upon release, two-thirds of convicts re-offend within three years, and rates of drug overdose and suicide actually increase.
Hippocrates said, “There are in fact two things, science and opinion; the former begets knowledge, the latter ignorance.” The data shows that a punitive law enforcement approach to drug use doesn’t work. What can we do differently?
In this column, I describe innovative approaches undertaken by other countries that have drug-related issues similar to our own.
For some thirty years a few English physicians in a major British city ran a heroin maintenance clinic without fanfare and provided positive health benefits to its participants. Politics intervened and the government closed the clinic.
A number of European countries, amidst the scourge of heroin addiction in the 1990s, elected to provide “experimental” Heroin Addiction Treatment (HAT). HAT consists of providing heroin addicts with pharmaceutical-grade heroin in medically supervised injection clinics.
Participating countries included Germany, Canada, Spain, the Netherlands, the United Kingdom and Switzerland. The programs were shown to provide positive social and health benefits for participants and the community, but moralizing politics led to program closure of several clinics by government fiat. Currently, the Netherlands, Switzerland, Germany and Denmark provide HAT (Google: Heroin Assisted Treatment/Heroin Maintenance/Drug War Facts).
The Swiss HAT program was started during an era of open-air drug shooting galleries, increased drug injection users, rising HIV rates, increased drug deaths and increased drug related crime.
The results defied conventional wisdom and moralizing overseers: Overdose deaths fell by 50% because users no longer risked the dangerously unpredictable contaminants of illegal street heroin. Clinics used sterile syringes, so HIV rates plunged. Property crimes committed by heroin users declined some 90%. New heroin users dropped by 80% over time because established users no longer needed to recruit new users to pay for their habit.
HAT data analysis taught the Swiss important truths about heroin abuse. For one, most of the harm caused by heroin is not related to the pharmacologic properties of the drug, but a counterproductive policy of treating use as a crime, rather than a public health problem. Stigmatizing users and then adding the trauma of arrest and imprisonment only compounds the drug users misery.
The Swiss have also learned that most drug abusers suffer from other mental illnesses, frequently have a history of childhood abuse or other trauma, and use heroin to self-medicate or cope with their emotional problems.
Portugal offers another example. Like its neighbors, Portugal had a growing drug problem, particularly regarding heroin. The government created an independent commission of doctors, judges and an academic researcher to study the issues and recommend solutions.
The commission drew on certain facts: The overwhelming majority of adult drug users, 90%, use for pleasure and don’t become addicted. The punitive approach to drug control, i.e., threats, arrest, incarceration, probation, loss of civil liberties, demonization, etc., wasn’t working. Most addicts are of two minds — one wants to use and one wants to stop. Negative reenforcement doesn’t work.
Based on the data, the commission recommended the decriminalization of all drugs in Portugal. Drug possession would not be a crime, but drug sales would be. Parliament passed the recommendations and the persecution and prosecution of drug offenders ended in 2001.
What happened? There were no miracles, but huge improvements in public safety and many lives saved. The total amount of drugs used remained about the same, but, unlike the rest of Europe, did not increase.
Addiction, in contrast to use, has been halved. Overdoses have declined. HIV is way down, dropping from 1,016 new cases in 2001 to 56 in 2012. Drug crimes have dropped substantially. And parents, listen up, overall teen drug use declined.
In sum, data analysis assisted these countries to understand that law enforcement as a primary pillar of drug control doesn’t control drugs and doesn’t help addicts. By implementing non-punitive, public-health-driven interventions, they were able to decrease addiction, its harms and criminality.
Incline Village resident Andrew Whyman, MD, is a clinical and forensic psychiatrist. He can be reached for comment at firstname.lastname@example.org.
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