tag:theconversation.com,2011:/global/topics/drug-policy-2727/articlesDrug policy – The Conversation2023-11-19T13:00:20Ztag:theconversation.com,2011:article/2176412023-11-19T13:00:20Z2023-11-19T13:00:20ZRaids on magic mushroom dispensaries are a knee-jerk reaction, but taking a blind-eye approach only allows the market to run wild<figure><img src="https://images.theconversation.com/files/559971/original/file-20231116-26-gz18nx.jpg?ixlib=rb-1.1.0&rect=0%2C46%2C6240%2C4100&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">A store selling psychedelics in Windsor, Ont. Recent police raids on psychedelics stores in Vancouver reflect misplaced attitudes toward drug regulation.</span> <span class="attribution"><span class="source">(Shutterstock)</span></span></figcaption></figure><iframe style="width: 100%; height: 100px; border: none; position: relative; z-index: 1;" allowtransparency="" allow="clipboard-read; clipboard-write" src="https://narrations.ad-auris.com/widget/the-conversation-canada/raids-on-magic-mushroom-dispensaries-are-a-knee-jerk-reaction-but-taking-a-blind-eye-approach-only-allows-the-market-to-run-wild" width="100%" height="400"></iframe>
<p>On Nov. 3, <a href="https://www.cbc.ca/news/canada/british-columbia/vancouver-police-raid-3-psilocybin-stores-seize-variety-of-controlled-substances-1.7015692">police raided</a> three Vancouver magic mushroom dispensaries and seized tens of thousands of dollars worth of psilocybin and other psychedelics. </p>
<p>One store has already re-opened, with the owner <a href="https://www.theglobeandmail.com/canada/article-magic-mushroom-dispensaries-raided-owner-arrested-as-vancouver-police/">saying</a> the other two will reopen soon. </p>
<p>Psychedelics remain predominantly illegal in Canada. But storefronts advertising psychedelics are popping up throughout downtown <a href="https://toronto.citynews.ca/2023/07/18/toronto-mushroom-dispensaries-remain-open-despite-being-illegal/">Toronto</a> and <a href="https://www.cbc.ca/news/canada/british-columbia/magic-mushroom-dispensaries-in-vancouver-1.6385792">Vancouver</a>. And there are hundreds more Canadian options online.</p>
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<figcaption><span class="caption">Mushroom dispensary owner Dana Larsen criticizes Vancouver police for raiding his dispensary and two others.</span></figcaption>
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<h2>Mushrooming trade</h2>
<p>As Canada lags on approving therapeutic psilocybin products, the illicit market is flourishing. Operating in a legal grey area, Canadian stores and websites are increasingly selling psilocybin, MDMA, ketamine and more. To date, the government has largely turned a blind eye to these stores. </p>
<p>The Vancouver police had previously expressed that their primary concern is gang-related opioid trafficking, but this appears to be changing, and police have indicated more raids will come. </p>
<p>We have seen this story before: <a href="https://toronto.ctvnews.ca/illegal-pot-shops-slam-city-s-reckless-behaviour-as-police-return-with-more-cement-blocks-1.4515747">repeated raids on cannabis dispensaries</a> failed to dissuade owners while using up vast police resources. </p>
<p>Yet simply ignoring the growing psychedelics storefronts allows stores to prioritize commercial interests over public health: with no regulations, sellers make wild assertions about their products with no oversight. Age checks — particularly online — are rarely conducted. </p>
<p>Perhaps most egregiously, public-facing marketing is totally unrestricted: while cannabis stores cannot even allow products to be viewable from the outdoors nor make any health claims about their products, psychedelics stores regularly showcase splashy branding and make unsubstantiated claims about psychedelics’ possibilities. </p>
<p>The lack of a regulated supply also impedes shops from making reliable dosing recommendations — those would require full knowledge of the actual ingredients.</p>
<h2>An unrealistic medical model</h2>
<p>To date, the Canadian government has solely focused on medical use of psychedelics. In June, Canada <a href="https://www.canada.ca/en/institutes-health-research/news/2023/06/government-of-canada-invests-nearly-3-million-to-study-the-potential-benefits-of-psilocybin-assisted-psychotherapy.html">invested nearly $3 million</a> into researching the benefits of psilocybin-assisted psychotherapy. </p>
<p>For now, the government <a href="https://www.canada.ca/en/health-canada/services/substance-use/controlled-illegal-drugs/magic-mushrooms.html">suggests seeking out clinical trials</a> to anyone interested in using psychedelics.</p>
<p>While the medical model is appealing, it also ignores the realities of psychedelics use in Canada. A <a href="https://doi.org/10.1080/02791072.2023.2242353">recent survey</a> found that less than 34 per cent of Canadians who reported using psychedelics did so to self-medicate a health condition. This means that about two-thirds of those using psychedelics would be unaffected by medical authorization unless able to convince a practitioner that they require the substance. </p>
<p>The recreational and medicinal markets are far more intertwined than many are aware. As so often happens, our denial of medical access has become intertwined with a burgeoning illicit market. We have seen this phenomenon with cannabis and opioids, and it now appears to be happening with psychedelics.</p>
<h2>A better way forward</h2>
<p>Policy reactions to illegal recreational drugs often fall within two categories: ignore the reality and hope the stores simply disappear; or overreact, executing ineffective and costly raids that do little to dissuade store owners (all while promising medical access that takes far too long to transpire). At present, the government appears to be missing the mark on both ends.</p>
<p>Instead of repeating history, a public-health approach would involve providing objective information about the risks and downsides, banning all marketing and promotion, and encouraging substance testing services. Basic age verification, as with tobacco and alcohol, should be required. </p>
<p>Those interested in purchasing should be provided with third-party, objective information on the health risks and benefits. Customers should, for instance, be made aware that psychedelics have <a href="https://doi.org/10.1002/hup.2742">a well-established risk</a> of exacerbating psychotic symptoms. They are therefore <a href="https://doi.org/10.1089/jpm.2017.0684">highly discouraged</a> for those with psychotic disorders, such as schizophrenic tendencies. </p>
<p>Similarly, customers should understand that Hallucinogen Persisting Perception Disorder (HPPD), often known as “flashbacks,” are a rare but noteworthy condition linked to psychedelics use. There are also <a href="https://doi.org/10.1503%2Fcmaj.141124">real risks during trips</a> of acute increases in anxiety, fear, heart rate and blood pressure.</p>
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<a href="https://images.theconversation.com/files/559840/original/file-20231116-15-if7wjj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="hands wearing surgical gloves hold a canister with desiccated mushrooms" src="https://images.theconversation.com/files/559840/original/file-20231116-15-if7wjj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/559840/original/file-20231116-15-if7wjj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=338&fit=crop&dpr=1 600w, https://images.theconversation.com/files/559840/original/file-20231116-15-if7wjj.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=338&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/559840/original/file-20231116-15-if7wjj.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=338&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/559840/original/file-20231116-15-if7wjj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=424&fit=crop&dpr=1 754w, https://images.theconversation.com/files/559840/original/file-20231116-15-if7wjj.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=424&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/559840/original/file-20231116-15-if7wjj.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=424&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">Canada has yet to approve therapeutic psilocybin products.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
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<p>Notwithstanding, adults should also not face fear-mongering around psychedelics. <a href="https://doi.org/10.3390/molecules26102948">Research suggests that</a> psilocybin has low physiological toxicity, minimal potential for addiction, and that overdoses are rare. </p>
<p>In short: adults should be trusted to make the right decisions about the non-addictive psychedelic drugs they wish to use. As such, policymakers should ensure that customers do so fully informed about the benefits and risks, conscious of the ingredients in the products, and without commercial pressure.</p>
<p>Psychedelics are an opportunity to do better than our past drug control strategies. Policymakers can avoid fearmongering while preventing commercial interests from running wild. We only have to look back at cannabis to know that our current approach will not be sustainable.</p><img src="https://counter.theconversation.com/content/217641/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Daniel Eisenkraft Klein receives funding from the Social Sciences and Humanities Research Council and reports employment with Health Canada's Tobacco Control Directorate and the University of Toronto. </span></em></p>Psychedelics are an opportunity to do better than our past drug control strategies. Adults should be trusted to make the right decisions, but policymakers should ensure they do so fully informed.Daniel Eisenkraft Klein, PhD Candidate, Dalla Lana School of Public Health, University of TorontoLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2124352023-08-30T21:16:09Z2023-08-30T21:16:09ZDecriminalization: How police drug seizure, even without arrest, can create harms<iframe style="width: 100%; height: 100px; border: none; position: relative; z-index: 1;" allowtransparency="" allow="clipboard-read; clipboard-write" src="https://narrations.ad-auris.com/widget/the-conversation-canada/decriminalization-how-police-drug-seizure-even-without-arrest-can-create-harms" width="100%" height="400"></iframe>
<p><a href="https://www.overdoseday.com/">International Overdose Awareness Day</a>, an annual campaign to end overdose and drug poisonings while also remembering those who have died, is Aug. 31. Events are being held in <a href="https://www.momsstoptheharm.com/ioad23">communities across Canada</a>, a sign of a worsening crisis that has taken more than <a href="https://health-infobase.canada.ca/substance-related-harms/opioids-stimulants/">36,000 lives since 2016</a>.</p>
<p>The day also represents an opportunity to discuss much-needed policy changes. The <a href="https://drugpolicy.org/issue/decriminalize-drugs-invest-in-health-services/">decriminalization of people who use drugs</a> has long been one of the proposed solutions, an approach that is currently being piloted in British Columbia.</p>
<p>On Jan. 31, 2023, B.C. began a first-in-Canada <a href="https://www.canada.ca/en/health-canada/services/health-concerns/controlled-substances-precursor-chemicals/policy-regulations/policy-documents/exemption-personal-possession-small-amounts-certain-illegal-drugs-british-columbia.html">pilot “decriminalization” policy</a>, in which criminal sanctions for the possession of small amounts of certain illegal drugs for personal use were removed for adults aged 18 or above.</p>
<p>Seven months into this experiment, the impact of this policy remains unclear. Because <a href="https://vancouverisland.ctvnews.ca/data-on-b-c-s-drug-decriminalization-plan-to-be-publicly-available-on-dashboard-1.6252744">a dashboard</a> of policy impact indicator data has not yet been published at the time of writing, it is difficult to weigh <a href="https://vancouversun.com/news/local-news/six-months-into-b-c-s-decriminalization-experiment-whats-working-and-whats-not">the initial effects of the policy</a>.</p>
<p>However, in the city of Vancouver, a policy of <a href="https://doi.org/10.1177/1477370819887514">depenalization</a> (also referred to as de facto decriminalization) has been in place since 2006, providing an opportunity to understand how the provincial pilot may be working — or even improved.</p>
<h2>Depenalization in Vancouver</h2>
<p>Seventeen years ago, the Vancouver Police Department (VPD) launched <a href="https://vpd.ca/wp-content/uploads/2021/06/vpd-policy-drug.pdf">its drug policy</a> to promote <a href="https://doi.org/10.1177/1477370819887514">the depenalization</a> of simple possession offences. Under this policy, VPD officers were encouraged to not arrest or charge people for simple drug possession for personal use except for certain circumstances.</p>
<p>The VPD’s policy differed from B.C.’s pilot decriminalization in several important ways. For example, the VPD’s policy did not specify the class or threshold quantity of drugs to define simple possession. VPD officers were given broad enforcement discretion with respect to drug possession.</p>
<p>Although publicly available VPD data are limited, <a href="https://vpd.ca/wp-content/uploads/2021/06/cleared-drug-charges-january-2014-to-present.pdf">available data</a> indeed indicated low and declining numbers of simple possession charges recommended by the VPD to Crown counsel from 2016 to 2019. These numbers have often <a href="https://vancouversun.com/news/drug-possession-charges-vary-widely-by-police">been cited</a> as the indicator of success of the VPD’s depenalization policy: fewer people are sent to the criminal justice system for the sake of personal drug use.</p>
<p>However, <a href="https://www.straight.com/news/1213101/vancouver-police-stats-suggest-softer-touch-drugs-users-say-its-different-story-streets">anecdotal reports</a> and <a href="https://doi.org/10.1016/j.drugpo.2021.103471">previous qualitative research</a> suggested that police officers might not arrest people for simple possession, but they would still seize drugs. Local communities of people who use drugs and public health advocates in Vancouver expressed concern about the harm created by this policing behaviour.</p>
<p>We undertook <a href="https://doi.org/10.1186/s12954-023-00833-7">surveys involving more than 1,800 people</a> who used drugs on a daily basis in Vancouver to investigate this often undocumented discretionary policing practice.</p>
<h2>Police drug seizures without arrest</h2>
<p>During a 16-month study period in 2019-2021, we found that six per cent of 995 people who used drugs daily in Vancouver (60 per cent residing in the Downtown Eastside neighbourhood that is known for high rates of marginalization and drug use) had had their drugs seized by police without arrest at least once in the past six months. Of those, more than one in four experienced it more than once during the same six-month period.</p>
<p>Of particular concern, 68 per cent of our study participants who had their drugs taken by police without arrest reported having obtained new drugs immediately after the seizure. This portion of the data was collected from the same study population between 2009 and 2012.</p>
<p><a href="https://www.pivotlegal.org/project_inclusion_full">Previous qualitative research</a> documented that acquiring drugs this way could put health and safety at risk in multiple ways. For example, it can put people at a higher risk of drug market violence by creating drug debts.</p>
<p>Some users may also be compelled to acquire new drugs in a rush from an unknown supplier, especially when experiencing painful withdrawal. <a href="https://app.powerbi.com/view?r=eyJrIjoiOGFhMTkwOTktYWQ1My00MzQ4LThlNzItMzVhOWY3NGFmOWQ4IiwidCI6IjZmZGI1MjAwLTNkMGQtNGE4YS1iMDM2LWQzNjg1ZTM1OWFkYyJ9">Amid the ongoing drug toxicity crisis</a>, increasing the frequency of buying drugs in the unregulated drug market, especially through an unknown source, increases risk of drug poisoning.</p>
<p>This is contrary to <a href="https://doi.org/10.1016/j.drugpo.2021.103471%22%22">a belief held among some police officers</a> that seizing drugs would prevent harms, including drug poisoning.</p>
<h2>The role of police in the toxic drug crisis</h2>
<p>A broader question is: Are there any circumstances where police drug seizures are beneficial in preventing drug poisoning? <a href="https://ajph.aphapublications.org/doi/10.2105/AJPH.2023.307291">A recent study from the United States</a> highlighted that police efforts to reduce the unregulated drug supply may worsen the drug toxicity crisis by showing a consistent pattern. As police seizures of drugs increased, drug poisoning cases also increased.</p>
<p>Several scholars noted that <a href="https://ajph.aphapublications.org/doi/10.2105/AJPH.2023.307328">police drug seizures would not address the toxic drug supply</a>, that <a href="https://ajph.aphapublications.org/doi/10.2105/AJPH.2023.307329">the narrow mission of police may exacerbate drug-related harms</a> and that <a href="https://ajph.aphapublications.org/doi/abs/10.2105/AJPH.2023.307320">more harm reduction interventions to address the toxic drug supply are needed</a>.</p>
<p><a href="https://doi.org/10.1186/s12954-023-00833-7">Findings from our study</a> indicate that the VPD’s depenalization policy essentially “<a href="https://d3n8a8pro7vhmx.cloudfront.net/pivotlegal/pages/3494/attachments/original/1639066365/Decriminalization_Report_Final_Revised.pdf">mimics the health and safety harms associated with criminalization</a>” and likely undermines overdose prevention efforts.</p>
<p>Under B.C.’s pilot decriminalization policy, police officers can no longer seize drugs from an adult who possesses up to 2.5 grams of certain illegal drugs. However, the threshold quantity of drugs that defined simple possession has been shown to be <a href="https://doi.org/10.1016/j.drugpo.2023.104126">too low</a> to fulfil the policy objectives. Some people who use drugs, particularly those more marginalized and engaging in high-intensity drug use, may carry more than 2.5 grams of drugs. They may get arrested or experience police drug seizures without arrest.</p>
<p>The annual International Overdose Awareness Day compels us to reckon with ongoing toxic drug deaths and what we can do to reverse this worsening crisis. If decriminalization is going to contribute to positive change, police need to stop seizing drugs from people who use them.</p><img src="https://counter.theconversation.com/content/212435/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Kanna Hayashi holds the St. Paul's Hospital Chair in Substance Use Research and is supported in part by a U.S. National Institute on Drug Abuse (NIDA) grant (U01DA038886) and the St. Paul’s Foundation. For the research work presented here, she received funding through a NIDA grant (U01DA038886), a Michael Smith Health Research BC Scholar Award and the William and Ada Isabelle Steel Fund through Simon Fraser University. She also receives funding from the Canadian Institutes of Health Research and the Social Sciences and Humanities Research Council to support her ongoing research in this area. She is also affiliated with the Vancouver Coastal Health Authority as research staff and the Division of Social Medicine, Department of Medicine, University of British Columbia as an affiliate assistant professor. </span></em></p>A police policy of not making arrests for simple possession is a way to essentially decriminalize personal drug use. However, confiscating drugs — even without arrests — can be harmful in many ways.Kanna Hayashi, Research Scientist at the British Columbia Centre on Substance Use & St. Paul's Hospital Chair in Substance Use Research and Associate Professor, Faculty of Health Sciences, Simon Fraser UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2079982023-07-24T14:47:10Z2023-07-24T14:47:10ZProdrugs: pills your body converts into an illicit drug can evade detection, but we don’t know how big the problem is<figure><img src="https://images.theconversation.com/files/534827/original/file-20230629-21-yyrva0.jpg?ixlib=rb-1.1.0&rect=7%2C0%2C4985%2C3323&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/young-woman-having-psychedelic-trip-hallucinations-2168132723">Blackday/Shutterstock</a></span></figcaption></figure><p>Drug traffickers have found a way to trick enforcement agencies by using one of the most potent tools our bodies have: our metabolism. Welcome to the world of prodrugs. </p>
<p>Prodrugs are substances that can only cause an effect after being broken down by enzymes in the digestive system or other chemical reactions in the body. While they have legitimate pharmacological uses (<a href="https://www.nature.com/articles/nrd2468">between 5% and 7% of approved drugs fall under this category</a>), their <a href="https://www.jstage.jst.go.jp/article/yakushi/140/11/140_20-00124/_article/-char/ja/">use</a> as street drugs is a relatively new phenomenon. </p>
<p>Most illicit drugs work by <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC80880/#:%7E:text=Drugs%20of%20abuse%20are%20able,over%20this%20mesolimbic%20dopaminergic%20pathway.">interacting with specific brain cell receptors</a>, stimulating or blocking the release of chemicals called neurotransmitters. They last for a short time before being transformed into inactive or less active chemicals, which are then eliminated from the body, usually in urine. </p>
<p>For prodrugs, however, a small part of the molecule needs to be removed or substituted before it can act on those receptors. This is done inside the body by natural processes. <a href="https://en.wikipedia.org/wiki/ALD-52">ALD-52</a> (1-acetyl-LSD), for example, is a prodrug that is converted by the body into LSD after the removal of two carbon and one oxygen atom.</p>
<p>Although some <a href="https://www.sciencedirect.com/book/9781483232966/the-hallucinogens">reports</a> indicate that ALD-52 has been around since the 1960s, it was first officially detected in <a href="http://www.emcdda.europa.eu/system/files/publications/4724/TDAN17001ENN_PDFWEB.pdf">2016</a> by the authorities in France. The UK government was quick to list this prodrug as a controlled substance <a href="https://www.legislation.gov.uk/uksi/2014/3276/article/2/made#text%3DALD-52">as early as 2014</a>, even though there were no reports of drug seizures or known harms. Since then, many other prodrugs <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/1556-4029.14268">have been identified</a>.</p>
<p>Seizure of LSD prodrugs, such as ALD-52, increased at the height of the <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8411784/">COVID pandemic in Italy</a>. Japanese authorities have been dealing with an increasing number of <a href="https://www.sciencedirect.com/science/article/abs/pii/S2352007822003675">similar LSD prodrug compounds</a>. And in Brazil, the <a href="https://www.sciencedirect.com/science/article/pii/S0379073822003279?casa_token=JAgmG-7fCD8AAAAA:HxfcYkSS4FVopGgc-lTolrwF39sibU0oX4M1VqvKsrW07Kpqxx0-tAlgStAJvUDzkpwZoT61NP-Q#bib24">first reports</a> of these LSD prodrug were made in 2022.</p>
<p>The party drug GHB also has a <a href="https://www.gov.uk/government/publications/assessment-of-the-harms-of-gamma-hydroxybutyric-acid-gamma-butyrolactone-and-closely-related-compounds">prodrug equivalent</a>. It is called GBL (gamma-butyrolactone). </p>
<p>The UK introduced tougher controls for GBL – which is usually sold as a cleaning agent – <a href="https://www.gov.uk/government/publications/circular-0012022-reclassification-of-ghb-and-related-substances/circular-0012022-reclassification-of-ghb-and-related-substances">in 2022</a>. Following strong recommendations from the government’s Advisory Council on Misuse of Drugs, GBL is now classified as a class B drug, alongside cannabis and ketamine.</p>
<p>For stimulants, it is known that some commercially available drugs can be converted in the body into amphetamines and may be <a href="https://journals.sagepub.com/doi/abs/10.1177/0269881109103113">abused</a> for their potentially psychoactive effects - which justifies the strict control in their prescription. </p>
<p>Drug traffickers have also developed ways to mask illegal MDMA (ecstasy) by adding a small molecule that can be removed by chemical reactions or in the stomach through contact <a href="https://analyticalsciencejournals.onlinelibrary.wiley.com/doi/10.1002/dta.2059">with gastric acid</a>.</p>
<h2>Hard to detect</h2>
<p>A major problem with prodrugs is they are difficult to detect. Police forces need <a href="https://wires.onlinelibrary.wiley.com/doi/full/10.1002/wfs2.1486">reference samples</a> to compare the drug with, or advanced equipment to discover its molecular structure. Since the list of these compounds is not known and minute chemical changes can lead to different patterns to be analysed, these new drugs are easy to miss. It also explains why many have only appeared in police reports in the past decade.</p>
<p>For biological samples (such as blood, urine or saliva), there is another difficulty. Since the prodrugs must be converted inside the body before they become active, they are, in effect, <a href="https://onlinelibrary.wiley.com/doi/10.1111/1556-4029.14268">absent</a> in cases of lethal overdoses, as the substance that causes harm and death is the product of that transformation. So telling apart prodrugs from the more classical components they are converted into is an obstacle. While the overall effects leading to death would be the same, appropriately identifying which drug was originally used can help indicate trends for illegal sales, use and availability.</p>
<p>For GHB prodrugs - namely GBL and 1,4-butanedione - lawmakers have been progressively including them in stricter and more specific legislation. But for LSD prodrugs, in many countries it falls under a grey area. While France, Japan and the UK have nominally included ALD-52 and 1p-LSD in their controlled substances laws, in the US and Canada they have to be proved to be an analogue – that is, they possess a similar molecular structure and can cause the same effects – or they are not covered by current law.</p>
<figure class="align-center ">
<img alt="Dog sniffing a suitcase at the airport" src="https://images.theconversation.com/files/538327/original/file-20230719-15-7nkpc7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/538327/original/file-20230719-15-7nkpc7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=409&fit=crop&dpr=1 600w, https://images.theconversation.com/files/538327/original/file-20230719-15-7nkpc7.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=409&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/538327/original/file-20230719-15-7nkpc7.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=409&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/538327/original/file-20230719-15-7nkpc7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=514&fit=crop&dpr=1 754w, https://images.theconversation.com/files/538327/original/file-20230719-15-7nkpc7.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=514&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/538327/original/file-20230719-15-7nkpc7.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=514&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Without a reference sample, prodrugs can be hard to detect.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/officer-dog-checking-suitcase-airport-closeup-1538486276">New Africa/Shutterstock</a></span>
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</figure>
<p>In the UK, new psychoactive substances are <a href="https://www.gov.uk/government/publications/forensic-early-warning-system-fews-annual-report/annual-report-on-the-home-office-forensic-early-warning-system-fews-2021-to-2022">defined as</a> either a compound controlled by the Psychoactive Substances Act 2016 or a compound controlled by the Misuse of Drugs Act (post-2008). However, to be included in the Psychoactive Substances Act 2016 there has to be evidence of causing psychoactivity - defined as those compounds that can affect mental functions, such as <a href="https://www.who.int/health-topics/drugs-psychoactive#tab=tab_1">cognition, mood and emotions</a>. </p>
<p>Psychoactivity can also be determined by laboratory <a href="https://www.cps.gov.uk/legal-guidance/psychoactive-substances">testing</a>. Drugs are incubated with a small number of cells and researchers measure whether they bind to proteins on the surface, which are called receptors. Many prodrugs, however, will not bind to the receptors before they are converted. Where a substance is not listed in the legislation as controlled, and laboratory tests (for molecular similarity or binding to receptors) are required, there’s more room for in-court dissent.</p>
<p>Even if such seizures are infrequent and do not reach the numbers for more commonly used drugs, such as cocaine, cannabis or heroin, their appearance in the illegal market should serve as a warning sign of potentially changing trends in the illicit drug market. </p>
<p>There are potentially unknown effects – in intensity and duration – but also difficulty in prosecuting people who supply these prodrugs. With one new psychoactive substance reaching the illegal market roughly <a href="https://www.unodc.org/res/wdr2022/MS/WDR22_Booklet_4.pdf">every week in 2021</a>, the sheer diversity of drugs on the market has been indicated as one of the <a href="https://www.emcdda.europa.eu/publications/european-drug-report/2023/drug-situation-in-europe-up-to-2023_en">main challenges</a> for toxicologists and forensic chemists.</p><img src="https://counter.theconversation.com/content/207998/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Julio de Carvalho Ponce does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>The problem with prodrugs is we don’t know how big the problem is because they are so hard to identify.Julio de Carvalho Ponce, Lecturer in Forensic Science, University of WinchesterLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2076792023-06-27T21:21:32Z2023-06-27T21:21:32ZLet evidence, not opinion, guide harm reduction policy and practice in Canada’s drug poisoning crisis<p>The poisoning of the unregulated drug supply, especially in Canada, is a public health crisis that deserves a high priority for the integration of evidence into policy and practice. </p>
<p>The <a href="https://www.cbc.ca/news/health/drug-poisoning-deaths-language-1.6457834">drug poisoning crisis</a> is often referred to as the opioid crisis, but it is all illicit substances, including stimulants, that are tainted with fentanyl, benzodiazepines and other dangerous ingredients, <a href="https://doi.org/10.1111/add.15844">increasing the risk of harm, especially overdose</a>. </p>
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Read more:
<a href="https://theconversation.com/benzo-dope-may-be-replacing-fentanyl-dangerous-substance-turning-up-in-unregulated-opioids-164286">‘Benzo-dope’ may be replacing fentanyl: Dangerous substance turning up in unregulated opioids</a>
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<p>It is still an ongoing battle for those in positions of power to submit to the rigorous evidence supporting harm reduction, despite strategies like <a href="https://doi.org/10.1186/s12954-017-0154-1">supervised consumption sites</a> and the distribution of drug equipment <a href="https://www.phs.ca/insite-an-anniversary-of-hope/">being more than two decades old</a>. </p>
<p>For example, North America’s first formal supervised consumption site, <a href="https://www.phs.ca/program/insite/">Insite</a>, has been in operation for 20 years showcasing what its founding organization, PHS Community Services, calls a “<a href="https://www.phs.ca/insite-an-anniversary-of-hope/">pragmatic and humane approach to the risks of drug use</a>.” </p>
<p>Thorough evaluation of harm reduction strategies has shown they can <a href="https://doi.org/10.1186/s12954-017-0154-1">save money, save lives and promote health</a> at an individual and population level. Furthermore, denial of access to supervised consumption is a <a href="https://scc-csc.lexum.com/scc-csc/scc-csc/en/item/7960/index.do">violation of Section 7 of the Canadian Charter of Rights and Freedoms</a>, which protects an individual’s right to life, liberty and security of the person.</p>
<h2>Stigma and ideology</h2>
<p>Recently, Canada’s leader of the Opposition Pierre Poilievre had his motion to defund safer supply voted down in Parliament. His reference to a “<a href="https://www.ourcommons.ca/DocumentViewer/en/44-1/house/sitting-200/hansard">tax-funded drug supply</a>” as fuelling addiction rather than recovery is not supported by evidence and follows the <a href="https://www.cbc.ca/news/politics/conservative-motion-safe-supply-fails-1.6858551">failed prejudicial ideology of the war on drugs era</a>. </p>
<p>Poilievre’s actions mirror the sentiments of former federal health minister Rona Ambrose, whose opinion also superseded evidence while in a position of influence. In 2013 she attempted to deny access to heroin assisted treatment (HAT) — an <a href="https://doi.org/10.1136/bmj.327.7410.310">opioid substitution treatment using diamorphine/diacetylmorphine (medical grade heroin</a>) — for persons with substance use disorder in Vancouver. </p>
<p><a href="https://www.providencehealthcare.org/sites/default/files/Supreme%20Court%20of%20British%20Columbia%20Decision.pdf">Ambrose publicly stated that</a> “Our policy is to take heroin out of the hands of addicts, not to put it into their arms.”</p>
<p>Ambrose made this public declaration <a href="https://doi.org/10.1016/j.jsat.2006.04.007">despite evidence</a> from both <a href="https://doi.org/10.1056/NEJMoa0810635">Canada</a> and <a href="https://doi.org/10.1136/bmj.317.7150.13">Europe</a> that <a href="https://doi.org/10.1192/bjp.bp.106.026112">showcased the efficacy</a> of HAT in six <a href="https://doi.org/10.1016/S0140-6736(10)60349-2">randomized controlled trials</a> with over 1,500 patients.</p>
<h2>What is evidence?</h2>
<p>What is considered evidence, especially regarding public health? From an epistemological (justified belief, as opposed to opinion) perspective, we may think evidence equals truth. However <a href="https://global.oup.com/academic/product/population-health-science-9780190459376?cc=ca&lang=en&">causation cannot be observed, only inferred</a>. While evidence may be viewed as more of a confirmation, truly <a href="https://doi.org/10.1046/j.1365-2753.2000.00244.x">definitive scientific evidence is rare due to its ever-changing and evolving nature</a>. </p>
<p>Evidence comes in many forms, and although it may not constitute absolute “proof,” it is reliable.</p>
<p>In harm reduction, best practices are grounded in evidence that comes from several facets including peer-reviewed literature, unpublished reports or grey literature, and the experiential knowledge of persons who use drugs themselves. </p>
<p>The way <a href="https://doi.org/10.1016/j.drugpo.2020.103015">harm reduction has progressed in Canada</a> tells us that <a href="https://doi.org/10.1186/s13011-021-00406-6">people who use drugs are key informants at the table</a> as they articulate their own experience of what it is like to use substances from an unregulated supply and to navigate the health and social services system. <a href="https://doi.org/10.1111/add.158441196COMMENTARIES">Their voice in the conversation</a> helps to reduce stigma, support client-centred essential services and policies, and prioritize the needs of people who use substances.</p>
<h2>Barriers to progress</h2>
<p>The question still remains as to why government policies across Canada, public stigma, and ignorance towards the use of substances and the people who use them, are still able to create barriers to the promotion of strategies that fight the current drug poisoning crisis. </p>
<p>During the COVID-19 pandemic, <a href="https://www.who.int/emergencies/diseases/novel-coronavirus-2019/interactive-timeline">public health strategies were implemented at a rapid pace</a>, but this same urgency is not translating to our community of people who use unregulated drugs. One would think that <a href="https://health-infobase.canada.ca/substance-related-harms/opioids-stimulants">the loss of nearly 40,000 Canadians to opioid overdoses since 2016</a> would be impetus for not just change, but bold action.</p>
<p>Has government not learned its lessons about taking all aspects of evidence into consideration while also considering the urgency of action required in crisis situations? After public health failures during the 2001 SARS crisis, <a href="https://doi.org/10.1098/rsfs.2021.0079">Justice Archie Campbell recommended in his report</a>: </p>
<blockquote>
<p>“Where there is reasonable evidence of an impending threat to public harm, it is inappropriate to require proof of causation beyond a reasonable doubt before taking steps to avert the threat…that reasonable efforts to reduce risk need not await scientific proof.” </p>
</blockquote>
<p>The ultimate question that needs to be asked to those who have the power to move harm reduction forward is: If they want to be a part of ending the drug toxicity crisis, then why and for whom? Is their primary objective more votes? Or is it to value all members of our community, and not just keep people who use drugs alive, but to help them thrive? </p>
<p>If the goal is wanting to be a part of ending this crisis for the betterment of the persons experiencing it, then the approach must include weighing evidence from a variety of sources and triumphing over public and political ideology and stigma. </p>
<p><a href="https://plato.stanford.edu/entries/egalitarianism/#Pri">Prioritarianism</a>, as a principle of justice, puts the focus on the population most in need, whether it be in terms of health, resources, opportunities or access. The moral and ethical values of this approach intend to maximize overall well-being for those who need it the most. </p>
<p>Movement forward requires collaboration that builds on existing strengths and capacities, with the guiding principle being to <a href="https://healthydebate.ca/2021/09/topic/encampments-pandemic-covid/">put the needs of the persons living this experience first</a>. Bioethicist Anita Ho describes epistemic humility — the ability to challenge one’s preconceived and biased assumptions — as “<a href="https://doi.org/10.2979/intjfemappbio.4.2.102">characterized by a commitment to mutual collaboration and trust with those they serve</a>.” </p>
<p>A healthy public includes us all.</p><img src="https://counter.theconversation.com/content/207679/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Ross Upshur receives funding from Health Canada, CIHR, Atlas Institute for Veterans and Families</span></em></p><p class="fine-print"><em><span>Karla Ghartey does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Harm reduction is grounded in evidence. But policies, stigma and ignorance about substance use still create barriers in battling Canada’s drug poisoning crisis.Karla Ghartey, Doctor of Public Health (DrPH) student, University of TorontoRoss Upshur, Professor, Dalla Lana School of Public Health, University of TorontoLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1880252022-10-13T16:43:33Z2022-10-13T16:43:33ZUK drug policy: how seizing passports will not stop illicit dug use<figure><img src="https://images.theconversation.com/files/477941/original/file-20220806-60240-s2snw5.jpg?ixlib=rb-1.1.0&rect=18%2C36%2C5988%2C3683&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Shutterstock</span></span></figcaption></figure><p>In <a href="https://www.gov.uk/government/consultations/swift-certain-tough-new-consequences-for-drug-possession-white-paper/swift-certain-tough-new-consequences-for-drug-possession-accessible-version">an attempt</a> to clamp down on recreational drug use, the British government recently set out a three-tier system for dealing with people caught in possession of illegal substances. </p>
<p>A scale of punishments would be introduced for those caught in possession once, twice or three times. These would begin with a fine and culminate in a variety of <a href="https://www.standard.co.uk/news/uk/government-take-away-recreational-drug-users-passports-tougher-new-measures-b1013243.html">deeply punitive options</a> such as tagging offenders, suspending their driving licence and even confiscating their passport.</p>
<p>All this is being promoted as part of a <a href="https://www.gov.uk/government/consultations/swift-certain-tough-new-consequences-for-drug-possession-white-paper/swift-certain-tough-new-consequences-for-drug-possession-accessible-version">government plan</a>, entitled Swift, Certain, Tough: new consequences for drug possession, which aims to bring overall drug use down to “a historic 30-year low” by “delivering a generational shift in demand”.</p>
<p>Other nations, including the US, <a href="https://sensiseeds.com/en/blog/countries/cannabis-in-jamaica-laws-use-history/">Jamaica</a> and <a href="https://www.washingtonpost.com/travel/2022/06/14/marijuana-legal-thailand-tourists/">Thailand</a> are modernising their drug policies and moving away from criminalisation. The UK, meanwhile, seems determined to disregard the evidence that has for decades contradicted the idea that ever-tougher responses are needed. </p>
<p>Research has long shown that punitive measures are not a deterrent. Further, most illegal drug use is recreational, more commonly associated with leisure and pleasure than criminality. <a href="https://www.researchgate.net/publication/295683507_Prohibition_privilege_and_the_drug_apartheid_The_failure_of_drug_policy_reform_to_address_the_underlying_fallacies_of_drug_prohibition">Research shows</a> that recreational drug use rarely leads to addiction or requires treatment. </p>
<p>The government seems far from understanding this, as is evident when it calls drugs the “root of untold harm and misery across our society” in its reform proposals. It is questionable whether this reductionist discourse applies to any drug user – there are, for example, functioning heroin addicts who live normal productive lives – let alone recreational drugs and their users. </p>
<p>Evidence shows criminalising otherwise law-abiding citizens for their drug use does <a href="https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/368489/DrugsInternationalComparators.pdf">not deter</a> them from doing it. In fact, it merely serves to damage their <a href="https://heinonline.org/HOL/Page?handle=hein.journals/cjrr37&div=5&g_sent=1&casa_token=LZj3VbIKfgUAAAAA:sIdLIf5hW9URNPFQEbBcleOsX2F6sBrVuTIjJWStB8iNCyzg_C3KT_KKQIYOvOXWtBpPMedLnw&collection=journals">life chances</a></p>
<p>We know that a conviction makes it harder for people (and particularly young people) to find housing, get a job and travel. It also makes them more likely to continue offending. All this should make the government think long and hard about which offences therefore justify serious punishment. </p>
<h2>Punitive measures are discriminatory in practice</h2>
<p>Drug laws and their punishments are not applied equitably and tend to discriminate along the lines of <a href="https://journals.sagepub.com/doi/abs/10.1177/0264550504048221?casa_token=DvDmXqVYtQMAAAAA:n_0fLxEZXvFie7CWz_UUUCCgcQmgdTOHWUwC3uwHDay_A50A8k6wsBq14MeYIR69WiUN2j16SN9QcA">class</a>, and <a href="https://papers.ssrn.com/sol3/papers.cfm?abstract_id=3032763">gender</a>, as we have already seen with cannabis warnings. Cannabis warnings are issued by the police for those found in possession of a small amount of cannabis and operate as the first stage of a similar three-tiered escalation system implemented to deal with cannabis use. </p>
<p>And when it comes to <a href="https://www.release.org.uk/sites/default/files/pdf/publications/The%20Colour%20of%20Injustice.pdf">race</a>, they discriminate too. In London, black people, often from deprived areas, receive cannabis warnings at <a href="https://www.release.org.uk/sites/default/files/pdf/publications/Release%20-%20Race%20Disparity%20Report%20final%20version.pdf">three times the rate of white people</a>. </p>
<p>Law enforcement measures are being used to deter recreational drug use, while more harmful substances such as <a href="https://theconversation.com/four-ways-alcohol-is-bad-for-your-health-92578#:%7E:text=It%20has%20been%20estimated%20that,worldwide%2C%20contributing%20to%20770%2C000%20cases.&text=Cancer%20risk%20can%20increase%20at,two%20standard%20drinks%20a%20day.">alcohol</a>, <a href="https://theconversation.com/smoking-age-heres-what-effect-raising-it-to-21-could-have-in-england-184874">tobacco</a> and <a href="https://theconversation.com/how-diets-high-in-sugar-and-saturated-fat-could-be-harming-your-brain-73657">sugar</a> remain legal and socially acceptable. This, despite the research being clear on how such substances cause more harm than many of their illicit counterparts. A truly evidence-based approach to drugs would look very different. </p>
<p>The proposed new “three-tier” approach may appear to be a reform but the reality is that while the government’s proposed punishments for first and second offences may appear to err towards decriminalisation, the punishments for third offences – tagging offenders, suspending their driving licences and confiscating their passports – are extreme. </p>
<figure class="align-center ">
<img alt="Two police officers question a man in a car." src="https://images.theconversation.com/files/477942/original/file-20220806-48698-gwa1qd.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/477942/original/file-20220806-48698-gwa1qd.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=338&fit=crop&dpr=1 600w, https://images.theconversation.com/files/477942/original/file-20220806-48698-gwa1qd.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=338&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/477942/original/file-20220806-48698-gwa1qd.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=338&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/477942/original/file-20220806-48698-gwa1qd.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=424&fit=crop&dpr=1 754w, https://images.theconversation.com/files/477942/original/file-20220806-48698-gwa1qd.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=424&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/477942/original/file-20220806-48698-gwa1qd.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=424&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Heavy policing doesn’t end drug use, as decades of the same approach have proved.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
</figcaption>
</figure>
<p>Ultimately, this remains a law enforcement approach that has already been shown to be ineffective. It will not bring overall drug use down. It will, however, undoubtedly cause untold harm to thousands of people. </p>
<p>Instead of focusing on low-level possession of recreational drugs, we need realistic, effective, evidence-based ways to reduce the harms of drugs, in terms of use and supply. We also need to <a href="https://theconversation.com/why-addiction-treatment-is-in-need-of-a-fix-43754">support those drug users</a> who want support, rather than inflicting punishments that will disproportionately criminalise certain groups of users.</p><img src="https://counter.theconversation.com/content/188025/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Tammy Ayres has previously received funding from a range of local and national authority bodies and registered organisations, including research councils. She does not however work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond her academic appointment.</span></em></p><p class="fine-print"><em><span>Stuart Taylor has previously received funding from a number of local authority bodies and registered charity organisations.</span></em></p>Research has long shown that criminalising otherwise law-abiding citizens for their drug use is no deterrent. It only damages their life chances, in a discriminatory fashion.Tammy Ayres, Lecturer in Criminology, University of LeicesterStuart Taylor, The Open UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1849262022-06-19T12:50:48Z2022-06-19T12:50:48ZDecriminalizing hard drugs in B.C. follows decades of public health advocacy<figure><img src="https://images.theconversation.com/files/469560/original/file-20220617-14205-7slb7v.JPG?ixlib=rb-1.1.0&rect=0%2C467%2C5439%2C3853&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">B.C. Minister of Mental Health and Addictions Sheila Malcolmson holds a copy of exemption documents that enable British Columbia to decriminalize possession of small amounts of 'hard' drugs for personal use. B.C.’s bold experiment will be closely watched as a comparator with other progressive jurisdictions.
</span> <span class="attribution"><span class="source">THE CANADIAN PRESS/Darryl Dyck</span></span></figcaption></figure><iframe style="width: 100%; height: 100px; border: none; position: relative; z-index: 1;" allowtransparency="" allow="clipboard-read; clipboard-write" src="https://narrations.ad-auris.com/widget/the-conversation-canada/decriminalizing-hard-drugs-in-b-c--follows-decades-of-public-health-advocacy" width="100%" height="400"></iframe>
<p><a href="https://globalnews.ca/news/8882290/bc-overdose-crisis-decriminalize-possession/?utm_source=NewsletterNational&utm_medium=Email&utm_campaign=2022">British Columbia has become</a> the first province to be granted an exemption under the <a href="https://laws-lois.justice.gc.ca/eng/acts/c-38.8/">Controlled Drugs and Substances Act</a> to remove criminal penalties for possession of opioids, cocaine, methamphetamine and MDMA for personal use. </p>
<p>This means that police will no longer arrest, charge or seize drugs from adults found with 2.5 grams or less of these substances. Instead, people with drugs will be offered information on available health and social services and assistance with referrals to access treatment if they choose.</p>
<p>B.C.’s bold experiment to decriminalize “hard” drugs will be closely watched as a comparator with other progressive jurisdictions, such as <a href="https://www.pbs.org/newshour/politics/oregon-1st-state-to-decriminalize-possession-of-hard-drugs">Oregon</a> and <a href="https://www.theguardian.com/news/2017/dec/05/portugals-radical-drugs-policy-is-working-why-hasnt-the-world-copied-it">Portugal</a>. Decriminalization in these places has been implemented differently, reflecting the distinctive circumstances and priorities that influence drug policy in different global contexts.</p>
<p>As a sociologist who has been studying drug policy development in Canada for nearly 30 years, it is plainly evident to me that decision-making is a political process that does not rest on facts alone. <a href="https://doi.org/10.1017/S0829320100006566">Drug policy</a> reflects <a href="https://doi.org/10.1080/0959523021000023270">ideological commitments</a> that are influenced by, and in turn influence, prevailing public understandings and opinions about drugs. <a href="https://doi.org/10.1080/09595230500404145">Exposure to the facts</a> — which are also contested — and <a href="https://doi.org/10.1016/S0955-3959(01)00085-8">constructive dialogue about social norms and values</a> is needed to facilitate more meaningful debate. </p>
<figure class="align-center ">
<img alt="Cropped image of a group of people, one of whom is holding a hand-lettered sign reading 'Every death is a drug policy failure'" src="https://images.theconversation.com/files/469561/original/file-20220617-20-ftu74x.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/469561/original/file-20220617-20-ftu74x.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/469561/original/file-20220617-20-ftu74x.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/469561/original/file-20220617-20-ftu74x.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/469561/original/file-20220617-20-ftu74x.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/469561/original/file-20220617-20-ftu74x.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/469561/original/file-20220617-20-ftu74x.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Advocates gather in Victoria to mark the anniversary of the declaration of a public health emergency in opioid-related overdoses in British Columbia on April 14.</span>
<span class="attribution"><span class="source">THE CANADIAN PRESS/Chad Hipolito</span></span>
</figcaption>
</figure>
<p>Decriminalizing drug use is the <a href="https://www.oupcanada.com/catalog/9780199007882.html">realization of 50 years of policy discussions</a> advocating for removal of all penalties for small amounts of drugs. The called-for public health perspective is just beginning to materialize, despite extensive evidence that <a href="https://cannabiscoalition.ca/info/HarmReductionHeadway_Resistance_IJDPX2008.pdf">the war on drugs has failed</a>. The research evidence instead supports the view that prohibition of substance use has been ineffective, costly, inhumane and harmful to the user and society.</p>
<h2>Why so little progress for so long?</h2>
<p>Canada has long pursued half-measures by adopting a hybrid model recognizing public health considerations within a legal framework that enforces prohibition. The <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1947221/pdf/canmedaj01573-0103.pdf">LeDain Commission of Inquiry</a> in 1972 proposed a gradual withdrawal from criminal penalties for illicit drug possession, phasing out incarceration in favour of medical treatment. </p>
<p>The LeDain report foreshadowed the emergence of drug policy with the goal of <a href="https://ontario.cmha.ca/harm-reduction/">harm reduction</a> and the need for more attention to the principles that underlie drug policy debates. What is meant by “harm” has been contentious when determining the proper role of law when the police and politicians define harm in ways that justify continued prohibition.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/469565/original/file-20220617-23-jl5q1d.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A woman at a podium in front of a row of flags, and two other women at opposite sides of stage, in front of background with the words 'A pathway to hope'" src="https://images.theconversation.com/files/469565/original/file-20220617-23-jl5q1d.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/469565/original/file-20220617-23-jl5q1d.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/469565/original/file-20220617-23-jl5q1d.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/469565/original/file-20220617-23-jl5q1d.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/469565/original/file-20220617-23-jl5q1d.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/469565/original/file-20220617-23-jl5q1d.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/469565/original/file-20220617-23-jl5q1d.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Minister of Mental Health and Addictions Sheila Malcolmson discusses details about the province’s application for decriminalization at the provincial legislature in Victoria on Nov. 1, 2021, as provincial health officer Dr. Bonnie Henry and chief coroner Lisa Lapointe look on.</span>
<span class="attribution"><span class="source">THE CANADIAN PRESS/Chad Hipolito</span></span>
</figcaption>
</figure>
<p>Ten years after the LeDain report, the enactment of the <a href="https://www.justice.gc.ca/eng/csj-sjc/rfc-dlc/ccrf-ccdl/">Charter of Rights and Freedoms</a> provided legal tools that complement more scientific evidence-based arguments for drug policy reform. The success of <a href="https://doi.org/10.1017/S0829320100006566">legal challenges on Charter grounds</a>, however, has been largely limited to striking down the most egregious policing practices and penalties for drug crimes.</p>
<p>Sweeping changes in the law might well have been expected with the launch of <a href="https://www.csc-scc.gc.ca/research/forum/e133/133a_e.pdf">Canada’s Drug Strategy</a> in 1987. The language change was monumental: it covered the full spectrum of non-medical drug use, including legal drugs like alcohol, prescription drugs and even solvents; and it signalled an intent to set out in a new direction that dramatically departed from the war-on-drugs approach. </p>
<p>The implementation of the strategy, however, was much less so. Police continued to command the lion’s share of funding, despite the promise of pursuing a “more balanced” and coherent public health approach to substance use. </p>
<p>Thirty-five years later, the situation has changed little. In 2018, after decades of debate, but little action indicating actual commitment to reform, <a href="https://www.justice.gc.ca/eng/cj-jp/cannabis/">cannabis was legalized in Canada</a>, transforming its users from pariahs to responsible consumers. Users of more dangerous drugs continue to be treated differently, primarily because such use elicits more concern for crime control than protecting health. </p>
<h2>Lessons from other jurisdictions</h2>
<p>In Oregon, the lack of full commitment to a public health approach explains the <a href="https://abcnews.go.com/Health/wireStory/oregon-decriminalized-drugs-2020-hows-83846382">“mixed results.”</a> U.S.-style decriminalization there has been adopted as a social justice remedy to mitigate the impact of policing on marginalized communities.</p>
<p>In 2020, Oregon voters approved a <a href="https://www.oregonlegislature.gov/lpro/Publications/Background-Brief-Measure-110-(2020).pdf">ballot measure to decriminalize hard drugs</a> as a way to keep addicts out of prison and get them into treatment. Possession of controlled substances is now a “violation” carrying a maximum US$100 fine. The fine is waived if the offender calls a hotline for assessment, which may lead to them receiving treatment. </p>
<p>However, after the first year, just one per cent had used the hotline, and nearly half did not show up to court, prompting criticism that the system is too lenient.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/469563/original/file-20220617-19-1btqrg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A black wall with colourful handprints and names on it" src="https://images.theconversation.com/files/469563/original/file-20220617-19-1btqrg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/469563/original/file-20220617-19-1btqrg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/469563/original/file-20220617-19-1btqrg.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/469563/original/file-20220617-19-1btqrg.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/469563/original/file-20220617-19-1btqrg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/469563/original/file-20220617-19-1btqrg.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/469563/original/file-20220617-19-1btqrg.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Some of the handprints of people recovering from drug addiction are seen on a wall in the parking lot of an addiction recovery centre in McMinnville, Ore., on Dec. 9, 2021.</span>
<span class="attribution"><span class="source">(AP Photo/Andrew Selsky)</span></span>
</figcaption>
</figure>
<p>Portugal’s adoption of decriminalization measures has been <a href="https://transformdrugs.org/blog/drug-decriminalisation-in-portugal-setting-the-record-straight">implemented more successfully</a>, in part because its social safety net is far more comprehensive and better integrated with the criminal justice system. </p>
<p>Portugal’s approach is both more vigorous and nuanced, recognizing that most drug use is “low risk” and requires no intervention. The vast majority of cases referred by the police are deemed non-problematic and the charges are suspended. Those who have a pattern of repeated violations may be issued fines or offered counselling appointments. Substance use dependence and abuse in high-risk cases more often triggers a referral for non-mandatory treatment. </p>
<p>Portugal’s adoption of a graduated system of intervention demonstrates a view that is consistent with coherent harm reduction policy development. Drug use is treated as a health issue. And the proof is in the pudding. Since these measures were enacted in 2001, drug-related deaths and rates of drug use have remained below the European Union average. The rates of HIV infection from injection drug use, and incarceration for committing drug offences, have also been dramatically reduced. </p>
<p>Canada’s adoption of a public health perspective on substance use is hampered by its failure to address the inconsistencies inherent in its hybridized approach. Enacting harm reduction within a prohibition framework perversely criminalizes people recognized as needing help.</p>
<p>B.C.’s bold experiment provides an opportunity to implement more balance in Canadian drug policy, and a more principled withdrawal from the war on drugs. Much can be learned from other places in deciding the path forward, and the world is waiting for new lessons to be learned.</p><img src="https://counter.theconversation.com/content/184926/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Andrew Hathaway does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>British Columbia’s bold experiment provides an opportunity to implement more balance in Canadian drug policy, and a more principled withdrawal from the war on drugs.Andrew Hathaway, Professor, Department of Sociology and Anthropology, University of GuelphLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1786242022-03-09T14:39:23Z2022-03-09T14:39:23ZUkraine’s opiate users: Russian invasion has severely disrupted access to drug-treatment services<p><a href="https://phc.org.ua/kontrol-zakhvoryuvan/zalezhnist-vid-psikhoaktivnikh-rechovin/zamisna-pidtrimuvalna-terapiya-zpt/statistika-zpt">About 317,000</a> Ukrainians inject drugs like heroin regularly. As of January, 14,868 of them were receiving substitute opiates such as methadone and buprenorphine. </p>
<p>Ukraine <a href="https://harmreductioneurasia.org/countries/ukraine/">has been funding</a> these treatment services since 2017. In that year, it also rapidly expanded its services for people in need of sterile syringes, condoms and peer support or counselling – the World Health Organization-recommended <a href="https://www.avert.org/news/undisputable-worth-ukrainian-harm-reduction-organisations-revealed-eight-year-analysis">minimum</a> for harm reduction among drug users and those at risk of HIV. </p>
<p>The Russian invasion has severely disrupted access to these specialist drug-treatment services. Before the war, some people would collect their methadone daily, but the Ministry of Health <a href="https://inpud.net/global-call-for-solidarity-with-people-who-use-drugs-in-ukraine/">has advised</a> that a 15-30 days’ supply should be given. This helps to reduce the number of trips to services, which in some parts of the country are risky. Yet even at this early stage in the war, ensuring people can secure medication is proving difficult.</p>
<p>Of the 1,328 people registered with drug services in Kyiv, so far, most have been able to get their opiate substitution medication. But services in other parts of the country aren’t faring so well. They are either running out of supplies or contact has been lost with local drug treatment teams.</p>
<p>Without this daily supply, people will develop <a href="https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1360-0443.1994.tb03745.x">severe withdrawal</a> symptoms. Although these are not life-threatening, they are extremely uncomfortable at a time when people are already experiencing significant stress. We know that food, water and safe accommodation <a href="https://theconversation.com/ukraine-crisis-why-you-should-donate-money-rather-than-supplies-178245">are disappearing</a> for many in Ukraine. </p>
<p>An increasing number of Ukrainians are leaving the country, <a href="https://theconversation.com/help-for-ukraines-fleeing-refugees-shows-the-power-of-support-when-the-political-will-is-there-178207">seeking refuge</a> in neighbouring countries. The Ministry of Health is trying to reach an agreement with its neighbours to ensure care is continued for those who need treatment for tuberculosis or HIV. </p>
<p>The International Narcotics Control Board <a href="https://www.incb.org/incb/en/news/news_2022/incb-statement-on-ensuring-availability-of-and-access-to-controlled-medicines-in-ukraine-and-neighbouring-countries.html">has encouraged</a> these countries to ensure there is also access to substitute opiates for refugees. Negotiations have been taking place between Ukrainian officials and health authorities in Moldova, Romania and Poland to ensure injecting drug users can continue to get treatment, though it is not clear how much effort or success there has been.</p>
<p>There are <a href="https://onlinelibrary.wiley.com/doi/full/10.1002/ejp.1786">significant differences</a> in the way neighbouring countries provide treatment to those who are dependent on drugs like opiates. Some countries are not as progressive as Ukraine in their attitudes to people who use drugs. Recent ceasefires have opened up humanitarian corridors to Belarus and Russia, both of which <a href="https://harmreductioneurasia.org/countries/russia/">are opposed</a> to treatment – hardly enticing options for people in need. </p>
<h2>Future looks bleak for drug users if Russia wins</h2>
<p>President Putin has made clear his disdain of people who use drugs, most <a href="https://www.theguardian.com/world/2022/feb/25/its-not-rational-putins-bizarre-speech-wrecks-his-once-pragmatic-image">recently accusing</a> Ukrainian leaders of being a “gang of drug addicts and neo-Nazis”. </p>
<p>In 2011, <a href="https://www.bmj.com/content/343/bmj.d4194.full">Russia declared</a> “total war” on the country’s drug problem. It is difficult to source reliable estimates of how many Russians now have problems with drugs, though <a href="https://www.tandfonline.com/doi/full/10.1080/10826084.2021.1906275">recent analysis</a> of debates held in the Russian parliament between 2014 and 2018 suggest about 8 million Russians use drugs regularly. This compares with 6 million in 2011. It is not clear what proportion depends on or needs treatment. </p>
<p>After decades of official denial that drug use existed in the Soviet Union, the post-Soviet authorities were forced to acknowledge the HIV/Aids epidemic in the 1990s. This was linked to injecting drug use, which <a href="https://www.politico.eu/article/everything-you-wanted-to-know-about-aids-in-russia-but-putin-was-afraid-to-ask/">today accounts</a> for 40% of new HIV infections in Russia. </p>
<p>An increasing number of Russians have developed problems with drugs such as heroin; a <a href="https://www.politico.eu/article/how-to-needle-vladimir-putin-on-hiv-prevention/">recent article</a> suggested that 3 million Russians are injecting drugs. Many of these people don’t have access to harm-reduction services such as needle and syringe exchange schemes. Without these, the risk of contracting HIV and other blood-borne viruses is increased. </p>
<p>Russia is also the <a href="https://www.who.int/substance_abuse/publications/en/PositionPaper_flyer_English.pdf?ua=1">only country</a> among the 47 member states of the Council of Europe that prohibits opioid substitution therapy. The prospect of long-term occupation by Russia therefore has deeply negative implications for harm reduction services in Ukraine.</p>
<p>Russia’s domestic drug policy has been counterproductive in fuelling disease spread, stigma and human rights abuses. There is no doubt that people who use drugs are vulnerable during conflicts, and those risks are amplified considerably when an invasion is orchestrated by a president who has complete contempt for them. </p>
<p>Ukrainians dependent on drugs have a right to healthcare. But that support looks to be evaporating quickly, albeit not for the lack of courage by those trying to provide treatment during this conflict.</p><img src="https://counter.theconversation.com/content/178624/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Ukraine’s 317,000 injecting drug users face a difficult future.Ian Hamilton, Associate Professor of Addiction, University of YorkJulia Buxton, Professor, Criminology, University of ManchesterLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1683332021-10-06T16:28:01Z2021-10-06T16:28:01ZScotland won’t prosecute personal possession of class A drugs, but outdated laws prevent deeper reforms<p>In Scotland, a person in possession of a class A drugs will be issued a police warning in most cases, <a href="https://www.bbc.co.uk/news/uk-scotland-scotland-politics-58652876">effectively decriminalising</a> personal possession. </p>
<p>This recent announcement comes hard on the heels of a record-high <a href="https://www.theguardian.com/uk-news/2021/jul/30/drugs-deaths-in-scotland-soar-to-record-level">1,339 drug-related deaths</a> in 2020. England and Wales also saw a record year of <a href="https://www.theguardian.com/society/2021/aug/03/drug-poisoning-deaths-in-england-and-wales-reach-record-high">drug-related deaths</a>.</p>
<p>A <a href="https://www.vice.com/en/article/bvxgn5/britains-second-largest-police-force-to-stop-criminalising-drug-users">handful of police forces</a> in England and Wales have adopted similar reforms, including schemes that divert people to drug education courses or treatment. While welcome, this is as far as the Scottish government or the police forces can go. The main legislation is the reserve of Westminster where the decades-old Misuse of Drugs Act remains the main blockage to real reform. </p>
<p>Enacted in 1971, the <a href="https://www.legislation.gov.uk/ukpga/1971/38/schedule/2">Misuse of Drugs Act</a> defines the list of controlled substances in the UK, a list that has expanded over time, as well as the penalties associated with the possession and supply of each.</p>
<p>The act entrenched a police-driven, criminalisation-centred strategy to suppress drug use, drug supply and drug markets, all of which have <a href="https://hansard.parliament.uk/commons/2021-06-17/debates/A1B14B26-EBB7-415F-9AA8-1620726307C5/MisuseOfDrugsAct">grown exponentially</a> since 1971. </p>
<h2>A harsh legacy</h2>
<p>The Misuse of Drugs Act has largely been a failure, and the government knows it. Successive official reports have shown criminalisation <a href="https://www.gov.uk/government/publications/drugs-international-comparators">does not deter use</a>. And, despite spending £1.6 billion a year on drug law enforcement, this approach has <a href="https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/628100/Drug_Strategy_Evaluation.PDF">“little impact</a> on the availability” of drugs.</p>
<p>The negative effects of UK drug laws are well documented, particularly in the way that policing practices, such as “stop and search”, are <a href="https://www.release.org.uk/publications/ColourOfInjustice">racialised</a>. In England and Wales, black people are <a href="https://www.release.org.uk/publications/ColourOfInjustice">nine times more likely</a> to be stopped and searched for drugs than white people, and 12 times more likely to be <a href="https://www.independent.co.uk/news/uk/politics/black-people-cannabis-prosecutions-b1853669.html">prosecuted for</a> cannabis possession, despite being less likely to use drugs. Deprived areas experience <a href="https://www.release.org.uk/publications/ColourOfInjustice">more intensive</a> drugs policing, despite drug use being ubiquitous across the different socioeconomic groups.</p>
<p>Prisons are <a href="http://www.prisonreformtrust.org.uk/Portals/0/Documents/Bromley%20Briefings/Summer%202021%20briefing%20web%20FINAL.pdf">overcrowded</a>, with high levels of <a href="https://www.theguardian.com/society/2020/jan/20/proportion-of-uk-prisoners-with-drug-problem-doubles-in-five-years-study">drug use</a> within. The UK has the <a href="https://www.emcdda.europa.eu/system/files/publications/13762/TD0221591ENN.pdf">highest levels</a> of fatal overdose in Europe, with Scotland at the top of this tragic league table, and England and Wales in third position. These are just a handful of the effects of trying to arrest our way out of “the drug problem”.</p>
<p><a href="https://www.release.org.uk/publications/covid-drugs-market-survey">Recent research</a> by the charity Release found that even the COVID lockdowns had little effect on the UK drug supply. If drug markets remained stable, even with a total shutdown of the country and a massive disruption in international travel and trade, it’s hard to imagine how even the most punitive application of the act could do so.</p>
<h2>Alternative approach</h2>
<p>Despite evidence that criminalisation doesn’t achieve a reduction in drug use and drug markets, the 1971 Misuse of Drugs Act continues to stand as the unquestioned basis of UK drug policy for the two main parties in Westminster. </p>
<p>This is because the “war on drugs” was never about drugs. It was, and continues to be, about social control, particularly of poor and racialised communities that governments view as “problematic”. As author and law lecturer <a href="https://www.hr-dp.org/contents/1596">Kojo Koram</a> writes, international drug control since the 19th century has been deeply intertwined with the European colonial project and the desire to control indigenous and colonised populations. It should come as no surprise then that domestic drug laws have a similar dynamic. </p>
<p>The UK government’s well-publicised focus on targeting “<a href="https://www.standard.co.uk/news/uk/london-stabbing-crimes-test-on-arrest-crackdown-met-police-b947828.html">middle-class drugs users</a>” is a good illustration of this, and stands as a tacit admission that drug laws have never been evenly applied, and have instead targeted poor communities and ethnic minorities. </p>
<p>In keeping with the twisted logic of prohibition, the proposed solution to racist and discriminatory drug laws is not to remove or reform those laws, but rather to widen the net to target more people. This is not just a perverted notion of promoting equality in the law, but dishonestly shields the law from scrutiny by suggesting the driver of racialised drug policing and drug-related deaths are middle-class users, not the law itself. </p>
<p>While legislative reform is not within the Scottish government’s gift, it does follow, as much a possible, the evidence of the <a href="https://www.talkingdrugs.org/drug-decriminalisation">30-plus countries</a> around the world that have ended criminal sanctions for possession of drugs. None experienced increased rates in drug use, many experienced better health and social outcomes, including lower rates of drug-related death – not solely because of the legal landscape, but also because they invested in <a href="https://blogs.lse.ac.uk/europpblog/2012/12/10/portuguese-drug-policy-alex-stevens/">evidence-based harm reduction, drug treatment and social welfare services</a>. </p>
<p>The drug-related death crisis is not only a Scottish problem but one for politicians across all four nations. True decriminalisation of people who use drugs, the regulation of drug markets in a way that includes communities who rely on the illicit economy to survive, and broader economic and social reforms that address inequality would be elements of a truly new and evidence-based drug strategy. If the government wants to save lives, it must reform our harmful laws, beginning with the Misuse of Drugs Act.</p><img src="https://counter.theconversation.com/content/168333/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>The Misuse of Drugs act started decades of criminalisation-centred drug policy that hasn’t worked.Rick Lines, Associate Professor of Crimininology and Human Rights, Swansea UniversityNiamh Eastwood, Associate Member of the Drug and Alcohol Research Centre, Middlesex University, Middlesex UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1672972021-09-06T11:54:51Z2021-09-06T11:54:51ZCriminalising nitrous oxide users distracts from more serious drug problems<p>In England and Wales, it is not illegal to possess nitrous oxide – but that could soon change. The UK’s home secretary, Priti Patel, has asked her scientific advisers to <a href="https://www.gov.uk/government/publications/nitrous-oxide-home-secretarys-letter-to-the-acmd">review</a> the evidence on the harm associated with its use. </p>
<p>Commonly known as “laughing gas”, this odourless <a href="https://theconversation.com/britain-has-the-highest-use-of-laughing-gas-in-world-but-is-this-hippy-crack-dangerous-61096">substance</a> is used in medicine, as an anaesthetic, and in catering to make whipped cream. It is the whipped-cream chargers that people buy for recreational use. The gas is usually inhaled by discharging a canister containing small amounts of the gas into a balloon. </p>
<p>It takes effect quickly and produces brief euphoria. Some users will want to repeat this, but for the vast majority of people, use is restricted to a few episodes a year. Some clinical case <a href="https://bpspubs.onlinelibrary.wiley.com/doi/full/10.1111/bcp.14779">reports</a> suggest very heavy patterns of use, but these are rare and may be more likely in those able to source large amounts of the gas, including diversion from legitimate medical supplies. </p>
<p>Patel has made it clear that she is ready to take “tough action” on its use, arguing that young people are at risk of physical harm when using the drug and that it has <a href="https://www.bbc.co.uk/news/uk-politics-58426792">“devastating” effects</a> on communities. This is part of a new strategy of paying <a href="https://www.independent.co.uk/news/uk/politics/priti-patel-middle-class-cocaine-b1903337.html">closer attention</a> to so-called “recreational” use of substances. It appears that she intends to make possession a criminal offence. </p>
<p>Supplying this drug for approved non-medical uses is already illegal under legislation introduced in 2016 under the <a href="https://www.legislation.gov.uk/ukpga/2016/2/contents/enacted">Psychoactive Substances Act</a>. The better known Misuse of Drugs Act 1971 (<a href="https://www.gov.uk/penalties-drug-possession-dealing">the ABC classification system</a>) introduces possession offences and affords police and regulators greater powers. </p>
<p>Existing legislation was meant to restrict the availability to medical and catering uses, but many loopholes exist, which means it is easy to buy the drug online. The law currently only applies to anyone supplying the drug for psychoactive use. As a result, catering suppliers warn customers that it is illegal to supply products if it’s going to be inhaled for its psychoactive effects, but this approach has been <a href="https://www.manchestereveningnews.co.uk/news/greater-manchester-news/nitrous-oxide-wigan-hindley-police-17816534">ineffective</a>.</p>
<p>The UK government’s Advisory Council on the Misuse of Drugs (ACMD) reviewed the harms of nitrous oxide in 2015 and <a href="https://www.gov.uk/government/publications/acmd-advice-on-nitrous-oxide-abuse">advised</a> that it did not warrant control under the 1971 Misuse of Drugs Act. Since 2015, there is better awareness and clarification of potential harms, but no new evidence has emerged that would necessarily warrant a new review. </p>
<p>Repeated and heavy use of nitrous oxide can <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6518054/">cause vitamin B12 deficiency</a>, which can lead to nerve damage. These cases seem to be mostly associated with very heavy use (dozens of canisters consumed a day over several months), or occupational exposure (dentists and anaesthetists). </p>
<p>On average, <a href="https://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/deaths/adhocs/008203deathsinvolvingnitrogenandnitrousoxideinenglandandwales2001to2016">five people die</a> every year using nitrous oxide, with an increase in deaths recorded as the number of people using it has increased in recent years. But most deaths are a result of accidental suffocation and have resulted after plastic bags or other devices have been placed over the head when inhaling the gas, or inhaling directly from large highly pressurised canisters. While no drug is without harm, inhaling nitrous oxide through balloons significantly reduces the risk of suffocation. </p>
<h2>What would a new law achieve?</h2>
<p>Tightening access to nitrous oxide in 2016 doesn’t appear to have had any effect on demand, as almost one in ten 16 to 24-year-olds <a href="https://www.ons.gov.uk/peoplepopulationandcommunity/crimeandjustice/articles/drugmisuseinenglandandwales/yearendingmarch2020">reported</a> using nitrous oxide in 2019-20. In this light, it might be understandable that the government wants to take a new approach. This raises important questions as to the purpose and function of drug laws. </p>
<p>Discarded canisters are a <a href="https://www.bbc.co.uk/news/uk-wales-56608533">visible and unpleasant littering problem</a>, but this should be seen in the context of existing littering laws, cuts to <a href="https://theconversation.com/why-englands-new-litter-strategy-is-actually-a-bit-rubbish-81202">local littering budgets </a>, and the lack of places to recycle the canisters at nighttime venues. </p>
<p>If reduction of harm is the main concern, then this is rarely achieved through drug laws. These often <a href="https://harmreductionjournal.biomedcentral.com/articles/10.1186/s12954-020-00434-8">lead</a> to the emergence of potentially more harmful substances, more risky use behaviour, and hesitancy in seeking help as users fear legal repercussions. There will also be tricky regulatory pathways to navigate if the catering industry faces burdensome new barriers. </p>
<p>It may be reasonable to conclude that a focus on nitrous oxide may be more about appearing “tough on drugs” than addressing serious drug harm. There are several ways this could be done without <a href="https://onlinelibrary.wiley.com/doi/abs/10.1111/add.12406">ratcheting</a> up penal sanctions. The giant online retailers could actively remove listings. Catering suppliers could clamp down on bulk purchases by limiting how many nitrous oxide canisters can be bought at once, and restricting sales to approved or registered purchasers. </p>
<p>There is scope to improve medical professionals’ knowledge of harm associated with the gas so that timely treatment can be offered. Local authorities could also be encouraged to use existing powers on <a href="https://love.lambeth.gov.uk/no-laughing-matter/">anti-social behaviour</a>. Although with cuts to <a href="https://www.cieh.org/ehn/public-health-and-protection/2019/may/mounting-evidence-that-budget-cuts-harming-eh-service/">local enforcement and environmental health teams</a> it may be tempting to offload enforcement to equally stretched police forces. </p>
<p>The ACMD will no doubt provide a thorough and considered review of the harms of nitrous oxide in their recommendations to the home secretary, but it is then the <a href="https://www.bbc.co.uk/news/uk-21165676">minister’s decision </a> on how to act on this advice. </p>
<p>The recent <a href="https://www.gov.uk/government/publications/review-of-drugs-phase-two-report">Dame Carol Black Review </a> identified a drug treatment system that was “<a href="https://www.bbc.co.uk/news/uk-politics-57757709">on its knees</a>”, with record high numbers of drug deaths. Many people are struggling to achieve meaningful recovery from drug use, and there are worrying signs of increases in the use of the most harmful substances in young people as drug prevention and education activities have disappeared. </p>
<p>Facing this ongoing public health crisis, is it right that so much resource and effort will be expended on nitrous oxide?</p><img src="https://counter.theconversation.com/content/167297/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Harry Sumnall receives and has received funding from public grant awarding bodies for alcohol and other drugs research. He is an unpaid member of the Scientific Advisory Board of the Mind Foundation, and a former unpaid member of the UK Government Advisory Council on the Misuse of Drugs.</span></em></p><p class="fine-print"><em><span>Ian Hamilton does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>The home secretary, Priti Patel, has ordered a review of nitrous oxide. But is this the right drug to get ‘tough’ on?Ian Hamilton, Honorary Fellow, Department of Health Sciences, University of YorkHarry Sumnall, Professor in Substance Use, Liverpool John Moores UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1622182021-07-07T19:51:07Z2021-07-07T19:51:07ZWith rising human drug use, a collateral rise of dogs ingesting cannabis and opioids<figure><img src="https://images.theconversation.com/files/409794/original/file-20210706-13-1gr37sz.jpg?ixlib=rb-1.1.0&rect=5%2C5%2C3366%2C2047&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">As recreational cannabis use increases, so has the number of calls regarding dogs who have accidentally consumed cannabis products.</span> <span class="attribution"><span class="source">(Shutterstock)</span></span></figcaption></figure><p>In the past few years, opioids and cannabinoids have received a great deal of attention from the media and public health authorities. </p>
<p>The dangers of opioids remains high, despite the efforts of public health authorities, the medical community, policy-makers and academics focused on combating addiction and substance abuse. In 2019 alone, there were <a href="https://www.drugabuse.gov/drug-topics/trends-statistics/overdose-death-rates">more than 49,000 opioid-related deaths in the United States</a>. </p>
<p>Additionally, changing attitudes towards cannabis and global trends in cannabis legalization have increased access to a variety of cannabis-based products, particularly edibles, <a href="https://doi.org/10.5864/d2019-019">which pose additional hazards as the public may be unfamiliar with their safe use</a>. </p>
<p>However, little has been published about how changing patterns of drug use have impacted vulnerable populations that can be accidentally exposed to these products, such as children and pets.</p>
<p>Until recently, claims that dogs are being poisoned through the accidental ingestion of recreational drugs have only been supported by anecdotal evidence from pet owners and veterinarians. Our recent research highlights the <a href="https://doi.org/10.1371/journal.pone.0227701">potential impacts of opioid</a> and <a href="https://doi.org/10.1371/journal.pone.0250323">cannabinoid use</a> patterns in humans on pet dogs.</p>
<h2>Pet poisonings</h2>
<p>Using data from reported calls to the Animal Poison Control Center (APCC) — which is administered by the American Society for the Prevention of Cruelty to Animals (ASPCA) — our research provides preliminary evidence that both human community-level factors and dog characteristics impact a dog’s risk of an opioid or cannabinoid poisoning. </p>
<p>Community-level factors reflect the level or nature of drug consumption in a given environment, while dog-level factors like breed and size affect an animal’s likelihood of exposure or the health impact of a particular exposure.</p>
<p>We found that in the U.S., the risk of opioid poisoning for dogs being reported to the APCC increases with rising opioid prescription rates in a county. In terms of dog-level characteristics, the risk of an opioid poisoning being reported is higher for non-neutered, younger and smaller dogs.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/409798/original/file-20210706-27-17rnhum.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A chihuahua peers over a fence" src="https://images.theconversation.com/files/409798/original/file-20210706-27-17rnhum.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/409798/original/file-20210706-27-17rnhum.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/409798/original/file-20210706-27-17rnhum.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/409798/original/file-20210706-27-17rnhum.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/409798/original/file-20210706-27-17rnhum.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/409798/original/file-20210706-27-17rnhum.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/409798/original/file-20210706-27-17rnhum.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">Dogs are inquisitive by nature and smaller breeds are more prone to poisoning.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
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</figure>
<p>For cannabis, our findings suggest that lower legal penalties for cannabis use and possession are associated with an increased risk of dog poisoning events involving cannabinoid products. The odds of these calls were also higher in counties with higher percentages of people living in urban environments and where income disparities were higher. The dogs’ characteristics also influenced these calls, with reports of poisoning from cannabinoid products being higher among non-neutered, smaller and male dogs.</p>
<p>For both opioids and cannabinoids, veterinarians were more likely to call and seek advice from the APCC about a poisoning event. This may reflect a fear among members of the public of reporting these poisonings due to social stigma and legal concerns surrounding illicit drugs.</p>
<p>Lastly, we found that opioid poisonings in dogs declined over the study period — between 2005 and 2014. This may indicate that opioid dog poisonings are more related to prescription opioids than illegally obtained opioids; the <a href="https://www.cdc.gov/drugoverdose/rxrate-maps/index.html">overall rate of prescribed opioids declined</a> while there has been an apparent <a href="https://www.drugabuse.gov/drug-topics/trends-statistics/overdose-death-rates">increase in the use of illegally obtained opioids, such as heroin</a>. </p>
<p>However, cannabinoid poisoning reports increased between 2009 and 2014, suggesting that the problem may be getting worse for canine populations.</p>
<h2>Spillover effects</h2>
<p>These studies are the first to quantify the spillover effects of human drug use patterns on pet poisonings. Yet there is still much work to be done. <a href="https://static1.squarespace.com/static/5dab51c52920995e635d4295/t/5e5ced44bd974c787362b6e3/1583148358799/Brutlag2018VetClinSmallAnimPrac.pdf">Cannabis</a> and <a href="https://bvajournals.onlinelibrary.wiley.com/doi/epdf/10.1002/vrc2.83">opioid</a> poisonings of pets can be traumatic for both dogs and their owners, but we do not have a clear picture of the full extent of the problem due to under-reporting. </p>
<p>While we have identified some socio-economic factors at the county level, we do not know if these characteristics are also shared by the dog owners.</p>
<p>Our research took advantage of a <a href="https://www.aspcapro.org/animal-poison-control-center-1">large pre-existing database</a>, but other studies still need to be conducted to support our findings. Education will likely play an important role in preventing these poisoning events, but the appropriate medium, target audiences and messages still need to be explored.</p>
<p>The goal of this research is not to vilify those who use drugs, justify if these drugs should or shouldn’t be legal, or even how they should be controlled. It is to use an epidemiological lens to determine if dogs are affected by human decisions and conditions related to drug use. Human health management and policy decisions related to what appeared to be an exclusively human health issue can have implications for animal populations.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/409796/original/file-20210706-25-gijlvk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A man and a woman chill on a rock by a lake while smoking a joint. The woman holds a pug on her lap" src="https://images.theconversation.com/files/409796/original/file-20210706-25-gijlvk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/409796/original/file-20210706-25-gijlvk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/409796/original/file-20210706-25-gijlvk.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/409796/original/file-20210706-25-gijlvk.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/409796/original/file-20210706-25-gijlvk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/409796/original/file-20210706-25-gijlvk.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/409796/original/file-20210706-25-gijlvk.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">Awareness of the risk posed to pets can make sure that dog owners safely manage the storage and use of their opioid and cannabinoid products.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
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</figure>
<p>In terms of drug policy, the shift away from a law enforcement to a public health focus should have enormous benefits <a href="https://www.pewtrusts.org/en/research-and-analysis/issue-briefs/2018/03/more-imprisonment-does-not-reduce-state-drug-problems">in the treatment of drug addiction</a>. </p>
<p>The recent popularity of the <a href="https://doi.org/10.1016/j.prevetmed.2010.07.003">One Health framework</a> to explore the relationships between human, animal and environmental health may reveal other unexpected connections. Education and policies to encourage the safe use, storage and disposal of cannabis and opioid products should consider a variety of vulnerable populations, including pet animals. </p>
<p>For the public, the main take home message from our research is that it is important for people to be aware of drugs in their environment. Accidental exposures to pets and other vulnerable populations, including children, are preventable. </p>
<p>For consumers of recreational drugs, whether legally or illegally acquired, there is a responsibility for the proper storage and disposal of these products. With education, we can prevent these tragic poisoning events.</p><img src="https://counter.theconversation.com/content/162218/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Howard-Azzeh's research is funded by an NSERC Discovery grant. </span></em></p><p class="fine-print"><em><span>David Pearl's research related to this article is funded through an NSERC Discovery Grant.</span></em></p>Accidental ingestion of drugs can have detrimental effects on dogs’ health. Education and awareness can help protect pets from consuming opioids and cannabis products.Mohammad Howard-Azzeh, PhD candidate, Population Medicine, University of GuelphDavid Pearl, Associate professor, Ontario Veterinary College, University of GuelphLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1577092021-04-06T05:29:46Z2021-04-06T05:29:46ZDrugs could soon be decriminalised in the ACT. Here’s why that would be a positive step<figure><img src="https://images.theconversation.com/files/393486/original/file-20210406-17-n21fl.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C1000%2C667&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Shutterstock</span></span></figcaption></figure><p>In February this year, Labor backbencher Michael Pettersson introduced a <a href="https://www.legislation.act.gov.au/b/db_63822">private members bill</a> to remove criminal penalties for possession of small amounts of some illicit drugs in the Australian Capital Territory.</p>
<p>This might seem like a radical step to some, but researchers and health professionals have been <a href="http://www.globalcommissionondrugs.org/wp-content/uploads/2016/11/GCDP-Report-2016-ENGLISH.pdf">calling for this reform for some time</a>.</p>
<p>Most Australians support decriminalisation and a <a href="https://theconversation.com/more-australians-back-legalising-cannabis-and-57-support-pill-testing-national-survey-shows-142720">less punitive</a> approach to drug use.</p>
<p>The bill is currently before a <a href="https://www.parliament.act.gov.au/parliamentary-business/in-committees/committees/select-committee-on-the-drugs-of-dependence-personal-use-amendment-bill-2021/inquiry-into-the-drugs-of-dependence-personal-use-amendment-bill-2021">parliamentary committee</a> that will look at the evidence and submissions from professionals, people who use drugs and the general public, and will report back in October this year.</p>
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<h2>How will decriminalisation work?</h2>
<p>Drug decriminalisation is not the same as legalisation. Decriminalisation means it’s still illegal, but you may get a fine, rather than a criminal charge. In this case, the proposal is for decriminalisation of use and possession only. Manufacturing and selling will still be a criminal offence.</p>
<p>Possession of cannabis has already been decriminalised in the ACT since 1992. Pettersson also introduced a bill that <a href="https://theconversation.com/home-grown-cannabis-to-be-legal-in-the-act-now-what-124268">came into effect in 2020</a>, which went one step further. It allowed adult residents in the ACT to legally grow and possess small amounts of cannabis for personal use.</p>
<p>Possession of cannabis has also been decriminalised in South Australia and the Northern Territory for nearly 30 years.</p>
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Read more:
<a href="https://theconversation.com/more-australians-back-legalising-cannabis-and-57-support-pill-testing-national-survey-shows-142720">More Australians back legalising cannabis and 57% support pill testing, national survey shows</a>
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<p>If the new legislation passes, possession of small amounts of a limited number of illicit drugs will no longer be a criminal offence. They will be decriminalised, like cannabis was between 1992 and 2020 in the ACT.</p>
<p>If someone is found in possession of illicit drugs, and the amount is under the “personal possession limit”, they risk a civil fine of 1 penalty unit ($160). The <a href="http://www6.austlii.edu.au/cgi-bin/viewdoc/au/legis/act/consol_act/doda1989169/s169.html">current criminal penalty</a> is a maximum fine of 50 penalty units ($8,000) or two years of imprisonment or both.</p>
<p>This means people who use drugs can avoid a criminal record if they pay the civil penalty within prescribed time period — a little like a speeding fine.</p>
<p>The proposed personal limit for possession is 0.5 grams of MDMA, 0.002 grams of LSD, and two grams of cocaine, amphetamines, psylocibin and heroin. These are much lower levels than the current definitions of “personal use” in the ACT.</p>
<h2>Why decriminalise drugs?</h2>
<p>Australia’s <a href="https://www.health.gov.au/resources/publications/national-drug-strategy-2017-2026">official national drug policy</a> includes reducing harms from legal and illegal drugs. Efforts to reduce harms from illicit drugs are severely hindered because possession and use is a criminal offence.</p>
<p>The legal status of some drugs has more to do with <a href="https://theconversation.com/history-not-harm-dictates-why-some-drugs-are-legal-and-others-arent-110564">history</a> than risk of harm. In fact, some of the major harms from using illicit drugs are because they are illegal.</p>
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<a href="https://theconversation.com/history-not-harm-dictates-why-some-drugs-are-legal-and-others-arent-110564">History, not harm, dictates why some drugs are legal and others aren't</a>
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<p>One of the biggest harms from illicit drug use is having a criminal record for possessing small amounts of a drug for personal use. Most people who use illicit drugs do so very occasionally and only in small amounts, and are <a href="https://theconversation.com/health-check-what-makes-it-so-hard-to-quit-drugs-69896">not dependent nor do they need treatment</a>. A criminal record can have a long-lasting negative impact on a person’s future, including on their career and their ability to travel.</p>
<p>Making them a criminal offence also means there is a lot of stigma attached to using these drugs. We know stigma makes it harder for people to seek help when they need it.</p>
<p>There are <a href="https://ndarc.med.unsw.edu.au/blog/australias-recreational-drug-policies-arent-working-so-what-are-options-reform">no clear benefits</a> from criminalisation of illicit drugs. In the justice system, a large amount of time and money is spent on addressing drug-related offences. Former Australian Federal Police Commissioner Mick Palmer has <a href="https://www.smh.com.au/politics/federal/after-33-years-i-can-no-longer-ignore-the-evidence-on-drugs-20120606-1zwpr.html">noted</a>: “drug law enforcement has had little impact on the Australian drug market”. There’s <a href="https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1745-9125.2002.tb00959.x">no evidence</a> criminalisation has reduced use of illicit drugs.</p>
<p>Decriminalisation significantly reduces the involvement of the justice system and allows existing resources to be better used to support treatment for people who need it, or to focus justice system efforts elsewhere.</p>
<p>Evaluation of drug decriminalisation in other countries, <a href="https://academic.oup.com/bjc/article-abstract/50/6/999/404023?redirectedFrom=fulltext">such as Portugal</a>, has found it increases the number of people accessing alcohol and drug treatment and does not result in increased drug use.</p>
<p>In the Northern Territory, South Australia and ACT, cannabis use did not increase when decriminalisation was introduced 30 years ago. <a href="https://www.aihw.gov.au/reports/illicit-use-of-drugs/national-drug-strategy-household-survey-2019/contents/summary">Rates of use</a> are no higher than other states. This suggests there are more benefits than risks to decriminalisation.</p>
<p>Recently, the state of Oregon in the United States decriminalised all drugs for personal use following <a href="https://theconversation.com/oregon-just-decriminalized-all-drugs-heres-why-voters-passed-this-groundbreaking-reform-150806">a vote</a> by residents.</p>
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Read more:
<a href="https://theconversation.com/oregon-just-decriminalized-all-drugs-heres-why-voters-passed-this-groundbreaking-reform-150806">Oregon just decriminalized all drugs – here's why voters passed this groundbreaking reform</a>
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<p>More and more jurisdictions are moving towards this approach. Decriminalisation of illicit drugs is the natural conclusion to decades of research on drug-related harms.</p><img src="https://counter.theconversation.com/content/157709/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Nicole Lee works as a consultant in the alcohol and other drug sector and a psychologist in private practice. She has previously been awarded funding by Australian and state governments, NHMRC and other bodies for evaluation and research into drug prevention and treatment. She currently holds grants and tenders from the Australian Government, and several state and territory governments. She is a member of the Australian Government's Australian National Advisory Council on Alcohol and other Drugs, a member of the board of directors of Hello Sunday Morning and volunteers with The Loop Australia.</span></em></p><p class="fine-print"><em><span>Jarryd Bartle is a consultant to the alcohol and other drug sector</span></em></p>Decriminalisation of illicit drugs is the natural conclusion to decades of research on drug-related harms.Nicole Lee, Professor at the National Drug Research Institute (Melbourne), Curtin UniversityJarryd Bartle, Sessional Lecturer, RMIT UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1542562021-04-01T17:44:04Z2021-04-01T17:44:04ZCBD, marijuana and hemp: What is the difference among these cannabis products, and which are legal?<p>New York recently became the <a href="https://www.vox.com/2021/3/31/22350330/new-york-marijuana-legalization-bill-law-andrew-cuomo">15th U.S. state to legalize cannabis for recreational use</a>. </p>
<p>While <a href="https://www.pewresearch.org/fact-tank/2019/11/14/americans-support-marijuana-legalization/">67% of U.S. adults support marijuana legalization</a>, public knowledge about cannabis is low. A third of Americans <a href="https://onlinelibrary.wiley.com/doi/abs/10.1093/aepp/ppz001">think hemp and marijuana are the same thing</a>, according to <a href="https://www.nccih.nih.gov/health/cannabis-marijuana-and-cannabinoids-what-you-need-to-know">the National Institutes of Health</a>, and many <a href="https://www.healthline.com/health/does-cbd-get-you-high">people still search Google to find out whether cannabidiol</a> – a cannabis derivative known as CBD – will get them high, as marijuana does.</p>
<p>Hemp, marijuana and CBD are all related, but they differ in significant ways. Here’s what you need to know about their legality, effects and potential health benefits. </p>
<h2>Hemp, marijuana and cannabanoidals</h2>
<p>Both hemp and marijuana belong to the same species, <em>Cannabis sativa</em>, and the two plants look somewhat similar. However, substantial variation can exist within a species. After all, great Danes and chihuahuas are both dogs, but they have obvious differences.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/392929/original/file-20210331-13-147haqe.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Tiny chihuahua sits next to a giant great dane" src="https://images.theconversation.com/files/392929/original/file-20210331-13-147haqe.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/392929/original/file-20210331-13-147haqe.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=444&fit=crop&dpr=1 600w, https://images.theconversation.com/files/392929/original/file-20210331-13-147haqe.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=444&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/392929/original/file-20210331-13-147haqe.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=444&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/392929/original/file-20210331-13-147haqe.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=558&fit=crop&dpr=1 754w, https://images.theconversation.com/files/392929/original/file-20210331-13-147haqe.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=558&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/392929/original/file-20210331-13-147haqe.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=558&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Great Danes and chihuahuas are distant cousins, like marijuana and hemp.</span>
<span class="attribution"><a class="source" href="https://pixy.org/1445408/">Pixy</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
</figcaption>
</figure>
<p>The defining difference between hemp and marijuana is their psychoactive component: <a href="https://medium.com/cbd-origin/hemp-vs-marijuana-the-difference-explained-a837c51aa8f7">tetrahydrocannabinol, or THC</a>. Hemp has 0.3% or less THC, meaning hemp-derived products don’t contain enough THC to create the “high” traditionally associated with marijuana. </p>
<p>CBD is a compound found in cannabis. There are <a href="https://doi.org/10.1016/j.plantsci.2019.03.022">hundreds of such compounds</a>, which are termed “cannabinoids,” because they interact with receptors involved in <a href="https://dx.doi.org/10.3390%2Fijms19030833">a variety of functions like appetite, anxiety, depression and pain sensation</a>. THC is also a cannabinoid.</p>
<p>Clinical research indicates that <a href="https://www.nytimes.com/2019/10/16/style/self-care/cbd-oil-benefits.html">CBD is effective at treating epilepsy</a>. Anecdotal evidence suggests it can help with pain and even anxiety – though scientifically <a href="https://theconversation.com/cbd-sales-are-soaring-but-evidence-is-still-slim-that-the-cannabis-derivative-makes-a-difference-for-anxiety-or-pain-149612">the jury is still out on that</a>. </p>
<p>Marijuana, containing both CBD and more THC than hemp, has <a href="https://www.pennlive.com/nation-world/2019/06/medical-marijuana-what-does-the-science-say.html">demonstrated therapeutic benefits</a> for people with <a href="https://theconversation.com/trials-a-step-forward-for-medicinal-cannabis-but-what-comes-next-40472">epilepsy</a>, <a href="https://theconversation.com/could-a-cannabis-pill-reduce-chemotherapy-induced-nausea-and-vomiting-heres-how-we-find-out-66774">nausea</a>, glaucoma and potentially even <a href="https://theconversation.com/can-marijuana-treat-ms-symptoms-its-hard-for-researchers-to-find-out-68405">multiple sclerosis</a> and <a href="https://theconversation.com/legal-weed-an-accidental-solution-to-the-opioid-crisis-81603">opioid-dependency disorder</a>.</p>
<p>However, medical research on marijuana is severely restricted by federal law. </p>
<p>The Drug Enforcement Agency <a href="https://www.deadiversion.usdoj.gov/schedules/">categorizes cannabis</a> as a Schedule 1 substance, meaning it handles cannabis as if there is no accepted medical use and a high potential for abuse. Scientists don’t know exactly <a href="https://theconversation.com/cbd-rising-star-or-popular-fad-110146">how CBD works</a>, nor how it interacts with other cannabinoids like THC to give marijuana its added therapeutic effects.</p>
<h2>Retail CBD</h2>
<p>CBD comes in food, tinctures and oils, just to name a few. Here are some commonly used terms used to describe CBD products in the store.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/392944/original/file-20210331-19-18i5psr.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Wood shelf with various CBD products from the R+R Medicinals label on it" src="https://images.theconversation.com/files/392944/original/file-20210331-19-18i5psr.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/392944/original/file-20210331-19-18i5psr.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/392944/original/file-20210331-19-18i5psr.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/392944/original/file-20210331-19-18i5psr.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/392944/original/file-20210331-19-18i5psr.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/392944/original/file-20210331-19-18i5psr.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/392944/original/file-20210331-19-18i5psr.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">Full spectrum CBD products for sale, including tinctures, topical creams, edible gummies and pet products.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/various-wellness-products-containing-full-spectrum-news-photo/1266349539?adppopup=true">Smith Collection/Gado/Getty Images</a></span>
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</figure>
<p>While the terms “CBD tincture” and “<a href="https://theconversation.com/cbd-oil-what-you-need-to-know-99430">CBD oil</a>” are often used interchangeably, the two are actually different. Tinctures are made by soaking cannabis in alcohol, while oils are made by suspending CBD in a carrier oil, like olive or coconut oil. </p>
<p>“Pure” CBD, also called “CBD isolate,” is called that because all other cannabinoids have been removed. So have terpenes and flavonoids, which give marijuana its strong aroma and earthy flavor. </p>
<p>“Broad spectrum” CBD typically contains at least three other cannabinoids, as well as some terpenes and flavonoids – but still no THC. “Full spectrum” CBD, also called “whole flower” CBD, is similar to broad spectrum but can contain up to 0.3% THC. </p>
<p>In states where recreational marijuana is legal, the list of cannabis-derived products greatly expands to include CBD with much higher THC content than 0.3%. </p>
<p><a href="https://www.scientificamerican.com/article/as-cbd-skyrockets-in-popularity-scientists-scramble-to-understand-how-its-metabolized/">There is no standardized dosage</a> of CBD. Some retailers may have enough knowledge to make a recommendation for first-timers. There are also online resources – <a href="https://dailycbd.com/en/cbd-dosage/">like this dosage calculator</a>.</p>
<p>Consumers concerned about content and the accuracy of CBD products, which are not regulated by the Food and Drug Administration, can look for certification from independent lab testing or by scanning a QR code on product packaging. </p>
<p>Note that CBD oil is different from hemp oil – which comes from pressing cannabis seeds, and may not contain CBD – and <a href="https://www.healthline.com/health/hemp-vs-cbd-oil">hempseed oil</a>, which is a source of essential fatty acids and contains no CBD. It’s a nutritional supplement, more like fish oil than CBD oil.</p>
<h2>Legal status</h2>
<p>Another big difference among hemp, marijuana and CBD is how the law treats them. </p>
<p>Though <a href="https://drugpolicy.org/issues/marijuana-legalization-and-regulation">15 states have now legalized recreational marijuana</a>, it remains illegal federally in the United States. Technically, those in possession of marijuana in a legal weed state can still be punished under federal law, and traveling across state borders with cannabis is prohibited.</p>
<p>Hemp, on the other hand, was made <a href="https://www.usda.gov/topics/hemp">legal to grow and sell in the United States</a> in the <a href="https://www.brookings.edu/blog/fixgov/2018/12/14/the-farm-bill-hemp-and-cbd-explainer/">2018 Farm Bill</a>. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/392928/original/file-20210331-15-5a153s.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Man wearing backpack looks at a row of hemp plants" src="https://images.theconversation.com/files/392928/original/file-20210331-15-5a153s.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/392928/original/file-20210331-15-5a153s.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=368&fit=crop&dpr=1 600w, https://images.theconversation.com/files/392928/original/file-20210331-15-5a153s.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=368&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/392928/original/file-20210331-15-5a153s.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=368&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/392928/original/file-20210331-15-5a153s.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=463&fit=crop&dpr=1 754w, https://images.theconversation.com/files/392928/original/file-20210331-15-5a153s.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=463&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/392928/original/file-20210331-15-5a153s.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=463&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">A stand at the 2019 Southern Hemp Expo, in Tennessee.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/an-attendee-stops-at-the-hemp-magazine-booth-at-the-news-photo/1166764427?adppopup=true">Bill Clark/CQ-Roll Call, Inc via Getty Images</a></span>
</figcaption>
</figure>
<p>One would assume, then, that hemp-derived CBD should be <a href="https://www.marieclaire.com/politics/a27033880/where-is-cbd-legal-in-the-united-states/">federally legal in every state</a> because the THC levels don’t surpass 0.3%. But CBD occupies a legal gray area. Several states, such as Nebraska and Idaho, still essentially regulate CBD oil as a Schedule 1 substance akin to marijuana.</p>
<p><a href="https://doi.org/10.1016/j.addbeh.2020.106799">Our recent study</a> found that Americans perceive hemp and CBD to be more like over-the-counter medication and THC to be more like a prescription drug. Still, the average person in the U.S. does not view hemp, CBD, THC or even marijuana in the same light as illicit substances like meth and cocaine – even though both are classified by the DEA as having a lower potential for abuse than marijuana.</p>
<p><iframe id="hZV2Y" class="tc-infographic-datawrapper" src="https://datawrapper.dwcdn.net/hZV2Y/4/" height="400px" width="100%" style="border: none" frameborder="0"></iframe></p>
<p>The current federal prohibition of marijuana, in other words, does not align with the public’s view – though state-based legalization shows that society is moving on without the blessing of politicians on Capitol Hill. U.S. recreational marijuana retail <a href="https://americanmarijuana.org/marijuana-statistics/#Recreational_Marijuana_Retail_Sales_in_the_US">sales may reach US$8.7 billion in 2021</a>, up from <a href="https://www.forbes.com/sites/debraborchardt/2017/01/03/marijuana-sales-totaled-6-7-billion-in-2016/?sh=20cf713975e3">$6.7 billion in 2016</a>.</p>
<p>As interest in other cannabinoids, <a href="https://www.healthline.com/health/cbg-oil#cbg-vs-cbd">like cannabigerol, or CBG</a> – which some are touting as the new CBD – continues to grow, so too grows the need for further medical research into cannabis.</p>
<p>[<em>Get the best of The Conversation, every weekend.</em> <a href="https://theconversation.com/us/newsletters/weekly-highlights-61?utm_source=TCUS&utm_medium=inline-link&utm_campaign=newsletter-text&utm_content=weeklybest">Sign up for our weekly newsletter</a>.]</p><img src="https://counter.theconversation.com/content/154256/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Brandon McFadden receives funding from U.S. Department of Agriculture. </span></em></p><p class="fine-print"><em><span>Trey Malone receives funding from the U.S. Department if Agriculture, the Charles Koch Foundation, and the Michigan Department of Agriculture and Rural Development. </span></em></p>Hemp, CBD and marijuana are all forms of cannabis – but they are different in significant ways, from form and legality to their potential uses as treatment for various health conditions.Brandon R. McFadden, Assistant Professor of Applied Economics and Statistics, University of DelawareTrey Malone, Assistant Professor and Extension Economist, Michigan State UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1553912021-02-21T08:32:30Z2021-02-21T08:32:30ZThe South African play that’s tackling the scourge of the street drug whoonga<figure><img src="https://images.theconversation.com/files/384697/original/file-20210217-17-1ndgld8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Zenzo Msomi as Sipho (front) and Ngcebo Cele as Andile in Ulwembu.</span> <span class="attribution"><span class="source">Val Adamson/Ulwembu</span></span></figcaption></figure><p>The drug <a href="http://www.kznhealth.gov.za/mental/Whoonga.pdf">whoonga</a> has plagued South African communities for at least a <a href="https://www.aljazeera.com/features/2010/11/3/whoonga-is-the-cruelest-high">decade</a>, yet only gained significant public <a href="https://www.newframe.com/destitute-drug-users-battle-forced-withdrawal/">attention</a> when it appeared <a href="https://www.groundup.org.za/article/woman-battles-escape-whoonga-park/">more visibly</a> in the inner-city and surrounding suburbs of Durban, the major city in the country’s KwaZulu-Natal province.</p>
<p>Also known as <a href="https://www.newframe.com/nyaope-the-drug-that-never-lets-go/">nyaope</a>, whoonga is a street concoction of B-grade heroin, rat-poison (strychnine) and various other chemical components. It’s most commonly sprinkled into a hand-rolled cigarette and is easily accessible and sold more cheaply than other street drugs. Withdrawal, known as “arosta”, is reported to cause severe stomach pain, that only eases by smoking again, trapping users in a vicious cycle. </p>
<p>Often used by young people, the drug has had a complex and devastating impact on communities. Yet government, city officials and non-governmental organisations have struggled to combine forces and react with the urgency and meaning to the crisis. At times their responses even appear at odds with one other. </p>
<p>In 2014 we began working in Durban’s <a href="https://www.sahistory.org.za/place/kwamashu">KwaMashu</a>, <a href="https://www.sahistory.org.za/place/umlazi">Umlazi</a> and inner city areas. As a team of academics and storytellers, we wanted to see if theatre could unlock more humane and collaborative responses to whoonga. Some of the users we met were as young as eight years old and living on the street with a severe heroin addiction.</p>
<p>Over two years we collaboratively developed a play called <a href="https://www.empatheatre.com/ulwembu"><em>Ulwembu</em></a> (‘spider web’ in isiZulu). We have since performed it to diverse affected communities and for policymakers, impacting lives, and the production is now set to travel internationally.</p>
<h2>Listening to the community</h2>
<p>The <a href="https://www.empatheatre.com/spotlight-on-big-brotherhood-productions">Big Brotherhood</a>, a KwaMashu-based theatre company had noticed the absence of fathers and good male role models in their community and in response created public storytelling processes, told by men. Our <a href="https://witspress.co.za/catalogue/ulwembu/">research</a> would confirm that almost every whoonga user we met had an absent father. </p>
<p>In 2015 the group began collaborating with award-winning South African playwright <a href="https://www.empatheatre.com/theteam">Neil Coppen</a>, Durban actress and ethnographer <a href="https://www.empatheatre.com/theteam">Mpume Mthombeni</a> and myself, an educational sociologist (with mentorship from academics at Durban’s <a href="https://www.dut.ac.za/faculty/engineering/urban_futures/">Urban Futures Centre</a>).</p>
<p>The goal was to diversify the pathways available to users to either manage the risk associated with whoonga use or manage their way out of addiction.</p>
<p>In the research process we could see that the pathologising of whoonga users was a significant problem. We began to look at what was absent: meaningful care and empathy for users. Instead of stigmatising and criminalising them, we wished to address addiction as a mental health issue. It was also clear that there was a need to establish more dynamic and empathetic forms of partnership between government and civil society groups. </p>
<p>So we gathered oral histories of diverse citizens – whoonga users, police, parents, health care workers, community safety groups, social workers, faith leaders, academics and others. We transformed these into an immersive theatrical production which ended up doubling as a policy brief. </p>
<h2>About the play</h2>
<p>The play tells the story of six people caught in the whoonga web. They include Bongani, a drug dealer; Portia, a police lieutenant on the front line of the fight against the scourge; her son Sipho; his friend Andile; and Emmanuel, a Mozambique-born shopkeeper. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/384696/original/file-20210217-13-183xj9v.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="An audience watches a pained middle-aged woman hold a bowl towards the mouth of a man handcuffed to a bed." src="https://images.theconversation.com/files/384696/original/file-20210217-13-183xj9v.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/384696/original/file-20210217-13-183xj9v.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=401&fit=crop&dpr=1 600w, https://images.theconversation.com/files/384696/original/file-20210217-13-183xj9v.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=401&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/384696/original/file-20210217-13-183xj9v.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=401&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/384696/original/file-20210217-13-183xj9v.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/384696/original/file-20210217-13-183xj9v.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/384696/original/file-20210217-13-183xj9v.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Portia (Mpume Mthombeni) tries to get her son Sipho (Zenzo Msomi) to eat as he withdraws from whoonga.</span>
<span class="attribution"><span class="source">Val Adamson/Ulwembu</span></span>
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<p>The play traces Sipho’s descent from talented scholar and aspirant musician to drug user. It also tells the story of an ambitious policewoman and mother whose son gets caught in the whoonga trap. Portia’s inner conflict mirrors what we witnessed in our research across the city. <em>Ulwembu</em> explores the effects of addiction not only on those who suffer from it but on communities, families and the police. It provides insight into the positions of those trying to control the trade, those who benefit from it, and those harmed by it – and how they’re all part of a complex social web. </p>
<p>To create <em>Ulwembu</em> we developed an interdisciplinary theatre methodology which we have named <a href="http://www.empatheatre.com/">Empatheatre</a>. Our hope was to create public storytelling encounters that form amphitheatres of empathy within which we could share real-life stories with the intention to inspire and develop a greater kindness in spaces of conflict or injustice.</p>
<p>In the <a href="https://witspress.co.za/catalogue/ulwembu/">published script</a>, <em>Ulwembu</em> specifically shares the many stories of young whoonga users in Durban and explores the role police and government services play in the lives of vulnerable youth in the city.</p>
<h2>Complex characters</h2>
<p>The police were clearly a group we wanted to work with. An empathetic approach challenged existing policing responses and policy directives. Street level drug addiction has, in South Africa, tended to focus on crackdowns, dispersal and heavy-handed enforcement. Inspired by Paulo Frere’s <em><a href="https://commons.princeton.edu/inclusivepedagogy/wp-content/uploads/sites/17/2016/07/freire_pedagogy_of_the_oppresed_ch2-3.pdf">Pedagogy of the Oppressed</a></em> we realised we needed to also consider the pedagogy – or teaching – of the oppressors. </p>
<p>And so Portia, a policewoman who desperately seeks balance between justice, mercy and empathy, centres the narrative. The character is based on testimonials gathered from police officers as well as parents of drug users, allowing us to examine two strands of research through the lens of a single character. </p>
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Read more:
<a href="https://theconversation.com/a-south-african-theatre-project-explores-collective-solutions-to-saving-the-ocean-135229">A South African theatre project explores collective solutions to saving the ocean</a>
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<p>The ‘oppressor’ dynamic of the police was detailed to us through interviews with users, social workers and health care workers. Even some police officers felt that arrest quotas and crackdowns cause more harm than good and longed for an alternative. Portia was our way of showing how, when it comes to addiction, the oppressor – the police – can in a relative instant be transformed into the oppressed – a mother trying to save her son from addiction. No one is immune.</p>
<p><em>Ulwembu</em> speaks to the realities of why people begin to use drugs in the first place. It does not aim to ‘scare’ young people into avoiding drugs. The life of a whoonga user is scary enough. Instead it tells everyone’s part of the drug story fairly, without judgement. This was central to how we dealt with stereotyping and the dangerous myth machine that influences our perceptions of street level users. </p>
<h2>The future</h2>
<p>Since launching <em>Ulwembu</em> our team has become involved in ongoing forums with various players in the city, law makers and government ministers. During our run at the Hillbrow Theatre in Johannesburg in 2017, we performed to members of parliament and organisations directly involved in drug policy. Afterwards, the director of the Hawks (the Directorate for Priority Crime Investigation) expressed how powerful the evening had been. Towards the end of 2018, the production was performed at the Drug Policy Week <a href="http://www.sadrugpolicyweek.com">conference</a> in Cape Town, with key local and international policy-makers in its audience. </p>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/384754/original/file-20210217-13-13trule.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A book cover with the word " src="https://images.theconversation.com/files/384754/original/file-20210217-13-13trule.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/384754/original/file-20210217-13-13trule.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=912&fit=crop&dpr=1 600w, https://images.theconversation.com/files/384754/original/file-20210217-13-13trule.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=912&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/384754/original/file-20210217-13-13trule.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=912&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/384754/original/file-20210217-13-13trule.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1146&fit=crop&dpr=1 754w, https://images.theconversation.com/files/384754/original/file-20210217-13-13trule.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1146&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/384754/original/file-20210217-13-13trule.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1146&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="attribution"><span class="source">Wits University Press</span></span>
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<p><em>Ulwembu</em> has been invited to participate in the Drug Policy Alliance Reform <a href="https://reformconference.org">conference</a> in the near future (pandemic depending)— and so its international journey begins.</p>
<p>We began this process with the goal of responding to the complexities surrounding street level drug addiction in Durban, yet found ourselves exploring and tending to a myriad of sociological, political, economic, cultural, psychological and spiritual realities that, in turn, changed us and the production. </p>
<p><em>The <a href="https://witspress.co.za/catalogue/ulwembu/">script</a> of Ulwembu also contains the production’s research and outcomes and is available from Wits University Press.</em></p><img src="https://counter.theconversation.com/content/155391/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The project is led by Writer/Director Neil Coppen, actress/story-teller Mpume Mthombeni, Dylan McGarry (Educational Sociologist and artist) and The Big Brotherhood (Vumani Khumalo, Phumlani Ngubane, Ngcebo Cele, Sandile Nxumalo and Zenzo Msomi) in association with the Urban Futures Centre, Twist Theatre Development Project (Twist Durban), Think Theatre and the generous constant support of the Denis Hurley Centre. Ulwembu has been primarily funded by the Open Society Foundations, as well as Twist (<a href="http://www.twistprojects.co.za">www.twistprojects.co.za</a>), Urban Future Centre, The Playhouse Company, the Denis Hurley Centre, National Institute for Humanities and Social Science. Ulwembu would not be possible without the support of Monique Marks, Kira Erwin, Emma Durden, Tina La Roux, Bryan Hiles, Margie Coppen, Kathryn Bennett, Rogers Ganesan, Stephanie Jenkins, Tamar Meskin, Raymond Perrier, Illa Thompson, Bongi Ngobese, Father Stephen Tully, Col. Vuyana, Pruthvi Karpoormath, Fathima Bi Bi Ally, Elena Naumkina, Cpt. Dingaan, Rob Chetty, Chris Overall, Commissioner Steve Middleton, Lloyd Gede, Greg Lomas, Carla-Dee Sims, Lynette Machado at Sad Sacks, Colwyn Thomas, Beata Bognar, Shaun Shelley, Val Adamson, Braam du Toit, Karen Logon, Iain (Ewok) Robinson, Don Fletcher, UKZN, DUT, Carrots; Peas at Kenneth Gardens, South African Police Services, Durban Metro Police, KZN Department of Health, City Press, Hillbrow Theatre and Gerad Bester.</span></em></p>With the community, the group of theatre-makers and academics created a play that could also serve as a policy brief on what’s missing from the battle to reduce drug use in Durban.Dylan McGarry, Senior Researcher in Educational Sociology at the Environmental Learning Research Centre, Rhodes UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1508062020-12-10T13:36:42Z2020-12-10T13:36:42ZOregon just decriminalized all drugs – here’s why voters passed this groundbreaking reform<figure><img src="https://images.theconversation.com/files/374023/original/file-20201209-21-1aik374.jpg?ixlib=rb-1.1.0&rect=30%2C7%2C5111%2C3423&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">According to Oregon law, possessing a small amount of drugs for personal consumption is now a civil – rather than criminal – offense. </span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/teenage-schoolgirl-reaching-for-cocaine-in-her-back-royalty-free-image/1132980785?adppopup=true">Peter Dazeley via Getty</a></span></figcaption></figure><p>Oregon became the first state in the United States to decriminalize the possession of all drugs on Nov. 3, 2020. </p>
<p><a href="https://ballotpedia.org/Oregon_Measure_110,_Drug_Decriminalization_and_Addiction_Treatment_Initiative_(2020)">Measure 110</a>, a ballot initiative <a href="https://www.klcc.org/post/election-preview-measure-110-would-make-oregon-1st-state-decriminalize-drug-use">funded by the Drug Policy Alliance, a nonprofit advocacy group backed in part by Facebook’s Mark Zuckerberg</a>, passed with more than 58% of the vote. Possessing heroin, cocaine, methamphetamine and other drugs for personal use is no longer a criminal offense in Oregon. </p>
<p>Those drugs are still against the law, as is selling them. But possession is now a civil – not criminal – violation that may result in a fine or court-ordered therapy, not jail. Marijuana, which Oregon legalized in 2014, remains fully legal.</p>
<p>Oregon’s move is radical for the United States, but several European countries <a href="https://www.loc.gov/law/help/decriminalization-of-narcotics/decriminalization-of-narcotics.pdf">have decriminalized drugs to some extent</a>. There are three main arguments for this major drug policy reform. </p>
<h2>#1. Drug prohibition has failed</h2>
<p>In 1971, President Richard Nixon declared drugs to be “public enemy number one” and launched a “<a href="https://www.theatlantic.com/health/archive/2012/03/the-war-on-drugs-how-president-nixon-tied-addiction-to-crime/254319/">war on drugs</a>” that continues today.</p>
<p>The ostensible rationale for harshly punishing drug users is to deter drug use. But decades of research – including <a href="http://tupress.temple.edu/book/20000000009196">our own on marijuana</a> and <a href="https://us.sagepub.com/en-us/nam/drugs-and-drug-policy/book258916">drugs generally</a> – has found the <a href="https://www.vera.org/publications/for-the-record-prison-paradox-incarceration-not-safer">deterrent effect of strict criminal punishment to be small</a>, if it exists at all. This is especially true among young people, who <a href="http://www.monitoringthefuture.org/pubs/monographs/mtf-vol2_2019.pdf">are the majority of drug users</a>. </p>
<p>This is partly due to the nature of addiction, and also because <a href="https://nij.ojp.gov/topics/articles/five-things-about-deterrence">there are simply limits to how much punishment can deter crime</a>. As a result, the U.S. has both <a href="https://www.sentencingproject.org/criminal-justice-facts/">the world’s highest incarceration rate</a> and <a href="http://www.espad.org/sites/espad.org/files/TD0116475ENN.pdf">among the highest rates of illegal drug use</a>. Roughly <a href="https://www.prisonpolicy.org/reports/pie2020.html">1 in 5 incarcerated people in the United States is in for a drug offense</a>. </p>
<p><a href="https://books.google.com/books?hl=en&lr=&id=dNcNUjn4UQEC&oi=fnd&pg=PP9&dq=Crime+in+the+Making:+Pathways+and+Turning+Points+Through+Life.&ots=UfXRYQfehU&sig=jAyUyb68tCm1Bw9dXXtlyUlXPro#v=onepage&q=Crime%20in%20the%20Making%3A%20Pathways%20and%20Turning%20Points%20Through%20Life.&f=false">Criminologists find</a> that other consequences of problematic drug use – such as harm to health, reduced quality of life and strained personal relationships – are more effective deterrents than criminal sanctions. </p>
<p>Because criminalizing drugs does not really prevent drug use, <a href="https://www.jstor.org/stable/3342518?seq=1">decriminalizing does not really increase it</a>. Portugal, <a href="https://time.com/longform/portugal-drug-use-decriminalization/">which decriminalized the personal possession of all drugs in 2001</a> in response to high illicit drug use, has <a href="https://www.emcdda.europa.eu/system/files/publications/11331/portugal-cdr-2019_0.pdf">much lower rates of drug use than the European average</a>. Use of cocaine among young adults age 15 to 34, for example, is 0.3% in Portugal, compared to 2.1% across the EU. <a href="https://www.emcdda.europa.eu/system/files/publications/11331/portugal-cdr-2019_0.pdf">Amphetamine and MDMA consumption is likewise lower in Portugal</a>. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/373956/original/file-20201209-13-1k3fxx5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Woman with a dog waits at a white van while a man drinks from a tiny cup" src="https://images.theconversation.com/files/373956/original/file-20201209-13-1k3fxx5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/373956/original/file-20201209-13-1k3fxx5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=391&fit=crop&dpr=1 600w, https://images.theconversation.com/files/373956/original/file-20201209-13-1k3fxx5.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=391&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/373956/original/file-20201209-13-1k3fxx5.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=391&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/373956/original/file-20201209-13-1k3fxx5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=492&fit=crop&dpr=1 754w, https://images.theconversation.com/files/373956/original/file-20201209-13-1k3fxx5.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=492&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/373956/original/file-20201209-13-1k3fxx5.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=492&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">A mobile drug-services van in Lisbon gives out methadone, a medication for people with opioid use disorder, in 2017.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/patient-rita-pestana-holds-her-puppy-while-her-husband-news-photo/857614826?adppopup=true">Horacio Villalobos - Corbis/Corbis via Getty Images</a></span>
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<h2>2. Decriminalization puts money to better use</h2>
<p>Arresting, prosecuting and imprisoning people for drug-related crimes is expensive. </p>
<p>The Harvard economist Jeffrey Miron estimates that all government drug prohibition-related expenditures <a href="https://www.cato.org/publications/tax-budget-bulletin/budgetary-effects-ending-drug-prohibition">were US$47.8 billion nationally</a> in 2016. Oregon spent about $375 million on drug prohibition in that year. </p>
<p>Oregon will now divert some the money previously used on drug enforcement to pay for <a href="https://www.statesmanjournal.com/story/news/politics/2020/10/16/oregon-2020-election-ballot-measure-110-decriminalize-drug-possession/3620146001/%22%22">about a dozen new drug prevention and treatment centers</a> statewide, which has been <a href="http://www.justicepolicy.org/uploads/justicepolicy/documents/04-01_rep_mdtreatmentorincarceration_ac-dp.pdf">found to be a significantly more cost-effective</a> strategy. Some tax revenue from <a href="https://www.bizjournals.com/portland/news/2019/07/25/oregon-cannabis-tax-revenue-gets-higher-and-higher.html">recreational marijuana sales</a>, which exceeded $100 million in 2019, will also go to addiction and recovery services. </p>
<p>Oregon <a href="https://www.oregonlegislature.gov/citizen_engagement/Reports/2019-OCJC-SB1041-Report.pdf">spent about $470 million on substance abuse treatment</a> between 2017 and 2019.</p>
<p>Not everyone who uses drugs needs treatment. Decriminalization makes help accessible to those who do need it – and keeps both those users and recreational users out of jail.</p>
<h2>3. The drug war targets people of color</h2>
<p>Another aim of decriminalization is to mitigate the significant <a href="https://www.sentencingproject.org/wp-content/uploads/2016/01/Disparity-by-Geography-The-War-on-Drugs-in-Americas-Cities.pdf">racial and ethnic disparities associated with drug enforcement</a>. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/373973/original/file-20201209-17-i30jco.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Black and whit image of police arresting a Black man in a New York subway station; no faces are seen" src="https://images.theconversation.com/files/373973/original/file-20201209-17-i30jco.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/373973/original/file-20201209-17-i30jco.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=339&fit=crop&dpr=1 600w, https://images.theconversation.com/files/373973/original/file-20201209-17-i30jco.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=339&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/373973/original/file-20201209-17-i30jco.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=339&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/373973/original/file-20201209-17-i30jco.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=426&fit=crop&dpr=1 754w, https://images.theconversation.com/files/373973/original/file-20201209-17-i30jco.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=426&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/373973/original/file-20201209-17-i30jco.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=426&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">New York’s ‘stop and frisk’ policing most often resulted in marijuana possession charges and targeted young Black men. It was declared unconstitutional in 2013.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/saw-this-young-man-being-stopped-in-nyc-subway-by-two-news-photo/185494998?adppopup=true">Third Eye Corporation/Getty</a></span>
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<p>Illegal drug use is <a href="https://www.samhsa.gov/data/sites/default/files/cbhsq-reports/NSDUHNationalFindingsReport2018/NSDUHNationalFindingsReport2018.pdf">roughly comparable across race</a> in the U.S. But people of color are significantly more likely to be <a href="https://ag.ny.gov/pdfs/OAG_REPORT_ON_SQF_PRACTICES_NOV_2013.pdf">searched</a>, <a href="https://www.drugabuse.gov/about-nida/noras-blog/2020/06/message-director-racially-motivated-violence">arrested and imprisoned for a drug-related offense</a>. Drug crimes can incur long prison sentences.</p>
<p>Discretion in drug enforcement and sentencing means prohibition is among the <a href="https://newjimcrow.com/">leading causes of incarceration of people of color in the United States</a> – an injustice <a href="https://www.cato.org/multimedia/daily-podcast/bipartisan-drug-policy-reform">many Americans on both sides of the aisle</a> increasingly recognize. </p>
<p>Freed up from policing drug use, departments may redirect their resources toward crime prevention and solving <a href="https://thecrimereport.org/2015/06/24/2015-06-reinventing-american-policing-a-seven-point-blueprin/">violent crimes like homicide and robbery</a>, which are time-consuming to investigate. That could help restore some trust between law enforcement and Oregon’s communities of color. </p>
<h2>Risks of decriminalization</h2>
<p>One common concern among Oregonians <a href="https://www.opb.org/article/2020/10/15/measure-110-oergon-politics-decriminalize-drugs/">who voted against decriminalization</a> was that lessening criminal penalties would endanger children. </p>
<p>“I think it sends a really bad message to them, and influences their perception of the risks,” James O’Rourke, a defense attorney who helped organize the opposition to measure 110, <a href="https://www.opb.org/article/2020/10/15/measure-110-oergon-politics-decriminalize-drugs/">told Oregon Public Broadcasting in October</a>.</p>
<p>But U.S. states that legalized marijuana haven’t seen adolescent use rise significantly. In fact, marijuana consumption among teens – <a href="https://onlinelibrary.wiley.com/doi/abs/10.1111/add.14939">though not among college-aged Americans</a> – actually <a href="https://jamanetwork.com/journals/jamapediatrics/fullarticle/2737637">declined in some states with legal marijuana</a>. This may be because legal, regulated marijuana is more difficult for minors to get than black-market drugs. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/373955/original/file-20201209-13-pm4j84.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Woman browses various types of marijuana in glass jars on shelves, in well-lit, upscale setting" src="https://images.theconversation.com/files/373955/original/file-20201209-13-pm4j84.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/373955/original/file-20201209-13-pm4j84.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=406&fit=crop&dpr=1 600w, https://images.theconversation.com/files/373955/original/file-20201209-13-pm4j84.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=406&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/373955/original/file-20201209-13-pm4j84.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=406&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/373955/original/file-20201209-13-pm4j84.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=510&fit=crop&dpr=1 754w, https://images.theconversation.com/files/373955/original/file-20201209-13-pm4j84.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=510&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/373955/original/file-20201209-13-pm4j84.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=510&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Customers must be 21 or older to purchase marijuana from dispensaries like Oregon’s Finest, in Portland.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/woman-shops-at-oregons-finest-a-marijuana-dispensary-in-news-photo/491438512?adppopup=true">Josh Edelson/AFP via Getty Images</a></span>
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<p>Research also shows that for some people, particularly the young, banning a behavior <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4675534/">makes it more alluring</a>. So defining drugs as a health concern rather than a crime could actually make them less appealing to young Oregonians.</p>
<p>Another worry about decriminalization is that it will attract people looking to use drugs. </p>
<p>So-called “drug tourism” <a href="https://www.economist.com/europe/2009/08/27/treating-not-punishing">hasn’t really been a problem for Portugal</a>, but it happened in Switzerland after officials in the 1980s and 1990s began officially “ignoring” heroin in Zurich’s Platzspitz Park. People came from across the country to <a href="https://theculturetrip.com/europe/switzerland/articles/a-brief-history-of-zurichs-needle-park/">inject heroin in public, leaving discarded needles on the ground</a>. </p>
<p>The local government shut down Platzspitz Park. But rather than chase off or arrest those who frequented it, it began offering methadone and prescription heroin to <a href="https://ssir.org/articles/entry/inside_switzerlands_radical_drug_policy_innovation">help people with opioid use disorder</a>. Public injection, HIV rates and overdoses – which had all become a problem in Zurich – <a href="https://www.northcarolinahealthnews.org/2019/01/21/switzerland-couldnt-stop-drug-users-so-it-started-supporting-them/">plummeted</a>. </p>
<p>Certain parts of Oregon already have higher rates of public drug consumption, namely Portland and Eugene. Because public drug use is still illegal in Oregon, however, we don’t expect a Platzspitz Park-style open drug scene to emerge.
These places should benefit from the expansion of methadone programs and other medication-assisted treatment, which is endorsed by the <a href="https://www.ama-assn.org/delivering-care/opioids/ama-push-better-access-opioid-use-disorder-treatments">American Medical Association</a>.</p>
<p><a href="https://www.theolympian.com/opinion/editorials/article247180921.html">If neighboring Washington state decriminalizes drugs</a>, which it is considering, the chances of drug tourism would drop further. </p>
<p>[<em>The Conversation’s science, health and technology editors pick their favorite stories.</em> <a href="https://theconversation.com/us/newsletters/science-editors-picks-71/?utm_source=TCUS&utm_medium=inline-link&utm_campaign=newsletter-text&utm_content=science-favorite">Weekly on Wednesdays</a>.]</p>
<h2>Upside – and downside</h2>
<p>There are risks with any major policy change. The question is whether the new policy results in a net benefit. </p>
<p>In Portugal, full decriminalization has proven more humane and effective than criminalization. Because drug users don’t worry about facing criminal charges, those who need help are more likely to seek it – and <a href="https://www.opensocietyfoundations.org/uploads/52ff6eb9-76c9-44a5-bc37-857fbbfedbdd/drug-policy-in-portugal-english-20120814.pdf">get it</a>. </p>
<p>Portugal’s <a href="https://www.emcdda.europa.eu/system/files/publications/11364/20191724_TDAT19001ENN_PDF.pdf%22%22">overdose death rate is five times lower than the EU average</a> – which is itself <a href="https://www.cdc.gov/nchs/products/databriefs/db356.htm">far lower than the United States’</a>. HIV infection rates among injection drug users also <a href="https://www.emcdda.europa.eu/system/files/publications/11331/portugal-cdr-2019_0.pdf">dropped massively</a> since 2001.</p>
<p>These policies show that problem drug use is a public health challenge to be managed, not a war that can be won.</p><img src="https://counter.theconversation.com/content/150806/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Possessing heroin, cocaine, meth and other drugs for personal use is no longer a criminal offense in Oregon. The idea is to get people with problem drug use help, not punishment.Scott Akins, Professor, Sociology Department, Oregon State UniversityClayton Mosher, Professor, Sociology Department, Washington State UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1442712020-08-11T20:10:22Z2020-08-11T20:10:22ZIt could take 10 years to measure the impact of legalising weed – should New Zealand’s proposed law be even stronger?<figure><img src="https://images.theconversation.com/files/352107/original/file-20200811-14-1yg24k9.jpg?ixlib=rb-1.1.0&rect=35%2C0%2C5955%2C3997&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">www.shutterstock.com</span></span></figcaption></figure><p>The referendum on legalising recreational cannabis use is just over a month away. Campaigns <a href="https://www.makeitlegal.nz/">for</a> and <a href="https://saynopetodope.org.nz/">against</a> the change are well under way. </p>
<p>We’ve had expert reports from the <a href="https://helenclark.foundation/wp-content/uploads/2019/09/the-case-for-yes-in-the-2020-cannabis-referendum.pdf">Helen Clark Foundation</a>, the Office of the Prime Minister’s <a>Chief Science Advisor</a>, the <a href="https://nzier.org.nz/static/media/filer_public/68/bc/68bc4d23-bf82-4c9e-b3ef-09d540ff1442/nzier_wp_2020-01_cannabis_referendum_paper.pdf">New Zealand Institute of Economic Research</a> and meetings around the country to discuss the likely effects of the Cannabis Legalisation and Control Bill (CLCB). </p>
<p>So, what can be learned from other countries that have already legalised cannabis or reformed their laws? And how does New Zealand’s <a href="https://www.referendums.govt.nz/materials/Cabinet-paper-Summary-of-policies-Cabinet-minutes-Exposure-draft-Cannabis-Legalisation-and-Control-Bill.pdf">proposed law</a> stack up against the overseas evidence?</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1289081907544649728"}"></div></p>
<h2>What other countries have done</h2>
<p>We recently collaborated with an international group of drug policy experts on a <a href="https://www.routledge.com/Legalizing-Cannabis-Experiences-Lessons-and-Scenarios/Decorte-Lenton-Wilkins/p/book/9781138370906">book</a> looking at a range of cannabis law reforms around the world over recent decades. These include:</p>
<ul>
<li><p>cannabis coffee shops in the Netherlands</p></li>
<li><p>cannabis decriminalisation in Australia</p></li>
<li><p>cannabis social clubs, which began in Spain and are government-registered, non-profit organisations producing cannabis exclusively for members’ personal consumption</p></li>
<li><p>full cannabis legalisation in 11 states of the US, with Colorado and Washington implementing fully commercial, alcohol-style reforms</p></li>
<li><p>Canada, which allowed its provinces and territories to decide the model of legal cannabis distribution, ranging from government stores in Quebec to private retail outlets in Alberta</p></li>
<li><p>the often overlooked reforms in Uruguay, where cannabis is legally available via home cultivation, social clubs and from pharmacies, with government control of production. </p></li>
</ul>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1291982591608762369"}"></div></p>
<h2>Evidence from profit-driven markets</h2>
<p>There are significant time lags between law change, establishing legal cannabis markets and apparent impacts on use, dependency and mental illness. For that reason, researchers have concluded it may take <a href="https://www.sciencedirect.com/science/article/pii/S0140673619317891?via%3Dihub">ten years</a> to fully understand the outcomes of legalisation. </p>
<p>However, preliminary evaluations of commercial cannabis legalisation suggest it has led to fewer arrests and significant taxes earned from sales. </p>
<p>At the same time, there is emerging evidence of increasing adult use and dependency, and industry influence over regulatory development.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/teen-use-of-cannabis-has-dropped-in-new-zealand-but-legalisation-could-make-access-easier-132165">Teen use of cannabis has dropped in New Zealand, but legalisation could make access easier</a>
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<p>The evidence on whether legalisation has increased youth use is mixed. More research is also needed to understand the impacts on drug driving, emergency hospital admissions and treatment demand. </p>
<p>One of the main rationales for legalisation is that it will eliminate illegal markets and provide products of known purity and potency. </p>
<p>The experience in the legal cannabis states of the US, however, clearly demonstrates the challenges of developing regulatory controls of <a href="https://www.sciencedirect.com/science/article/pii/S0955395917300324">pesticides, fertilisers</a> and product potency.</p>
<p>Early experience suggests legalisation can substantially reduce, but not eliminate, the black market. Legal production and competition also drive down the price of legal cannabis and therefore price-linked tax earnings. </p>
<p>Industry <a href="https://onlinelibrary.wiley.com/doi/abs/10.1111/dar.12459">targets</a> daily cannabis users as they are responsible for the majority of sales. Many of these users may be at risk of dependence and other harms.</p>
<p>On the other hand, legalisation provides opportunities to address social equity issues related to cannabis enforcement, including discrimination against minorities and disproportionate penalties. </p>
<p>This can even extend to expunging previous convictions and supporting cannabis business and employment in affected communities.</p>
<figure class="align-center ">
<img alt="People outside a cannabis cafe" src="https://images.theconversation.com/files/352110/original/file-20200811-14-6d1zqp.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/352110/original/file-20200811-14-6d1zqp.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/352110/original/file-20200811-14-6d1zqp.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/352110/original/file-20200811-14-6d1zqp.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/352110/original/file-20200811-14-6d1zqp.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/352110/original/file-20200811-14-6d1zqp.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/352110/original/file-20200811-14-6d1zqp.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">A legal cannabis cafe in Amsterdam: regulation and enforcement will be key to successful law reform.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
</figcaption>
</figure>
<h2>Finding a middle ground</h2>
<p>It’s important not to view the legal cannabis debate as a competition between extremes – strict prohibition on the one hand and profit-driven markets on the other. Drug policy experts point to a number of middle-ground policy options that have received a lot less media and research attention. </p>
<p>For example, non-commercial methods of legal cannabis supply, such as home cultivation and <a href="https://www.sciencedirect.com/science/article/pii/S0955395917300014?via%3Dihub">cannabis social clubs</a>, have proved popular in Uruguay and Spain. But there are questions about whether these will be attractive to all types of consumers. </p>
<p>Similarly, <a href="https://www.sciencedirect.com/science/article/pii/S0955395917303584">community trusts</a> in New Zealand offer an alternative approach to reduce commercialisation and provide funding to local community services. Rules would be needed, though, to prevent cannabis companies from using community funding to enhance their public image and political influence.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/reforming-cannabis-laws-is-a-complex-challenge-but-new-zealands-history-of-drug-reform-holds-important-lessons-141113">Reforming cannabis laws is a complex challenge, but New Zealand's history of drug reform holds important lessons</a>
</strong>
</em>
</p>
<hr>
<p>Finally, many of the key lessons from regulatory responses to alcohol and tobacco harm are highly relevant to the regulation of legal cannabis. This includes minimum pricing, limits on the density of retail outlets, plain packaging, smoke-free policies and restrictions on advertising.</p>
<p>State or <a href="https://www.sciencedirect.com/science/article/pii/S0955395919300635">not-for-profit monopolies</a> for alcohol have been effective at achieving public health objectives and could be considered for legal cannabis sales. </p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1169116076925493248"}"></div></p>
<h2>How does the New Zealand bill stack up?</h2>
<p>While there is much we still don’t know about the full consequences of cannabis legalisation, there is a strong case for a conservative regulatory approach that seeks to limit the adverse impacts of the new market and curtails industry power. </p>
<p>This makes more sense than allowing profit-driven commercialisation and then struggling to roll back the consequences, as happened with tobacco.</p>
<p>Much of the CLCB is broadly consistent with this restrictive approach to cannabis legalisation. It provides for government licensing of production, no advertising, plain packaging, outlet controls, excise tax based on weight and potency, and provisions for community partnerships and not-for-profit retail outlets.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/tweets-about-cannabis-health-benefits-are-full-of-mistruths-129409">Tweets about cannabis' health benefits are full of mistruths</a>
</strong>
</em>
</p>
<hr>
<p>However, the CLCB could be <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/add.15144">strengthened</a> with a lower potency cap, formal minimum pricing, a commitment to a high excise tax, and provisions to allow cannabis social clubs. </p>
<p>The recent attempt to regulate the harmful “legal high” <a href="https://www.sciencedirect.com/science/article/pii/S0955395918300537">market</a> in New Zealand highlighted the importance of adequately resourcing regulatory agencies and enforcement, engaging with key health stakeholders and communicating policy aims to the public.</p>
<p>If the referendum passes, then, careful attention will be needed during <a href="https://www.nzma.org.nz/journal-articles/the-governments-proposal-to-legalise-cannabis-in-new-zealand-10-key-questions">implementation</a> to ensure the law realises its harm-minimisation goals.</p><img src="https://counter.theconversation.com/content/144271/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Chris Wilkins receives funding from the New Zealand Royal Society Marsden Fund and New Zealand Health Research Council. He has never accepted funding directly from cannabis, alcohol, gambling, legal highs or other unhealthy commodity industries. </span></em></p><p class="fine-print"><em><span>Simon Lenton is supported by funding from the Australian Government under the Drug and Alcohol Program through its core funding of the National Drug Research Institute. He also served (unpaid) on Mundipharma’s Advisory Board, providing advice related to its Nyxoid naloxone product.</span></em></p><p class="fine-print"><em><span>Tom Decorte does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Overseas evidence suggests cannabis law reform should favour caution and strict enforcement of the new rules.Chris Wilkins, Associate Professor of illegal drug research, Massey UniversitySimon Lenton, Professor and Director, National Drug Research Institute, Curtin UniversityTom Decorte, Professor of Criminology, Ghent UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1314502020-02-11T12:32:01Z2020-02-11T12:32:01ZThe opioid crisis is a big issue in New Hampshire – 5 questions answered on what voters want the candidates to do<figure><img src="https://images.theconversation.com/files/314597/original/file-20200210-109887-xqm1eg.jpg?ixlib=rb-1.1.0&rect=14%2C9%2C3232%2C2140&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">At the New Hampshire primary debate, America's opioid crisis came up as an issue.</span> <span class="attribution"><a class="source" href="http://www.apimages.com/metadata/Index/Election-2020-Debate/452cf965ccb24d25b03304498e910d47/15/0">Elise Amendola/AP Photo</a></span></figcaption></figure><p><em>America’s opioid crisis has hit New Hampshire hard, creating an epidemic of overdoses and addiction-related health issues in the early primary state.</em></p>
<p><em>We asked Amanda Latimore, an <a href="https://www.jhsph.edu/faculty/directory/profile/3091/amanda-latimore">opioid and behavioral health expert at Johns Hopkins Bloomberg School of Public Health</a>, to explain why the opioid crisis is important to voters and what candidates could be doing to address it.</em></p>
<h2>1. How important is the opioid crisis to NH voters?</h2>
<p>Drug misuse was the number one issue for New Hampshire voters <a href="https://www.cnbc.com/2016/02/09/no-1-issue-for-new-hampshire-voters-may-surprise-you.html">in 2016 polls</a>, overshadowing jobs, the economy and health care. At the time, the state was second in the nation for drug overdose deaths. Four years later, New Hampshire remains among the states with the highest rates of <a href="https://www.drugabuse.gov/drugs-abuse/opioids/opioid-summaries-by-state">opioid-</a> and <a href="https://www.cdc.gov/drugoverdose/data/statedeaths.html">total drug-related deaths</a>. Yet according to <a href="https://d279m997dpfwgl.cloudfront.net/wp/2020/01/Crosstabs-2020-01-WBUR-NH-D-Primary-Politics.pdf">a January 2020 poll</a> only 1% of voters want Democratic candidates to discuss opioids, while nearly half (48%) want to hear more from candidates on health care. </p>
<p>Is this a signal that addiction and the opioid crisis are no longer an important issue for the New Hampshire primary? Not likely. </p>
<p>I suspect that New Hampshire voters are recognizing that addiction is not a moral failing, but a chronic illness that is part of a broader health care discussion. There may be greater awareness that effective medications are available to treat addiction and that supportive conversations about substance use disorder can happen in your primary care doctor’s office. </p>
<h2>2. Is concern split evenly across party lines?</h2>
<p>Regardless of their political affiliation, the opioid crisis has likely affected everyone in New Hampshire either directly or indirectly. Drug pricing is one area that seems to <a href="https://socialsecurityworks.org/wp-content/uploads/2019/05/Drug-Pricing-Swing-District-Poll-Results.pdf">cross party lines</a>, with 84% of Republicans and 96% of Democrats agreeing that drug prices are an important issue. Collaboration in Congress on this issue could reduce the price of the overdose-reversing medication, naloxone, which is currently so expensive that it <a href="https://www.washingtonpost.com/national/2017/11/21/as-opioid-crisis-worsens-a-drug-used-to-reverse-overdoses-can-be-difficult-to-access/">strains government agency budgets</a> across the U.S. and deters the average American from picking up naloxone at their pharmacy.</p>
<h2>3. What remedies to the crisis are popular among voters?</h2>
<p>Requiring insurers to cover addiction treatment was <a href="https://d279m997dpfwgl.cloudfront.net/wp/2020/01/Crosstabs-2020-01-WBUR-NH-D-Primary-Politics.pdf">the most popular strategy</a> cited by likely voters in the New Hampshire Democratic primary, according to a poll conducted for Boston-based WBUR. With 90% approval for that measure, candidates would be well-advised to campaign on enforcing laws which already require insurance companies to cover behavioral health services at the same level as other medical benefits.</p>
<p>Other popular solutions include expanding needle exchanges (71% in favor); taking legal action against pharmaceutical companies for their role in the opioid crisis (80%); supervised consumption spaces, where people can safely use drugs under medical supervision (57%), and decriminalizing possession of small amounts of drugs (66%).</p>
<p>Harm reduction strategies, like needle exchange programs, recognize that not everyone is ready to stop using drugs, but still help people stay safe. This approach is essential for <a href="https://www.ncbi.nlm.nih.gov/pubmed/23975473">preventing the transmission</a> of infectious diseases like HIV. Supervised consumption spaces have been <a href="https://harmreductionjournal.biomedcentral.com/articles/10.1186/s12954-017-0154-1">found to reduce overdoses</a>, particularly in the area near the program site. They also create an open door for people who are typically poorly served by traditional health care settings, if and when they’re ready to seek treatment.</p>
<p>The state of New Hampshire primed its voters to understand that accessible behavioral health does not operate in a silo. The state takes a “no wrong door” approach to supporting those affected by the opioid crisis. This includes initiatives like <a href="https://www.wellsense.org/-/media/1019ec4c0a6d43e9bb826607c3df2d5d.ashx">Safe Stations</a> and <a href="https://thedoorway.nh.gov/home">The Doorway</a>, through which those seeking addiction treatment or support for themselves or a loved one can get a referral. </p>
<p>New Hampshire laws that explicitly protect syringe service programs and the participants they serve and Medicaid coverage for opioid use disorder medications like methadone and buprenorphine make it easier for people to get access to the support they need when they need it.</p>
<h2>4. What policies do health experts recommend?</h2>
<p><a href="https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2760032">Medications for opioid use disorder</a> help reduce both overdose deaths and use of high-cost medical services, but only 12% of people with opioid use disorder are treated with these life-saving drugs. While those medications are covered by New Hampshire’s Medicaid expansion, <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6330240/">several barriers still exist</a>. Doctors currently must undergo additional training to prescribe buprenorphine and are further restricted by having a cap on the number of patients to which they can prescribe the medication. Removing these unnecessary barriers, that don’t exist for most other chronic illness medications, would improve access.</p>
<p>To win over New Hampshire voters, candidates should consider supporting efforts to create national standards for behavioral health services. Individuals seeking care should have access to information about the quality of a treatment facility and whether it offers evidence-based services.</p>
<p>State adoption of Medicaid expansion in the U.S. between 2001 and 2017 was associated with a <a href="https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2758476">6% decrease</a> in opioid overdose deaths. Any action that restricts or eliminates coverage could reverse progress.</p>
<h2>5. How do the candidates positions differ?</h2>
<p>Elizabeth Warren, Bernie Sanders and Pete Buttigieg all propose increasing funding to support treatment and harm-reduction initiatives.</p>
<p>Joe Biden seeks to build on the existing health care system and enforce insurance coverage rules. </p>
<p>Decriminalizing addiction may be the single most important factor for reducing stigma on addiction. And once we stop seeing those who are addicted as criminals, resistance clears for implementing evidence-based strategies.</p>
<p>Pre-arrest diversion programs recognize that people need treatment not jail time. It is encouraging to me that this sentiment has been shared by nearly all Democratic primary candidates. </p>
<p>Andrew Yang takes a bold stance on decriminalizing several drugs, but he also suggests imposing mandatory treatment after an overdose and significant restrictions on those who can prescribe opioids. Neither of these approaches are supported by evidence and, in my opinion, may do more harm than good. </p>
<p>Amy Klobuchar is one of the few candidates talking about early prevention. The evidence suggests that problematic drug use in adulthood is less likely if youth reach age-appropriate academic and social milestones. Candidates should develop strategies that ensure families and communities get the economic and social supports they need to help youth reach these goals. </p>
<p>In the debate ahead of the New Hampshire primary, opioids got a mention. But the conversation – taking place in a state that is 94% white – didn’t go deep into how drug policy, along with inequitable economic and health outcomes, works against black and brown Americans. To be truly transformative, candidates must show how their solutions for the opioid crisis will uproot the country’s legacy of inequity to improve health and well-being for all. </p>
<p>[<em>You’re smart and curious about the world. So are The Conversation’s authors and editors.</em> <a href="https://theconversation.com/us/newsletters?utm_source=TCUS&utm_medium=inline-link&utm_campaign=newsletter-text&utm_content=youresmart">You can read us daily by subscribing to our newsletter</a>.]</p><img src="https://counter.theconversation.com/content/131450/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Amanda Latimore does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>In 2016, drug misuse was cited as the top concern among New Hampshire voters. What remedies are the Democratic primary contenders putting forward to combat the opioid crisis?Amanda Latimore, Assistant Scientist, Johns Hopkins UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1308262020-02-10T13:49:31Z2020-02-10T13:49:31ZThree reasons the Conservative government might legalise cannabis<p>The Conservative government abruptly and unexpectedly <a href="https://theconversation.com/uk-law-on-medicinal-cannabis-changed-six-months-ago-what-have-we-learned-114846">lifted restrictions</a> on medicinal cannabis in 2018. This is viewed by some as a necessary prelude to <a href="https://www.economist.com/international/2019/08/29/a-global-revolution-in-attitudes-towards-cannabis-is-under-way">a more liberal</a> approach to recreational drug use. Certainly, recent opinion polls suggest the British public <a href="https://d25d2506sfb94s.cloudfront.net/cumulus_uploads/document/jebv23n429/CDPRG_190617_190619_Combined.pdf">support legalisation</a> - even if they are unsure of Prime Minister <a href="https://yougov.co.uk/topics/politics/articles-reports/2019/07/25/what-does-boris-believe">Boris Johnson’s</a> views on this. </p>
<p>Predicting what will happen with drug policy is <a href="https://www.gov.uk/government/publications/drugs-futures-2025">difficult</a>, but here are three reasons a shift in cannabis policy could well happen.</p>
<h2>1. Voter appeal</h2>
<p>Such a shift would appeal to younger voters, while not necessarily riling traditional (and new) Conservative supporters. Tailoring a message to these differing groups is something <a href="https://theconversation.com/dominic-cummings-boris-johnsons-new-adviser-will-relish-his-controversial-status-121267">Dominic Cummings</a> has proved to be adept at. Health-orientated responses to drugs tend to be better supported by younger people. In contrast, criminal justice is the priority for older people and those who identify as being <a href="https://d25d2506sfb94s.cloudfront.net/cumulus_uploads/document/jebv23n429/CDPRG_190617_190619_Combined.pdf">politically conservative</a>. </p>
<p>One of Johnson’s key <a href="https://www.bloomberg.com/news/articles/2019-07-31/johnson-hires-pot-legalization-advocate-gibbs-as-justice-adviser">crime and justice advisers</a>, Blair Gibbs, has worked with prominent UK cannabis policy reform groups. This brings specialist insights into the framing of cannabis policy proposals and the potential impacts of legal change. </p>
<p>There is growing public concern about the harms of <a href="https://theconversation.com/county-lines-the-dark-realities-of-life-for-teenage-drug-runners-103929">county lines</a>, where gangs expand their drug dealing activity from urban to rural areas. There is also concern about modern slavery and the exploitation of trafficked growers. While the <a href="https://theconversation.com/not-all-drug-dealers-are-the-same-its-time-to-ditch-outdated-stereotypes-93773">reality</a> doesn’t always match the <a href="https://www.sciencedirect.com/science/article/abs/pii/S0955395920300086">headlines</a>, it’s clear that these are issues that <a href="https://news.sky.com/story/county-line-gangs-make-me-sick-home-secretary-vows-to-help-child-drug-mules-11910645">ministers see</a> as a priority and ones the public care about. </p>
<p>New modern slavery powers have been introduced that are designed to tackle the domestic and <a href="https://www.bbc.co.uk/news/stories-51176958">international trafficking</a> of vulnerable people in the drugs trade. A legally regulated domestic cannabis market could disrupt both gangs and traffickers and undermine their operations.</p>
<p>A strategy that permits adult recreational use that is “sold” to the public through protection of the health of the vulnerable but still shows toughness towards other types of drug use, might bridge this generational divide. </p>
<h2>2. Mental health benefits</h2>
<p>The Conservatives <a href="https://www.mind.org.uk/news-campaigns/news/mind-responds-to-conservative-party-manifesto/">have already promised</a> to treat mental health with the same urgency as physical health. We could go some way to <a href="https://www.nejm.org/doi/full/10.1056/NEJMp1614783">protect the population</a> by limiting the <a href="https://www.nhs.uk/news/mental-health/high-strength-skunk-now-dominates-uk-cannabis-market/">THC content</a> of cannabis. Regulation could also limit contaminants or pesticides that consumers are exposed to in cannabis products. We should learn from the way that American states have tried to regulate access to cannabis, some appear to have <a href="http://www.emcdda.europa.eu/system/files/publications/12543/TD0220009ENN.pdf">little influence</a> on the strength of cannabis products or prevent other public safety issues such as drug driving. </p>
<h2>3. Tax revenues</h2>
<p>The potential for raising tax revenue and making investors and party donors rich may be the most compelling attraction for regulation. States in the US that have legalised cannabis have raised <a href="https://www.forbes.com/sites/nickkovacevich/2018/12/05/cannabis-is-a-tax-bonanza-for-states/">hundreds of millions of dollars</a>. But caution is warranted because tax receipts haven’t always matched <a href="https://www.politico.com/agenda/story/2019/10/14/marijuana-tax-revenue-001062">optimistic projections</a>, and we may be seeing a <a href="https://www.bbc.co.uk/news/world-us-canada-50664578">burst of the cannabis investment bubble</a>. </p>
<p>This tax revenue is often <a href="https://www.forbes.com/sites/niallmccarthy/2019/03/26/which-states-made-the-most-tax-revenue-from-marijuana-in-2018-infographic/#717e8fc97085">pledged</a> to fund specialist drug treatment, something governments should be doing anyway. Relying on overly optimistic tax revenue projections adds to the <a href="https://www.theguardian.com/society/2017/oct/14/drug-overdoses-rise-most-treatment-cuts-are-deepest">fragility</a> of these services. And as we saw with <a href="https://www.thegrocer.co.uk/health/soft-drinks-sugar-levy-revenues-swallowed-up-by-treasury-review/597309.article">sugar tax revenue</a>, unless the money is protected, the danger is that it is just absorbed by the Treasury.</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1226837295338160128"}"></div></p>
<p>While we might not be able to predict the speed and nature of cannabis policy change, new approaches must be informed by <a href="https://theconversation.com/why-nzs-cannabis-bill-needs-to-stop-industry-from-influencing-policy-128530">lessons learned</a> from the regulation of the tobacco and alcohol markets. If policy does change, it’s important to prioritise public health and social justice interests, rather than just those of industry. </p>
<p>We also need to ensure that smaller growers and distributors have <a href="https://mass-cannabis-control.com/equityprograms-2/">equitable access</a> to any new market - not concentration of industry populated by the already rich and privileged. But if the history of alcohol and tobacco regulation is repeated for cannabis, then perhaps money rather than evidence will shape who sells and who benefits from policy change.</p><img src="https://counter.theconversation.com/content/130826/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Ian Hamilton is affiliated with Alcohol Change UK. </span></em></p><p class="fine-print"><em><span>Harry Sumnall receives and has received funding from public grant awarding bodies for alcohol and other drugs research. He is an unpaid co-optee of the Advisory Council on the Misuse of Drugs (ACMD) Working Group that develops recommendations on cannabis-based medicinal products and is evaluating the impact of rescheduling. Please note that the contents and framing of this article are deliberately not based on any privileged information emerging from that work. He was an unpaid member of a non-party affiliated independent expert group that developed a framework for a legal UK cannabis market on behalf of the Liberal Democrats. This article represents his personal views only.</span></em></p>If the Tories do go liberal on pot, they should learn the lessons from the regulation of tobacco and alcohol.Ian Hamilton, Associate Professor, Addiction and Mental Health, University of YorkHarry Sumnall, Professor in Substance Use, Liverpool John Moores UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1298652020-02-03T13:52:41Z2020-02-03T13:52:41ZInside Mexico’s war on drugs: Conversations with ‘el narco’<figure><img src="https://images.theconversation.com/files/310622/original/file-20200117-118315-z81n0y.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C5997%2C4007&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">More than 35,000 people were killed in Mexico in 2019, the deadliest year on record. Violence has spiked as a result of the government's ongoing assault on drug cartels.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/es/image-photo/mexico-city07-october-2019-various-weapons-1525889897">Leonardo Emiliozzi Ph / Shutterstock</a></span></figcaption></figure><p>I am from northern Mexico, one of the regions most affected by the global <a href="https://theconversation.com/rising-suicides-in-mexico-expose-the-mental-health-toll-of-living-with-extreme-chronic-violence-99131">war on drugs</a>. </p>
<p>From 2008 to 2012 my hometown – which I’m not naming here for safety reasons – went through one of the most violent times in its history. Shootings between cartels and the military became frequent events, which could happen at any time of the day anywhere in the city. I personally witnessed a shooting just across from the university where I used to teach.</p>
<p>My friends and family had similar experiences. Some of them witnessed shootings from their cars, others from their home. </p>
<p>In addition to the growing violence, the Zetas cartel started to bribe the local businesses. If owners did not pay, the cartel would either destroy their businesses or kidnap a family member. As a result, many businesses had to close their doors. The cartels fueled paranoia on social media. “Do not come out tonight,” a tweet would warn, “because there will be a shooting.” Sometimes, these threats proved to be true.</p>
<p>Similar <a href="http://theconversation.com/mexican-mennonites-combat-fears-of-violence-with-a-new-christmas-tradition-127982">terror</a> is occurring <a href="https://www.milenio.com/mileniotv/policia/cierran-negocios-por-violencia-en-cordoba-veracruz">across Mexico</a> as a <a href="https://theconversation.com/a-record-29-000-mexicans-were-murdered-last-year-can-soldiers-stop-the-bloodshed-90574">result of the war on cartels launched by former President Felipe Calderón</a> in 2006. The violence unleashed by the government’s assault on drug-trafficking groups <a href="https://theconversation.com/a-record-29-000-mexicans-were-murdered-last-year-can-soldiers-stop-the-bloodshed-90574">has wracked a nation</a>.</p>
<h2>Life stories of former drug traffickers</h2>
<p>Not wanting to stay in a country where I felt so vulnerable, I decided to continue my postgraduate studies abroad, in England. There, I channeled my frustration with Mexico’s war on cartels into my <a href="https://research-information.bris.ac.uk/files/193726176/Final_Copy_2018_11_06_Garcia_K_G_PhD_Redacted.pdf">doctoral dissertation</a>, which analyzes drug-related violence through the lens of those who committed the crimes. </p>
<p>Between October 2014 and January 2015, I interviewed 33 men who used to work in the drug trade to understand how their experiences relate to their involvement in drug trafficking. From street drug dealers to hitmen and bodyguards, I found, they all share similar life stories. </p>
<p>These firsthand interviews with former drug traffickers, widely known as “narcos” in Mexico, bring a new perspective to <a href="https://theconversation.com/us/topics/mexican-drug-wars-37657">political science research on Mexico’s drug war</a>: that of the perpetrators. </p>
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<p>This analysis of the narcos’ narratives sheds light on the possible causes of these men’s involvement in the drug trade and elucidates the logic through which they understand the world. </p>
<p>This view is almost entirely neglected by researchers and politicians. To date, Mexican policies to <a href="https://theconversation.com/el-chapo-jailbreak-is-both-a-mexican-and-an-american-story-44679">curb drug trafficking</a> and <a href="https://theconversation.com/amnesty-for-drug-traffickers-thats-one-mexican-presidential-candidates-pitch-to-voters-96063">reduce violence</a> have been designed using solely the logic of policymakers. </p>
<p>Is it any surprise they’ve failed?</p>
<h2>Neither monsters nor victims</h2>
<p>My research begins with the premise that the narcos are part of Mexican society, just like anyone else. They are exposed to the same messages, values and traditions. </p>
<p>Yet the Mexican government has systematically rejected this notion, preferring to invoke the same binaries present in U.S. policies like the war on drugs and the war on terror. It’s “us” against “them,” this framing goes: the “good guys” versus the “<a href="https://journals.sagepub.com/doi/abs/10.1177/0094582X13509069">bad people</a>.” </p>
<p>In the movies, the narcos are portrayed as <a href="https://www.rogerebert.com/reviews/traffic-2001">bloodthirsty criminals</a>. More compassionate views, especially in academia, suggest the drug trade is the “only option” for poor kids in <a href="http://mexicanadesociologia.unam.mx/docs/vol74/num1/v74n1a1.pdf">cartel-infested parts of the country</a>.</p>
<p>Beyond being simplistic, such framing conceals nuances that may actually help to explain the root causes of Mexico’s drug violence. </p>
<p>The narcos I spoke with do not see themselves as victims or monsters. They do not justify their involvement in the drug trade as a survival strategy. They acknowledge that they chose this illegal industry – even when work in the informal economy would have allowed them to support their families – because, they told me, they wanted “more.” </p>
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<p>Despite seeing themselves as free agents who decided to work in the drug trade, the men I interviewed also see themselves as disposable. They shared feelings of social exclusion and a lack of a life purpose, making them feel that their lives are worthless. </p>
<p>“I knew I was alone,” one man, Rigoleto, told me. “If I wanted something, I had to get it myself.” </p>
<p>My research also reveals that these narcos embrace the government’s binary discourse. They identified as “they” – the people excluded from “our” civil society. The former drug traffickers I spoke with also reproduce the individualistic, every-man-for-himself ethos that has permeated Mexican society since the introduction of a <a href="https://www.jstor.org/stable/3993429">neoliberal, U.S.-style economic system</a> in the late 1980s. </p>
<p>This ethos is a double-edged sword. Mexico’s narcos may not blame the state or society for their condition of poverty – each is, after all, his own man – but they don’t feel remorse for their crimes, either. They had the “bad luck” of being born in poverty, they told me, and their victims had the “bad luck” to be in their way. </p>
<p>The narco’s logic is simple, according to Yuca, one of the men I interviewed: We are, all of us, bound to the “law of the fittest.” </p>
<p>As Cristian said: “In my neighborhood we all knew the rules: You snooze, you lose. That was the law. You have to be tough, you have to be violent, you have to take care of yourself, because nobody will do it for you.”</p>
<h2>Poverty: A fixed and inevitable condition</h2>
<p>This is one of several shared values I identified in my interviews, which together form what I refer to in my dissertation as “the narco discourse.” </p>
<p>The narco discourse puts poverty in sharp relief. The men I spoke with believe poor people have no future and, therefore, have nothing to lose. </p>
<p>“I knew I would grow up and die in poverty,” said one of my interviewees, Wilson. “I just asked God: Why me?”</p>
<p>Poverty is understood as an inevitable condition. “Somebody has to be poor,” said one man, Lamberto. </p>
<p>“There is nothing you can do to avoid it,” said another, Tabo. </p>
<p>The narco discourse also assumes that poor children will, like them, inevitably become involved with drugs and gangs. It is taken for granted that poor children have no future, that they are disposable. </p>
<p>“When you grow up in a poor neighborhood you know that at some point you will become a drug addict,” said Palomo. “When you are a drug addict you see yourself as rubbish. Who would care about the life of a poor drug addict?”</p>
<p>In this crowd, I learned, an early death is also seen as inevitable. </p>
<p>“When you see so many of your peers dying in street fights, from an overdose, shot by the police, you think that that is your future as well,” a man I’ll call Tigre told me. </p>
<p>The possibility of being killed or killing, then, isn’t necessarily a drawback of the drug trade. The kids who grow up to be drug traffickers assume that death is their destiny. </p>
<p>“I always thought that my destiny was to die from an overdose or by a bullet,” said Pancho.</p>
<h2>Consumerism</h2>
<p>One of the few ways poor kids with this worldview could imagine enjoying life, they told me, is by buying stuff – nice stuff, luxury items, things they couldn’t afford. </p>
<p>The only way to achieve that is with the “easy money” that an “easy life” in the drug business would give them. </p>
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<p>They understood the happiness brought on by easy money to be momentary. But still, they said, it was worth it. My interview subjects assume that “in this world you’re a nobody without money,” as Canastas put it. </p>
<p>Crucially, the narcos recognize that the flip side of the “easy life” is either death or jail.</p>
<p>“One day you are in a nice restaurant, surrounded by beautiful women and important people,” Ponciano told me. “The next day you may wake up in a dungeon.”</p>
<p>That’s why the easy life has to be so fast, so hedonistic – to maximize the benefits of that easy money. </p>
<p>As Jaime told me, “My goal was to live every day as if was the last. I did not pinch pennies when it came to enjoy[ing] myself. [I bought] the best trucks, the best wines [and had] the most beautiful women.”</p>
<h2>‘A real man’</h2>
<p>In the narco discourse, physical violence is essential to survive, literally, in poor neighborhoods which participants referred as “the jungle.”</p>
<p>Violence, I was informed, is learned. Men are not born violent, but they must become violent. As Jorge explained: </p>
<p>“When I was a child, older children hit me, they took advantage of me because I was alone. I was not violent, but I had to become even more violent than them. You must do it if you want to survive in the streets.”</p>
<p>In “the jungle,” men also had to keep a certain reputation as a “real man.” As they see it, that means being an aggressive, heterosexual, violent womanizer. A true man is “good for the party, drugs and alcohol,” said Dávila. </p>
<p>The real man cannot show his fears – no emotions, no weaknesses. The best way to hide them, the narcos I interviewed said, is by proving their strength. This can be done in different ways: within your own gangs, fighting rival gangs or at home, with their family. </p>
<p>A recurrent theme in my interviews was the anger that participants felt against their fathers, most of whom were domestic abusers. </p>
<p>Twenty-eight out of the 33 men admitted that at some point in their lives their greatest aspiration had been to kill their fathers. All said their biggest frustration had been watching their fathers beat their mothers. They wanted revenge not for themselves, but for their mothers.</p>
<p>The men invoked the trauma of witnessing gender violence not only when we spoke about their childhood but also when we discussed their reasons for illegal acts like drug use, vandalism and drug trafficking.</p>
<p>To some participants, a fantasy of making their fathers suffer was their main motivation to work in the drug trade. </p>
<p>“My only thought was to kill my father when I grew up,” Rorro explained. “I wanted to cut him into little pieces.” Being a narco gave him that power. </p>
<p>A man named Ponciano told me that he thought of his father when he was torturing his victims. </p>
<p>“And I made them suffer even more, like he made us suffer.”</p>
<p>Not everyone who had the opportunity to kill their fathers could follow through. Facundo, wishing his father to suffer but unable to kill him, told his dad to leave town. </p>
<p>“If I see you again, I will kill you,” he said. </p>
<h2>What can we learn in Latin America?</h2>
<p>Poverty and toxic masculinity. These are, my research finds, two common themes driving the men who commit <a href="https://theconversation.com/murder-and-the-mexican-state-34286">so much violence not only in Mexico</a> but across Latin America, the <a href="https://theconversation.com/how-to-fix-latin-americas-homicide-problem-79731">world’s most violent region</a>.</p>
<p>The everyday life of these narcos are a breeding ground for all sorts of violence, from domestic abuse to gang rivalry. When policymakers focus on “ending drug violence,” this is the view so often missing.</p>
<p>Even when poverty is <a href="http://www.scielo.org.mx/pdf/desacatos/n40/n40a2.pdf">acknowledged</a> as the root of other major social problems in Mexico, as some <a href="https://revistas.uam.es/index.php/relacionesinternacionales/article/viewFile/5115/5568">researchers have done</a>, there is insufficient knowledge of what living in poverty actually means for these people. While many experiences of poverty where shared by my interviewees, each person in each region and each neighborhood had their own problems and specific needs. </p>
<p>Understanding how that background leads to violence would mean listening – really listening – to men like those I interviewed. And it means asking questions that don’t fit within the “us versus them” mentality of presidents, policymakers and police chiefs. To design more effective policies for ending violence, one must understand the logic, the worldview, of its perpetrators. </p>
<p>Where does all this violence come from? Who justifies its use, and how? How is violence reproduced within Mexican families, and echoed within communities? When the government responds to this violence with more violence – by <a href="https://theconversation.com/a-record-29-000-mexicans-were-murdered-last-year-can-soldiers-stop-the-bloodshed-90574">sending soldiers out to fight crime</a>, as Mexico has done for 12 years – what message does that send? </p>
<p>As long as governments maintain their discourse about “good people” versus “bad men,” my research suggests, it will only feed “their” indifference to “us.”</p>
<hr>
<p><em>This article was adapted from the <a href="https://ciperchile.cl/2020/01/03/por-que-fracasa-la-guerra-contra-el-narcotrafico-entrevista-a-33-ex-narcos-mexicanos-para-quienes-morir-es-un-alivio/">original version</a>, published on The Conversation España as part of a collaboration with the Centro de Investigación Periodística (<a href="https://ciperchile.cl/">CIPER</a>) in Chile.</em></p><img src="https://counter.theconversation.com/content/129865/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Karina Garcia Reyes' PhD dissertation received funding from the Consejo Nacional de Ciencia y Tecnología (CONACYT) and additional support from the Secretaría de Educación Pública (SEP) in Mexico.</span></em></p>A researcher who fled crime-beset Mexico returns to interview the drug cartels behind so much of the violence, asking 33 ‘narcos’ everything about their lives, from birth to their latest murder.Karina G. Garcia Reyes, Profesora de la Escuela de Sociología, Política y Relaciones Internacionales y del departamento de Estudios Latinoamericanos, University of BristolLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1282462020-01-29T12:41:41Z2020-01-29T12:41:41ZSecret histories of drugs – legal and illegal – in southern Africa<figure><img src="https://images.theconversation.com/files/311110/original/file-20200121-117907-1k57lih.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Shutterstock</span></span></figcaption></figure><p>If you want to score heroin in some of the historically black suburbs, or townships, of Johannesburg, South Africa, you need to find yourself a ‘Snyman’. A ‘Snyman’ is a drug dealer. The word is used in <a href="https://link.springer.com/chapter/10.1057/978-1-137-01593-8_18">tsotsitaal</a>, the creole, urban dialect that emerged during the colonial and apartheid eras of segregation. </p>
<p>‘Snyman’ entered this lexicon in the late 1960s and early 1970s. It was around this time that cannabis smugglers supplying the gold mining compounds and nearby settlements began to diversify into pharmaceuticals. One drug of choice was methaqualone, also known as Mandrax. </p>
<p>Today, most young people who rely on a Snyman to supply them with a
bit of a heroin admixture locally known as <a href="https://www.sciencedirect.com/science/article/pii/S037907381830481X">nyaope</a> aren’t aware that they are invoking the name of a mid-century professor of medicine at the University of Pretoria, Dr HW Snyman. In 1961 Snyman headed a governmental commission that bore his name. Its recommendations led to the Medicines and Related Substances <a href="https://www.nda.agric.za/vetweb/Legislation/Other%20acts/R_Medicines_and_related_substances.htm">Control Act</a> of 1965.</p>
<p>This means that, at the height of the apartheid era, black entrepreneurs trading in illicit pharmaceuticals adopted and repurposed the name of a white medical expert who enacted the state’s vision of drug regulation. In calling themselves ‘Snyman’, they showed a hefty dose of defiance as well as ironic humour.</p>
<p>The anecdote may be read as a metaphor of grassroots challenges to apartheid statecraft. But it also confirms growing, global evidence that drug prohibitions have never been far from the workings of ‘shadow’ economies. Indeed, chemically and socially, the <a href="https://www.strath.ac.uk/humanities/schoolofhumanities/history/centreforthesocialhistoryofhealthhealthcare/beyondthemedicinesdrugsdichotomyhistoricalperspectivesongoodandevilinpharmacy/">dichotomies</a> historically crafted between (legitimated) medicines and (illicit) drugs just don’t hold in practice. </p>
<p>We see this currently, for example, in the rapidly <a href="https://www.economist.com/international/2019/08/29/a-global-revolution-in-attitudes-towards-cannabis-is-under-way">shifting legal status</a> of cannabis (including in <a href="http://theconversation.com/south-african-court-frees-cannabis-from-colonial-and-apartheid-past-103644">South African law</a>) and its speedy absorption into <a href="https://www.marketwatch.com/story/10-largest-marijuana-companies-2019-01-02">corporate commerce</a>; in <a href="https://www.theguardian.com/us-news/2019/oct/04/purdue-pharma-oxycontin-sacklers-opioid-lawsuits">painkiller</a> ‘opioid crises’ and <a href="https://www.cdc.gov/nchs/pressroom/podcasts/20190911/20190911.htm">fentanyl overdose deaths</a> in the US; in the <a href="https://www.unodc.org/nigeria/en/key-findings-of-unodc-study-on-tramadol-trafficking-in-west-africa-discussed-at-regional-meeting.html">illicit trade</a> in the painkiller Tramadol in West Africa; and in clandestine exports of Chinese Xanax into the hands of South African <a href="https://www.newframe.com/prescription-drug-poses-new-threat-to-youths/">school kids</a>.</p>
<p>A special issue of the <a href="https://www.tandfonline.com/toc/rshj20/current">South African Historical Journal</a>, Drug Regimes in Southern Africa, showcases research about some of the ‘secret’ histories of drugs from the southern region of the African continent. These range from Cape Town’s opium dens to cannabis experiments on cats; from big pharma bio-prospecting to the politics of synthetic sedatives and controversial cow vaccines.</p>
<p>But why spend time reading about the past when today’s drug dilemmas seem so urgent?</p>
<h2>Why history matters</h2>
<p>Historical research can offer critical perspectives that help make sense of current dilemmas. Historians don’t generally set out to inform policy. Nevertheless complex understandings of the past are key to sound decision-making in both legislative and medical practices. Historians know that debates about substances commonly called ‘drugs’ are far from new. As was pointed out by organisers of a recent <a href="https://www.strath.ac.uk/humanities/schoolofhumanities/history/changingmindssocietiesstatesthesciencesandpsychoactivesubstancesinhistory/">history conference</a> held in Shanghai:</p>
<blockquote>
<p>After all, experts offering definitive accounts of psychoactive substances, vacillating bureaucrats and politicians, unyielding moralists and fickle consumers are all among the figures familiar to historians from other periods and a range of places.</p>
</blockquote>
<p>Historical research on ‘drugs’, whether defined as <a href="https://www.intoxicatingspaces.org/">intoxicants</a> or medicines, is an established field among scholars in the global North. This is shown in the work of the <a href="https://alcoholanddrugshistorysociety.org/about/">Alcohol and Drugs History Society</a> and its excellent journal, <a href="https://www.journals.uchicago.edu/toc/shad/current">Social History of Alcohol and Drugs</a>. </p>
<p>But drugs history scholarship from and about the global South grows ever more vibrant. Histories of <a href="https://uncpress.org/book/9780807859056/andean-cocaine/">cocaine </a> in South America and <a href="https://www.strath.ac.uk/humanities/schoolofhumanities/history/centreforthesocialhistoryofhealthhealthcare/ourresearch/theasiancocainecrisis/">Asia</a>, <a href="https://uncpress.org/book/9781469613727/home-grown/">cannabis in Mexico </a> and <a href="https://www.cambridge.org/core/journals/journal-of-modern-african-studies/article/politics-of-law-enforcement-in-nigeria-lessons-from-the-war-on-drugs/8B56707532B2902B3C2A26354C97966B">Nigeria</a>, <a href="https://brill.com/view/title/13754">khat in Kenya</a> and the politics of <a href="https://www.cambridge.org/core/books/drugs-politics/E2EFB2A2A59AC5C2D6854BC4C4501558">drug use in Iran</a> are a few examples. </p>
<p><a href="https://www.palgrave.com/gp/book/9781137321893">Histories of drugs in Africa</a> are of growing interest worldwide.</p>
<p>Since the late 19th century especially, global flows of neurochemical substances and products have deepened the entanglements of consumers in Africa in networks of legal and illicit drugs production, flow, profit and risk. Historical perspectives bring to light the social processes through which bioactive plants, manufactured pharmaceuticals and techniques of treatment come to figure in diverse and changing human experiences. </p>
<p>In the 20th century, the contexts of colonialism, apartheid and democracy shaped <a href="https://mh.bmj.com/content/44/4/253">drug control, provision and regulation</a> in South Africa.</p>
<p>Today media reports on drug issues in this country often invite panicked responses. Journalism frequently reproduces the hyperbole and moralism that have – for over a century – shaped public opinion here. Narratives that sometimes exaggerate or even mislead the public about new forms of substances, coming across borders, or the behaviours they allegedly cause, have had very negative consequences. These have included fuelling <a href="https://www.theguardian.com/world/2019/sep/10/we-are-a-target-wave-of-xenophobic-attacks-sweeps-johannesburg">xenophobic sentiments</a> as well as <a href="https://www.hsrcpress.ac.za/books/opioids-in-south-africa">the stigma</a> attached to people using drugs. </p>
<p>At the same time, there are hopeful signs of change in public opinion. And there are positive indications of a quest for evidence-based policy and treatment solutions. An example is the case of <a href="https://www.hsrcpress.ac.za/books/opioids-in-south-africa">harm reduction approaches</a> to opioid addiction.</p>
<h2>What’s needed</h2>
<p>The promises of pharmaceutical technologies are evident. So are the challenges. In today’s global world, we need the evidence offered by history to develop more informed, nuanced and less reactionary responses.</p>
<p>The <a href="https://www.tandfonline.com/toc/rshj20/current">special issue</a> ‘Drug Regimes in Southern Africa’ is proof of a growing body of work on the histories of drugs – illegal and legal – across the continent. </p>
<p><em>The information that ‘Snyman’ is used as a word for drug dealer was provided by Msawenkosi Gibson Nzimande, a University of Johannesburg Masters student currently doing research on substance use in Johannesburg.</em></p>
<p><em>This is the first article in a <a href="https://theconversation.com/africa/search?utf8=%E2%9C%93&q=DRSA">series</a> on drug regimes in southern Africa. They are based on research done for a special edition for the <a href="https://www.tandfonline.com/toc/rshj20/current">South African Historical Journal</a>. Read the full paper over <a href="https://www.tandfonline.com/doi/full/10.1080/02582473.2019.1681073">here</a>.</em></p><img src="https://counter.theconversation.com/content/128246/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Thembisa Waetjen receives funding from the National Research Foundation (NRF).</span></em></p><p class="fine-print"><em><span>Julie Parle receives funding from the National Research Council (NRF).</span></em></p><p class="fine-print"><em><span>Rebecca Hodes receives funding from the Medicines Research Council and the Human Sciences Research Council of South Africa, the Medical Research Council of the United Kingdom, the Fogarty International Centre and the National Institute of Mental Health at the National Institutes of Health, United States, the European Research Council, and the Desmond Tutu HIV Foundation.</span></em></p>From colonial poppy fields to pharmatrash, southern Africa offers a fascinating history of drug regimes – one that helps us make sense of drug policies and legislation today.Thembisa Waetjen, Associate Professor of History, University of JohannesburgJulie Parle, Honorary Professor in History, University of KwaZulu-NatalRebecca Hodes, Director, AIDS and Society Research Unit, University of Cape TownLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1204492019-08-15T08:53:16Z2019-08-15T08:53:16ZUK drug deaths continue to rise – time for action<figure><img src="https://images.theconversation.com/files/287990/original/file-20190814-136203-zdgykg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/download/confirm/1215689563?src=WdYmyGcwLDAVNT9Ex5VBQQ-1-14&size=medium_jpg">Impact Photography/Shutterstock</a></span></figcaption></figure><p>Every year since 2013, the UK’s Office for National Statistics has reported an <a href="https://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/deaths/bulletins/deathsrelatedtodrugpoisoninginenglandandwales/2018registrations">increase</a> in drug-related deaths in England. Last year, we reported that drugs had <a href="https://theconversation.com/record-level-of-drug-deaths-in-england-and-wales-latest-official-figures-99710">overtaken traffic accidents</a> as a leading cause of death. This year, they have <a href="https://www.telegraph.co.uk/news/2019/08/06/drug-overdose-eclipses-suicide-biggest-killer-middle-aged-men/?WT.mc_id=tmg_share_tw">outstripped suicides</a> among men aged 35-49. As these deaths continue to rise ever higher, the government continues to cut funding for drug treatment and actively blocks services that would save people’s lives.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/288147/original/file-20190815-136176-1774mvt.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/288147/original/file-20190815-136176-1774mvt.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/288147/original/file-20190815-136176-1774mvt.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=360&fit=crop&dpr=1 600w, https://images.theconversation.com/files/288147/original/file-20190815-136176-1774mvt.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=360&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/288147/original/file-20190815-136176-1774mvt.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=360&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/288147/original/file-20190815-136176-1774mvt.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=452&fit=crop&dpr=1 754w, https://images.theconversation.com/files/288147/original/file-20190815-136176-1774mvt.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=452&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/288147/original/file-20190815-136176-1774mvt.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=452&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Drug deaths chart.</span>
<span class="attribution"><span class="source">ONS</span></span>
</figcaption>
</figure>
<p>Just this week, prime minister Boris Johnson promised to spend billions of pounds on <a href="https://www.theguardian.com/politics/2019/aug/12/boris-johnson-crime-crackdown-policing-prisons">ineffective criminal justice policies</a>, including <a href="https://news.sky.com/story/how-much-do-all-of-boris-johnsons-promises-cost-11783796">£2.5 billion</a> a year to expand the prison population by another 10,000 people. It is highly doubtful whether these pledges will be any more real than <a href="https://www.bbc.co.uk/news/uk-49318400">previous unfulfilled promises</a>, but they stand in stark contrast to sharp cuts in investment in preventing people from dying from drugs.</p>
<p><a href="https://www.gov.uk/government/collections/local-authority-revenue-expenditure-and-financing#2018-to-2019">Government figures</a> show a 27% reduction in spending on drug treatment services for adults since 2015-16. In some places with very high rates of drug-related deaths - such as Blackpool, Hartlepool, Liverpool and North Tyneside - the budget for drug treatment has been cut by more than half. </p>
<p>Drug-related deaths are not spread equally among British communities. The greatest burden is among those living in the most <a href="https://www.ons.gov.uk/peoplepopulationandcommunity/healthandsocialcare/healthandwellbeing/articles/middleagedgenerationmostlikelytodiebysuicideanddrugpoisoning/2019-08-13">deprived</a> areas. Until recently, the media has largely ignored communities which lose middle-aged opiate users on a daily basis. More attention has been paid to young people dying as a result of party drugs, such as ecstasy. </p>
<p>As the deaths mount, this is beginning to change. Heartbreaking stories of deaths, such as <a href="https://www.walesonline.co.uk/news/wales-news/son-heroin-addict-grieving-mothers-16724022">Kevin Lane</a>, are getting more coverage. Lane had struggled with drug dependency for several years. He also had mental health problems – an all too common combination for people who have problems with drugs. His life ended prematurely when he was found in a shop toilet having overdosed on heroin aged just 32. </p>
<p>The shocking practice of “<a href="https://www.bbc.co.uk/news/uk-wales-46738016">cuckooing</a>” - where drug dealers take over the homes of vulnerable people - also shows that people who use drugs deserve protection, not just blame. </p>
<h2>Ignoring the evidence</h2>
<p>In Scotland, record levels of drug deaths have been recognised as a symptom of <a href="http://www.sdf.org.uk/blog-poverty-is-the-root-of-scotlands-fatal-drug-overdose-crisis/">entreneched poverty</a>. Deaths both north and south of the Scottish border are a <a href="https://www.thelancet.com/journals/lanpsy/article/PIIS2215-0366(19)30209-3/fulltext">public health crisis</a> triggering calls for a <a href="https://www.thenational.scot/news/17829530.scottish-drugs-forum-warns-urgent-rethink-required-street-valium-deaths/">different approach</a> by bereaved families, advocacy groups and many others. But Westminster has failed to implement evidence-based measures, recommended by the <a href="https://www.gov.uk/government/publications/reducing-opioid-related-deaths-in-the-uk">Advisory Council on the Misuse of Drugs</a>, for reducing deaths. </p>
<p>Instead of investing in effective opioid-substitution treatment, it has slashed the available funding. It has left it to cash-strapped local authorities to provide <a href="https://www.cambridge.org/core/journals/the-british-journal-of-psychiatry/article/heroin-on-trial-systematic-review-and-metaanalysis-of-randomised-trials-of-diamorphineprescribing-as-treatment-for-refractory-heroin-addiction/A3C4F1D0F709099E47472B42507FF97C">heroin-assisted treatment</a>. And it has refused to support <a href="https://transformdrugs.org/the-governments-arguments-against-drug-consumption-rooms-have-fallen-one-by-one/">drug consumption facilities</a>. These facilities <a href="https://theconversation.com/what-goes-on-inside-a-medically-supervised-injection-facility-87341">save</a> lives, but they need political support and funding – not easy when the <a href="https://www.jrf.org.uk/sites/default/files/jrf/migrated/files/9781859354711.pdf">public</a> perceive these as facilitating drug use rather than a means to reducing drug-related harm.</p>
<p>All drug-related deaths are avoidable. We know how to reverse this dreadful trend in mortality, but this knowledge needs to be acted on by politicians. Unless this happens, we fear that next year yet another record in drug-related deaths will be reported.</p><img src="https://counter.theconversation.com/content/120449/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Alex Stevens is a member of the Advisory Council on the Misuse of Drugs, but does not speak for it here.</span></em></p><p class="fine-print"><em><span>Ian Hamilton does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>There are proven ways to reduce drug deaths in the UK. But the government is ignoring them.Ian Hamilton, Associate Professor, University of YorkAlex Stevens, Professor in Criminal Justice and Faculty Director of Public Engagement, University of KentLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1205582019-08-07T13:38:51Z2019-08-07T13:38:51ZFrench cannabis legalization debate ignores race, religion and the mass incarceration of Muslims<figure><img src="https://images.theconversation.com/files/287107/original/file-20190806-84210-1dsw0i5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Evidence suggests that Muslim men in France have been disproportionately arrested and jailed for cannabis-related crimes since the drug became illegal in 1970.</span> <span class="attribution"><a class="source" href="https://www.flickr.com/photos/francisco_osorio/4977990504/in/photolist-8zTv9u-B1k938-6afVLk-87j3TU-8pdjy4-hP7vgs-8TfWUQ-RTuk8L-286TveU-M4roSU-27PfhL8-29c9WnD-SthGRk-26rpDLS-286Nae3-Sh5Y3t-26rsHMb-M4r8jQ-Srk5bE-286V31w-4KqDVQ-6afVDi-6afVyR-7gvLPB-E1RSo-59cKgy-7CsArq-7gzA71-7Cszo9-7gzBJU-8VeEE6-StLf8R-21inHSo-dDKSHJ-Rr8diz-StnAiF-AtWitz-25uMaQt-QBavfz-2crXZ5w-225FvMS-Sh5ZXR-7kj7sT-RecthX-Sh61da-SBqZUA-SBrz7C-StnCrP-B33Fs7-27Per9T">Francisco Osorio/flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></span></figcaption></figure><p>Last summer in France, dozens of “CBD cafés” suddenly opened across the country.</p>
<p>Exploiting a legal loophole originally created for hemp farmers, these pop-up businesses sold queuing customers oils, drinks and salves infused with cannabidiol, a cannabis compound <a href="https://theconversation.com/cbd-rising-star-or-popular-fad-110146">that is a faddish if unproven “cure”</a> for insomnia, anxiety and more. The French government reacted quickly and by mid-June had <a href="http://www.drogues.gouv.fr/actualites/cannabidiol-cbd-point-legislation">officially prohibited the sale of CBD</a>. The CBD cafés vanished within a month. </p>
<p>But France’s brief experiment with cannabidiol seems to have started a movement to legalize cannabis, which has been illegal since <a href="https://www.legifrance.gouv.fr/affichTexte.do?cidTexte=JORFTEXT000000321402&categorieLien=id">1970</a>. </p>
<p>On June 19, dozens of French economists, physicians and politicians published an open letter in the popular news magazine <a href="https://www.nouvelobs.com/societe/20190619.OBS14590/l-appel-de-70-medecins-elus-economistes-pourquoi-nous-voulons-legaliser-le-cannabis.html">L’Obs</a>, denouncing the “bankruptcy” of cannabis prohibition and imploring the nation to “Légalisons-Le!” Soon after, an economic advisory council to the French prime minister released a <a href="https://www.legifrance.gouv.fr/jo_pdf.do?cidTexte=JORFTEXT000000321402">report</a> criticizing France’s drug war as a costly “French failure” and calling for cannabis legalization on financial grounds. </p>
<p>Then, in July, France’s drug safety agency <a href="https://ansm.sante.fr/S-informer/Actualite/Cannabis-a-visee-therapeutique-en-France-l-ANSM-souscrit-au-cadre-de-la-phase-experimentale-de-mise-a-disposition-propose-par-le-Comite-d-experts-Point-d-information">approved</a> the launch of medical cannabis trials in France — something physicians and activists have pushed for since 2013. </p>
<p>France’s drug policy debate largely echoes similar conversations that have lead a <a href="https://theconversation.com/marijuana-expands-into-3-more-states-but-nationwide-legalization-still-unlikely-106512">dozen U.S. states</a> to legalize and regulate cannabis since 2014, but for one difference: France has all but ignored the <a href="https://www.cnsnews.com/news/article/susan-jones/cory-booker-calls-marijuana-justice-biden-says-drug-criminals-shouldnt-be">link</a> between <a href="https://www.nbcnews.com/news/nbcblk/legal-marijuana-made-big-promises-racial-equity-fell-short-n952376">race</a>, cannabis and <a href="https://www.nytimes.com/2019/03/11/nyregion/marijuana-legalization-african-americans.html">mass incarceration</a>.</p>
<h2>France’s hidden war on drugs</h2>
<p>Evidence suggests that cannabis prohibition over the past 50 years has disproportionately punished France’s Muslim minority. </p>
<p>About one-fifth of French prisoners were convicted for drug offenses, according to the <a href="http://www.justice.gouv.fr/art_pix/Stat_Annuaire_ministere-justice_2017_chapitre8.pdf">French Ministry of Justice</a> – a rate comparable to that of the <a href="https://www.prisonpolicy.org/reports/pie2019.html">United States</a>. Nearly all of them are men. </p>
<p>There is no demographic breakdown of this population, because the French credo of “absolute equality” among citizens has made it <a href="https://www.independent.co.uk/news/world/politics/how-french-law-makes-minorities-invisible-a7416656.html">illegal since 1978 to collect</a> statistics based on race, ethnicity or religion. But sociologist <a href="http://cadis.ehess.fr/index.php?1142">Farhad Khosrokhavar</a>, who studies France’s prison system, has found that roughly half of the 69,000 people incarcerated today in France are Muslims of Arab descent.</p>
<p>Muslims make up just 9% of France’s 67 million people.</p>
<figure class="align-right ">
<img alt="" src="https://images.theconversation.com/files/287106/original/file-20190806-84244-16wo80g.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/287106/original/file-20190806-84244-16wo80g.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=583&fit=crop&dpr=1 600w, https://images.theconversation.com/files/287106/original/file-20190806-84244-16wo80g.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=583&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/287106/original/file-20190806-84244-16wo80g.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=583&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/287106/original/file-20190806-84244-16wo80g.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=732&fit=crop&dpr=1 754w, https://images.theconversation.com/files/287106/original/file-20190806-84244-16wo80g.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=732&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/287106/original/file-20190806-84244-16wo80g.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=732&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption"></span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/download/success?u=http%3A%2F%2Fdownload.shutterstock.com%2Fgatekeeper%2FW3siZSI6MTU2NTE1MjUxNywiYyI6Il9waG90b19zZXNzaW9uX2lkIiwiZGMiOiJpZGxfMTQwMjg3NjI2OCIsImsiOiJwaG90by8xNDAyODc2MjY4L2h1Z2UuanBnIiwibSI6MSwiZCI6InNodXR0ZXJzdG9jay1tZWRpYSJ9LCJYZElldkdqWkk0V1MwWFNabTdlOGwyZ2NndUUiXQ%2Fshutterstock_1402876268.jpg&pi=33421636&m=1402876268&src=GxC2BHBfNf7nnlBX4w5Kzg-1-25">Shutterstock</a></span>
</figcaption>
</figure>
<p>According to a <a href="http://www.assemblee-nationale.fr/15/rap-info/i0595.asp">January 2018 study</a> commissioned by the French National Assembly, of the 117,421 arrests for drugs in France in 2010, 86% involved cannabis. Cannabis arrests are rising quickly, too. The same study reported that number of people arrested annually for “simple use” of cannabis in France increased 10-fold between 2000 and 2015, from 14,501 to 139,683.</p>
<p>Taken together, this and <a href="https://www.ofdt.fr/BDD/publications/docs/DCC2019.pdf">other data</a> suggests that up to 1 in 6 prisoners in France today may be an Arab Muslim man who used, possessed or sold cannabis. </p>
<h2>Hashish assassins</h2>
<p>The disproportionate impact of French drug laws on Muslim men is unsurprising considering that the French have long associated Muslims with cannabis – specifically hashish, a cannabis resin.</p>
<p>As I argue in my <a href="https://digital.library.temple.edu/digital/collection/p245801coll10/id/490292/">doctoral dissertation</a> and forthcoming book on the history of hashish in France, the 19th-century French believed this mild drug caused insanity, violence and criminality among Muslim North Africans.</p>
<p>Writing in the early 1800s, the famed French scholar <a href="https://gallica.bnf.fr/ark:/12148/bpt6k5656689h/f85.item.r=Sacy">Antoine-Isaac Silvestre de Sacy</a> popularized the idea that the word “assassin” derived from the Arabic word “hashish” and that both originated with a Muslim sect called the Assassins of Alamut, who operated during the Crusades. </p>
<p>First described in the 1300 Italian travelogue “<a href="https://www.wdl.org/en/item/14300/">The Travels of Marco Polo</a>,” the Assassins of Alamut were rumored to use an “intoxicating potion” to dupe devotees in Iraq and Syria into becoming assassins. Sacy believed the potion was made from hashish, citing contemporary Arabic references to the sect as the “al-Hashishiyya,” or “hashish-eaters.” </p>
<p>These assassins, Sacy argued, “were specifically raised to kill” by their leader, known as the Old Man of the Mountain. They were fed hashish to ensure “absolute resignation to the will of their leader.” </p>
<p>Though largely a fiction, Sacy’s contentions about cannabis-eating Muslim assassins <a href="https://www.journals.uchicago.edu/doi/abs/10.1086/SHAD30010050">gained traction</a> in France, particularly in medicine. </p>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/287108/original/file-20190806-84195-1mfz8rw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/287108/original/file-20190806-84195-1mfz8rw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/287108/original/file-20190806-84195-1mfz8rw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=558&fit=crop&dpr=1 600w, https://images.theconversation.com/files/287108/original/file-20190806-84195-1mfz8rw.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=558&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/287108/original/file-20190806-84195-1mfz8rw.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=558&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/287108/original/file-20190806-84195-1mfz8rw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=701&fit=crop&dpr=1 754w, https://images.theconversation.com/files/287108/original/file-20190806-84195-1mfz8rw.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=701&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/287108/original/file-20190806-84195-1mfz8rw.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=701&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Hashish.</span>
<span class="attribution"><a class="source" href="https://commons.wikimedia.org/wiki/File:American_medical_hashish(2).jpg">Mjpresson/Wikimedia Commons</a>, <a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></span>
</figcaption>
</figure>
<p>Dozens of mid 19th-century doctors cited Sacy’s work in their research, my research uncovered. They believed that Western pharmaceutical science could “tame” hashish – this dangerous and exotic intoxicant from the Orient – for use by physicians to treat such fearsome diseases as insanity, the plague and cholera. </p>
<p>Medical hashish, primarily in the form of tincture, <a href="https://digital.library.temple.edu/digital/collection/p245801coll10/id/490272">flourished</a> in France during the 1830s and 1840s. </p>
<p>But the French soon grew disillusioned with their wonder drug. Cannabis, we now know, eases the symptoms of some diseases – but it cannot cure cholera.</p>
<p>As failed treatments mounted and many of the medical philosophies that underpinned the use of hashish became obsolete in France by the late 19th century, its use as medicine largely ended. In <a href="https://www.legifrance.gouv.fr/affichTexte.do?cidTexte=JORFTEXT000000845281&categorieLien=id">1953</a>, France made medicinal hashish illegal. </p>
<h2>Colonial reefer madness</h2>
<p>The link between hashish and violent Muslims, however, was ingrained in the national consciousness. And it influenced French public policy for decades.</p>
<p>Officials and physicians in French colonial Algeria, viewing hashish use as a cause of <a href="http://jubilotheque.upmc.fr/ead.html?id=CS_000020_020#!%7B%22content%22:%5B%22CS_000020_020_toc298%22,false,%22%22%5D%7D">insanity and violent criminality</a>, filled psychiatric hospitals across Algeria with local Muslims supposedly suffering “folie haschischique” – basically, “<a href="https://theconversation.com/re-criminalizing-cannabis-is-worse-than-1930s-reefer-madness-89821">reefer madness</a>.”</p>
<p>Such thinking also helped justify the creation of the <a href="https://www.editions-zones.fr/livres/de-l-indigenat/">Code de l’Indigènat</a> in 1875, a French law that institutionalized racism and apartheid in French North Africa by officially designating Muslims as subjects rather than citizens. </p>
<p>In the name of promoting “colonial order,” France established separate and unequal legal codes that promoted the segregation, <a href="https://journals.openedition.org/civilisations/1717?lang=fr">forced labor</a> and civil rights restrictions of Muslims and other Africans.</p>
<p>The stigmatizing association between Muslims, hashish and criminality persisted after the end of the <a href="https://www.oxfordscholarship.com/view/10.1093/acprof:oso/9780199668311.001.0001/acprof-9780199668311-chapter-5">French Empire</a> in 1968. It followed North Africans who emigrated to France, who were believed to <a href="https://read.dukeupress.edu/french-historical-studies/article-abstract/36/3/479/9749/Colonial-Techniques-in-the-Imperial-Capital-The?redirectedFrom=fulltext">prone to violence</a> and criminality and as such subject to government surveillance, interrogations and excessive police force in France.</p>
<p>French parliamentarians seeking to criminalize cannabis in the late 1960s embraced these discriminatory views. </p>
<p>They described the nation’s growing drug problem as a “<a href="http://archives.assemblee-nationale.fr/4/cri/1969-1970-ordinaire1/015.pdf">foreign plague</a>” spread by Arab drug traffickers. One French National Assembly member even cited Sacy, reminding fellow lawmakers that cannabis had once inspired a cult of Muslim murderers called the “Hachichins.” </p>
<p>French lawmakers today probably would not use such discredited research or stigmatizing language to connect Muslims to cannabis. But the number of Muslims imprisoned for drug-related crimes suggests that this historic racism is alive and well in France. </p>
<p>If France moves to regulate legal cannabis, many doctors, pot smokers and libertarian economists will surely rejoice. But it may be French Muslims who benefit the most.</p>
<p>[ <em>Like what you’ve read? Want more?</em> <a href="https://theconversation.com/us/newsletters?utm_source=TCUS&utm_medium=inline-link&utm_campaign=newsletter-text&utm_content=likethis">Sign up for The Conversation’s daily newsletter</a>. ]</p><img src="https://counter.theconversation.com/content/120558/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>David A. Guba Jr. does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Muslims make up 9% of France’s population and half of all its prisoners – many convicted on drug charges. But social justice isn’t part of the country’s growing debate on legalization.David A. Guba Jr., History Faculty, Bard CollegeLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1212212019-08-02T11:59:31Z2019-08-02T11:59:31ZDrug laws on possession: several countries are revisiting them and these are their options<figure><img src="https://images.theconversation.com/files/286584/original/file-20190801-169684-1q60gc3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Not worth locking people up for.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/download/confirm/1404310937?src=X1W-wBFUmUinaRdxEkm0RA-1-65&studio=1&size=medium_jpg">Bobkov Evgeniy/Shutterstock</a></span></figcaption></figure><p>Many countries are changing the way they approach people who use drugs. The Irish government <a href="http://www.justice.ie/en/JELR/Final_Report_of_the_Working_Group.pdf/Files/Final_Report_of_the_Working_Group.pdf">has just announced</a> possible alternatives to criminalisation for possession of some drugs. Other countries, including <a href="https://www.huffingtonpost.com.au/entry/norway-decriminalize-drug-use_n_5a387b70e4b0860bf4aa96c4">Norway</a> and <a href="https://www.aljazeera.com/news/2019/06/malaysia-decriminalise-drug-health-minister-190628060223845.html">Malaysia</a>, are weighing options. But what can countries do if they don’t want to arrest or convict people because they use drugs?</p>
<p>To inform the Irish government’s decision, we carried out a <a href="http://www.justice.ie/en/JELR/ANNEXE_I_-_Hughes_Stevens_Hulme_Cassidy_-_2018_-_Review_of_approaches_taken_in_Ireland_and_in_other_jurisdictions_to_simple_possession_drug_offences.pdf/Files/ANNEXE_I_-_Hughes_Stevens_Hulme_Cassidy_-_2018_-_Review_of_approaches_taken_in_Ireland_and_in_other_jurisdictions_to_simple_possession_drug_offences.pdf">detailed review</a> of approaches in various countries. These countries were Australia, the Czech Republic, Denmark, Germany, Jamaica, the Netherlands, Portugal, the UK and the US. We found three main approaches: depenalisation, diversion and decriminalisation. (We did not review models of legally regulating the production and sale of drugs. Decriminalisation is not the same as legalisation.)</p>
<p><strong>Depenalisation</strong> is where the crime remains in law, but the police stop imposing penalties for some people. For example, police in England and Wales can issue written <a href="https://theconversation.com/policing-of-cannabis-possession-is-largely-accidental-and-many-officers-dont-think-it-makes-a-difference-100102">warnings</a> to people found to be in possession of small amounts of cannabis for the first time, instead of arresting them.</p>
<p><strong>Diversion</strong> is when people found to be in possession of drugs are sent to education sessions, treatment or social services, instead of being charged and prosecuted. These schemes have been adopted in Australian states, such as <a href="https://ndarc.med.unsw.edu.au/sites/default/files/ndarc/resources/DPMP%20Monograph%2027%20-%202019%20-%20Criminal%20justice%20responses%20relating%20to%20personal%20use%20and%20possession%20of%20illicit%20drugs.pdf">New South Wales</a>, and in some parts of England and the US. Some schemes, including one in Queensland, are written into law. Others, like County Durham’s <a href="https://www.durham.police.uk/Information-and-advice/Pages/Checkpoint.aspx">Checkpoint</a> scheme and the <a href="http://leadkingcounty.org/">LEAD programme</a> in Seattle, are based only on changes in police practice.</p>
<p><strong>Decriminalisation</strong> involves legal changes so that it is no longer a criminal offence to possess a small quantity of drugs for personal use. But there are three approaches to this model. </p>
<p>Since the 1970s, many US states have replaced criminal sanctions and prison sentences with civil sanctions, such as fines for the possession of less than an ounce of cannabis. Similar schemes operate in the Czech Republic, Jamaica and some Australian states, such as South Australia. </p>
<p>Other countries and states, such as <a href="https://journals.sagepub.com/doi/pdf/10.1177/002204260403400302">Germany</a> and <a href="https://eu.burlingtonfreepress.com/story/news/politics/government/2018/01/22/vermonts-legal-marijuana-law-what-you-should-know/1045478001/">Vermont</a> have decriminalisation with no sanction at all. Still others, like Portugal, have favoured decriminalisation with diversion to targeted health and social responses. </p>
<p>In 2001, Portugal decriminalised the possession of small amounts of all kinds of drugs, combined with the possibility to impose civil sanctions (such as fines or suspension of driving licences) and diverting people into treatment, via a meeting with a “commission for the dissuasion of addiction”. In practice, most cases end with no sanction. Portugal also expanded access to treatment, health and social services with <a href="https://academic.oup.com/bjc/article/50/6/999/404023">positive results</a>.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/286586/original/file-20190801-169714-19x6e8w.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/286586/original/file-20190801-169714-19x6e8w.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=398&fit=crop&dpr=1 600w, https://images.theconversation.com/files/286586/original/file-20190801-169714-19x6e8w.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=398&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/286586/original/file-20190801-169714-19x6e8w.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=398&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/286586/original/file-20190801-169714-19x6e8w.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=501&fit=crop&dpr=1 754w, https://images.theconversation.com/files/286586/original/file-20190801-169714-19x6e8w.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=501&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/286586/original/file-20190801-169714-19x6e8w.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=501&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Portugal decriminalised possession of small amounts of street drugs.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/download/confirm/164082287?src=3cXlH6wgf7kJB83UGM0aHA-1-0&studio=1&size=medium_jpg">Arsenie Krasnevsky/Shutterstock</a></span>
</figcaption>
</figure>
<h2>How the models stack up</h2>
<p>Each approach has its own advantages and drawbacks. Depenalisation, for example, is easy to implement and lets police use their discretion in deciding who to arrest. But this may lead to discriminatory enforcement, as black people are often <a href="https://www.release.org.uk/publications/ColourOfInjustice">far more likely</a> to be stopped, arrested and punished for drugs. </p>
<p>Decriminalisation requires legal changes to be made. Some may argue that it leaves authorities without legal opportunities to intervene in undesired activities, such as public drug use. But these can still be banned by separate rules. Indeed, possession of cannabis has been formally decriminalised in New York State since 1977, but it has still been an offence to have the drug “in public view”, leading to hundreds of thousands of arrests for low-level drug offences, again falling most heavily on <a href="http://www.drugpolicy.org/new-york/marijuana-reform">people of colour</a>. </p>
<p>But decriminalisation also brings the potential for health, social and criminal justice benefits, by reducing stigma surrounding drug use - a known barrier to treatment and harm reduction - and <a href="http://www.ndlerf.gov.au/sites/default/files/publication-documents/monographs/monograph-66.pdf">improving employment prospects and housing stability</a>. It can also reduce the burden on police and courts. In Portugal, the extra spending on health services was offset by savings in the criminal justice system and other benefits, meaning the <a href="https://www.sciencediret.com/science/article/pii/S095539591400231X?via%3Dihub">overall social cost of drugs fell</a> </p>
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<strong>
Read more:
<a href="https://theconversation.com/fear-of-police-stop-and-search-can-deter-opioid-users-from-carrying-anti-overdose-kits-102955">Fear of police stop and search can deter opioid users from carrying anti-overdose kits</a>
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<h2>No models lead to increased drug use</h2>
<p>Importantly, we did not find evidence that any of these alternative measures consistently increased the use of drugs. A <a href="https://www.sciencedirect.com/science/article/pii/S0955395919300210?via%3Dihub">study</a> of over 100,000 teenagers in 38 countries did not show higher rates of drug use in countries with more liberal approaches. Recent decriminalisations in five US states produced big reductions in arrests but <a href="https://www.sciencedirect.com/science/article/pii/S0955395918301786?via%3Dihub">no apparent increase</a> in cannabis use among young people.</p>
<p>As countries look for ways to implement <a href="https://www.unsceb.org/CEBPublicFiles/CEB-2018-2-SoD.pdf">UN recommendations</a> to avoid criminalising people for using drugs, they will need to consider these different options carefully. They will, <a href="https://www.irishtimes.com/news/politics/first-time-drug-offenders-to-be-referred-to-hse-in-policy-overhaul-1.3974643">as Ireland has found</a>, need to adapt them to their own legal, social and drug use contexts. They can do so with a fair amount of confidence that removing the harms of punishment is not likely to increase drug use. But, given some models bring greater long-term gains, there is merit in arguing that governments ought to be bold.</p><img src="https://counter.theconversation.com/content/121221/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Our review was funded by the Department of Justice and Equality and the Department of Health of the Republic of Ireland.</span></em></p><p class="fine-print"><em><span>Caitlin Hughes has received funding from the Australian Research Council, National Drug Law Enforcement Research Fund, Australian Institute of Criminology, and federal and state Governments (Commonwealth, ACT, WA) and the Irish Government. She undertook this research while working at the National Drug and Alcohol Research Centre which receives funding from the Australian Government, and she remains a visiting academic at this centre.</span></em></p>There are better ways to deal with drug possession (for personal use) than putting the person behind bars.Alex Stevens, Professor in Criminal Justice and Faculty Director of Public Engagement, University of KentCaitlin Hughes, Associate Professor in Criminology and Drug Policy, Centre for Crime Policy and Research, Flinders UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1205562019-07-18T20:38:53Z2019-07-18T20:38:53ZCartel kingpin El Chapo is jailed for life, but the US-Mexico drug trade is booming<figure><img src="https://images.theconversation.com/files/284797/original/file-20190718-116557-mxrtwm.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Kingpin no longer.</span> <span class="attribution"><a class="source" href="http://www.apimages.com/metadata/Index/El-Chapo-Prosecution/635a9ecf92af43c78e2a31c6f9e7b25c/11/0">AP Photo/Eduardo Verdugo, File</a></span></figcaption></figure><p>The infamous Mexican drug lord Joaquín Archivaldo Guzmán Loera – aka “El Chapo” – has been <a href="https://www.theguardian.com/world/2019/jul/17/el-chapo-sentence-life-prison-mexican-drug-lord-trial">sentenced to life</a> plus an additional 30 years for <a href="https://www.justice.gov/opa/press-release/file/929896/download">drug trafficking, conspiracy, money laundering and weapons charges</a>, among other crimes committed over the past quarter-century as head of Mexico’s Sinaloa cartel, the <a href="https://fortune.com/2014/09/14/biggest-organized-crime-groups-in-the-world/">Western Hemisphere’s most powerful organized crime syndicate</a>. </p>
<p>Judge Brian Cogan also <a href="https://www.justice.gov/opa/pr/joaquin-el-chapo-guzman-sinaloa-cartel-leader-sentenced-life-prison-plus-30-years">ordered</a> Guzmán – who was convicted in U.S. federal court in February after a <a href="https://theconversation.com/el-chapo-trial-shows-why-a-wall-wont-stop-drugs-from-crossing-the-us-mexico-border-110001">dramatic three-month trial</a> – to forfeit US$12.6 billion in illicit narcotics proceeds.</p>
<p>U.S. officials celebrated El Chapo’s demise as a triumph in the <a href="https://www.npr.org/2019/04/26/717389563/a-brief-history-of-the-war-on-drugs">war on drugs</a>. President Donald Trump has taken an aggressive <a href="https://www.youtube.com/watch?v=Ns7ocpRhDD8">stance on Mexican drug cartels</a>, vowing at his <a href="https://www.whitehouse.gov/inaugural-address">January 2017 inauguration</a> to stop “the crime and gangs and drugs that have stolen too many lives.” </p>
<p>“This sentencing shows the world that no matter how protected or powerful you are, DEA will ensure that you face justice,” <a href="https://www.justice.gov/opa/pr/joaquin-el-chapo-guzman-sinaloa-cartel-leader-sentenced-life-prison-plus-30-years">said</a> the acting administrator of the U.S. Drug Enforcement Administration, Uttam Dhillon, at Guzmán’s sentencing.</p>
<p>Having studied the <a href="https://theconversation.com/a-decade-of-murder-and-grief-mexicos-drug-war-turns-ten-70036">politics</a> and economics of the <a href="https://theconversation.com/el-chapo-jailbreak-is-both-a-mexican-and-an-american-story-44679">U.S.-Mexico drug trade</a>, I see a different lesson in Guzmán’s life story. The U.S. may have <a href="https://www.theguardian.com/world/2019/jul/17/el-chapo-sentence-life-prison-mexican-drug-lord-trial">locked up</a> Mexico’s worst “bad hombre,” but the business he ran is far too big to fail.</p>
<h2>‘Insatiable demand’</h2>
<p>Mexicans have greeted Guzmán’s demise with more skepticism.</p>
<p>The <a href="https://www.jornada.com.mx/ultimas/politica/2019/07/17/dan-cadena-perpetua-a-el-chapo-guzman-6225.html">Mexican newspaper La Jornada</a> noted that the flow of illicit drugs into the United States has not diminished since El Chapo’s arrest.</p>
<p>Mexican estimates suggest that each month the Sinaloa cartel <a href="http://www.nexos.com.mx/?p=19103">trades</a> two tons of cocaine and 10,000 tons of marijuana plus heroine, methamphetamine and other drugs. Founded in Sinaloa state in the late 1980s, the cartel now <a href="http://www.insightcrime.org/mexico-organized-crime-news/sinaloa-cartel-profile">distributes drugs</a> in 50 countries, including Argentina, the Philippines and Russia. </p>
<p>But Mexican cartels were born to serve consumers in the United States, the world’s <a href="https://www.unodc.org/wdr2016/interactive-map.html">biggest consumer</a> of illicit drugs. </p>
<p>It’s Americans’ “insatiable demand for illegal drugs,” as then-Secretary of State Hillary Clinton <a href="http://www.nytimes.com/2009/03/26/world/americas/26mexico.html">said in 2009</a>, that allowed Guzmán’s Sinaloa cartel to become the world’s biggest supplier of illicit drugs. </p>
<p>Drug trafficking has a highly lucrative business model. According to data from 2016, the <a href="https://www.unodc.org/wdr2016/field/10.3_Price_and_Purity_-_Cocaine.xls">wholesale price</a> for a gram of cocaine is approximately US$2.30 in Colombia and $12.50 in Mexico. The same gram will cost $28 in the U.S. By the time it gets to Australia, it could fetch as much as $176.50. </p>
<p><a href="https://www.unodc.org/wdr2016/field/10.3_Price_and_Purity_-_Cocaine.xls">Retail prices</a> per gram are even higher: $82 in the U.S. and $400 in Australia. </p>
<p>Drug prices rise significantly during transit as intermediaries demand compensation for the <a href="http://faculty.publicpolicy.umd.edu/sites/default/files/reuter/files/Risks_and_prices.pdf">risk</a> they assume in getting the product to consumers. This liability markup is one reason that keeping drugs illegal has made them so expensive on the streets and so profitable for the people who trade in them. </p>
<h2>Killing, threats and bribes</h2>
<p>Illegality is also the reason that the drug trade is so violent.</p>
<p>Running an <a href="http://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.503.9024&rep=rep1&type=pdf">illegal operation</a>, kingpins like Guzmán must enforce their own agreements and protect themselves from authorities and competitors. They do so using a combination of killing, threats and bribes.</p>
<p>At least eight <a href="http://www.excelsior.com.mx/nacional/2016/04/10/1085638#imagen-1">armed groups</a> once worked under Guzman’s command in Mexico, <a href="https://www.theguardian.com/world/2017/jan/21/how-el-chapo-built-sinaloa-cartel">attacking</a> competing cartels and members deemed traitors.</p>
<p>Guzmán also <a href="http://time.com/3968992/joaquin-el-chapo-guzman-escape-seven-arrested/">bribed</a> as many officers as necessary to succeed in his business. </p>
<p>Alex Cifuentes, a close associate of Guzmán, <a href="https://www.reuters.com/article/us-usa-mexico-el-chapo/el-chapo-paid-former-mexican-president-100-million-bribe-trial-witness-idUSKCN1P92OS">testified</a> in the trial that the cartel chief once paid a $100 million bribe to then-Mexican President Enrique Peña Nieto – an accusation Peña Nieto’s administration <a href="https://twitter.com/fco__guzman/status/1085358965129654272?lang=es">dismissed</a> as “false, defamatory and absurd.”</p>
<p>Guzmán certainly <a href="https://mexiconewsdaily.com/news/prisons-former-security-chief-recalls-el-chapos-perks/">bribed Mexican prison officials</a>. In 2015, he <a href="https://theconversation.com/el-chapo-jailbreak-is-both-a-mexican-and-an-american-story-44679">escaped from jail</a> by riding a motorcycle through a lit, ventilated mile-long tunnel constructed directly underneath his cell.</p>
<h2>Walls versus profit</h2>
<p>For five decades since President Richard Nixon <a href="https://www.cnn.com/2016/03/23/politics/john-ehrlichman-richard-nixon-drug-war-blacks-hippie/index.html">launched the war on drugs</a>, the United States has chose not to focus on the economic forces driving this clandestine industry in favor of punishment, sending <a href="https://www.americanprogress.org/issues/criminal-justice/reports/2018/06/27/452819/ending-war-drugs-numbers/">millions</a> of drug traffickers, corner dealers and drug users to jail. </p>
<p>Even as states try to ease mass incarceration by <a href="https://theconversation.com/marijuana-is-on-the-ballot-in-four-states-but-legalization-may-soon-stall-researchers-say-105342">legalizing cannabis</a> and decriminalizing minor drug offenses like possession, President Trump has called for escalating the federal government’s drug war. </p>
<p>In 2018, Trump delivered an <a href="https://www.whitehouse.gov/briefings-statements/remarks-president-trump-global-call-action-world-drug-problem-event/">incendiary speech</a> at the United Nations decrying the “scourge” of drugs, followed with a <a href="https://www.documentcloud.org/documents/4901223-Global-Call-to-Action-on-the-World-Drug-Problem.html">pledge</a> signed by 129 nations to “cut off the supply of illicit drugs by stopping their production…and flow across borders.”</p>
<p>Trump’s main proposals for ending the U.S.-Mexico drug trade are to more <a href="https://theconversation.com/trump-plan-to-execute-big-drug-pushers-will-do-nothing-to-stop-opioid-overdoses-93898">harshly punish drug dealers</a> and to build a border wall, which <a href="https://www.whitehouse.gov/the-press-office/2017/01/25/presidential-executive-order-enhancing-public-safety-interior-united">will be monitored by</a> 10,000 additional immigration officers.</p>
<p>A <a href="https://theconversation.com/the-wall-and-the-beast-trumps-triumph-from-the-mexican-side-of-the-border-68559">physical barrier</a> is unlikely to thwart drug smugglers, particularly the wily Sinaloa cartel, history shows. </p>
<p>When confronted with a high-tech border fence in Arizona, constructed long before Trump’s administration, Mexican smugglers use a <a href="https://www.cnn.com/2017/02/15/us/marijuana-catapult-trnd/index.html">catapult</a> to fling <a href="https://www.nytimes.com/2012/06/17/magazine/how-a-mexican-drug-cartel-makes-its-billions.html">hundred-pound bales of marijuana</a> over to the American side. </p>
<p>“We’ve got the best fence money can buy,” former DEA chief Michael Brown <a href="http://www.nytimes.com/2012/06/17/magazine/how-a-mexican-drug-cartel-makes-its-billions.html">told</a> New York Times journalist Patrick Radden Keefe in 2017, “and they counter us with a 2,500-year-old technology.”</p>
<p>Then there’s the other ancient technology perfected by Guzmán: <a href="http://www.newyorker.com/magazine/2015/08/03/underworld-monte-reel">the tunnel</a>. In the past quarter-century, <a href="https://www.sandiegouniontribune.com/news/border-baja-california/sdut-border-tunnels-2013oct31-htmlstory.html">officials have discovered about 180</a> cleverly disguised illicit passages under the U.S.-Mexico border. Many, like the one Guzmán used to escape prison, are equipped with electricity, ventilation and elevators.</p>
<p>Corruption undermines the law outside Mexico, too. Between 2006 and 2016 some 200 employees and contractors of the Department of Homeland Security – the agency charged with defending the U.S. border – have accepted nearly $15 million in bribes, <a href="https://www.nytimes.com/2016/12/28/us/homeland-security-border-bribes.html?_r=0">according to The New York Times</a>.</p>
<p>“Almost no evidence about corrupt American officials” was allowed at El Chapo’s trial, the Times <a href="https://twitter.com/alanfeuer/status/1082820817438822400">reports</a>.</p>
<h2>After El Chapo</h2>
<p>El Chapo’s downfall hasn’t reduced the availability, price, use or lethality of currently illegal drugs. </p>
<p>In 2017, the year of Guzmán’s <a href="https://www.independent.co.uk/news/world/americas/el-chapo-trial-verdict-joaquin-guzman-drug-lord-mexico-court-new-york-a8776681.html">extradition</a> to the U.S., 70,237 people <a href="https://www.drugabuse.gov/related-topics/trends-statistics/overdose-death-rates">died of drug overdose</a> in the United States. </p>
<p>Another <a href="https://aristeguinoticias.com/2101/mexico/en-2017-mas-de-29-mil-asesinatos-en-mexico-671-fueron-feminicidios/">29,168 people were murdered</a> in Mexico, where the <a href="https://theconversation.com/a-decade-of-murder-and-grief-mexicos-drug-war-turns-ten-70036">government’s decade-long cartel war</a> has caused violence to escalate nationwide.</p>
<p>Guzmán’s capture hasn’t even hurt the Sinaloa cartel, which has a <a href="https://www.huffpost.com/entry/ismael-el-mayo-zambada-sinaloa_n_56a0becce4b0404eb8f05313">new boss</a> who promotes a <a href="https://www.washingtonpost.com/world/2019/07/18/el-chapo-is-contained-drug-war-is-not/?utm_term=.371867785d2c">more horizontal leadership structure</a> and is expanding its operations into other criminal activities like illegal mining and human trafficking.</p>
<p>Drug trafficking, of course, is not just a Mexican business. In June, U.S. authorities in Philadelphia <a href="https://edition.cnn.com/2019/07/10/business/jpmorgan-msc-gayane-cocaine-seizure/index.html">seized</a> a cargo vessel carrying nearly 20 tons of cocaine. </p>
<p>The drug-running ship didn’t belong to the Sinaloa cartel. It was owned by a fund run by banking giant JPMorgan Chase.</p>
<p><em>This story is an updated version of an <a href="https://theconversation.com/el-chapo-story-of-a-kingpin-or-why-trumps-plan-to-defeat-mexican-cartels-is-doomed-to-fail-71781">article</a> originally published on Feb. 17, 2017.</em></p><img src="https://counter.theconversation.com/content/120556/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Luis Gómez Romero does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>The conviction of Mexican drug kingpin Joaquín Guzmán Loera, who evaded justice in Mexico, is a win for US officials. But it’s a pyrrhic victory in the war on drugs.Luis Gómez Romero, Senior Lecturer in Human Rights, Constitutional Law and Legal Theory, University of WollongongLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1188272019-07-07T20:10:50Z2019-07-07T20:10:50ZTesting festival goers’ pills isn’t the only way to reduce overdoses. Here’s what else works<figure><img src="https://images.theconversation.com/files/282609/original/file-20190704-126376-1qy5c4g.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Festival goers bring their phones. So why not use them to receive tweets about high-dose drugs in circulation, as the UK is doing?</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/grodno-belarus-september-17-2016-teenagers-1258396705?src=4km6UC1HndwfYPP9pnphCA-1-8&studio=1">from Vinnikava Viktoryia/www.shutterstock.com</a></span></figcaption></figure><p>The <a href="https://www.smh.com.au/national/nsw/music-festival-deaths-inquest-set-down-for-july-20190228-p510sz.html">NSW inquest into recent drug deaths at music festivals</a> is due to start this week. So focus is turning to how to make music festivals safer by reducing drug-related incidents. </p>
<p>We know that <a href="https://theconversation.com/australias-recreational-drug-policies-arent-working-so-what-are-the-options-for-reform-55493">prohibition doesn’t work</a> to reduce either harms or drug use. But what does?</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/australias-recreational-drug-policies-arent-working-so-what-are-the-options-for-reform-55493">Australia's recreational drug policies aren't working, so what are the options for reform?</a>
</strong>
</em>
</p>
<hr>
<h2>How do drugs cause harm?</h2>
<p>Most illicit drugs used at festivals, including <a href="https://adf.org.au/drug-facts/mdma/">ecstasy</a> (methylenedioxymethamphetamine or MDMA), started out as relatively benign pharmaceuticals. </p>
<p>MDMA is most commonly implicated in drug-related harm at festivals. Fatal and non-fatal MDMA overdoses <a href="https://theconversation.com/how-does-mdma-kill-109506">are usually a result</a> of high-purity MDMA, dangerous contaminants, or environmental factors such as overheating or drinking too much or too little water. So to reduce harms we need to address all these problems.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/weekly-dose-ecstasy-the-party-drug-that-could-be-used-to-treat-ptsd-55149">Weekly Dose: ecstasy, the party drug that could be used to treat PTSD</a>
</strong>
</em>
</p>
<hr>
<h2>What doesn’t work</h2>
<p><a href="https://www.sciencedirect.com/science/article/pii/S0955395916303899">Police presence, random drug searches and drug detection dogs</a> don’t deter drug use and may increase harms. Yet they are common at festivals and come at a substantial financial cost to festival goers, which has to be covered in the price of the ticket. </p>
<p>People who go to festivals say that <a href="https://www.ncbi.nlm.nih.gov/pubmed/30176423">police presence doesn’t discourage them</a> from taking drugs; and there are many documented cases of people <a href="https://www.ncbi.nlm.nih.gov/pubmed/30176423">taking multiple pills at once</a> to avoid searches and sniffer dog detection, which increases the risk of overdose.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/why-drug-detection-dogs-are-sniffing-up-the-wrong-tree-57343">Why drug-detection dogs are sniffing up the wrong tree</a>
</strong>
</em>
</p>
<hr>
<p>Publicly, the police focus is on drug dealing, but the reality is that most people who are arrested at festivals are people who use, rather than sell, drugs. NSW police reported that, at <a href="https://www.abc.net.au/triplej/programs/hack/nearly-200-drug-arrests-at-field-day-music-festival/10679504">Sydney’s 2019 Field Day Festival</a>, of the 28,000 people who attended, there were 155 drug-related arrests: 149 for possession and 6 for supply.</p>
<p>When police dogs are present, people are more likely to <a href="https://www.sciencedirect.com/science/article/pii/S0955395916303899">buy drugs inside the festival</a> rather than risk detection by carrying drugs in. This means they are more likely to buy from unknown sources, which <a href="https://www.sciencedirect.com/science/article/abs/pii/S0955395918302755">increases their risk</a> of harm compared with buying from a trusted source.</p>
<p><a href="https://theconversation.com/australias-recreational-drug-policies-arent-working-so-what-are-the-options-for-reform-55493">Decriminalising illicit drugs</a> would significantly reduce harms and allow festival police to focus on public safety issues, such as antisocial behaviour and public drunkenness.</p>
<h2>What works</h2>
<p>There are already effective <a href="https://www2.health.vic.gov.au/Api/downloadmedia/%7B672393DE-E7DB-4118-8C9F-7BD1D5F045DB%7D">harm reduction strategies</a> in place at festivals. These include:</p>
<ul>
<li>presence of peer-led organisations, like <a href="https://www.hrvic.org.au/dancewize">Dancewize</a>, which provide harm reduction information and support</li>
<li>emergency services and first aid</li>
<li>chill out spaces</li>
<li>availability of cool clean water</li>
<li>good ventilation in indoor spaces, and</li>
<li>staff and volunteer training in responding to drug affected people.</li>
</ul>
<h2>Pill testing direct to consumer</h2>
<p><a href="https://theconversation.com/six-reasons-australia-should-pilot-pill-testing-party-drugs-34073">On-site pill testing</a>, which identifies the content and purity of drugs brought in by festival goers, also includes contact with a health professional to provide a brief intervention, that can include advice about risks of taking drugs and harm reduction information. Festival goers are always told that it is safest not to take drugs at all.</p>
<p><a href="https://www.aracy.org.au/publications-resources/command/download_file/id/106/filename/Interventions_to_reduce_harm_associated_with_adolescent_substance_use.pdf">Brief interventions</a> from a health professional can reduce risky drug use among young people. But without a way to offer an intervention, most young people who go to festivals will not come into contact with a health worker to receive that information.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/heres-why-doctors-are-backing-pill-testing-at-music-festivals-across-australia-109430">Here's why doctors are backing pill testing at music festivals across Australia</a>
</strong>
</em>
</p>
<hr>
<p>Some <a href="https://www.theage.com.au/national/victoria/festivals-face-permit-system-as-ashton-brands-testing-a-distraction-20190131-p50uq9.html">Australian police</a>, <a href="https://www.abc.net.au/news/health/2018-12-21/guide-to-pill-testing-at-australian-music-festivals/10638732">politicians and policymakers</a> are reluctant to consider pill testing at festivals. That may be because, so far, only on-site, direct-from-consumer testing has been offered as a viable way of reducing harm. </p>
<p>Some people have concerns about the idea of accepting and testing illicit drugs direct from the people using them, given that they are still illegal.</p>
<p>But there are many other ways of pill testing that can also reduce harm.</p>
<h2>Testing of police-acquired drugs</h2>
<p>We could also test drugs on-site that have been seized by police, acquired from emergency services after an incident or surrendered in <a href="https://www.theage.com.au/national/victoria/pressure-mounts-to-introduce-drug-amnesty-bins-at-festivals-20160131-gmhwoi.html">amnesty bins</a>.</p>
<p>This approach has been used at a number of <a href="https://wearetheloop.org/about-us">festivals in the UK</a> since 2013. When a potentially problematic drug is identified during the festival, <a href="https://wearetheloop.org/drug-alerts">an alert</a> is issued on-site through social media usually within hours, to alert others who may have bought drugs from similar batches.</p>
<p>As well as potentially reducing harm for people who use drugs, these alerts mean police are better able to monitor the local drug market; on-site paramedics, first aid and outreach workers are better informed about drugs in circulation, helping to improve responses; and according to the <a href="https://www.sciencedirect.com/science/article/abs/pii/S0955395918302755">UK testing facility</a>, medical services report having more confidence in dealing with presentations because of the alerts.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/282619/original/file-20190704-126376-rb2fhy.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/282619/original/file-20190704-126376-rb2fhy.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/282619/original/file-20190704-126376-rb2fhy.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=397&fit=crop&dpr=1 600w, https://images.theconversation.com/files/282619/original/file-20190704-126376-rb2fhy.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=397&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/282619/original/file-20190704-126376-rb2fhy.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=397&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/282619/original/file-20190704-126376-rb2fhy.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=499&fit=crop&dpr=1 754w, https://images.theconversation.com/files/282619/original/file-20190704-126376-rb2fhy.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=499&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/282619/original/file-20190704-126376-rb2fhy.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=499&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Medical services can also benefit from alerts letting people know which problem drugs might still be in circulation.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/sign-pointing-hospital-emergency-room-melbourne-618969788?src=_Xu6Ho-TVA-Uon0TmZa_yw-1-35&studio=1">from www.shutterstock.com</a></span>
</figcaption>
</figure>
<p>This approach is not as effective in reducing harms as direct-from-consumer testing. That’s because it doesn’t include contact with a health professional who can offer a brief intervention, and the information about pill contents doesn’t go direct to the people intending to use them. </p>
<p>But if testing of police acquired drugs is combined with real-time alerts about potential problem drugs to festival goers, it can still reduce harms.</p>
<h2>Off-site testing</h2>
<p>Testing of pills brought in by festival goers can also occur off site before the festival. It works the same way as onsite testing, and includes brief intervention, but operates away from the festival site.</p>
<p>It’s the primary model used in <a href="https://www.trimbos.nl/aanbod/webwinkel/product/af1677-the-drugs-information-and-monitoring-system-dims">The Netherlands</a>.</p>
<p>Off-site testing removes the need to change the way the drugs are policed at festivals, so may be more acceptable to some. If both off-site and on-site testing are implemented, testing services will have greater reach and be more effective in reducing harm.</p>
<h2>Testing drug purity</h2>
<p>The only official pill testing that has been undertaken in Australia has been at <a href="https://www.harmreductionaustralia.org.au/wp-content/uploads/2018/06/Pill-Testing-Pilot-ACT-June-2018-Final-Report.pdf">Canberra’s Groovin’ the Moo in 2018</a> and 2019. The on-site facility tested samples provided directly by consumers and identified the drugs present. But they could only estimate the purity of drug powders and did not measure the dose of MDMA in the pills.</p>
<p>High-dose MDMA has been implicated in a number of the recent festivals deaths. Knowing the dose may help reduce overdoses from MDMA pills because people can choose to take a smaller amount of the drug if they know the strength is high.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/when-to-seek-help-after-taking-a-pill-109876">When to seek help after taking a pill</a>
</strong>
</em>
</p>
<hr>
<p><a href="https://wearetheloop.org">The Loop UK</a> has developed a method of more accurately measuring the dose in MDMA pills, which could help reduce the harms associated with high purity. The process does not require any specialised equipment and is performed on-site by trained chemists. At this year’s <a href="https://parklife.uk.com">Parklife Festival</a> the organisation identified high-strength pills and send out warnings.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/280815/original/file-20190622-61737-1fu9brf.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/280815/original/file-20190622-61737-1fu9brf.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=776&fit=crop&dpr=1 600w, https://images.theconversation.com/files/280815/original/file-20190622-61737-1fu9brf.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=776&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/280815/original/file-20190622-61737-1fu9brf.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=776&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/280815/original/file-20190622-61737-1fu9brf.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=975&fit=crop&dpr=1 754w, https://images.theconversation.com/files/280815/original/file-20190622-61737-1fu9brf.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=975&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/280815/original/file-20190622-61737-1fu9brf.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=975&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Example of alerts from The Loop UK at this year’s Parklife Festival.</span>
</figcaption>
</figure>
<h2>Understanding drug use at festivals</h2>
<p>We also don’t really know how many young people use drugs at Australian festivals and how much they use. Most of what we know is from anecdotal reports. There’s probably differences between festivals.</p>
<p>We know both festival attendance and <a href="https://www.aihw.gov.au/reports/illicit-use-of-drugs/ndshs-2016-detailed/contents/table-of-contents">illicit drug use</a> hit a peak among people in their 20s. So more research on how common drug use is at festivals and the kinds of drugs people use would help inform better and more targeted harm reduction policies.</p>
<p>We will never completely eliminate drug use at festivals but we can make them safer by implementing what we know works and stopping what we know doesn’t. It’s normal for young people to take risks. Whether you agree with drug taking or not, our young people don’t deserve to die just because they have taken drugs.</p><img src="https://counter.theconversation.com/content/118827/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Nicole Lee works as a paid consultant in the alcohol and other drug sector. She has previously been awarded grants by state and federal governments, NHMRC and other public funding bodies for alcohol and other drug research. She contributes volunteer time to The Loop Australia.
</span></em></p><p class="fine-print"><em><span>Monica Barratt receives funding from the National Health and Medical Research Council, the Marsden Foundation (NZ) and the National Institutes of Health (US). In addition to her academic research role, she volunteers as Director of Research at Bluelight.org and as Victorian Strategic Engagement Coordinator at The Loop Australia.</span></em></p>There are many ways to reduce harm from drugs at music festivals beyond the much publicised pill testing. Here’s what else we can do.Nicole Lee, Professor at the National Drug Research Institute, Curtin UniversityMonica Barratt, Vice Chancellor’s Senior Research Fellow, Social and Global Studies Centre, RMIT UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1172832019-06-03T13:33:57Z2019-06-03T13:33:57ZMillions use cannabis, but figures for how many become dependent aren’t reliable<figure><img src="https://images.theconversation.com/files/277361/original/file-20190531-69071-1oanvji.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/download/confirm/625586630?src=i-bvuMEefR9YIggY2BFXsw-1-4&size=medium_jpg">Mitch M/Shutterstock</a></span></figcaption></figure><p>Cannabis has an image of being a relatively harmless drug. But all drugs carry a degree of risk, and cannabis is no exception. One of those risks is dependence, which many people assume is only something that happens to those who use “hard drugs”, such as crack or heroin. In fact, the <a href="https://accp1.onlinelibrary.wiley.com/doi/abs/10.1002/j.1552-4604.2002.tb06000.x">estimated</a> risk of dependence on cannabis is about one in ten. </p>
<p>This risk may seem relatively low, but given that there are an <a href="https://apps.who.int/iris/bitstream/handle/10665/251056/9789241510240-eng.pdf">estimated</a> 200m cannabis users across the globe, the potential number of people who are dependent on the drug is around 20m – roughly, the population of <a href="https://www.worldometers.info/world-population/romania-population/">Romania</a>. </p>
<p>It’s worth exploring how this figure of one in ten is constructed. Several studies of cannabis dependence used the <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3767415/#R66">criteria</a> (see below) laid out in the American Psychiatric Association’s diagnostic bible, the Diagnostic and Statistical Manual of Mental Disorders (DSM) to determine cannabis dependence. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/276644/original/file-20190527-193501-85jejp.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/276644/original/file-20190527-193501-85jejp.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/276644/original/file-20190527-193501-85jejp.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=450&fit=crop&dpr=1 600w, https://images.theconversation.com/files/276644/original/file-20190527-193501-85jejp.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=450&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/276644/original/file-20190527-193501-85jejp.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=450&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/276644/original/file-20190527-193501-85jejp.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=566&fit=crop&dpr=1 754w, https://images.theconversation.com/files/276644/original/file-20190527-193501-85jejp.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=566&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/276644/original/file-20190527-193501-85jejp.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=566&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">DSM IV Substance Dependence Criteria.</span>
<span class="attribution"><span class="source">American Psychiatric Association</span></span>
</figcaption>
</figure>
<p>Examining these criteria highlights just how challenging making this diagnosis is. A reliable way to assess dependence on any drug, including cannabis, is to see what happens when a person stops using it. If they experience physical or psychological withdrawal symptoms, then it is likely they are dependent. </p>
<p>The DSM makes it clear that to qualify for a diagnosis of cannabis dependence, these withdrawal symptoms should not be due to another substance – which is logical but fiendishly difficult to determine in practice. For example, many people <a href="https://theconversation.com/how-we-could-make-cannabis-safer-for-users-73638">mix</a> tobacco with cannabis. Compared with cannabis, the chances of becoming dependent on tobacco are <a href="https://www.bmj.com/content/365/bmj.l2204?utm_source=twitter&utm_medium=hootsuite&utm_term=&utm_content=&utm_campaign=editors">five times greater</a>. So the discomfort people experience when they stop smoking joints could be due to tobacco rather than cannabis. There is considerable overlap in the <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4345250/">withdrawal</a> symptoms of both drugs.</p>
<p>Previous versions of the DSM criteria for substance dependence had a gender bias. One of the <a href="https://link.springer.com/article/10.1007/s00406-019-01008-x">questions</a> assessing dependence asked if the person was ever intoxicated while driving a truck. Given that more men drive trucks than women, this raised the dependency criteria threshold for women. Consequently, we have underestimated the number of women who are dependent. Also, cannabis-related offences are <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3767415/">greater</a> for men than women. DSM criteria include this issue, again contributing to an underestimate of women.</p>
<p>Psychiatrists decide whether a person qualifies for a diagnosis of cannabis dependence, so, although cannabis is used across the world, most of the data we have about population-level use of cannabis and dependence is <a href="https://www.sciencedirect.com/science/article/abs/pii/S0955395919301318">drawn</a> from America, Europe and Australia. This significantly limits estimates of cannabis dependence in non-Western countries where there are few psychiatrists. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/276585/original/file-20190527-40059-1217jox.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/276585/original/file-20190527-40059-1217jox.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/276585/original/file-20190527-40059-1217jox.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=361&fit=crop&dpr=1 600w, https://images.theconversation.com/files/276585/original/file-20190527-40059-1217jox.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=361&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/276585/original/file-20190527-40059-1217jox.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=361&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/276585/original/file-20190527-40059-1217jox.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=453&fit=crop&dpr=1 754w, https://images.theconversation.com/files/276585/original/file-20190527-40059-1217jox.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=453&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/276585/original/file-20190527-40059-1217jox.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=453&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Cannabis use versus treatment.</span>
<span class="attribution"><span class="source">Public Health England & ONS</span></span>
</figcaption>
</figure>
<h2>Credible stats</h2>
<p>Several countries and US states have legalised or decriminalised cannabis. This policy change has contributed to the <a href="https://www.newyorker.com/magazine/2019/01/14/is-marijuana-as-safe-as-we-think">perception</a> that cannabis use is risk free. To challenge this perception, we need credible estimates for cannabis dependence. As we’ve seen, the methods used to date aren’t up to scratch and the assessment criteria are biased towards Western men. No one is helped by estimates of cannabis dependence that overlook key groups in a population, namely women and those from non-Western countries. </p>
<p>Most people who use cannabis won’t become dependent, but there needs to be raised awareness of the risk. The danger is that people don’t realise they have a problem or if they become aware of their dependency; they believe they are unique. Added to which is the <a href="https://link.springer.com/chapter/10.1007/978-3-319-90365-1_10">misconception</a> that anyone can just abstain from cannabis without experiencing withdrawal symptoms.</p>
<p>However, improving the way we count those dependent on cannabis is not ambitious enough, we should be able to predict who is at <a href="https://onlinelibrary.wiley.com/doi/abs/10.1111/add.14174">risk</a> in the first place. This offers the potential to reduce rates of dependence, not merely calculate the numbers after the problem has developed.</p><img src="https://counter.theconversation.com/content/117283/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Ian Hamilton is affiliated with Alcohol research UK.</span></em></p>One in ten cannabis users are dependent on the drug, according to some estimates.Ian Hamilton, Associate Professor, University of YorkLicensed as Creative Commons – attribution, no derivatives.