Issue 38 / 10 October 2011

A COUPLE of years ago, British psychiatrist Professor David Nutt landed in hot water after he wrote in the Journal of Psychopharmacology about an addictive behaviour that caused injury once in every 350 uses.

He cited traffic accidents, neurological damage and deaths. He found that the risks of the behaviour compared unfavourably with those associated with the party drug ecstasy, which leads to acute injury only once in every 10 000 uses.

What is this dangerous practice that puts those who indulge in it at such serious risk of harm?

The answer is horseriding, an addiction Nutt jokingly referred to as “equasy”.

When it comes to debating drug policy, such levity is not appreciated — as Professor Nutt soon found out.

Australian journalist Lisa Pryor documents what happened next in her new book, A small book about drugs. She explains that Nutt was forced to apologise and eventually sacked from his position as chair of the UK government’s Advisory Council on the Misuse of Drugs after questioning official policy on cannabis.

But there was a serious point behind Professor Nutt’s perhaps provocative analogy.

When it comes to the various mind-altering substances available in contemporary society, it seems very hard for us to have a rational debate.

We more or less tolerate the devastating toll of alcohol misuse, but brand a teenager who brings a bag of pills to a dance party with her friends a criminal.

NSW police, for example, recently proudly announced that they had searched 550 people at a music festival in outer Sydney, charging 81 with possession of drugs, in most cases ecstasy or cocaine.

Are such operations really the best way for us to tackle the undeniable harms caused by recreational drugs?

Pryor, who has been inspired to study medicine by her experiences researching her book, argues such crackdowns may actually increase risk, encouraging users to take drugs in locations with less access to medical care or to take larger quantities at once to avoid detection.

In fact, she makes a reasoned case for a harm minimisation approach that would see drugs at least decriminalised or, preferably, legalised.

Legalisation would, she argues, ensure standardisation of ingredients, encourage safer practices by users, provide tax revenue that could be used for drug rehabilitation and — perhaps most importantly — break the nexus between the drug trade and organised crime.

That doesn’t mean Pryor is advocating open slather: “Those who fear it would be disastrous to allow free and easy access to all drugs are absolutely right. Thankfully, this is not what decriminalisation and even legalisation would mean. Moving towards more rational and effective drug policies should be nuanced and gradual, reflecting the particular nature and extent of the dangers of each drug, the way it is taken, and by whom.”

We don’t have evidence on the results of legalisation, since no jurisdiction has yet gone down that path, but Pryor draws upon the experience of Portugal, which decriminalised personal use of all drugs in 2001.

The British Journal of Criminology last year reported the controversial move had not led to major increases in drug use.

In fact, the researchers, from the National Drug and Alcohol Research Centre at the University of NSW, said Portugal had experienced a decline in problematic drug use and in drug-related harms in the wake of decriminalisation.

Drugs can ruin lives — but that statement should not be the end the discussion.

Whether it’s cocaine or pinot, no policy is ever going to eliminate the potential damage of mind-altering substances.

The real question is which policy model delivers the least harm. Our answer to that should be based on evidence, not emotion.

Jane McCredie is a Sydney-based science and medicine writer.

Posted 10 October 2011

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One thought on “Jane McCredie: A rational drug debate

  1. Anonymous says:

    What experience and history teaches us is this – that people and governments never have learnt anything from history, or acted on principles deduced from it…………. George Wilhelm Hegel (1770-1831)

    We don’t have to look far to find an legal addictive drug and see its effects. Alcohol has been freely available and early last century the changing of the closing time of pubs to 10pm was supposed to stop the “6 o’clock swill” but only made equal problems later. The pubs, bars and clubs were allowed to open later and what do we see. The TV shows us alcohol fuelled brawls (after midnight) which put both the public and police in danger.
    Certainly in the 1960s when drinking in the workplace and driving after drinking were not particularly frowned upon I spent my time patching people up. Two patients demonstrate the problem. A man arrived vomiting blood and gave a history of driving a forklift at a brewery and he was given as much beer as he liked so he would consume at least a bottle a day and had wine at night. His oesophageal varices were tied off and he survived. Another hard worker had risen through his company and he became responsible for ordering materials. With the pressures and because of his position his alcoholic consumption rose but nothing was done until he started to order things twice. He had developed Korsakoff’s Amnestic Syndrome and lost his job. As with many alcoholics he had a cigarette with his drink and developed chronic bronchitis. To complicate the treatment many of the bronchits mixtures had an alcoholic base.
    Has there been any improvement since this time? The answer is yes because consuming alcohol at certain times has become illegal by stealth. First there was random breath test (with a limit too high) when driving a car, then the limit was reduced and since this time it has spread to the work place. Making it illegal does work.
    This is not the full answer because as yet the population has not psychologically come to grips with the problem. As a general practitioner I saw many wives and children (and an occasional a husband) who came for help because one of the family was an alcoholic. It is good to see the campaign against wife bashing because a lot of this is alcoholic related.
    Over the years the problem of drug taking has increased as has the call for help. The call for decriminalising of marijuana and the statements by some academics, school teaches and politicians how they smoked it in their youth (often with the aside that “I didn’t inhale”) is thrown back to me when a youth is brought in by usually a mother.
    Let us try and change the perception towards alcohol and drugs and point out the dangers inherent in both. Let us continue to protect the community at large by gradually criminalise alcohol where it puts the public in danger and never relax our fight against drug taking or we will get in a similar situation of that hidden effect, as seen with alcohol, with a lot of tut tutting but not truly facing up to the problem.

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