I’ve just read another engaging, scary article from America about their drug policy – Reefer Madness Redux: If You Smoke It, You Will Become Addicted! Much like the Storyville documentary I recommended last week (see Wonkblog for an interview with the director), it points out the freakish hysteria that surrounds drug policy in the States – which is frightening not only because of its extremity (reminiscent of Brass Eye’s ‘cake’), but also because it exposes the origins of our own society’s beliefs about drugs and those who use them.
I have to admit, the recent blogs I have written on decriminalisation, the comments that have followed, and then the paper released a week ago by, of all people, the supposedly stuffy old folk from The House of Lords, have had quite a profound effect on me. Possibly because the primary focus of my work for so long has been heroin users, I have discounted the idea of legalising drugs as a ludicrous notion. The cycle of hard dependency is awful, debilitating, inhumane even, and to enable that process, to support it, is just not right. If you prescribe a heroin user heroin, he will always be a heroin user. Where is the motivation to stop? And hence he will always be trapped in that miserable existence, always dependent and disempowered.
And to be fair, whilst working with heroin users, I couldn’t really muster up the energy to even entertain the discussion. I didn’t read newspapers, I didn’t watch the news, I didn’t even watch documentaries which I knew would be interesting but which required some emotional investment and deep thought. My coping mechanism to manage the daily adrenaline come-down and affective exhaustion was to shut down any chance of a conversation, social or internal, with something so conclusive and sharp that there was really nowhere for the enquirer to go. And so the topic of decriminalisation remained, as with anything else contentious, packed at the back of my mind, stacked underneath more important and unattended issues such as ‘stopping smoking’ and ‘life direction’.
But recently, for the first time, and from the perspective or decriminalisation instead of legalisation, I thought about it more fully. Heroin users make up a small proportion of illicit drug users (I think there are about 160,000 heroin users in treatment at present, which is tiny percentage of the population when you think about it – I mean, in the UK 10 years ago, 500,000 people were taking ecstacy every weekend night, by way of comparison) and I realised how fixated I had become on the misery of opiate addiction.
And so, thanks to this blog, my mind has been reopened to the debate. The questions I am asking myself, and the possible conclusions that could be drawn, are honestly head-mangling. Here are my confessions…
The first thing I have realised, which may sound obvious but clearly I’m not that bright, is – drugs have been conceptualised in our society as being ‘bad’ (as in “Drugs are bad kids, m’kay” – Mr Mackey, school counsellor, South Park). Of course I appreciate that there are obvious links between drug use and crime – if you have a physical dependence on heroin, you are more prone to stealing something to avoid painful and anxiety-provoking withdrawal symptoms. However, how many ecstasy, or cannabis, users do you know that have ever stolen anything? Anyone who went clubbing during the height of ecstacy use will know that you were more likely to leave a club with a selection of random presents (eg a dog made out of drinking straws, a crown made out of flowers – people were very creative in showing their boundless pleasure to meet you) than you were to get your wallet or phone snatched. And in terms of violence, you were a hundred times more likely to get an exuberant hug from some sweaty random on the dance floor than you were a slap.
And where the American Government got the idea that cannabis smokers were likely to be violent… You’re more likely to get a fight out of road kill.
Now I have always known that the Americans made most of this scare-mongering up to maintain control – my understanding was that, in the case of cannabis, it was to ensure the ongoing success of the cotton trade on which the American economy depended, to safeguard against the main market rival, hemp. The documentary I keep banging on about, The House I Live In, states it was used as a method of controlling and criminalising the Mexican population. The article I mentioned at the top of this page points out that as these theories have become unsustainable, the fear-badgers are claiming that 1 an every 6 adolescents who try cannabis will become addicted, develop mental health problems and need treatment.
The jump for me is to see the bare truth of this process – making drug use and drug users immoral – in our own country and with all the drugs that come somewhere on the sliding scale between cannabis and heroin. To disclose drug use outside of closed drug-using circles is social suicide – people will look you differently, watch next time you go to their house to make sure you don’t nick that fiver they’ve left on the side, and definitely not trust you with their children. Now these are moral judgements. They are not based on any evidence about you as a person, nor are they based in evidence about drug use. (Well they could be, you might be a right dodgy little scally for all I know, I’ve got no idea.)
But the shocking realisation for me is that I have, to some degree, internalised this moral code and perpetuated it. Despite my education, despite the years spent surrounded by drug users, and despite even my own substance use, it is only now that I realise that I accepted, at some subconscious level, that drug use was bad. People who took them were either to be pitied for needing them, or deserved what they got because they were choosing to break the law. And breaking the law must be immoral, because why else would these rules be made if not to protect us? God, it is scary acknowledging one’s own indoctrination. And yes, possibly my substance use served to prove what I had always known – that I was frankly a pathetic and despicable human being (Catholic-style guilt, must beat oneself with a stick).
Yet despite this, I still worked with people, to some degree, by categorising them in one of these two genii – to be pitied or getting what they deserved. To some extent, I understand that a) this was a survival technique, one can’t manage a horrendous caseload AND be philosophical, and b) there is some truth in these sub-groups – people do make choices, both as a result of their past experiences and their present, informed options. But what if I dumped the value-load? What if drug users were just people who chose to put substances in their bodies, not bad or sad?
Were this standpoint adopted, it would have an impact on the drug treatment system. For a start, a significant group currently receiving drug treatment would not want it. Without the label of illegality, those just trying to avoid prison would almost certainly lose their motivation to engage with services. This could be a positive and a negative thing – but it would free up resources for people who wanted to make changes to their lifestyles (instead of the pointless, endless investment in people who have no interest in reducing their drug use or making it safer, as per current service provision), and would certainly make drugs workers’ jobs less depressing.
However, it would open drug treatment to a much wider group – those who don’t want negative repercussions, such as having their drug use recorded on their medical records, which could cause problems with insurance or employment in the future, or those with children who fear judgement by the authorities and worry that by speaking about their problems with substances they may lose the right to parent. These people, surely, deserve access to advice and support as much as any other – and think about how the country would run if the next generation weren’t burdened with the hidden harm of substance misuse.
The epiphany for me is – it is not just our legislation that needs to change in this country, although of course this is a major part of social change (look at what the smoking ban has achieved). It is our conceptualisation of drug use, a paradigm shift from the domain of morality to that of health and economics. Again, look at the changes to social perceptions of smoking since the introduction the ban in public places, which has been, in some ways, the reverse process – smoking is bad now, and people who do it are wrong for polluting other people’s air. But that was for a substance at the other end of the scale, that was too sociably acceptable, to the point that it was difficult to enjoy a meal in a restaurant, going out in the evening came with a guarantee of waking up smelling like an ashtray, and those in the pub trade were becoming ill and even dying because of other people’s substance use. What I am starting to realise is that drugs that have been, for many years, unacceptable even in one’s own home with no negative impact on anyone but possibly oneself, need to be ‘less bad’, or even not bad at all, for there to be any honest discourse about the real problems they cause people. Imagine a smoker refusing to present for lung cancer treatment because they thought they would have their kids taken off them.
There is really no difference, morally, between the smoker with lung cancer and the amphetamine user with psychosis. Or between the businessman who drinks every day and has a heart attack, and the heroin user with a deep vein thrombosis. All make choices to use a substance that puts them in need of a health intervention. Without that health intervention taking place as early as possible, the cost of the intervention itself will increase as the problem becomes more complicated and effects other areas of the individual’s health. The person’s level of productivity and function will decrease. This all costs the taxpayer. So, like it or not, moral judgements can be expensive.
Sweet jesus, first I acknowledge my secret affiliations with the Iron Bitch, now I’m putting my hand up to judging drug users. I’m doing a pretty good job of discrediting myself and my life’s work. Well done me.