Archive for the ‘War on drugs’ Tag

Legal drug-pushers and the US smack boom

Monday, March 3rd, 2014

It’s nearly a year since I warned about bumper heroin crops in Afghanistan, and months since raising the issue of soaring opiate painkiller abuse in the US. Yet the debate is still fresh, it seems, after reporting this week about the speed with which heroin use continues to increase in America.

Using stats from the substance misuse treatment centres in a sample district, heroin use increased 425% between 1996 and 2011. Four out of every five people presenting for treatment for their heroin use reported first becoming addicted to opiate painkillers. Use of these painkillers, in the same sample, had increased 1,136%.

But the really interesting part is how and why this happened.

On one side, there is the argument that this epidemic rise in opiate use is due to the drug companies. Marketing techniques for OxyContin, for example, were apparently so aggressive that doctors were ‘convinced’ (by what means, I am unsure, but we can imagine) that the tablets were completely safe to prescribe long-term. (Now I haven’t got a degree in medicine, but it would take more than a marketing campaign to persuade me that making an opiate slow-release stopped it from being addictive..)

Whatever methods the drug company used, they worked, and as sales soared, so did the deaths. In 2009, more than fifteen and a half thousand people died of opiate painkiller overdoses in the US – more than double the numbers in 2002.

The manufacturers were later fined over six hundred millions dollars for misleading doctors and patients about the addictive nature of the pills.

But there is another perspective – that the War On Drugs is to blame for the over-prescribing and addiction problems. The DEA, according to some, have turned decisions that should remain in the medical domain into legal issues – by scapegoating legitimate prescribers.

The case of pain specialist William Hurwitz is a poignant one. Of the hundreds of patients under his care, fifteen were found to be selling their medication. This was without Hurwitz’s knowledge. However, he received a custodial sentence of fifty-seven months for distributing narcotics.

As someone who has worked in drug treatment for many years, this is a chilling tale. There is no way of ensuring that meds are not diverted – even on daily supervised consumption, where pharmacists are paid to watch people take their medication every day, people will hide meds in their cheeks, sneak them out and sell them on in the spat-out form. And people will buy them. Such is the desperate nature of opiate addiction. But if I were held responsible for my patients making these choices, would I continue to provide prescriptions? Unlikely. And then, for the majority taking their meds as prescribed, where would they turn when the script stopped and the withdrawal symptoms and agonising pain set in?

Unsurprisingly, this type of prosecution discouraged doctors from signing legitimate prescriptions for people with genuine chronic pain, raising human rights issues for sufferers. In response, unscrupulous, or humane (depending which stance you take), doctors set up ‘pill mills’ – centres where prescriptions for opiate painkillers were provided more freely than was medically advised, both to pain sufferers and to addicts. The black market became flooded and, conversely to DEA intentions, that meant that the tighter legislation in fact enabled the boom in opiate dependence.

Whatever your beliefs about opiate prescribing, there is no doubt that America is facing a top-down public health crisis. And now, here we are – 2014. Poverty, depression and opiate addiction. Just in time for the heroin mega-crop. Yeehaa, as the they say in the States.

Ooo, doesn’t it make you nostalgic…

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Stick reclassification up your K-hole

Wednesday, December 11th, 2013

The Government are now considering upgrading ketamine to Class B, as they have just realised it is popular and causes bladder damage. Fingers on the pulse again there, guys. Not only did they miss the original ketamine boom which took place years ago when I was a student (and spent a considerable amount of time watching people slumped in corners wondering why anyone would want to do that to themselves) – and then miss the more recent frenzy which occurred a few years ago in the wake of MCat legislation – but by increasing the penalties for possessing the drug, the Advisory Council for the Misuse of Drugs have very much missed the point. The people who are taking ketamine daily and dissolving their urinary tracts are not going to stop just because the label is changed, or they are told they are now very naughty. They will just be less likely to disclose their use to anyone in the health profession, and their treatment will be less timely, less effective and more expensive.

It’s not exactly breaking news that ketamine causes significant health problems, either. The impact on the bladder is well-documented, and very young people are also being found to have irreversible damage to their kidneys, liver and brain. It’s not that I don’t think these facts need to be made more available – which I’m sure is the Government’s intention – it’s just that the last fifty years of prohibition have proved that the punitive method just does not work.

And I wonder, if there is any other policy which had failed so dramatically, and which had caused so much harm as a by-product? Why would any political organisation continue to implement a method so poor at achieving its targets?

I have been told not to bitch about Theresa May any more as apparently it has started to sound like a personal vendetta – but if she had listened to me on the khat issue, maybe her bumbling drug policies wouldn’t get her into so much trouble. Under pressure last week to reverse the ban, Khat Woman herself has been accused of implementing legislation without any supporting evidence, and, in the process, potentially damaging relations with Kenya. As a Home Office report has pointed out, given that khat is not associated with any social or medical harm, and there was no consultation with the people who use, produce or import the drug, this may have been a somewhat rash and uneducated decision to make. It could, in fact, impact negatively on unemployment and crime figures, as livelihoods are destroyed, and has led to accusations of hypocrisy within a supposed free market.

Instead, Keith Vaz MP has recommended introducing a licensing system for the substance. So maybe Keith has been reading even if Theresa hasn’t.

Lord Coca Leaf vs Baron Cocaine

Thursday, October 10th, 2013

Those cheeky peers have been at it again. Following their revelationary recommendations back in January, which suggested we dropped the moral stance on drug use and took a more pragmatic approach, this week the All Party Parliamentary Group For Drug Policy Reform have come up with an idea so good and so politically-unaligned that it has blown my socks off.

Using the same level-headed, true harm-reduction manner as Towards a Safer Drugs Policy, Baroness Meacher and Co. have this week published Coca Leaf: A Political Dilemma?. This new document, commissioned and published by the peers but written by a specialist in The Americas’ human rights, tracks the damage done in Latin America by the War On Drugs, and then looks at the ancient benefits found in the coca leaf in its unprocessed form.

The report provides a historical context to the current UN Drug Conventions, which, since 1961, have prohibited not only the production of cocaine but also the coca leaf. This has resulted in mass fumigation programmes, leaving huge areas of South America desolate. The poverty has left populations open to exploitation by drugs barons, and massive territories have fallen under criminal control. This has, in turn, undermined democratic systems, and destroyed large areas of jungle and wildlife.

Attempts to counter this movement have met strong opposition. Publication of evidence from the World Health Organisation, which stated that coca leaf had “no negative health effects”, was blocked, and when Bolivia made its case to exclude coca production from the UN Convention for traditional use, the USA and fourteen other countries objected. Despite this, Bolivia won, and legal coca leaf production is now underway. The report released this week appears to be in response to this change, and to President Santos’ recent call for a more pragmatic approach to the impact that drugs are having in the region. It looks towards the 2016 United Nations General Assembly Special Session on Drugs, where, it seem, it is hoped that the international sanctions on coca leaf production will be lifted.

In terms of the benefits offered by the coca leaf, it has long been used to enable working at high altitudes. However, it is now thought that this may not be, as originally thought, related to oxygen saturation or blood pressure – instead, it appears to moderate blood sugar levels. This indicates its possible uses in diabetes treatment. Because of the UN restrictions, it has been impossible for any research to be carried out in the modern era, but the high iron and calcium content, along with its richness of vitamins and minerals and a variety of other health-giving properties, mean that there may potential in the future to use it in the treatment of asthma, anaemia, gastrointestinal illnesses, low immunity and colds, and as an analgesic and antibacterial.

Its potential use in the food and nutrition industries, too, is possible. Containing seven times more iron and seventy-four times more calcium that the average plants we eat, it is thought to be useful for those with broken bones or osteoporosis, and its high protein content also has dietary implications. (It contains more calcium than milk or eggs, and more protein than meat.) It could also be used as an appetite suppressant for treating obesity, or taken like caffeine to increase energy levels and enhance performance. Given that it can be processed into flour, its use in the modern diet has great potential.

And finally, it is also thought to be usable in the treatment of cocaine addiction. Research is needed to test claims that the coca leaf could be used as methadone is in the treatment of opiate dependence, or whether it can also be used like buprenorphine by limiting the neural rewards available from taking the drug.

For any of these hypotheses to be rigorously tested, legal access to the coca leaf needs to be improved. Unsurprisingly, the report calls for restrictions on coca leaf production to be lifted, work to be done with the local governments to ensure that production be channelled for legal purposes instead of being made available to the drugs trade, and for farming communities to be supported in freeing themselves from black-market slavery.

These are big asks, and not requests to be implemented half-heatedly or quickly. However, with international political unity, and humanitarian aid from the countries that caused the damage in the first place (for example, maybe the four thousand US troops currently based in South America fighting the War On Drugs could be redeployed to protect the farmers?), maybe there is a glimmer of hope on the horizon for millions of South Americans.

Well done, peers. You continue to surprise and educate me.

The end of the Road

Thursday, October 3rd, 2013

Some interesting updates on previous articles have appeared in the news this week.

Silk Road has finally been taken offline, and the alleged administrator, the pseudonymed Dread Pirate Roberts, has been arrested. The website appears to have been a one-man operation based in San Fransisco. The suspect, Ross William Ulbricht, kept his operations so secretive that his housemates knew him only as Josh, the guy who spent all his time in his room on his computer, and the FBI had to scour years of data to find very rare glitches in his online personas in order to identify him. It was only when a package containing fake IDs were seized at the Canadian border with Ulbricht’s picture on them, that investigators linked this to online activity – Dread Pirate Roberts had asked for advice on gaining fake identities to set up more servers. Given that Silk Road had a estimated $1.2 million worth of trading each month, and the FBI have seized $3.6 million worth of Bitcoin during the operation, it is astounding that Ulbricht has evaded identification and capture for so long. I wonder whether the US authorities will now power on with their War On Drugs and hunt down his suppliers and customers..

It will also be interesting to see whether previous Silk Road customers see a decline in the quality of their purchases now they have lost access to the Ebay-style seller rating system.. If there are any ex-customers out there, I would love for you to get in touch and let me know how you are buying your drugs now and what impact this has had on you.

Following on from last week’s blog about the normalisation of alcohol, a couple of interesting articles have been suggested to me by staff at Sheffield University. The first informed me of the alcohol industry-driven marketing concept that is Arthur’s Day. The producers of Guinness launched this national event in Ireland four years ago to ‘celebrate Arthur Guinness’, and then refused to accept any responsibility when alcohol-related ambulance call-outs increased by thirty percent. This somewhat sinister celebration, cleverly timed six months after St Patrick’s Day and on the busiest drinking night of the month (Thursday – student night, 26th – payday), has been described by some as exploitation of Irish culture for capitalist gain – and the way it has been embraced by the public suggests that alcohol marketing is even more powerful and socially influential than anyone could have predicted. (Apart from the Dr Evil-style masterminds at Guiness, obviously.)

This seems somewhat in conflict with the Irish health minister’s claim today that he wants to ‘denormalise’ tobacco use, and achieve a ‘tobacco-free state’ by 2025. Yet another example of policy-makers’ bizarre lack of parity between substances. Given that the Irish Government are encouraring Arthur’s Day as a tourist opportunity, I’m guessing from this that they would take a different approach to smoking were Marlborough produced in Galway…

The second article recommended looked at the normalisation of women’s alcohol use in the UK. It presents some scary facts about women’s health, and considers how the pressures of being a working mum are influencing alcohol intake. Again, it is pointed out that wine is sociably acceptable whilst cooking, and suggests we really need to question what has become ‘normal’ behaviour. It does make me wonder whether our kids think we drink that like all the time, been as that’s all they see of us. And with our young women drinking more than any others in the western world, maybe we need to look at ourselves and the patterns our children emulate.

And finally – I know you will all have seen this, so I will be brief – in a brave move which may mean he does himself out of a job, Chief of Police Mike Barton has stated that decriminalisation is the way forward. Drawing a clear division between drug dealers and drug users, Mike is making a bigger statement than many of us realise, given that many Police targets focus on homogenising and prosecuting anyone associated with drugs because ‘drugs are bad’. Mike draws the same comparisons that have been previously drawn here between the War On Drugs and alcohol prohibition in 1920s America – instead of stopping the trade, it routes the profits directly to criminals. It’s a relief to know that the frontline last bastion of the moral crusade, the Police, are willing to make their voices heard – instead of, as with the Police in 20s America, seeing the battle as a way of either lining their own pockets or buying their way into heaven. I think it is an honest and altruistic move by Mike, one which may well both damage his career and sit him outside his peer group, but I for one am heartened by his stance.

What’s morality got to do with drugs?

Friday, September 13th, 2013

My beliefs about the criminalisation of drug use have changed over the last few months of researching and writing this blog. Although I always supported a health agenda, I spent years working alongside criminal justice agencies and, in essence, being part of the machine that maintained the War On Drugs. Drugs caused harm – that was for sure – and whilst I insisted on working for health services and within a harm reduction agenda, I still had to contribute drug tests and pre-sentence statements to criminal justice organisations on behalf of people I didn’t really think were doing anything wrong. Besides, most of the criminal justice drugs services were part of the NHS. The whole agenda was blurred – and the lines between health and justice disappeared under the weight of morality. As we all know, drugs are bad, kids.

But let’s face it – they’re not. They’re just drugs. If it’s a moral compass we’re using, some of them, such as anaesthetic, are definitely good. But this isn’t the issue I want to discuss here – I want to showcase a couple of the best resources I have found which outline the damage caused by unquestioningly taking this legal and moral standpoint on drug use.

Count The Costs has published an Alternative World Drug Report to coincide with the UN’s Global Commission On Drugs Policy (which I wrote about in The War On Drugs versus livers, and focuses on the public health implications of socially excluding drug users). Instead of relying on self-reporting by international governments, the Alternative Report collates its own data, looking at the unintended negative consequences of the War On Drugs.

It is organised into seven main areas of damage that is caused by the continuing approach taken by drugs policies across the world:

undermining development and security, fuelling conflict
threatening public health, spreading disease and death
undermining human rights
promoting stigma and discrimination
creating crime, enriching criminals
deforestation and pollution
wasting billions on drug law enforcement

For those of you who haven’t considered some of these arguments before, or if there is a particular issue that catches your attention, do have a look at this website. It really is the best, most comprehensive single resource I have seen, and isn’t so arrogant as to presume it has the answers – it merely forces the question.

A more capsule summary of the War On Drugs is available from Peter Watt of Sheffield University, whose recent piece on the upcoming legalisation of cannabis in Uruguay identifies the main motivations behind the problems in South America, the continent most damaged by the US-driven criminalisation agenda. Uruguay is an experiment worth watching – and it seems that the countries most crippled but the War On Drugs are starting to take matters into their own hands and make some interesting moves when it comes to drug policy (as previously discussed in Santos speaks out).

A specialist in the South American drug wars, Peter also identifies the value to the US economy of perpetuating the War On Drugs, by generating the private prison industry. Quoting journalist Chris Hedges, “Poor people, especially those of colour, are worth nothing to corporations and private contractors if they are on the street. In jails and prisons, however, they each can generate corporate revenues of $30,000 to $40,000 a year”.

This sentiment is shared in Eugene Jarecki’s excellent documentary, The House I Live In, which looks at the impact of the War On Drugs on the USA’s poorest, predominantly black, communities and asks who this system is benefitting. Despite drug use being proportional across racial groups in the US, almost all those incarcerated for drug offences are black – one in three young black men spend time in prison in the US.

I hope some of you will look at these links, and that, if you find them interesting, you will share them. This is not a small problem – areas of Asia, South America and Africa are being destroyed by this nonsensical battle, where poverty is exploited by organised criminals using fear and violence – and the continents providing the target markets, North America, Australasia and Europe, are also seeing their poorest and most excluded communities injured by the trade. Drug use isn’t bad – whether it is smoking crack or having a quiet pint on a Friday, we all do it to some degree, and until the moral and criminal precursors are removed from the debate, a practical, just solution will remain evasive.

America, Land of the Brown

Wednesday, August 21st, 2013

I warned about a resurgence of heroin use, following this year’s bumper opium crop in Afghanistan, in Smacktastic Britain, and unfortunately this may be already starting to come true, with reports of presentations of new heroin users at services (too young to remember the stigma of the last wave) and increased purity levels of the drug. But, given that there has been an international drought for the last three years, I guess this could just be business getting back to normal. And it will be another few months, possibly into early next year, before that crop reaches our shores and heroin use becomes a tempting prospect again – and people like the drug so much they start dying all over the place.

There has, however, been somewhat more of a significant increase in America. Fox News report that heroin use is “on the rise: cheap, available and out of control”, and the Wall Street Journal state that “heroin use in the U.S. is soaring, especially in rural areas”.

Fox’s Dr Manny Alvarez makes the claim that this increase is due to the last decade of prescription drug abuse, as painkillers such as Vicodin and oxycodone have been dished out like sweets and created large numbers of opiate addicts. The report also spells heroin with an ‘e’ on the end, claims that it causes miscarriage, and demands that America starts another War On Drugs – so I’m guessing we can take its contents with a pinch of salt – but it remains however an interesting suggestion that America’s increase is heroin use may be self-created. This claim is supported by other reports, which claim that OxyContin (the market name for oxycodone) has been refomulated to make it less abusable (by making it harder to crush and pastey, so that snorting or injecting is more difficult), and that, compared to the price of buying prescription meds, heroin is by far the cheaper option for those who find themselves dependent.

The Wall Street Journal, who also support the idea of a vast shift from prescribed opiates to painkillers, give some insightful and scary facts on the country’s growing heroin problem – seizures from the Mexico border have quadrupled between 2008 and 2012, and overdoses are going through the roof. Some of the rural communities are heroin-naive, most of them have no service provision, and heroin purity is at its highest in years, making overdose an inevitable consequence. Even more headline-grabbing – these medicated kids are white and middle-class.

So maybe we haven’t got as much to worry about in the UK as we first thought. The US market is prepped, desperate, and think that heroin is a bargain. If I was a drugs baron, I know where I’d be taking my bumper crop. Something tells me that the horrendous US drug overdose death rate of someone every nineteen minutes might be about to get a lot, lot worse…

Texas fights the War On Drugs (no, really)

Wednesday, August 14th, 2013

A bizarrely sensible change to US drug policy appears to have been made this week – based on a model trialled in Texas. In what seems to me to be a primarily fiscal move spun into a moral one by the Obama administration, the ideas from the conservative Bible Belt state are being rolled out to the rest of the country. Described as ‘a major shift in criminal justice policy’ by The New York Times, the changes are being implemented without the agreement of Congress, in order to bypass Republican opposition. Instead of changing legislation, alterations are being made to criminal justice directives, or the guidelines which inform federal prosecutors. The changes will stop the amount of the drug possessed from being declared in court, to avoid minimum sentencing requirements being triggered, and instead allow shorter sentencing or community orders where there is no violence, no sales to minors, no significant criminal history, and no links to organised crime and gangs.

This, in principle, seems like a positive move. However, when we consider the model originated in Texas, where millions of dollars were saved by avoiding building new prisons, and potential inmates were diverted into treatment and work programmes, we can be fairly confident the reasoning is financial rather than compassionate. It remains open to prosecutors’ discretion, which may well not reduce the race gap in prison populations (80% of those incarcerated for drug-related crime are black, which equates to one in three, yes that’s ONE IN THREE, young black males), and could in fact increase the racial discrepancy should prosecutors use their discretion biasedly. As the decriminalisation movement in America point out, this “tepid new directive.. smacks of… good spin and no spine”.

But Attorney General, Eric Holder, who unveiled the new plans this week to The Washington Post, offered some reassurance of the administration’s good intentions and understanding, saying “A vicious cycle of poverty, criminality and incarceration traps too many Americans and weakens too many communities… many aspects of our criminal justice system may actually exacerbate these problems rather than alleviate them”.

Only time will tell whether this will have the intended impact. But whatever the motive for the changes, the outcome will be fewer non-violent drug users incarcerated, the release of older inmates who were imprisoned for what would now be considered more minor drug offences, and hopefully a social shift in the perceived criminality and dangerousness of drug users in the US. A vast reduction the criminal justice budget is another good outcome – especially for a country which apparently now houses 25% of the world’s prisoners – and if the move is supported with an increased access to work and housing for these people, they should soon be contributing positively to tax figures instead of eating away at the other end.

Drug policy fails – again

Wednesday, July 24th, 2013

Another kick in the teeth this week for Theresa May and her determined squeal that drugs policy is working. After ignoring the research-based recommendations from a group of cross-party peers concerning decriminalisation, then developing selective deafness towards her drugs advisory board by banning khat, Theresa seems fixated on perpetuating the War On Drugs, whether anyone agrees with her or not.

It will be interesting, then, to see how she reacts to the news that cannabis psychosis admissions have actually increased since the drug was reclassified as a Class B substance. Yep, you’ve got us there, Theresa, you font of knowledge for all things street – clearly drugs policy is reducing use and minimising harm just as it should. Well done for sticking to your guns, and thank god those running the country know what they’re talking about. Phew.

Tottering Tory Totty aside, I have to admit this is a pretty bizarre finding. At no point did I think that reclassifying the drug would decrease the harm caused – why would it, it’s still illegal and that didn’t put people off before – but the inverted correlation between cannabis-related psychosis hospital admissions and reclassification of the drug is difficult to explain.

I have been pondering on this. Without subscribing to the Journal of Drug Policy (which is, I have to admit, surprisingly tempting, but takes money, of which I have little), I can’t see whether participants who suffered psychotic admissions had taken solely cannabis. My hunch is that something different may be afoot here. Rates of psychosis amongst my client-group have gone through the roof since MCat has surfaced, and I have heard similar reports from prisons regarding synthetic cannabanoids. I know that, until very recently, and certainly not within the confined dates of this longitudinal study, testing facilities for these drugs had not been developed – and even if they had, the average mental health ward would not have had access to them. So, my sneaky conclusion is that the increased rates of psychosis admission may have been due to the use of other substances – which were not only impossible to detect, but were also legal at the time and so potentially not reported or classified.

That is my suspicion. Just don’t tell Theresa. I can’t wait to see what shit she spins to explain away this one. Although, to be fair, I think she’s more likely to get a bad case of tinnitus than indulge in any scientific analysis. You keep on trucking girl, we’re all behind you (with a metaphorical spade).

Santos speaks out

Wednesday, June 5th, 2013

While we are all whining on about the impact of drugs on our communities, and the effects on individuals, South America and Mexico continue to deal with the shocking human cost of producing and distributing cocaine, methamphetamine, cannabis and other drugs. Much like the opium situation in Afghanistan, cocaine and cannabis are cash-crops – but unlike Afghanistan, it’s not just the fluffy types at the UN wanting the curb the trade. Pressure on South American and Mexican governments from the USA to stop the export of cocaine and other drugs has meant tough penalties for those manufacturing and trafficking, because failure to adhere to these US-enforced policies means risking international relations with their closest, richest neighbours and vital trade partners. This has caused a full-on war between the authorities and organised criminals, leading to death rates that surpass most genocides. In Mexico alone, between 2006 and 2011, it is thought that around 60,000 were killed or ‘disappeared’, many of whom remain unidentified after being found in mass ‘narco-graves‘.

In an unusual (and strangely under-reported) move, Columbian president Juan Manuel Santos has this week published an article in The Guardian’s ‘Comment Is Free’, outlining the main points of a report produced by the Organisation of American States (OAS) in partnership with Oxford University. The report suggests ways in which the issue could be tackled, not from a moral perspective (ie what should happen) but from a pragmatic standpoint (what could happen). Santos states that this new set of approaches broadens the debate past the polarised ‘warriors’ and ‘legalisers’ arguments – after all, this is not Star Wars, there is no good versus evil, and neither extreme offers valid ideas to vastly improve the lives of ordinary people.

The scenarios proposed in the report, which has been released as the OAS leaders meet this week in Guatemala, involve providing better health, education and employment opportunities to offer real economic alternatives to those embroiled in drug production and trafficking and their communities; strengthening public institutions to improve the welfare of citizens; better (and, I would imagine, less hierarchical) co-operation with international partners; and redirecting budgets currently spent on international priorities (law enforcement in an attempt to stop the drugs being produced and exported) to local priorities. Clearly some of these approaches will require international support to be implemented – as long as the US and the rest of us keep pushing for the problems to be contained, the internal wars and consequential deaths will continue.

However, the headline-grabbing proposal made in the report is to look at alternatives to criminalisation, starting with the legalisation of cannabis. It seems to me that the OAS have seen an opportunity to use the current cannabis debate in the US, which has resulted in Colorado and Washington legalising the drug, cleverly to their advantage. The report suggests South America and Mexico follow suit, and so appears to be jumping on the US bandwagon. After all, it would be highly hypocritical for the US to claim that the rights they offer their citizens were not applicable to the citizens of their neighbouring countries. But it also uses the US model to politely point out that the problems the War On Drugs causes the USA might cause one or two little problems in their countries too – and they don’t just have over-run prisons and drug treatment centres, they have pits of nameless dead.

Luckily, President Santos does seem to be getting some parallel support from this side off the pond. A letter from a group of MPs and celebrities to our Government was published in The Times this week, signed not only by candyfloss-haired minted powerhouse Richard Branson, marathon-shagging squealer Sting, and you-get-loads-of-sex-how? lanky slime-ball Russell Brand, but also politicians from the Conservatives, Labour, and the Liberal Democrats. The movement is being led by Caroline Lucas of the Green Party, whose personal stake in the matter may be the destruction of vast areas of rainforest as chemical byproducts of drug production are illegally dumped. The letter questions the validity of the War On Drugs and asks how the Government can justify their £3b a year spending on their current approach, suggesting that possibly an evidenced approach might be a better use of public money. (You know, try to see if something works before you spend our hard-earned cash implementing it. Just a thought.)

Whilst the letter does not make direct reference to the situation in America, it is yet another high-profile attack on existing drug policy – and only adds to the ever-increasing international momentum for things to change. It seems to me that we are on the cusp of the greatest social paradigm shift since the abolition of slavery. But then I am a bit of a drama queen.

The War on Drugs versus livers

Thursday, May 30th, 2013

Kofi Annan has been reading my blog again. Last week I again raised my concerns about the spread of Hepatitis C, and this week he and his Global Commission on Drugs Policy have concluded that current drugs policy has resulted in a Hep C pandemic. I’m impressed he managed to pull a paper together so quickly – but then he’s probably been a follower of mine for a while if his opinions on the futility on the War on Drugs are anything to go by.

He and his posse of world leaders have this week published a report stating that current drugs policy is “repressive” and “ineffective”. Claiming that, by treating drug use as a criminal justice issue instead of a health issue, governments are breaching human rights and putting their communities at unnecessary risk, their argument about the spread of Hep C is conclusive and damning.

The report claims that those countries with the harshest drug policies, including the USA, provide the biggest deterrent to accessing health services which would reduce the chance of contracting the virus. This has led the commission to conclude that “The war on drugs is a war on common sense”.

There are some positives though (and not just the Hep C type), with Scotland being hailed as a model of good practice. Having learned about blood-bourne virus (BBV) transmission the hard way with the HIV outbreak of the 80s, Scotland’s Hepatitis C Action Plan has succeeded in reducing the numbers of those infected, both by increasing preventative measures, such as hugely increasing access to clean injecting equipment to reduce new infections, and by improving access to treatment for those who already have the virus.

The biggest win, for me, is Scotland’s eight-fold increase in Hep C treatment in prisons. Working with the War on Drugs policies, rather than against them, this idea uses the revolving door of incarceration as an intervention opportunity. Whereas, in England, it’s still nigh on impossible to even get liver function tests done for someone in prison (to enable quicker prescribing of an opiate blocker to encourage no ongoing use on release – common bloody sense, but seemingly too much trouble for prison healthcare teams, whose responsibilities end the second the individual walks out of their door), Scotland are now offering full Hep C treatment in prisons.

This is refreshing – treatment services in England are notoriously out-dated and a nightmare to negotiate. I have taken clients to appointment after appointment at hospitals, only to be told that six months drug-free is not a long enough period of stability to ensure treatment success and reduce risk of reinfection (“because drug addiction is a relapsing condition” – thanks for the positivity, guys), or that reducing alcohol use from nine cans of Special Brew a day to two cans of Carling is still not enough of a reduction in consumption. There is no evidence-base to support their criteria – in fact some Hep C services go and dish out treatment on the streets to current drinkers and injectors – but the liver specialists in big hospitals do not particularly relish being forced into changing their treatment population. They’d much rather work with people with hereditary liver conditions, or even drinkers, than IV drug users, and they gate-keep their services accordingly.

Because of the potential and significant mental health impacts of the intense treatment, reported low mood is another classic reason for being deemed ‘not appropriate for treatment’. This seems to miss that point that, for someone whose existence is miserable, repetitive and cut-throat, and who may not have anywhere to live or food in their belly, low mood is kind of a must-have. So no drug or alcohol use, never feeling down, and a stable living environment – it makes you wonder who amongst us would actually qualify for Hep C treatment. (I would fail on all counts.)

But if this public health disaster isn’t bad enough, there is a hidden population who do not seek testing or treatment, because they perceive their injecting behaviour to be healthy. Steroid users are increasing in numbers, with little or no access to safer injecting information or blood-bourne virus prevention advice. I have heard many reports of one needle being passed around four or five men in a gym toilet, meaning a high risk for all of BBV infection and bacterial infection. And given that drug users generally spend their time working out and bulking up whilst in prison – and Hep C rates amongst IV drug users are estimated at 80% in the county I work in – it doesn’t bode well for the beefcakes, who may not know that the healthy-looking, fake-tanned meathead in front of them was once a pale, scrawny smackhead.

Whilst working in a busy city-centre needle exchange several years ago, one canny gym owner used to come and get boxes of needles to distribute to his customers. Most gym owners aren’t so conscientious – they will happily sell steroids to their members, but these come without injecting advice or equipment. One gym owner in the whole of one of the biggest cities in the country. That’s a whole lot of new livers required in twenty years’ time – for those whose hearts last that long.

Anyway, for the rest of you, some quick advice – don’t share toothbrushes or razors, and use a clean piece of paper or a straw each instead of sharing a grimy twenty pound note when you’re banging cocaine up your noses in pub toilets. Hep C can be transmitted by a single invisible drop of blood, and, unlike HIV, can live outside the body for up to four weeks. It’s a feisty little beast. And livers are quite handy.

Also here’s a shout-out to the big man, KA, and all his homeboys and girls. Good work on the report, guys, and let me know if you want me to join your little commission thing – and in the meantime, peace.

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