Friday, November 23, 2007

Transform commentary in the British Medical Journal

Following on from the last week's BMJ head to head on 'should we decriminalise drugs?' (read the yes response here, the no here) and a reasonably engaging follow on debate in the online rapid response forum (responses to the 'yes', responses to the 'no') this week's print edition of the journal has run six letters in response, including, I'm pleased to say first in line, one from me. (I also get another quote in a summary response from the letters editor).





My letter is a heavily trimmed version of my (really far better and more detailed) online response to the anti-decriminlisation piece by Joseph Califano, combined with some snippets from my response to the pro-decriminalisation piece (or rather the responses to it). In fact even the heavily trimmed letter I submitted (at their request, with a very strict word count) was itself heavily edited, in doing so rather confusing a few of the points being made and somewhat tempering my glee at getting published in the BMJ. I've posted my unedited letter in the comments section below for reference.

All of the letters are behind an annoying subscription pay wall, meaning you can only read the first 150 words and not see the references. This is particularly ridiculous given the the original articles and the rapid responses are all freely available, and the fact that the letters are mostly not much more than 150 words anyway meaning that mostly it is just the last sentence missing. Pointless copyright snottiness that serves no useful purpose, which I am therefore about to unilaterally over-rule by posting my letter, and my quoted comment from the letters editor, in toto:


Prohibition is an ideologically driven failure

Califano's objections to legal regulation of illicit drugs are based on misrepresentation of the reform position bolstered by irrelevant, cherry picked, or misleading facts. 1 A similar piece appeared in the Financial Times 2 and was systematically critiqued in the paper's economists' forum. 3 While Califano's rhetoric has since been moderated, and facts fine tuned, the conceptual flaws remain.

The example of Zurich's "needle park" misrepresents legalisation as heroin was never legally supplied. As an experimental tolerance zone it was a failure. Yet, Califano fails to mention that the government responded by legalising heroin. It set up clinics for long term users, where legally prescribed heroin was used under supervision. The success of this approach on key social, health, and criminal justice indicators led to its replication by many countries including Canada, Australia, and much of mainland Europe. The UK is piloting a similar scheme.

Califano relates Italy's high heroin addiction rate to its de facto decriminalisation for possession, but other countries with similar approaches have lower levels of addiction (Netherlands, Portugal), while the UK has a punitive approach yet higher addiction. Califano's grotesque conflation of Italy's decriminalisation policy with the spread of AIDS ignores the reality that supervised use of prescribed heroin with clean needles results in zero HIV transmission. Califano defends a policy that caused the tragic outcomes he identifies, while attacking advocates of responses that eliminate the problem.

Cheap illicit drugs are freely available under prohibition. Despite Califano's assertions, once an illicit market is established (and criminal profiteers will see to that) levels of use are mostly culturally determined and demand led. Problematic drug use is not driven by changes in availability or price. 4

Califano doesn't understand that the huge profits offered by prohibition attract the violent gangsters now in control, while it is precisely because drugs are dangerous that they need to be regulated and controlled. They are too dangerous to be left in the hands of criminals.



Stephen A Rolles, information officer

Transform Drug Policy Foundation, Easton Business Centre, Bristol BS8 OHE

steve@tdpf.org.uk


--------------------------------------------------------------------------------
Competing interests: None declared.

References

note:
regards above where is says no competing interests declared, in the online response I did declare my interests as follows: "I am Information Officer for Transform Drug Policy Foundation and provided some support with factual references for Dr Chand's companion article in favour of drug decriminalisation". The BMJ editors chose not to reproduce this. No idea why - maybe because my interests were non-financial.


Sweden's story in responses

Echoing Califano's citation of Sweden's drug policy in his contribution to the head to head debate,1 H C Raabe writes:

"Around three decades ago, Sweden adopted the goal to create a ‘drug-free society.' The result is impressive with essentially the lowest rates of drug abuse in Europe, lower than, for example, the Netherlands and much lower than the UK."

But, replies Andrew Byrne, "Sweden's goal of a drug-free society has been a cruel hoax on its people. Read the official EMC [European Monitoring Centre] figures from Lisbon: high rates of hepatitis C, enormous alcohol problems, amphetamines at higher rates than many other European countries. Its approach has been repressive, expensive, and largely ineffective. Along with the USA, Sweden is one of the last western countries without a needle services for drug users. This leads to HIV, bacterial infections, and other preventable and costly burdens on the Swedes."

Stephen A Rolles concludes that there is no correlation between the harshness of prohibition's enforcement and the use or misuse of drugs. "Some countries with harsh enforcement policies (including, prominently the UK and US) have very high levels of use while other countries with very different policies, such as Greece, or more famously, the Netherlands, have low levels of use comparable to Sweden."

Sharon Davies, letters editor

BMJ, London WC1H 9JR

sdavies@bmj.com


Competing interests: None declared.

References
1. Califano JA, Jr. Should drugs be decriminalised? No. BMJ 2007;335:967. (10 November.)[Free Full Text]

1 comment:

Steve R said...

unedited letter text:

Califano's objections to the legal regulation of currently illicit drug markets are based on misrepresentations of the reform position bolstered by irrelevant, cherry picked, or misleading facts. A similar piece appeared in the Financial Times (1) and was systematically critiqued in the FT’s economists forum (2). Whilst Califanos rhetoric has since been moderated, and facts fine tuned, the conceptual flaws remain.



The example of Zurich’s ‘Needle Park’ misrepresents the legalisation position as heroin was never legally supplied. As an experimental tolerance zone "Needle Park" was a failure. Yet, critically, Califano fails to mention how the Government response was to move to actual legalisation by setting up a network of clinics for long term problematic users, where legally prescribed pharmaceutical heroin could be consumed under supervision. The success of this approach on key social, health and criminal justice indicators has unsurprisingly led to its been replicated by many countries including Canada, Australia and much of mainland Europe. The UK is currently piloting a similar scheme.



Citing Italy’s high heroin addiction rate in relation to its de-facto decriminlaisation for possession obscures that fact that comparing enforcement policies and incidence rates between countries demonstrates no discernable correlation. Other countries with a similar approach to Italy have lower levels of addiction (Netherlands, Portugal), whilst the UK has higher addiction levels but a very punitive approach. Califano’s grotesque conflation of Italy’s decriminalisation policy with the spread of HIV/AIDS ignores the reality that supervised use of prescribed heroin with clean needles is associated with zero HIV transmission. HIV transmission through injecting drug use is specifically an outcome of prohibition and the high risk behaviours it fosters. Califano defends a policy that has caused the tragic outcomes he identifies, whilst attacking advocates of responses proven to entirely eliminate the problem.



Illicit drugs are freely available under prohibition, indeed have never been cheaper. In contrast to Califano’s assertions, it is clear that once an illicit market is established (and criminal profiteers will see to that) levels of use are predominantly culturally determined and demand led. The Prime Minister’s 2003 strategy unit drugs report noted that: ‘initiation into problematic drug use is not driven by changes in availability or price’ (3)



Califano misunderstands that it is the extraordinary profits offered by prohibition that attract the violent gangsters who are now in control, whilst it is precisely because drugs are dangerous that they need to be regulated and controlled; they are too dangerous to be left in the hands of criminals.