- Drug testing identifies substance ‘use’ rather than any substance disorder/problem. This misguidedly widens the net of concern, which should be directed towards the person with a drug problem not towards the recreational user.
- Most people with a chronic drug problem have endured damaging personal and social circumstances before drugs became an issue and need considerable help and support in life, more generally. Drug testing can lead to a pre-occupation on drug presence, and this narrow focus risks overlooking the real underlying issues, which if not addressed, will almost certainly lead to drug problem relapse.
- Women drug users with child care responsibilities are often forced to undertake regular or even daily drug tests to prove they are ‘drug’ free, this disproportionately focuses attention on drug presence rather than fitness to parent. Regular positive drug tests are then used wrongly as evidence as to why the child should be ‘looked after’ by the state. Any assessment of a mothers parental capability to care for her child should never be reduced to a drug test.
- A pre-occupation with drug testing by key stakeholders can result in a paradigm shift in which abstinence and so-called ‘clean’ drug tests become the desired measure of any successful outcome. Not only does harm reduction get marginalised in the process, but the messy and challenging process of rehabilitation and social reintegration may be forgotten in the satisfaction that the person appears to be drug free.
- Around 30-70% of young people in most western countries have used illicit drugs and the vast majority manage to avoid: a criminal record; a drug problem; harm to themselves or harm to others. Widespread random drug testing in schools, at the roadside, in employment, on benefit claimants etc., will only waste resources and result in capturing mainly non-problematic drug users who then risk being ascribed damaging labels as ‘deviant’ or ‘addicts’ that will pose serious damage to future life opportunities (education, employment, travel, insurance, housing etc) and in relationships.
- Resources for public and voluntary services are limited and money that could be used to deliver much needed harm reduction services is wasted on expensive drug testing for people who don’t use drugs, or those who use drugs in a non-problematic recreational manner.
- Random drug testing of pupils, students and children often accompanied by police and sniffer dogs as a health promotion strategy is misguided. Cultural behavioural change is not achieved through policing, confronting and punishing, but it is facilitating by meaningful, culturally relevant, reliable information exchange, harm reduction education, relationships and peer dialogue.
- The most widely used illicit drug (cannabis) is much less harmful than the promoted legal drugs alcohol and tobacco, it is therefore, untenable or indeed hypocritical to pursue drug testing and punish cannabis use and not drug test and punish alcohol and tobacco use.
- Drug testing regimes with sanctions, such as random drug tests in schools to exclude students who test positive, create a ‘cat and mouse’ game in which an adversarial relationship is established, both sides then seek to out-smart the other with new technology or deceptive techniques. The winners in this game are the drug testing businesses and underground laboratories; but the losers are honesty, trust and communication.
- Tougher drug testing regimes to stamp out illicit drug use, such as drug testing in employment, have spawn the proliferation of new synthetic designer ‘legal’ highs to avoid detection (such as Spice). However, once these new drugs have been detected and subsequently outlawed the drug testing ‘net’ widens, then new legal highs are further developed and the never ending spiral continues. These ‘legal highs’ may be considerably more dangerous than commonly used illicit drugs.
- Some drugs such as cannabis can stay in the body for over four weeks whereas drugs like cocaine can be out of the body within 48 hours. Random drug testing regimes (such as those in prisons) have inadvertently pressurised people to switch from the less harmful cannabis to the more dangerous heroin, spice or cocaine.
- Drug testing concentrates attention towards illegal drug use and unhelpfully firms up the misguided bifurcation between licit and illicit substances. It is not the use of any illicit drug that warrants attention but rather the misuse of any drug legal and illegal that should warrants attention. The legally promoted drugs (alcohol, caffeine, tobacco and sugar) can pose serious risks, sometimes greater than their illegal counterparts.
- A positive drug test may reduce the risk of people who are intoxicated from using machinery, driving a car or flying a plane, however, testing positive for a drug doesn’t necessarily mean that the person is intoxicated or impaired – for example cannabis can be detected a month after not using, so a positive drug test could result in misguided concern, and unfair dismissals.
- Some maintenance opioid substitute prescribing regimes rooted in harm reduction engage in regular drug testing, but as a consequence of a positive drug test for illicit drug use some automatically suspend or even terminate prescribing. The use of drug testing in this manner transforms what was a low threshold harm reduction prescribing philosophy into a punitive abstinence only regime.
- A positive drug test indicates drug presence but not necessarily drug impairment, but as in the case of drug driving government campaigns are often conflating drug presence with drug impairment, ascribing much more to drug testing than it is telling us. Association does not mean causation.
- A positive drug test may be incorrect due to a small percentage of ‘false positives’ caused by equipment failure or human error, and conversely ‘false negative’ can occur.
- An accurate positive drug test still maybe misleading. It is assumed that the person has taken illicit drugs when those drugs may have been ingested legally. For example, consuming poppy seeds in bread can lead to a positive drug test for opiates, or if the person took a paracodeine tablet for a headache they’d show positive for opiates.
As the ideologically driven nonsense that underpinned the Drug War becomes increasingly apparent and the need for drug law reform gathers momentum, it is important to recognise some of the subtle approaches and ideas expressed towards a drug reform model could well result in Prohibition 2.0. An approach that fails to fundamentally address the fallacies of prohibition, perpetuates the drug apartheid and uses the medical profession and civil society as enforcers rather than the police, armed forces and customs.
What are the signs that could open the door to Prohibition 2.0? Well here are some common statements which on first impression, may appear to offer good support to a reform agenda, but on closer scrutiny these statements seriously risk replicating misinformation, and could open the door to new forms of state control, coercive treatment and punishment for people using the ‘wrong’ drugs.
- Drugs are dangerous that’s why we need strict regulation.
- Drug users shouldn’t go to prison, Drug Court is an effective alternative.
- We must accept our drug laws are out of date and need reforming.
- Drug use is not a crime problem it’s a public health problem.
- Soft drugs like cannabis should be decriminalised.
- NPS should be regulated, while unapproved NPS should be illegal to possess.
- People with substance use disorders should be forced to get treatment.
- Drugs that are legalised should only be available from approved suppliers.
- Tackling drug use through the criminal justice system was wrong we must tackle drug use through public health approaches.
- The drug war was a mistake but the state must protect people from the risk of addiction with strict controls over possession and supply.
- People diagnosed with substance use disorders cannot risk using drugs.
- Drug testing has an important role in public health and safety.
- Drug use is a problem we can’t eradicate so we must minimise it.
- Drug use isn’t a police problem it’s a medical issue.
- Only a small proportion of people use drugs and we are going to have to learn to accommodate them.
- We need to change drug laws not because drugs are safe, but because drugs are harmful and people are not being protected by current drug laws.
- Addiction is a brain disease so it shouldn’t be a criminal offence.
Perhaps most worrying is some reformers are calling for drug REGULATION, but this simply means state laws and policies to manage and control drugs (which is what we already have albeit done badly). Regulation is a broad and vague rally call to get behind. While it is more specifically understood as state overseen production, distribution, sale, advertising, labelling, storage and use of drugs, (which for example already happens for opiates), regulation may also continue to make the possession of certain drugs illegal. Substances that are unapproved and/or deemed unsafe by the state may, as in the case of the New Zealand model of regulation, be an offence to possess. This is prohibition by any other name, and replicates the present system of bifurcation.
Julian Buchanan, Associate Professor, Institute of Criminology, Victoria University of Wellington, Aotearoa, New Zealand.
Getting naloxone into the community was recommended by the World Health Organisation, and some countries like the USA, Australia, Scotland, Wales have made excellent progress, but here in New Zealand it has been difficult to get naloxone on the drug policy agenda let alone into the community, despite the fact that Coroner data indicates that every week someone dies of an opioid overdose.
Why should this be so difficult when naloxone has no abuse potential, is relatively cheap, easy to administer and is so effective at reversing overdose? Unfortunately, the failure to deliver a humane and effective drug policy has little to do with a lack of evidence, understanding or science, but much more to do with a lack of interest, care or regard for people who use illicit drugs, the people who inject drugs (PWID) are often even lower down the stigma pecking order, and naloxone is primarily a service for PWID.
In August 2013 fifty-five agencies were represented at an invitiaton-only National Think Tank Event led and coordinating by the New Zealand Drug Foundation. After two days debating priorities, values and strategy, to shape the future of drug policy in Aotearoa, the NZ Drug Foundation produced a 12,000 word vision statement, that became known as the Wellington Declaration – but surprisingly this comprehensive document failed to even mention naloxone.
A year later in August 2014 in it’s Matters of Substance Magazine rather than present a robust case for naloxone distribution the NZ Drug Foundation magazine framed Naloxone take-home as an issue open to debate and offered arguments for and against. This included some insulting arguments against naloxone distribution including “there could be an unintended consequence from widening availability of naloxone” and “people could become less cautious about their drug use because they know life-saving treatment is close at hand”.
In October 2014 after a new government was elected the NZ Drug Foundation prepared a twenty page Briefing Paper to Parliament designed to identify key drug policy priorities to provide ‘opportunities to make real reductions in drug related harm‘ (p.3). While the document emphasised the need to secure New Zealand representation at the United Nations international meetings (see below), and specifically highlighted the need to tackle deaths caused by huffing solvents, it astonishingly made no reference or representation to the new government concerning fatal opioid overdoses or the need to distribute naloxone into the hands of users, families and friends.
With this lack of formal commitment to naloxone from the lead NGO organisation for drug users/drug agencies in New Zealand, it was hardly surprising that when the new government eventually rolled out its five year Drug Policy Strategy 2015-2020 on 28th August 2015, the policy document made no mention of naloxone whatsoever. Interestingly, the new drug policy did, as promoted in the NZ Drug Foundation Briefing Paper, prioritise a commitment to ensure New Zealand would be represented at international UNGASS meetings (p.22).
Belatedly, Matters of Substance published a better informed and considered magazine feature on Naloxone after the embarrassing ‘for or against’ debate, and then in June 2015 the New Zealand Drug Foundation produced a stand alone Naloxone Background Paper. However, while this discussion paper includes some excellent sources and appears to offer a robust argument for reducing overdose, it is also undermined and littered with some odd statements and inclusions, such as “Due to the controversial nature of drug harm reduction and naloxone access”, and it confusingly recommends consideration for: “legal protection from arrest for drug possession and/or the act of injecting someone for people who administer naloxone in an emergency situation”, [my highlight in red], as well as recommending “reclassifying naloxone as restricted medication” rather than pharmacy only, largely it seems, to ensure that anyone who accesses naloxone receives training. The briefing paper also aired some odd arguments against naloxone: “There may also be views that wider access is not necessary with naloxone already available in hospitals and with advanced paramedics” and it further “[naloxone] will lead to greater risk taking behaviour”.
There are other disconcerting aspects buried within what might otherwise appear a solid report arguing for greater naloxone distribution, such as the omission of data concerning the high percentage of overdose deaths that occur before the medics arrive, for example, a London study by Hickman et al (2007:320) found that when an ambulance was called the person who overdosed was already dead before the arrival of the ambulance in 85% of cases. Had this information been included in the NZ Drug Foundation background paper they would surely have given greater emphasis to ensuring naloxone is in the hands of People Who Inject Drugs (PWID), their friends and family, but the report seems to priority naloxone training over naloxone distribution. The recommendations in the paper also includes loop holes that seem to almost invite a piecemeal approach to distributing naloxone, by suggesting various components of naloxone distribution could be seen as possible ‘separate options’ for consideration.
While this paper was primarily about the role of naloxone to reduce overdose death, it was an ideal opportunity to mention closely related strategies known to reduce OD deaths in New Zealand, such as the benefit of allowing prescribing injectable drugs in New Zealand to people who continually inject rather than restrict them to oral methadone which is then invariably injected, or the effectiveness of Drug Consumption Rooms in reducing overdose. Here’s a link to the report that includes my highlighted concerns and critique.
Despite the absence of any clear formal commitment to wider naloxone distribution, the campaigning in Aotearoa NZ must continue for naloxone take-home, and indeed for other strategies to reduce overdose and drug policy harm, including: drug checking; prescribing injectable opioids to opioid injectors; a Good Samaritan Law to end arrests for possession and manslaughter when co-users call for emergency help; end the risk of criminalisation for possession of needles and utensils in New Zealand (unless proven to be obtained from the needle exchanges); and establishing Drug Consumption Rooms.
In view of this failure to put naloxone on the formal agenda, it was somewhat incongruous see the Director of the NZ Drug Foundation on International Overdose Day showcase a persuasively well-argued newspaper article (with no sense of irony or doublespeak), asserting that New Zealand must do more to tackle overdose and distribute naloxone. If the New Zealand Drug Foundation had proactively promoted the need for naloxone, it could have been quite different. It’s New Zealand Drug Foundation in its pivotal drug policy advisory role, that needs to do more to tackle overdose and distribute naloxone.
It is hard to understand given the insights clearly displayed in their newspaper piece on International Overdose Day why the New Zealand Drug Foundation have omitted naloxone from important documents (the Wellington Declaration & the Harm Reduction Briefing to Parliament) and why they haven’t campaigned when and where it matters, for naloxone take-home from the outset. They did however, as promoted and prioritised in the harm reduction Briefing to Parliament, go to Vienna and New York and engage in the inertia of the UN drug control system that is committed to a ‘drug’ free world.
With an alternative emphasis on national drug policy reforms in New Zealand rather than international networking, important drug policy harms could be tackled. Key issues that need tackling here in New Zealand Drug Policy include:
The 2016 and 2017 CND and UNGASS meetings predictably delivered no tangible positive outcomes or progress. It’s now May 2017 and New Zealand users, families and friends are still unable to gain access to naloxone. Distribution has been agreed in principle, but debates surrounding the cost and production of additional health education material to accompany the naloxone have delayed distribution. Talks continue with no deadlines announced for completion.
While nations like New Zealand, inexcusably fail to deliver easy to implement drug policy reforms at a national level, and instead invest considerable energy on high maintenance, but low outcome international drug policy reform gatherings, serious harms continue. A growing number of drug reformers are recognising the need for genuine policy transformation. It is time to stop talking the talk and start delivering outcomes, one in particular Low Threshold, Easy Access, Naloxone Take Home.
In the meantime, people who use illicit drugs are needlessly suffering, some are dying. No naloxone take home – no excuse, it is literally a matter of life or death.
Dr Julian Buchanan, is a retired Associate Professor, Victoria University of Wellington, Institute of Criminology
31st August 2015 on International Overdose Day. (updated 11th May 2017)
by Julian Buchanan (updated Dec 2016)
While it can be argued that some groups have benefitted from drug prohibition, this divisive and ill-founded strategy has caused untold harm to many. Yet despite the unequivocal evidence of social damage, severe law enforcement measures to deter the use of certain substances have continued unabated for over five decades. In their eagerness to end the draconian drug war and replace it with a policy rooted in evidence, science and reason, should Drug Reformers accept and embrace any policy improvement as a step in the right direction? Before we consider the issue of drug reform in terms of incremental change versus abolition, we need to distinguish between individuals, and the organisations/leaders/spokespeople who have an interest in drug policy. With regard to individuals who may have shifted from once embracing the dominant discourse of prohibition to a more informed and enlightened view of drugs, any incremental move warrants encouragement and supportive discussion. In respect of organisations, leaders, and spokespeople with an interest in drug policy, however, I think we need to be more much more questioning and critical.
An incrementalist approach, which perceives any step away from the traditional drug war model as an inherently positive move, is at best naive. It mistakenly assumes that incremental changes to Prohibition should automatically be supported, as key steps towards ending the Drug War. Herein lies a major issue. So, for example – imagine that one ‘Reform’ organisation campaigns to get drugs ‘out of the hands of gangsters‘ and wants drugs to be regulated.
On the face of it, this sounds good – as if we are on the same page, heading in the same direction. If, however, the proposed changes promoted by this ‘Reform’ organisation mean that some drugs will be legalised, but will only be available via BigPharma or Big Business, and new laws will be rolled out to make possession of ‘unregulated’ drugs a criminal offence – then we are definitely not on the same page: I can’t support replacing prohibition with Prohibition 2.0.
For me, the wrongful policing, criminalisation, and incarceration of people for possession of banned drugs is the most important issue in the Drug War, and I think it is paramount, from a human rights perspective, that in the course of any reform, the State shouldn’t decide what a person can and can’t consume, and shouldn’t seek to prevent such consumption, or to punish people for personal possession of unapproved drugs. Such enforcement has always been selective, repeatedly and unfairly targeting disadvantaged people, indigenous people, Black people, women and ethnic and minority groups. So, what might appear to be a step in the right direction could end up being a lost opportunity for genuine reform. If reformers aren’t careful, they could wind up supporting the launch of a new regime of Prohibition.
The example above highlights the importance of clarity and transparency concerning what individuals and organisations who ‘sit around the table’ to tackle the drug war, are actually seeking to replace it with, and why. Inevitably, abolition will involve a process of change, but it is vital to support only those changes that are clearly part of the bigger process of abolition.
A further example would be a shared concern regarding the huge number of people going to prison for drug-defined crimes (such as possession, cultivation, and supply). An organisation comes along and says prison for drug-defined crime is wrong. Yes, this appears to be another incremental step in the right direction that we should support. On the surface it is; but this penal reform organisation seeking to keep offenders out of prison, later also disturbingly argues that we can stop drug users going to prison by setting up Drug Abstinence Courts, random drug testing, scran tags and 12-step rehabilitation programmes. In our shared efforts to produce incremental reform, we risk supporting new oppressive regimes rooted in prohibition and abstinence.
Should we support this ‘incremental improvement’ away from prison to Drug Abstinence Courts? I don’t think so. Drug Abstinence Courts are new prohibition, utilising quasi-compulsory methods to enforce abstinence and impose a blanket ban on drug use. In the USA, this apparent step in the right direction has spawned a huge rehab and drug-testing business that profits from these drug ‘offenders’. There are now around 3,000 Drug Courts, with more being rolled out in other Anglophile countries.
A third example would be a reform organisation promoting the view that drug use is not a crime problem, but a public health issue. In our gratitude at the prospect of drugs moving out of the law enforcement arena to which they should never have been consigned, it would be easy to lend support to this change. Further examination and discussion, however, reveals that while the ‘reform’ organisation supports decriminalisation of all drugs, it sees the use of all currently-banned drugs as a public health issue, and fails to distinguish between recreational use and problematic use, or between different drugs. The risk here is that the oppression for so long endured at the hands of law enforcement could be replaced by oppression at the hands of the medical and health professions coercively ‘treating’ people for their ‘public health’ problem.
A fourth example is that of campaigns to legalise particular drugs, such as the growing move to legalise cannabis. While this is laudable, and a move I wholeheartedly agree with in principle, selectively privileging particular drugs, based upon their popularity, to join the licit market in alcohol, caffeine and tobacco does not signal an end to Prohibition – on the contrary; it arguably bolsters prohibition. Granting pardons for particular drugs is a dangerous and uncertain pathway towards drug reform. Instead, we should challenge the very foundations of prohibition and push for the legal right to possess any substance for personal use, without threat, intimidation or punishment from the state.
The trouble with combating a major injustice such as the Drug War, and then settling for incremental adjustments, is that it compromises, complicates and confuses the reform movement and message, it dilutes and divides the drive for reform, and it establishes a new regime which then gains its own momentum, and poses its own problems, which are even harder to correct.
The Drug War will be remembered in history as one of the greatest social policy disasters in modern times, an ill-founded and ill-conceived approach, a serious breach of human rights which has devastated the lives of individuals, families, communities, and indeed whole countries. There is only one acceptable solution to Prohibition and that is Abolition.
*With thanks to Jerry Dorey for helpful edits and suggestions!
We need to tackle the folly and futility of drug prohibition, in which we have created an irrational and unscientific bifurcation of drugs. An archaic system that favours, promotes and culturally embeds the use of some drugs, while fiercely policing, prohibiting and punishing the use of other drugs.
The 1961 UN Single Convention on Narcotic Drugs and the drug laws it has spawned, are deeply flawed, misinformed and misguided, they are an abuse of human rights and civil liberties. The realisation of this historic mistake and the momentum to end this draconian regime has gathered pace in recent years. While the US government has been a driving force defending and upholding drug prohibition, it is ironically the people of the US who are challenging the regime by voting to legalise cannabis. This is seen as a major step change by drug reformers to bring an end to prohibition, however, I question how Inviting cannabis to enjoy the privileges of other favoured drugs (alcohol, caffeine and tobacco) will tackle the wider and fundamental problem of drug prohibition.
Ironically, the legalisation of cannabis might actually bolster prohibition. The global and united drug reform movement could be undermined by an unintended consequence of privileging cannabis to join the elite drugs and subsequently ‘divide and rule’ to maintain the bifurcation process. No doubt, and understandably, after the decades of oppression suffered by cannabis users, legalisation of their drug of choice will be met with a celebration of the new found freedoms and privileges, but possibly also by a lack of interest to fight to end the prohibition of all drugs. Indeed, further, it could give rise to a new momentum against ‘drugs’ or ‘hard drugs’ – as recently liberated cannabis users redefining themselves as herbalists or sensible recreational users of ‘soft’ drugs.
I want to see cannabis legalised and sensibly (rather than strictly) regulated – in a way that avoids the oppression inherent in prohibition, and in a way that avoids the commercial exploitation we’ve seen in tobacco and alcohol. However, this is not something we should do for one or two selected substances, while maintaining and uphold the madness of prohibition again others. I’m an abolitionist, and I want to see all drugs legalised and regulated – there is no place for law enforcement and prohibition, personal drug consumption is not an issue per se, and if it does become a problem it is a social and health issue not a police matter.
Selectively privileging particular drugs based upon their popularity, to join alcohol, caffeine and tobacco as commercial products is not the way forward, it’s simply an extension of the principles of prohibition. Granting pardons for particular drugs is a dangerous and uncertain pathway towards drug reform. Instead, we should challenge the very foundations of prohibition and fight for the decriminalisation of every drug as a first step towards a comprehensive process to abolition, once this is achieved we urgently engage in the difficult and complex process to explore how best to legalise and regulate all drugs.
Julian Buchanan 27th April 2015
Julian Buchanan, Associate Professor, Institute of Criminology, Victoria University of Wellington, New Zealand