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Breaking Free From Prohibition: A Human Rights Approach to Successful Drug Reform

4754231502_940e0fe7f1_zImage courtesy of Connor Tarter

 


by Julian Buchanan 15th May 2018

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We have a global drug policy problem


‘Drug’ P
rohibition is an archaic system rooted in the 1950s that’s had a devastating global impact upon individuals, families, communities and countries. In decades to come, it will be remembered as one of the most arbitrary, barbaric and brutal systems of oppression in recent history.

Offensive prejudices and beliefs prevalent in the 1950s directed towards indigenous people, homosexuality, black people, women, mental illness and learning disabilities resulted in institutionalised oppression of these groups. State sanctioned discrimination legitimised and normalised oppression of these groups at a structural, cultural and at an individual level. Thankfully, seven decades later these offensive prejudices, nurtured by ignorance, misinformation and lies, have been successfully exposed and challenged, and such attitudes are no longer socially acceptable, however, the legacy still pervades and there remains much work to be done.

Those oppressive attitudes in the 1950s directed towards people who used ‘drugs’ became enshrined in the 1961 UN Single Convention on Narcotic Drugs – and quite remarkably, by contrast, little has changed. Arguably, discrimination fuelled by ignorance, misinformation and lies is worse today than it was in the 1950s, as surveillance, enforcement and exclusionary measures have extended beyond the criminal realm into the civil domain, with drug testing people on welfare benefits, students, motorists and employees.

 

“What we have come to regard as ‘drugs’ is a social and cultural construct lacking any pharmacological evidence base.”

 


During this period we have been conned and coerced into embracing and promoting state approved drugs (alcohol, caffeine, tobacco & sugar), and to view with disdain all substances banned by the government. This sharp distinction between state approved and state banned drugs has no scientific or pharmacological foundation to support it, it is entirely based on political propaganda. What is commonly referred to as ‘drugs’ is simply a list of substances arbitrarily excluded for political reasons. Despite the lack of evidence to support this distinction between substances, banned drugs have been demonised by attributing blame upon the drug for the devastating damage caused by prohibition, or by a circular government argument that: ‘drugs are dangerous and the evidence that they are dangerous, is that they are illegal’.

What we have come to regard as ‘drugs’ is a social and cultural construct lacking any pharmacological evidence base. Perversely, banned substances (if under the same quality control conditions as state-approved drugs), are generally less physically, socially and psychologically harmful, – and arguably more pleasurable and desirable. Further, there are medical benefits to many banned drugs that have been to denied to patients, leaving some people with epilepsy, PTSD, depression, autism, Alzheimer’s, MS, Parkinson’s and cancer, to needlessly suffer, or alternatively risk criminalisation and punishment.

Prohibition too has distorted and thwarted our thinking on drug prevention, drug education and drug treatment which have instead become preoccupied with avoiding ‘drugs’, lifelong abstinence to become ‘clean’, and stigma towards people that use ‘drugs’. In some instances, this prohibitionist dogma has produced damaging and potentially dangerous ‘treatment’.

Arguably, the greatest harms have been meted out by enforcement measures. On an individual level prohibition means users have little idea of the strength of a substance, nor of the content – it could be ‘cut’ with highly toxic ingredients. If there is a quality control issue the purchaser has no legal process for complaint, and if they get into personal difficulties or become seriously intoxicated, they are much less likely to seek assistance for fear of stigma, arrest and/or punishment.

 

“Prohibition too, has distorted and thwarted our thinking on drug prevention, drug eduction and drug treatment which have instead become preoccupied with avoiding ‘drugs’”

 

 

Indeed, one of the greatest threats to life is posed not by drugs, but by a drug conviction. A criminal record for a drug defined crime may result in insurmountable hurdles when seeking employment, education, accommodation, international travel, insurance and relationships. In some countries, a drug conviction can lead to incarceration – even the death penalty. A growing punitiveness has seen Duterte in the Philippines and Trump in the US, both advocate death for drug dealers, which in the Philippines appears to have been interpreted as legitimating the killing of suspects without trial or due process. This barbaric reaction to suspected drug dealers excludes of course, without any sense of irony or hypocrisy, those who deal in state-approved drugs.

‘Drug’ enforcement has been deeply divisive – targeting the poor, the indigenous, people of colour, and people from black and minority ethnic groups (BME), despite evidence that levels of drug use are similar across most communities. This discriminatory policing has resulted in deeply worrying disparities in terms of over-representation of indigenous people and people of colour in prison, particularly in New Zealand, Australia, UK & USA. So bad is the problem for ‘people of colour’ in the USA, Professor Michelle Alexander has referred to drug law enforcement as the New Jim Crow. Indeed, in most countries Prohibition has seriously damaged relationships between these communities and law enforcement.

The drug policy ratchet under seven decades of prohibition only ever allows for more punitive approaches. However, research indicates that policing to remove dealers from stable supply chains has actually increased violence in communities, while militarised responses to drug cartels have effectively resulted in violent ‘drug wars’ that have destabilised countries such as Mexico. The worrying growth of violent gangs, gangsters and drug cartels are not inevitable by-products of drugs, as we are led to believe. No, they are inevitable outcomes spawned from a brutally enforced system of drug prohibition, as also witnessed in the 1920s with alcohol prohibition. 

 

“‘Drug’ enforcement has been deeply divisive – targeting the poor, the indigenous, people of colour, and people from black and minority ethnic groups”

 

 

Efforts to eradicate supply over many decades have largely been futile, they have barely had any impact whatsoever, on reducing illegal drug supplies. But in countries such as Afghanistan and Colombia crop eradication and carcinogenic crop spraying have devastated some of the poorest farmers in the country, a desperately poor community with few viable alternatives available to them.

Prohibition has fuelled misinformation, division, harm, violence and death – locally, nationally and internationally. It has undermined public health, facilitated the spread of dangerous diseases such as HIV & Hepatitis, caused deforestation and pollution, weakened human rights, encouraged hostility, stigma and discrimination towards the ‘Other’, undermined international development and security, increased crime, facilitated lucrative illegal markets, negatively redefined police-community relations, led to overcrowded prisons, and wasted billions of dollars in a relentless attempt to enforce a system that can’t be, and shouldn’t be enforced. So impossible is the task of prohibiting drug possession, that even high-security prisons are rife with prohibited drugs. The full extent of the damage caused by prohibition has been comprehensively detailed by the excellent work of  “Count the Costs”

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What needs to be done?

There are two main risks for people who use prohibited substances: the damage caused by law enforcement, criminalisation and punishment; and the other is the damage caused by not knowing what you are using because there is no framework for quality control. Both issues must be resolved, – but the greatest extent of damage is caused by former not the latter.

 

“…people who are both white and privileged are rarely captured in the ever extending enforcement net of prohibition.”

 

It is important to remember, that brutal enforcement measures meted out for drug defined crimes disproportionately target and impact the poor, BME and indigenous people.  Whereas, by contrast, people who are both white and privileged are rarely captured in the ever-extending enforcement net of prohibition. For this privileged group the greatest threat is not a heavy-handed criminal justice system that threatens to target and ruin life opportunities with a drug conviction, no, the more likely threat they face is posed by ingesting an adulterated drug with has not been quality controlled.

Hardly surprising then, two strategies gaining the most traction in the drug reform movement, (led by the privileged class), are ‘drug checking’  at festivals (not at needle exchanges or drug consumption rooms) and cannabis legalisation. Bottom line, the drive for Legal Regulation is a commitment to secure a clean legal supply is available for those who can afford to buy legally regulated drugs from the new government approved drug business entrepreneurs. This removes the brunt of prohibition as experienced by the privileged (the lack of quality control) and additionally facilitates new business opportunities.

It should really come as no surprise, given that prohibition has always been about power, profit and privilege, that in areas of North America where cannabis has been legalised, ex-drug law enforcement officers who so vehemently rallied against ‘drugs’, are switching sides to seize the lucrative business opportunities.

 

“Legal Regulation is a somewhat vague ‘rally call’ from drug law reformers a little like a rallying call asking the government to take control of drugs.”

 

If in seeking to end Prohibition, we rally behind Legal Regulation, we are supporting a vague concept. For example, alcohol is a legally regulated drug (poorly regulated in my opinion), but opioids too, are a legally regulated drug (far too strictly in my opinion). So when we call for Legal Regulation what are we actually rallying behind, and what would it look like in policy and practice?

Regulation simply means managed by the state and legally available in certain circumstances. In most countries, it is possible for an adult to purchase beer (alcohol) in a supermarket and codeine (opioids) at a pharmacy – without much difficulty. Under the regulation of other opioids such as morphine, diamorphine or fentanyl are legal to use, in particular circumstances – such as when prescribed for acute pain relief. However, while opioids are legally regulated, possession of certain opioids are in most circumstances strictly prohibited, and unapproved possession and/or supply can result to some of the harshest punishments available to the criminal courts – including life imprisonment. By contrast restrictions and punishments concerning possession and supply of another regulated drug, alcohol, are more liberal and generally lenient, as are regulations concerning alcohol sale outlets, sponsorship, media coverage and advertising.

So supporting Legal Regulation is a somewhat vague ‘rally call’ from drug law reformers a little like a rallying call asking the government to take control of drugs. Legal Regulation is a response to a symptom of Prohibition, but it fails to address the cause of our drug policy problem – Prohibition!

Yes, we do need a legally regulated supply of all drugs, (and not just cannabis), but whether that addresses the problem of an illegal market depends greatly on how the ‘regulation’ model operates. A Legal Regulation model that incorporates the prohibition and punishment of unapproved adult personal possession and social dealing, is I’d argue,  simply perpetuating the problems in a repackaged Prohibition 2.0.

Under a regulation model, the state may approve and legally regulate a wider range of drugs, while still prohibiting so-called ‘dangerous drugs’. We see this happening now where cannabis is invited to the top table to join the other privileged state approved drugs. Some may see this as a slow but incremental dismantling of prohibition, I think paradoxically, it is more likely to extend prohibition. Even if the state made all drugs available under a Legal Regulation model, the model still allows the government to insist that those substances remain prohibited, unless purchased from state-licensed companies. We would then have a model in which it is an offence to be in possession of any drug from an unregulated source – for example, homegrown cannabis. Prohibition 2.0 would then continue to fuel an underground illegal drug market, and drug law enforcement desperately needing a cultural change of focus, would continue as before, once again targeting the poor, the indigenous, black and minority ethnic (BME) groups.

 

“Regulation that perpetuates a two tier system of state approved drugs that can only be purchased; and unapproved drugs which are banned; simply replicates the existing oppressive model.”

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Those who suffered most under Prohibition must be the first to be protected in any new regime.

Let’s be clear and tell it as it is: the problem is Prohibition (not drugs per se); the protagonists are the UN & government law enforcement (not gangsters); the damage is largely caused by the military, criminal and community justice system (not criminals); and the victims we must protect are not so much the privileged class (who are relatively by comparison, unaffected), but the poor, indigenous and BME communities who have for decades suffered unfairly under prohibition.

To the privileged class prohibition is a flawed policy worthy of discussion and in need of reform, but rarely are they subject to drug law enforcement measures. Whereas under prohibition poor people, indigenous communities and BME groups face considerable daily threats: being stopped, searched; arrested; charged; found guilty; imprisoned; excluded; marginalised; denied employed, housing, insurance, healthcare, travel and participation.

Regulation that perpetuates a two-tier system of state-approved drugs that can only be purchased; and unapproved drugs which are banned; simply replicates the existing oppressive model. Less privileged members of society unable to afford the prices charged by state-licensed suppliers would turn to the underground illegal market, and find themselves once again subject to drug law enforcement measures. Legal Regulation could be to Prohibition, what Jim Crow was to Slavery.

Legal Regulation fails to properly address the core problems of prohibition – the breach of human rights over your body and what you choose to ingest and the deeply discriminatory law enforcement measures imposed. It deals with harshest aspects of prohibition as experienced by the privileged class, by enabling them new opportunities to purchase a clean legal supply.

Before any regulation model should be considered, we must first and foremost decriminalise ALL possession, cultivation and production of drugs for personal use. This is a simple step that could be enacted quickly and with little cost. Importantly, it sets the human rights framework to then explore the complex process of legal regulation, and that new framework must ultimately ensure we move beyond the initial stage of decriminalisation, and establish a legal right for adults to possess, cultivate and/or produce any drug for personal use. 

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The way forward

 We should not support any Legal Regulation model that includes punishing adults for personal possession or consumption of ‘unapproved’ substances. This is a fundamental human right abuse enshrined in Prohibition that under no circumstances should be accommodated in reform. It’s your body and your choice what you ingest.  Most advocates for Legal Regulation are silent on such issues, or regard trading those rights as a necessary compromise to broker ‘reform’.  For example, New Zealand received global acclaim for its highly publicised ‘World Leading Drug Reform’ when they introduced the Psychoactive Substances Act 2013 to legally regulate New Psychoactive Substances.

 

“We should not support any Legal Regulation model that includes punishing adults for personal possession or consumption of ‘unapproved’ substances. This is a fundamental human right abuse”

 

However, what the model did was widened the net of prohibition by making the possession of previously legal drugs (legal highs or NPS) illegal, and it also offered an approval system for NPS via a regulation process. The fact that it worryingly punished personal adult possession of unapproved substances, leaving the door open to the heart of the problem (Prohibition) seemed to be overlooked by drug reformers.

Given the enforcement abuses under drug prohibition, one clear non-negotiable principle in any reform must be to ensure that we reclaim the Human Right over our bodies to be able to choose what we ingest without the threat of criminalisation, punishment, hospitalisation, imprisonment or the death penalty by the state.  

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Decriminalisation – the low hanging fruit

Portugal did the right thing in 2001 when they decriminalising all personal possession of drugs and built in additional support for the small percentage of drug users who develop problems with addiction. It’s a drug reform no-brainer! It is a decision that makes great sense and it has had positive outcomes in reducing: addiction rates; the burden on the criminal justice system; and fatal overdoses.

Decriminalisation of all personal possession is easy picking ‘low-hanging fruit’ that should be the first step of reform for every country. But so much more needs to be done. Decriminalising cultivation and production for personal use only would be a second easy step that would help users reduce the need for engagement in the criminal underworld, especially when the most popular drug used by far (cannabis) is easily homegrown. After that government should rescind drug laws and ensure they are replaced with a sensible evidence-based model of Legal Regulation rooted firmly in human rights and harm reduction.  People with drug defined conviction should have their convictions removed, be issued with an apology and compensation.

 

“…the key reform priority is to end all law enforcement for adult drug possession, cultivation and production for personal use.”

 

An open invitation to state (the perpetrators of prohibition), who have consistently and deliberately ignored science and evidence and continued to enforce a brutal and draconian system of prohibition for decades, to devise a new regulation model, is likely to result in continued disproportionate law enforcement measures imposed on the poor, the indigenous and BME groups for possession of ‘unapproved’ drugs. Before the state even begins to think about the difficult and complex process of legally regulating drugs, we must first and foremost, ensure we abolish Prohibition once and for all and restore human rights.

To most reformers (myself included) the key reform priority is to end all law enforcement for adult drug possession, cultivation and production for personal use. This is a matter of principle that cannot be compromised and should not be diluted by attempting to roll out human rights incrementally. The Human Right over your body must be instantly restored, while the devastating law enforcement abuses in policing drug possession must end, and this will require cultural reform as well as legal reform. Once those human rights are secured and bolted down, then the important work to establish an appropriately regulated drug market can begin.


I would make all drugs available to adults under a legally regulated market, with strict regulation over the businesses (rather than consumers). Governments have a poor record of regulating the pharmaceutical (for example Fentanyl), sugar, alcohol and tobacco industry, so if the state is going to sensibly regulate all ‘drugs’ in a manner that protects human rights and promotes harm reduction they will need careful oversight, advice and political pressure. The risk of oppression from the state can be minimised by ensuring that the new regulatory frameworks sit on a foundation of well established human rights concerning personal use, cultivation and production.

 

“…hopefully we have learned lessons from alcohol and tobacco regulation, so forewarned and forearmed – we can do a much better job living with all drugs.”


In terms of adult accessing drugs initially, the main outlets could be pharmacies, soon followed by off licenses and gradually a cultural change with the most commonly preferred social and recreational drugs being available in cafe’s, bars, restaurants and major events. This may sound like unknown territory, but it isn’t really. Regrettably,  we have already regulated, culturally accommodated, privileged and promoted arguably the most harmful drug of all – alcohol – and we’ve regulated it badly. However, despite pushing a particularly poisonous harmful drug and managing it poorly, we have lived to tell the tale, and while reading this folk might be enjoying a glass of Pinot Noir, rightly without any sense of panic or fear. We know from the folly of alcohol prohibition we need to live with drugs, but hopefully, we have learned lessons from alcohol and tobacco regulation, so forewarned and forearmed – we can do a much better job living with all drugs. While there will be a concern for an increased range of drug-related issues, the wider availability and choice is likely to lead to some wiser and better-informed choices – some already being witnessed in areas that have legalised cannabis.


Alongside this new legal freedom must be easy access to sensible and truthful balanced information about the risks posed by all drugs. Drug education, addiction prevention and addiction treatment should be informed not by ideological belief or moral crusade but by evidence-based research. These services must promote harm reduction and human rights. We should not be in the business of preventing drug use, in the same way, that we shouldn’t seek to prevent people from having a cup of coffee, glass of wine, or cigar – instead we must be in the business of preventing drug policy harms caused by prohibition policies, and preventing and treating drug addiction.

 

Dr Julian Buchanan is a retired Associate Professor from the Institute of Criminology at Victoria University of Wellington, Aotearoa New Zealand.

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Oral Presentation on New Zealand Medicinal Cannabis Bill

 

Address to Health Select Committee:
Urging human rights amendments 
to the Medicinal Cannabis Bill

Last week the 2018 London Marathon was started a 71-year-old American Katherine Switzer.

50yrs ago she became the first woman to run a marathon.

Male runners pushed and barracked her.

A race official chased after her yelling:

 “Get the hell out of my race and give me those numbers!”

The official tried to pull the race number off her vest.

Afterwards a committee, like this one, met to decide whether it was appropriate for a woman to run the marathon.

The committee disqualified Katherine Switzer from the race, and from the US Athletics Federation because:

a) she had run with men

b) ran without a chaperone

c) ran more than 1.5miles

and they accused of fraudulently entering the race.

In the 1950/60s Anglophile countries adopted some shameful and oppressive laws – policies that infringed human rights and individual liberties.

Not only directing what woman can and cant do – Anglophile countries also had laws against:

– Gay and lesbian people who were criminalised and sent to prison

– Indigenous people whose children were rounded up and taken into care

– Black and Minority Ethnic communities who were forcibly segregated & excluded.

Laws that made drugs, homosexuality, suicide and abortion serious criminal offences.

By 2018 in most Anglophile countries these laws have been exposed, challenged & repealed.

But shockingly laws concerning drug policies have hardly changed at all.

The 1950s fear of the ‘Other’ (the Chinese, the Mexican, the Jamaican and people from BME communities ) and the different drug they used – led to an arbitrary list called ‘drugs’.

That list became the backbone of the 1961 UN Single Convention on Narcotic Drugs.

This list of ‘controlled’ substances was then incorporated in our NZ MDA 1975.

The MDA rooted in 1950s fallacy and misinformation was comprehensively reviewed by the NZ Law Commission in 2011

The first recommendation of the Law Commission was that the 40yr old MDA should be repealed:

“The Misuse of Drugs Act 1975 should be repealed and replaced by a new Act, which should be administered by the Ministry of Health” (R1 p.23)

But here we are 30th April 2018 and the MDA remains unaltered.

In respect of drugs we continue to be conned and coerced by the same 1950s policy propaganda that protects & promotes state approved drugs (alcohol, caffeine, tobacco and sugar) and encourages us to look with fear and disdain towards drugs on the 1961 UN list.

This distinction between government approved drugs and drugs banned by the state is based on political agendas and fallacy.

It’s not based upon science, pharmacology or evidence.

Today we have the opportunity to make a small, but significant, contribution to remove some of the harms caused by our archaic and draconian drug policies.

We can make minor amendments to allow people with chronic debilitating conditions to self medicate with a herbal plant that’s only been outlawed because in 1961 it was arbitrarily listed as a so called ‘dangerous narcotic drugs’.

This committee has an opportunity to be on the right side of history, as Aotearoa NZ has on so many other matters of human rights.

As a parent, for years I watched helplessly as my son had repeated life threatening grand-mal seizures. Seizures that were rarely controlled by anti-epileptic drugs – we tried everything.

But we were denied the chance of seeing if cannabis might control his epilepsy.

I was working as a probation officer at the time. I felt it was too risky for me to break law.

Maybe I made the wrong decision.

But I felt I couldn’t risk a drug conviction, I might have lost my job, it might have ruined my career, I could have been denied entry to the USA (where my sister and nephew live), and my application for employment and emigration to New Zealand may have been declined.

So I urge you, for people like my son, to extend the present remit beyond terminal illness and ensure anyone diagnosed with a chronic or debilitating conditions such as Epilepsy, PSTD, MS, Alzheimers, Parkinson’s etc are allowed access to pharmaceutical cannabis AND allowed to self medicate with home grown cannabis.

These patients should not be convicted or punished for trying to make their untreatable condition more bearable by self medicating with cannabis.

Most patients cannot afford expensive pharmaceutical cannabis products – even if they are subsequently made legally available.

They must be allowed to self medicate and grow their own cannabis – removing their need to engage in criminal networks.

Allowing these patients statutory defence, offers compassion,  but it also adds stress and uncertainty.  It risks dragging chronically sick people through the criminal justice system on drug charges with the possibility of reprieve.

A CJS which is more likely to disproportionately target poor people and the Māori population.

So we must, if we can, find a way to make it completely legal for these patients with chronic debilitating conditions to possess, grow and consume cannabis for medicinal use.

Thank you for reading my written submission, listening today and considering these important issues.

Julian Buchanan
30th April 201

Harm Reduction: More than just clean needles

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Harm reduction is a realistic, pragmatic and non-judgmental approach based upon openness, understanding and respect. It was initially adopted as an ‘alternative’ approach to try to engage people using banned drugs in the 1980s, partly because the dominant abstinence approach was failing, but largely because agencies were worried about the spread of HIV/AIDS to the wider community. To encourage safer sex and safer drug use governments reluctantly adopted harm reduction drug policies as a means to reach and engage the cooperation injecting drug users.

 

The global threat posed by AIDS in the 1990s has now subsided, by no coincidence so has the government commitment to harm reduction. However, harm reduction has proven to be effective in engaging people with drug problems into treatment, reducing the spread of infectious diseases, reducing fatal overdose, and reducing addiction. But in some countries harm reduction has stalled and failed to move much further than needle exchange schemes.

Having proved so effective harm reduction has evolved, and now harm reduction is no longer confined to reducing harms from disease, but more significantly it’s more broadly about reducing the harm caused by prohibitionist drug policies.

Has your country moved on from a 1980s model of harm reduction which was largely confined to running needle exchanges? To check out just how far your country has progressed and evolved with it’s harm reduction philosophy here are thirty-one harm reduction policies:

 

    1. Naloxone take home kits for users and friends
    2. Naloxone available without prescription at pharmacies
    3. Naloxone in public areas alongside AEDs
    4. Good Samaritan laws
    5. Legalisation of all injecting equipment
    6. Drug Consumption Rooms/Injecting Facilities
    7. Drug Consumption Rooms for those who don’t inject
    8. Drug checking at Drug Consumption Rooms
    9. Prescribing the drug the person is addicted to
    10. Oral, inhale-able and injectable prescribing
    11. Injectable heroin prescribing
    12. Injectable methadone prescribing
    13. Client led maintenance prescribing
    14. Free Needle/syringe distribution* in cities
    15. Free Needle/syringe distribution* outreach mobile units
    16. Drug checking at Needle/syringe distribution centres
    17. Condom distribution at all drug agencies
    18. Sharps boxes in public toilets
    19. Sharps boxes in all drug agencies
    20. Drug checking at needle/syringe distribution centres
    21. Decriminalise all drug possession for personal use
    22. Decriminalise all cultivation/production for personal use
    23. Drug checking at public events/festivals
    24. Social media early warning system for rogue drugs
    25. Substitute prescribing in prisons
    26. Needle/syringe exchange in prisons
    27. Wet houses for people with drink problems
    28. Rehabs that support oral & ampoule maintenance prescribing
    29. Injecting technique advice at DCRs
    30. Injecting technique advice at Needle Exchanges
    31. Basic health care (showers, laundry room & nurse) at DCRs

*Facilitating collection – not exchange only

Julian Buchanan
April 2018

 

Treating drugs as the problem when prohibition is the problem.

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When promoting drug reform we should reject the deeply entrenched anti-drug narratives that have dominated drug discourse, these narratives are often rooted in fallacy, distortion and sweeping generalisations. Instead, drug reform should maintain integrity and ensure arguments are firmly rooted in reason, rationale, science and evidence. We need to be clear, there is no global drug problem – we are struggling with a global drug policy problem, and the cause of the problem isn’t gangsters – it’s governments. Drugs can pose risks but it’s prohibition that makes drugs dangerous not drugs per se.

 

 

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A tweet posted by the Transform Drug Policy Foundation to 27.5k followers

 


Transform do some great work building solid reliable evidence and they have campaigned tirelessly for drug reform, but the underlying assumptions and messages in this particular tweet/poster are disappointing, they encapsulate some worrying aspects within the drug reform movement. There are three significant flawed premises in the tweet/poster. Let me unpack them separately:

 

Claim #1. ‘Drugs are not safe they are potentially dangerous’.

The key message that ‘drugs’ are not safe and potentially dangerous is misleading and inaccurate. It perpetuates prohibition propaganda that fuels the fear and hype that demonises ‘drugs’. By comparison, while cannabis has never killed anyone, water, salt and peanuts can all be lethal for consumption in certain situations and quantities, but I’d feel uncomfortable if an organisation starts asserting that water, salt and peanuts are not safe, potentially dangerous and need to be controlled. So what about ‘drugs’– is the reform movement seriously suggesting having an unregulated coffee, or an unregulated glass of wine, chewing khat or coca leaves or smoking unregulated homegrown cannabis is somehow unsafe and potentially dangerous?

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There are circumstances where almost any activity (eating habits, riding a bike, watching TV, hillwalking etc.) can be potentially risky, but to generalise and assert these activities are inherently dangerous and unsafe per se is misleading and wrong. Let us be clear people can be harmed by some drugs, but we must also acknowledge most harm is exacerbated by prohibitive and intolerant drug policies, and the level of risk posed by different drugs varies enormously according to the interplay between the substance, the person (set) and the environment (setting).

The broad-brush notion that drugs per se are unsafe and potentially dangerous is an exaggerated, misleading and inappropriate blanket assertion that belongs to the language of prohibition, it’s the sort of propaganda that has clouded rational debate and informed discussion on ‘drugs’ for many decades, and in my opinion these stereotypical misrepresentations (even if said to gain support for policy change), should have no place in reform discourse. The term drugs refer to a diverse range of substances, so applying any sweeping statement to describe their potential risk is meaningless, and particularly misleading when most dangers are created by prohibitionist driven drug policies. It could be argued that at every appropriate opportunity drug reformers should be challenging the prohibitionist misinformation, including the notion of ‘drugs’, not adopting it. ‘Drugs’ is a convenient socially constructed concept consolidated in the 1961 UN Single Convention on Narcotic Drugs to falsely separate state approved psychoactive substance (alcohol, caffeine, tobacco and pharmaceuticals), from state unapproved psychoactive substances (drugs), it is simply a list of substances that have no science or evidence base to support it.

“…notion that drugs per se are unsafe and potentially dangerous is an exaggerated and misleading assertion

…propaganda that has clouded rational debate and discussion on ‘drugs’ for decades”

 

Bad drug policies rooted in prohibition, propaganda and punishment have made these unapproved drugs potentially dangerous to consume, people could be arrested and get convicted which could seriously damage life opportunities for employment, housing, insurance, relationships and travel. Tough law enforcement creates necessarily secretive environments so it becomes more difficult to seek assistance and to check the quality, content and purity of what you are taking, but these risks are the product of ill-conceived drug policy, they are not an inherent consequence of ‘drugs’.



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Claim #2. ‘No drug is safe when unregulated and sold by gangsters’.

When drug use and drug markets have become particularly unsafe and potentially dangerous, it is not because the state hasn’t intervened, but it’s because of state intervention; by imposing severe law enforcement and military measures to prevent the use of some drugs, while promoting other drugs such as pharmaceuticals, alcohol, caffeine, tobacco and sugar. The idea that without strict government regulation the daily activities of growing, producing, buying, selling and exchanging goods and services is unsafe and will inevitably drift into the hands of gangsters, who’ll manage the business with guns, knives and baseball bats is ludicrous and insulting. It is not a lack of regulation, but it is the extreme and fiercely imposed law enforcement measures that have created a hostile and violent environment within which a lucrative prohibited drug business operates.

“…arguably the only thing that connects drugs and gangsters is prohibition.”

 

The suggestion that unregulated substances and gangsters are inextricably linked to drugs is wrong. Indeed, arguably the only thing that connects drugs and gangsters is prohibition. Prohibition, like it did with alcohol in the 1930s, has spawned gangsters, drugs have not spawned gangsters. The present criminal sub-culture that surrounds the illicit drug market has everything to do with fierce law enforcement and prohibition, and little to do with the product on sale. Unregulated drug markets such as the Silk Road website are not dissimilar in principle to Amazon, TradeMe or eBay, not ideal and certainly not perfect, but with user reviews, feedback and ratings, it can hardly be described as a market dominated by violence, threat and gangsters.


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Claim #3. ‘The answer is to regulate drugs’

Of course, I want to see a clean legal supply of regulated drugs available for sale, that is desirable in any drug reform – but rallying behind the state to deliver ‘regulation’ is a vague concept to support. It’s simply a call for government control to regulate drugs so they are available in certain circumstances, which is actually what is already in place. For example, opiates are already a ‘regulated’ drug, they are available to buy as panadeine, paracodol or codeine in pharmacists in most countries, opiates are also strictly regulated and used widely in medicine. Under the regulations, most opiate products are illegal to possess and supply, and anyone caught in possession faces serious charges.

 “…’regulation’ is a vague concept to support.” 

While regulation could mean the state may approve and legally regulate a much wider range of drugs, while still prohibiting a small group of so-called dangerous drugs, the state may also continue to prohibit possession of unregulated drugs. Under a Regulation model that prioritises quality control, the state may insist that Big Pharma is the only state-approved dealers and therefore it would be an offence to be in possession of any drug from an unregulated source – and that could include home-grown cannabis for example. Regulation can so easily result in Prohibition 2.0.

Strict regulation is needed for businesses, not people, but even then, government has a poor record of regulating the pharmaceutical (Fentanyl the source of many fatal overdoses is a regulated drug), alcohol and tobacco industry, so placing hope in the State to sensibly regulate ‘drugs’ in a manner that protects human rights and promotes harm reduction is at best optimistic. The risk is that the state who have resolutely maintained a draconian and austere system of drug prohibition for five decades will pursue a model of regulation that will punish possession, production and/or cultivation of unapproved drugs for personal use.

 


Conclusion

In my view, an open invitation for state regulation is likely to continue to result in disproportionate law enforcement measures imposed on the poor, the indigenous and minority groups for possession of ‘unapproved’ drugs.  Before we even begin the tricky process of asking the state to regulate drugs we must first and foremost, rally reform to abolish Prohibition and restore the human right to possess, produce and/or cultivate any drug for personal use without threat, punishment, or incarceration by the state. Once this is secured then we have a strong foundation to begin to secure a suitable model of regulation, although at present the detail of the desired model for regulation is worryingly vague.

“…abolish Prohibition and restore the human right to possess, produce and/or cultivate any drug for personal use without threat, punishment, or incarceration by the state.”

If, in an attempt to win support for drug policy change, we collude with these myths: that drugs per se are inherently unsafe; that drugs per se are potentially dangerous; that drugs are sold by gangsters; and that state regulation and control is the solution to the problems caused by state prohibition; then we sabotage human rights based reform by perpetuating myth, misunderstanding and misinformation, and we embark on a journey that is more likely to lead to Prohibition 2.0. Regulation could be to Prohibition what Jim Crow was to Slavery.

 


Discussion

(Between Steve Rolles Transform & Julian Buchanan)

Hi julian

– Sorry to say I dont agree with some of your analysis.

you say ‘The key message that ‘drugs’ are not safe and potentially dangerous is misleading and inaccurate’ – but then go on to explain why its actually true.

We are very clear that the level of regulation needed and state intervention justified is determined by the risk of a particular substance – as clearly stated in the infographic this is excerpted from. http://www.tdpf.org.uk/case-for-reform

Almost all the examples you give are heavily regulated
– penauts: foods standards, quality control, sell by dates, allergy warnings on packaging, banned in schools etc
– drinking water is similarly heavily regulated for bacterial and toxic contaminants
– salt – again trades decription, quality control, salt content and health risk info on food packaging etc.

So yes – they are and should be appropriately regulated because they present some risks.

Some low risk drugs – coca and coffee to use your examples – dont need much more than these products (as we say in the infographic!). Alcohol is much more risky and does need more – we advocate age controls, heavier marketing restrictions and minimum pricing for example. Cannabis – which has *some* risks (even if not of death) – sits somewhere in between (for retail sales). This is all spelt out very clearly in the infographic and in exhaustive detail in our various books and reports.

You seem to miunderstand the concepts of risk – which is about about a probability of harm, and regulation, which is about management and minimisation of risk. The fact that many people particpate in an activity and arent harmed entirely misses the point and function of regulation – which targets risky products and behaviours, and at-risk populations (like kids). Claiming there is no risk is not accurate or in the policy context – helpful. Indeed Cannabis campaigning based on this premise has achieved little and is often counterproductive.

Consider the idea that, maybe, turning the prohibitionist thinking on its head and saying we need to to legalise drugs because they are risky, not because they are safe, may actually be a clever and useful way of engaging key audiences – those not of a libertarian persuasion (who dont need persuading anyway).

for 2 – you misquote the graphic then have a circular argument with yourself. LOOK at the whole info-graphic: it could hardly be clearer. We arent disagreeing with you.

on 3 – weve mapped out a pretty clear blueprint of how we think differeent drugs should be regulated. No sweeping generalisations in the infographic and certainly not in our books.

We obviously dont support criminalisation of posession or use of any drug and have *always* campaigned on that basis.

Your conclusion suggests only an all or nothing approach will do – legalise *everything* or its prohibition 2.0. But you support harm reduction, correct? – what is that if not pragmatic compromise that stops short of full (indeed any) legalisation? And where would the boundaries lie for you? sales to children? crack in sweetshops? you dont say – you just endlessly criticise us.

We do say – in detail – in our entrely non-vague 270-page 70k-word downloaded-a-million-times Blueprint (and elsewhere), and Im happy to discuss it. But please stop misrepresenting our work – even if you disagree on strategy or some detail.


Hi Steve,

Prohibition with its fierce military, legal and civil enforcement arsenal to impose it, is one of the greatest global human rights abuses in living memory. These draconian UN led and government enforced drug policies have ruined lives, families, communities and indeed countries.

For the most part the pain, harms and risks are not caused by drugs they are caused by the regime of prohibition, and the the main casualties under this regime are not the privileged class, but the poor, the indigenous and Black and minority ethnic communities. A key pathway to targeted law enforcement abuse under the guise of drug law enforcement, is the offence of personal possession of substances prohibited by the state. So paramount and unambiguous in any reform is the restoration of the human right for adults to possess any substance for personal use without threat, punishment or sanction from the state. There must be no compromise on this position and any call for regulation must make that clear and non-negotiable.

When the New Zealand government extended prohibition by introducing a new drug law (the Psychoactive Substance Act 2013), it rolled out a blanket ban on the possession of all legal highs (s.71), unless they have been approved under a new Regulation model. As far as I am concerned extending sanctions for adult personal possession is untenable in any Regulation model, it perpetuates prohibition, but on twitter you argued these new offences for unregulated possession and supply in our NZ PSA were: ‘perhaps necessary compromises at this pioneering moment to effect key change’. In Addiction (109,10, pp1589–159) you further assert (along with co-author Danny Kushlick), that ‘The New Zealand regulated model — for all its potential flaws — remains preferable to either an unregulated online ‘free-for-all’ or a blanket prohibition’.

I cannot support the state punishing adults for possessing or consuming substances the state doesn’t approve of, and I do not think these human rights should be compromised, not only are they misguided but they open the door to the abuse of power. Given the enforcement abuses under drug prohibition, one clear non-negotiable principle in any reform must be to ensure that adult possession of any substance for personal use is free from all criminal and civil sanctions. While the NZ PSA2013 offered approval of NPS via a regulation process it worryingly punished personal adult possession of unapproved substances, leaving the door open to the heart of the problem – prohibition, unreasonable law enforcement and discrimination.

More recently Transform tweeted praise (26th September 2017) for a regulation model it described as ‘impressive and measured’ – a model that proposed new Drug Regulation laws that would ensure: “severe criminal and civil sanctions will be meted out on those that consume, manufacture or deal drugs inappropriately”. It went on to insist that harsh responses are critical to the success of this new Regulation model. I have no doubt who will be the victims of these harsh responses and severe criminal sanctions, it wont be the privileged classes.

Your strategic approach of: “turning the prohibitionist thinking on its head and saying we need to to legalise drugs because they are risky, not because they are safe, may actually be a clever and useful way of engaging key audiences” is worrying. I appreciate it’s a genuine and pragmatic attempt to lever change and gain acceptance with prohibitionists, but I think it is an irresponsible and potentially dangerous position to take, it’s like the Women’s Movement strategically adopting the argument: ‘Women might not be good bricklayers – but sexism is wrong’ to tackle misogyny. It appears to support change by challenging oppression, but it’s not only inaccurate, it is subliminally reinforcing the very discrimination and misinformation it claims to be challenging.

Tackling prohibition (a discriminatory and prejudicial system of oppression) by adopting false premises peddled by prohibition is dubious and apologetic. It’s not the way disablism, sexism, classism, homophobia or racism should be tackled, nor is it in my view, the way the divisive Drug Apartheid should be tackled. The pragmatism to appease, engage or win over prohibitionists by using their language is well meaning but misguided, and I am concerned it will lead to reform policies that reflect that misplaced and exaggerated sense of risk and danger and ultimately result in delivering Prohibition 2.0.

Let’s be clear and tell it as it is: the problem is Prohibition (not drugs per se); the protagonists are the UN & Government law enforcement (not gangsters); the damage is being imposed largely by the military and criminal & community justice system (not criminals); and the victims that we must prioritise in any reform we support, are the poor, indigenous and BME communities who have for decades been the target of prohibition (not the privileged class).

To the privileged class prohibition is a flawed policy worthy of discussion and reform but the privileged class are rarely directly affected by the fierce drug law enforcement measures that are so often meted out on the poor, indigenous and Black and Minority Ethnic Groups. For the privileged class the greatest risks arise from the lack of a clean regulated supply: fatal overdose; no access to medicinal cannabis; no naloxone etc.

While poor people, indigenous communities and Black and minority ethnic groups face the same issues as a result of no access to clean regulated drugs, they face greater threats; being stopped, searched, arrested, charged, found guilty, imprisoned, excluded, marginalised, unemployed and made homeless because of drug prohibition, indeed, managing to avoid law enforcement of drug prohibition can be a matter of life or death.

Back in 1942 C.S. Lewis realised where the real threat was posed:

“The greatest evil is not now done in those sordid “dens of crime” that Dickens loved to paint. It is not done even in concentration camps and labour camps. In those we see its final result. But it is conceived and ordered (moved, seconded, carried, and minuted) in clean, carpeted, warmed and well-lighted offices, by quiet men with white collars and cut fingernails and smooth-shaven cheeks who do not need to raise their voices. Hence, naturally enough, my symbol for Hell is something like the bureaucracy of a police state or the office of a thoroughly nasty business concern.”


Steve replies:

Drug use *is* risky – it’s not a false premise or prohibitionist propaganda to assert that (obvious and undeniable) fact as a basis for a discussion on regulation options that might reduce risk. And in no way does it preclude a critique of prohibition which, as we state endlessly, including in the infographic youve taken issue with.

We have exhaustively chronicled the harms of prohibition in the 192-page Alternative World Drug Repor. who has done more? I utterly reject the suggestion that it is something we ignore – it is analysis at the heart of literally everything we do.

But drug problems do not disappear after prohibition – prohibition problems do. Drug misuse problems just become much lessened, and I would suggest it is inaccurate and politically unhelpful to suggest otherwise – as you seem to (but Im not quite sure)

You’ve picked up on two quotes – one is from a tweet I didn’t write, about an article by someone else. I don’t think its a brilliantly worded sentence, but the piece itself was pretty good. As I think danny explained on twitter he took the sanctions re inappropriate consumption to be for things like drug-impaired driving – which yes, we believe sanctions should remain for. Regulation means establishing parameters around a legal market – beyond which some activities, drug driving, sales to kids etc – remain prohibited. Fine to argue over where the line should be drawn – of course, but don’t confuse absolute prohibition with regulation where some things remain prohibited – they are NOT the same.

The other quote in Addiction – I absolutely stand by. I think some progress is better than none; I support decrim as a step to legalisation. I support the legalisation of some drugs as a step towards the legalisation of others. I support legalisation in one jurisdiction as a step to legalisation in others. Prohibtion is not going to be dismantled in one go – it will be an incremental process, and that sequencing means some harmful laws will sometimes stay in place for a time whilst others change. This is a sequencing compromise that is an inevitable reality. Our job is to accelerate the incremental reform process as best we can. Suggesting that ANY compromise of this sort means our principles are also compromised or that we are prohibtionists makes no sense in the context of our extensive body of work (that you dont quote), and is just a bit offensive. It feels like you are trying to find a disagreement where genuinely i don’t think there is one. In my response i make a point about your support for harm reduction interventions which you haven’t responded to – But it was that harm reduction (NPS, OST etc) is precisely the sort of compromise that you criticise us of. Harm reduction isn’t legalisation and its often not decriminalisation either. I still support it because its better that no harm reduction – and until we can dismantle the wider prohitbionist drivers that create many of the harms in the first place.

I honestly dont see where we disagree on anything – so i dont know why you keep trying to find some moral high ground for yourself by misrepresenting us. Were all on the same high ground. Go and find someone doing something bad and pick a fight with them.


Hi Steve

As I said in my blog I respect and appreciate much of the work done by Transform:

Transform do some great work building solid reliable evidence and they have campaigned tirelessly for drug reform

including the 192pp Alternative Drug Report which I have promoted and circulated widely. Yes we agree on much, and I value Transform’s contribution to drug reform. However, it’s clear there are some important issues we disagree on:

a) Transform campaign strategies such as “saying we need to to legalise drugs because they are risky, not because they are safe, may actually be a clever and useful way of engaging key audiences” risk colluding with discrimination and misinformation by strategically adopting a distorted over-emphasis that ‘drugs’ (caffeine, tobacco, khat, coca leaves, LSD, alcohol, ecstatcy, mushrooms etc) are all dangerous and out of control. Yes having worked for six years as a drugs worker on Merseyside, and subsequently conducted years of research fieldwork with people struggling with addiction, I know that some illegal drugs can be dangerous to some people in somecircumstances, but far more dangerous and damaging to the people I saw was the impact of prohibitionist drug policies and law enforcement upon their lives.

b) Transform’s approach seems too naive regarding the risks of the state continuing to abuse power in any new Regulation model, risks that would leave the poor, indigenous and minority ethnic groups at risk. Illustrate by the praise for a Regulation model that pledged “severe criminal and civil sanctions will be meted out on those that consume, manufacture or deal drugs inappropriately”. When I read this alarm bells rang loudly, I’m imagining (not unreasonably) how Theresa May or any neoliberal political leader might interpret this new drug regulation approach that promised ‘severe criminal sanctions for inappropriate drug consumption’.

c) In respect of unregulated but legal NPS, while I am keen to provide a reliable regulated supply, I am strongly opposed to replacing any unregulated ‘legal high’ market with a New Zealand styled Psychoactive Substances Act that makes personal possession an offence (unless the NPS has been approved and regulated by the state), this is simply widening the net of Prohibition, law enforcement and punishment. Whereas in respect of your support for the NZ PSA 2013 you say” “I absolutely stand by. I think some progress is better than none“, seeing it as a worthwhile compromise towards drug Regulation reform.

To most reformers (myself included) the key priority of reform is to end all law enforcement for adult drug possession for personal use. This is not something that should be compromised, nor is it something that needs to be done incrementally. Ending the prohibition of all personal possession should be the first blanket decision in reform. The Human Right over your body to ingest what you choose without threat or punishment from the state must be restored, while the devastating law enforcement abuses in policing drug possession must end. Once that is secured and bolted down, then the important work toward ensuring a clean and appropriately regulated drug market can be implemented. Interestingly too, since the New Zealand Psychoactive Substances Act was introduced legal highs have been removed from shops and driven underground, not a single NPS has been approved by the state and more people are dying from NPS in New Zealand than ever before, but the PSA has delivered what the Associate Health Minister Peter Dunne promised it would, when in July 2012 he declared his desire to extend prohibition: “We are winning the battle [against drugs] and we are about to deliver the knockout blow with this legislation“. In New Zealand our Drug War struggle now is not just the damage from the Misuse of Drugs Act 1975, but we must now also contend with a punitive Psychoactive Substances Act 2013. History and experience tells is the policy ratchet tends to make drugs laws more punitive.

Yes, you know my commitment to harm reduction having pioneered it across Sefton and the Merseyside Probation Service in the mid 1980, it’s pragmatic, realistic and humanistic. In attempting to apply it to the strategic approach to end prohibition I have no doubt that the priority to reduce most harm to the greatest number would be to end all sanctions on personal possession. However, I’d be cautious about applying it too far as a strategy for ending prohibition, prohibition is I believe, a violent oppression of human rights, so like say sexism or racism, the notion of pragmatically adopting the language or discourse of the oppressor, or making Human Rights compromises on the basis some harms have been reduced can become offensive, problematic and inappropriate. For example, if adopting a harm reduction approach to a Human Rights abuse under the South African Apartheid it could argue that allowing equality for the Asian heritage South Africans is an important first step towards dismantling Apartheid. A deeply flawed strategy on principle and an untenable position to adopt in my opinion.

Finally, it is important not to personalise this discussion. The blog and these comments are critical contributions for a wider global reform audience to help us all as we seek the very important and challenging task of negotiating pathways to end Prohibition and establish Reform. It is vital we get it as right as we possibly can. This critical analytical debate is not directed to you personally, and I assumed you were contributing on behalf of Transform hence my inclusion in my response of a tweet by Transform. Interpreting my perspective and contribution in this debate as simply seeking some moral high ground to ‘pick a fight‘ is disappointing and demeaning, I would have hoped the issues explored may have been more apparent and more seriously considered, so I think it’s best to end the discussion here.

Best regards

Julian

Seventeen Disconcerting Facts About Drug Testing

 

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What does a drug test actually tell us?


  1. 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.

  2. 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.

  3. 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.

  4. 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.

  5. 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.

  6. 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.

  7. 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.

  8. 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.

  9. 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.

  10. 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.

  11. 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.

  12. 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.

  13. 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.

  14. 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.

  15. 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.

  16. 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.

  17. 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.

 

 

Julian Buchanan

JulianBuchanan@gmail.com

 

Drug Testing: Misleading Simplicity Masking Complex Issues


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The Wider Social Context

Our sophisticated techy gadgets, gismos and latest ‘apps’ make life easier, simpler and quicker. Our technology driven society monitors, measures and controls almost every aspect of daily life. The Internet tracks our lifestyle, values and interests, bar codes scan our shopping habits, CCTV cameras our movement, GPS/mobile phones track our precise location – this mass of data provides greater surveillance, knowledge and certainty for a world with an insatiable appetite for the measurable, tangible and controllable.

But the real world is not so certain or quantifiable; it is blurred, complex and messy. The apparent ‘evidence’ and ‘facts’ we possess are more contested than we would like to acknowledge. The trend to simplify social problems is both seductive and dangerous. In recent decades there has been a growing tendency to stifle debate on complex issues to reduce discussion to simple binary opposites, such as, ‘you are either for us, or against us’.

In respect of recreational drug use, this resulted in a crude unscientific bifurcation, in which unapproved substances (such as LSD, heroin, cannabis and cocaine) are presented as dangerous, immoral and likely to lead to addiction, whereas approved and promoted substances (such as caffeine, alcohol and tobacco) risks are minimised and use is normalised, indeed rarely are they even considered as ‘drugs’. Despite the mounting evidence concerning the risks posed by these state approved and promoted drugs, alongside the relative safety, by comparison, of some illicit drugs, the over-simplistic misinformed binary approach dominates law, policy and practice.

People who regularly enjoy state approved drugs take offence at being considered a ‘drug user’. If they develop physical, social and psychological problems with legal drugs are never referred to as ‘addicts’, junkies or problem drug users. Despite the fact that more people are killed by tobacco and alcohol than all the other illegal drug deaths combined, it is illicit drugs that will not be tolerated and drug testing is a key weapon to deter and eradicate the use of unapproved drugs.

 

The Appeal of the Drug Test

Legal and illegal drugs can for a small proportion of people result in serious health and social problems – in rare cases with devastating and fatal consequences. It is understandable that a concern to prevent such tragedies creates an interest in a possible role for drug testing. The technology appears to offer some tempting evidence and insight. There are a growing number of companies selling a wide range of equipment to test saliva, hair, perspiration, blood and urine for a variety of drugs. It’s a burgeoning industry with strong connections with law enforcement, often managed by ex-police officers.

Drug testing has long history of use with the substitute prescribing, initially used for safety reasons to ensure that people issued with a clean legal supply of opioids had actually been using opiates. However, some prescribing regimes continue to use drug testing on its long term patients, as a punitive tool to impose sanctions for any on-going use of illicit street drugs.

More recently drug-testing technology has been incorporated as a central tenet of Drug Courts and positive tests invariably lead to warnings, breach and sometimes short periods of imprisonment. Drug testing has become popular with some employers – a positive result may lead to suspension or termination from employment. Some countries (like USA and New Zealand) drug test welfare benefit claimants and stop payments if the person continues to test positive for illegal drugs. In some countries, like Sweden, drug testing is used in schools and colleges, in the USA parent groups advocate randomly drug-testing their children – there appears to be an endless range of circumstance when a drug test may ‘apparently’ prove useful.

When faced with a complicated situation of determining and responding appropriately to drug misuse a positive drug test appears to offer conclusive proof – clear evidence upon which straight talking and tough sanctions can be imposed. This measurable and quantifiable certainty of a drug test, in an era dominated by ‘punitive populism’ and simplistic approaches must have appeal, but sadly it can also undermine any attempt to engage effectively with the complexity of the issue, indeed it can do more harm than good.

What Does a Positive Drug Test Actually Tell Us?

A positive drug test provides an illusion of clear evidence, fact and truth. The illusion occurs because the results of the test are not 100% reliable and can be contested. First, the test could produce a ‘false’ positive, or for that matter a ‘false’ negative. Errors and misreading’s can be caused by human error in the testing process, or by faulty testing equipment. While this is not usual, there really should be no room for error given that the outcome could result in loss of liberty, loss of employment, damage to personal relationships and considerable repercussions in later life. Secondly, the result may not be a ‘misreading’ but it could be misleading – the person may accurately show positive for an illicit drug, but it might be a drug which was consumed as a herbal supplement or medication, for example, a person who takes a paracodeine tablet for a severe headache would test positive for opiates. It would then be misleading to assume the person was ‘back on heroin’ even though they tested positive. Thirdly, relying upon the apparent ‘truth’ of a drug test can be flawed because negative test results may be achieved via kits readily available from the Internet that mask the presence of the illicit drugs. So a positive or negative drug test isn’t necessarily a definitive outcome, it could be a contested and/or misleading outcome.

However, it could be argued that in most cases they provide useful and fairly accurate information. Well let us assume that the test is indeed accurate – what does it actually tell the parent, teacher, employer, court or drug worker? Imagine you had a drink problem and at a later date you test positive for the drug alcohol, what does it indicate – it doesn’t tell us how you took the drug (it could have been a sherry trifle), where you took the drug, why you took the drug, when you took the drug or who you took the drug with. Most important, a positive drug test would give no real insight as to whether or not you have an alcohol problem. It is important to be absolutely clear drug use is not indicative of drug misuse, and a positive result will not indicate why or in what circumstances the drug was ingested.

These contextual details are much more important than the apparent ‘factual’ detail of the presence of a drug in your body. At best drug testing technology is only able to provide contested ‘evidence’ that a person is (or is not) free from a particular drug. This crude indicator risks decontextualize and over-simplifying the issue of illicit drug use. Thinking can easily drifts into binary measure of:

  • you are either drug free or a drug addict;
  • you are either telling the truth or you are lying;
  • you are either co-operating or being deviant;
  • you either want help or you don’t want help.

Armed with a ‘hard copy’ evidence of a positive drug test gives those in power and authority confidence to impose sanctions and punishments upon the ‘outsider’ or ‘deviant’ based upon what masquerades as indisputable evidence. This approach is not only deeply flawed, it can also have a number of serious adverse and unintended consequences.


17 Negative Consequences of Drug Testing:

  1. 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.

  2. 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.

  3. 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.

  4. 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.

  5. 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.

  6. 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.

  7. 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.

  8. 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.

  9. 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.

  10. 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.

  11. 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.

  12. 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.

  13. 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.

  14. 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.

  15. 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.

  16. 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.

  17. 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 para-codeine tablet for a headache they’d show positive for opiates.

Conclusion

While drug testing seems to offers seductive simplicity, the shortfalls, ambiguities and misuse of drug testing technology has arguably greater potential to mislead and distort rather than to inform. The future of drug prevention and drug treatment lie not with monitoring, coercion and punishments, but with listening, engaging and caring – drug testing sits firmly with the former and not with the latter. Drug checking by contrast is an important harm reduction strategy to check the contents of unknown substances to protect people from overdose or poisoning. Testing pills is quite different to drug testing people, one is vital and the other is a counter productive waste of money.

Julian Buchanan


  • This blog is based on a conference paper, the PowerPoint presentation which can be accessed here

The most vulnerable need advocates to campaign on their behalf: The New Zealand experience of naloxone

 

 

 

No naloxone available? No excuse.

No excuse either for drug agencies failing to formally lend their support for naloxone distribution to users, families, and friends.


 

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, and people who inject drugs (PWID) tend to be the most marginalized. Naloxone distribution is a vital life saving service for PWID.

 

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Numerous opportunities have existed in New Zealand to ensure naloxone is available to users, families and friends. In August 2013 sixty-seven 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 in this comprehensive document outlining drug policy priorities naloxone didn’t even get a mention.

A year later in August 2014 in it’s Matters of Substance Magazine, rather than present a robust case for naloxone distribution in New Zealand, the NZ Drug Foundation Magazine framed Naloxone take-home as a contestable issue, open to debate. They offered arguments for and against naloxone. This included some spurious 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”.

 

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In October 2014 after a new government was elected the NZ Drug Foundation prepared a twenty page Briefing Paper to Parliament which was designed to identify key drug policy priorities to enable ‘opportunities to make real reductions in drug related harm‘ (p.3). 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, but astonishingly made no reference or representation to the new government concerning fatal opioid overdoses nor did it mention the need to distribute naloxone to users, families and friends.

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With this lack of formal commitment to naloxone distribution 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).

 

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Belatedly, Matters of Substance published a better informed and considered magazine feature on Naloxone after the embarrassing ‘for or against’ debate, the Foundation produced a stand alone Naloxone Background Paper. However, while this discussion paper includes some excellent sources and appeared to offer a robust argument for reducing overdose, it also undermined the campaign 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 must receive 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 give the impression of 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 understood and 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 prioritise 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.

 

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

 

 

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 push for naloxone distribution.

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 & subsequently the Harm Reduction Briefing to Parliament), and why they haven’t campaigned when and where it matters, for naloxone take-home from the outset. Staff from the NZ Drug Foundation did however, as promoted and prioritised in the harm reduction Briefing to Parliament, go to Vienna and New York (see here) 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 drug policy issues that need tackling here in New Zealand include:

 

 

1. Possession of needle/syringes is an offence if it can be proved they were not obtained from a Needle Exchange.

2. There is no naloxone take home.


3. There is no injectable maintenance prescribing.


4. There is no heroin prescribing.


5. There is no Good Samaritan law.


6. There are no Drug Consumption Rooms / Supervised Injection Facilities.


7. Unemployed people on state benefits are drug tested and lose benefits if they repeatedly test positive for illegal drugs.


8. People with life limiting illnesses are criminalised if caught self medicating with cannabis.


9. The Police and Air Force scour the countryside every year digging up millions of dollars worth cannabis plants.


10. The Alcohol and Other Drug Treatment Courts adopted from the USA and based on an abstinence and disease model of addiction that uses scram bracelets and random alcohol and drug testing, have had their five year ‘pilot’ extended a further three years.


11. New legislation to enforce Compulsory Assessment & Compulsory Treatment of Addiction came in force in February 2018.


12. The Psychoactive Substances Act 2013 made possession and supply of all NPS an offence – unless approved by the state (none have been approved).


13. Housing NZ have fuelled a needless moral panic about methaphetamine contaminated houses and awarded over $50m to companies to decontaminate houses.


 

 

The 2016 and 2017 CND and UNGASS meetings predictably delivered no tangible positive outcomes or progress. It’s now International Overdose Awareness Day 2017 and New Zealand users, families and friends are still struggling to gain access to naloxone. Distribution has been agreed in principle, but procrastination concerning the cost and production of additional health education material to accompany the naloxone have stalled distribution.

Having failed to even mention naloxone in the weighty 2013 Wellington Drug Policy Declaration, and failed to mention it in the 2015 Briefing to Parliament, the urgent need for naloxone was finally acknowledged in the New Zealand Drug Foundation December 2017 Briefing to Parliament;

 

 

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 in New Zealand are needlessly suffering, some are dying. No naloxone take home – no excuse.

It is literally a matter of life or death.

 

Julian Buchanan

Dr Julian Buchanan, is a retired Associate Professor, Victoria University of Wellington, Institute of Criminology

 

 

31st August 2015 on International Overdose Day. (updated  5th January 2018)

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