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:
- Naloxone take home kits for users and friends
- Naloxone available without prescription at pharmacies
- Naloxone in public areas alongside AEDs
- Good Samaritan laws
- Legalisation of all injecting equipment
- Drug Consumption Rooms/Injecting Facilities
- Drug Consumption Rooms for those who don’t inject
- Drug checking at Drug Consumption Rooms
- Prescribing the drug the person is addicted to
- Oral, inhale-able and injectable prescribing
- Injectable heroin prescribing
- Injectable methadone prescribing
- Client led maintenance prescribing
- Free Needle/syringe distribution* in cities
- Free Needle/syringe distribution* outreach mobile units
- Drug checking at Needle/syringe distribution centres
- Condom distribution at all drug agencies
- Sharps boxes in public toilets
- Sharps boxes in all public agencies
- Decriminalise all drug possession for personal use
- Decriminalise all cultivation/production for personal use
- Drug checking at public events/festivals
- Social media early warning system for rogue drugs
- Substitute prescribing in prisons
- Needle/syringe exchange in prisons
- Wet houses for people with drink problems
- Rehabs that support oral & ampoule maintenance prescribing
- Injecting technique advice at DCRs
- Injecting technique advice at Needle Exchanges
- Basic health care (showers, laundry room & nurse) at DCRs
- Showing people better injecting technique and alternative injecting sites
- Providing foil, bongs and pipes.
*Facilitating collection – not exchange only
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.
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?
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’.
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.
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.
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.
(Between Steve Rolles Transform & Julian Buchanan)
– 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.
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 [Transform’s] 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.”
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.
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.
- A positive drug test indicates drug presence, but not necessarily drug impairment, so campaigns such as drug testing drivers, tend to conflate drug presence with drug impairment by ascribing much more to a positive drug test result than it is telling us. Association does not mean causation, while presence doesn’t necessarily mean under the influence or impairment.
- A positive drug test may be incorrect due to a small percentage of ‘false positives’ caused by equipment failure or human error, and conversely ‘false negative’ can occur.
- An accurate positive drug test still maybe misleading. It is assumed that the person has taken illicit drugs when those drugs may have been ingested legally. For example, consuming poppy seeds in bread can lead to a positive drug test for opiates, or if the person took a paracodeine tablet for a headache they’d show positive for opiates.
- Drug testing identifies substance ‘use’ rather than any substance disorder/problem. This misguidedly widens the net of concern, which should be directed towards the person with a drug problem not towards the recreational user.
- Most people with a chronic drug problem have endured damaging personal and social circumstances before drugs became an issue and need considerable help and support in life, more generally. Drug testing can lead to a pre-occupation on drug presence, and this narrow focus risks overlooking the real underlying issues, which if not addressed, will almost certainly lead to drug problem relapse.
- Women drug users with child care responsibilities are often forced to undertake regular or even daily drug tests to prove they are ‘drug’ free, this disproportionately focuses attention on drug presence rather than fitness to parent. Regular positive drug tests are then used wrongly as evidence as to why the child should be ‘looked after’ by the state. Any assessment of a mothers parental capability to care for her child should never be reduced to a drug test.
- A pre-occupation with drug testing by key stakeholders can result in a paradigm shift in which abstinence and so-called ‘clean’ drug tests become the desired measure of any successful outcome. Not only does harm reduction get marginalised in the process, but the messy and challenging process of rehabilitation and social reintegration may be forgotten in the satisfaction that the person appears to be drug-free.
- Around 30-70% of young people in most western countries have used illicit drugs and the vast majority manage to avoid: a criminal record; a drug problem; harm to themselves or harm to others. Widespread random drug testing in schools, at the roadside, in employment, on benefit claimants etc., will only waste resources and result in capturing mainly non-problematic drug users who then risk being ascribed damaging labels as ‘deviant’ or ‘addicts’ that will pose serious damage to future life opportunities (education, employment, travel, insurance, housing etc) and in relationships.
- Resources for public and voluntary services are limited and money that could be used to deliver much-needed harm reduction services is wasted on expensive drug testing for people who don’t use drugs or those who use drugs in a non-problematic recreational manner.
- Random drug testing of pupils, students and children often accompanied by police and sniffer dogs as a health promotion strategy is misguided. Cultural behavioural change is not achieved through policing, confronting and punishing, but it is facilitating through meaningful, culturally relevant, reliable information exchange, harm reduction education, relationships and peer dialogue.
- The most widely used illicit drug (cannabis) is much less harmful than the promoted legal drugs alcohol and tobacco, it is, therefore, untenable or indeed hypocritical to pursue drug testing and punish cannabis use and not drug test and punish alcohol and tobacco use.
- Drug testing regimes with sanctions, such as random drug tests in schools to exclude students who test positive, create a ‘cat and mouse’ game in which an adversarial relationship is established, both sides then seek to out-smart the other with new technology or deceptive techniques. The winners in this game are the drug testing businesses and underground laboratories; but the losers are honesty, trust and communication.
- Tougher drug testing regimes to stamp out illicit drug use, such as drug testing in employment, have spawned the proliferation of new synthetic designer ‘legal’ highs to avoid detection (such as Spice). However, once these new drugs have been detected and subsequently outlawed the drug testing ‘net’ widens, then new legal highs are further developed and the never-ending spiral continues. These ‘legal highs’ may be considerably more dangerous than commonly used illicit drugs.
- Some drugs such as cannabis can stay in the body for over four weeks whereas drugs like cocaine can be out of the body within 48 hours. Random drug testing regimes (such as those in prisons) have inadvertently pressurised people to switch from the less harmful cannabis to the more dangerous heroin, spice or cocaine.
- Drug testing concentrates attention towards illegal drug use and unhelpfully firms up the misguided bifurcation between licit and illicit substances. It is not the use of any illicit drug that warrants attention but rather the misuse of any drug legal and illegal that should warrant attention. The legally promoted drugs (alcohol, caffeine, tobacco and sugar) can pose serious risks, sometimes greater than their illegal counterparts.
- A positive drug test may reduce the risk of people who are intoxicated from using machinery, driving a car or flying a plane, however, testing positive for a drug doesn’t necessarily mean that the person is intoxicated or impaired – for example cannabis can be detected a month after not using, so a positive drug test could result in misguided concern and unfair dismissals.
- Some maintenance opioid substitute prescribing regimes rooted in harm reduction engage in regular drug testing, but as a consequence of a positive drug test for illicit drug use, some automatically suspend or even terminate prescribing. The use of drug testing in this manner transforms what was a low threshold harm reduction prescribing philosophy into a punitive abstinence-only regime.
As the ideologically driven nonsense that underpinned the Drug War becomes increasingly apparent and the need for drug law reform gathers momentum, it is important to recognise some of the subtle approaches and ideas expressed towards a drug reform model could well result in Prohibition 2.0. An approach that fails to fundamentally address the fallacies of prohibition, perpetuates the drug apartheid and uses the medical profession and civil society as enforcers rather than the police, armed forces and customs.
What are the signs that could open the door to Prohibition 2.0? Well here are some common statements which on first impression, may appear to offer good support to a reform agenda, but on closer scrutiny these statements seriously risk replicating misinformation, and could open the door to new forms of state control, coercive treatment and punishment for people using the ‘wrong’ drugs.
- Drugs are dangerous that’s why we need strict regulation.
- Drug users shouldn’t go to prison, Drug Court is an effective alternative.
- We must accept our drug laws are out of date and need reforming.
- Drug use is not a crime problem it’s a public health problem.
- Soft drugs like cannabis should be decriminalised.
- NPS should be regulated, while unapproved NPS should be illegal to possess.
- People with substance use disorders should be forced to get treatment.
- Drugs that are legalised should only be available from approved suppliers.
- Tackling drug use through the criminal justice system was wrong we must tackle drug use through public health approaches.
- The drug war was a mistake but the state must protect people from the risk of addiction with strict controls over possession and supply.
- People diagnosed with substance use disorders cannot risk using drugs.
- Drug testing has an important role in public health and safety.
- Drug use is a problem we can’t eradicate so we must minimise it.
- Drug use isn’t a police problem it’s a medical issue.
- Only a small proportion of people use drugs and we are going to have to learn to accommodate them.
- We need to change drug laws not because drugs are safe, but because drugs are harmful and people are not being protected by current drug laws.
- Addiction is a brain disease so it shouldn’t be a criminal offence.
Perhaps most worrying is some reformers are calling for drug REGULATION, but this simply means state laws and policies to manage and control drugs (which is what we already have albeit done badly). Regulation is a broad and vague rally call to get behind. While it is more specifically understood as state overseen production, distribution, sale, advertising, labelling, storage and use of drugs, (which for example already happens for opiates), regulation may also continue to make the possession of certain drugs illegal. Substances that are unapproved and/or deemed unsafe by the state may, as in the case of the New Zealand model of regulation, be an offence to possess. This is prohibition by any other name, and replicates the present system of bifurcation.
Julian Buchanan, Associate Professor, Institute of Criminology, Victoria University of Wellington, Aotearoa, New Zealand.