Monday, 17 June 2013

Neither prohibition nor regulation will prevent stupidity!

An article in today's Daily Telegraph written by Dr Gordian Fulde, Head of the Emergency Department of St Vincent's Hospital, Sydney, (he does one most weeks, discussing some of the injuries this busy inner city hospital (one of the most unusual in the country having both Kings Cross and the Oxford St nightclub strip nearby) deals with over the weekend) highlights the great problem we have dealing with alcohol and other drugs.

Both sides of the 'synthetic drugs' debate – those who want to regulate the industry and those who think continually banning new substances will fix the problem need to look at this very short piece and think whether either of the two ends of the spectrum are ever going to make a great deal of difference in reducing the harm associated with alcohol and other drug use …

The incidents that Dr Fulde describes in his piece are as follows:
  • a 27-year-old woman using 'meow meow' or mephedrone, mixed with amphetamine ('speed') who experienced "total body spasms, a racing heart, raised body temperature"
  • a 29-year-old danced off the podium, falling on her face and losing some front teeth and lots of blood from a cut lip (no drug was mentioned but she was obviously intoxicated on something to be included in the piece)
  • a 19-year-old woman who, after at least 15 drinks, was confused, very distressed and could not stop crying
  • a drunken man, 40, who fell down 18 stairs crashing his face into concrete and breaking his  jaw "so badly the ends burst apart"
  • a 22-year-old, beaten up and cut with something sharp with bad lacerations to his ear and scalp
  • a young man, cut and knocked out by a bottle smashed into the back of his head
  • a 19-year-old admitted "dangerously agitated after taking six ecstasy tablets"
  • a 21-year-old who became violent after mixing a cocktail of drink and drugs, admitted with a head injury
A number of the incidents involved illegal drugs. These drugs are prohibited – they are not meant to be readily available – amphetamine and ecstasy can't be bought in your local deli. But there were at least three people in the list above who were able to locate the drug of their choosing and purchase it. On the face of it, prohibition did not reduce the harm in these cases. Simply banning a substance does not mean it is going to disappear – it certainly may mean that it becomes a little more difficult to find for a while, but that doesn't usually last for too long and when it does come back it is often a little more expensive and criminal gangs are much more likely to be involved in its distribution.

The majority of the incidents described, however, were alcohol-related. This is a regulated product, labelled, only allowed to be sold under certain conditions, each can or bottle clearly indicating how much alcohol is contained (i.e., how many standard drinks and percentage alcohol content), restricted for sale to those above 18 years …. I could go on and on! Clearly regulation made little difference in the cases listed here - even though these people had all the information about what they were drinking, all the laws around the provision of alcohol were in place, it did not fix up all the problems. Would banning alcohol make the situation worse? Without a doubt. We only have to look at the US experience of prohibition in the 1920s to see what happened with that experiment!

Drugs, legal or illegal, are, for the most part, taken to 'change where we're at' – they alter our perception and in many cases, make us feel good – that's why people continue to take them. This has been happening since man first peeled off a bit of bark, chewed it and had a pleasant experience! We are pleasure-seeking animals – nothing is going to change that. Some of us don't just want a 'little bit of pleasure' – for some the belief is that if one pill makes you feel good, taking eight will make you feel fantastic!

In this article we have a woman who mixed mephedrone with speed, another who drank at least 15 drinks in a session and a 19 year old who had taken six ecstasy pills – prohibition didn't stop those who used the illicit drugs and alcohol regulation didn't make any difference for the drinker. These people did 'dumb things' – they wanted a good time and things went horribly wrong!

So is there a simple answer, is there a 'silver bullet'?

Going down the prohibition line certainly reduces access to some extent (they become harder to get) and the simple fact that something is illegal is enough of a deterrent for some people to not want to use the substance. On the other hand, the regulation of drugs such as ecstasy would reduce the risk of more dangerous adulterants being found in those substances, ensure that information would be provided on the contents of the drug, as well as the potential risks and correct dosage (similar to that of pharmaceutical drugs) and the sale of the drug would be monitored and carried out under strict conditions.

They are the pluses but in reality neither of these strategies would make a bit of difference in the three cases above … neither prohibition nor regulation will prevent plain stupidity!

I wrote another blog entry last week on this topic and Monica Barratt, one of Australia's top researchers on this topic, responded with the following:
"… one of the benefits you didn't mention about lifting prohibition is that hopefully this will enable a more frank conversation to occur about drug use - its benefits and risks - and perhaps younger people will have more respective for authorities because we would no longer be lying to them about drugs always being equally harmful. We know that people are more likely to seek help if the drug isn't prohibition or stigmatised … The key for me is if we could, as a society, have a mature and respectful conversation about drug use, then we'd have more chance of avoiding some of these tragedies and harms." 

Monica is an amazing woman who has really put herself out there in this area - I truly admire the work she has done and her efforts in the area of harm reduction. Her final sentence is the winner for me – "if we could, as a society, have a mature and respectful conversation about drug use". I have been speaking on this subject for the past 25 years and I still can't believe how both sides of the drug argument can't see that if were willing to move into the middle just a little more things could be better.

Cannabis is the best example of the polarisation of views in this area. This is a drug that people perceive as either 'the devil’s weed' or 'God's sweet nectar' – neither is true. Of course cannabis can cause harm to some people, it's ridiculous and na├»ve to think it doesn't, but it is also important to acknowledge that the majority of people who use the drug, do so (often for a short period of time) and move away from it and never experience any problems. If both sides could somehow acknowledge the other in a mature way and sit down at the table and try to work together rather than throw insults at each other maybe we could move forward in a positive way.

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