Recovery, harm reduction or just better regulation?

Two developments this week on the “what to do about drug addiction” front, one about problematic use of illegal drugs, and one about a legal drug. The two responses couldn’t be more different. Not only that, but we’ve got a new buzz word on the illegal drug front: “Recovery”. Ah yes, of course, everyone wants addicts to “recover” don’t they?

Scotland is sadly famous for having areas of extreme deprivation and it’s long had a huge alcohol problem, that’s hardly news. However, as booze isn’t (in the eyes of the Scottish government) a drug, it doesn’t feature in their new strategy for dealing with that countries huge number of problem drug users. Published this week by the Scottish Government (The Road to Recovery: A New Approach to Tackling Scotland’s Drug Problem) sets out what it claims is new thinking

The Scottish Government has become concerned – possibly rightly so – about the huge and growing number of problem drug users who have become long term Methadone dependent. Under the mantra of “harm reduction” (compromised by prohibition) Methadone is an opiate replacement therapy designed to wean people off – or at least reduce their use of – illegal heroin. It has some undeniable benefits as a strategy, it reduces the dangers of injecting contaminated street smack, allows addicts to stabilise their habit and it reduces crime associated with the need to feed a habit through the illegal street trade. However, as the report states, it doesn’t cure people of their drug problem, indeed at best it simply substitutes one form of addiction for another or at worst adds another to a continuing addiction problem.

So we have this new buzz word: Recovery.

Dictionary definition of “Recovery”:

1. the act of recovering from sickness, a shock, or a setback
2. restoration to a former and better condition
3. the regaining of something lost

The stated aim of the new strategy is to enable problem drug users to recover from their problematic drug use. All well and good. Indeed, the strategy accepts that the road to recovery will be different for different people, However, it defines “recovery” as:

81. What do we mean by recovery? We mean a process through which an individual is enabled to move on from their problem drug use, towards a drug-free life as an active and contributing member of society.

So recovery to the Scottish Government means, ultimately, abstinence. What it specifically doesn’t mean is a state of non-problematic drug use.

This is why one core issue you won’t find anywhere in the whole policy is heroin maintenance, it’s just not there as an option. The only type of maintenance programme they acknowledge is with methadone, which most heroin addicts will tell you isn’t what they want. No consideration has been given in this report to allowing addicted heroin users a legal way to get their lives in order without, at least initially, ceasing their use of heroin. Although it is accepted that many will  continue to buy it from the street dealers. Threading it’s way throughout this whole document is a dedication to prohibition and the idea of “prevention” as being the only real way to deal with the problem.

A couple of illustrations of the mindset of the report: It defines drug users as basically being of three types:

Experimenters – people who try legal and illegal drugs, including alcohol, tobacco, cannabis and psychostimulants. They are unlikely to be in touch with drug services, except for those providing information. They will come from a mixed social and demographic group.

Regular users – individuals who are typically using legal and illegal drugs regularly. As with experimenters, they will be from a mixed social and demographic profile. They may have had some contact with drug information services, but are unlikely to have used any other drug service.

Problem Drug Users – this is the category of people who will be experiencing or causing social, psychological, physical, medical or legal problems because of their drug use. They are likely to be in touch with drug treatment services, although many will not.

What happened to social users? Social users of course form by far the majority of drug users who are in the most part – the vastly most part – non problematic users.

The reports also states that:

Although users of cannabis and cocaine are not included in the estimated 52,000 problem drug users, this does not mean that use of these drugs cannot cause problems – it is the economic, health and social consequences of drug use that should concern us, not the choice of drug.

So all drugs are bad, m’kay?

Of course cannabis isn’t included in the figures relating to problematic drug use because it doesn’t cause problematic drug use on anything remotely comparable to street heroin, and although it doesn’t actually admit it the number of normal, well adjusted social users of cannabis dwarf the 52,000 problematic users (and the users of cocaine incidentally), probably by an of order of magnitude at least. But according to this report, the best way to deal with these problematic users is to prevent the use of cannabis because enforcement and prevention is a key aspect of this “new” strategy. Have the Scottish Government bought into the idea that cannabis is a gateway drug as rabid prohibitionists always claim? It sounds like it.
Regarding enforcement the report looks forward to a new golden dawn:

We want to get to a position where targeted enforcement activity means reducing supply for a sustained period, long enough to let other agencies involved in drug use intervene to promote treatment services, education and ultimately achieving demand reduction.

Anyone else hear the sound of flapping pigs wings? After all these decades of futile enforcement, they still believe it can be done. They still believe that prohibition holds the key to preventing problematic drug use, when all the evidence shows it simply makes the problem worse.

Half a world away Dan Gardner, writing in The Ottawa Citizen about his own government’s similar naivety put it this way:

And every decade or two, the government quickly and firmly rejects real alternatives to the status quo. And every decade or two ministers and police chiefs tell parliamentary committees that the solution is prevention, treatment and law enforcement — and they say this with all the wide-eyed enthusiasm of ignoramuses who think they are the first to ever utter these sparkling words.

How right he is. Of course, what the Scottish Government has totally ignored is the concept of controlling and regulating the supply side of drugs. Whilst they remain illegal, uncontrolled and unregulated all any government can offer is this dewy eyed hope of a new dawn where enforcement can be made to work. Clearly it’s not only drugs that cause delusions.

The other addictive drug strategy story this week concerns a drug at least as addictive as heroin; tobacco. Now, tobacco along with alcohol isn’t included in the Scottish strategy and hardly gets a mention in it, but along with alcohol it does have one property which offers the possibility of effective controls – it’s legal. So it is that the British government (ie the UK without Scotland) has issued a consultation document which proposes a raft of new controls and regulations for the tobacco trade. Included in this are proposals for a ban on designer packaging and removal from public display, although still allowing the sale of tobacco from sweet shops – whoops. Compared with the story concerning illegal drugs the policy toward tobacco makes so much more sense – apart from selling it in sweet shops of course – by removing promotion and advertising (aka pushing). This is the latest stage of what has been a hugely effective drive to reduce the use of tobacco over recent years, all done via regulation and controls, the very weapons unavailable in the “war” against illegal drugs. There’s a message in there somewhere.

We all want recovery when it comes to problematic drug use, but if this word is to be used as a way of repackaging prohibition it will debase it in the same way as “Prevention” and “controlled” have been debased. Unless the trade in these substances is controlled – really controlled and properly regulated – “recovery” will be just another hollow and meaningless word politicians use to justify the failure of prohibition.