THE WORLD may be on the brink of a recession, but for one business prospects
have never been brighter. World heroin production has tripled in ten years, and
cocaine production doubled. Hard drugs are no longer the preserve of the
affluent. A hundred years ago the typical opiate addict in the West was a
middle-class woman in her forties. Now it鈥檚 a young, uneducated male. Even
nicotine continues to enjoy steady global growth, as people in the developing
world embrace the habit.
Despite all the health campaigns and the billions spent on law enforcement,
there are more addicts living today than at any time in modern history.
Governments hooked on 鈥渮ero tolerance鈥� policies are condemned to locking up ever
more drugs offenders, and footing the soaring bill for the crimes they
commit鈥攐r in the case of smokers, the medical treatments they need.
There has to be a better way, and it鈥檚 there for the asking鈥攖he
alternative philosophy of harm reduction, in which the aim is not necessarily to
wrench addicts away from their drug, but to minimise the harm drugs do to users
and society. Take nicotine. What kills smokers is not the drug they are addicted
to but all the disease-causing gunk in the smoke they inhale to get their fix.
The good news is that there are now much safer ways of taking nicotine; the bad
is that governments are failing to ensure these products are taken up. Across
Europe, for instance, cigarettes containing all sorts of untested additives
continue to be sold. Yet a comparatively safe form of chewing tobacco is banned
(see 鈥淢y friend nicotine鈥�).
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Even more bizarrely, governments still lack the power to compel cigarette
manufacturers to make their products safer. A method already exists, for
example, to reduce the levels of cancer-causing nitrosamines in tobacco smoke,
and major manufacturers are said to be interested. The catch is they want to
continue selling all their usual brands and market the new cigarettes as being
鈥渟afer鈥�. This is like car manufacturers demanding the right to sell cars with
and without seat belts in the name of consumer choice. The difference is that
governments can insist on seat belts, but not on specific safety measures for
cigarettes. Acquiring such powers should be an urgent priority.
It鈥檚 not so very different with heroin addiction. As with nicotine, the
dangers have been massively distorted. Heroin does not rot your brain or body:
if heroin addicts look haggard and thin, it鈥檚 because they鈥檙e spending every
waking moment worrying where their next fix is coming from, and spending their
last cent on black market drugs rather than food. True, many heroin users lead
risky lives. But this is mostly due to the unhygienic and dangerous conditions
in which the drug is bought. Forced to go to criminals, addicts pay excessive
prices for erratic supplies that are likely to be bulked up with harmful
substances. Recently heroin has turned up on the streets containing the nerve
toxin scopolamine, a deadly Clostridium bacterium and even anthrax
spores.
Worse, addicts soon learn how to eke out their erratic supplies by mixing
heroin with other drugs. And it鈥檚 this鈥攏ot the heroin itself鈥攖hat
kills most addicts. To take a typical set of figures, out of 84 deaths linked to
opiate abuse in Dublin in 1999, 73 victims had two or more drugs in their body.
And a majority of the victims had no remnants of heroin in them at all, only
methadone, the substitute drug that鈥檚 often prescribed to addicts to wean them
off heroin.
The answer seems obvious. If the black market is the source of harm and
methadone is more dangerous than heroin (as the evidence increasingly suggests),
why not let doctors prescribe 鈥渃lean鈥� heroin? Switzerland, the Netherlands and
Germany are already piloting the approach, and even Britain is now quietly
licensing doctors to prescribe heroin to addicts who seem unable to give up. But
such schemes are limited in number and are still bitterly opposed by many
politicians and anti-drugs campaigners. At best, they are tolerated rather than
enthusiastically endorsed.
This is a pity, but hardly surprising. Addiction is never a good thing and
nearly everyone has some moral qualms about it. But the fact is that some people
will always seek out drugs and there are no miracle cures for addiction on the
horizon. For now, harm reduction is the best strategy we have.
For too long we鈥檝e been forcing addicts to choose between prison, abstinence
or therapy. What many of them really need is the drug of their choice, supplied
to them in the safest possible way.