Lit_Match

Inclusion and social control are the ways to tackle drugs problem
10-26-06|theherald.co.uk

Professor Neil McKeganey (October 25) writes that "Perhaps what we need is a good deal more intolerance of all illegal drugs". We are perplexed at this opinion, which contradicts the evidence about solutions to drug problems. Be intolerant of the psychological, social and economic conditions that perpetuate drug problems, rather than of use and users.

Near-zero tolerance was tried between about 1980 and 1995, particularly in the US, while levels of illegal drug use rose to unprecedented levels. Fortunes are spent trying to diminish the supply of drugs, with minimal effect. The illegal drugs industry (one of the world's largest industries) will operate as long as there is demand for illegal drugs, passing on to the consumer the added costs of social and legal "intolerance". Increased expenditure on Customs and police activities would not be worth the cost. Furthermore, it serves the drugs industry's interests to remain illegal, because operating in an entirely unregulated fashion maximises profits.

Being intolerant of individual drug users might be an alternative. Is it possible to stigmatise and socially exclude people having problems with Class A drugs any further?

The Swedish intolerant approach has indeed suppressed the prevalence of drug use, but at the cost of inhumane stigmatisation of users. At one point, there were discussions about isolating all HIV-positive people on an island. Remember, Sweden takes a similarly intolerant view of alcohol. The consequences are lower rates of alcohol-related problems, but a high incidence of heavy binge drinking. An alternative model is the Netherlands, which has a lower prevalence of use than the UK despite more accommodation of drug users.

The hyped benefits of zero tolerance policing in the US are due to other factors, including a generation switching away from crack cocaine in disgust and alarm at what happened to their older brothers and sisters. Another example of the difficulties of zero tolerance is that that prisons cannot be made drug-free, only harsher and more unstable, as prisoners find ways to obtain drugs despite restrictions; this in a closed society. Making an open society drug-free may be impossible.

Some success has been achieved in Scotland with socially inclusive approaches. For example, by prescribing heroin users methadone and dispensing it on daily visits to community pharmacies. This approach was inspired in part by Neil McKeganey and Marina Barnard's classic book on heroin injectors. Other options include abstinence programmes for those who want them and tackling the conditions associated with some of the worst drug problems in society, namely poverty and poor life opportunities.

Most Scots have a cannabis user among their friends and family, whether they know it or not, as over 20% of younger adults have used in the previous year. Should we not also be intolerant of alcohol and tobacco, not mentioned in Neil McKeganey's article?

Not really: shuffling the classification of the drugs people get high on is beside the point. People can come to harm using any drug, or alcohol, or tobacco. They can also use most of these drugs, up to and including heroin and cocaine, without harm, as our own research has found. We need realistic mores, with formal and informal regulation of drug and alcohol use so that people come to the least harm possible. We should also tackle the social causes of problem drug-use. Intolerance on the other hand simply fosters a criminal and ethical free-for-all that relinquishes social control over who uses what, where, how, at what age and with whom.


Professor Richard Hammersley, Director, Centre for Behavioural Aspects of Health and Disease, Glasgow Caledonian University; David Shewan and Roger Houchin, Co-directors, Glasgow Centre for the Study of Violence, Glasgow Caledonian University; Professor Lawrie Elliott, Centre for Integrated Healthcare Research, Napier University, Edinburgh; Professor Avril Taylor, Director, Institute for Applied Social and Health Care Research, University of Paisley; Niall Coggans, Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow; Phil Dalgarno, Centre for Behavioural Aspects of Health and Disease, Glasgow Caledonian University.