Ideas: The war on drugs

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WHAT do you call a war that lasts a hundred years, costs trillions of dollars but leaves you miles away from attaining your objective? By most conventional measures, a failure. This is the unfortunate truth of the gung-ho, clamp-down approach in the war against drugs that was personified by the United Nations’ General Assembly Special Session in the World Drug Problem slogan: “A drug-free world — we can do it!”.

Governments are gradually realising that living in a completely drug-free world is unrealistic. Globally, policies tend to focus on end manifestations of the misuse of drugs, rather than the root causes of addiction. The most common approaches include criminalising and incarcerating users, alongside a total ban on sales and distribution.

Unfortunately, this approach is not without its costs. One only has to look at the horrific headlines coming out of Mexico or the manner in which the American prison system is creaking at the seams to appreciate the complexity of the issue. It is arguably far more pertinent to look at measures which we can take to help users who have fallen through the cracks — those who become addicts. If we can reduce the demand, then the supply will tail off.

 

Addiction

It is important to appreciate the fact that not all drug users become addicts. Ninety per cent of drug use, according to the UN Office on Drugs and Crime, is non-problematic. Why is the situation different for the other 10%?

Bruce Alexander, in his book The Globalisation of Addiction, noted that although 20% of American soldiers in the Vietnam War were using heroin, 95% stopped when they went home without the need for rehabilitation or treatment.

This fits with the theory that addiction is not 100% physiological, but is tethered to one’s environment and ability to cope in stressful situations. Social isolation and poverty (even relative poverty) are strong drivers for drug misuse. It is unsurprising that the majority of addicts in Malaysia work as labourers and unfortunate that more than two-thirds are Malays. Why are these communities more likely to be driven to addiction?

 

Policy

It has been said that the single most important policy-related insight in economics is that changes in policies lead to behavioural responses. To quote from Superfreakonomics (by Steven Levitt and Stephen Dubner), “People aren’t ‘good’ or ‘bad.’ People are people, and they respond to incentives. They can nearly always be manipulated — for good or ill — if only you find the right levers.”

When crafting policy, it is important that one has realistic and attainable goals, especially in this age of austerity. It is just as important to identify policies that have failed and take measures to rectify them.

Portugal is an interesting and unique case study in the matter of drug policy. At the turn of the century, 1% of its population was addicted to heroin. A non-partisan panel was set up which concluded that drug addiction should be decriminalised and that funds should be diverted to helping addicts reintegrate into society. This included measures such as paying part of their wages to overcome employers’ stigma. Ultimately, the objective was to help addicts identify a reason to live healthily, to give them a purpose in life.

 The latest analysis of drug use in Portugal has shown significant improvements. From a public health perspective, there are far fewer HIV infections and deaths attributable to drugs. Drug misuse has actually decreased, in direct contrast to earlier fears of the policy having the opposite effect.

 

Harm reduction

Government policies, irrespective of context, may be cloaked with ideology but should be driven by data. It is reassuring to note that our Ministry of Health offers needle exchange programmes and methadone maintenance therapy, a recognition of the need for harm reduction as a strategy.

Malaysia is also fortunate to host the 2015 International Harm Reduction Conference from Oct 18 to 21.  The conference, organised in partnership with the Malaysian AIDS Council, provides a platform for the exchange of ideas and experiences and will no doubt lead to robust discussions on global policy matters.

Addressing the psychological and economic needs of drug addicts instead of punitively treating them as lifelong criminals is a more difficult approach, but the rewards are greater too. As Professor Adeeba Kamarulzaman of Universiti Malaya’s Centre of Excellence for Research in AIDS pointed out in a paper published in the International Journal of Drug Policy, “when viewed through the Islamic principles of the preservation and protection of the faith, life, intellect, progeny and wealth, harm reduction programmes are permissible and in fact provide a practical solution to a problem that could result in far greater damage to the society at large if left unaddressed”.

 It is likely that drug addiction will rise as we navigate the choppy waters of economic stagnation. However, it is in our own interests to support and destigmatise addicts by ensuring that they have access to appropriate care.

Desperate men resort to desperate measures, and only an approach based on compassion and understanding will coax them back to being functioning members of society.


Dr Helmy Haja Mydin is an associate professor at Universiti Malaya and a founding associate of the Institute for Democracy and Economic Affairs (IDEAS)

This article first appeared in Opinion, digitaledge Weekly, on September 14 - 20, 2015.