Thursday, 28 August 2014

Licences for heroin?

Two (not particularly recent) articles by Keith Humphreys, former White House drug policy advisor, caught my eye last week.  I’ll be blogging about them separately, as they’re not particularly related.

First, as I’ve been thinking about drug policy over the last week or two, I was interested in the idea that heroin overdoses – or those relating to opioids more generally – aren’t actually to do with the relative purity of street heroin.  This is one of the key planks of legalisation campaigns: users will be safer when they know what they’re consuming.  I’d say this argument still holds, given the discussion of deaths related to ‘legal highs’ in my previous post, particularly the idea that PMA might be implicated in many of these, and few people are deliberately choosing to consume this drug.

However, this raises questions for my current view on drug policy, which suggests that, at least in an ideal world, we’d have something not too dissimilar from the legal but highly regulated market advocated by Transform.  Since I started working for a DAAT, I’ve felt (possibly unreasonably) that sometimes while the arts might sometimes have been condemned for celebrating drug use, academics have sometimes abstracted it such that the associated problems seem to disappear.

Those from Transform would probably argue that most of the problems associated with drug use are the result of the criminalisation of possession and supply, and I’d largely agree, but I have a separate fear.

I fear that if drug other than alcohol, tobacco and so forth were legal, I’d be more inclined and able to use them than I am now.  That might not be a bad thing – if I substituted cannabis and ecstasy for alcohol, or a low dose of amphetamine for coffee.

I’ve been wrestling with the idea of overdose, though, which would be highly unlikely in any of these cases.  You could respond by pointing out that alcohol is legal and yet plenty of people ‘overdose’, but that’s not a justification for opening up the door for another drug to do the same.

A certain liberal mentality wouldn’t have a problem with this: if the overdose risk comes from taking too much or mixing with other drugs, and everything’s clearly explained and labelled, it’s simply a poor decision by that individual.

However, the Darke and Farrell paper cited by Keith Humphreys suggests that quite a lot of us are that poor at making decisions regarding opioids (possibly because we get addicted to them, which – for my money and Mick Bloomfield’s – amounts to more than simply an ingrained bad habit).  Addiction, if it means anything, means someone isn’t great at decision-making, particularly when that specific substance is involved.

This is the old debate about liberalism and drugs, brilliantly covered by James Nicholls in relation to alcohol here and here (and which I’m going to post about soon again).  I won’t do full justice to those issues here, but suffice to say I think that in principle there’s no reason the government shouldn’t intervene in this sort of situation, and regulate or ban certain substances.

Maybe the answer, though, isn’t as complicated as it seems.  As some harm reduction advocates never tire of pointing out, there’s never been an overdose death in a supervised consumption room.  We sometimes forget the different ways alcohol is regulated (for consumption on and off the premises), and that these could be tweaked and applied to drugs.  Most advocates for legalisation tend not to forget this.)  And the regulation of all drugs wouldn’t have to be identical – we currently regulate caffeine, alcohol and tobacco very differently from each other.

So perhaps the solution is relatively simple: for drugs where there is a notable risk of overdose, consumption would have to be on-premises, but for other substances, off-licences could be developed.

Of course the argument could be made that illicit opioids would continue to flourish, because people would want the hit without the medical setting – but then again logic suggests licence design could be based simply on the safety of the facility, not levels of comfort and welcome.  Think of CCB or ‘improved’ pubs, which were designed to be respectable and comfortable in order to engender a certain culture in relation to alcohol consumption.

The problem is that such an approach does feel like it would encourage opiate use, which I’m just not entirely comfortable with.  The approach of these sort of schemes is that the state sanctions consumption, but with a certain level of austerity, or restraint.  Although I am strangely attracted by such schemes, I’m not convinced they’re effective or sensible – particularly in relation to certain drugs.

And this ‘feeling’ is actually important.  As Virginia Berridge points out, whether we like it or not, we start from a particular cultural and historical setting that affects how different drug policies are viewed – and in fact how they would be responded to – not only by politicians and the media, but (potential) drug users, who are not acultural rational automatons.


It turns out, then, that one quick blog post can’t resolve this complicated issue.  Never mind, there’s always the new guide by Transform to read.  Maybe that’ll give me a few more ideas.

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