Wednesday, 15 February 2017

Ideology or technocracy in drug policy reform in 2017

Last week Volte Face published a report called ‘Black Sheep’ written by Lizzie McCulloch that aimed to highlight how substance misuse treatment services could better serve cannabis users who need support.  The conclusions could be thought of as having two elements: first, that the whole issue would be easier if cannabis wasn’t illegal, but rather formally regulated; second, that even if we keep the current legal status, our services could do better.

They brought together a panel of experts, including Lizzie, to discuss this.  Paul Hayes, former head of the NTA and now with Collective Voice, was there, as was Chris Ford, who I’ve followed through her regular DDN column, and Zaki Solosho, who’s previously run into problems with his own use of cannabis (and tobacco).  The discussion was chaired by award-winning scientist and journalist Suzi Gage.  And then they asked me to be there.  I’m not sure why, but I’m not one to turn down an invitation, so I went along.

For a clear write-up of the report and the discussion, check out this piece by Rosalind Stone.  As usual, I’m going to take a slightly different tack in my reflections; if you want to know what the report itself says, it’s not too long and it’s well-written, so there’s no point me paraphrasing here.  Read it!

The debate on Twitter beforehand and the event itself were eye-openers for me.  As Paul Hayes joked, some people really do seem to think cannabis is the only substance known to humanity that has no possible ill effects.  Of course, one of the reasons that VolteFace is interested in this issue is that it has a political mission.  It’s trying to affect the terms of the public debate about drug policy, and add a bit of nuance to the general starting point of ‘drugs are dangerous and therefore should be illegal’.

Of course, some people’s political calculation is that the best way to do this is to challenge it head-on and say that issues related to cannabis are ‘largely mythical’.  But other campaigners acknowledge there are harms related to cannabis, and then to suggest that the current policy approach actually makes these worse.  By taking the second approach, campaigners can’t be hit (so easily) with the accusation that they don’t care about risk or harm, and the argument potentially becomes less moral (heard as ‘drugs aren’t bad’) and more technocratic (how do we minimise harm).

This is a reasonable tactic, and can be seen as underpinning the introduction of needle exchanges in the 1980s and the expansion of drug treatment in the 2000s, but I wonder how powerful it is in today’s political climate.

Without wishing to turn this into yet another ill-informed blog post about Brexit and Trump, I do have some concerns about trying to mobilise public opinion by suggesting drug policy reform as a technocratic solution (even if it’s one that could save lives).  And as Paul Hayes’ response suggests, it’s not even one that the technocrats will all get solidly behind.

I’ve written before about alcohol policy, and how frustrating I find it when people criticise the methodology and findings of research, when their actual concerns are about the political philosophy of a policy.  That is, people attack the research behind drinking guidelines rather than simply sticking to the fundamental principle that people should be free to drink how they choose.

And I’ve been thinking about whether the same point applies to drug policy debates.  Campaigners could acknowledge, yes, that (for example) opiates in themselves aren’t terribly bad for people physiologically, and the harms of addiction are probably heightened by the way in which we regulate them – but then make the broader, more fundamental point that drug policy is really a question of liberty.

The idea of a ‘rational’, ‘technocratic’ drug policy is a chimera.  The harm of drugs isn’t inherent in the substance, and it isn’t inherent in drug policy either.  The harm is a result of a myriad of factors, including genetics and the wider social context.  Just look at how people drink differently in different societies – and for all that talk of safe continental drinking cultures, for most of the 20th century the French might have been restrained while drinking, but their liver disease rates certainly weren’t.



I started this blog as an attempt to comment on how policy debates could be more open and honest, having experienced odd distortions in the two fields I’ve worked in: substance misuse and higher education.  But which is more honest: an appeal to people’s emotions and principles in an age of post-truth politics, by saying drug policy is about liberty, or an appeal to rationality by claiming that legalisation – sorry, regulation – is a harm reduction initiative that we should implement regardless of our views on the morality of intoxication?

And actually, which is more realistic?  For all that this is supposedly an age of ‘alternative facts’ and emotional politics, where it’s no longer about ‘the economy, stupid’, the path to legalisation in the USA has been one of incremental, technocratic change – which then resulted in popular support because the terms of the debate had been changed.

And here’s where Paul Hayes and VolteFace have something in common: they’re both realists.  I’ve written before about my discomfort with the ‘bargain’ Paul (and others) made with policymakers and government, gaining funding for drug treatment by branding users as dangerous.  This was, in a way, disingenuous: the reason most of us are involved in this ‘sector’ is (and I don’t think this is overly idealistic) because of a wish to help people and make the world a better place; not because we think drug users need to be controlled.  And I’d say that slightly disingenuous bargain is exactly what VolteFace is trying to do with Black Sheep: making all the reasonable and technocratic arguments to change the terms of the debate, and steering clear from an unproductive discussion about the rights and wrongs of altering one’s mental state.

But then they part company.  Paul’s scepticism and realism informs his views on legalisation: he’s worried big business would take control (if not immediately), and harms would increase, as with tobacco, alcohol or gambling.  His is a full commitment to pragmatism.  The VolteFace view is more interesting: they’re taking a realpolitik approach to achieve an idealistic change.

I’m not sure which I prefer, though there is something easier about Paul Hayes’ consistency.  But equally, my ambivalence is probably fitting, given how frustrated I was at the launch event that there were two ‘sides’ of this debate (as in alcohol policy) and the atmosphere seemed to encourage people to choose one or the other, rather than acknowledging that under whatever regime, as long as humans are involved (not to mention cannabis), the situation will be imperfect.


Perhaps I can just remain an interested observer.

2 comments:

  1. A thoughtful piece Will but I maintain that the evidence fully supports my view that harms requiring substance misuse treatment related to cannabis are "largely mythical". That doesn't mean they are non-existent and there is a very small number of people who are badly affected.

    Sadly my experience of all those trying to offer drug therapy for cannabis is that they are talking up the problem in their own self-interest. I can think of one particular loon who also advertises treatment for chocolate addiction alongside her cannabis services.

    Cannabis dependency is a real but largely trivial condition. It arises in 9% of regular users, a slightly lower prevalence than caffeine addiction amongst regular coffee drinkers. The withdrawal symptoms are also similar: insomnia, lack of appetite and irritability, easily overcome within a week or so.

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    1. I largely agree, Peter, if we're talking about specifically 'dependence'. But treatment services aren't really about that; detox is a minor element of what they need to deliver, and certainly doesn't guarantee recovery. (My VolteFace article talks about this a bit more, as I remember.) I take your point about it being talked up; I'm not sure cannabis treatment can or should be a significant priority for substance misuse treatment. That's why I use the word 'disingenuous' in the piece. But it's interesting as a way into discussing support for people who have substance misuse or wider 'problems of living' as Nick Heather has put it.

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