Stop Treating Drug Users As Criminals

The U.S.-style law-and-order drug policies that the Conservative cabinet appears poised to embrace are doomed to fail in this country, as they have everywhere. What’s worse, they make impossible the rational and humane treatment of hard-core drug addiction.

It is not feasible to rehabilitate large numbers of substance-dependent people in the context of the so-called war on drugs. “The federal government continues to invest heavily in policies and practices that have been repeatedly shown in the scientific literature to be ineffective or harmful,” says a new study by physicians and researchers at the B.C. Centre for Excellence in HIV/AIDS.

As a doctor serving a heavily addicted population in Vancouver’s Downtown Eastside, I witness that harm every day. My last patient the same morning this new study was reported was Priscilla, a 32-year-old woman who came panting into my office with a high fever and a strangulating cough. Her pneumonia began several days ago when she woke after one of Vancouver’s heavy windstorms to find that the windows of her dilapidated hotel room had been shattered during the night and that the water in her sink was frozen solid.

Priscilla is one of the enemy in the war on drugs. She sells cocaine to support her own habit, a dependence from which no calamity has been able to shake her loose: not the loss of her child, not HIV, not multiple illnesses, not brutal beatings at the hands of male “clients.” She became one of the enemy at 15 when, after many years of sexual abuse by her grandfather and uncle, her mother injected her with heroin and sold her into prostitution.

Children who endure trauma often grow up to have insufficient supplies of certain essential “reward” chemicals in the brain, such as endorphins and dopamine — the very chemicals that drugs of abuse either supplant or enhance. The core assumption of the war on drugs that addicts freely “choose” their habits and could “just say no” is a cruel mockery of the reality of Priscilla’s existence, as is the belief that imposing negative consequences on traumatized people will somehow force them to give up their addiction. If that were the case, Priscilla would have recovered long ago. Chronic drug use further impairs the addict’s capacity for rational decision-making.

The scientific literature makes clear that emotional stress is the most consistent trigger for addictive behaviours. How does that affect people such as Priscilla? A study published in The Journal of the American Medical Association concluded that “a history of childhood abuse per se is related to increased [nervous and hormonal] stress reactivity, which is further enhanced when additional trauma is experienced in adulthood.” The point is that the addict is retraumatized over and over again by ostracism, harassment, dire poverty, disease, the frantic hunt for a source of the substance of dependence, the violence of the underground drug world and harsh chastisement at the hands of the law — all consequences of the war on drugs.

This war has failed to curtail drug use, trafficking or the spread of addiction. It only enriches international drug cartels and funds the futile activities of legions of law- enforcement agencies. Its targets are most commonly impoverished Third World peasants or small-scale traffickers and users such as Priscilla. The war is doomed to fail because neither the methods of war nor the war metaphor itself are appropriate to a complex social problem that calls for compassion, self-searching insight, and factually researched scientific understanding.

If we want to support people’s potential for healthy transformation, we must cease to impose debilitating stress on their already burdened existence. Proper nutrition, shelter, the controlled provision of their substances of dependence, counselling, and compassionate caring are what most addicts need if we are to help wean them from their debilitating habits.

“Drug addiction has to be devilified,” child psychiatrist and brain researcher Bruce Perry has said. “If we create environments that are safe and predictable and relationally enriched, then all of the other factors involved in substance abuse and dependence will be so much easier to dissolve away. Our challenge is to figure out how to create these environments.”

The possibilities would be truly inspiring if we were to channel the energies and multiple billions now squandered on the war on drugs into building an evidence-based and humane rehabilitation and treatment system.

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