Pubdate: Wed, 13 Jul 2005
Source: New York Times (NY)
Copyright: 2005 The New York Times Company
Author: Maia Szalavitz
Bookmark: (Heroin)
Bookmark: (Chronic Pain)

Let a Thousand Licensed Poppies Bloom

EVEN as Afghanistan's immense opium harvest feeds lawlessness and 
instability, finances terrorism and fuels heroin addiction, the developing 
world is experiencing a severe shortage of opium-derived pain medications, 
according to the World Health Organization. Developing countries are home 
to 80 percent of the world's population, but they consume just 6 percent of 
the medical opioids. In those countries, most people with cancer, AIDS and 
other painful conditions live and die in agony.

The United States wants Afghanistan to destroy its potentially merciful 
crop, which has increased sevenfold since 2002 and now constitutes 60 
percent of the country's gross domestic product. But why not bolster the 
country's stability and end both the pain and the trafficking problems by 
licensing Afghanistan with the International Narcotics Control Board to 
sell its opium legally?

The Senlis Council, a European drug-policy research institution, has 
proposed this truly winning solution. Adopting it would improve the Afghan 
economy, deprive terrorists of income and keep heroin away from dealers and 
addicts, all while offering pain relief to the third world.

The United Nations estimated that Afghanistan produced more than 4,200 tons 
of opium last year; cultivation jumped to 323,701 acres from 197,680 acres 
in 2003. Ten percent of the Afghan population is believed to be involved in 
the trade, which supplies nearly 90 percent of the world's illegal heroin. 
Clearly, this drug war is not being won.

The global pain crisis is just as daunting. The World Health Organization 
has said that opioids are "absolutely necessary" for treating severe pain. 
But half the world's countries use them only rarely if at all even for the 
dying, and even though research shows that addiction is exceedingly 
uncommon among pain patients without a history of it.

Here in the United States, only half of all dying patients receive adequate 
relief, and those suffering from chronic non-cancer pain are even more 
likely to be undermedicated. Senlis estimates that meeting the global need 
for pain medications would require 10,000 tons of opium a year - more than 
twice Afghanistan's current production.

This shortfall is in part attributable to misguided regulation. 
Restrictions aimed at preventing diversion to the illegal market are so 
severe that in some countries, medical use of opioids is practically 
prohibited. Often, the rich retain access to expensive synthetic opioids 
like OxyContin, while those who cannot afford brand-name drugs receive no 
treatment at all. Generic morphine and codeine, made from Afghan opium, 
could help.

Because farmers aren't the ones who make the big bucks in the illegal drug 
trade, purchasing their poppies at competitive rates should be possible. 
But even if we paid exactly what the drug lords do, the entire crop would 
cost only about $600 million - less than the $780 million the United States 
planned to spend on eradication in Afghanistan this year.

Besides, eradication efforts have never eliminated a drug crop. Cocaine 
continues to be widely available, despite the roughly $3 billion that the 
United States has spent on coca eradication in Colombia over the last five 
years. And that is only the most recent example.

India's thriving generic drug industry suggests that there is plenty of 
money to be made in the marketing of generic pain relievers. But even if 
returns are modest, generating any profit at all is better than stamping 
out the major driver of an unstable country's economy. Legal products are 
also safer and easier to regulate than illegal drugs.

Of course, the Senlis plan does present serious logistical problems. 
Warlords would not relinquish profits without a fight, and their attempts 
to undermine the proposal could be formidable.

But think of it this way: what's an easier sell with farmers, hard cash now 
or pesticide spraying and potentially empty promises of economic 
assistance? Few Afghans begrudge farmers' efforts to feed their families - 
but many would turn against greedy planters who continued supplying drug 
lords despite adequate alternatives.

The real barriers here are political, not practical. The Afghan government 
initially appeared open to the proposal: its counternarcotics minister 
spoke at a Senlis meeting in Vienna in March. But another minister later 
dismissed the idea in front of foreign reporters and Hamid Karzai ducked 
the question in a March meeting with Secretary of State Condoleezza Rice.

The Bush administration has criticized Mr. Karzai's "leadership" on opium 
(despite his call for "jihad on drugs") but refuses to support measures 
beyond eradication. Responding to the Senlis proposal, one former State 
Department official who had been working on narcotics and law enforcement 
told The Christian Science Monitor: "Anything that went about legalizing an 
opiate in that market would send exactly the wrong message. It would 
suggest that there is something legitimate to growing."

But there is: countries like India are licensed by the International 
Narcotics Control Board to grow opium because modern medicine cannot find 
anything better than opioids to relieve pain. And think of the goodwill 
such a gesture could produce, a message that we literally want to assuage 
the world's suffering - not to mention that of the 30 million to 50 million 
Americans who endure chronic pain.

The Senlis Council is holding a conference in Kabul this September to 
secure support from drug policy expertsfor a feasibility study of its 
proposal. As Afghanistan seems to grow increasingly unstable by the day, 
let's hope that proposal receives the backing it deserves.

Maia Szalavitz is a senior fellow at Stats, a media watchdog group.
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MAP posted-by: Jay Bergstrom