Pubdate: Sat, 13 Jun 2009
Source: Guardian, The (UK)
Column: Bad Science
Page: 8
Copyright: 2009 Guardian News and Media Limited
Contact:  http://www.guardian.co.uk/guardian/
Details: http://www.mapinc.org/media/175
Author: Ben Goldacre, The Guardian
Referenced: The WHO report http://www.tdpf.org.uk/WHOleaked.pdf
Bookmark: http://www.mapinc.org/coke.htm (Cocaine)
Bookmark: http://www.mapinc.org/find?207 (Cannabis - United Kingdom)
Bookmark: http://www.mapinc.org/hr.htm (Harm Reduction)
Bookmark: http://www.mapinc.org/corrupt.htm (Corruption - United States)

COCAINE STUDY THAT GOT UP THE NOSE OF THE US

In areas of moral and political conflict people will always behave 
badly with evidence, so the war on drugs is a consistent source of 
entertainment. We have already seen how cannabis being "25 times 
stronger" was a fantasy, how drugs--related deaths were quietly 
dropped from the measures for drugs policy, and how a trivial pile of 
poppies was presented by the government as a serious dent in the 
Taliban's heroin revenue.

The Commons home affairs select committee is looking at the best way 
to deal with cocaine. You may wonder why they're bothering. When the 
Advisory Council for the Misuse of Drugs looked at the evidence on 
the reclassification of cannabis it was ignored. When Professor David 
Nutt, the new head of the advisory council, wrote a scientific paper 
on the relatively modest risks of MDMA (the active ingredient in the 
club drug ecstasy) he was attacked by the home secretary, Jacqui Smith .

In the case of cocaine there is an even more striking precedent for 
evidence being ignored: the World Health Organisation (WHO) conducted 
what is probably the largest ever study of global use. In March 1995 
they released a briefing kit which summarised their conclusions, with 
some tantalising bullet points.

"Health problems from the use of legal substances, particularly 
alcohol and tobacco, are greater than health problems from cocaine 
use," they said. "Cocaine-related problems are widely perceived to be 
more common and more severe for intensive, high-dosage users and very 
rare and much less severe for occasional, low-dosage users."

The full report - which has never been published - was extremely 
critical of most US policies. It suggested that supply reduction and 
law enforcement strategies have failed, and that options such as 
decriminalisation might be explored, flagging up such programmes in 
Australia, Bolivia, Canada and Colombia. "Approaches which 
over-emphasise punitive drug control measures may actually contribute 
to the development of heath-related problems," it said, before 
committing heresy by recommending research into the adverse 
consequences of prohibition, and discussing "harm reduction" strategies.

"An increase in the adoption of responses such as education, 
treatment and rehabilitation programmes," it said, "is a desirable 
counterbalance to the over-reliance on law enforcement."

It singled out anti-drug adverts based on fear. "Most programmes do 
not prevent myths, but perpetuate stereotypes and misinform the general public.

"Such programmes rely on sensationalised, exaggerated statements 
about cocaine which misinform about patterns of use, stigmatise 
users, and destroy the educator's credibility."

It also dared to challenge the prevailing policy view that all drug 
use is harmful misuse. "An enormous variety was found in the types of 
people who use cocaine, the amount of drug used, the frequency of 
use, the duration and intensity of use, the reasons for using and any 
associated problems."

Experimental and occasional use were by far the most common types of 
use, it said, and compulsive or dysfunctional use, though worthy of 
close attention, were much less common.

It then descended into outright heresy. "Occasional cocaine use does 
not typically lead to severe or even minor physical or social 
problems ... a minority of people ... use casually for a short or 
long period, and suffer little or no negative consequences."

And finally: "Use of coca leaves appears to have no negative health 
effects and has positive, therapeutic, sacred and social functions 
for indigenous Andean populations."

At the point where mild cocaine use was described in positive tones 
the Americans presumably blew some kind of outrage fuse. This report 
was never published because the US representative to the WHO 
threatened to withdraw US funding for all its research projects and 
interventions unless the organisation "dissociated itself from the 
study" and cancelled publication. According to the WHO this document 
does not exist, (although you can read a leaked copy at 
www.tdpf.org.uk/WHOleaked.pdf ).

Drugs show the classic problem for evidence-based social policy. It 
may well be that prohibition, and distribution of drugs by criminals, 
gives worse results for the outcomes we think are important, such as 
harm to the user and to communities through crime. But equally, we 
may tolerate these outcomes, because we decide it is more important 
that we declare ourselves to disapprove of drug use. It's okay to do 
that. You can have policies that go against your stated outcomes, for 
moral or political reasons: but that doesn't mean you can hide the evidence. 
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MAP posted-by: Richard Lake