Pubdate: Wed, 27 Jun 2012
Source: Ottawa Citizen (CN ON)
Copyright: 2012 The Ottawa Citizen
Author: Dan Gardner


Injecting Drugs Is Unpleasant and Dangerous, but Drug Prohibition 
Makes It Worthwhile for Addicts, Writes Dan Gardner.

The United Nations and national governments the world over, including 
Canada's, are actively promoting an epidemic. They are infecting 
people by the tens and hundreds of thousands. God knows how many will die.

A report released this week by the Global Commission on Drug Policy 
isn't quite that blunt, but it comes close. "The global war on drugs 
is driving the HIV/AIDS pandemic among people use who drugs and their 
sexual partners," it concludes. "Throughout the world, research has 
consistently shown that repressive drug law enforcement practices 
force drug users away from public health services and into hidden 
environments where HIV risk becomes markedly elevated. Mass 
incarceration of non-violent drug offenders also plays a major role 
in increasing HIV risk. ... The war on drugs has also led to a policy 
distortion whereby evidence-based addiction treatment and public 
health measures have been downplayed or ignored."

Among most drug policy researchers and public health officials, that 
paragraph is no more controversial than saying smoking causes lung 
cancer. But the members of the Global Commission include former 
presidents of Brazil, Mexico and Colombia. And George Schultz, the 
U.S. secretary of state in the Reagan administration. And Paul 
Volcker, the near-legendary former chairman of the U.S. Federal 
Reserve. And Canada's Louise Arbour, a former Supreme Court justice 
and former UN High Commissioner for Human Rights. It's extraordinary 
to have people of that background and stature agreeing in public 
that, as the report put it, "the war on drugs has failed and millions 
of new HIV infections and AIDS deaths can be averted if action is taken now."

But, as excellent as the report is, it omits a critical piece of the puzzle.

Why do users take drugs by intravenous injection?

After all, drugs can be swallowed, inhaled or smoked. Each of these 
methods is inherently more pleasant than sliding a sliver of cold 
steel into a vein. What's more, each of these methods is less likely 
to result in overdose. Each is less likely to result in abscesses or 
bacterial infections of the heart. And each involves little or no 
risk of transmitting blood-borne diseases like hepatitis and HIV.

So why do people use the most unpleasant and dangerous method?

If you look around today, you would say it's just part of the illicit 
drug culture. If you hook up with someone who injects, that's how you 
learn to take drugs, and, in time, you become habituated to it. Users 
may even come to feel affection for the little rituals involved in 
preparing the needle. So that's why they do it.

But that answer simply pushes the question back a little further: 
When and why did the most unpleasant and dangerous method of taking 
drugs become widespread?

In the 19th century, currently illicit drugs were legal. Sometimes 
people mixed them with alcohol or tea and drank them. Sometimes they 
smoked them. And occasionally they injected drugs, especially 
morphine, a more-potent derivative of opium.

But drugs weren't injected into the veins. Instead, following the 
medical practice of the day, these were subcutaneous (below the skin) 
injections. "No one seems to have injected morphine intravenously 
until the 20th century," writes historian Richard Davenport-Hines in 
The Pursuit of Oblivion: A Global History of Narcotics.

We know roughly where and when it started. It was 1925. In Terre 
Haute, Indiana. That's the earliest known account of intravenous drug 
use. From there, the habit spread like a virus. In 1935, almost half 
the addicts admitted to an American drug treatment hospital were 
doing it. By the early 1950s, injection had become so routine that 
when a heroin panic swept North America - immortalized by Frank 
Sinatra in The Man With The Golden Arm - the needle symbolized the threat.

So what caused this dramatic change in users' behaviour? Drugs were 

Banning drugs didn't wipe them out. It merely shifted their sale to 
the black market. That had two immediate effects.

First, the available drugs tended to come in more potent forms for 
the simple reason that smuggling a highly potent drug is easier than 
smuggling the same drug in less potent form. Imagine having to choose 
between smuggling a case of vodka or several kegs of beer and you get 
the idea. As a result, opium was increasingly replaced by morphine 
and its even more potent chemical cousin, heroin.

The other thing the switch to the black market did was raise the 
price by as much as 10 times or more. Inevitably, users became very 
concerned about the efficiency of the method by which they took the 
drug: They had to get the "the most bang for the buck." So forget 
eating or drinking the drug. That's the most inefficient method. 
Smoking is better. So is inhaling.

But the most efficient method of all, by far, is intravenous injection.

Out went opium smoking and the other, safer 19th-century methods of 
drug consumption. In came heroin injection.

Something like this pattern can be seen whenever drugs were banned.

Opium had been smoked in Thailand for centuries. But in 1959, at the 
insistence of the United States, the Thai government banned it. 
Heroin injection appeared and spread almost immediately, so, when 
AIDS arrived in the 1980s, it raced from one needle to another, 
producing one-third of new infections.

Now I have to confess that I've plagiarized myself here. I wrote 
almost everything in this column a decade ago. But that underscores 
the point, doesn't it?

All of this has been known for years. Even decades. The science 
writer Edward Brecher laid out much of it in 1972.

But entire generations of politicians have simply refused to examine 
the evidence and reconsider their policies. Even on something as 
relatively simple as the efficacy of Insite, the Vancouver injection 
site, Stephen Harper, Dalton McGuinty, Jim Watson and a long list of 
other politicians have steadfastly refused to take a serious look the 
evidence and talk about it. It's hard to imagine any of them having 
the intellectual honesty and political courage to call for a royal 
commission into the whole bloody mess.

But who knows? Sometimes, even when it's least expected, change 
happens. Maybe the Global Commission on Drug Policy is a straw in the wind.

I sure hope so. Nothing would be more depressing than writing this 
column again a decade from now.
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