Pubdate: Mon, 11 Apr 2016
Source: Globe and Mail (Canada)
Page: A5
Copyright: 2016 The Globe and Mail Company
Author: Andre Picard


The most dangerous consequences of narcotics largely stem from their 
criminalization, yet we continue to try to control supply

Canada is in the midst of a fentanyl crisis. Actually, fentanyl is 
just the latest drug to take centre stage in a seemingly never-ending 
string of crises featuring the "fill-in-theblank" drug du jour: 
opium, cocaine, heroin, crack, OxyContin, heroin again and now fentanyl.

What's next? The word on the street is that W-18, a drug 100 times 
more potent than fentanyl, is displacing it.

The names change but the carnage continues. And so it goes.

The real crisis is not any particular drug, but our failed public 
policy responses to drug use and abuse.

There always has been and always will be an appetite for the kind of 
escape and pain relief that drugs can provide, from alcohol through 
to W-18 and beyond. There has also long been a countervailing 
puritanical need to demonize pleasure and glorify suffering.

Sure, drugs have the potential for harm, chief among them addiction. 
But most people who use drugs - even fentanyl - tend to do so 
responsibly, or at least how they're told to use it.

The worst consequences of drugs, those that are decried by political 
leaders and in newspaper headlines every day - like drug wars, 
criminality, violence, overdoses, the spread of infectious disease - 
are largely the result of criminalization (and to a lesser extent, 
misinformation), not drug use per se.

They are self-inflicted wounds of prohibitionist policies.

Cracking down on supply has never worked. We've known that at least 
since the Opium Wars in the 19th century.

Yet we continue, futilely, to attempt to control supply, even as it 
gets ever easier to distribute drugs. You don't need a ship to move 
drug shipments any more. Fentanyl doses are measured in micrograms; 
with one gram of base product, you can produce 1,000 tablets.

No border is tight enough to control the movement of drugs in the 
modern world, and no amount of policing will prevent people who want 
to use drugs from using them. So our aim should be responsible use - 
aiming to maximize education and minimize harm.

When it comes to fentanyl, and other opioids that are garnering so 
much media attention these days, there are a number of harm-reduction 
measures that can be enacted.

There are also a couple of distinct issues that, while related, we 
need to be careful not to conflate.

Most users of opioids - up to and including fentanyl - are getting 
the drugs legally; they are being prescribed medication for the 
treatment of pain. The problem here is that the drugs are 
overprescribed, particularly to those with chronic pain. There were a 
whopping 19.1 million opioid prescriptions last year, making 
Canadians the world's biggest users of narcotic painkillers.

These prescriptions are, for the most part, well intentioned. The 
number of people living with chronic pain is staggering - about one 
in five in the general population, and as many as three in five seniors.

Yet the wait to be seen at a pain clinic can stretch for years, and 
the investment in physiotherapy and rehabilitation - alternatives to 
drugs - is paltry. So we drug people to a disturbing degree with 
often grim results: Some get hooked and some overdose. But the 
prescription fentanyl/opioids problem is solvable, relatively easily.

The issue of so-called recreational users of drugs is different. Many 
people, from all walks of life (we're not sure how many because 
tracking illicit drug use is difficult), take opioids like OxyContin, 
heroin and fentanyl because it gives them a good buzz. They are 
occasional users.

Then there is a small minority of opioid addicts, people we see 
living on the streets of our cities, big and small, and who populate 
jails because of their drug crimes. Addiction has many technical 
definitions, but it is characterized by the persistence of use 
despite negative consequences. Locking up addicts isn't going to "fix" them.

Criminalizing drug use, for addicts and occasional users alike, 
merely increases the risks. They buy drugs of unknown quality and, in 
dealing with criminals, put themselves at risk of physical and financial harm.

The main reason people die from opioid overdoses is that the dose 
they took was greater than they believed, the drug was cut with 
harmful byproducts and they were unable to get help.

Harm-reduction measures include needle exchanges to minimize the 
spread of infections such as HIV and hepatitis C, making the 
OD-reversing drug naloxone widely available, supervised injection 
sites like Insite and accessible drug-test kits (which allow users to 
figure out easily and quickly what they're actually consuming).

The War on Drugs folk think of these measures as aiding and abetting 
drug use and abuse. Public-health proponents are more pragmatic: They 
recognize that drug use is going to happen, so they focus on 
minimizing the broader harms.

"Insanity," Albert Einstein is credited with saying, "is doing the 
same thing over and over again and expecting different results."

For more than 150 years, we've been treating drug use, up to and 
including addiction, as a criminal matter rather than a public health 
issue. It's well past time to concede that prosecution and 
persecution are poor substitutes for appropriate health and social services. 
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MAP posted-by: Jo-D