At Health Beat, Maggie Mahar and Niko Karvounis discuss how a science-based view of the use of illegal substances could lead to more enlightened methods of dealing with related individual and social problems than that currently used in the US and increasingly, Canada: criminalization of those who buy, possess and use them:
… rather than engaging in yet another political argument about personal responsibility vs. society’s responsibility to help its poorest citizens, it might be helpful to take a look at what medical science has been learning about drug addiction over the past few decades.
Addiction Treatment: Science and Policy for the Twenty-first Century (Johns Hopkins U. Press, 2007) does just that, and in the process “highlights the amazing discord between scientific knowledge and public perception,” according to a review by Stanford University’s Dr. Alex Macario in the June 4th JAMA.
In this collection of short, incisive essays, the authors don’t always agree on specifics, but they do reach a consensus of sorts: the scientific community needs to educate the public about drug addiction—and our approach to treatment should be based on medical evidence rather than personal ideology.
Today, medical technology allows scientists to observe first-hand what happens inside the brain when it is, in the words of William R. Miller, a psychiatrist at the University of New Mexico, “hijacked by drugs.” Thanks to brain imaging, for example, we know that regular drug use disrupts the frontal cortex, which regulates cognitive activities like decision-making, planning, and memory. In other words, drugs affect an individual’s capacity to make the choices that the Reaganites insist addicts “should” be able to make (Just Say No!). Undoubtedly the drug user could have said “no” the very first time he let desire over-ride good judgment. But after that, Miller notes, “neuroadaptation involves biological changes in response to drug use that increase the likelihood of repetition and escalation, undermining the person’s capacity for volitional control.” Recent studies have even shown that drug addiction changes our brains at the genetic level, influencing how our DNA is translated into enzymes and proteins.
As a result of this new information, experts are increasingly incorporating the recognition that addiction is, in part, a “brain disease” into their treatment recommendations. This perspective has even made headway in the halls of power. Last year Congress introduced the Recognizing Addiction as a Disease Act, which would institutionalize the disease model by changing into the name of the National Institute on Drug Abuse to the National Institute on Diseases of Addiction and change the name of the National Institute on Alcohol Abuse and Alcoholism to the National Institute on Alcohol Disorders and Health.
The text of the act embraces the disease model, noting that “the pejorative term ‘abuse’ used in connection with diseases of addiction has the adverse effect of increasing social stigma and personal shame, both of which are so often barriers to an individual’s decision to seek treatment.”
All extremely interesting and helpful. But since we are still arguing the merits of scientific theories of evolution versus faith-based adherence to the myth of creation by a divine deity, I’m afraid it may take too many hundred years to convince people that the possession and use of illegal drugs is a medical rather than moral problem. Much as it might be more interesting and less troublesome to escape to the world of science, it’s just not a good idea to try to de-politicize a highly political problem. I’m not denigrating the science. It’s important. It provides informative ammunition. It just won’t ever be a sufficient replacement for organized action on political grounds. The brain medicine that leads to good rehab practices is only available to rich people or those with good private health insurance anyway. Even in Canada. Yes it is!
Recently, certain Canadian laws with respect to drug possession and trafficking were struck down as unconstitutional by the B.C. Supreme Court. InSite is a safe-injection site in Vancouver’s downtown east side. It’s been in operation since 2003 under an exemption from the drug laws, granted by the Federal government of Liberal P.M. Paul Martin. The exemption was due to expire on June 30th of this year and it was pretty clear that Health Minister Tony Clement wasn’t going to extend it, so Insite, along with several habitual drug users, challenged the drug prohibition laws in the courts.
In May, Justice Ian Pitfield found that sections of Canada’s drug laws are inconsistent with section 7 of the Charter of Rights and Freedoms:
Pitfield says in his ruling that denying access to the site ignores the illness of addiction.
“While there is nothing to be said in favour of the injection of controlled substances that leads to addiction, there is much to be said against denying addicts health care services that will ameliorate the effects of their condition,” he wrote.
“I cannot agree with the submission that an addict must feed his addiction in an unsafe environment when a safe environment that may lead to rehabilitation is the alternative.”
Sometimes, logic does creep in to judicial decision making.
Pitfield’s decision gives the Feds till June 20, 2009 to bring the law into accord with constitutional principles of fundamental justice. Neil Boyd, a criminologist at Simon Fraser University, points out that the decision is in line with the trend toward understanding the use of addictive drugs as a health problem rather than a problem for criminal law. However, he pointed out on the day of the decision that it wasn’t likely the end of the story, as several levels of appeal were and are still available to the Feds.
Sure enough, a day later, our illustrious Health Minister indicated Ottawa’s intention to appeal Pitfield’s decision. Of course.
“We have been offering drug maintenance rather than drug treatment,” said Clement. “We have been sending a message [to addicts] that says we have given up on them, and that we do not expect them to recover.”
Clement said that Insite only saves about one life per year, and that up to 97 percent of injections occur outside of Insite. But he refused to answer whether or not the research he was presenting had been peer-reviewed.
Thomas Kerr, a research scientist at the British Columbia Centre for Excellence in HIV/AIDS, and the chief researcher for Insite, has actually conducted a series of peer-reviewed studies on supervised injection sites.
In his studies, Kerr concluded that Insite does in fact lead to a reduction of syringe sharing and the number of overdoses resulting in deaths.
“How many peer-reviewed papers does the government need before they believe us?” said Donald MacPherson, the City of Vancouver’s drug policy coordinator.
“The only negative result we’ve found from these safe injections sites is that there aren’t enough of them to really make a big impact.”
Clement argued that a decision about harm reduction should be based on public policy, and referred to the scientific evidence around the facility as “mixed.”
He said that he instead wanted to focus government spending on treatment and prevention programs, as well as increasing the number of beds available to sex workers in Vancouver’s downtown eastside.
“Injection drug users are not dying — there is still hope for them,” said Clement. “Even if they fail treatment the first time, we can help them to get up and try again.”
Many MPs were frustrated with the fact that Clement did not seem to understand the importance of harm reduction programs for drug addicts.
Few drug addicts will move to abstinence overnight, they argued. This is why harm reduction programs are essential in terms of getting those addicts in the door first, and then gradually moving them towards treatment.
“To have low threshold programs is a critical policy, and I don’t know why you don’t get that,” said NDP MP Libby Davies, voicing her frustration towards Clement.
“It must be because of an ideological reason that you can’t move on,” she said. “Practically everyone else on this committee is on board with [Insite] except for you.”
“You are the only barrier to Insite’s continuation.”
Since the best available information, and there’s plenty of it, tells us that putting people in prison doesn’t cure addiction and hasn’t put an end to the purchase and sale of banned drugs, what could the problem be? Is Stephen Harper just an incredible blockhead? Are the leaders of the free world in the US just as thick? We like to think so sometimes. I think not.
In order to understand these hyper-conservative strategies, we have to look at who is hurt by them, and who benefits.
The US has managed to imprison 65% of the male African American population of the country. I would venture to guess that these men also tend to reside in the lowest of socio-economic brackets, since middle-class and wealthy people are criminalized at a much lower rate. The numbers of female African Americans in prison, while smaller by 15% than males, is the fastest growing prison population.
In Canada, rates of incarceration are actually falling. Except among women, and Aboriginal peoples generally. Indigenous people represent
- 3% of the total canadian adult population – (2001 Census)
- 22% of admissions to provincial/territorial sentenced custody
- 17% of admissions to federal prisons
- 21% of male prisoner population
- 30% of female prisoner population
60% of all those incarcerated in Canada are on remand. This is a direct result of “law and order” agitation about criminals on the loose and a growing urge among judges, who have been much critisized, to err on the side of caution when dealing with accused (and assumed innocent) people awaiting trial. There is a high correlation between custodial remand and conviction. So, the more people imprisoned on remand, the more people convicted. Remand may not be a direct cause, but it would be disingenuous to say that it has no effect. Release on bail isn’t necessarily related to the seriousness of the offence. Rather, to the likelihood that the accused person can be depended upon to return to court for trial. Having a home, a job, a secure place in a community and mental wellness contribute to the view of an accused’s reliability. As does freedom from drug or alcohol abuse.
The rate of growth in Canada’s imprisonment rates will also be affected by mandatory sentences that have been introduced for certain criminal offences, another result of that “law and order” agenda. It is estimated that the sentenced population will increase by 1,000 prisoners per year as a direct result of mandatory sentencing.
Suicide rates in Canadian (and US) prisons are higher than in the general population. But most people who die in prison die of acute and chronic health problems. As in the US, many of the imprisoned suffer from a variety of mental illness, which makes them more likely to be held in segregation for long periods of time. Especially women. Which means, especially Aboriginal women. African American women. See? We care.
Alchohol and substance abuse is very significantly related to crime in Aboriginal populations. The stats are similar for Aboriginal crime in the US. And for African Americans. Do we know how much white collar crime is committed because of the cocaine or alcohol addled brains of managers and CEOs? You tell me. Does a love of single malt scotch contribute to tax evasion? Does anyone care?
But we have a very hefty investment in the prison industry which, in America, has become the prison industrial complex. We’re headed in the direction of privatization in prison “services” in Canada too. Once we get that kind of investment in putting people in prison and keeping them there, it’s hard to take it away. There’s a real commitment to keeping it going and growing. There are jobs involved in an economy that is turning into a “service” economy. There are corporate profits involved. Stockholders – pensioners and everyday Jill and Joe investors. Sometimes, the whole economy of rural areas and small towns is dependent on the prison economy.
Stacked against the economic arguments, conveniently buttressed by smug assumptions about the reasons for drug dependence, is the idea that we need to commit society, through our politicians, to solving problems related to the history of slavery, Jim Crow, systemic racism and economic inequality in the US; colonialism, genocide and the destruction of Aboriginal culture and custom in Canada. It will take a concerted, organized, political effort to convince men like Harper and yes, even Obama, to embark upon that course. Because the problems are long-standing, endemic and complex. Collective acknowledgement of root causes and a profound commitment to equality is required; the collective will to begin a journey towards rehabilitation – the rehabilition of us all - and justice is required.
Brain science can give us many things. But it can’t give us that.
