Science has never supported prohibition. That is a policing concept that naturally produces artificial product scarcity and the necessary criminal delivery system. Technically, we can do the same thing for any difficult to supply consumer product. What is offensive is that science and medicine is coopted to go along.
At the same time, the
police enjoy a strong public constituency that is difficult to challenge
politically. It is a career ender or at least
it has been. The press worsens it all by
leaping at the chance to destroy such public careers.
Are the politicians
really this dumb? Hell no, they just
like their jobs. It is way easier to go
along than to try to change it.
In the meantime, the
reformers are radicalized but then aimed at the politicians were they do not
really bother anyone.
Drug reform requires a
major intervention.
1
Mandate a completely new protocol for
managing all drug abuse. This must
include tobacco and alcohol. This at
least divides the special interests and their constituencies and ensures almost
everyone has a stake in the outcome.
2
Mandate all abuse as a medical issue and
depending on risk and severity, various levels of medical supervision. This will range from a below the threshold usage
level to an actual withdrawal of personal freedom for an out of control addict
that poses real danger to himself and others.
It all stops been criminal.
An excellent example is
alcohol driven violence. Such a person
should be immediately ordered to attend a two week tree planting project in a completely
dry camp to meditate on his unacceptable behavior. It may not work but it will certainly get
trees planted and sooner or later the individual may actually decide he can
take better care of himself.
Better yet, quick
justice of this type teaches all his social circle that discipline is a good
thing and they all learn to manage the usage far better.
You will notice that I have
not mentioned any of the other drugs yet. The reason is that unless we tackle
drug abuse generally we will never solve it.
Solve it for the acceptable ones and simply legalizing the rest then
works by collapsing their markets with cheap product under managed distribution
usually requiring a prescription given out only to established addicts. The process becomes managed on the basis of
scientific harm and benefit but not through any form of black market.
Such a regime would
give grass an easier ride than alcohol for example but be strictly prohibited
for medical reasons to minors.
Gabor Maté: A letter to
Rona Ambrose, Canada’s "minister of disease"?
by GABOR MATÉ on OCT
23, 2013 at 11:15 AM
Health
Minister Rona Ambrose visited the University of Alberta to demonstrate an
interest in science, but her government rejects experts’ advice on drug
addiction.
AS
A MEMBER of the federal government, you are currently titled Canada’s
health minister. I question the accuracy of that nomenclature.
You
have recently taken it upon yourself to void a decision by Health Canada, the
public agency granted the task of supervising health practices in this country.
The decision authorized a few physicians in Vancouver to prescribe heroin to a
selected number of clients, patients who have failed other treatment attempts
to keep their addictive habits manageable. The doctors did not seek such
authorization because they wish to promote drug use but because clinical
practice and scientific evidence have shown that the provision of this opiate
is beneficial in some cases.
Your
reported comments were that there are already safe treatments for heroin
addiction, such as methadone, and that there is insufficient proof that heroin
is a safe treatment for drug addicts. I find your statements puzzling, at best.
There has been no sign that you or your government pay the least attention to
scientific data in formulating drug policies. It would be helpful if you were
to cite publicly which studies you have consulted, which ones support your
position, or how the many that do not may be lacking in scientific acumen,
method, or objectivity.
For
many years, I worked as a physician in Vancouver’s Downtown Eastside. I can
personally attest that some people simply fail methadone treatment. It does
very little for them. Their particular biochemistry does not respond to that
synthetic opiate. They still need to keep using heroin. It’s just how it is. I
trust you don’t like that. I don’t like it either. I wish it were otherwise,
but what you or I may wish is not the issue. The issue is reality.
Here
is how a University of British Columbia professor who worked on a study
published in the New England Journal of Medicine, probably the world’s
most prestigious medical publication, put it: “Heroin assistance treatment has
a very small, but very important, role in the addiction treatment system,” Dr.
Eugenia Oviedo-Joekes told a Globe and Mail reporter recently. “It is
not meant as a first-line treatment; it is meant to continue the care of people
we cannot reach with what is available.” According to European studies, those
people may be about 10 percent of the heroin-addicted clientele.
In
the absence of medically provided heroin in a safe environment, such
unfortunate individuals will continue to seek illegal sources of drugs,
potentially impure, and inject them under frequently unsafe circumstances. The
resulting illness, overdose, and deaths are surely not outcomes you would
desire.
The
documented benefits, according to Canadian and international studies, include:
•
less crime
•
better employment outcomes
•
improved physical and mental health, increased longevity
•
financial savings to the public purse
•
enhanced life satisfaction and social integration
Given
such findings, Minister, your opposition to this Health Canada permission,
which you have moved to block, has little to do with insufficient proof. More
to the point may be another statement of yours: “This decision is in direct
opposition to the government’s antidrug policy.”
There’s
the rub, that policy. In response to the tragedy of addiction, your government
has an antidrug stance. What you do not have is a pro-health strategy.
The
War on Drugs you and your cabinet mates favour has been proven, numerous times,
to be an unrelieved disaster: it kills people, promotes illness, rewards drug
trafficking on a massive international scale, ostracizes and marginalizes the
most hurt and vulnerable among our population, destroys families, and incurs
crippling financial costs. And it has utterly failed to curtail drug
trafficking and drug use. In recent decades the purity of street drugs has
improved while the price has decreased, despite all efforts to interdict their
transmission and sale by draconian legal measures and despite greatly increased
drug seizures.
“The
bottom line is that organized crime’s efforts to succeed in these markets has
flourished, and the criminal justice system’s efforts to contain these markets
have really been quite remarkably unsuccessful,” Dr. Evan Wood, Canada Research
Chair in inner-city medicine at UBC, told Canadian Press on September 13. “By
every metric, the war on drugs has failed.” As Werner Antweiler, a professor of
economics at UBC, pointed out in that same article, “The drug problem has not
become less, but more.”
Three
years ago, an experienced colleague and I were invited to Ottawa to address a
Senate subcommittee then considering your government’s omnibus “tough on crime,
tough on drugs” legislation, since enacted. The senators from your political
party endured our testimony with unflinching politeness, listened impassively
as we presented fact upon fact about the nature of addiction and the
trauma-burdened life histories of addicted human beings, the flaws of drug-war
approaches, the retrograde effects of criminalization, the necessity of
harm-reduction measures such as the provision of opiates to confirmed addicts.
Your senatorial party mates spoke afterwards as if they had not heard a word.
Nor do you appear to hear any words that question what you believe. But what
you believe personally should not matter when it comes to the health of human
beings.
“I
want to be crystal clear,” your predecessor as health minister, Leona Aglukkaq,
said last year. “I do not believe that politicians should pick and choose which
drugs get approved.” Perhaps that is why you have replaced her. Nor does your
British Columbia counterpart agree with you. “I know that the thought of using
heroin as a treatment is scary for people,” B.C. health minister Terry Lake has
said, “but I think we have to take the emotions out of it and let science
inform the discussion.”
There
is that word again, science. Based on which, your invalidation of this
Health Canada decision will have predictable effects: illness, death,
suffering.
I
know that is not your intention. I’m sure in your heart you wish, as we all do,
that addicted people would heal, that drugs would no longer blight the lives of
so many. I’m convinced of that. But an objective regard for the facts leads me
to this lamentable conclusion: whatever your intentions are, so long as you
embrace policies that promote illness, you are in fact serving as Canada’s
minister of disease.
Dr.
Gabor Maté is the author of several books, including In the Realm of
Hungry Ghosts: Close Encounters With Addiction. This article first appeared on
his blog at drgabormate.com/blog/.
COMMENTS (6)
Paula
Pothier
OCT
24, 2013 at 7:15 AM
Deeply
angers and saddens me to see how much clout and decision-making power these
political ignoramuses (that are elected by "the people") are allowed
to wield. Ambrose's unwillingness to listen to scientific evidence and her
resulting head-in-the-sand policy that has such dire consequences for so many
people on so many levels, is sickening. It saddens me further to realize that
even if she read Dr Maté's book: In the Realm of Hungry Ghosts, she probably
still wouldn't get it...such is the disease of political power gone bad.
Perhaps the only thing that would change her mind is having a direct and lived
experience being and working with people with addiction. Too bad we can't make
'job shadows' (read 'reality checks') mandatory for these myopic public
officials.
2x2
project
OCT
24, 2013 at 5:14 PM
Pls
read our open letter to Ms. Ambrose in support of heroin addiction treatment
with DAM
Pls RT our open letter to Ambrose for #heroin #addiction #therapy
Pls RT our open letter to Ambrose for #heroin #addiction #therapy
BikerCK
OCT
24, 2013 at 9:31 PM
"Hungry
Ghosts" is such a first rate book that any politician at any level would
benefit from reading it, esp. a federal minister of health. But one suspects
the current government has other issues to deal with at the moment, sadly of
their own making. Which is the real insult to Canadian taxpayers isn't it?
Instead of doing their jobs, because of incompetence and avarice, they're
spending their time, paid for by us, in what looks a lot like trying to save
their jobs.
FCG
OCT
24, 2013 at 10:10 PM
Bravo
Dr. Mate! You tell it like it is.
Poppy
OCT
24, 2013 at 10:10 PM
Superb
letter
RT03
OCT
25, 2013 at 3:35 AM
Before
you can comment on failed enforcement tactics I think you should post how many
criminal drug investigations you have personally been part of. I have no issues
with a doctor prescribing heroin to a patient if it is going to show positive
manageable results. I say this because I am not a doctor and don't have the
same training as you. Just a you are not a law enforcement professional and
don't have the same training as I do when it comes to the so called war on
drugs. There are many reasons that the drug trade in this country has
skyrocketed and many of those have to do with the complete lack of commitment
to enforce the law by our justice system. As to the quality and availability of
drugs, that speaks directly to innovation and lower cost of production on the
part of the producers and traffickers of these drugs. I support your comments
on politicians keeping quiet on medical treatments but I also say doctors
shouldn't have a say in how law enforcement gets done either. You heal em I'll
protect em.
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