Medicating our pleasure and pain

Singer Michael Jackson is becoming more famous in death for his addiction to prescription medicines than for his musical legacy, and he is not the first pop artist to go down in history as a victim of drug abuse. Like Elvis Presley and Anna Nicole Smith, he ended his life, from all accounts, in a tragic state of dependency on medications to relieve the distress that lay behind his successful persona.

Yet, in essence, the "King of pop" was doing no more than millions of his countrymen do in an average week by resorting to painkillers and sleeping aids, alcohol and cigarettes in order to make their lives more pleasant or bearable. A recent warning about a common pain-reliever, acetaminophen (Tylenol in the US), brought to light that Americans purchased more than 28 billion doses of acetaminophen in 2005, and roughly 19 percent of the US adult population uses some form of the medication in a given week. Reaching for some analgesic or soporific is second nature to modern people brought up to seek pleasure and avoid pain -- even when the pain may not be very bad or the pleasure-inducing substance may have harmful effects.

Most people stop there, within the boundaries of what is legal and, much of the time, perfectly legitimate medication or indulgence. The same pleasure-seeking, pain-relieving reflexes, however, push others towards excessive drinking or harder, illegal drugs and into the black hole of addiction. Drug pushers working for local gangs and international cartels provide any number of opportunities in the clubs and party venues of the city.

‘Our insatiable demand for drugs’

The result is what US Secretary of State Hillary Clinton referred to earlier this year in the context of the Mexico-US drug traffic as "our [America’s] insatiable demand for drugs". Drug abuse is a scourge that afflicts every country to some degree, the rich even more than the poor. It breeds crime, corruption and chaos. It destroys individuals, families and whole communities. It is even capable of ruining nations. Speaking at a meeting in Europe earlier this year a politician from Namibia warned that the youth of the country was "wasting away as a result of drug misuse" and that the "development, security and stability of many countries are affected."

In its recently issued 2008 report, the United Nations Office on Drugs and Crime estimates that there are 28 million people worldwide who are physically or psychologically drug-dependent.

As many as 250 million people used illicit drugs at least once in 2008, says the UN. A large number of them would be young people taking their first puff of cannabis -- most likely in today’s stronger and more dangerous form known as "skunk" -- or swallowing their first methamphetamine or ecstasy pill. Some will certainly become addicted.

But what is to be done? How can the criminal exploitation of human weakness be stopped? Can we do anything about the weakness itself?

In another MercatorNet article this week, UN drug czar Antonio Maria Costa responds to the "growing chorus" of those who say that drug control -- enforcement of laws banning certain drugs -- is not working, that it actually generates the criminal market and makes the whole problem worse. Without conceding their whole case, Costa agrees that there needs to be a change of focus from drug users to drug traffickers; drug users -- especially heavy users -- should be dealt with through health and social policy, while law enforcement should go all out to stop trafficking.

Regarding treatment, he says:

"Drug courts and medical assistance are more likely to build healthier and safer societies than incarceration. I appeal to Member States to pursue the goal of universal access to drug treatment as a commitment to save lives and reduce drug demand: the fall of supply, and associated crime revenues, will follow."

Addressing the social dimension of drugs he calls for "an end to the tragedy of cities out of control" -- poor and lawless areas of cities where criminal groups have free reign:

"The problem can only be solved by addressing the problem of slums and dereliction in our cities, through renewal of infrastructures and investment in people – especially by assisting the youth, who are vulnerable to drugs and crime, with education, jobs and sport. Ghettos do not create junkies and the jobless: it is often the other way around. And in the process mafias thrive."

These seem very reasonable propositions. People would still be accountable before the law for illegal drug use, but drug courts, going by those that already operate in the United States, would pursue law enforcement through intensive judicial supervision, mandatory drug testing, escalating sanctions and treatment to help substance abusing offenders break the cycle of addiction and the crime that accompanies it.

What works, really?

If it is a question of what "works", the example of Sweden is instructive. In a way similar to its dealings with prostitution, Sweden flirted with a liberal drug regime in the second half of the 1960s and then progressively tightened its laws, criminalizing illicit drug use and providing early intervention and coercive treatment. The vision has been the ambitious one of a drug free society. The message: Don’t.

The result, according to the UN’s 2007 report, has been notable success. In 2006, 6 percent of students aged 15-16 had used drugs, down from 15 percent in 1971. Lifetime prevalence of drug use for that age group was also 6 percent, compared with 22 percent for Europe. Overall, drug use had declined in Sweden at a time when it was increasing in Europe and the country had low levels of injecting drug-use-related HIV/AIDS infections.

Sweden has certain advantages over the rest of Europe, as the UN report points out. It is not located on any major drug trafficking route. It is a welfare state without extremes of income inequality and the kind of "underclass" that disposes young people to get into drug dealing. Its population is very health conscious. Most important, perhaps, it "has enjoyed a broad political consensus over the direction of drug policy, thus avoiding sending mixed messages to potentially vulnerable groups of society."

Even so, the country’s achievements in drug control has come at a considerable cost -- as much as 0.5 percent of GDP, which is the second highest in the EU, after The Netherlands -- and the results fluctuate with ups and the downs in the budget. Also, says the UN, although Swedish drug policy is highly effective in preventing drug use, it is less effective in preventing drug users from becoming drug addicts: levels of problem drug use in Sweden are only slightly below the EU average.

Sweden’s story demonstrates that an ambitious goal with broad public backing is the first requirement for a successful national effort. But it also suggests that the insatiable appetite for drugs found in developed countries can be significantly reduced only in particularly favourable circumstances and by huge and ongoing public expenditure.

Even then, a decline in one type of drug might be cancelled out by the rise of a new fashion. The use of cannabis and cocaine is down among teenagers in North America and western Europe, but the abuse of prescription medicines (tranquilizers, barbiturates and sedatives) is up among American youth. One reason is that legal medicines are easier to access; they might even be in the bathroom cupboard at home.

Self restraint - an unrealistic goal?

Teenagers are going to experiment with what adults do. If their parents are always popping pills and having an extra drink, they will be tempted to do the same. In this sense the answer to the drug problem lies at home. It comes down to learning from an early age -- from the example of parents as well as from their timely interventions -- how to control impulses and say no to what is wrong and harmful. It is a question of acquiring the habit of self restraint -- a virtue whose loss is behind most, if not all of today’s social problems. Without this kind of upbringing the most creative and well funded school drug programmes seem unlikely to have much effect.

Experts on the whole are not going to like this argument. Many either don’t believe in virtue or think it is simply unrealistic to build a public health strategy on it. When confronted with what looks like a permanent error in human programming, their tendency is to look for a silver bullet -- a technical solution that will bypass the emotions and will and go straight to the brain or some part of the body. We have seen it with the condom and the human papilloma virus (HPV) vaccine as the answer to sexual promiscuity.

It s not surprising, then, that scientists are developing vaccines against drug addiction. An interview with a couple of them on Australian television two years ago began with this introduction: "What if you were able to vaccinate your children against addictive drugs like nicotine, heroin, cocaine or amphetamines before they were even old enough to try them? … imagine if there was a vaccine that would stop these drugs from having any pleasurable effect on the brain and body… no rush, no high and no reward to get addicted to."

But it is no longer just a question of imagination: a recent article in the Washington Examiner mentioned that a clinical trial on a cocaine vaccine would start this year in the US. The article, however, was mainly an expose of how some of this research involves giving addicts doses of illegal drugs. (The war on drugs can be just as indiscriminate as any other war, it seems.)

It is not difficult to guess who the target populations for anti-narcotic immunisations would be: those kids growing up in the urban ghettos Antonio Maria Costa talks about. It would be so much easier -- wouldn’t it? -- than assisting them with education, jobs and sport. Easier by far, also, than helping parents and teachers with the character education that would arm kids against peer pressure and the lure of easy pleasures. If it worked.

But even if it did, we would be no closer to curing the habit that drives the Michael Jacksons of the world to seize on something -- anything -- to ease their pain or increase their pleasure. For that we need a much bigger vision.

Carolyn Moynihan is deputy editor of MercatorNet.


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