We are told drugs are dangerous. One try, one experiment, one little use is all it takes, and we will be hooked. Our lives will inevitably and irrevocably spiral out of control. Drugs are chemical hooks that will not only ensnare our bodies into addiction but will also cause our bodies to crave ever increasingly higher doses, leading to a runaway drug addiction that will finally succumb us.
But if drugs are so addictive, why is it that most medical patients who have been prescribed powerful opiates to treat for pain do not become addicted to these opiates? And of the estimated 16 to 39 million drug users worldwide—according to the 2010 report by UNODC (United Nations Office on Drugs and Crime)—why is it that only 10-13% of them are addicts? Similarly, Dr. Carl Hart from the Columbia University observed no more than 20% (or 3% on average) of crack cocaine users would eventually become addicts.
The startling truth is this: drug use seldom leads to drug addiction. Research even as early as the 1970s have been telling us that drug addiction is not down solely to the biochemical effects. Drug addiction is also influenced very much by our environment and our susceptibility to addiction. Drug addiction, rather than being the cause, is the symptom of our social psychological problems and our adaptation to our environment.
Rats placed in an environment with plenty of stimuli, for instance, would prefer to drink from a bottled water filled with only water, even when a bottled of drugged water (water laced with morphine) was offered to them. But take away all the stimuli and something profound occurs. The rats now preferred to drink from the bottle with the drugged water rather than from the bottle with only water. The rats’ addiction to the morphine soon ensued which almost always led to their deaths.
The so-called “Rat Park” experiment designed by Prof. Bruce Alexander, then at the Simon Fraser University, British Columbia. Although conducted in the 1970s, this experiment was under-appreciated, perhaps biasedly ignored, until recently (photo from brucekalexander.com).
Rats, when given plenty stimuli (such as many choices of food, play, and other rats for company and sex), preferred to drink only water than water mixed with morphine. But take away all the stimuli and rats will instead prefer to drink the latter (photo from brucekalexander.com).
But could we humans also act in the same way as these rats? As it turns out, yes. In the 1970s, there were more heroin addicts in the US army in Vietnam than all the heroin addicts back home. There was a fear then that the US would face a crippling drug addiction problem when all these US servicemen finally returned home. But this fear was unfounded because as many as 95% of the addicted US servicemen quit within a year upon returning home. Upon returning home, these addicted US servicemen remitted because they were no longer exposed to the same kind of environment and social interaction that they had in Vietnam. Even when more than half of the Vietnam addicts tried heroin again after their return home, they did not become re-addicted, and even if they did, they were addicted only briefly. Heroin’s notoriety as a very addictive drug appeared over-hyped. Heroin addiction, rather than for life, would typically last 5 to 6 years, as the addicts were able to “mature out” of their addiction, mostly on their own, regardless if they had any treatment.
In the 1970s, heroin addiction was rife among US soldiers in Vietnam. However, 95% of them remitted their addiction upon returning home to the US. Why? (photo from AP)
But there is another reason why people do drugs: a desire that is natural and innate to be intoxicated. Prof. Ronald K. Siegel, who was the adviser to two US presidents and WHO and the book author of “Intoxication”, reveals that seeking out intoxication is human nature, just as it is human nature for us to satisfy our food, drink, and sex demands. Humans naturally seek out intoxication just as animals would. Cats, for instance, seek out catnip for pleasure, bees certain nectar, birds inebriating berries, elephants fermented fruits, monkeys “magic mushrooms”, and in the case of vervet monkeys on the Caribbean islands, fermented sugar cane.
Animals seek out intoxication too: vervet monkeys will actively seek out fermented sugar cane, discarded on the plantations, due to the alcohol content in the sugar cane (photo from bbc.com).
Solving the drug problem in the society, asserts Siegel, begins by understanding that seeking out intoxication is our fundamental and natural drive and that drug use should not always be associated with what only dysfunctional people do. Just as some people would smoke or drink alcohol for intoxication, some people will instead do drugs.
Perhaps then it shouldn’t surprise us to learn that in 2009, WikiLeaks leaked a 1995 WHO report that had been suppressed for 13 years because this report sensationally found that experimental and occasional use of cocaine was by far the most common reason for cocaine use and compulsive or dysfunctional use much less a reason.
In most societies, drug addicts face high social stigma and are treated exactly like criminals. The Malaysian Narcotics Crime Investigation Department, for instance, spends 70% of their drug enforcement energies on apprehending drug users and only 30% on drug dealers. What social stigma and criminalization do is they ostracize addicts, compounding the problem by making addicts carry on with their drug habits. A survey done by Mahmood in 1996, for instance, found that 95% of 60 families interviewed in Peninsular Malaysia opined that drug addicts are useless to the country, and 6% thought that addicts cannot be forgiven and should be relocated far from anyone.
Like most other countries, Malaysia treats drug addicts like criminals. But by doing this, Malaysia is compounding the drug addiction problem, not shaming or scaring these addicts to quit (photo from Zainal Abd Halim / Reuters).
When drug addicts are treated as criminals, it deters them from seeking an early treatment for their addiction. Most drug addicts are brought to treatment by coercion through the criminal justice system. Even then, success from conventional treatments to break drug addictions has been disappointing. Forced abstinence seldom works for long. In Malaysia, as high as 90% of former addicts would relapse to their drug habits within half a year after their release from drug treatment, and even as early as within a month after their release, 40% of former addicts would begin to pine for drugs. In a survey, these addicts reported that they inevitably relapse because they suffer from low self-efficacy and that they face high social stigma, lack employment opportunities due to lack of trust by employers, and lack open interaction with their family members.
War on drugs
For the past 50 years, the world is at war with drugs, a war fought literally with guns and violence and resulting in a staggering loss of lives. The war on drugs started in 1961 when UN Single Convention on Narcotic Drugs was established to create a drug-free world. Since then increasingly more countries have declared their war against drugs. US declared theirs on June 18, 1971 when the then US President Nixon called drugs “public enemy number one” in the country. Malaysia declared theirs on Feb. 19, 1983 by categorizing drugs as a national disaster , and on Jan. 22, 2003, Malaysia made 2003 the “Year of Total War Against Drugs”. The country further strengthened the resolve against drugs by pledging to be a drug-free nation by 2015.
While the US had the “Just Say No” slogan against drugs, Malaysia had a much more boorish slogan: “Dadah Adalah Najis” to mean exactly as uncomfortably intended because, in English, Malaysia’s slogan literally translates to “Drugs Are Shit”.
Despite harsh drug laws in most countries, UNODC (United Nations Office on Drugs and Crime) estimates that illegal drugs remain the world’s largest illicit commodity market, with an estimated turnover of USD330 billion per year. The cost of fighting the war is enormous. The world spends at least USD100 billion a year in its war against drugs. No one knows exactly how many lives have been lost or missing to the drug wars. But in Mexico, the cost of fighting the drug war has cost the country an estimated 100,000 lives lost and missing in just ten years and in Columbia 15,000 over a 20-year period.
The Mexican drug war is perhaps the most violent war in the world against drug cartels. It is a war that involves large losses of lives, widespread corruption, and horrific violence. This is because drugs, when banned, offer enormous wealth and power to criminals that far outweigh the harsh penalties of drug laws (photo from AP).
When drugs are criminalized, the drugs do not disappear. Criminals instead take over the supply and trade of drugs, and they use violence to enforce their control. These criminals would actually prefer if drugs remain banned because it keeps them involved in the drug trade. The harsh penalties of drug laws are far outweighed by the large amount of money and power offered by drugs. The highest number of violence in the US occurred during periods when alcohol and drugs were banned: 1920-23 for alcohol and 1970-90 the peak of the drug prohibition period. Milton Friedman, the American economist and statistician, estimated that the alcohol prohibition had caused an estimated 10,000 more murders and the height of the drug prohibition 25-75% more murders. US police face unsustainable benefits when they undertake major offensives to clean up neighborhoods from drug dealers. These neighborhoods stay clean from several weeks (at times only a week) before drug dealers and street gangs return and resume their drug peddling. One criminal put away is merely replaced by another and one street gang dismantled causes another gang to take over.
Indonesia will soon execute these two Australian drug traffickers. Unfazed from criticisms and pleas from Australia, the President of Indonesia, Joko Widodo, says their executions will send a strong message to all drug smugglers. Indonesia has 4.5 million people in rehabilitation centers, 1.5 million of whom are incurable. Evidence have shown that harsh penalties even death sentences do not deter drug criminals (photo from Reuters).
The UK Home Office recently revealed that after 40 years, there was no indication that UK’s tough drug laws had any effect on lowering drug use in the country.
And despite the noble intentions of being a drug-free nation by 2015, Malaysia today is still far from becoming one, with little signs that drugs would soon become a diminishing problem. Malaysia had only 711 registered new drug addicts in 1970, but this figure soon exploded to 14,624 in 1983, the year Malaysia declared war on drugs. Although the number of new drug addicts declined sharply to 6,138 in 1985, Malaysia’s early success on the war on drugs did not continue. By 2004, the number of new drug addicts had climbed to a maximum of 38,568. Since then, the number of new drug addicts has dropped but has remained rather steady at about 17,500 over 2007-13 period.
Number of registered new drug addicts (including relapse cases) in Malaysia. Note: values for 1971-79 and 1986-99 are estimated.
Likewise, the number of drug-related arrests (averaging 44,000 cases per year) showed no clear declining or rising trend from 2005 to 2012. The exceptional year was 2013 with 128,412 number of arrests, 3 times higher than that in 2012. Whether this high number of arrests is an indication of the coming trend or merely a blimp remains to be seen.
Number of drug-related arrests in Malaysia.
Drug use decriminalization and drug legalization
There are greater calls today for a change in how we approach our fight against drugs, considering even whether we should decriminalize drug use or go as far as legalizing drugs, both of which are controversial issues because they run against our notion that something harmful like drugs must be of course be prohibited.
Lord Ian Blair, the former Metropolitan Police Commissioner of the Scotland Yard, warns that drug legalization is an irreversible experiment that we can ill afford because we have no idea what impact it would have on the society. But Lord Blair is wrong. Some countries today have radicalized they way they approach and treat the drug problems in their respective countries. Their examples give us some insight as to what would happen if drug use was ever to be decriminalized or drugs legalized.
In the 1980s, Portugal had one of the highest drug users in the world, and by 1990, there were one drug addict for every 100 persons in the country. Portugal had tried tough law enforcement but saw little returns. Out of desperation, Portugal chose a radical approach: they decriminalize all drug use, the first country to do so, in 2001. While using and carrying drugs (up to certain limits) were legal, selling and making drugs remained illegal in Portugal. One key benefit decriminalization did was to remove the social stigma of drug users, causing addicts to voluntarily seek treatment. And instead of just a quick “Just Say No” response to drugs, Portugal asked instead their schoolchildren reflect on why people might want to use drugs and the possible repercussions from their decision.
A cannabis smoker in Portugal. In 2001, Portugal became the first country to legalize all drug use (photo from Estela Silva/EPA).
Many studies have since been done to examine the outcome of Portugal’s drug decriminalization policy after ten years. The results have confusingly been mixed. Nonetheless, in 2012, Hughes and Stevens, two Australian university researchers, re-examined the evidence and determined that although Portugal’s drug policy was not a resounding success, it did however lower the drug use by youths aged 15-24 years old by as much as 10-30% between 2001 and 2007 and that drug-related deaths fell sharply by about 75% during the same period. That the youths aged 15-24 years used less drugs is important because this age group is considered most susceptible to drug use initiation and prolonged drug use. Portugal’s success in dealing with the drug problems was concluded to be slightly better or on par with most European countries.
Australia, Denmark, Canada, and Switzerland provide safe havens or drug clinics where addicts can receive clean drugs for free and be intoxicated under supervised conditions. The drugs provided by these clinics are purer, unadulterated, and clean from contaminants, unlike those unreliable, possibly contaminated drugs sold on the streets. Drugs provided by the drug cartels do not undergo any quality control, so it is easy for drug users to overdose because the users do not know what they are taking: is it 1% or 40% heroin?
A supervised drug injection center in Vancouver, Canada, where drug users can obtain free and clean drugs and inject themselves under monitored conditions. Canada sees such centers as essential to protect drug addicts from overdosing and being infected by the usual diseases (like HIV) from drug use. Such centers also reduce drug-related crimes. More such centers are planned for Montreal, Toronto and Victoria (photo from macleans.ca).
Consequently, because of these drug clinics, deaths by drug overdose and HIV infections ceased completely. Moreover, these drug clinics observed that addicts, when given a freedom to request for higher doses, will at first aim for a higher dose, then stabilize it, with some even later asking for a lesser dose. That addicts could stabilize their doses or choose a lower dose breaks the myth that addiction leads to increased tolerance to drugs, so addicts would inevitably crave increasingly higher doses.
Drugs sold at the streets have their prices set at whatever level demanded by the criminals. This often encourages drug users to commit crimes to help pay for their addiction. So, when clean drugs are provided for free under the Swiss’ drug program, this resulted in fewer drug-related crimes: 55% fewer vehicle thefts and 88% fewer muggings and burglaries committed by drug addicts. HIV infection due to drug use fell from 85% in 1985 to 5% in 2009.
By providing clean and free drugs and in proper doses, addicts under this program could function as normal, remaining lucid and in control.
“If you would meet these people [addicts] in the street, you would never know they are on substitution. They are married, with kids, working at the bank,” remarks Dr. Roberto Pirrotta, the senior psychiatrist at the Arud Drug Treatment Centre at Aussersihl, Switzerland.
A methadone counter at the Arud Drug Treatment Center at Aussersihl, Switzerland. Addicts can come to such centers for their free fix and under supervised conditions (photo from Fifa and Sarah, 2014).
Addicts under this drug prescription treatment could each own a home, and one-third of them would eventually come out of welfare. Addicts under this drug prescription treatment would carry on with their addiction for no more than 3 years, with only 15% of them continuing for longer periods. The Swiss drug prescription treatment is also cheaper by more than 20% than the previous method of arresting, trying, and convicting drug users.
Netherlands has also legalized the sale of cannabis at sanctioned coffee shops. Although cannabis use across all age groups rose in Netherlands, they remained low at 5% (and not out of control) of the population, compared to 6.5% in the US and 7% in European Union countries. The number of hard addicts in Netherlands has stabilized and the average age of addicts has risen to 38 years, an indication of their drug policy is working.
Increasingly more countries today are changing their approach to handling the drug problem. Uruguay has recently legalized the growing and sale of marijuana. Even the US has softened their fight against drugs.
Malaysia too are beginning to treat drug addicts more as medical patients and less as criminals, as remarked by Nancy Shukri, the Minister in the Prime Minister’s Department. Malaysian pilot trials using methadone as an opioid substitution have shown promising results. Drug addicts given methadone as a substitution for opiates saw two thirds of them securing permanent jobs, as many as 80% of patients choosing to remain under this program, and only 3% of patients testing positive for drugs in their urine tests. The opioid substitution treatment is also cheaper by a remarkable 7.5 times than the conventional treatment. Countries that have tried this opioid substitution program also see similar promising results.
Two addicts at the Methadone Research Clinic, run by the Universiti Malaya Centre of Addiction Sciences, at Kuala Lumpur. They are waiting to receive their fix as the staff prepares the methadone dose for them (photo from bazuki.com).
What countries like Australia, Canada, Denmark, Switzerland, Portugal, and Netherlands have shown us is that there is an alternative and successful approach to handling the drug problem. Skeptics may disagree that drug use should be decriminalized or drugs legalized, but even they would disagree that the world is winning the drug wars. But instead of upping the fight against drugs, we should rely on science and evidence to reevaluate our position and stance on drugs.
Malaysia in particular needs to reevaluate its drug policy to one that is more evidence-based. Changes however will be difficult and have to be done in stages. Decriminalizing drug use or providing free drugs clinic require much planning to ensure that drug addicts receive effective treatments for their addiction and that they can function as normal and contribute positively to the society. Money, rather spent to arrest, try, and incarcerate drug addicts, could be used instead for their treatment.
A change to an evidence-based drug policy is not an admission of defeat that the drugs have won. Far from it. Instead, it is about us regaining control of drugs by taking away at least some of the power and wealth from the drug cartels, dealers, and smugglers, and street gangs. It is about giving real hope to drug addicts. And it is about us taking back our streets and neighborhoods, making them safer by reducing drug-related deaths, crimes, and violence.
Johann Hari argues in “Chasing the Scream” that we have misunderstood the drug problem and are fighting against drugs in a catastrophic manner (photo from theguardian.com).
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