The battle to tackle drug addiction is not lost

The debate about legalisation is a distraction.

It is impossible not to be moved by the plight of communities in Mexico and other drug-producing countries across the world. Crime and violence related to the supply of drugs are without a doubt causing extreme grief to citizens and governments. But reaching to decriminalise or legalise those drugs in the hope that it will overcome those communities’ deep-rooted problems offers them a false prospectus, and overlooks the nuanced picture of drug use and addiction which in this country at least, is in decline.

For many producer nations, drugs are one of a number of complex factors contributing to adverse conditions within their countries.  Legalisation would compound the devastating effects of drug use and the drugs trade, as former UN head of drugs and crime Antonio Maria Costa argues, especially if the structural issues that leave those states without the resources to tackle the causes and consequences of their drug problem are not addressed.

The legal framework in this country does not prevent those with drug problems from being treated humanely and effectively. Drug treatment is freely and quickly available via the NHS in England, and offers users the prospect of stability and recovery from the chaotic lives inherent in addiction. Over the last six years, 340,000 mainly heroin users have got help for their addiction, of whom around one third successfully completed their treatment, which compares favourably to the international evidence of recovery. Addicts are treated as patients in the health service, and if there are other crimes to account for, addiction treatment is offered for offenders in the community and in prison in line with NHS standards.

Drug use in this country is falling, particularly amongst young people. Heroin, crack and cannabis are being used by fewer people, and whilst there are more young people taking so-called legal highs and novel drugs, their numbers are nowhere near the levels we faced when setting up the nation’s treatment response primarily for heroin addicts more than a decade ago. At the same time, more people are recovering from drug addiction in England. There is no cause for complacency, in fact we are accelerating efforts to orientate drug treatment towards recovery, but it is worth pointing out that the trends on use, addiction and recovery are heading in the right direction.

Domestically and globally, the public discourse about drugs tends to exaggerate the power of the drug, and minimises the impact of social and economic circumstances. Compared to the 2.8million who use illegal drugs there are around 300,000 heroin or crack users in England, over half of whom are in treatment each year. Probably another 30,000 or so are in treatment for dependency on other drugs e.g. powder cocaine, cannabis and ecstasy. Those who become addicted tend to be seen by the media as the victims of hedonism, the random by-product of widespread recreational drug use. A steady trickle of millionaires’ children and celebrities fuel this myth, playing to the anxieties of middle class readers about their own children. Too often, those in the public eye think they understand drug addiction because of personal or family experiences which bear little relation to the multiple disadvantages experienced by most addicts.

In reality drug addiction is targeted. The 300,000 heroin and crack addicts are not a random sub set of England’s regular drug users. If they were, they would be as likely to live in Surrey as Salford, to have been to Westminster School as Wandsworth Prison, and their childhood would have been as likely to have been overseen by a live-in nanny as much as by Newham Borough Council.

Addiction, unlike use, is concentrated in our poorest communities, and within those communities it is the individuals with the least capital who are the most vulnerable to succumb and least able to extricate themselves. Compared to the rest of the population, heroin and crack addicts are male, working class, offenders, products of the care system, with poor educational records, little or no experience of employment, and a history of mental illness. Increasingly they are also in their forties with declining physical health. They will tend to struggle more than most to make sound personal decisions, which contributes to their other problems.

The reputation of heroin is such that few people will even try it. Of those who become addicted, the majority will recognise where they may be heading and stop. Amongst them will be people who are intelligent, resourceful and ambitious who will realise they are in “in over their heads”, pull themselves up sharp, and sort themselves out. Others will not necessarily have the innate resources to do this but will have family and friends to support them to achieve the same outcome. Key to this success will be the existence of an alternative life with the reality or realistic prospect of a job, a secure home, a stake in society and supportive relationships. The access to social, personal and economic capital not only enables individuals to overcome their immediate addiction, but to avoid relapse.

The government’s 2010 drug strategy recognises that treating addicts in isolation from efforts to address their employment, their housing status and the myriad other problems they face is unlikely to lead to long term recovery. According addiction primacy as a cause of poverty, criminality, worklessness, and child neglect denies the fact that it is as much a consequence of individual family and community breakdown as its genesis. Drug addiction exacerbates problems, and unless it is addressed will inhibit or even prevent progress in other aspects of people’s lives, but addressing it in isolation is not a silver bullet.

Drugs are not the unique barrier to normal social functioning for most addicted people. Drugs are not the unique barrier to a better, fairer and safer world in drug producing countries. The debate about legalisation is a distraction from facing and comprehensively addressing the social and economic factors that underpin drug use, addiction and the drugs trade.

Paul Hayes is the Chief Executive of the National Treatment Agency for Substance Misuse (NTA)

Opium poppy buds in an Afghan field. Photograph: Getty Images

Paul Hayes is the Chief Executive of the National Treatment Agency for Substance Misuse (NTA)

Photo: Getty
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This is no time for civility towards Republicans – even John McCain

Appeals for compassion towards the cancer-stricken senator downplay the damage he and his party are doing on healthcare.

If it passes, the Republican health care bill currently being debated in the Senate will kill people. Over the past few months, the party has made several attempts to repeal and replace the Affordable Care Act passed under Obama, all of which share one key feature: they leave millions more people without healthcare.

Data indicates that every year, one in every 830 Americans who lack healthcare insurance will die unnecessarily. A report by the Congressional Budget Office suggests that the newest “skinny repeal” plan will leave an extra 16 million individuals uninsured. That’s an estimated annual body count of 19,277. Many more will be forced to live with treatable painful, chronic and debilitating conditions. Some will develop preventable but permanent disabilities and disfigurements - losing their sight, hearing or use of limbs.

This is upsetting to think about as an observer - thousands of miles across the Atlantic, in a country that has had universal, free at the point of delivery healthcare for almost seven decades. It is monstrously, unfathomably traumatic if you’re one of the millions of Americans who stand to be affected. If you’ve got loved ones who stand to be affected. If you’ve got an ongoing health condition and have no idea how you’ll afford treatment if this bill passes.

I’ve got friends who’re in this situation. They’re petrified, furious and increasingly exhausted. This process has been going on for months. Repeatedly, people have been forced to phone their elected representatives and beg for their lives. There is absolutely no ambiguity about consequences of the legislation. Every senator who supports the health care bill does so in the knowledge it will cost tens of thousands of lives - and having taken calls from its terrified potential victims.

They consider this justifiable because it will enable them to cut taxes for the rich. This might sound like an over simplistic or hyperbolic assertion, but it’s factually true. Past versions of the bill have included tax cuts for healthcare corporations and for individuals with incomes over $200,000 per year, or married couples making over $250,000. The current “skinny repeal” plan has dropped some of these changes, but does remove the employer mandate - which requires medium and large businesses to provide affordable health insurance for 95 per cent full-time employees.

On Tuesday, Senator John McCain took time out from state-funded brain cancer treatment to vote to aid a bill that will deny that same medical care to millions of poorer citizens. In response, ordinary US citizens cursed and insulted him and in some cases wished him dead. This backlash provoked a backlash of its own, with commentators in both the UK and US bemoaning the lack of civility in contemporary discourse. The conflict revealed a fundamental divide in the way we understand politics, cause and effect, and moral culpability.

Over 170 years ago, Engels coined the term “social murder” to describe the process by which societies place poor people in conditions which ensure “they inevitably meet a too early… death”. Morally, it’s hard to see what distinguishes voting to pass a healthcare bill you know will kill tens of thousands from shooting someone and stealing their wallet. The only difference seems to be scale and the number of steps involved. It’s not necessary to wield the weapon yourself to have blood on your hands.

In normal murder cases, few people would even begin to argue that killers deserve to be treated with respect. Most us would avoid lecturing victims’ on politeness and calm, rational debate, and would recognise any anger and hate they feel towards the perpetrator as legitimate emotion. We’d accept the existence of moral rights and wrongs. Even if we feel that two wrongs don’t make a right, we’d understand that when one wrong is vastly more abhorrent and consequential than the other, it should be the focus of our condemnation. Certainly, we wouldn’t pompously insist that a person who willingly took another’s life is “wrong, not evil”.

Knowing the sheer, frantic terror many of my friends in the US are currently experiencing, I’ve found it sickening to watch them be scolded about politeness by individuals with no skin in the game. If it’s not you our your family at risk, it’s far easier to remain cool and detached. Approaching policy debates as an intellectual exercise isn’t evidence of moral superiority - it’s a function of privilege.

Increasingly, I’m coming round to the idea that incivility isn’t merely justifiable, but actively necessary. Senators voted 51-50 in favour of debating a bill that will strip healthcare from millions of people. It’s unpleasant to wish that John McCain was dead—but is it illegitimate to note that, had he been unable to vote, legislation that will kill tens of thousands of others might have been blocked? Crude, visceral language can be a way to force people to acknowledge that this isn’t simply an abstract debate—it’s a matter of life and death.

As Democratic congressman Keith Ellison has argued, merely resisting efforts to cut healthcare isn’t enough. Millions of Americans already lack health insurance and tens of thousands die every year as a result. The Affordable Care Act was a step in the right direction, but the coalition of resistance that has been built to defend it must also push further, for universal coverage. Righteous anger is necessary fuel for that fight.