Memorial mural to recently-deceased actor Philip Seymour Hoffman. Photo: Garrett Ziegler / Flickr
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The international mood on drug use and addiction is shifting from punishment to treatment

The UN has added its voice to the growing cry to rebrand substance abuse disorders as an issue of public health – a matter for doctors, not police.

The NHS estimates around 2 million Britons suffer from addiction. This is probably a gross underestimate - just take a look at nicotine. There are 6 million adults in the UK alone who say "they would find it hard to last a whole day without smoking". Cigarettes kill more than 100,000 people annually, but addiction means two-thirds of smokers say they're struggling to stop. Our society actively supports those trying to kick the habit, though, with things like e-cigarettes and nicotine patches, and it works. Evidence-based anti-smoking campaigns have been hugely successful, enabling almost half of all tobacco users to eventually quit

Unfortunately, this is not the case for most addictions. Where the substance being abused is illegal, a stigma exists that has repulsed efforts to effectively combat it. The police, rather than the NHS, are in charge - and addicts are criminals to be apprehended, not patients to be treated. That hypocrisy was the subject of a discussion featuring Nora Volkow, the director of America's National Institute on Drug Abuse and an expert on how drug addiction affects the brain, at the World Science Festival two weeks ago:

Addiction is a disease of the brain... Unfortunately - even though the science has shown it's a disease of the brain - it has been very difficult to incorporate into the healthcare system.

And as a result of that, many cases of drug addiction are never recognised. Or prevented. Or treated."

Addiction is a contentious issue. Entire areas of our health and drugs policies are influenced by the way we view addicts, and our criminal justice system is inextricably linked with substance dependence. It informs our attitudes on every poverty-related subject from homelessness to welfare. Most damagingly, it has led us to participate in a bitterly destructive war.

It follows that both policymakers and the public should be well-informed of the nature of addiction. Yet in a society where drug addicts are viewed as feckless criminals - lacking either the desire or the willpower to quit - there is a mounting body of evidence to suggest our perceptions are off, and as a result a growing number of nations are starting to put international pressure on changing the global war on drugs. A recent report by the United Nations’ Commission on Narcotic Drugs (CND) has adopted resolutions recognising that:

[S]ubstance use disorders can result in chronic, relapsing conditions requiring, like other health conditions, treatment based on scientific evidence, support for those affected and, where indicated, governmental and community initiatives to promote recovery and facilitate reintegration”

Essentially, addiction is a disease, which requires effective medical treatment and support from society - and historically neither of those facts have been popular with the public.

Writing in The Spectator last year, Russell Brand - a recovered heroin addict - struck upon the source of our hostility towards substance abusers:

It is difficult to feel sympathy for these people.

Can there be any other disease that renders its victims so unappealing?

Would Great Ormond Street be so attractive a cause if its beds were riddled with obnoxious little criminals who had ‘brought it on themselves’?”

The notion that addiction is a choice - and the underlying insinuation that addicts are getting their dues - is incredibly pervasive. They are, as is often the case, a plausible scapegoat for all of society's troubles. This ‘othering’ of drug addicts is so common in government and media that the Society of Editors published ‘Dealing with the Stigma of Drugs - a Guide for Journalists’.  Executive director Bob Satchwell described the negative effect using words like “junkie” can have:

The award of a deviant social status to drug users may serve to discourage use but it does little to assist those most in need of help. Studies have consistently shown that perceived devaluation and worthlessness on behalf of the user does little to spur them towards recovery.

The ‘shame’ of addiction is a reason why people with drug problems - and their families - often do not seek help.”

This deep-rooted stigma also goes some way to understanding why there is such disparity between political decisions and the scientific advice. The UK Drug Policy Commission’s 2012 report recognised the UK's attitude towards drugs as a barrier in effective policy-making:

The UK is unusual among EU countries in that the Home Office is the lead department for drug policy; most countries situate their leadership in the Ministry of Health.

It has been suggested that the Home Office leadership encourages a view of drugs as a crime issue rather than a matter of health.”

The reasons behind this are evident. The “tough on crime” line is a tried-and-tested vote winner, appeasing our fears with strong rhetoric and firm action. Yet it flies in the face of the scientific recommendations. Criminalising drug addicts only exacerbates the problem. Dr. Volkow (also chairperson of the working group advising the CND) discussed the dangers of this attitude at a Kavli Foundation-hosted teleconference last month. The three neuroscientists spoke of unanimous agreement amongst members that “substance use disorders are a disease ... and thus should be addressed within a public health framework".

Unfortunately, the notion of the British government ignoring science in favour of politics is nothing new - particularly when it comes to drugs. Neuropsychopharmacologist David Nutt was sacked from the Advisory Council for the Misuse of Drugs after criticising the government’s failure to listen to its recommendations. In a post on his blog (aptly titled "Evidence not Exaggeration") he explains that turning a blind-eye to scientific advice is foolhardy: 

Approaches which explicitly reject an evidence-based public health approach, but instead focus on incarceration and criminalisation of addicts, continue to utterly fail, at enormous financial and human cost.”

Instead, policy-makers must be prepared to accept the findings of its advisors - even when they disagree with convention. Nutt goes on to examine Switzerland’s successful strategy - a programme of providing supposedly-untreatable heroin addicts with a clean supply of the drug, which has flourished in the face of sharp political criticism:

It has stabilised chaotic lives, allowing users to be socially reintegrated, getting homes and sometimes jobs, and as well as removing the health harms associated with polluted, inconsistent street drugs. Addicts in this treatment get fitter, they virtually never overdose, and very few die.

Unlike those in other regimes, most stay in treatment, allowing some to progress later to abstinence. "

The idea of providing free, clean drugs to addicts is steadily gaining momentum as further evidence emerges for its effectiveness. Chief Constable Mike Barnett echoed this sentiment when he declared "it is time to end the war on drugs" in an article in the Observer last year. "[Addicts] must be treated and cared for and encouraged to break the cycle of addiction. They do not need to be criminalised."

In a blogpost after the 57th session of the CND in March, Dr. Volkow summarised what is now rapidly becoming scientific consensus:

The recommendations of our committee crystalize a paradigm shift in how the problem of substance abuse and addiction are viewed by modern societies.

Shifting the problem of drug abuse and addiction from the legal (or moral) sphere to that of science and medicine, where it properly belongs, is a crucial step toward successfully tackling the problem."

So the call for a radical rethink of our approach to drug policy continues to grow. A large part of this is intrinsically defined by the way we view and treat those suffering from substance disorders. But it is perhaps inevitable - given the continual dehumanisation of drug addicts - that discussion about addiction would eventually lose focus on those suffering from substance dependency and switch to a more pressing issue for the government.

On the Swiss clean-heroin policy, Nutt declared:

It isn’t just the addicts who benefit; crime fell enormously once users could access heroin from the State rather than profiteering dealers. The State, and taxpayers don’t lose out in this arrangement, the expensive program more than pays for itself in healthcare and law enforcement savings.”

An appeal to the economics of patient-centred treatment might be just what's needed to convince the Coalition to rethink their plans. Not only would a health-focussed approach save lives, it would save money as well. Surely that’s a language the Home Office can understand?

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Age verification rules won't just affect porn sites – they'll harm our ability to discuss sex

Relying on censorship to avoid talking about sex lets children down.

The British have a long history of censoring sex. In 1580, politician William Lambarde drafted the first bill to ban "licentious" and "hurtful... books, pamphlets, ditties, songs, and other works that promote the art of lascivious ungodly love". Last week, the UK government decided to have another crack at censorship, formally announcing that age verification for all online pornographic content will be mandatory from April 2018.

It is unclear at this point what this mandatory check will entail, but it's expected that you will need to submit your credit card details to a site before being allowed to access adult content (credit cards can’t be issued to under-18s).

The appointed regulator will almost certainly be the British Board of Film Classification who will have the authority to levy fines of up to £250,000 or shut down sites that do not comply. These measures are being directly linked to research conducted by the NSPCC, the Children’s Commissioner and the University of Middlesex in 2016, which surveyed more than 1,000 11 to 16-year-olds about viewing online pornography and found over half had accessed it. 

Digital minister Matt Hancock said age verification "means that while we can enjoy the freedom of the web, the UK will have the most robust internet child protection measures of any country in the world". And who can argue with that? No sane adult would think that it’s a good idea for children to watch hardcore pornography. And because we all agree kids should be watching Peppa Pig rather than The Poonies, the act has been waved through virtually unchallenged.

So, let’s put the issue of hardcore pornography to one side, because surely we are all in agreement. I’m asking you to look at the bigger picture. It’s not just children who will be censored and it’s not just Pornhub and Redtube which will be forced to age check UK viewers. This act will potentially censor any UK site that carries adult content, which is broadly defined by the BBFC as "that it was produced solely or principally for the purposes of sexual arousal".

I am a UK academic and research the history of sexuality. I curate the online research project www.thewhoresofyore.com, where academics, activists, artists and sex workers contribute articles on all aspects of sexuality in the hope of joining up conversations around sex that affect everyone. The site also archives many historical images; from the erotic brothel frescoes of Pompeii to early Victorian daguerreotypes of couples having sex. And yet, I do not consider myself to be a porn baron. These are fascinating and important historical documents that can teach us a great deal about our own attitudes to sex and beauty.

The site clearly signposts the content and asks viewers to click to confirm they are over 18, but under the Digital Economy Act this will not be enough. Although the site is not for profit and educational in purpose, some of the historical artefacts fit the definition of  "pornographic’" and are thereby liable to fall foul of the new laws.

And I’m not the only one; erotic artists, photographers, nude models, writers, sex shops, sex education sites, burlesque sites, BDSM sites, archivists of vintage erotica, and (of course) anyone in the adult industry who markets their business with a website, can all be termed pornographic and forced to buy expensive software to screen their users or risk being shut down or fined. I have contacted the BBFC to ask if my research will be criminalised and blocked, but was told "work in this area has not yet begun and so we are not in a position to advice [sic] you on your website". No one is able to tell me what software will need to be purchased if I am to collect viewers' credit card details, how I would keep them safe, or how much this would all cost. The BBFC suggested I contact my MP for further details. But, she doesn’t know either.

Before we even get into the ethical issues around adults having to enter their credit card details into a government database in order to look at legal content, we need to ask: will this work? Will blocking research projects like mine make children any safer? Well, no. The laws will have no power over social media sites such as Twitter, Snapchat and Periscope which allow users to share pornographic images. Messenger apps will still allow users to sext, as well as stream, send and receiving pornographic images and videos. Any tech savvy teenager knows that Virtual Private Network (VPN) software will circumvent UK age verification restrictions, and the less tech savvy can always steal their parents' credit card details.

The proposed censorship is unworkable and many sites containing nudity will be caught in the crossfire. If we want to keep our children "safe" from online pornography, we need to do something we British aren’t very good at doing; we need to talk openly and honestly about sex and porn. This is a conversation I hope projects like mine can help facilitate. Last year, Pornhub (the biggest porn site in the world) revealed ten years of user data. In 2016, Brits visited Pornhub over 111 million times and 20 per cent of those UK viewers are women. We are watching porn and we need to be open about this. We need to talk to each other and we need to talk to our kids. If you’re relying on government censorship to get you out of that tricky conversation, you are letting your children down.

The NSPCC report into children watching online pornography directly asked the participants about the effectiveness of age verification, and said the children "pointed out its limitations". When asked what intervention would most benefit them, this was the overwhelming response: "Whether provided in the classroom, or digitally, young people wanted to be able to find out about sex and relationships and about pornography in ways that were safe, private and credible." I suggest we listen to the very people we are trying to protect and educate, rather than eliminate. 

Dr Kate Lister researches the history of sexuality at Leeds Trinity University