The harm done
Jul 26th 2001
From The Economist print edition
Drugs cause many problems, but they need to be kept in
perspective
IN A former warehouse under
Manhattan bridge in New York, now
home to a therapeutic community run
by Phoenix House, 42-year-old Michael
talks sadly of the cost of 30 years on
heroin and crack cocaine. “I couldn't
see further than the next bag of dope.
I was hustling, shoplifting and getting
high. I couldn't deal with people. I
have a 14-year-old son that I could
never look after.”
Michael has now been voluntarily at
Phoenix House for four months,
learning how to cope with others and
with himself. He is well-dressed,
articulate and eager to escape. The
desire to be a decent father to his
son, coupled with the skills training
and accommodation that Phoenix House provides, may be just
what he needs to kick his habit, get a job and rejoin the human
race. Gabriel has a tougher job ahead: he has been in a clinic in
Tijuana, just south of Mexico's border with the United States,
after spending 14 of his 30 years on methamphetamines. His
mother, who once threw him out for stealing from her, found him
ragged and emaciated, and persuaded him to go for treatment at
one of Mexico's very few professionally run clinics. Now sleek and
handsome, he is off drugs. But he will struggle to find work, and
will return to live in the same community where his addiction
began.
Many people take drugs because they get pleasure from them. To
those who prefer a glass of burgundy and a cigar, that may seem
hard to understand. It is, however, improbable that so many
people would spend so much money on voluntarily eating, smoking
or sniffing drugs if doing so brought them nothing but misery.
That said, though, abusing drugs
undoubtedly wrecks many lives. Once
people become truly dependent, it can
take them years to break the cycle. As
with cigarettes, the pleasure then consists mainly of avoiding the
pain of giving up. But the vast majority of drug users end up like
neither Michael nor Gabriel. They go through a period when drugs
form part of their lives, and then they move on. Peter Cohen, of
the Centre for Drug Research at the University of Amsterdam,
followed a sample of cocaine users whom he describes as typical.
After ten years, 60% had become completely abstinent and 40%
remained occasional users. “Most drug users ultimately stop,” he
says. “Drugs no longer fit their lifestyle. They get jobs, they have
to get up early, they stop going to the disco, they have kids.”
The dangers of drugs should not be underestimated, but nor
should they be exaggerated. With the exception of heroin, drugs
contribute to far fewer deaths among their users than either
nicotine or alcohol. In America, for instance, tobacco kills
proportionately more smokers than heroin kills its users, and
alcohol kills more drinkers than cocaine kills its devotees.
Consuming a drug is rarely the only cause of death. More often,
the user is taking some extra risk. That is true even for heroin.
The European Monitoring Centre for Drugs and Drug Addiction
(EMCDDA), which collects and analyses European statistics,
reports that the mortality rate for people who inject heroin is two
to four times as high as that for non-injectors, mainly because of
the danger of contracting HIV or hepatitis from dirty needles.
“Acute deaths related solely to cocaine, amphetamines or ecstasy
are unusual,” says the EMCDDA in a recent report, “despite the
publicity they receive.” Dr van Brussel, the addiction care expert,
agrees: “We have about 100 deaths a year from heroin addiction
in the Netherlands,” he says, “but only one or two from cocaine.”
Even though much of the world's ecstasy passes through the
Netherlands, the country has only one death a year of a person
with ecstasy in his bloodstream. Even then, it is rarely clear that
ecstasy (MDMA) alone is the killer. According to Charles Grob, a
professor at the UCLA School of Medicine, people who take MDMA
incur health risks mainly if they are already unfit. He recalls one
man, who had experienced no previous problems with ecstasy,
whose blood pressure began to rise alarmingly after taking it. It
transpired that he had stayed at a friend's house, and used an
asthma inhaler because he was allergic to his friend's cat. It was
the combination of substances that had caused the trouble.
Even drugs that do not kill people may still hurt them. More and
more evidence suggests that drugs may affect brain activity.
Some even hint that marijuana, regarded by its fans as safer than
sugar doughnuts (and less addictive), may do damage. A study
recently reported in the American Heart Association's journal
suggested that for middle-aged people the risk of a heart attack
rose by nearly five times in the first hour after smoking marijuana.
But the overall impression remains that, in the words of the
Lancet, a British medical journal, “It would be reasonable to judge
cannabis less of a threat than alcohol or tobacco...On the medical
evidence available, moderate indulgence in cannabis has little
ill-effect on health.”
Whereas some drugs harm people's health, some may also do
good. Hospitals still use heroin derivatives to treat pain. They
cannot usually prescribe marijuana, even though a study published
by the Institute of Medicine in 1999 suggested that marijuana
could help to treat nausea, loss of appetite, pain and anxiety. In
America, such findings have turned medical marijuana into the main
issue in the campaign to soften the law on drugs.
Health apart, drugs cause other kinds of
harm—not just to the individual user but
to society at large. Crack cocaine seems
to be linked to domestic violence,
marijuana makes workers groggy, no drug
is good for motorists. And some people
who use drugs heavily—“chaotic” drug
users – are disproportionately likely to
commit crimes. A mere 5,000 of the
country's estimated 25,000 hard-drug addicts are responsible for
about half of all petty crimes committed in the Netherlands,
guesses Bob Keizer, drugs policy adviser to the Dutch Ministry of
Health.
Crime and chaos
Given the expense of a heavy habit, petty crime is an obvious
income source. However, Michael Hough, director of the Criminal
Policy Research Unit at the University of the South Bank in
London, believes that the link is not simple. Rather, the sort of
person who becomes a “chaotic” drug user is also
disproportionately likely already to be an “acquisitive offender”: a
thief, shoplifter (the addict's crime of choice) or burglar. “The
preconditions for starting on heroin are to be a risk-taker, and to
have quite a bit of money,” he says. He points to a study of
people arrested in Britain, by Trevor Bennett of Cambridge
University, which calculated that the cost of consuming heroin and
crack accounted for 32% of criminal activity.
Where drug use directly harms society, government is right to
intervene. But the best way to protect society is not necessarily
to ban drugs. If that were the right course, governments would
begin by banning alcohol, which causes far more aggression and
misbehaviour than any other substance, licit or illicit. Instead,
governments everywhere pursue tougher policies against drugs,
some of which are more harmful than the drugs themselves.