INCLUSION AND SOCIAL CONTROL ARE THE WAYS TO TACKLE DRUGS PROBLEM

Professor Neil McKeganey (October 25) writes that "Perhaps what we
need is a good deal more intolerance of all illegal drugs". We are
perplexed at this opinion, which contradicts the evidence about
solutions to drug problems. Be intolerant of the psychological, social
and economic conditions that perpetuate drug problems, rather than of
use and users.

Near-zero tolerance was tried between about 1980 and 1995,
particularly in the US, while levels of illegal drug use rose to
unprecedented levels. Fortunes are spent trying to diminish the supply
of drugs, with minimal effect. The illegal drugs industry (one of the
world's largest industries) will operate as long as there is demand
for illegal drugs, passing on to the consumer the added costs of
social and legal "intolerance". Increased expenditure on Customs and
police activities would not be worth the cost. Furthermore, it serves
the drugs industry's interests to remain illegal, because operating in
an entirely unregulated fashion maximises profits.

Being intolerant of individual drug users might be an alternative. Is
it possible to stigmatise and socially exclude people having problems
with Class A drugs any further?

The Swedish intolerant approach has indeed suppressed the prevalence
of drug use, but at the cost of inhumane stigmatisation of users. At
one point, there were discussions about isolating all HIV-positive
people on an island. Remember, Sweden takes a similarly intolerant
view of alcohol. The consequences are lower rates of alcohol-related
problems, but a high incidence of heavy binge drinking. An alternative
model is the Netherlands, which has a lower prevalence of use than the
UK despite more accommodation of drug users.

The hyped benefits of zero tolerance policing in the US are due to
other factors, including a generation switching away from crack
cocaine in disgust and alarm at what happened to their older brothers
and sisters. Another example of the difficulties of zero tolerance is
that that prisons cannot be made drug-free, only harsher and more
unstable, as prisoners find ways to obtain drugs despite restrictions;
this in a closed society. Making an open society drug-free may be impossible.

Some success has been achieved in Scotland with socially inclusive
approaches. For example, by prescribing heroin users methadone and
dispensing it on daily visits to community pharmacies. This approach
was inspired in part by Neil McKeganey and Marina Barnard's classic
book on heroin injectors. Other options include abstinence programmes
for those who want them and tackling the conditions associated with
some of the worst drug problems in society, namely poverty and poor
life opportunities. Most Scots have a cannabis user among their
friends and family, whether they know it or not, as over 20% of
younger adults have used in the previous year. Should we not also be
intolerant of alcohol and tobacco, not mentioned in Neil McKeganey's
article?

Not really: shuffling the classification of the drugs people get high
on is beside the point. People can come to harm using any drug, or
alcohol, or tobacco. They can also use most of these drugs, up to and
including heroin and cocaine, without harm, as our own research has
found. We need realistic mores, with formal and informal regulation of
drug and alcohol use so that people come to the least harm possible.
We should also tackle the social causes of problem drug-use.
Intolerance on the other hand simply fosters a criminal and ethical
free-for-all that relinquishes social control over who uses what,
where, how, at what age and with whom.

Professor Richard Hammersley, Director, Centre for Behavioural Aspects
of Health and Disease, Glasgow Caledonian University; David Shewan and
Roger Houchin, Co-directors, Glasgow Centre for the Study of Violence,
Glasgow Caledonian University; Professor Lawrie Elliott, Centre for
Integrated Healthcare Research, Napier University, Edinburgh;
Professor Avril Taylor, Director, Institute for Applied Social and
Health Care Research, University of Paisley; Niall Coggans, Institute
of Pharmacy and Biomedical Sciences, University of Strathclyde,
Glasgow; Phil Dalgarno, Centre for Behavioural Aspects of Health and
Disease, Glasgow Caledonian University.