1 IN 20 USED ILLICIT DRUGS IN THE PAST YEAR

Data on illicit drug use are sorely lacking. It is no coincidence
that public policy in this area is abysmal.

Our response to drug use is, by and large, moralistic and vengeful,
not evidence-based.

While we spend billions of dollars on the "War on Drugs," there has
been a pittance spent on research to understand the root causes of
drug use (and addiction in particular), little dispassionate
examination of the harms that result and, especially, analysis of the
responses that will minimize those harms

If you want to fashion sound public-health policies, you need good data.

So a new series of studies, published in the Lancet, is a welcome
contribution.

The paper prepared by Louisa Degenhardt of the National Drug and
Alcohol ResearchCentre in Sydney, Australia, has received the most
attention. It shows that at least one in 20 people aged 15 to 64 used
illicit drugs in the past year.

That includes an estimated:

- - 125-203 million cannabis users (marijuana);

- - 56 million amphetamine users (speed, crystal meth);

- - 12-21 million problem users of opioids (heroin, oxycodone);

- - 14-21 million cocaine users.

The researchers did not include data on use of drugs like
hallucinogens, inhalants, steroids, or prescription drugs that are
abused because data are unreliable.

Dr. Degenhardt said the numbers are no doubt an underestimate. "Drug
use is often hidden, particularly when people fear the consequence of
being discovered for using drugs, such as being imprisoned," she said.

Worldwide, illicit drug use accounts for about 250,000 deaths each
year. That is significant but still doesn't not compare to the deadly
impact of legal drugs like alcohol, which kills 2.3 million a year,
and tobacco, which causes 5.1 million deaths annually.

Still, the vast majority of users of illicit drugs particularly
so-called soft drugs like cannabis do not suffer appreciable harm.
There are some societal costs like injuries from drugged driving,
lost productivity and the violence sometimes associated with drug misuse.

But the real problems, individually and socially, stem from the
minority of problematic or dependent users addicts, in the common
parlance. The new research estimates there are about 39 million
addicts worldwide, most of them injection drug users.

Addiction is a disease, not a choice. But there is no doubt the
disease and the drug-seeking leads to many poor choices.

In addition to the overdoses they suffer, IV drug users are at high
risk of contracting infectious diseases like hepatitis and HIV-AIDS,
and often turn to risky practices like selling sex and committing
crimes like break-ins to fuel their addiction.

Paradoxically, it is those who suffer the most harm physically who
bear the brunt of public policies, most of which focus on repressive measures.

The key question: Do those policies achieve what we want to make
the general population healthier and safer? For the most part, the
answer is "No," according to a second paper in The Lancet that was
prepared by a team led by John Strang of the National Addiction
Centre in London (which included Benedikt Fischer of Simon Fraser
University in Burnaby, B.C.) The main anti-drug strategy worldwide is
to try and control supply in a bid to drive up prices and make drugs
less accessible. This includes imprisoning drug suppliers and
dealers. Enforcement and sanctions vary dramatically from country to country.

The research shows that incarcerating high-level dealers like
Colombian drug barons can have an impact on supply and prices, at
least temporarily, but street-level enforcement is generally costly
and ineffective.

Prolonged imprisonment of drug users is also very expensive and does
little to reduce illicit drug use. Researchers found, however, that
specific, immediate and brief sentences with mandated testing of
offenders is quite effective at reducing drug use and associated crime.

Legalization, or decriminalization, is often touted as a solution,
but the study notes that most research in this area is of poor
quality. However, there is good circumstantial evidence that
decriminalization is effective at moving cannabis users away from
other drug markets.

On the prevention front, the news is rather grim. School-based and
mass media programs alike are generally ineffective at influencing
behaviour. There is a little bit of evidence showing that
family-based or parenting programs might help young people make
better choices. What works best, though, is secondary
prevention intervening early with those who misuse drugs (or
alcohol). In other words, they need treatment, not didactic lectures
and not punishment.

Similarly, this is the approach that has shown to be the most
influential with problematic users.

There is good evidence, for example, that opioid substitution with
drugs like methadone or buprenorphine reduces mortality, heroin use,
crime, HIV and hepatitis infections. Residential rehab programs gets
good marks, but the quality of the research is mediocre. Rehab is
also expensive, although less expensive than prison.

In short, the research shows that when it comes to illicit drugs, the
focus needs to be on the problematic users, and that public-health
measures work better than criminal sanctions.

There is no magic bullet not zero tolerance and not supervised
injection facilities. Rather, a broad range of interventions are
required, targeting different drug problems.

The hardest part of this approach may be setting aside our prejudices
and preconceived notions to adopt evidence-based approaches that are
not always politically popular.

As The Lancet notes in an editorial highlighting the new research:
"Few diseases can compete with addiction in their capacity to
generate misinformation, misjudgment, or misunderstanding."

Addiction is a complex disease a global problem that has no global
solution, but rather many community-based solutions.