Dagga not linked to middle age mental decline

Middle-aged adults whose memories have grown hazy can’t blame occasional pot smoking or other light illicit drug use for their forgetfulness, according to a British study, although experts warn heavy, prolonged use could harm mental functions. 

The study, carried in the American Journal of Epidemiology, tested the mental function and memory of nearly 9 000 Britons at age 50 and found that those who had used illegal drugs as recently as in their 40s did just as well, or slightly better, on the tests than peers who had never used drugs.      

Marijuana was by far the most common indulgence for the participants — who were surveyed at age 42 about current or past drug use, then tested at age 50 — with 6% saying they had used it in the past year, while one-quarter said they had ever used it.     

Other drugs they were asked about included amphetamines, LSD, hallucinogenic mushrooms, cocaine and ecstasy — with anywhere from 3% to 8% of study participants saying they’d ever used those drugs.       

“Overall, at the population level, the results seem to suggest that past or even current illicit drug use is not necessarily associated with impaired cognitive functioning in early middle age,” said lead researcher Alex Dregan, of King’s College London.     

“However, our results do not exclude possible harmful effects in some individuals who may be heavily exposed to drugs over longer periods of time.”        

A small subset of participants who said they had ever been treated for their drug use, which could suggest heavy or addicted drug use, did not fare as well cognitively at 50, but there were too few of them to draw meaningful conclusions, the study authors noted.     

Dregan’s team used data on 8 992 42-year-olds participating in a UK national health study, who were asked if they had ever used any of 12 illegal drugs. Then, at the age of 50, they took standard tests of memory, attention and other cognitive abilities.     

Overall, the study found, there was no evidence that current or past drug users had poorer mental performance. In fact, when current and past users were lumped together, their test scores tended to be higher.     

But that advantage was small, the researchers said, and might just reflect another finding — that people who’d ever used drugs generally had a higher education level than non-users.     

“In a Western population of occasional drug users, this is what you’d expect to see,” said John Halpern, a psychiatrist at Harvard Medical School and McLean Hospital in Belmont, Massachusetts, who has studied the potential cognitive effects of drug use.      

“In some ways, this is not surprising. The brain is resilient.”     

Though some studies have found that drugs like marijuana and cocaine may cloud thinking, memory and attention in the short term, the current findings support the notion that those effects may be temporary, Dregan’s team said.     

Halpern noted that work focusing on people who have smoked pot regularly for years showed that once they stop the drugs, their deficits on cognitive tests improve after a month.     

Still, he said this should not be taken as an endorsement of drug use, noting that the current study did not rule out the possibility of lasting negative cognitive effects from heavy, prolonged drug use. 

- Timeslive

Report shows fewer traffic fatalities after states pass medical-pot laws

The passage of state medical-marijuana laws is associated with a subsequent drop in the rate of traffic fatalities, according to a newly released study by two university professors.

The study — by University of Colorado Denver professor Daniel Rees and Montana State University professor D. Mark Anderson — found that the traffic-death rate drops by nearly 9 percent in states after they legalize marijuana for medical use. The researchers arrived at that figure, Rees said, after controlling for other variables such as changes in traffic laws, seat-belt usage and miles driven. The study stops short of saying the medical-marijuana laws cause the drop in traffic deaths.

"We were pretty surprised that they went down," Rees said Tuesday.
The study was posted this month on the website of the Bonn, Germany- based Institute for the Study of Labor and has not yet been peer-reviewed.

Rees said the main reason for the drop appears to be that medical-marijuana laws mean young people spend less time drinking and more time smoking cannabis. Legalization of medical marijuana, the researchers report, is associated with a 12-percent drop in the alcohol-related fatal-crash rate and a 19-percent decrease in the fatality rate of people in their 20s, according to the study.

The study also found that medical- marijuana legalization is associated with a drop in beer sales. "The result that comes through again and again and again is (that) young adults . . . drink less when marijuana is legalized and traffic fatalities go down," Rees said.

The study is sure to add fuel to a debate over the impacts of Colorado's medical-marijuana boom on traffic safety, which has embroiled cannabis advocates and law enforcement officials for more than a year.

The state legislature this year rejected a bill that would have set a threshold of THC — the psychoactive chemical in marijuana — that would qualify someone as too stoned to drive. After more research and a fractious debate, the Colorado Commission on Criminal and Juvenile Justice will not recommend that the legislature try again with such a bill this year.

"The working group was not able to come to consensus," said Arapahoe County Sheriff Grayson Robinson, who led the subcommittee that studied the issue.

Much of that debate has focused on marijuana's impact on an individual's driving abilities. Rees and Anderson say their study does not mean it is safer to drive stoned than drunk. Instead, they write, increased medical-marijuana usage at home might change patterns of substance use and driving.

Mason Tvert, the head of the pro- marijuana-legalization group SAFER, said the study suggests legalizing marijuana would be beneficial in unexpected ways.

"People who are drinking drive faster, take more risks, underestimate how impaired they are," he said.

- Denver Post

SA is a nation of boozers, addicts

The average South African drinks a bakkie-load of booze a year, or 20.1litres of pure alcohol, research by the Central Drug Authority has found.

The authority 's acting chairman, Dr Ray Eberlein, told a parliamentary committee yesterday: "If we had a boozing world cup, South Africa wouldn't even have to practise."

The 20.1 litres are equivalent to 196 six-packs of beer, 62 bottles of spirits, 220 bottles of wine or 666 cartons of sorghum beer.

Eberlein told MPs that about 37% of South Africans "drink from early Friday afternoon until Monday morning, staying drunk all weekend".

"The worst of it all is on Monday, when 10% of the people on the road are likely to be drunk."

The research, which surveyed more than 200 000 people nationally between June last year and March, also found that the rates of substance abuse in South Africa were very high, with the use of drugs such as dagga and cocaine being twice the global average.

South Africans, said Eberlein, were among the top 10 consumers of alcohol globally.

He warned that binge drinking was becoming a serious problem - about 7000 people are killed by drunken drivers each year.

The authority also found that the problem of alcoholism had worsened since March.

The damage caused by alcohol abuse is estimated at R78-billion a year.

Eberlein also raised the alarm bells about a string of new addictive substances flooding into South Africa.

Eastern Cape and KwaZulu-Natal are awash with nicotine-rich "kuber", which is labelled as breath freshener and sold in shops in plastic sachets.

Eberlein said that, though the authority is still waiting for the results of drug analyses, the substance has reportedly been banned in Malawi because it is highly addictive.

Kuber reportedly sells for between R2.50 and R5 for a small packet.

The Times' sister publication, the Sowetan, reported earlier this year that Durban street vendors were selling a chewable tobacco as a "Chinese sweet" that "prolonged sexual enjoyment".

In Limpopo, children were plucking the ephedrine based-khat - khat is a flowering plant endemic to East Africa - and chewing it on their way to school.

The drug is also vacuum-packed and transported to Cape Town in refrigerated trucks, he said.

Tik was rapidly spreading from Cape Town to the Northern Cape, and pupils are also mixing cocaine with lip-ice, Vaseline, or Zambuk so that they can apply the drug to their lips during school hours.

"We have no indication that this is yet being sold," he said.

Eberlein said the Central Drug Authority had recently detected a 61% increase in the growth of opium-producing poppies in Afghanistan.

"So we are expecting an increase in opium on our shores and a drastic reduction in the price," he said.

With many drug users earning less than R1000 a month, "economic necessity dictates that drug users consume whatever they can get their hands on".

The Times reported last month that, according to the SA Community Epidemiology Network on Drug Use, the most popular narcotic for people younger than 20 in Western Cape is dagga, followed by tik.

- timeslive

Let’s talk ‘people’ and not ‘addicts’

There is no silver bullet in dealing with drug problems in our society. If we want solutions, we need a co-operative effort that has realistic, implementable and sustainable plans. More than that, these plans need to use a multipronged approach based on reason, research, knowledge and compassion.

Tony Ehrenreich’s suggestion (Friday Grill, October 14) that we need a “leader” in the “battle on drugs” looks at the drug problem, and more especially the solution, in a one-dimensional way.

Second, there is no “battle on drugs”. That is so last century. Unfortunately it is often the media that perpetuate such emotive terminology. The entire world has discovered that the “war on drugs” has been an enormous mistake. It has not only wasted financial and human resources, but has actually exacerbated some of the problems.

One “unintended consequence” of the drug war is that people can’t distinguish between the drug and the users. It makes it more difficult for people to access treatment because of the stigma – they feel the “war” is against them.

The worst unintended consequence was in Mexico, where it turned into a gang/drug war that has cost 25 000 Mexicans their lives. Some were even killed while they were in residential treatment or rehab.

Methamphetamine (tik) is the most widely used illicit drug in the world, except for cannabis. Forty million people worldwide regularly use tik, according to the UN World Drug Report, about 10 million use cocaine and 15 million use heroin.

We need to understand that it’s not only South Africa that has drug problems, nor indeed only the Western Cape – it’s global.

Our illegal drug problems came later than more developed countries, and they came rapidly. Seventeen years ago our only illegal drugs were dagga, mandrax and Welcanol. We were underprepared for the flood of drugs like tik, heroin, cocaine and crack through our borders.

Research tells us that alcohol and drug use underpins most of our family and community challenges – crime, violence, risky sexual behaviour, unemployment, abuse and poverty. Alcohol misuse alone is going to cost the Western Cape more than R3 billion in the next year

We need to learn from those who have gone before us; countries that have been dealing with tik for more than 20 years and with heroin for 40. Some of these countries are years ahead of us in skills, resources and systems, and have found many solutions, but still have drug problems.

It is worth noting that rather than dragging their feet over the past five years, as Ehrenreich implies, the City of Cape Town and the Western Cape government have developed free interventions that are being complimented by professionals around the world.

The Matrix Institute on Addictions at UCLA has been successfully treating people with tik problems for the past two and a half decades.

The institute’s executive director, Jeanne Obert, recently wrote about Tafelsig Clinic in Mitchells Plain, the first of the city’s four free drug and alcohol treatment programmes: “Let me say that the Tafelsig Clinic is one I talk about all the time with people all over the world. The most amazing thing about that clinic is that you established it within a primary health care setting where it is just one of a number of services offered to surrounding residents.

“Countries like the US are struggling to emulate such a model. Giving patients access to such a wide array of services without sending them to many different locations is a wonderful and very futuristic model.”

The same model has been used in the Cares (Community Awareness, Rehabilitation and Education Services) project in Hout Bay. This is a prime example of everyone working together – civil society and the provincial departments of social development and health are partners in the project.

There is a wealth of local and international research that tells us what works, and there’s even more that tells us what doesn’t.

Drugs are a great leveller. It doesn’t matter what faith, nationality, colour, gender or social status, individuals, families and communities all have the same feelings of hopelessness and helplessness. A drug- or alcohol-affected family suffers the same anguish whether they live in Bishop Lavis or Bishopscourt. The difference is that one suffers in more comfort. But suffer they do.

All spheres of government have realised that drug problems are complex medical and social issues and there is no quick fix. There have to be inclusive plans with clear and measurable objectives; everyone needs to know what the plan is, what their roles and responsibilities are, and have enough knowledge to make informed decisions.

If all structures develop multi-pronged interventions, we’ll be making huge strides forward.

All spheres of government understand that the solutions lie in two separate, yet parallel, strategies: supply reduction and demand reduction.

Supply reduction includes police, customs and other law enforcement agencies, the criminal justice system and projects such as Ceasefire and Violence Prevention through Urban Upgrading.

Demand reduction is all about a range of services, from prevention, treatment and after-care, to education, skills development and job creation. If we are successful with demand reduction it has a huge impact on supply reduction, and vice versa.

We need to intervene on every level and not wait until someone has become dependent. But we must ensure our interventions are practical, research-based and effective, not simplistic one-line messages or one-off talks at schools.

One key component is building knowledge, capacity and skills among our service providers. However, we need to ensure public money is well spent by the government on effective “training” programmes. In the past this sometimes wasn’t the case. Training was often eclectic, unmonitored and hardly ever sustainable.

An example would be the extensive (and expensive) “training” the previous provincial administration gave to religious leaders, Cosatu, the Siyavulela campaign (1 000 random community members) and others. Had this “training” been effective, Ehrenreich would be more informed.

The current provincial administration has recognised this as a problem, and so has provided bursaries at all three universities in the Western Cape for specific courses on addictions – a first in South Africa. It might also be a good idea for them to make sure city councillors and provincial MECs also receive reliable information so they can engage in informed debate.

The city has had a measurable strategic plan between 2007 and last year. It has achieved much of this, and in the new strategy moving forward to 2015, this will help communities to develop strategies for managing their specific drug problems and challenges.

It will also be an effective way of identifying referral routes and gaps in services, and planning community-based prevention and education campaigns and interventions.

As we learn more about what does and doesn’t work globally, we need to make changes. Language is one of the more subtle components needed to create change.

I would argue that for a newspaper to ask if “Cosatu (sic) and the ANC in Cape Town view drugs as a scourge akin to apartheid” is at best naive, at worst irresponsible and uninformed.

Newspaper reports, no matter how positive, often refer to “addicts”.

Often people refer to themselves as addicts but this is generally after they have stopped using drugs – and they are talking about themselves.

Let’s start talking about “people” with alcohol and drug problems rather than the stigmatising word “addict”, or worse still, “tikmonster”.

People with alcohol and drug problems, and their families, suffer. Let’s start to restore the individuals, their families and our communities, and let’s do it in a spirit of unity.

We need to start living in the solution and not dwelling in the problem, and we need to make sure everything we do is based on reason, research and compassion.

* Fisher is the executive director of Smart (Substance Misuse: Advocacy, Research, Training)

Sauce

Drinking is dangerous

The alcohol and advertising industries have recently circulated a petition aimed at pressuring government to abandon its intended ban on advertising alcohol.

Their view is that while alcohol as a product has disastrous effects on individual users, families and communities, government should not focus on advertising or other strategies to reduce the demand and supply of alcohol. Instead, we should focus on the underlying factors driving alcohol abuse.

To them, the driving factors are solely the high levels of poverty, joblessness and the more vague notions of family issues.

We welcome their acknowledgement that alcohol has significant negative impacts, but we are committed to using evidence-based strategies to reduce the harm caused by alcohol use and abuse.

Before looking into strategies to reduce alcohol-related harm, it is useful to discuss the product itself.

Beneath the fancy bottling, packaging and slick advertising linking alcoholic products to sporting prowess, business savvy and overwhelming sexiness, lies a drug called ethanol.

Ethanol is the drug found in beer, wines and spirits similar to the active ingredient Tetrahydrocannabinol (THC) that is found in the plant marijuana.

Like THC, ethanol when ingested – as a cold beer, in wine and in a shot of even the most expensive whisky – impacts negatively on the physiology of the drinker and impairs his or her senses.

The drinking of ethanol in its fancy packaging has been identified as a leading risk factor for death and disability globally. In an article due to be published in the journal Addiction, entitled “Alcohol Consumption and Non-Communicable Diseases: Epidemiology and Policy Implications” by Charles Parry, Jayadeep Patra and Jurgen Rehm, the role of alcohol as a risk factor in the spread of Non-Communicable Diseases (NCDs) is outlined clearly.

They found that alcohol accounted for 3.8 percent of deaths globally and 4.6 percent of Disability Adjusted Life Years in 2004. Alcohol was found to be the fifth highest risk factor for deaths in middle income countries. In terms of Disability Adjusted Life Years lost in 2004, alcohol ranked first in middle income countries. With South Africa being a middle income country, the scale of the problem is clearly a cause for alarm.

Parry et al also cite the International Agency for Research and Cancer which asserted that there was significant evidence for a causal link between alcohol and cancer of the oral cavity, pharynx, larynx oesophagus, liver, colon, rectum and female breast. These cancers showed evidence of what is known as dose-response relationship.

That is, the more people drink ethanol through their brand of choice, the higher the risk of getting any of these life-threatening illnesses. This research is backed up by similar evidence garnered by the World Health Organisation and medical research done here and abroad. Alcohol is not just another consumer product, but impacts negatively on the health of those who consume it and places an enormous strain on the health system.

The relationship between alcohol and social disorder may be worse. The South African Health Information network, using research by the Medical Research Council, indicates that alcohol intoxication is associated with morbidities arising from intentional and non-intentional injuries, with increased risk of contracting sexually transmitted diseases. It impacts negatively on the criminal justice system as the evidence indicates a significant association between drinking and committing or being a victim of a crime.

Mortuary statistics for 2002 indicate that alcohol played a role on average of up to 46 percent of transport-related deaths and homicides. The picture was more alarming in the metro areas where for example, in Port Elizabeth, alcohol accounted for 63 percent of transport-related deaths and 69 percent of homicides. The figures for the other major cities were equally startling.

In addition, research conducted by the Crime Research and Statistics component of Crime Intelligence over the past decade, has confirmed that about 70 percent to 80 percent of murders, 60 percent of attempted murders, 75 percent of rapes and 90 percent of all assaults involve victims and perpetrators who know one another.

The analysis indicates that alcohol, and to a lesser extent other drug abuse, frequently played a role in these crimes. This is why the five crimes in question are referred to as social contact crimes. The latest research indicates that roughly 65 percent of murders are associated with social behaviour fuelled by alcohol abuse.

The evidence related to the negative impact of alcohol on the health of South Africans and the social fabric shows that we have to be robust in reducing the harm caused by alcohol. This means we have to implement measures that will reduce exposure of young people and the general population to advertising that falsely portrays carefully packaged ethanol as being cool and successful.

We have to ensure that we raise the price of alcohol to make it less accessible. We have to ensure that we regulate the number of licensed outlets so that we limit access. We have to put in place measures that will raise the legal age for buying alcohol so that we can protect our youth and become very strict with regard to drink driving.

These strategies are regarded as common sense and serve as guidelines for good policy by the World Health Organisation.

The alcohol and advertising industries on the other hand would want us to ignore best practice and evidence garnered from local and international experts and have us focus on the one area that has been shown in research to be the least effective, that is, public education.

Public education and awareness campaigns are only successful if accompanied by legislative measures such as the restriction of advertising and increasing the price of alcohol. We intend to implement all these measures and not just one or two.

We are aware that alcohol consumption has occurred for thousands of years and is seen as part of “our culture”. However, many of its varied health effects have been discovered fairly recently. Notwithstanding this relatively new evidence of the link between alcohol consumption and its negative health and social consequences, we have to battle a well-resourced industry tasked with saving its bottom lines and preserving alcohol as part of a cultural identity that makes it an acceptable drug.

We hope that the public sees the difference between our attempts to promote public health and social integrity and the attempts of the industry to maintain the unhealthy status quo.

I would like to re-tell a story published by James Siddall, on his struggle with addiction. He tackles the myth related to drugs that asserts that “if it’s legal, it can’t be that bad”. He quotes William L White, author of the book Pathways From the Culture of Addiction to the Culture of Recovery: A Travel Guide for Addiction Professionals, who writes that society celebrates alcohol, tolerates nicotine and prohibits other drugs such as marijuana and cocaine.

White suggests that what separates legal from illegal substances is, to a huge degree, society’s perception (culture).

White further writes that anyone using prohibited drugs is painted as bad and worse. Alcohol, on the other hand, is part of the warp and weft of Western society. Never mind that, more than any other drug, it attacks every single organ and tissue in the body and has incalculable social costs.

He emphasises the dangers of alcohol by pointing out that alcohol is one of the few substances whose withdrawal can kill. Not even heroin shares that dubious quality.

Dlamini is Minister of Social Development

- Sunday Independant

‘Cannabis should be legalised in UK’

Cannabis should be legalised in Britain and all other personal drug use decriminalised, delegates voted on Sunday by an overwhelming margin.

They called for the creation of a panel to review the 1971 Misuse of Drugs Act so that “possession of any controlled drug for personal use would not be a criminal offence”.

The motion said those caught with hard drugs should be dispatched to a panel of social workers.

It also paved the way for the British government to set up “a strictly controlled and regulated cannabis market” - effectively legalising the drug.

Ewan Hoyle, from South Glasgow, proposed the policy and told the conference that politicians had not tackled the issue because of “cowardice”.

He said: “The motion calls for models of cannabis regulation to be investigated. I personally favour sale from pharmacies.”

George Miles, a delegate sporting a green T-shirt emblazoned with the image of a cannabis leaf, declared: “John Lennon and Eric Clapton didn’t say legalise heroin or cocaine, but Bob Marley says legalise cannabis.”

The plans immediately become binding Liberal Democrat policy, though they will not be enacted by the government because they are not in the coalition agreement.

The proposals will be opposed not just by the Tories but also by the Labour Party, which got into a huge mess over the classification of cannabis.

When the Blair government reduced it to a Class C drug, evidence from scientists about its psychotic properties caused a U-turn.

Tory MP Charles Walker said the Lib Dem motion “sends out the message that taking drugs is okay but it is not”.

He added: “If the Liberal Democrats think taking heroin, cocaine and smoking skunk is OK then that is up to them but the government and I think most people in Britain do not agree with them.” - Daily Mail

‘Alcohol abuse costs SA’

Alcohol abuse costs South Africa's economy R9 billion a year, Deputy Trade and Industry Minister Elizabeth Thabethe said on Monday.

This amounted to one percent of the country's gross domestic product, she told the start of a Sobriety Week campaign in Pretoria, according to a statement issued by her office.

“According to the World Health Organisation, the annual liquor consumption by South Africans amounts to 7.81 litres of pure alcohol per person. This level of consumption ranks South Africa 52nd on a list of 191 countries.”

The effects of alcohol abuse on the economy could be seen in absenteeism, poor productivity, high job turnover, interpersonal conflict, injuries and damage to property.

The campaign called on all South Africans to ensure fellow citizens were protected from the irresponsible consumption of, and trading in, alcohol.

Public awareness and education campaigns would be launched in areas where alcohol abuse was most prevalent. - Sapa

WC substance abuse 'fuels mental illness'

Western Cape Health Department officials fear the province may have the highest incidence of mental illness in the country due to high levels of substance abuse.About 75 percent of patients admitted to psychiatric institutions have a history of drug or alcohol abuse.

Health Department officials said more institutions are needed as the patient load increases.

The new Somerset Hospital unveiled its bigger psychiatric unit on Tuesday.

The psychiatric unit’s walls are painted stark white and have bright fluorescent lighting.

Patients addicted to tik, dagga, heroin and alcohol share rooms while undergoing treatment.

One patient dressed in a blue gown banged on his room door in a bid for attention.

If there are psychotic mood swings and outburst patients are isolated in a small room with just a mattress on the floor.

The Health Department’s Dr Linda Hering said nurses are trained to deal with dangerous situations.

Some patients stay an average of five and a half days at a facility, but many of the same patients return over and over for treatment.

(Edited by Lindiwe Mlandu)

Source

Jackson FUCKING IDIOT Mthembu!

A warning from this poster: Jackson FUCKING IDIOT Mthembu , please call me so I can say this to your face!

The Drunk Driving ANC Spokesasshole can't take the blame for failing to raise his own child, who now has a drug problem.

So now he wants to tell society what's it's problems are so that they can fix the problems. YOU DIDN'T NOTICE FOR 5 YEARS - ehm too busy drinking and driving?!?!?!?!

OH Jackson FUCKING IDIOT Mthembu! YOU ARE A FUCKING IDIOT!!!!!!!!!!!!!

You're bad example is WHY YOUR child turned out like this - don't fucking blame anyone else boet!

Dagga plantation found in Atteridgeville

Police discovered a two hectare dagga plantation in Atteridgeville, Pretoria, with an estimated street value of R5-million.

"We've never come across such a huge dagga plantation in Tshwane... It is [larger than] two rugby fields," City of Tshwane spokesman William Baloyi said on Thursday morning. It was located in the Brazzaville informal settlement.

Some 60 officials from the parks division started cutting it down at 9am. It would then be burnt down. This would probably take the whole day.

The discovery was made following a tip-off from local residents.

Baloyi acknowledged Tshwane had a large drugs problem, particularly in schools.

- Timeslive

Time To Decriminalise Drugs? – South African Medical Journal

An article published in the Feb 2011 edition of South African Medical Journal (SAMJ). The article, written by JP de V van Niekerk, editor of SAMJ and former Dean of the UCT faculty of Health Sciencies, broadly covers the failed war on drugs and how South Africa needs to rethink its drug policies. JP de Van Niekerk will also be on on radio today at 3:30pm and will be discussing these issues further. You can tune in on 567 Cape Talk if you’re in Cape Town, or radio 702 if you’re in Johannesburg. Alternatively, you can stream it online.

The drug trade has increased globally in intensity and reach, and substance abuse in South Africa has escalated rapidly. Drug misuse is a major social, legal and public health challenge despite the war on drugs, in which the USA has a disproportionate influence. Why this lack of progress and what can be done about it?

The use of psychotropic substances is as old as human history. Some use drugs as part of religious observations. The majority of people who partake of drugs use them for recreational purposes. Some become addicted and may cause harm to themselves, their families and society. If drugs are bad it seems logical to wage war on them. However, although ‘get tough’ measures sound attractive they are often counterproductive.

Attempts to stem evil

Over the centuries, countries, societies and communities have fruitlessly tried to regulate perceived evils, often related to powerful human needs and drives, namely sex, food and seeking happiness. The Victorians were obsessed with what they perceived as the evils of sex, leading to distorted teachings and actions and much unnecessary emotional suffering.

Despite alcohol having been used since antiquity, many countries have tried prohibiting its use. The most familiar is the failed prohibition experiment in the USA from 1920 to 1933. Breweries and distillers in surrounding countries flourished as widespread bootlegging and organised crime took control of the distribution of alcohol in the USA. Countries have gone to war over drugs: the Opium Wars (1839 – 1842, 1856 – 1860) resulted from trade disputes between China and the British Empire after China sought to limit illegal British opium trafficking. China lost the wars and had to tolerate the opium trade. War-torn Afghanistan now cultivates as much as 90% of the world’s opium, its trade also supporting the Taliban.

In the USA Richard Nixon launched the war on drugs in 1970. Another lifestyle result of human excesses is the rising tide of obesity, though war has not yet been declared on foods.

Harmful substances

The International Narcotics Control Board established by the United Nations under the UN Single Convention on Narcotic Drugs, 1961, lists a vast spectrum of narcotic drugs, psychotropic agents and precursors ‘under international control’. However, the substances that cause by far the most damage to individuals and societies, namely alcohol, cigarette smoking and prescription medicines, are not illegal. (To this we should perhaps add the lifestyle matters of food and sex?)

Harmful drugs are regulated according to classification systems that purport to relate to the harms and risks of each drug. Nutt and colleagues found that the current classification of drugs is unscientific, unsystematic and arbitrary. Using an evidence-based expert delphic procedure they developed and explored a rational scale to assess the harms of illicit drugs and also included five legal drugs of misuse (alcohol, khat, solvents, alkyl nitrates and tobacco). They provide a systemic methodology and process that could benefit regulatory bodies in assessing the harm of drugs of abuse. Their ranking, based on categories of harm (physical harm, dependence, effects on families, communities and society), differed from those in current use. Tobacco and alcohol together account for about 90% of all drug-related deaths in the UK. They are the most widely used unclassified substances, but were both ranked in the top 10 higher harm group and cannabis (marijuana) in the lower 10 (out of 20). Drugs that can be taken intravenously, such as heroin, carry a high risk of death and score highly. Their results also emphasise that excluding alcohol and tobacco from the Misuse of Drugs Act is, from a scientific perspective, arbitrary and that there is no clear distinction between socially acceptable and illicit substances.

Effects of the drug wars

Declaring war means that one must have enemies. In the USA these are the drug dealers but also the users. A large percentage of the population has used and currently uses illegal recreational substances such as marijuana and cocaine. Apprehending these ‘enemies’ has resulted in the USA having the world’s largest prison population, 738 per 100 000 people (other examples per 100000 people are 335 for South Africa, 124 for the UK and 30 for India). A large sector of the population is thus criminalised.

Producer countries have been politically destabilised by the US war on drugs. Huge profits made from cocaine and other drugs from countries such as Colombia, Bolivia, Peru and Brazil, largely because they are illegal in the USA, have resulted in flourishing drug cartels. Those controlling the supply routes to the USA through Mexico and Caribbean countries wreak havoc through their criminal paramilitary and guerrilla groups, with murder, kidnapping, bribery and corruption, money laundering, etc. Coca has been cultivated for centuries in the Andes. Its legitimate uses include chewing the leaves for their mild stimulant and appetite suppression effects, and as a tea that reduces the effects of altitude sickness. Coca farmers are often at the difficult and potentially violent intersection of government-sponsored eradication efforts, illegal cocaine producers and traffickers seeking coca supplies, anti-government paramilitary forces trafficking in cocaine as a source of revolutionary funding, and the hardships of rural subsistence farming. Further pressure to grow coca for the cocaine trade is caused by the dumping of subsidised surpluses of fruit, vegetables, grain, etc., mainly by the USA and European Union.

Drug prohibition inevitably leads to political and police corruption. Jackie Selebi, former head of South Africa’s police and Interpol President, was found guilty of corruption and sentenced for accepting bribes from a drug trafficker in 2010. ‘Wars’ on, for example, local growers of coca, marijuana and poppies increase the price of drugs, lessen competition, and encourage cartels by increasing their potential profits. People who become addicted to substances often cannot fund the high prices of illicit products and turn to drug running, robbery and other criminal methods to meet their needs.

Regulation/legislation

Regulations vary widely from country to country. The UN Single Convention on Narcotic Drugs, 1961, under the auspices of which the International Narcotics Control Board (INCB) was established, was regarded as a milestone in the history of international drug control by its proponents. The Single Convention codified multilateral treaties on drug control, including the cultivation of plants grown as the raw material of narcotic drugs. Its principal objectives are to limit the possession, use, trade, distribution, import, export, manufacture and production of drugs exclusively to medical and scientific purposes and to deter and discourage drug traffickers through international co-operation. The INCB monitors apparent violations of the treaties and addresses those within its mandate.

In the USA, where marijuana may be used for medical use in several states, there is a strong growing movement to have it legalised. However, the official US stance is to strengthen the war on marijuana. Elected officials are willing to acknowledge the failure of the drug war in private, but the degeneration of their political discourse and campaign tactics has made reforming the drug war synonymous with political suicide. And since politicians have short-term interests, who represents the interests of future generations?

South Africa has given much thought and effort to combating the abuse of illicit and legal substances. The Prevention and Treatment for Substance Abuse Act No. 70, 2008, and the National Drug Master Plan 2006 – 2011 seek to reduce demand, reduce harm and reduce the supply of illicit substances (including education and raising awareness) and associated crimes through law enforcement, prevention of community-based substance abuse, early intervention, drug treatment (including rehabilitation and risk reduction) and research. They are supported by many other Acts, government departments, statutory bodies, non-governmental organisations, etc. The City of Cape Town has an Operational Alcohol and Drug Strategy that recognises that the whole community is responsible for tackling the problem. This requires systematic, multifaceted, integrated responses; social inclusiveness; commitment to funding and resource allocation; and recognition that demand reduction is a key principle. The Central Drug Authority is a statutory body established to co-ordinate and direct drug counteraction across South Africa on both the demand and supply side. Further legal sanction is provided by the Drugs and Drug Trafficking Act No. 140 of 1992, which determines what the legal acts are in terms of possession, distribution, manufacture, etc. of ‘any dependence-producing substance; or any dangerous dependence-producing substance or any undesirable dependence-producing substance’. South Africa is signatory to the UN Single Convention on Narcotic Drugs, 1961, and other international and regional agreements concerning drugs.

The case for decriminalisation

The war on drugs has failed! Humans have always taken psychoactive substances and prohibition has never kept them from doing so. The international evidence suggests that drug policy has very limited impact on the overall level of drug use. Making people criminals for taking psychoactive substances is in itself criminal, for one is dealing with, at worst, a vice but not a crime.

The two most widely used legal drugs, alcohol and tobacco, lie in the upper half of the harms ranking. This important information should surely be taken into account in public debate on illegal drug use. Discussions based on formal assessment of harm rather than on prejudice and assumptions would enable a more rational debate about the relative risks and harms of drugs. Pragmatism is urgently needed in debates about these issues and our responses to them. The tone of our debate about responses to the treatment and supervision of drug-dependent offenders should change. Focusing on enforcement and compliance further erodes discretion for those responsible for treating and supervising such offenders. Policy should aim to reduce the harm that drugs cause, and not to embroil more people in the criminal justice system. Society should have some faith in the capacity of drug-using offenders to change, and actively assist and enable them to achieve this goal.

People with a history of drug problems are seen as blameworthy and to be feared. Stigma is a major barrier to their successful recovery and prevents them from playing a more positive role in communities and re-integrating into society. People recovering from drug dependence should be part of the normal community. Such actions have been successfully implemented in some European countries. In the USA there is increasing support for initiatives such as the California Proposition 19, also known as the Regulate, Control and Tax Cannabis Act of 2010, that would have legalised various marijuana-related activities, allowed local governments to regulate and collect marijuana-related fees and taxes, and authorised various criminal and civil penalties.

While much of South Africa’s approach to drug abuse is progressive and enlightened, evidence-based facts and sober reflection suggest that our strategies require re-thinking.

• The Vision of the National Drug Master Plan is a drug-free society. Human history and international experience clearly demonstrate that this does not reflect reality. We should acknowledge this and develop better ways of dealing with human frailty.
• A more evidence-based, nuanced approach to the harms of drugs is required. For example, it makes no sense to legalise the use of alcohol and tobacco but not the less dangerous cannabis
  (which also has beneficial effects).
• Using psychoactive substances may be a vice but should not be considered to be a crime, thus criminalising a large proportion of our citizens.
• Making drugs illicit cedes their control to the drug dealer.
• Escalating the drug war makes drugs more valuable and attracts more participants into the illicit drug economy.
• Improved state control of substances, as with alcohol and cigarettes, could provide taxes and significantly reduce the roles of drug dealers.

A recent MRC Research Brief outlines strategies to effectively address substance abuse problems among young people, but decriminalisation is not mentioned. It is time to face realities squarely and rationally debate the question of decriminalisation. Vested interests in maintaining the status quo will have unexpected support from those who stand to lose the most, namely the drug dealers and those in their pay (including the law and politics). All the more reason to proceed!

J P de V van Niekerk
Managing Editor – South African Medical Journal

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10. Drugs and Drug Trafficking Act No. 140 of 1992.
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- SAMJ

Read the SAMJ Responses

Teens arrested over dagga plantation

Five 14-year-old high school pupils were arrested on Tuesday in Lenasia South for allegedly owning a dagga plantation and dealing in the drug, Gauteng police said.

The eight square metre plantation was discovered when a boy reported to the police after smelling dagga in the area, Lieutenant-Colonel Lungelo Dlamini said.

After being questioned, the boy led the police to the plantation where they found the four boys and arrested them.

“Some of the dagga plants were already picked up and dried. More schoolboys might have been involved.

“It is suspected that they were smoking it and a possibility that they were also selling it to other school children may not be ruled out,” Dlamini said.

The boys would be released to their parents. - Sapa

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