Tue. May 30th, 2023

Good stories often conflict with good science. And it’s hard to imagine a stronger illustration of this collision than the one presented by Johann Hari’s compulsively readable new book, Chasing the Scream: The First and Last Days of the War on Drugs.

The book begins with the juicy story of Harry Anslinger, America’s first “drug czar,” who headed federal narcotics enforcement from 1930 to 1962 and helped us become the world’s drug cop. Mainly focusing on his irrational pursuit of jazz great Billie Holiday, it shows how the crusading narc is the epitome of everything wrong with the drug war.

With in-depth historical research, Hari deftly connects the dots, showing how all the drug war issues were present with his father and at birth. Like our biased enforcement strategies today, Anslinger was racist. He claimed without remorse that the reason marijuana had to be banned was because of its effects on the “degenerate races.” Specifically, he argued, “Reefer makes darkies think they’re just as good as white men.”

Like our enforcement and treatment policies, Anslinger was also hypocritical. After shutting down clinics that successfully supplied maintenance drugs to opiate addicts and relentlessly prosecuting Holiday for her heroin addiction, he made sure his friend Senator Joe McCarthy (yes, that McCarthy) had a clean, pharmaceutical supply after he became addicted. Holiday was black, so she deserved punishment; McCarthy was white, so he was treated.

And like our typically unscientific approach to issues like rehabilitation, medical marijuana, and drug prevention, Anslinger put ideology over data. Before deciding to campaign against marijuana so he could grow his state property, he consulted 30 experts about its potential dangers. 29 said it should not be made illegal. He only mentioned the 30e.

Hari shines when he tells stories like this, providing a vivid, global portrait of the havoc wreaked by our attempts to stop behaviors that are prevalent in every culture and even our evolutionary ancestors. With compassion and clarity, he illustrates why addiction is more likely to be seen as caused by trauma and social disruption than by drugs and why empathy prevails over punishment in treatment and management. These are important points, emphasized by addiction researchers for years, but much less known by the public and policymakers – and the book deserves wide reading because it states them so clearly.

Unfortunately, he is on much shakier ground when it comes to critically examining science and proposing solutions. For example, in a discussion of nicotine addiction, he argues that because the nicotine patch helps people quit only 17.7 percent of the time, this means that only that portion of cigarette addiction is due to the action of the drug nicotine and the rest of the nicotine addiction. addictive behavior is determined by a person’s background and social environment. While those factors certainly matter, this completely ignores the role that dosing, dose planning, and route of administration play in addiction—which have no bearing whatsoever on how the chemical itself works.

Another example is even more telling. Hari twice uncritically cites a study suggesting that marijuana may lower intelligence. He writes, “I’d rather my nephews drink beer than smoke a drug that could actually permanently damage their IQ.” The study he refers to, published in the Procedures of the National Academy of Sciences found an 8-point reduction in IQ in 2012 in people who started using before age 18 and who continued to smoke heavily enough to be diagnosed with marijuana addiction three times by age 38. This represented about 8 percent of teen marijuana users — 37 people, total.

Not only is that a small group to base such a large conclusion on, it’s also a single article – one that has not been replicated or even universally accepted; another study published in the same prestigious journal suggested an alternative explanation for the results. Nor can this study prove that any damage is irreversible: the addicts were not treated and then tested again. Calling it solid science is especially questionable given the history of exaggerated claims about marijuana that Hari so gleefully dissects elsewhere in the book. There is also no reason to believe that alcohol is any safer.

Hari errs in a more worrying way when he tells the story of a doctor who prescribed heroin and cocaine to addicts in Liverpool in the 1980s and 1990s. He paints Dr. John Marks as a Galileo figure, whose unpopular but correct ideas drove him to ruin.

According to Hari, Marks invaded a desperate town and solved the addiction and crime problem by prescribing what addicts wanted. When this became publicly and politically problematic, he was chased out of town, leaving his patients to die or go to prison. As Hari summarizes: ‘In Liverpool heroin was prescribed; people got better; then it was shut down.”

But that’s not exactly what happened. In the early 1990s, I visited Marks’ clinic to interview him about his approach and speak with some of his patients. I had told him I was recovering from cocaine and heroin addiction. At that point he was trying to argue that my cocaine use hadn’t really been harmful.

‘You have a good job now, you are abroad. How has cocaine harmed you?” he said. I had shot it 40 times a day; I told him I couldn’t keep a job doing that.

“Listen, if you had never seen cocaine or heroin in your life, how do you know you would be different if you hadn’t had heroin or cocaine? You might as well have been a zombie,’ he replied. I had certainly used drugs to treat pre-existing mental health issues, but no one who saw my trajectory at the time could begin to argue that the way I used them did not catastrophically worsen both my mental and physical health.

And what kind of doctor tells someone in recovery that her drug use wasn’t really a problem after all? This is the opposite of what most experts in the field would recommend.

While I believed that heroin and maybe even cocaine maintenance could sometimes be good harm reduction policies — and the data is now quite clear that well-managed heroin maintenance reduces crime and improves lives — I found the encounter disturbing. It seemed to raise questions about Marks’ ability to safely manage addiction programs.

And I wasn’t the only one worried. In Liverpool, Marks is a highly polarizing figure and his claims to have reduced crime and death are disputed by other researchers. And Hari’s account of his work is not entirely accurate. Far from being dropped upon his departure, many of his patients were able to continue their heroin prescriptions with other doctors.

None of this ambiguity appears in Hari’s portrayal. Of course, as a journalist, I can empathize with this kind of mistake: it’s pretty easy to get carried away by a charismatic source and accidentally only interview people who are on one side of a controversy.

But this is where science and the skeptical evaluation of data matter. There is little data supporting cocaine maintenance. The drug’s pharmacology is different from that of long-acting opioids, allowing regular dosing to create a stable state of complete tolerance. This replaces the ups and downs of getting high and then withdrawing with a stable, unblemished state that allows for safe driving, productive work and a normal family life. Cocaine, on the other hand, has a short-term high and is generally taken in binges, which produce paranoia and cravings rather than stability. Knowledge of these basic data about the drug alone should raise questions.

This is not to say that the general idea of ​​harm reduction as the basis of drug policy is wrong: most of the strategies advocated by Hari Are effective and supported by excellent data, but they are not panacea and should not be claimed.

Such overpromises can thwart reform efforts: for example, if people expect prescribing heroin to cure addiction, they will be very disappointed when many addicts continue to lead chaotic lives and do not benefit from it, even though many more will get better through maintenance than the case. when addiction is a criminal offence. It is still possible that cocaine maintenance could work in some cases – although a more promising treatment for stimulant addiction would almost certainly have a longer acting effect than cocaine – but this would need to be properly tested.

Hari is absolutely right that the drug war is an abomination. However, many previous attempts to reverse it have failed when those seeking to liberalize laws acted in the same way he did: being unclear about what harms can be mitigated by ending prohibition and which cannot.

In the 1970s, for example, the US came close to decriminalizing marijuana at the federal level. But then a backlash grew among parents whose own experience with the drug suggested it wasn’t always as harmless to children as many proponents claimed. Their efforts helped gain widespread support for the policies that led to the current mass incarceration.

The drug policy is not orderly and tidy; what helps one may harm another and compromises must be made all the time to balance risks and benefits. Read this book to understand why the drug war must end, but look elsewhere for a critical examination of the science for better alternatives.

Maia Szalavitz is an award-winning journalist who has written about drugs and addiction for nearly 30 years. She has authored or co-authored seven books, including the forthcoming one Unbroken Brain: why addiction is a learning disability and what you can do about it.

View image by josh via Flickr

By akfire1

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