Police should catch actual criminals, not harass drug addicts - UN drug expert

The debate on narcotics is gaining momentum, with society growing more and more tolerant toward soft drugs such as marijuana. But the question still stands - would the legalization of drugs help the people, or drive thousands to their deaths? Earlier, on Sophie&Co we’ve heard voices against legalization - but now it’s time to hear an opposite point of view. French physician, member of the Global Commission on Drug Policy and an advocate of legalization, professor Michel Kazatchkine is on Sophie&Co today.

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Sophie Shevardnadze: French physician, member of the Global Commission on Drug Policy, professor Michel Kazatchkine, welcome to the show, great to have you with us. Now, you believe in legalizing certain drugs, saying it’s “a simple choice between control being in the hands of governments or gangsters”. So, specifically, what drugs should be legalised in your opinion?

Michel Kazatchkine: Now, it’s up to governments, depending on their cultural, historical, societal context to sort of go for one or the other drugs. I think the obvious first candidates would be cannabis, and as you know there’s a lot happening in this respect already in the world, and the others would be the synthetic drugs: the new amphetamine-type stimulants, particularly, following the example of what’s happening in New Zealand - maybe we’ll come back to that.

SS: Why do you think that they are safe?

MK: They are not safe! It is because they are not safe that they need to be regulated - you see? That’s the point we’re making. If something is not safe and prohibited, then it will come up on the illegal market. If something is not safe, you need to control it. Think of tobacco, think of alcohol, or think of anything that is dangerous; let’s say, firearms or a car. I mean, you will not prohibit cars or people from driving cars, because cars are dangerous. You will have a code of how to drive, you will have safety belts, you would have safety requirements for car manufacturers. That’s what is called legal regulation.

SS: But then you would argue, why regulate things when you can just ban it, if it’s not safe. For example, use of marijuana is much lower than alcohol or tobacco, almost certainly because it is illegal. So why change that?

MK: In general, there’s an estimated 200,000 deaths per year, overall, for all drugs, world-wide - that’s the estimate of the UN Agency on Drugs and Crime, and it’s somewhere around 2.5 million for alcohol - and one in two people, who smoke, will eventually die of a health consequences from smoking.

SS: Is alcohol being legal a model for legalising drugs in general? Can society take both?

MK: Well, alcohol is legal, alcohol is regulated, but of course, the world has been failing on alcohol. Alcohol is very complex issue, because there’s a sort of societal tolerance to alcohol, and there are lots of good things about alcohol and the benefits of wine. For example, that has been associated with feasts, with the good mood and various things. Alcohol is fine and enjoyable, provided that it is consumed within reasonable quantities, and if it is of good quality. The same should be true for drugs.

SS: Just want to talk about legalising marijuana in particular. It has been legalised in some U.S. states, Latin America and European countries - I want to ask you about governments. Do they just want the cash?

MK: in Europe the evidence is that since marijuana has been legalised, let’s say, for example, in Portugal or in the Czech Republic, there hasn’t been an increase in consumption, so the idea that legalising or having it sort of available on the market will increase consumption is not corroborated by evidence. In the U.S., and in Uruguay now, the experiment is going on in Colorado and Washington states, and soon, other states will vote for it, I expect more states in the U.S. to come to legalisation of marijuana within the next months.

SS: What I am asking is something little different - I am asking, where’s the money going? Where’s the money from legalising these drug is going?

MK: You’re raising an important point. What we’re seeing now in Colorado is actually a risk of over-commercialisation of marijuana, and there’s now almost an industry growing out of it - and that’s certainly not a good thing. So, whereas in Uruguay, or in Portugal, the cannabis is sold under government and the money is going to the government, actually just as the tax on cigarettes is a source of revenue for many-many governments throughout the world. What we’re saying at the Commission, again, is that legalisation has to be experimented, and we will look at what happens in Colorado and Washington states. For example, Washington state is having a more cautious approach and more strict regulatory framework than Colorado. I think that’s behind your question probably, that we are seeing some excesses in the sort of privatisation of trade around legalisation of cannabis in Colorado. Let’s wait and see the experiment.

SS: I guess, what I am asking is how do you see it - because you’re someone who is proposing the bill. What I am asking is that, are we seeing gangsters being replaced by politicians, basically? How do we make sure that the money, actually, goes to the right causes, after the taxes and everything?

MK: Well , if government is in charge, and here I’m thinking of Uruguay, then the money goes to the government, just as, as I said earlier, the tax on alcohol or tax on cigarettes goes to government. That’s part of the public budget, and I hope that that money will be re-invested in prevention campaigns, in health and in social programs, rather than wasted on inefficient law enforcement prohibition.

SS: States already have healthcare systems that are overloaded with demand - do you think there’ll be resources and expertise to treat any increase in addiction and drug-related accidents, for example, or incidents - because you can’t exclude that option, if drugs are legalised, you don’t know if people will use them last. For example, in Netherlands, the statistics show the opposite - it shows that ever since it has been legalised, the use of drugs and marijuana tripled in the age span of 18 to 20, and the government is reconsidering the whole legislation policy - so we don’t know how each country is going to react to that. Do you think the healthcare systems can take that?

MK: And yes, indeed, there has been an increase in the number of marijuana smokers in Netherlands, but that doesn’t mean that these people are smoking in a way that damages health. They are actually smoking reasonably. In my country, France, which is country where cannabis is prohibited, this is number One country in consumption of cannabis in Europe - and this is where we’re actually having concerns about people who smoke in ways that can damage their health, beyond the limits, and I’m convinced - and that’s what the Commission says, again, based on the available evidence - that currently, prohibition leads to unsafe ways of consuming drugs in general, unregulated ways of consuming and health damage, including overdoses from drugs and death from overdosing. So, the current threshold is just unacceptable. What I am saying is that we need to decrease that threshold and regulation should help decrease that threshold rather that it would increase it. I do not believe that the health systems currently are overwhelmed with drugs at all - it is a very-very small fraction of the healthcare. Actually, people who use drugs in general are underserved by the health system, and what the Commission says, again, is that we should totally rethink the way that we look at drugs and give health much much greater priority than currently.

SS: So, the Global Commission on Drug Policy report suggests stopping criminalising people for drug use and possession. Now, if the person is a drug addict and breaking the law through dealing, perhaps - should you treat the addiction or should you punish the crime?

MK: If that person is a non-violent person and if the crime is only possession of a drug, because that drug is illicit, then we believe there’s no reason, except the current ideological background to prohibition, to have that person arrested and incarcerated. Prison by itself is a place, where, actually, when you get out of it, you’re even more addicted and more prone to violence than when you enter it. There’s huge overpopulation of people for minor drug offences throughout the world, in prisons.

SS: Wouldn’t decriminalising and legalising drug use make it more socially acceptable behaviour? I mean, there’s evidence that people that are put in prison, under drug influence, they are actually more prone to violence - there’s a direct link.

MK: Well, they are prone to violence, and yes, indeed, there’s violence among people who use drugs and heroin users, because these people have to fight every day to find the money to buy expensive illegal drugs on the streets. If these people could either be on what we call “substitutive therapy” with methadone or buprenorphine as it is done in most countries in Western Europe, or if people could even receive for the very-very small proportion of them who needs heroin...

SS: We’re going to get to methadone, but just answer the question - wouldn’t decriminalising and legalising drugs actually make it more socially-acceptable behaviour?

MK: Socially-acceptable behaviour is fine, if it is controlled. Again, I think we’re moving towards a socially-acceptable way of smoking or drinking - if people smoke very cautiously or they drink within reasonable amounts. Prohibiting and criminalising and incarcerating doesn’t help - it actually increases the problem.

SS: You often compare drug use to alcohol and cigarettes. But when you smoke cigarette, it doesn’t alter your mind - 80% of people who actually consume alcohol, aren’t intoxicated with alcohol. Now, for majority of people who use drugs, the primary purpose is actually get high - that’s a huge difference between the example that you’re giving.

MK: I mean, it’s to get high, just as you feel good, when you inject heroin, and just as you feel good after two glasses of vodka.

SS: But, look, currently finding a dealer is risky - I mean, a lot of people wouldn’t go through the trouble. But if drugs are freely sold, wouldn’t more people do it, just because they can?

MK: There are people, and I’m not only thinking of small dealers, I would also think of some of the people who grow the drugs, who grow coca or grow opium, who actually are to do it for economic reasons. So, legal regulation of drugs and fighting the criminals and decriminalising also means, actually, putting in place strong social and development programs that offer alternatives…

SS: Okay, I am not talking about drug addicts, I am talking about just normal people. Let me just clarify - you don’t think that if drugs are accessible for everybody, not drug addicts, but everybody, they’ll be just more prone to do them and try them - that’s what I am asking?

MK: I am not sure. We are moving in many societies towards a better regulated, still far from where we would wish to be, but better regulated ways of consuming both alcohol and tobacco and the same will happen with drugs. As far as drugs remain totally available on the criminal market, that will never lead to any education or that will never lead to safe consumption.

SS: Talking about legalisation, you said marijuana and some other drugs - but if heavy drugs are still illegal, I mean, the war on drugs will have to continue - so what’s the point of legalisation?

MK: There are, obviously, some drugs, that will continue to be prohibited in our mind, I mean, Krokodil - there’s no reason why Krokodil should be legalised. This is extremely dangerous drug and don’t see any way of consuming it in a safe and reasonable way. What the Commision does believe, however, is that with a number of drugs being more easily available, we’ll actually have the opposite effect of what you were saying earlier - which is that people will go for what they know is controlled and safe, rather than go for the unknown.

SS: Is it possible to live a normal, long life, with drug use, if it is done safe and kept under control - like, under methadone, for example?

MK: Of course. Actually, people who are on methadone therapy...there’s now strong evidence, and I would say undisputable evidence, that their life expectancy is longer than people who are not on methadone. So, they live better lives, for longer time and there’s actually also even evidence that substitution with methadone in time increases your chances of quitting drugs. So, the answer is “Yes” to your question.

SS: It still doesn’t eliminate the problem though…

MK: Why would you like to eliminate the problem?

SS: Drug addiction? I would like to eliminate drug addiction, if I was addicted…

MK: Sophie, I am sorry: if you have diabetes - you cannot eradicate diabetes, you will have to be on insulin every day during your life. If you have high blood pressure, you will take pills against high blood pressure. If you are addicted to heroin, you take methadone every day and you live a normal and healthy life, and you do not have any of the risks associated with heroin.

SS: But what about just beating the addiction, what about getting over it? I spoke to former drug addict, Chip Somers, maybe you know who he is - he’s now clean and he has opened a rehab clinic in Britain, and he told me that he was on substitute drugs for 12 years, and he insists that abstinence is the only way for an addict to get clean.

MK: Actually, abstinence fails, and abstinence programs have been failing. People who can become abstinent - fine for them. I’m not encouraging people to use drugs, I’m saying that those who can stop - it’s fine, I’m saying that with methadone not only you are out of the risks, but you increase your chances of quitting drugs at the end. But promoting abstinence is just like promoting abstinence for sex or promoting abstinence for alcohol - that just doesn’t work. It doesn’t work to say “it’s forbidden” or “you shouldn’t do it” - we know it doesn’t work.

SS: Let’s touch upon the financial side of the thing. Giving people methadone is pretty cheap - but keeping somebody on methadone for 4-5 years is ultimately going to cost more than putting somebody through a rehab 2 or 3 times. Why not invest in rehab?

MK: First because...again, I am not against rehab, and here I’m speaking as physician and scientist, having been in this area for 30 years. I’m not saying it’s methadone or nothing, and I’m not saying it’s rehab or nothing. If a rehab programme is running well and effective, I want to see the evidence and I will agree with it. To me rehab and methadone could be complementary approaches, I don’t think it’s a choice between one or the other. What I know is that the evidence for the efficiency of methadone in substituting, in decreasing the risk of HIV, in decreasing the health damages from drugs is overwhelming and undisputable - that’s what I am saying. By any means, from a financial perspective, a methadone program is far, far cheaper than actually having policemen spending their time, arresting drug users on the streets and having them in prison, rather than having these policemen serve the communities and help the people in need.

SS: Now, these places where drug addicts come to get a hit in safe way. There are clean conditions and from the point of view of fighting HIV epidemic it totally makes sense. But how they’re going to beat addiction and get off drugs if they’re getting high anytime they want?

MK: First, if you come and see one of the substitution clinics or if you come and see one of the safe-injection sites, such as some of those that we have here in Geneva, you will see that this is not just a room where you enter, you shoot, and you get out. This is a site, where you’re meeting with professionals, with social workers, with psychologists, with doctors, with colleagues, with peers and all of that is somehow creating a favorable, supportive environment that will help that person. So, people who are on substitution therapy - again, there’s strong and I would repeat, undisputable evidence that they can find work, they can have families, they live healthy lives, and they’re re-socialised, whereas when they’re on the street and they have to fight every day to find the money to buy heroin, which currently costs over 45 dollars a gram on the streets of Geneva - this is a huge issue.

SS: I have to ask you this: have you ever tried drugs? And, if not, what drugs would you try if they were legal?

MK: I would say, as everyone in my generation, yes, I have smoked marijuana, of course.

SS: Alright, so I take it as you know what you’re talking about. Thanks a lot for this interesting insight from the other side. Michel Kazatchkine, member of the Global Commission on Drugs, we were talking about what the effects of legalising drugs would be. Thanks a lot, that’s it for this edition of Sophie&Co, I’ll see you next time.