Sunday, September 09, 2018

Epic failure of global war on drugs under lead of US

The United Nations Office on Drugs and Crime (UNODC) in its ‘World Drug Report 2018’ published in June 2018, reports that 275m people worldwide — roughly 5.6% of the global population aged 15–64 years — used drugs at least once during 2016. Cannabis which comes in 3 forms (marijuana from dried flowers and leaves; hashish made from the resin [a secreted gum] of the cannabis plant and hash oil, the most potent) accounted for illicit use by 70% of the drug-taking population.

UNDOC said cocaine manufacture in 2016 reached the highest level ever reported dominated by Colombia while from 2016-2017 global opium production jumped by 65%, with a rise in yields in Afghanistan — years of eradication efforts by the US in both countries had got nowhere.

However, it’s synthetic opioids, not the traditional plant-based ones that have the greatest danger, accounting for about 49,000 overdose deaths from a total of over 72,000 in the US in 2017 (this is likely an underestimate). In Canada in 2017 (population 37m, 11.3% of US level) there were more than 4,000 overdose deaths — more Canadians are now dying of overdoses than motor vehicle accidents and homicides combined.

Prince, the American musician, in 2016 died from an overdose of fentanyl, a synthetic opioid 50 times stronger than heroin, according to a medical examination. On “how injury occurred,” the report concluded: “The decedent self-administered fentanyl.”

Fentanyl, launched in 1960 as a treatment for cancer pain, is convenient for transportation because it is so potent — a smattering of grains makes a deadly dose — it is available on the web and can be distributed around the world in tiny, concealable packages.  

How to Win a War on Drugs
Portugal treats addiction as a disease, not a crime

The US Centers for Disease Control and Prevention (CDC) says that from 1999 to 2016, more than 200,000 people died in the United States from overdoses related to prescription opioids. At the end of 2017 the number was at 250,000 people — this total maybe underestimated by 20 to 35%. Overdose deaths involving prescription opioids were five times higher in 2016 than in 1999. The overall opioid prescribing rate in the United States peaked and leveled off from 2010-2012 and has been declining since 2012, but the amount of opioids in morphine milligram equivalents (MME) prescribed per person is still around three times higher than it was in 1999.

The government of Canada says “synthetic opioids such as fentanyl, W-18, and U-47700, to name but a few, are extremely potent. Fentanyl and its analogues (e.g. carfentanil, furanylfentanyl, acetylfentanyl) are becoming more prevalent on the illegal drug market and are increasingly combined with other controlled substances, which increases their potential toxicity and the risk of an overdose.”

UNDOC says that 168,000 people may have died of a drug overdose worldwide in 2015; 52,000 had died in the US; China reported that 49,000 died in 2014; about 7,500 died in the European Union, which has a population that is 57% higher than the United States.

America's modern drug cartels and drug pushers

While President Nixon’s wish to criminalise the black community in America through mass incarceration was successful (see below), the typical drug pusher in recent times is a medic in a white coat, while the executives and shareholders of pharmaceutical companies like the official drug cartel of the British Empire, gained mightily from “free trade in poison.”  

Fentanyl today is mainly produced in China and synthetic opioids can be produced anywhere, making them harder to locate. A fentanyl analogue is a drug that has been designed to mimic the pharmacological effects of the original drug and for example the carfentanyl analogue, a general anesthetic for large animals, has a quantitative potency approximately 10,000 times that of morphine, 100 times that of fentanyl, and 50 times that of heroin, according to the US National Institute on Drug Abuse (NIH). 

Stanford University addiction specialist Anna Lembke, author of ‘Drug Dealer, MD,’ describesthe Toyotazation of medicine — tremendous pressure on doctors within these large integrated health care centers to practice medicine in a certain way and get patients out in a timely fashion to be able to bill insurers at the highest possible level and to make sure that their patients were satisfied customers.”

US with 5% of the world's population consumes over 80% of the world's opioids

"Opioids have become a proxy for a social safety net. So we have doctors routinely confronted with patients who not only have multiple medical problems — from diabetes to hypertension to asthma to cardiac disease — but also very significant psychological, social, and economic problems. Many of them are undereducated. Many of them are underemployed. Many of them are homeless. Many of them are struggling with multigenerational trauma.

"Because we lack a social safety net to take care of these people, we are now medicalizing their problems, and telling doctors that they have to take care of their problems. Doctors are feeling incredibly overwhelmed in this space with this growing population of individuals with very complex biological and psychosocial problems. In the face of that, they’re prescribing opioids — because opioids work quickly, patients are grateful, and it seems to be something they can do in the face of overwhelming problems."

A New Yorker 2017 article, 'The Family That Built an Empire of Pain; The Sackler dynasty’s ruthless marketing of painkillers has generated billions of dollars — and millions of addicts,' reported, "Between 2006 and 2015, Purdue and other painkiller producers, along with their associated nonprofits, spent nearly nine hundred million dollars on lobbying and political contributions — eight times what the gun lobby spent during that period."

The Financial Times reported this month that billionaire Richard Sackler, whose family owns and operates privately held Purdue Pharma, has been granted a patent for an opioid painkiller addiction treatment. The new drug is a form of buprenorphine, a mild opioid that is used to ease withdrawal symptoms.

“It’s reprehensible what Purdue Pharma has done to our public health,” Luke Nasta, director of Camelot, a New York-based treatment center for drug and alcohol addiction, told the FT and added that the Sackler family “shouldn’t be allowed to peddle any more synthetic opiates — and that includes opioid substitutes.” 

In 2007 The New York Times reported that Purdue, the maker of the painkiller OxyContin, and three of its then current and former executives had pleaded guilty in federal court to criminal charges that "it had misled doctors and patients when it claimed the drug was less likely to be abused than traditional narcotics."

The White House Council of Economic Advisers estimated that in 2015, the economic cost of the opioid crisis was $504.0bn, or 2.8% of GDP that year.  

The US pharmaceutical companies are likely to exploit the potential for opioid business overseas and become agents of death elsewhere.

Opiates as old as Mesopotamia

Opiates have a long history and the modern term opioid, encompasses opiates derived from plants and any substance, natural or synthetic, which impacts the brain’s opioid receptors – those parts responsible for controlling pain, reward and addictive behaviours.

In Homer's ‘Odyssey,’ the epic ancient Greek poem from about the end of the 8th century BC, Helen of Troy casts “a drug into the wine whereof they drank, a drug to lull all pain and anger, and bring forgetfulness of every sorrow.” In more recent times Coca-Cola was launched in 1886 as a “patent medicine.” The name refers to coca leaves (cocaine) from South America, and kola nuts infused with caffeine (the world's most widely consumed psychoactive drug that is also found in tea, coffee and cacao plants) from African tropical rainforests.

The opium poppy is native to the area of modern Turkey and it has been used as an opiate since the early human settlements in West Asia.  Heroin and morphine are derived from it and the two biggest illicit drug cartels in history were operated by companies that were given trade monopolies by the British Empire and the Dutch Republic: the British East India Company (EIC) and the Dutch East India Company (Dutch: Vereenigde Oostindische Compagnie; VOC). The VOC was the first joint-stock company and later the EIC adopted this form. Colonialism in Asia had effectively been outsourced to them and they each had war-making powers.

In 1729 Imperial China banned the importation of opium and through the century as demand for Chinese tea, silk, and porcelain grew in Britain, the British government was faced with a big trade deficit as China had no interest in British manufactures. Chinese imports had to be paid for in silver or gold and the solution was for the British East India Company to take monopoly control of opium production in India with the plan to ship via middlemen the vast production to China. Karl Marx who had coined the term “religion is the opium of the people” in 1843, wrote in 1858 that the British Empire was “preaching free trade in poison,” and by the start of the 20th century China with a population of 400 million was in the grip of an opium addiction disaster on a scale that had never been seen before or since, in the history of humanity.

In the following years, several countries put restrictions or bans on opiates and in 1909, in the waning days of the crumbling Qing Dynasty (1644-1912), the first international conference to discuss the world's narcotics problems was convened in Shanghai and was told by Chinese officials that about one-quarter of the male population was addicted to opium.

See here for more detail on the British Empire on opium. It fought two wars with China to keep its opium trade open.

US war on drugs

In 1971 President Richard Nixon, a heavy drinker and possibly an alcoholic, declared a war on drugs. and proclaimed in an address to Congress, “America’s public enemy number one in the United States is drug abuse. In order to fight and defeat this enemy, it is necessary to wage a new, all-out offensive.”

Nixon had a political motivation to make an issue of drugs but there was also a reality as reported on May 16, 1971, by The New York Times from Saigon (now Ho Chi Minh City), South Vietnam, under the headline ‘G.I. Heroin Addiction Epidemic in Vietnam “So serious is the problem considered that Ambassador Ellsworth Bunker and Gen. Creighton W. Abrams, the military commander, recently met with President Nguyen Van Thieu on measures to be taken by the Saigon Government, including agreement on a special task force that will now report directly to Mr. Thieu.”

Nixon said that “In 1960, less than 200 narcotic deaths were recorded in New York City. In 1970, the figure had risen to over 1,000.”

The New York Times reported this year “In 2016, the opioid epidemic claimed 1,374 lives in New York City.”

There were almost 3,000 overdose deaths in the United States in 1970, while more than 72,000 Americans died from drug overdoses in 2017, up from 64,000 in 2016, according to the US Centers for Disease Control and Prevention (CDC).

In 2016 the CDC’s survey of drug use in the US, reported that the percentage of persons aged 12 years and over with any illicit drug use in the past month, in 2015 was 10.1%. Marijuana accounted for 8.3%.

The consumption of illicit drugs has been dominated by the least dangerous drug and there are NO DATA on anyone dying from the drug in the United States.

In May 1972 Milton Friedman, America’s foremost monetarist/ free market economist, wrote in his Newsweek magazine column:

"Legalising drugs would simultaneously reduce the amount of crime and raise the quality of law enforcement. Can you conceive of any other measure that would accomplish so much to promote law and order?

But, you may say, must we accept defeat? Why not simply end the drug traffic? That is where experience under Prohibition is most relevant. We cannot end the drug traffic. We may be able to cut off opium from Turkey but there are innumerable other places where the opium poppy grows. With French cooperation, we may be able to make Marseilles an unhealthy place to manufacture heroin but there are innumerable other places where the simple manufacturing operations involved can be carried out. So long as large sums of money are involved — and they are bound to be if drugs are illegal — it is literally hopeless to expect to end the traffic or even to reduce seriously its scope. In drugs, as in other areas, persuasion and example are likely to be far more effective than the use of force to shape others in our image."

John Ehrlichman, a Nixon aide who was jailed for his role in the Watergate conspiracy, told an interviewer in 1994:

“The Nixon campaign in 1968, and the Nixon White House after that had two enemies: the antiwar left and black people. You understand what I’m saying? We knew we couldn’t make it illegal to be either against the war or black, but by getting the public to associate the hippies with marijuana and blacks with heroin, and then criminalizing both heavily, we could disrupt those communities. We could arrest their leaders, raid their homes, break up their meetings, and vilify them night after night on the evening news. Did we know we were lying about the drugs? Of course, we did.”

How Portugal and Colorado solved their drug problems | The Economist

The World If ... drugs become legal | The Economist

Cannabis (marijuana/ hemp)

Uruguay became the first country in the world to fully legalise marijuana in 2003. In 2018 Canada legalised consumption and cultivation and the law will take effect from next month.

In 1970 the US Congress passed the Controlled Substances Act establishing marijuana as a Schedule I drug, “with no currently accepted medical use and a high potential for abuse.” This put what is commonly known as pot in the same category that includes heroin and MDMA (ecstasy).

In 1971 President Nixon appointed Raymond Shafer, the governor of Pennsylvania, to head a commission to report on control of illicit drugs.

In March 1972 the Shafer Commission (National Commission on Marihuana and Drug Abuse) stunned the status quo when it recommended legalising possession and sales of small amounts of marijuana but not decriminalising trade in cannabis.

"Marihuana's relative potential for harm to the vast majority of individual users and its actual impact on society does not justify a social policy designed to seek out and firmly punish those who use it. This judgment is based on prevalent use patterns, on behavior exhibited by the vast majority of users and on our interpretations of existing medical and scientific data. This position also is consistent with the estimate by law enforcement personnel that the elimination of use is unattainable."

Marihuana was then the common American spelling for marijuana.

Nixon rejected the findings of the 13-member commission, telling reporters, “I do not believe you can have effective criminal justice based on the philosophy that something is half legal and half illegal.”

The Drugs Policy Alliance, a US advocacy group, says that "Between 1973 and 1977 [] eleven states decriminalised marijuana possession. In January 1977, President Jimmy Carter was inaugurated on a campaign platform that included marijuana decriminalisation. In October 1977, the Senate Judiciary Committee voted to decriminalize possession of up to an ounce of marijuana for personal use."

Carter himself had not supported legalisation and President Ronald Reagan from 1981 supported zero tolerance for illegal drug use.

The late Gary Becker and Kevin Murphy, University of Chicago economists, wrote in The Wall Street Journal in 2013: "The total number of persons incarcerated in state and federal prisons in the US has grown from 330,000 in 1980 to about 1.6m today. Much of the increase in this population is directly due to the war on drugs and the severe punishment for persons convicted of drug trafficking. About 50% of the inmates in federal prisons and 20% of those in state prisons have been convicted of either selling or using drugs. The many minor drug traffickers and drug users who spend time in jail find fewer opportunities for legal employment after they get out of prison, and they develop better skills at criminal activities."

The economists quoted an annual direct cost of the war for the US government at $40bn and others estimate that over $1tn has been spent since 1971. They say a number of factors may explain the continuing high dropout rate of 25% for black and Hispanic children and they cite "the temptation to drop out of school in order to profit from the drug trade."

Vox, the online news service reports that in the US in recent years “Thirteen states have moved toward decriminalising marijuana but not legalising it — so possession of small amounts of pot no longer carries criminal penalties like prison time, but possession of larger amounts and trafficking, including sales for recreational purposes, remain criminally illegal...Thirty states and Washington, DC, allow marijuana for medical purposes, although their approaches can significantly differ."

However, possession of weed is still a federal crime, and the Trump administration allows federal prosecutors to crack down on marijuana even in states where it's legal — which could let federal law enforcement shut down state-legal businesses.

Portugal decriminalised the use of all drugs in 2001, deciding to treat possession and use of small quantities of these drugs as a public health issue, not a criminal one. It has the lowest drugs overdose rate in Europe.

The editors of the 'Scientific American' magazine say "marijuana is far less dangerous than many other drugs, and cannabis or its derivatives have been used to treat everything from chronic pain to post-traumatic stress disorder to childhood epilepsy."

Alcohol and tobacco may have greater risks. 

"The main risk of cannabis is losing control of your cannabis intake," Mark Kleiman, a drug policy expert at New York University's Marron Institute, quoted by Vox said. "That's going to have consequences in terms of the amount of time you spend not fully functional. When that's hours per day times years, that's bad." Read Vox's summary here.

Researchers in 2015 reported that alcohol is much more toxic than cannabis. 

Conclusion

Drug addiction should be a health issue, not a law enforcement one. With the exception of some Islamic countries (majority Muslim Malaysia and Indonesia have breweries), neither addictive alcohol or tobacco are banned — it would simply be foolish to make criminal gangs very rich while failing to kill the consumption of the products.

Prof Milton Friedman saw correctly that a new version of alcohol Prohibition* in the US would not work — President Richard Nixon may well have not believed in it either but what he did was empower well-meaning fools, and once law enforcement became the main approach to drug addiction, cowardly politicians could not reverse the carnage.  

The war against drugs has abjectly failed to stop people from taking them while driving up the price of narcotics to the point where they generate about $300bn a year for their dealers and traffickers. Typically in the United States, about 1.4m drug arrests are made annually, while black Americans are jailed for drug offences at ten times the rate of whites.

Massive violence has been fanned from Mexico (even though this country is not a significant drug producer) through Central America on the murderous cocaine route as far as Peru.

In recent times the lawless president of the Philippines has organised the murder of possibly 15,000 people in the forlorn hope of ending the illicit drugs trade.

Cigarettes weren't banned and according to the OECD the percentage of the 15+ population that smoked in 2017 (or latest year of data) ranged from 7% in Brazil, 12% in US to Russia at 31% and 40% in Indonesia. This is a huge development in both the advanced and developed world.

In the US the contrast between the attitude toward drug addiction among low-income black and brown people in big urban areas and the more compassionate attitude to white addiction evident in rural and small-town communities in so-called Red States, is stark. The New York Times noted this in 2015 and last April a report headed 'Just Steps from the White House, a Memorial to Victims of America’s Drug Crisis' was posted on the White House website.

The opioid crisis is also impacting minority communities and in February 2018 the US surgeon general tweeted that African Americans aged 12 to 17 were more likely than their white peers to have used opioids. A study by the Chicago Urban League found that the African-American overdose death rate is higher than that of the general population in areas throughout the country.

Despite some progressive changes in a small number of countries, the world at large is still guided by the ignorant and cowardly on opposition to legalising illicit drugs. Legal drugs have caused much more havoc in the United States as the same politicians who oppose legalisation accept what in effect are bribes, from what are officially sanctioned elite drug cartels.

*Prohibition did not make drinking alcohol a federal crime — in 1920, the Eighteenth Amendment to the US Constitution banned the manufacture, sale, and transport of “intoxicating liquors” within the United States. The amendment was repealed in 1933 in the first year of the administration of Franklin Delano Roosevelt.

George Shultz, ex-US secretary of state & Vicente Fox ex-president of Mexico
on ending the War on Drugs