IDEOLOGY RESEARCH & POLICY

Pat O'Hare talks to Peter Cohen

POH. Peter, during one of your presentations in our recent seminars to mark the launch of this journal, you mentioned that the European drug field should organize itself against the American influence on European national drug policies. Why do you feel this is necessary?

PC. I say this because I am more and more worried about the direction the American Drug war is taking, and because of the enormous energy the U.S. invest in trying to shape European Drug policies after their own image.

Just before I left for England to take part in your series of lectures and seminars, I was attending a Congress organized by the Dutch Ministries of Health and Justice, and by NIDA. The title of this congress was "Drug Policy: An American Dutch Debate". One of the participants was Mr. Primm, owner of a few methadone programmes in New York, who had given himself the task of explaining the new "no more nonsense" drug policy of the Bennett area. This explanation left me more worried than I ever was before. Primm clarified how, on the operational level, the war against drug users and drug addicts was going to be fought and I was flabbergasted. Drug addicts all had to be clean before a certain date. If they were not, they were going to be incarcerated in big camps, where they would receive a military education to become marines. Users of any drugs who were caught, would have to pay fines of up to $10,000 and their terms in jail would have to be financed by themselves. Furthermore, the often discussed random urine testing was to be further developed. Also, all federal funding for programmes in which addicts were taught to clean their needles before injecting with bleach would be terminated, there would be little possibility at all for syringe exchange programmes. "No more of such nonsense" Mr Primm literally said. Clearly, one can see that the lives of possible Aids patients are of no importance at all.

POH. We more or less know the direction of American Drug policy for a couple of years. You did not really answer my question about why the European drug field would have to organise itself against the American influence.

PC. This is the basis of my concern. The need for systematic and conscious organization in the European field has to do with the ways the Americans influence the European countries.

The amount of money they spend on drug research, mostly via NIDA, is very big and in this way America is able to wrap its disastrous policies in all the quasi objective packaging they buy with this money. With slick research reports in their hands, the Americans are able to influence European politicians who usually know nothing about drugs.

The enormous quantity of American drug research, the topics that are chosen for research and the selling power the Americans put behind these so-called research results has shaped my feeling that Europeans should organize themselves. And, of course, the basis of this organization should be research. I am convinced that illegal drug use in the European countries is very different in each country, and very different again from illegal drug use in the USA.

Also, drug policies and the possibilities of variability in drug policies are different in Europe than they are in the States. By letting the Americans dominate the research effort in the field of drugs we more or less accept that drug use in Europe can easily be compared with drug use in the States. And, therefore, that the direction American drug policy is taking can be generalized to European conditions. And this is completely false. Even for the States, the American drug policy is a disaster, but I am afraid we can do little about that.

POH. You say the Americans are spending a lot of money on research, but you seem to think this research is without any value. Is this true, and if so, why ?

PC. This is a complicated matter. And I will try to explain my attitudes towards American research efforts with a few anecdotes.

As you know, my main interest in the field of drug research is cocaine use. In 1987 I was asked to present a paper on the use of cocaine in Amsterdam at a meeting organized by the Faculty of Psychiatry of my University at which Howard Kleber was also speaking. Kleber's NIDA financed research was beautifully presented with a lot of colour slides. I forgot what it was about but I do not forget one small incident. Kleber projected onto a screen a list of different types of cocaine use. While explaining these he mentioned "recreational use", a pattern not represented on his slide. When I discussed this with him later he said he had made a mistake. NIDA did not feel, that in research financed by it, the term "recreational cocaine use" could be mentioned because, according to the present ideology, "recreational" use of illegal drugs is not possible. Kleber told me this problem had little relevance for him because he was only interested in addicted users.

Now, just imagine for one moment what would happen if I applied for NIDA money, assuming I was an American researcher, to find out about the hows and whys of "recreational cocaine use", or how often such a pattern is found in relation to heavy or addicted use!

Another anecdote concerns the famous registration of "hospital mentionings" of drugs NIDA presents each year. This research is contracted out to a private research company. In May 1988 researchers presented some results at a meeting in Rome of epidemiology researchers from NIDA and the Pompidou group. Hospital mentioning of most drugs had gone up. When I later discussed the possible relevance of these data in private with the man presenting them, we not only agreed that their relevance was very small, because of the way these data were collected, but I was also told, quite sincerely, that if his research company had not found a way of collecting these data, to show that most mentionings had gone up, they would lose the contract. This may be exaggerated, but it shows once more what sort of issues the top people of NIDA are interested in. I personally know many people working at NIDA I would trust, but they are not in a position to influence the direction of NlDA's research policy.

POH. You mentioned the other day that Harvey Feldman and Pat Biernacki could have funding problems in the future.

PC. Yes, this is something that infuriates me very much. Harvey Feldman and Pat Biernacki, both drugs ethnographers of first class quality, were doing research about needle cleaning practice among i.v. drug users in the poorest areas of San Francisco. But, as you know, needle cleaning or even teaching people how to clean needles will be out if the Helms Amendment is passed. As a result, any federal funding will be withdrawn from projects in which needle cleaning is encouraged. This is completely irrespective of the fact that results seem to indicate it is possible to interest people to clean their needles, even if they have not done so ever before in their drug injecting career. At the moment, a lot of research that is not directly concerned with American orthodox drug policy is no longer supported by NIDA, although the NIDA research budget is higher than ever.

These anecdotes show you that the American drug research system is creating data of one particular kind, i.e. data that conform to the official ideology and policies. Making research or data interpretations that show otherwise, or that would create doubt, has become increasingly difficult. This is why I say that Europeans have to organize their own research effort, not only along national lines but also ideologically within a much less fundamentalistic framework. Only then does it become possible to discuss the options of different and complicated policies in a rational way to deal with the negative aspects of some present forms of drug use.

At the moment there is such a lack of good, comparative and yearly repeated research in Europe that automatically this void is being filled with American data. But, as I said earlier, the assumption that all American drug use or its consequences can be compared with European drug use is wrong. And as I tried to show, the available data that illustrate "American drug use" are increasingly one- sided.

POH. Why do you think such a European research effort is possible and how would it be accomplished practically?

PC. Of course I am not sure that such an effort is possible, but we have to try. Moreover, I see indications all over that Europeans are developing drug policies along other lines than the Americans.

Let us take, for instance, the seminars your Journal organized. Many participants I met expressed interest in getting more data, for instance about the use of cocaine in their own areas. Cocaine seems to have become a hot issue in the U.K. because some politicans see a chance of exploiting it. In the field, the absence of British data on this topic is felt as a serious lack. But it is not only Britain that

has no data on cocaine, such data are simply absent in Europe, let alone comparable data. Apart from my own research in Amsterdam and a small pilot research on this topic in Rome, Munich and Rotterdam there is no empirical research on this topic in Europe. This triggers the mechanism I illustrated before, that is, American data fills the void. But at least the English seem to understand the need for autonomous data collection. And this is also the case with most of the Government advisers I have met in the U.K. This means England could play a role at a national level by organising autonomous cocaine research, and at the European level by trying to have data created in other countries in comparable ways.

Another help for the development of more drug research in Europe is the latest report Virginia Berridge wrote for the WHO about European research efforts in the drug field. And this report comes at a time when the European Parliament has a member, chosen on a programme that contains solely drug related issues. This new member (Marco Taradash from Rome, Italy. See vol. 1, no. 2 of this journal) is interested in fundamental changes in the drug policies of European countries, and I am sure he will exploit the available support for a good European research programme to the full.

POH. What kind of role can the European Parliament play in getting such an initiative off the ground?

PC. The European Parliament has some influence on the European Commission where, at the moment, only a few people are trying to get some European drug research going, until now, without a programme and without any political push from the European Parliament.
And my work in the Pompidou group has given me the certainty that also in Strasbourg there is enough will and expert power to develop good, comparative research in Europe, provided the means are made available. My research collegues from all over Europe, whom I frequently meet in the context of Pompidou, would certainly assist in assessing the qualities of such a programme and in executing it. So, there is some basis for the development of a European Drug Research Programme. In such a programme, we might even invite the fine American expertise that is now unemployed for both research and teaching.

POH. My colleague, Russell Newcombe, talks about research and drug policy being like ships that pass in the night which occasionally collide. What is your view on this relationship?

PC. The relationship between research and policy is incredibly complex. To begin with, each country has a very idiosyncratic research system on drugs, ranging from almost non-existent, like Finland, to highly elaborate but partial, like America. Secondly, direct implications of research at the highest levels of policymaking are rare because drug policy is 80% manipulation or exploitation of symbolic meanings. But indirectly, there are many consequences for policy, from good research. Some research results may help some politicians or journalists who are critical of present policies. Also, good research can get to policy advisors below the top levels, who may then be able to influence policymakers with the results. This, in turn, may change their positions in as far as they have a role in advising governments.

POH. Thank you, Peter.