Pubdate: Sat, 13 Jun 2009
Source: Guardian, The (UK)
Column: Bad Science
Page: 8
Copyright: 2009 Guardian News and Media Limited
Contact: This e-mail address is being protected from spambots. You need JavaScript enabled to view it
Website: http://www.guardian.co.uk/guardian/
Details: http://www.mapinc.org/media/175
Author: Ben Goldacre, The Guardian
Referenced: The WHO report http://www.tdpf.org.uk/WHOleaked.pdf
Bookmark: http://www.mapinc.org/coke.htm (Cocaine)
Bookmark: http://www.mapinc.org/find?207 (Cannabis - United Kingdom)
Bookmark: http://www.mapinc.org/hr.htm (Harm Reduction)
Bookmark: http://www.mapinc.org/corrupt.htm (Corruption - United States)

COCAINE STUDY THAT GOT UP THE NOSE OF THE US

In areas of moral and political conflict people will always behave
badly with evidence, so the war on drugs is a consistent source of
entertainment. We have already seen how cannabis being "25 times
stronger" was a fantasy, how drugs--related deaths were quietly
dropped from the measures for drugs policy, and how a trivial pile of
poppies was presented by the government as a serious dent in the
Taliban's heroin revenue.

The Commons home affairs select committee is looking at the best way
to deal with cocaine. You may wonder why they're bothering. When the
Advisory Council for the Misuse of Drugs looked at the evidence on
the reclassification of cannabis it was ignored. When Professor David
Nutt, the new head of the advisory council, wrote a scientific paper
on the relatively modest risks of MDMA (the active ingredient in the
club drug ecstasy) he was attacked by the home secretary, Jacqui Smith .

In the case of cocaine there is an even more striking precedent for
evidence being ignored: the World Health Organisation (WHO) conducted
what is probably the largest ever study of global use. In March 1995
they released a briefing kit which summarised their conclusions, with
some tantalising bullet points.

"Health problems from the use of legal substances, particularly
alcohol and tobacco, are greater than health problems from cocaine
use," they said. "Cocaine-related problems are widely perceived to be
more common and more severe for intensive, high-dosage users and very
rare and much less severe for occasional, low-dosage users."

The full report - which has never been published - was extremely
critical of most US policies. It suggested that supply reduction and
law enforcement strategies have failed, and that options such as
decriminalisation might be explored, flagging up such programmes in
Australia, Bolivia, Canada and Colombia. "Approaches which
over-emphasise punitive drug control measures may actually contribute
to the development of heath-related problems," it said, before
committing heresy by recommending research into the adverse
consequences of prohibition, and discussing "harm reduction" strategies.

"An increase in the adoption of responses such as education,
treatment and rehabilitation programmes," it said, "is a desirable
counterbalance to the over-reliance on law enforcement."

It singled out anti-drug adverts based on fear. "Most programmes do
not prevent myths, but perpetuate stereotypes and misinform the general public.

"Such programmes rely on sensationalised, exaggerated statements
about cocaine which misinform about patterns of use, stigmatise
users, and destroy the educator's credibility."

It also dared to challenge the prevailing policy view that all drug
use is harmful misuse. "An enormous variety was found in the types of
people who use cocaine, the amount of drug used, the frequency of
use, the duration and intensity of use, the reasons for using and any
associated problems."

Experimental and occasional use were by far the most common types of
use, it said, and compulsive or dysfunctional use, though worthy of
close attention, were much less common.

It then descended into outright heresy. "Occasional cocaine use does
not typically lead to severe or even minor physical or social
problems ... a minority of people ... use casually for a short or
long period, and suffer little or no negative consequences."

And finally: "Use of coca leaves appears to have no negative health
effects and has positive, therapeutic, sacred and social functions
for indigenous Andean populations."

At the point where mild cocaine use was described in positive tones
the Americans presumably blew some kind of outrage fuse. This report
was never published because the US representative to the WHO
threatened to withdraw US funding for all its research projects and
interventions unless the organisation "dissociated itself from the
study" and cancelled publication. According to the WHO this document
does not exist, (although you can read a leaked copy at
www.tdpf.org.uk/WHOleaked.pdf ).

Drugs show the classic problem for evidence-based social policy. It
may well be that prohibition, and distribution of drugs by criminals,
gives worse results for the outcomes we think are important, such as
harm to the user and to communities through crime. But equally, we
may tolerate these outcomes, because we decide it is more important
that we declare ourselves to disapprove of drug use. It's okay to do
that. You can have policies that go against your stated outcomes, for
moral or political reasons: but that doesn't mean you can hide the evidence.
_________________________________________________