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About this book

The rapid deepening of the global drug problem has spurred increasingly heated debate over the best solutions. For example, should drug use be an issue for healthcare services or a matter of criminal justice? Is universal abstinence both unrealistic and undesirable? Does drug legalization offer a viable answer?

This book provides a lively and thought-provoking account of some of the most pressing issues for policy makers and practitioners in the debate about drugs. Designed as a platform for further discussion, it presents the full spectrum of perspectives on chronic and contemporary challenges to drug policy and explores the reality for drug users, dealers, suppliers and producers.

Drawing on an international evidence base, the author considers:
? Drug enforcement measures: do they work and are they always ethical?
? Addiction treatment: its purpose, cost and limitations;
? Drug research: the strength of its impact on policy and practice;
? Possible solutions: from classic criminalization to radical harm reduction.

Both engaging and timely, Controversies in Drugs Policy and Practice is an essential read for all social science students taking modules related to drug use, addiction and treatment. It also makes illuminating reading for academics and practitioners working within the field.

Table of Contents

Chapter 1. The Rapidly Changing World of Illegal Drugs

Abstract
The world of illegal drugs is a domain of truly staggering statistics. Estimated to be worth some $400 billion a year, the drugs trade is second only to the arms industry in scale and outstrips the arms industry in terms of profitability. The United Nations Office on Drugs and Crime has estimated that in 2007 somewhere between 172 million and 250 million people had used illicit drugs in the last year; between 15 and 21 million are estimated to have used opiates; 16 and 21 million to have used cocaine; 143 and 190 million to have used cannabis and between 16 and 51 million to have used amphetamines (UNODC 2009). Within Europe it has been conservatively estimated that some €34B is spent each year tackling the problem of illegal drugs; since this figure relates to 2005, it is likely that the current figure is significantly higher (EMCDDA 2009).
Neil McKeganey

Chapter 2. What’s Wrong With Harm Reduction?

Abstract
The concept of reducing the harm associated with the use of illegal drugs has been the single most influential idea impacting upon the drugs field over the last 20 years. In that time harm reduction has gone from being a radical new idea challenging the established ideas of drug treatment to becoming a global social movement with its own distinctive set of ideas, evidence base, politics, professional practice, internal conflicts, international conference and academic journal. In addition to being hugely influential, harm reduction has also been hugely controversial seen, by some, as a Trojan horse leading ultimately to drug legalization.
Neil McKeganey

Chapter 3. Drug Treatment: So What’s All the Fuss About?

Abstract
If there is one statement that sums up the view of drug abuse treatment over the last 15 years it must surely be that “treatment works”. So prevalent has been the notion that drug abuse treatment does indeed “work” that there has been an unparalleled growth in many countries in the funding for treatment and in the numbers of drug users in treatment. Within England, for example, over the 6 years from 2001 to 2007 there was a 70% increase in the numbers of drug users in treatment from 118,500 to 202,000. Over that period the funding for drug abuse treatment rose from around £390 million a year in 2002 to £800 million a year in 2007. The view that “drug abuse treatment works” was virtually unshakeable in the United Kingdom until around 2007 when the confidence in that statement evaporated virtually overnight and a definite sense of crisis descended:
Is it fair to say our field is in crisis at this point in time? Unfortunately I believe it is. I believe that this is because of two things. First, I think we are divided within. Second, increasingly there are attacks on drug treatment from outside — and these are becoming more virulent, sustained, and widespread. (Ian Wardle quoted in Great Debate 2009: 7)
Neil McKeganey

Chapter 4. Drug Enforcement: A World of Myth and Reality

Abstract
If there is one abiding image of the application of the drug laws it must surely be the sight and sound of splintering door jams and stunned residents as another early morning drugs raid takes place. The fact that such events are held in vivid detail within the popular imagination, and yet rarely if ever actually witnessed, stands as a testimony to the fact that when it comes to drug enforcement, appearance and reality are often very far from being the same thing. Politicians love to talk tough about illegal drugs, reassuring a concerned public that robust action is being taken and that they are working determinedly to tackle the drug problem. The current UK drug strategy is no exception in its stated commitment to “present drug misusing offenders with tough choices to change their behaviour or face the consequences of it” (Home Office 2008: 16). The strategy promises to:
Send a clear message that drug use is unacceptable; that we are on the side of the community; that we demand respect for the law and will not tolerate illegal or antisocial behaviour; that we will provide help for those who are trying to turn their lives around, to get off drugs and into work to ensure that drug problem are not handed on to the next generation. (Home Office 2008: 7)
Neil McKeganey

Chapter 5. Cannabis and the Classification Mystery (or How to Make a Hash of the World’s Favourite Illegal Drug)

Abstract
No book on controversies in drugs policy and practice could be complete without a discussion of cannabis. Cannabis is the world’s favourite illegal drug, with the United Nations Office on Drugs and Crime estimating that in 2007 somewhere between 145 million and 190 million people used it at least once (UNODC 2009). As well as being the world’s favourite illegal drug, cannabis is also the drug that excites more polarized debate than any other. On one side of the debate are those who regard cannabis as a relatively innocuous substance, with few adverse effects and unlikely to produce any long-term harm. For those who hold that view, cannabis should not even be classified as an illegal drug given that, in their view, it is associated with less harm than the currently legal drugs of alcohol and tobacco. On the other side of the debate are those who regard cannabis as a harmful substance that has acquired an entirely misplaced reputation as a soft or recreational drug, and which remains rightfully included within the illegal drugs legislation of countries across the globe.
Neil McKeganey

Chapter 6. Meeting the Needs of the Children of Drug Addicted Parents

Abstract
Over the last 10 years a revelation has taken place in the drugs field. That revelation consists in the realization that dependent drug users have children. Hardly a shattering realization you might think but there it is in all its predictable simplicity. The realization that drug users do indeed have children, and that many of those children suffer multiple harms as a result of their parent’s drug use, seems to have eluded drug policy for most of the last 50 years. Within the United Kingdom the first national drugs strategy “Tackling Drugs to Build a Better Britain”, published in 1998, talks at length about drug prevention, about treatment, about reducing drug users’ rates of re-offending and about reducing the availability of drugs on the streets. All but the most alert of readers of that document will probably have missed the single, passing reference to the importance of meeting the needs of children with drug-dependent parents.
Neil McKeganey

Chapter 7. Drug Legalization: Solution or Social Problem?

Abstract
Drug law reform is sweeping across the countries of central and southern America. The Argentine Supreme Court has ruled that it is unconstitutional to prosecute individuals for possessing drugs for their personal use. The court argued that adults should be free to make lifestyle decisions without the intervention of the state (Jenkins 2009). Mexico is similarly considering the benefits of decriminalizing drug possession as it faces the reality of drug gangs that are more heavily armed than the national military and 5,376 drug-related murders in a single year (BBC News 9 December 2008). It has been reported that Brazil and Ecuador are also proposing to follow the Latin American route to drug decriminalization and in due course perhaps full legalization (Jenkins 2009). In 2001, Portugal decriminalized the possession of small amounts of illegal drugs for personal use. Within the context of these developments questions are being increasingly asked whether drug legalization or some form of decriminalization should now be pursued more broadly. Writing in the Observer newspaper the respected philosopher John Gray has argued strongly in favour of legalization:
In rich societies like Britain, the US and continental Europe, the drug war has inflicted multiple harms. Since the inevitable result is to raise the price of a serious drug habit beyond what many can afford, penalising use drives otherwise law-abiding people into the criminal economy. As well as criminalising users prohibition exposes them to major health risks. Illegal drugs can’t easily be tested for quality and toxicity and overdosing are constant risks. Where the drugs are injected there is the danger of hepatitis and HIV being transmitted. Again criminalising some drugs while allowing a free market in others distracts attention from those that are legal and harmful as alcohol. Whilst it is certainly possible that legalisation could see more people take drugs a drug users life would be much safer and healthier than at present. (Gray 2009)
Neil McKeganey

Chapter 8. The Politics of Drugs Research: A Journey into the Cold

Abstract
There is a hidden controversy in the world of drugs policy that is rarely acknowledged and hardly ever discussed. It is a controversy that became a global news story in the winter of 2009 when the British Home Secretary dismissed his chief drugs advisor Professor David Nutt. That controversy concerns the relationship between the science and the politics of drugs research and it is a controversy that runs very deep.
Neil McKeganey

Chapter 9. Conclusion: So What’s Morality Got to Do with It?

Abstract
In this final chapter I would like to look at the moral dimension of our views and responses to illegal drugs. For the last 20 years our drug policies have been guided by the principle of pragmatism. That principle, applied to the drugs issue, has rarely been defined but consists largely in the view that one should accept the inevitability of illegal drug use and seek to minimize the various harms associated with that use. The principle of pragmatism, closely associated with the philosophy of harm reduction, places one about as far from the principle of moral judgement as it is possible to get. Whereas the notion of moral judgement might characterize drug use as something that ought not to be occurring, a behaviour that offends some deeper moral code, the principle of pragmatism eschews any such judgement and concentrates solely on how the harms associated with that behaviour might be reduced.
Neil McKeganey
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