Ben Goldacre

Saturday 13 June 2009

The Guardian

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 outcome measures for drugs policy, and how a trivial pile of poppies was presented by the government as a serious dent in the Taleban’s heroin revenue

The Home Affairs Select Committee is now looking at the best way way to deal with cocaine. You may wonder why they’re bothering. When the Advisory Council for the Misuse of Drugs Act looked at the evidence on the reclassification of cannabis, they were simply ignored. When Professor David Nutt, the new head of the advisory council, wrote a scientific paper on the relatively modest risks of MDMA, he was personally attacked by the Home Secretary.

In the case of cocaine, there is an even more striking precedent for evidence being ignored: during the early 1990s the World Health Organisation conducted what is probably the largest ever study of global cocaine 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. “Few experts describe cocaine as invariably harmful to health. 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 – went on to challenge several of the key principles driving prohibition, and was extremely critical of most US policies. It suggested that supply reduction and law enforcement strategies have failed, and that alternative strategies such as decriminalisation might be explored, flagging up such programmes in Australia, Bolivia, Canada and Colombia.

“Current national and local approaches which over-emphasize punitive drug control measures may actually contribute to the development of heath-related problems,” it said, before committing heresy by recommending research into the unintended adverse consequences of prohibition, and discussing “harm reduction” strategies. “An increase in the adoption of more humane, compassionate responses such as education, treatment and rehabilitation programmes,” it said, “is seen as a desirable counterbalance to the overreliance on law enforcement measures.”

It specifically singled out anti-drug adverts which sought to modify behaviour through fear. “Despite a broad range of educational and prevention approaches, most programmes do not prevent myths, but perpetuate stereotypes and misinform the general public. Such programmes rely on sensationalized, exaggerated statements about cocaine which misinform about patterns of use, stigmatize users, and destroy the educator’s credibility. This has given most education campaigns a naïve image and has reduced confidence in the quality and accuracy of these campaigns.”

It also dared to challenge the prevailing policy view – still enduring – 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 they experience.” Experimental and occasional use are by far the most common types of use, it said, and compulsive or dysfunctional use, though clearly worthy of close attention, are 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 start using cocaine or related products, use casually for a short or long period, and suffer little or no negative consequences, even after years of use.” 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 just two months after the press briefing was released, at the 48th World Health Assembly, the US representative to WHO threatened to withdraw US funding for all their research projects and interventions unless the organisation “dissociated itself from the conclusions of the study” and cancelled the publication. According to WHO, even today, this document does not exist, (although you can read a leaked copy in full on the website of the drugs policy think tank Transform at www.tdpf.org.uk/WHOleaked.pdf ).

Drugs instantiate the classic problem for evidence based social policy. It may well be that prohibition, and the inevitable distribution of drugs by criminals, gives worse results for all the outcomes we think are important, like harm to the user, harm to our communities through crime, and so on. But equally, it may well be that we will tolerate these worse outcomes, because we decide it is somehow more important that we publicly declare ourselves, as a culture, to be disapproving of drug use, and enshrine that principle in law. 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, it simply means you must be clear that you don’t care about it.