Sunday, February 21, 2010

Law Commission on Drugs Part 2 - Drug Harms

Chapter 2 - The harms arising from drug use, pages 18 -36

It is "unarguable" that drugs, both legal and illegal, cause significant harm to society (2.1). There's a nice admission of societal biases. The harms of legal drugs are usually understated, while illegal drug harm is generally overstated. This comment is footnoted by the Law Commission's recent Alcohol in Our Lives paper.

Personally, I reckon society has got a fairly good grip on the harms of legal drugs, such as alcohol and tobacco. Public understanding of illegal drugs is more ignorance than overstatement. It's the moral tub thumpers that overstate the alleged harms. Ignorance and morality are the inbred parents of our current drug laws.

Psychoactive drugs change mood, perception, cognition and behaviour (2.2). Well, duh. That definition is accurate enough to include the publicly acceptable legal highs such as caffeine, sugar and chocolate, and wide enough to include non-drug events such as gambling, Shortland St and the weather. They narrow this down by describing how drugs change the psyche to create binary "effects and possible harms" - toxicity and dependence.

I would consider Shortland St to be toxic and harmful with many addicts, but the report is limited to looking at illegal ingested substances. Soap is legal in NZ. But the toxicity/dependence paradigm is apt. You can easily apply those terms to caffeine, sugar and chocolate, and they are applicable to the other legal and illegal drugs on the wider legislative menu.

The report goes on to list other less direct harms associated with drug use; prostitution, fraud and impaired driving (2.3). Drug use can also harm others (2.4), and reads like that infamous BERL report, which will rear its head eight paragraphs into the future.

2.5 caveats these supposed harms, stating that much of it is unquantifiable, and polydrug use clouds where harms might be attributed. Harms differ depending on a range of uncontrollable factors (2.6), and not all drugs are equal in the harm department (2.7). The harms caused by drug prohibition are often confused as drug harm (2.8)

And if drugs are so bad for people, why do they take them anyway? 2.9 sez:
These benefits may include the pleasurable effects of an altered state of consciousness (ranging from increased relaxation to increased energy), better social bonding with peers, or an escape from the realities of everyday life. Many of these benefits have parallels with the social benefits of alcohol (although the latter are more readily acknowledged than the former).
This is what happens when you ask a lawyer what Fun means. There are other uses too. The name Drugs is a bit of a giveaway. Their main contribution to humanity is as medicine. From 2.10:
Heroin, for example, was available on prescription in New Zealand until the mid-1950s. Some consider the inability to develop and use illegal drugs like cannabis for medicinal purposes as a particular harm of drug prohibition.
This is why many drug reformers get so angry over the current drug laws, and why many are especially angry with alleged Justice Minister Simon Power at his immediate dismissal of the subject. What right does he have to stand between a chronic pain sufferer and the most effective pain relief?

"Notwithstanding these real challenges in describing and quantifying the harms", 2.11 introduces the infamous BERL report, and spends the next page and a half quoting liberally from the discredited document. 2.14 spends a short time describing the 2005 UK Drug Harm Index, but not actually mentioning what it concluded. To refresh your memory and to fill its absence from the Law Commission report, here it is again:

In fairness to the Law Commission, they spend the next few  paragraphs (2.15 to 2.20) caveating all to hell these quantifications of harms, concluding with great scepticism in 2.21. The report goes into some detail comparing and contrasting the relative harms of cannabis and methamphetamine.

2.22 describes cannabis, 2.23 describes how it is used (reefer, pipe, bong, "spotted", vaporiser or eating). In the last example of eating, they don't explain that cannabis is a readily fat-soluble food ingredient. Some poor bugger reading that line in the report might conclude that people sit down and eat the buds by themselves.

Immediate effects and harms of cannabis use are listed (2.25, 2.26). Fatal overdoses are mentioned in 2.27:
Cannabis use has a much lower risk of fatal overdose or other life-threatening conditions than many other psychoactive drugs. It has been estimated that a lethal dose of cannabis is in the range of 15 grams to 70 grams, which is many times greater than what even heavy users would consume in a day.
This is the first outright lie in the report. No-one in recorded history has ever died from a cannabis overdose. The report somewhat admits this by footnoting the NZ Drug Foundation:
The New Zealand Drug Foundation ( estimates that a lethal dose is 40,000 times that which is needed to become intoxicated. In total, two human deaths have been reported from cannabis poisoning worldwide. However, it is not clear that those deaths were the result of cannabis.
People have drank themselves to death. A lethal dose of caffeine varies between 60 and 80 cups of espresso in a 24 hour period. Hell, men have carked it over Viagra. But no-one has ever died from smoking too much cannabis.

The long-term effects of cannabis use is explored in 2.28, quoting extensively from the Dunedin and Christchurch Longitudinal Studies:
In New Zealand, the Dunedin Multidisciplinary Health and Development Study found that 18.3% of cannabis users in its cohort were cannabis dependent at age 26. This proportion was similar to that observed for alcohol (17.9%) but lower than that observed for tobacco (34%)... Cannabis dependent users were more likely to be male and Mäori.
Male and Maori. That's another big clue, which will be revisited in a future chapter.

Smoked cannabis harm is compared with tobacco (2.29), and minor cognitive impairment is mentioned in 2.30 (verbal learning, memory, attention). "Debate continues about the extent of these impairments, and whether they can be recovered after cannabis use stops." The old chestnut of the supposed causal link between chronic use and psychiatric disorders comes up in 2.30 to 2.33.

BERL reappears in 2.34, this time to estimate the social harms of cannabis. A long disclaimer is listed in 2.35, before 2.36's insistence that the BERL numbers are indicative and not, for example, expensive meaningless drivel.

The link between cannabis and crime is explored (2.37). 2.38 says there is no link:
However, there is little support here or elsewhere for the view that cannabis intoxication itself causes users to commit crime. It is more likely that the same factors predispose people to commit crime and to use cannabis. In New Zealand, NZ-ADAM findings were that only a small proportion of participants who had been using cannabis at the time of their arrest believed that their drug use had contributed to “some” or “all” of the activities which led to that arrest.  NZ-ADAM findings also support international research which suggests that cannabis generally inhibits aggression and violence in users.
Public Health harms supposedly include drug driving (2.40), although evidence presented shows fewer problems compared with alcohol. Pregnant women are advised against using cannabis (2.41), adding to the long long list of things they should avoid while breeding.

The report spends some time on the "substantial" costs of cannabis prohibition (2.42 to 2.44). Most of the figures quoted are just wild estimates (BERL returns). One thing does stick out:
[A]lthough 30% of NZ-ADAM participants considered that the cannabis market was very or fairly risky or violent, the cannabis market was also perceived to be less violent or risky than the other drug markets covered (amphetamines, ecstasy, and heroin).
The National-led Health select committee in 1998 blamed cannabis prohibition for problems in effective drug education (2.45), not to mention the blatant hypocrisy and double standards observed by the "younger generation."

The report moves onto methamphetamine use. In comparison to cannabis, the harms of meth are almost at the other end of the spectrum. Although there are no recorded deaths from meth in NZ (2.51), long term users experience far more psychotic symptoms (2.52), more and stronger dependence issues (2.54).

The link between meth and crime looms large (2.58 and 2.59):
62% of methamphetamine users reported [in the NZADAM study] that their use of methamphetamine had contributed to some extent to their current criminal activity, with 47% saying it had contributed “all/a lot” and 15% saying it had “some” contribution... Of particular public concern is the perceived link between methamphetamine intoxication and violent crime... In New Zealand, NZ-ADAM identified that methamphetamine was the most likely of all drugs covered to increase users’ likelihood of getting angry.
The meth manufacturing process is in itself highly hazardous (2.63 to 2.66), and more users admit driving under the influence, including risky behaviour;  "driving too fast, losing their temper at another driver, losing concentration, or nearly hitting something."

Not all drugs are equal.

Up Next: Chapter 3 - Drug Policy