Canada's drug problem: new solutions needed
CMAJ 1998;158:167
Re: "Mainstreaming methadone maintenance treatment: the role of the family physician" (CMAJ 1997;157[4]:395-8 [full text / résumé]), by Drs. Mark Latowsky and Evelyn Kallen, and "Methadone maintenance treatment: a Canadian perspective" (CMAJ 1997;157[4]:399-401 [full text / résumé]), by Drs. Bruna Brands and David C. Marsh.
In response to: R.A Durnin
See also:
Our editorial was meant to stimulate further interest and discussion, so we welcome Dr. Durnin's comments. Currently, 3 models have been proposed to deal with the illicit drug "problem": punishment, maintenance and legalization.
As discussed in our editorial, punitive models promote incarceration as a consequence and abstinence as a logical outcome goal. We agree, as others have argued, that the failure of the "war on drugs" has at its root a fundamental flaw of profit motive1 and entails significant economic costs.2 Many authors argue further that criminalization itself has been the most significant factor responsible for the current social problem of opioid addiction.3
Methadone maintenance, in contrast, has achieved a certain measure of success. Where it has failed, however, is that it has not significantly altered public prejudice and discrimination toward drug users, nor has it succeeded in shifting public policy decision-making toward maintenance as a publicly accepted and legitimate treatment alternative to punishment.
Legalization, although strongly advocated by some as more logical, humane and consistent with evolving human rights principles,4 remains an untapped but viable treatment option that is opposed by people with powerful vested interests, who continue to lobby successfully to maintain the status quo.
Those who use public health approaches suggest that it is not the drugs themselves that cause the greatest harm, but the restrictive social and public policies that shape the human behaviour surrounding their acquisition and that affect the manner and consequences of their use. Educating the public about the health risks of drug use, the ways in which to use drugs responsibly and the social controls to prevent drug abuse and dependence are sensible alternatives.
We agree that we need nonemotional and unbiased scientific studies and arguments to help shape rational public policy. However, public policy has never been dictated solely by objective criteria of harm.5 It has been and continues to be strongly influenced by factors that are judged or defined as problems by powerful decision-makers. This subjective construction allows for what Durnin correctly identifies as a contradiction in society's tolerance for alcohol use and its opposition to drug use. We argue that this contradiction also allows for continuing public misinformation and the consequent persistent stereotyping and stigmatization of illicit drug use.
This contradiction raises a critical point of public misconception: equating illicit drug use with abuse. We should all be concerned with preventing and treating abuse of and dependence on all drugs, whether legal or illegal. Those who incorrectly equate illicit drug use with abuse stigmatize all illicit drug users and unjustifiably invite the wrath of punishment to curb these users' "deviance."
The human rights approach adopted in our editorial considers both individual and group-level differences to be valued reflections of human diversity. Following from this, treatment goals involving drug abuse and dependence should include not only the restoration of function but the reclamation of the dignity, opportunities and freedoms that every human being deserves.
Mark Latowsky, MD
Opiate Dependency Program
Addiction Research Foundation
Toronto, Ont.
Evelyn Kallen, PhD
Professor Emeritus
Division of Social Science
York University
North York, Ont.
References
- Nadelmann EA. Drug prohibition in the United States: costs, consequences and alternatives. Science 1989;245:939-47.
- Dennis RJ. The economics of legalizing drugs. Atlantic Monthly 1990;Nov:126-32.
- Goode E. Deviant behavior: an interactionist approach. Englewood Cliffs (NJ): Prentice-Hall; 1978. p. 288-9.
- Szasz T. Our right to drugs: the case for a free market. New York: Praeger; 1992.
- Ledain Commission report: a report of the inquiry into the non-medical use of drugs. Ottawa: Information Canada; 1972.
 |
Send a letter to the editor responding to this letter
Envoyez une lettre à la rédaction au sujet de cette lettre |
Letters