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On the Scientific Value of the Research Studies
Accompanying Heroin Distribution...
A Critique. by Ernst Aeschbach, M.D.
"Criticism
of the Experiments on Medical Prescription of Narcotics in Switzerland" by Dr.(med)
Ernst Aeschbach (Lecture held at the Drug Conference in San Patrignano, October 14, 1995).
Susan Kaplin's
paper on research used to block the UK "Royal Commission on Cannabis" May, 1994.
Ernst Aeschbach, M.D.
For the past eight to ten years, the Citizens of the German speaking sector of
Switzerland have been witnessing a highly questionable change of drug policy: open drug
scenes, toleration of rising crime rates, and pursuit of "survival aid
measures," sometimes known as "harm reduction." These "measures"
facilitate addictive behaviour instead of behaviour which favours the abandonment of drug
use and positive perspectives on life.
Though the failure of Swiss drug policy seems obvious, nevertheless, models are still
being proposed which more or less advocate the free availability of all drugs. One of
these models calls for the distribution of heroin. The common denominator of all these
models is the theory that drugs themselves are not dangerous, but rather the way they are
used.
Two prerequisites are necessary for the political endorsement of these models. First, the
media must disseminate the mistaken notion that drugs themselves are not dangerous, but
only the way they are used. And second, the "heroin experiment" must be
presented as a "scientific study."
There is no scientific interest or reason for this heroin experiment. The hazards of
heroin use have long been proven. Indeed, for the heroin experiment, the term
"scientific study" is being used as a subterfuge. This is the only way available
for proponents to introduce the broad distribution of heroin in Switzerland.
Federal Council of Switzerland 1992: Drug Abstinence as Primary Goal in May of 1992, the
Federal Council of Switzerland voted, under massive political pressure, to allow a
temporary experiment to distribute heroin to addicts. It should be noted that the conduct
of the experiment contradicted the prevailing narcotics law.
In its implementing decree of October 21, 1992, the Federal Council of Switzerland
stipulated that scientific research must accompany drug prevention measures, so that
improvements in the health and living conditions of drug addicts, as well as their
integration into society, may be analysed. Drug abstinence was still the primary goal of
the prevention and welfare measures. This decree forms the legal and substantive basis of
the General Experimentation Plan, published by the Federal Office of Public Health. The
Experimentation Plan delineates the binding guidelines for the establishment and
implementation of the heroin experiment. It also explicitly states that drug abstinence is
the primary goal, thereby setting forth the primary criteria for evaluating the results.
The first project applications for the experiment were submitted by several cities and
organisations and approved by the Federal Office of Public Health in the Fall, 1993. The
first experiment began in early December 1993, in Zurich. One of the major components of
the project was the trial prescription of heroin. This is an essential factor for
determining scientifically the possible basis for permanent distribution of heroin in the
future. Since the distribution of heroin to addicts represents a fundamental deviation
from hitherto proven principles of treatment, it is imperative that a critical analysis of
this experiment be undertaken.
Scientific Objectivity:
Scientific research demands objective behaviour in the formulation of experimentation
concepts, as well as in practical procedure. Pre judgment on the part of those responsible
could lead to biased results and may later cause erroneous political decisions. When
massive political pressure exists, as is the case with this heroin experiment, then at
least those who evaluate the individual projects should be neutral. However, in this
particular case, the evaluators' neutrality is highly questionable.
As early as 1991, the director of the current heroin project ZokL2, A. Seidenberg, stated
the following: "A medicalization of the drug problem, as seen in this experiment,
does not represent a definitive solution to the drug problem. Instead, it represents a
partial step towards normalisation....Even before a broad distribution has been
implemented, it is possible to enter into a discussion concerning additional
market-deregulating measures."1
Continuous opposition to the Experimentation Plan has stated:
* The Experimentation Plan is based on drug-policy, not scientific reasoning.
* There is a call for broad distribution of opiates to drug addicts.
* There are exceptionally premature "success reports" by project managers
and evaluators.
Making unequivocal drug policy claims, and then trying to substantiate them
scientifically, can lead to only seeing what advocates want to see. Internationally
accepted scientific standards appear to have been violated.
Flaws in the Federal Office of Public Health's General Experimentation Plan:
The design of the General Experimentation Plan contains methodological flaws and critical
errors, some of which are presented below:
1. A major omission is the lack of a control group of drug addicts, to whom narcotics are
not prescribed, but who nonetheless receive the same welfare measures. Having a control
group would have allowed an analysis of the results, to determine whether the results are
due to heroin prescription or welfare measures. Without such a control group, positive
results can be due to the quality of counselling and supervision given, and can occur
without regard to the prescription of heroin. The use of control groups is a scientific
standard which all serious researchers include in order to insure recognition of their
work.
2. A major limitation is the unreliability of data collected. Details of physical and
mental health, as well as social circumstances, were primarily taken from interviews. This
procedure is not in itself invalid, yet a scientist must assure the reliability of
collected data by hard facts and field surveys. Without such reliable data, conclusions
can only be speculative. In this case, such supporting information has not been verified.
In addition, the collected data are not corroborated by reports from third parties, such
as relatives, employers, police, etc. Moreover, easily subjective data have not been
collected systematically. For example: although physical examinations were given when
participants entered the project, a preliminary report of November 1995, shows that
apparently not even systematic laboratory tests were given to determine such important
parameters as HIV-status and hepatitis infections.
3. A major contradiction is that quantitative conclusions cannot be drawn from the
ambiguous formulation of many questions. For example: according to the General
Experimentation Plan, risk behaviour with regard to HIV must be examined. However, the
criteria for measuring risk behaviour remains completely unclear. Since the participants
were not required to take routine HIV-tests, no conclusion can be drawn with respect to
the frequency of initial HIV infections, not to mention those which may have occurred
during the time of participation in the experiment.
4. A major concern is that the majority continued actively in the drug scene and consumed
additional narcotic substances during the experiment. Since no records were kept of the
drug types and amount consumed, no conclusions can be deemed valid about the relationship
between health and consumption behaviour or changes in social circumstances during the
experiment. This problem could have been avoided by prohibiting participants from taking
drugs outside of the experiment and introducing controls such as obligatory random drug
tests. Here the Experimentation Plan once again failed to maximise the reliability of the
data required for objective evaluation.
5. Some critics, since the beginning of the heroin experiment, have raised the following
questions:
* Could the experiment have various negative effects on the drug scene?
* Could a general increase in drug consumption lead to increased drug-induced delinquency?
* Could HIV infection spread further?
According to the General Experimentation Plan, precisely these questions will not be
examined in the evaluation. In addition, cooperation by the police has been categorically
rejected, and this insures that the impact of the experiment on public safety will not be
appropriately verified.
Dubious Changes in the Experimentation Plan:
In its decree of October 21, 1992 the Federal Council of Switzerland designated abstinence
as the primary goal of the experiment. Moreover, it limited drug prescription to the end
of 1996, except for the oral intake of methadone. It authorised only 5 projects with a
maximum of 50 participants each, thus setting a ceiling of 250, so that the
"scientific experiment with human beings not exceed certain bounds."
These limitations have been attacked by various advocates of the experiment. These
advocates essentially called for: (1) an increase in the number of participants; (2)
authorisation of prescriptions for other drugs, for example, cocaine (U. Locher, Neue
Zrcher Zeitung (NZZ), August 16, 1995); and, (3) less controlled distribution conditions,
i.e., such as the ability to take drugs home (M. Stocker, NZZ, August 16, 1995). These
criticisms should be construed as an indication that the advocates themselves do not
consider the projects to be scientific research, but rather the means to implement drug
policy measures. Unfortunately, the Federal Council of Switzerland succumbed to pressure
from the experiment's advocates, and in October 1994, one year after it began, the Council
voted to allow the first change in the General Experimentation Plan. The number of
participants eligible for heroin prescription was raised from 250 to 500, with those for
morphine reduced from 250 to100 and methadone reduced from 200 to 100. The reason given
was that heroin, in contrast to morphine and methadone, was more readily accepted by
heroin addicts.
Another rationale for changing the ratio of heroin, morphine and methadone subjects was
that initially fewer side effects and incidents were reported with heroin. By greatly
increasing the number of heroin subjects and reducing the number of other participants,
the results of the study could be artificially altered. This example shows very clearly
that the experiment is not based on scientific criteria. Instead, it was designed to
accommodate the preferences of heroin addicts.
It is of considerable interest to note that no important successes have been recorded with
regard to the experiments' official primary goal, drug abstinence -- the one factor which
might have justified any eventual changes in the Experimentation Plan. It seems that the
real reason for the change was based on the preference of heroin addicts to take heroin.
The second change in the General Experimentation Plan was made in May 1995. This time, the
number of participants was increased to 800. With this change, the following three
additional research areas were added to the study. The contribution of each one to the
scientific validity of the experiment is questionable:
(1) Drug distribution to mentally ill addicts . . .
This proposal was made even though clinical evidence demonstrates that providing drugs to
such patients is particularly dangerous to their health.
(2) Drug distribution in prison . . .
This proposal contradicts policy designed to motivate prisoners to accept long term
therapy toward abstinence after physical withdrawal has been completed.
(3) Heroin distribution to patients in already existing ambulatory methadone programs
and other therapy centers . . . This proposal undermines the essence of the methadone
programs and mixes heroin and methadone recipients in the same facilities. This is
inconsistent with the objective of helping methadone patients stay away from the drug
scene and encouraging them to participate in abstinence oriented therapy. Once heroin
programs are combined with methadone programs, those receiving methadone face a greater
danger of becoming de-motivated in
overcoming their drug addiction.
Preliminary Results Justify Abandoning the Experiment:
Within the scientific community, it is customary to publish results in scientific journals
and thus make them available for verification and discussion. Non-compliance with this
discipline violates important scientific procedures. Announcing results for the first time
at a press conference is a most unusual procedure among researchers. But this is precisely
what the Federal Office of Public Health and the experiment's directors did in November
1995, when they presented the first results at the press conference and deemed them
predominantly positive. The feasibility of the experiment and the accessibility of
participants within target groups were emphasised. Considering drug addicts' desire for
heroin and the very low demands made on them in the experiment, this is not surprising.
The preliminary report indicates that the General Experimentation Plan's designated goal
of abstinence2 has been replaced by a new goal "...to test new approaches in the
treatment of drug addicts." This means that the experiment violates the letter and
intent of the original 1992 decree of the Federal Council of Switzerland.
Analysis of the individual results presented by the Federal Office of Public Health and
the directors of the experiment indicates the following specific failures of the
experiment:
1. Improvements in health did not occur within 6 months of the entrance of a participant
in the experiment. Physical symptoms such as insomnia, loss of appetite, tiredness and
loss of energy (a decrease from 47% to 46%!), nocturnal sweating, dry throat, etc.,
improved only by a small percentage during the first 6 months -- not enough to meet
minimum objectives anticipated for improvement of the participants' health. Indeed, the
biggest improvement reported reflects only a better "injection technique", which
astonishingly has been included in the list of physical symptoms.
Based on the data provided, improvements in physical health are more probably the result
of care given than narcotics prescribed. In addition, no comparison was made of the
results among the various groups receiving different narcotics. Hence, it is completely
inconceivable that researchers could arrive at an optimistic conclusion based on such
incomplete data.
2. The amount of narcotics consumed stabilised after about a month. A significant
reduction in dosage and frequency of consumption was therefore not achieved.
3. Improvements in living and working conditions of the participants, as well as their
social environment, are to be welcomed. However, it is more likely that these results are
due to psycho-social welfare measures rather than to the supply of heroin. The inclusion
of control groups would most probably have substantiated this conclusion.
4. The research directors gave great importance to the high retention rate among the
participants -- 73% until June 1995, with 82% participating for at least 6 months. Such
continuing participation in the program, with continuous access to heroin, must be deemed
a failure in light of the goal of abstinence set for the project.
There is little or no information provided about how far the experiment has been able to
attain the goal of abstinence, or the extent to which a controlled narcotics prescription
program can help drug addicts quit the vicious circle of addiction (NZZ, November 24,
1995).
5. The high retention rate in the experiment in comparison to in-patient therapy centers
was especially emphasised by A. Uchtenhagen, but this comparison is invalid and implies
erroneous conclusions. A high retention rate in heroin distribution programs is, on the
contrary, not an accomplishment if drug abstinence is the ultimate goal.
6. The reported decrease in illegal activities from 53% to 13% is based on information
provided exclusively by the addicts who participated in the heroin experiment. Therefore,
it cannot be considered as objective proof of the impact of the heroin project on criminal
behaviour, as alleged by A. Seidenberg (NZZ, No. 228). This data has no value.
Conclusions on delinquent behaviour can only be based on verified police records. In the
semi-annual report of the Federal Police Bureau of Switzerland, the central narcotics task
force noted that "validated scientific findings are lacking, and the only limited
information available is based on certain anecdotal observations of the drug
scene...." This has occurred primarily because the police have not been included in
the heroin projects. Zurich's cantonal police force has also expressed its concern that
the evaluation of the experiment will turn out to be biased.
Consequences of Heroin Distribution:
The real objective of the Swiss heroin experiment is to introduce a definitive program to
distribute heroin to addicts as soon as possible. The planned revision of the narcotics
law and the introduction of a new pharmaceutical law will provide the necessary legal
framework for achieving this objective. However, the political, social and therapeutic
consequences associated with a departure from proven and accepted principles of drug
therapy have been ignored to date.
In this connection the following considerations warrant careful attention.
* The implications of such a major change in Switzerland's drug policy has not been
appreciated beyond its borders.
* Nothing similar is being undertaken anywhere else in the world.
* Even in the United Kingdom, heroin distribution has had universally negative results,
reflected by an increase in the number of drug addicts, an increase in the death rate, and
extensive health problems.
Any program distributing narcotics is full of perils. A. Uchtenhagen, director of the
Swiss evaluation team acknowledged this when he stated, "The distribution of
narcotics to addicts is being undertaken with great caution and restraint throughout the
world. In certain cases temporary and very structured methadone programs have been
provided as a bridge toward abstinence-oriented treatment." (A. Uchtenhagen,
Zrichsee-Zeitung, March 30, 1995).
Caution in the distribution of narcotics is based on experience. On a societal level and
by the addicts themselves, such measures are perceived as acts of resignation. Trust in
established abstinence-oriented treatments decreases. The danger involved in changing this
mind set of an addict is frequently not recognised. Often addicts will more willingly
fulfil the conditions needed to receive heroin in a distribution program than decide on a
treatment process which is considered to be arduous. Thus, motivation to enter therapy is
easily destroyed, and with it the hope for a life without drugs. The negative consequences
of drug use have represented the most important reason for an addict to give up drugs.
Easy access to drugs and belittling the consequences of drug use, instead of
abstinence-oriented treatment, are counterproductive measures that facilitate drug use and
encourage distribution projects.
One of the reasons for launching the Swiss referendum "Youth Without Drugs" in
December 1992, was the initiators' concern that the Swiss heroin experiment could be
misused to promote the liberalization/legalisation of drugs. If the referendum is enacted,
heroin projects would be forbidden. At the same time, appropriate and necessary measures
would be implemented to aid drug addicts.
It is crucial that a broad and knowledgeable discussion be held on the scientific value of
the heroin experiment. For this purpose, the World Health Organisation's (WHO) current
evaluation of the experiment is too limited. Scientists and doctors beyond Switzerland
should be invited to join in a critical professional assessment of this experiment.
1 The translations which appear in this article have been prepared by the author.
2 The original statement in the General Experimentation Plan, BAG, November 1, 1993:
"The experiments involving the medical prescription of narcotics to drug addicts are
defined as scientific experiments aimed at investigating the success of the therapy
delineated here as a step towards drug abstinence."
Ernst Aeschbach, M.D., specialist for Psychiatry & Psychotherapy FMH
Dr. med. Ernst Aeschbach, Spezialarzt FMH for Psychiatrie und Psychotherapie
Susenbergstr. 53
CH - 8044 Zurich
Switzerland
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First I want to thank the organisers for the invitation and the opportunity to give you a short presentation of the heroin distribution projects carried out in Switzerland.
For about eight years now, we have witnessed a gradual shift from a restrictive to a more and more liberal drug policy in Switzerland. This eventually led to the big open drug scene at the Platzspitz and later at the Lettensteg in Zurich. Because of the reduced law enforcement, drugs became more and more available. At that time, the distribution of heroin as a measure of help for drug addicts was put on the political agenda.
In my presentation, I'll shortly explain the attitude of the Swiss Government on drug policy. Then, after a presentation of the heroin projects, I will focus on the scientific insufficiencies of these experiments.
In February 1991 the Swiss Federal Government demanded measures to stabilise the number of drug addicts by 1993 and to reduce it by 20% until 1996. It demanded further efforts in the field of prevention and therapy as well as assistance and support for addicts. At that time, a scientifically accompanied pilot project on the distribution of narcotics to addicts was taken into consideration; the distribution of heroin, however, should be excluded in any case. This was in 1991: definitely no heroin distribution.
Nevertheless, the Federal Government - under strong political pressure - agreed upon a scientifically accompanied project on the medical prescription of narcotics including heroin in May 1992. In October 1993, the responsible authority, the Federal Office of Public Health, approved on 7 submitted projects in bigger cities of Switzerland.
In the experimental design the general objective of the experiments is described as follows:
"Projects on the medical prescription of narcotics to drug addicts are defined as scientific experiments aimed at examining the success of this kind of therapy as one step towards drug abstinence."
Thus, the success of the projects should be determined by the number of participants who become drug abstinent.
Further aims are:
The experimental plan includes a number of questions, for instance about general well-being, ability to work, contacts with the drug scene, delinquent behaviour, risk behaviour, subjective effects of drugs, preference of drugs and ways of application, to mention only some of them. The data come from questionnaires and interviews with the participants.
The participants get either iv heroin, iv morphine or iv methadone. They also get other substances like oral methadone, benzodiazepines or anti-depressants. The experiment is conducted in five different types of projects. They deal with different target groups or contextual conditions. In three of the project types the decision which drug is given to which addict is made by the doctor who asks the addict for his preferences. Two projects started with a randomised allocation one of them is also double blind. This double blind project, however, was soon abandoned. The addicts may now choose the substance themselves.
Originally, the experimental groups (heroin, methadone, morphine) were supposed to be of the same size, 250 subjects each. For heroin being the drug of choice of most of the addicts, the heroin groups were filled much faster than the other two groups. So in December 1994, there was a first extension of the heroin group up to 500 subjects. In May 1995 a second extension was decided upon. The number of heroin places was then increased up to 800. Additionally, the project design was changed in that the heroin distribution projects were to be integrated into existing methadone maintenance programs and the prescription of narcotics should be extended to patients with psychiatric disorders and to prisoners. The next steps which are discussed are the possibilities to take drugs home, to make cocaine available and to further extent the inclusion criteria (NZZ 16.8.95). This means they want to make it easier for the addicts to participate in the projects.
By April 1st, 1995, there were 286 participants in the heroin group, 28 in the morphine group and 41 in the methadone group. Of the possible number of 988 places, only 355 are filled.
From a scientific point of view, those narcotics distribution projects in Switzerland and their scientific evaluation have to be criticised for a lot of reasons.
First of all, I think that the distribution of heroin to drug addicts has to be rejected for ethical reasons. Human beings should not be misused as experimental rabbits! Negative effects on the whole society, an increase of the drug problem, an increase of delinquency and of the HIV epidemic have to be expected. The devastating effects of such projects were already demonstrated in different countries at different times.
Let us continue with the research questions. They are partly formulated in a very general and unspecific way. The answers to this questions will be based on questionnaires and interviews done with addicts who know that their future depends on their answers, and taken by professionals whose professional future depends on the outcome of these projects. A lot of energy is wasted and questions such as drug tolerance, side effects and withdrawal symptoms could have been answered easily by referring to the existing scientific literature.
Unfortunately, the most controversial questions are not examined: The effect of the projects on the drug scene, the effect on drug related delinquency and the effect on the AIDS epidemic.
A fact which will result in a very difficult scientific problem is that the project design was changed several times in different ways. The number of subjects was changed, the number of experimental groups was changed, the type of drug allocation was changed.
A major criticism has to focus on the different group size of the heroin and the other groups. You get into serious statistical trouble if you try to get significant results from a comparison of two groups if the number of subjects in one group is ten times higher than the number in the other group. Being aware of this forthcoming problem, the director of the experiment decided just not to compare the three groups. For my understanding, this is one further step away from a scientific approach.
Another basic deficiency of the project design is that there is no drug free control group.
And above all, the polydrug use is a major pitfall of the evaluation of the heroin projects. According to Prof. Uchtenhagen, the director of the experiment, only 10% of the participants are pure heroin consumers, whereas about 80% additionally consume cocaine and/or other drugs. The participants are not required to take only the drugs they get in the projects and there is no systematic testing on drugs.
Obviously, the politicians who favoured this type of project and evaluation do not really believe in what is said in the general objective of the experiment itself, namely that this kind of therapy should be one step towards drug abstinence.
I think it is generally questionable if such a controversial issue like giving heroin to heroin addicts is to be evaluated by means of a project which is not designed according to scientific standards. The term scientific just refers to the "accompanying scientific evaluation". Ladies and Gentlemen, such a kind of scientific evaluation cannot compensate for the weaknesses of the project design and for the soft and biased data.
Please address any comments on the above paper to Dr.Ernst Aeschbach directly at (e-mail) 76057.1653@compuserve.com
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In February, 1994, a "Royal Commission on Cannabis" was proposed to
"review the prohibition of the use of cannabis and to examine alternative options for
control of the drug within the law". It was noted in this proposed motion that there
is a "growing body of evidence which testifies to the medicinal and therapeutic
properties of cannabis and its relative safety compared with other legalised drugs".
However, an amendment was made and passed stating that increased penalties for possession
of cannabis set by the government were welcomed "in the light of overwhelming medical
evidence that cannabis leads to poor short-term memory and learning problems, lung damage
and cancer risks that are 50-70 per cent greater than those associated with tobacco use,
reduced immunity producing cells, and impairment of heart function: (it is noted that)
cannabis causes greater organic brain damage than any other drug with the possible
exception of PCP and the end stages of alcoholism; and that the effect of one cannabis
cigarette lasts five or six times as long as one unit of alcohol". It was then stated
that "(this House) deplores any moves towards the legalisation of cannabis, based on
the experience in Alaska where such a move was abandoned in 1990, having led to the
increased use of both soft (sic) and hard (sic) drugs, increased drug related crime and
increased health care costs".
A letter from a pro-legalisation organisation questioning the facts of this passed
amendment was sent to the Member of Parliament responsible for its draft. This paper sets
out to address these questions by citing recent relevant research findings.
The effects of cannabis in the amendment are not "falsified" nor are they a
"form of outdated propaganda (laid) onto people.... ". In addition, the
information on the harmful effects of cannabis are not based on "biased newspaper
reports". In fact, in reviewing the newspapers over the past three years, there has
not been a true factual representation of the harmful effects of cannabis nor the
potential dangers in legalising or decriminalising it. Instead, pro-cannabis individuals
and groups have been able to use the newspapers as a forum for their "cause" to
the exclusion of factual information on cannabis and its effects.
The facts on cannabis are not a "form of outdated propaganda". It should be
pointed out that most of the studies cited in the pro-legalisation letter are outdated -
documenting the evidence that "no detrimental effects (of cannabis) can be
proved," when examining reference 1-13, eight of these are from the 1970s, one is
from 1982, two are from the l990s (both of these sources, High Times and HEMP, "Help
Eliminate Marijuana Prohibition," are pro-cannabis) and two are listed as
"1893-4" and "1944". The majority of the research cited in the letter,
therefore, is outdated. This is a major problem because medical research in general has
advanced technically since the 1970s. The "long-term" studies cited in the
letter are from 1977 (Greek study) and 1975 (Jamaican study). It should be noted that
recent studies are able to assess the longer term effects of cannabis, using more advanced
research techniques (see below for examples). In addition, the study cited in the letter
which examined the effect of cannabis on the immune system was from 1976. This is before
AIDS was discovered. More recent studies on the immune system (how it works and what
affects it) have occurred since 1976 and these studies show the impairing effect cannabis
has on the immune system (see below for more detail).
The following are some examples of more recent research to counter the research claims
mentioned in the letter:
In regard to Alaska, cannabis was decriminalised, not legalised,
through the Alaska Supreme Court and through the initial support of police primarily
because they first thought crime would decrease. However, cannabis use and problem use
went up (with heavy increases in health and social costs). An important factor in
rescinding decriminalisation was the response of the police, who saw first hand the
problems caused by decriminalisation. Whether or not there was a direct cause and effect
relationship between cannabis decriminalisation and the increase in crime,
decriminalisation was seen to have failed. In seeing this failure, the police who had
initially supported decriminalisation fully supported rescinding the law.
"Legalisation could provide significant benefits to society," as claimed in the
letter, is not true when examining cities that tried decriminalisation. In addition to
Alaska's experience with decriminalisation, when examining the effects of their lenient
cannabis laws, the Dutch policy has been associated with a progressive increase in
cannabis use among 15- 19 year old (from 4% in 1984 to over 8% in 1989). Between 1984 and
1988, the use of cannabis increased by almost 100% among upper high school students in the
Netherlands. The policy of "harm reduction@' has not prevented a steady and
significant rise in drug addiction (cannabis, cocaine and opiates) among 15-19 year olds
and young adults. ("Drug Reform: The Dutch Experience," Richard H. Schwartz,
1993). The Dutch Institute on Alcohol and Drugs recently questioned 8,000 young people and
also found that the percentage of students smoking cannabis has more than doubled in four
years (from 3% in 1984 to 7% in 1988). (Guardian 9 November 1993).
It should also be noted that references in the letter to support the claim that
"legalisation could provide significant benefits to society" included three
sources of information from the 1970s. In addition, the two 1993 resources are by
pro-cannabis, and thus, biased, authors.
Finally, in contrast to the 1993 report, cited in the letter, on the decreased health
costs and lower absenteeism of drug-using employees in Utah Power and Light and Georgia
Power (originally appearing in High Times, a pro-cannabis and therefore, biased
publication), it should be noted that over 85% of the largest employers in the USA use
urinalysis drug testing as a means of preventing illegal drug use on and off the job.
Several studies have been conducted that examine work performance of employees using
illegal drugs compared with those who have tested negatively for such drugs.
For example, at the U.S. Postal Service, the biggest employer in the USA, 300 people who
tested positively for illegal drugs were compared with non-drug users who started work at
the same time. After eight months, accident rates, injury, absenteeism, and disciplinary
problems were found to be far higher for the illegal drug users than for non-drug users.
(Supervisors did not know which employees tested positive for drugs). Those who tested
positive had higher termination and turnover rates than the no-drug user. After 16 months,
absenteeism, termination, and turnover rates increased even more for the drug-users. The
U. S. Postal Service has decided to do pre-employment drug testing to save 62 million
dollars a year and decrease absenteeism, turnover, and accidents ("Testing for
Illicit Drugs in the Workplace," Peter Bensinger, Former Director, Drug Enforcement
Administration, Washington D.C.) (Cannabis: Physiopathology. Epidemiology, Detection,
1993). In addition, it was recently found (March 1994) that drug use and resulting
disciplinary problems by some Chicago postal employees has resulted in the nondelivery of
nearly 10,000 pieces of mail, some of which was dumped and burned. This problem has had a
major effect on the people and business in the areas affected.
In conclusion, it is clear that the defeat of the proposed "Royal Commission on
Cannabis" is based on factual and recent research and is a positive move to support
prevention.
For further information:
"Information on Cannabis," 1993. "Issues in the Prevention Field: The
Definition of Prevention, Prevention Research and Legalisation of Cannabis," 1993.
"The Effects of Drug Laws on Crime and Other Social Problems in the UK," 1993.
"The Effects of Harm Reduction and Prevention: An International Assessment,"
1994.
Susan Kaplin. Senior Researcher, International Drug Strategy Institute. May, 1994
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