by Peter Stoker – Director, National Drug Prevention Alliance
Update of paper originally written for ECOD conference 1994, from conversation between Peter Stoker and David Partington, then Director of Yeldall Christian Centres.

Harm Reduction, Decriminalisation, Legalisation, Cannabis the Peaceful Cure all these contentious issues are deeply interlinked. One must therefore consider them in combination

Thousands of years before Christ, advice was already being given as to moderation in drinking alcohol. One might say this was one of the earliest examples of Harm Reduction. It stemmed from the philosophy that if someone is irrevocably set on ingesting a substance they had best do it with the least risk.. But the only sure way to avoid risk was, and still is, not to partake. For example, “Eve, leave that apple alone or you’ll be sorry”. Abstinence can in some ways be regarded as the ultimate Harm Reduction, not just for alcohol and other drugs but also in other health-risk areas such as sexual behaviour. The Harm Reduction guidance for tobacco is, in fact, “Just Say No”. This raises an instructive point of comparison between Harm Reduction for alcohol and for tobacco. Both have been around for thousands of years. Neither has been prohibited for most of this time. Both have very slick and highly-financed PR and sales promotion. And yet in recent years there has been a crusade against tobacco, i.e. abstinence is best, compared with moderation as the rule for alcohol. A cynic might say the difference is in the manufacturer’s PR. But this is not borne out by observation. What has tipped the balance against tobacco has been acceptance by society of what they see as the hard facts, of which the death toll (100,000 per year) is only one. Even though alcohol is no slouch in this context, accounting for any where up to 50,000 deaths per year and is the Number One drug of abuse by youth, (cannabis comes second), there are no signs of people Just Saying No to a tipple. Alcoholism still continues to occur, in priests and paupers, but drink is here to stay, it seems. Why?

Perhaps the answer lies in the Harm Reduction aspect of alcohol. In contrast with most if not all other drugs you can take just a little alcohol as a beverage, i.e. for thirst, or taste, or social/religious rituals. Or you can use it as a drug, by taking higher volumes, and risk the consequences – health, social, legal, and of course spiritual. We say to ourselves that controlled beverage drinking is what we do. Uncontrolled excess is what other people do. But because we can handle it, it should remain legal and those others need to learn their Harm Reduction lessons better. This is a more tenable position with legal drugs, including pharmaceuticals, than with street drugs, precisely because more is known. (Though the professionals still let us in for unexpected Harm with these from time to time; witness Thalidomide, Valium, Ativan, and so on.) Strengths, or to put it another way, toxicities, are marked on the bottle or packet, and there may even be a sober little message from the government. Research into the negative effects of alcohol or tobacco has been produced over long years by many august bodies. Not a little of this research is funded by tobacco or alcohol manufacturers, which makes for a fair degree of scepticism in the reader.

STREET INCREDIBILITY
Street drugs are another matter entirely. There are no Quality Controllers in the back-street labs, or in the fields of the Golden Crescent, the Golden Triangle, the hinterlands of Medellin and Cali. What you buy is a lottery; that powder might be worthless talc or something that boosts you so high that you never wake up; not in this world, anyway. The more severe consequences are more likely to happen to the inexperienced or to the recently relapsed, therefore Harm Reduction advice must take account of where the user is in what some euphemistically entitle “their drug-using career”. (For ‘Harm Reduction’ read ‘Career Guidance’ !) That amazing new dance drug you’ve just paid £15 for could be a caffeine tablet dyed blue. Your £5 ‘trip’ could have nothing more hallucinogenic than the picture of the Pink Panther on the top. Even the grass you buy could be freshly mown. Things change rapidly too. The Mexican grass which Haight-Ashbury hippies smoked to get high often rated little stronger than 0.5% THC (Tetra-hydra-cannabinol, the bio-active molecule that stones you). Today you can buy ‘Skunk’ and other genetically modified varieties of “Nederweed” which can go as high as 25-30% THC. And who is around to advise you on this? The man who is selling it, that’s who.

That astonishing growth in strength is equivalent to being advised to take one aspirin a day “for a healthier heart”, and the day after being told to take 50 aspirins a day for the same reason. Would you do it? With aspirin? Well, young people do it every day with street drugs. And that certainly includes the spuriously-entitled “soft” drugs. Harm reduction with street drugs and related behaviour needs to happen, because harm is happening. We may, some of us anyway, still be working to encourage people to choose a lifestyle free of drug abuse but meanwhile we must strive to minimise the harm that is happening now, albeit to a minority. Today’s minority will become tomorrow’s majority if we get this wrong. But we need to recognise that in offering Harm Reduction advice (which itself may not be welcomed by the user) we are addressing the use of dynamically variable substances by dynamically variable people in dynamically variable social settings. Responsible behaviour may be no more than accidental in people doing irresponsible things, like abusing drugs. Harm Reduction can help, but if you are delivering it you need to approach the process with a certain humility as to the outcome you are likely to achieve.

ABUSE WITHIN ABUSE
Empowerment can come from Harm Reduction. Empowerment for the individual user to feel more in control of their life, less fearful of the damage they may be causing themselves or others. Perhaps, in this more stable setting, they can become better able to look at the longer term and make some positive decisions.

That is the good side of Harm Reduction. The side that says, in all moral conscience, one cannot withhold damage-limiting information from people just because their current behaviour is outside your norms. Deliver a message for life free of drug abuse by all means, but also give them what they need to stay as healthy as they can; to stay alive, in extreme cases. Where a darker side of Harm Reduction occurs is when it is hijacked by unscrupulous groups for their own purposes. The seemingly solid rock of logic which, when you pick it up, crumbles to dust in your hand, but not before revealing some nasty things underneath. This should hardly be surprising; many a good idea in history has been perverted to serve aims radically different to those which gave birth to the idea in the first place. In this case the hijackers are an alliance of drug-legalisers, libertarians and radical educationists. (Other forces including politics, commerce and organised crime are also in play). Their broad strategy is something like this:

Spread the (false) idea that you can’t prevent drug abuse. Spread the thought that it is morally wrong and “value-laden” to try to do so.
Argue for the removal of values in teaching. (In fact a “value vacuum” philosophy is an extremely value-laden concept, leaving children prey to “someone else’s” values sooner or later).
Allege that ‘everyone’ is doing it, or ‘millions’ are. (Truth is 8 out of 10 youth either never try or else give up after two or less tries. As for ‘millions’ – even if 5 million in Britain are, which is very doubtful, this means 51 million are not).
Spread the (tendentious) idea that as all youth might use drugs (but teaching them not to is “wrong”) what is needed is Harm Reduction teaching for all children in schools, with no guidance as to use or no use. (The inference the young people will draw is self evident).
Tell parents to “switch off”, it’s just youth rites of passage, you were young once, you smoke, so lay off preaching, the kids are alright, etc .etc.
Spread the (false) idea that cannabis is harmless. (Therefore needing no Harm Reduction limits).
POTTY IDEAS
This last one, the “Harmless Cannabis” myth, is strategically very important to the legalisers. They see it as the crucial first domino which could topple the drug array. And if it doesn’t, well at least it’ll be nice to get stoned legally at last. This is why they fight so hard to keep you believing there is ‘no Harm’, ‘no problem’. A library of over 12,000 worldwide accredited research papers (held at Mississippi University), testifying to its harmfulness, is studiously ignored. Hard evidence shows brain cells damaged or even killed; heart, lungs and endocrine impaired, immune system broken down, faster lung cancer than tobacco, paranoid psychoses, schizophrenia precipitated, addiction in physical as well as psychological terms, etc., etc. The list goes on, but is steadfastly shunned by the pot lobby, whose rallying cry seems to be, “Don’t confuse me with the facts!”. Blind faith and epidemic denial are the rule. Obviously no one has told these lobbyists that the toxicity of substances is not decided by debate.
An especially significant point concerns the areas of Health (and therefore of Harm) other than the physical, i.e. intellectual, emotional, spiritual, environmental and social. These areas are totally blanked out by the drug apologists – mainly because they have no answer; this is harm they cannot reduce. Speculative and extravagant claims as to pot’s medicinal value are made, all of them discredited years ago but still exhumed regularly and reverently. In fact, the medicinal value of cannabis is limited, more than overshadowed by the negative side-effects, and other drugs do the jobs better.

Within the last few years the BMA, the Lords Science & Technology Committee, and the prestigious Institute of Medicine in the USA have all come down against the use of raw (unprocessed) cannabis as medicine, and certainly not when smoked. Every relevant medical institution in the USA has tested and rejected it as medicine for any ailment, from glaucoma to MS, from cancer to HIV/AIDS. Faced with the 8-parameter approval schedule the Food and Drug Administration apply to every drug, cannabis could not even pass one. The French Government have also concluded that cannabis can no longer be defined as a ‘soft’ drug; in fact they believe it should be termed ‘hard’. The media persists in promoting ‘debates’ in which the prevention worker is faced with the user(s) in wheelchairs; the former is then harangued by the interviewer for ‘denying’ this useful medicine to the sick.

Medical use is a hostage to legalisation. Don’t take my word for it; as long ago as 1980 Keith Stroup, the then director of NORML, the oldest pro-pot campaign in the world, was publicly quoted as saying “We will use the medical marijuana issue as a red herring to give pot a good name”. And they did. Even so, were medical use of extracts to be proved valid in future (and it’s nowhere in sight yet) this would only be a basis for medical prescription, and certainly not a basis for relaxing laws on use for non-medical purposes. So, there is much to be rejected in the pleadings of legalisers. And yet we, the public, see through the tobacco propaganda, so what is different about cannabis? What is different is where the media stand. And they mainly stand, apart from some exemplary exceptions, shoulder-to-shoulder with the cannabis lobby, refusing to let evidence impede their ‘journalistic privilege’. This compulsion to romanticise pot can only partly be explained by the search for newsworthy copy. Quite what the whole truth is, it would be fascinating to find out.

The combined thrust of the above-listed radical ploys is to gradually shift public attitudes, to convince us that drug abuse is no more than the equivalent of a little scrumping “when you were a lad”, youth should be empowered without “adult-imposed” value systems, their drug taking (now or in the future) should be facilitated with teachings of D-I-Y Harm Reduction. And of course they would be at less risk of “legal harm” (i.e. arrest and penalty) if the stuff were legalised… …decriminalisation is quite definitely only the first step.

MY LIBERTY, RIGHT OR WRONG
Legalisation (and its half sister, Decriminalisation) is not a very bright idea, owing more to pipe dreams than reality, as you might expect. Everywhere it has been tried things have got worse and drug use has increased. Sweden, China, Spain, Italy; there are just a few of the many examples of countries who painfully discovered what are the real costs of relaxing drug laws. The ‘Mecca’ for the drugs pilgrims is of course Amsterdam.

Protagonists allege that drug use there has not been increased by decriminalisation, but this is based on a survey known to be flawed, and other surveys which give more breakdown show youth use – the critical parameter – increasing by between two and four times. The evidence on the streets is that pot-purveying ‘coffee’ shops have soared from less than 200 before law change to more than 8000 now. Are we really supposed to believe that all these retail outlets are flourishing on the trade that 200 once made do with? Incidentally Holland is also the most crime-prone country in Europe, hardly a coincidence. But perhaps the most irrefutable evidence (which is why the legalisers try to studiously ignore it) comes from Alaska, a modern state with a population of millions. Decriminalisation of cannabis was introduced, with the support of the police, nearly 20 years ago, after hearing all the arguments now being peddled over here, such as: general use won’t go up; problem use won’t go up; use of other drugs won’t go up, and crime will of course come down. Reviewed in the early 90s, this policy was found to have produced enormous increases in general use, and in problem use, and in use of all other drugs, and – shockingly for many – crime went up. Faced with this incontrovertible proof, the police and other authorities enacted a repeal, returning drug possession to the illegal status it deserves as a negative influence on society.

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At least in part Harm Reduction is a response to a feeling of being overwhelmed by drugs, a feeling which the media do much to foster. There is no need to surrender, nor even to encourage self fulfilling prophecies. Several countries have marked reduced usage levels – the US by 60% in the 1980–92 period; Sweden, from critical levels down to a few percent in recent years; Eastern Belgium, by 20-30% compared to neighbouring provinces… the list goes on. What characterises these achievements is that they have all been pro-active, actively facilitating prevention whilst at the same time providing intervention and treatment. Harm Reduction is seen as just one aspect of intervention i.e. it has a place, but it should be kept in its place.

These and other countries have painfully learnt an important lesson; that the pursuit of Liberty is valid but the pursuit of Licence is not – and that Liberty which harms or jeopardises other is not worthy of the name. A sense of proportion about all aspects of drug services is needed. When addressing this vexed subject it may be helpful to remember a few simple guidelines, based on some essential truths:

Most people do not want a drug-addled society.
Legalisation is Fool’s Gold; don’t you be the fool.
Drug Prevention works well if you do it well, and empowers young people more than drug use ever will.
“Liberation” is not achieved by ingesting toxic substances.
Be alive to the distinction between “Liberty” and “Licence”.
It is healthier in every respect to rely not on substances but on strengthening one’s own resources. In this context, the search for one’s own spirituality can never be other than impeded in a consciousness which has been artificially distorted.
Harm Reduction is appropriate for those that use and not for those who don’t; (you’ll make your own sensible judgements about those on the fringe).
And, as ever, the most effective and balanced answer is a sensitive mix of Prevention (even for users), Harm Reduction for users, and the other safety nets of Treatment and Rehabilitation beneath these initial strategies.
Let us, on this basis, therefore all strive to promote Health more than just reduce Harm, remembering that in all the great religions, and in secular bodies such as the World Health Organisation, Health is defined not just as physical competency, but also intellectual, social health, emotional, and environmental, and, especially in the light of this conference, spiritual health.