Medical Marijuana February 7, 2011

Time To Decriminalise Drugs? – South African Medical Journal

An article published in the Feb 2011 edition of South African Medical Journal (SAMJ). The article, written by JP de V van Niekerk, editor of SAMJ and former Dean of the UCT faculty of Health Sciencies, broadly covers the failed war on drugs and how South Africa needs to rethink its drug policies. JP de Van Niekerk will also be on on radio today at 3:30pm and will be discussing these issues further. You can tune in on 567 Cape Talk if you’re in Cape Town, or radio 702 if you’re in Johannesburg. Alternatively, you can stream it online.

The drug trade has increased globally in intensity and reach, and substance abuse in South Africa has escalated rapidly. Drug misuse is a major social, legal and public health challenge despite the war on drugs, in which the USA has a disproportionate influence. Why this lack of progress and what can be done about it?

The use of psychotropic substances is as old as human history. Some use drugs as part of religious observations. The majority of people who partake of drugs use them for recreational purposes. Some become addicted and may cause harm to themselves, their families and society. If drugs are bad it seems logical to wage war on them. However, although ‘get tough’ measures sound attractive they are often counterproductive.

Attempts to stem evil

Over the centuries, countries, societies and communities have fruitlessly tried to regulate perceived evils, often related to powerful human needs and drives, namely sex, food and seeking happiness. The Victorians were obsessed with what they perceived as the evils of sex, leading to distorted teachings and actions and much unnecessary emotional suffering.

Despite alcohol having been used since antiquity, many countries have tried prohibiting its use. The most familiar is the failed prohibition experiment in the USA from 1920 to 1933. Breweries and distillers in surrounding countries flourished as widespread bootlegging and organised crime took control of the distribution of alcohol in the USA. Countries have gone to war over drugs: the Opium Wars (1839 – 1842, 1856 – 1860) resulted from trade disputes between China and the British Empire after China sought to limit illegal British opium trafficking. China lost the wars and had to tolerate the opium trade. War-torn Afghanistan now cultivates as much as 90% of the world’s opium, its trade also supporting the Taliban.

In the USA Richard Nixon launched the war on drugs in 1970. Another lifestyle result of human excesses is the rising tide of obesity, though war has not yet been declared on foods.

Harmful substances

The International Narcotics Control Board established by the United Nations under the UN Single Convention on Narcotic Drugs, 1961, lists a vast spectrum of narcotic drugs, psychotropic agents and precursors ‘under international control’. However, the substances that cause by far the most damage to individuals and societies, namely alcohol, cigarette smoking and prescription medicines, are not illegal. (To this we should perhaps add the lifestyle matters of food and sex?)

Harmful drugs are regulated according to classification systems that purport to relate to the harms and risks of each drug. Nutt and colleagues found that the current classification of drugs is unscientific, unsystematic and arbitrary. Using an evidence-based expert delphic procedure they developed and explored a rational scale to assess the harms of illicit drugs and also included five legal drugs of misuse (alcohol, khat, solvents, alkyl nitrates and tobacco). They provide a systemic methodology and process that could benefit regulatory bodies in assessing the harm of drugs of abuse. Their ranking, based on categories of harm (physical harm, dependence, effects on families, communities and society), differed from those in current use. Tobacco and alcohol together account for about 90% of all drug-related deaths in the UK. They are the most widely used unclassified substances, but were both ranked in the top 10 higher harm group and cannabis (marijuana) in the lower 10 (out of 20). Drugs that can be taken intravenously, such as heroin, carry a high risk of death and score highly. Their results also emphasise that excluding alcohol and tobacco from the Misuse of Drugs Act is, from a scientific perspective, arbitrary and that there is no clear distinction between socially acceptable and illicit substances.

Effects of the drug wars

Declaring war means that one must have enemies. In the USA these are the drug dealers but also the users. A large percentage of the population has used and currently uses illegal recreational substances such as marijuana and cocaine. Apprehending these ‘enemies’ has resulted in the USA having the world’s largest prison population, 738 per 100 000 people (other examples per 100000 people are 335 for South Africa, 124 for the UK and 30 for India). A large sector of the population is thus criminalised.

Producer countries have been politically destabilised by the US war on drugs. Huge profits made from cocaine and other drugs from countries such as Colombia, Bolivia, Peru and Brazil, largely because they are illegal in the USA, have resulted in flourishing drug cartels. Those controlling the supply routes to the USA through Mexico and Caribbean countries wreak havoc through their criminal paramilitary and guerrilla groups, with murder, kidnapping, bribery and corruption, money laundering, etc. Coca has been cultivated for centuries in the Andes. Its legitimate uses include chewing the leaves for their mild stimulant and appetite suppression effects, and as a tea that reduces the effects of altitude sickness. Coca farmers are often at the difficult and potentially violent intersection of government-sponsored eradication efforts, illegal cocaine producers and traffickers seeking coca supplies, anti-government paramilitary forces trafficking in cocaine as a source of revolutionary funding, and the hardships of rural subsistence farming. Further pressure to grow coca for the cocaine trade is caused by the dumping of subsidised surpluses of fruit, vegetables, grain, etc., mainly by the USA and European Union.

Drug prohibition inevitably leads to political and police corruption. Jackie Selebi, former head of South Africa’s police and Interpol President, was found guilty of corruption and sentenced for accepting bribes from a drug trafficker in 2010. ‘Wars’ on, for example, local growers of coca, marijuana and poppies increase the price of drugs, lessen competition, and encourage cartels by increasing their potential profits. People who become addicted to substances often cannot fund the high prices of illicit products and turn to drug running, robbery and other criminal methods to meet their needs.

Regulation/legislation

Regulations vary widely from country to country. The UN Single Convention on Narcotic Drugs, 1961, under the auspices of which the International Narcotics Control Board (INCB) was established, was regarded as a milestone in the history of international drug control by its proponents. The Single Convention codified multilateral treaties on drug control, including the cultivation of plants grown as the raw material of narcotic drugs. Its principal objectives are to limit the possession, use, trade, distribution, import, export, manufacture and production of drugs exclusively to medical and scientific purposes and to deter and discourage drug traffickers through international co-operation. The INCB monitors apparent violations of the treaties and addresses those within its mandate.

In the USA, where marijuana may be used for medical use in several states, there is a strong growing movement to have it legalised. However, the official US stance is to strengthen the war on marijuana. Elected officials are willing to acknowledge the failure of the drug war in private, but the degeneration of their political discourse and campaign tactics has made reforming the drug war synonymous with political suicide. And since politicians have short-term interests, who represents the interests of future generations?

South Africa has given much thought and effort to combating the abuse of illicit and legal substances. The Prevention and Treatment for Substance Abuse Act No. 70, 2008, and the National Drug Master Plan 2006 – 2011 seek to reduce demand, reduce harm and reduce the supply of illicit substances (including education and raising awareness) and associated crimes through law enforcement, prevention of community-based substance abuse, early intervention, drug treatment (including rehabilitation and risk reduction) and research. They are supported by many other Acts, government departments, statutory bodies, non-governmental organisations, etc. The City of Cape Town has an Operational Alcohol and Drug Strategy that recognises that the whole community is responsible for tackling the problem. This requires systematic, multifaceted, integrated responses; social inclusiveness; commitment to funding and resource allocation; and recognition that demand reduction is a key principle. The Central Drug Authority is a statutory body established to co-ordinate and direct drug counteraction across South Africa on both the demand and supply side. Further legal sanction is provided by the Drugs and Drug Trafficking Act No. 140 of 1992, which determines what the legal acts are in terms of possession, distribution, manufacture, etc. of ‘any dependence-producing substance; or any dangerous dependence-producing substance or any undesirable dependence-producing substance’. South Africa is signatory to the UN Single Convention on Narcotic Drugs, 1961, and other international and regional agreements concerning drugs.

The case for decriminalisation

The war on drugs has failed! Humans have always taken psychoactive substances and prohibition has never kept them from doing so. The international evidence suggests that drug policy has very limited impact on the overall level of drug use. Making people criminals for taking psychoactive substances is in itself criminal, for one is dealing with, at worst, a vice but not a crime.

The two most widely used legal drugs, alcohol and tobacco, lie in the upper half of the harms ranking. This important information should surely be taken into account in public debate on illegal drug use. Discussions based on formal assessment of harm rather than on prejudice and assumptions would enable a more rational debate about the relative risks and harms of drugs. Pragmatism is urgently needed in debates about these issues and our responses to them. The tone of our debate about responses to the treatment and supervision of drug-dependent offenders should change. Focusing on enforcement and compliance further erodes discretion for those responsible for treating and supervising such offenders. Policy should aim to reduce the harm that drugs cause, and not to embroil more people in the criminal justice system. Society should have some faith in the capacity of drug-using offenders to change, and actively assist and enable them to achieve this goal.

People with a history of drug problems are seen as blameworthy and to be feared. Stigma is a major barrier to their successful recovery and prevents them from playing a more positive role in communities and re-integrating into society. People recovering from drug dependence should be part of the normal community. Such actions have been successfully implemented in some European countries. In the USA there is increasing support for initiatives such as the California Proposition 19, also known as the Regulate, Control and Tax Cannabis Act of 2010, that would have legalised various marijuana-related activities, allowed local governments to regulate and collect marijuana-related fees and taxes, and authorised various criminal and civil penalties.

While much of South Africa’s approach to drug abuse is progressive and enlightened, evidence-based facts and sober reflection suggest that our strategies require re-thinking.

  • The Vision of the National Drug Master Plan is a drug-free society. Human history and international experience clearly demonstrate that this does not reflect reality. We should acknowledge this and develop better ways of dealing with human frailty.
  • A more evidence-based, nuanced approach to the harms of drugs is required. For example, it makes no sense to legalise the use of alcohol and tobacco but not the less dangerous cannabis
    (which also has beneficial effects).
  • Using psychoactive substances may be a vice but should not be considered to be a crime, thus criminalising a large proportion of our citizens.
  • Making drugs illicit cedes their control to the drug dealer.
  • Escalating the drug war makes drugs more valuable and attracts more participants into the illicit drug economy.
  • Improved state control of substances, as with alcohol and cigarettes, could provide taxes and significantly reduce the roles of drug dealers.

A recent MRC Research Brief outlines strategies to effectively address substance abuse problems among young people, but decriminalisation is not mentioned. It is time to face realities squarely and rationally debate the question of decriminalisation. Vested interests in maintaining the status quo will have unexpected support from those who stand to lose the most, namely the drug dealers and those in their pay (including the law and politics). All the more reason to proceed!

J P de V van Niekerk
Managing Editor – South African Medical Journal

1. The Prevention and Treatment for Substance Abuse Act No. 70, 2008.
2. National Drug Master Plan 2006-2011.
3. UN Single Convention on Narcotic Drugs, 1961.
4. Nutt D, King LA, Saulsbury W, Blakemore C. Development of a rational scale to assess the harm of drugs of potential misuse. Lancet 2007;369:1047-1053.
5. http://www.allcountries.org/ranks/prison_incarceration_rates_of_countries_2007.html (accessed 22 December 2010).
6. War on drugs. 2010. Wikipedia. http://en.wikipedia.org/wiki/War_on_Drugs (accessed 7 January 2011).
7. Statement from ONDCP Director R Gil Kerlikowske. Why marijuana legalization would compromise public health and public safety. http://ondcp.gov/news/speech10/030410_Chief.pdf (accessed 22 December 2010).
8. Tree S. How to get politicians to admit in public that the drug war has been a complete failure. 2010 Institute for Policy Studies. http://www.ips-dc.org/articles/politicians_drug_war_failure (accessed 10 November 2010).
9. City of Cape Town Draft Operational Drug & Alcohol Strategy 2007-2010.
10. Drugs and Drug Trafficking Act No. 140 of 1992.
11. Feiling T. The Candy Machine: How Cocaine Took Over the World. Penguin Books, 2009.
12. McSweeney T, Turnbull PJ, Hough M. The Treatment and Supervision of Drug-Dependent Offenders. A Review of the Literature Prepared for the UK Drug Policy Commission. London: Institute for Criminal Policy Research, King’s College London, 2008.
13. http://www.ukdpc.org.uk/publications.shtml (accessed 21 December 2010).
14. Ware MA, Wang T, Shapiro S, et al. Smoke cannabis for chronic neuropathic pain: a randomized
controlled trial. CMAJ 2010;182:1515-1521.
15. Morojele NK, Parry CDH, Brook JS. Substance abuse and the young: Taking action. MRC Research Brief, 2009. http://www.sahealthinfo.org/admodule/substance2009.pdf (accessed 7 January 2011).
16. Kolhatkar S. Reefer sadness. Bloomberg Businessweek 2010; 7 Nov: 62-65.

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26 thoughts on “Time To Decriminalise Drugs? – South African Medical Journal

  1. Really looking forward to hearing this show.

  2. Wow.

    That was an epic article. I’ve been following the “War on drugs” for a long time and completely support what is said in here. Most users are victims, not criminals. But like most cases, there are a few bad apples that add to the stigma and all the false information fed by the government to people that cant think for themselves also doesn’t help.

    I think a drug support system run by the government for users would be more productive than criminalization and if they can figure out how to regulate and sell to the public, the product can be taxed and also there would be a product standard that would have to be met which at the moment is up to the whim of the mad grower / cooker. (Who’s had Rattax / doom in their E? Sick for days after use? Yeah)

    Grower’s / cookers would be put out of business since they would never be able to compete with “perfect, engineered goods” and this, I believe would have an immediate positive effect on the community.

    PEACE!

  3. I agree fully with this article!

    We need to Educate!

    I’m looking forward to the radio interview later. Let’s just hope I remember to listen to it.

    twitch
    slightly insane

  4. Great read.
    Looking forward as well !
    Keep up the articles !

  5. Reason is KING!

  6. The radio discussion was shorter than I expected… Was hoping for some people to call in and have a debate. Either way, great to hear this sort of thing being discussed on the airwaves.

  7. Firstly, all drugs are legal in the sense they are regulated by law. The piece speaks out against prohibition but doesn’t offer any real answers. I would think the paradigm shift is towards harm reduction. Essentially this is what Niekerk appears to be trying to get at. We need to reduce the harm in society and prohibition hasn’t worked. Point taken. However, what are the steps towards getting there?

    I don’t believe the idealist position is tenable. A libertarian might say the only sane position is informed consent and moral agency, we all need the freedom to make decisions concerning our own bodies and minds, but then waht?

    Once you make such a decision and if the result causes harm, who cleans up afterwards?

    A medical approach might state that we need to allow for self-prescription, even medical marijuana, and there are good reasons for taking a few recreational and consciousness expanding drugs. LSD can overcome fear of dying for instance. There is a lot of medical knowledge out there which confirms this.

    Doctors routinely prescribe morphine and heroin is Diacetylmorphine, a stronger, more potent derivative opiate, the opiates offer all sorts of recreational ups and downs.

    On the street, the value of heroin and cocaine increases a hundredfold. It is used by gangs to enslave and lure men and women into prostitution.

    Legalising hard drugs might remove the criminal element, but without regulation, they would inevitably be used for criminal purposes, the question really is how to schedule some of the more interesting drugs like dimethyltriptomine or harmaline?

    The piece appears open to the idea of entheogenic research. This is a good sign, but offers no solution in the way of scheduling or regulation for lawmakers.

  8. yeah, also streamed and listened in. I heard a few people calling. Great that drug war is being discussed by professionals. Its only time and things will change with reasoning. One love.

  9. in south africa only there are 25000 times more deaths from tabacco than from cannabis yet it remains illigal, the war on drugs has failed but i dont agree with people when they say legalise all drugs because that means you are allowed to just go buy and use things like herion, meth and other hard drugs.

  10. Nice article.

  11. When he said goodbye to Van Niekerk i tuned out :/ missed the call ins. Did anyone have anything interesting to say?

  12. […] This post was mentioned on Twitter by Imiel Visser, Below The Lion. Below The Lion said: New article in this months issue of South African Medical Journal : Time to decriminalise drugs? http://fb.me/PuWyzBc7 […]

  13. Cant you get a podcast? I couldn’t get reception where I was. 🙁

    Such a great article. This movement is getting bigger!

  14. “In south africa only there are 25000 times more deaths from tabacco than from cannabis yet it remains illegal.” ?? news to me.. there has never been a death directly related to cannabis.. ever!!

  15. No podcast available… Couldn’t get online streaming to work, had to listen via my hi-fi system.

  16. […] ”Time To Decriminalise Drugs?” (South African Medical Journal) […]

  17. […] South African Medical Journal’s (SAMJ) call for the legalisation of soft drugs would of course be a sticky topic, and […]

  18. A man of wise words, inspirational to know that there are seemingly more people that see the benefit in so many more ways than one of the goverment controlling the things that they should be controlling. Instead of trying to nationalise every last piece industrial value to the country, they should rather concentrate on the things that look after the people, like drug control, like poaching, like our last bits of green enviroment ( the should build in barren areas so that its becomes something instead of wiping out whatever is left), liwould make stopping all the govermental theft, and on and on!
    The danger in this country to beware of is if ever such requirments would materialise, would we have wiped out the inhumane theft of the tax payers and goverment generated funds?

  19. Goverments, especially the USA, have stubbornly stuck to their guns and have used various media to display a false image of marijuana for decades.
    The truth has always been out there and it is fantastic to see the media now play a facilitating role in enabling the truth to surface.
    Sites such as BTL also play a key role in creating awareness and support against archaic laws.

    Well done Dr de Van Niekerk for saying it like it is!

  20. well done to the good doctor, although his message is a very dangerous one, the planet’s drugs are controlled by the CIA and south africa’s government (and other countries governments) have been involved for decades and still making lekker money from this trade!

    nixon was only a puppet in the launching the war on drugs, he knew they were the main suppliers to big drug cartels globally! just think why is amerikkka’s defence force still in afganistan?

  21. Such a brilliant article… But y was his sought after debate given so weakly? We need more Young adults to fight for the cause on a defining basis!

    Blessings BTL!

  22. […] following letter is a response by Attorney, Marius De Kock, to Dr. Van Niekerks article about the decriminalization of cannabis & other drugs in South Africa. The letter was originally published in the South African Medical Journal. Thanks Chris for the […]

  23. […] 7 January 2011). 16. Kolhatkar S. Reefer sadness. Bloomberg Businessweek 2010; 7 Nov: 62-65. via http://www.btl.co.za Share this:EmailDiggPrintLike this:LikeBe the first to like this post. This entry was posted in […]

  24. Legalising hard drugs may not be 100% the right path to go down, but I do believe it would put us in a better position than we are currently in. When it comes to legalsing marijuana though I believe it should be a no-brainer. Unfortunately though the government and medical industries, along with many others, realise that legalising this “god like plant” would damage them finincially by rendering many of the current prescription drugs available to us useless. Also, by growing hemp and using the seeds we can suppliment and in most cases replace so many of the processes and products that contribute to global warming. FREE THE WEED!

  25. […] today about Dagga and the ignorance surrounding it. It covers The Dagga Couple, JP Van De Niekerks article about decriminilisation in the South African Medical Journal, as well as other studies and facts surrounded Cannabis. […]

  26. […] “Making people criminals for taking psychoactive substances is in itself criminal, for one is dealing with, at worst, a vice but not a crime.” – JP van Niekerk, Managing Editor – South African Medical Journal […]

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