EUROPE'S DRUG WAR TARGETS MORE DEADLY MENACE THAN
NARCOTICS
EDITOR'S NOTE: Flush with victory from the Gulf war, America finds
itself still very much embroiled in the war that never seems to end, the
one on drugs. Yet Europe is increasingly going its own way on drug
policy, spurred by fears of an enemy more deadly than any narcotic:
AIDS. Its approach, known as "harm reduction," is saving lives. PNS
correspondent David Beers recently visited European cities that have
pioneered this approach in recent years. Beers is a senior editor of
Mother Jones, where his lengthier look at harm reduction appears.
BY DAVID BEERS, PACIFIC NEWS SERVICE
The drug control buzzword in Europe these days is "Harm Reduction,"
a logic that spurns legalization but also abandons the U.S. metaphor of
war. Its success is declared by police and health workers alike because it
draws drug users above ground while keeping in check a far more
deadly menace than any narcotic -- AIDS transmitted by dirty needles.
In harm reduction embracing Holland, government figures show the
nation's addict population, smaller per capita than the U.S.'s, is aging
and not growing. HIV rates among injectors in the big cities levelled
off at 20 percent three years ago. (In New York the HIV rate among
junkies is around 60 percent.) In England's Liverpool, a harm
reduction pioneer hard hit by heroin, that rate is now 1.6 percent.
Harm reduction approaches take sometimes startling shape, as a recent
visit to The Netherlands and Liverpool revealed:
* Aggressive needle exchange. Backed by a well-endowed national
health system, 40 Dutch cities have syringe exchange programs.
Amsterdam alone swaps nearly a million syringes a year through
clinics and vans that crisscross the city, dispensing the heroin substitute
methadone, clean needles and AIDS advice. The mobile approach
reaches skittish users and also defuses citizens' "not in my
neighborhood" attitudes toward permanent clinics.
In Rotterdam the health department has installed vending machines
to serve needle users when clinics are closed. Pop a used needle in the
syringe-shaped slot, and out slides a wrapped, sterile replacement.
In Liverpool, the government-funded needle exchange got started in
1986 by swapping bags of used needles with a major dealer. The state
issues plastic boxes to heavy users and even sellers, so they can
transport dozens of dirty needles safely back to the clinic, and get more.
* Health centers for on-going addicts. "Drug services in this country
have been aimed at people who want to stop," says Allan Parry, a
founder of Liverpool's Maryland Center. "Now, because of AIDS, we
have to reach drug users who want to carry on. And that means we
have to change our services to suit their lifestyle." So his health clinic
sends savvy workers out to find drug users and not only swap needles
and hand out condoms, but teach them less dangerous ways of
injecting. The Center first attracts addicts by offering syringes, then
ends up treating abscesses and other conditions they would rarely have
revealed to the regular health care system.
*A Junky "Union." The Dutch government pays drug addicts to fight
for their rights, giving nearly $100,000 a year to the Amsterdam
Junkybund (Junky Union) ensconced in an old canalside office.
Headed by non-drug using Rene Mol, addicts press for late-night needle
exchanges and less police harassment. The Junkybund also advises the
government on its drug programs and helped work the bugs out of the
needle vending machine.
* Public places where drug use is allowed. In Rotterdam, Father Hans
Visser makes a spacious lavatory in the basement of his church
available to addicts, and refuses to speculate on what goes on in the
stalls. His logic is that "it is better than doing it out on the streets," and
gives a chance to reach drug users with treatment and AIDS
information, as well as religion. Motivated by similar logic,
Switzerland allows addicts to shoot up openly in a city park.
Holland's famed "coffee shops," where technically illegal cannabis can
be bought and smoked, are sanctioned refuges because, as Dutch
officials explain, they "split the market" so that a marijuana buyer
won't be urged to try more dangerous stuff. Coffee shops caught
purveying harder drugs, like cocaine or heroin, are promptly shut
down.
* "Flexible" drug enforcement. Holland's "drug czar" Eddy Engelsman,
perhaps Europe's leading harm reduction proponent, argues that
severely criminalizing drug use just drives it underground, making
health and crime problems worse.
The best approach, says Engelsman, is nuanced, pragmatic, businesslike
-- zakelyk is the Dutch word for all three rolled into one. Holland's
drug laws carry stiff penalties for users and sellers, but police and
judges are given wide latitude in how they are enforced; the official
goal is that the punishment should never outweigh the harm that
drug taking itself causes.
The Netherlands inverts the U.S. drug budget ratio, funnelling the
bulk of its funds into prevention, treatment and research, funding a
wide range of rehabilitation programs, and a curriculum that teaches
kids the risks of all intoxicants. For fear of glamorizing illegal drug
taking's outlaw appeal, "We keep a low profile," says Engelsman. "No
mass media campaigns. No policemen into the school. No fingers
pointing, saying you shouldn't do this and that. Reduce the problem,
control the problem and don't make a moral issue of it."
* Prescribed drugs for addicts. From his bland offices in the town of
Widness just outside Liverpool, psychiatrist John Marks carries out the
most controversial of all harm reduction approaches. He writes out
dozens of prescriptions for heroin, crack-style cocaine and
amphetamines for local addicts who declare no intention of quitting.
It has been British policy since 1924 that the best way to treat addicts is
to wean them off drugs, but if that can't be done, to prescribe whatever
the doctor thinks they need. Marks is one of the few doctors with the
stomach to prescribe hard stuff, though. He reminds that heroin
addicts finance their habits by buying more than they need, cutting it
with "something nice and heavy, like brick dust," pushing that to new
recruits, thus expanding the industry. Marks asserts that his
prescriptions have undermined that criminal pyramid scheme.
"Nobody's going to pay a fortune to gangsters to get rubbish and
perhaps be threatened, when they can get pure, excellent stuff from me
for free."
Given a way out of the black market hustle, Marks argues, his clients
might now be able to imagine a future beyond the next fix, and if that
leads them to decide they do want to kick, Marks is there to guide them
into one of many free rehab programs. His willingness to cooperate
with police -- he turns in patients he knows are committing drug
crimes -- plus the fact that heroin street sales and drug-related crime
has dropped in the Widness area, has the powers-that-be on his side,
says Marks.
While harm reduction methods can set an American's ethical compass
tumbling, so can the increasingly skewed casualty figures from this
country's own war on drugs. Although 80 percent of U.S. drug users
are white, the majority arrested are black. (Drug prosecutions of white
juveniles actually dropped 15 percent between 1985 and 1988, while
jumping 88 percent for minority youth.) The U.S. now incarcerates its
citizens at a higher rate than any other nation, and three quarters of the
new $10 billion drug war budget continues to go to policing and prisons
instead of education and treatment. Middle-class cocaine use is down,
but inner-city crack and heroin use is on the rise and the HIV virus
spread via dirty needles is today the number one source of AIDS in the
United States, hitting minority groups especially hard.
Dr. Arnold Trebach, who teaches criminology at American University
in Washington D.C. and heads the nearby private Drug Policy
Foundation, argues that it is time this country began experimenting
with harm reduction techniques, for the simple reason that they save
more lives. "What the English and Dutch have taught me," he says,
"is that you can disapprove of drug use, but you don't have to hate
users."
