Substance Abuse Harm Reduction
Harm Reduction: More than just side effects!
The recent stance from the managing editor of the South African Medical Journal in favor of the extremely controversial practice of decriminalizing drugs of abuse (Harm Reduction) is both surprising and disconcerting. It shows a mixture of “arm chair medicine”, selective quoting of studies and conventions, and some really flawed reasoning. One wonders when last he has sat in front of a drug addict who’s lost their family, through being consumed by an overriding passion for drugs, or lost their job due to multiple accidents in the workplace related to the abuse of cannabis, heroin or other drugs. Or when last has he treated a marijuana smoker who has developed schizophrenia as a result of his marijuana smoking, a complication which has become increasingly well established in medical publications over the last 4 years? Medical Science is exploding with new research on virtually a weekly basis, that proves the harmful effects of marijuana use including: · Causing psychosis in healthy people.  · Harming the brains of teenagers.  · Increasing the risk of testicular cancer.  · Poor foetal growth.  · Suppression of the immune system.  I suppose he has also not had to treat wash-out drug addicts from Switzerland like some of us have had to, where they have tried to regulate substance abuse through the medical provision of clean needles, syringes and drugs. The archaic argument that we cannot root out drug abuse by keeping it a crime is also a strange way of thinking to Doctors for Life. Since time began we have not managed to root out one single crime, but we are far from considering decriminalizing murder, rape, theft and fraud, to name but a few. Really, to use the example of Jackie Selebi’s corruption as a argument to legalize drugs is an illogical and distorted way of reasoning. Even though the article has quite a few references and appears very scientific, one is kind of left wondering what has happened to common sense. Dr van Niekerk keeps on quoting the fact that more harm is caused by legal drugs such as tobacco and alcohol (90% of all drug related deaths in the UK!) than illegal drugs, and somehow seems to miss the obvious point that having legalized them did not reduce the harm done by them. On the contrary, it appears to have increased the harm they cause. The implications of legalizing the use of drugs of abuse for the benefit of the economy of the country are vast. To mention just a few: · Politoxemia, the simultaneous addiction to different drugs. · The financial implication of increased accidents in the workplace. · An increase in hours off work. · Medical expenses for treating the complications of substance abuse. It also includes the expense of establishing an infrastructure of medical personal to oversee the handing out of these drugs (and that in a country where our health system is already overloaded). DFL finds the reasoning justifying decriminalization immature. Dr. van Niekerk also quotes the UN Single Convention on Narcotic Drugs of 1961, but does not mention the UNODC’s 52nd session of the Annual Commission on Narcotic Drugs March 2009, to which South Africa is a co-signatory. When some parties tried to slip in a Harm Reduction policy (such as Dr. van Niekerk is supporting), Sweden, Russia, Japan, USA, Colombia, Sri Lanka and Cuba refused to sign the document unless the reference to harm reduction was removed. Experiences of a few countries that have moved in the direction of decriminalisation should also be taken note of: The Alaska Supreme Court ruled in 1975 that the state could not interfere with an adult’s possession of marijuana for personal consumption in the home. Although the ruling was limited to persons 19 and over, a 1988 University of Alaska study, the state’s 12 to 17-year-olds used marijuana at more than twice the national average for their age group. Alaska’s residents voted in 1990 to re-criminalize the possession of marijuana, demonstrating their belief that increased use was too high a price to pay. In Holland the Dutch government started closing down a third of their coffee shops because they found that many of the coffee shops had become a legal outlet for the illegal drug trade and after 15 years of legalised marijuana use, they were unable to separate the illegal and crime related activities from the legal trade. With the South African Police Force struggling to effectively police crime in the country, how do we think we ever are going to better the Dutch! The U.K. first reclassified marijuana as a less harmful Class C drug, but in January 2009 moved it back to a more dangerous Class B drug. Doctors For Life International is all in favour of doing more regarding the rehabilitation of drug addicts. But we do feel that having a prison sentence as an alternative to being sent for rehabilitation is a powerful incentive for many substance abusers to try and get help. To this end we would argue for more government funding to established rehabilitation units, and for NGO’s, who to a large extent have taken over the responsibility of the government in this regard. Doctors for Life International, represents more than 1800 medical doctors and specialists, three-quarters of whom practice in South Africa. Since 1991 DFL has been actively promoting sound science in the medical profession and health care that is safe and efficient for all South Africans. For more information visit: http://www.doctorsforlife.co.za References:  Causing psychosis in healthy people: Dr Theresa Moore, Theresa HM Moore MSc, Dr Stanley Zammit PhD, Anne Lingford-Hughes PhD, Thomas RE Barnes DSc, Peter B Jones PhD, Margaret Burke MSc, Glyn Lewis PhD Cannabis use and risk of psychotic or affective mental health outcomes: a systematic review. University of Bristol, Institute of Psychiatry in Cardiff University, Wales. The Lancet, Volume 370, Issue 9584, Pages 319 – 328, 28 July 2007  Harming the brains of teenagers: Manzar Ashtari, Ph.D: Children’s Hospital of Philadelphia Staci A. Gruber:Harvard Medical School http://news.harvard.edu/gazette/story/2010/11/marijuana-study/  Increased risk of testicular cancer: Fred Hutchinson Cancer Research Center : Stephen Schwartz Association of Marijuana Use and the Incidence of Testicular Germ Cell Tumours http://www.fhcrc.org/about/ne/news/2009/02/09/marijuana.html Kristen Woodward, 206-667-5095 or firstname.lastname@example.org  Poor foetal growth: Hanan El Marroun, Henning Tiemeier, Eric A.P. Steegers, Vincent W.V. Jaddoe, Albert Hofman, Frank C. Verhulst, Wim van den Brink, Anja C. Huizink. Intrauterine Cannabis Exposure Affects Fetal Growth Trajectories: The Generation R Study Journal of the American Academy of Child & Adolescent Psychiatry December 2009 (Vol. 48, Issue 12, Pages 1173-1181)  Suppression of the immune system: Venkatesh L. Hegde, Mitzi Nagarkatti and Prakash S. Nagarkatti. Cannabinoid receptor activation leads to massive mobilization of myeloid-derived suppressor cells with potent immunosuppressive properties. European Journal of Immunology, 2010; 40 (12): 3358-3371 DOI: 10.1002/eji.201040667