I would like to thank Cate Faehrrman, Member of Parliament, for “coming out” about her drug use in her younger days (1). I believe that her confession letter was smart, brave, and honourable. Honesty about drug use is a rare quality in Australian society. In this essay, I will try to highlight how our tendency to hide our drug use by staying in the closet causes suffering to both the individuals and the wider society. I will back up my arguments with empirical data; my clinical experiences of working with clients with drugs and mental health problems, and my personal life experiences of growing up in Iran before my 2006 migration to Australia. I hope this process will lead to a more honest and realistic conversation about drug use in our society.
My name is Pejman Hoviatdoost, and I am a clinical psychologist who has worked with many young people with drug and alcohol problems for more than a decade. I am familiar with the pain that problematic drug use causes in people’s lives. It may be hard to hear, but the truth is that drug use is normal human behaviour. We use drugs to treat illnesses; improve our general health; enhance our performance; enrich our experiences, or sometimes to have fun – how many of us like having a cold beer on a hot summer day? In my opinion, our resistance in accepting the reality of our drug use as normal human behaviour, results in health and social problems in our society.
Let me start with this: the term “drugs” is indeed misleading. It covers such a wide range of substances—from coffee, alcohol, tobacco, marijuana and MDMA, to methamphetamines, sedatives and heroin—that it is almost impossible to discuss its benefits and costs in an intelligent manner. It is needless to stress that these substances vastly differ not only in their use, but in their impact on individuals. Such poverty in our actual vocabulary—the use of a single word to refer to so many seemingly dissimilar substances—leads to several fundamental problems in the societal understanding of drugs and their associated patterns of use. In general, there seems to be a confusion between the “legality” of a drug and its “harmfulness”. This confusion could lead to two major problems, namely (i) an underestimation of the risk of using legal drugs, such as alcohol, and (ii) demonization of the use of all illegal drugs, resulting in ignorance of the positive and fun aspects of drugs. Moreover, this confusion leads to major cultural misunderstandings and ineffective policy-making on a large scale, as well as intense experiences of guilt and shame at an individual level.
The lack of distinction between what is harmful and what is legal could lead to the perception by the public that legal drugs are harmless. For example, the vast majority of Australians do not consider alcohol a “drug”. Alcohol is indeed a highly addictive drug that is considered by some experts to be one of the top three most harmful drugs, alongside heroin and crack cocaine (2 p. 658);(3). Alcohol use is very prevalent amongst Australians, with 8 out of 10 people reporting having a drink during the past 12 months (4). Furthermore, 1 in every 4 people who drank reported being a victim of an alcohol-related incident. In 2016, there was a staggering number of more than 5 million individuals in Australia being a victim of an alcohol-related incident. In total, alcohol is responsible for 5.1% of the total burden of disease and injury in Australia in 2011 (traffic injuries, liver disease, suicide, and self-inflicted injuries). In contrast, all illicit drugs together contributed to only 1.8% of the total burden of disease and injury in Australia in the same year (5). The data on tobacco use is hardly any more encouraging. In 2011, tobacco smoking was the leading risk factor contributing to death and diseases in Australia, and was responsible for 9% of the total burden of disease and injury. Eighty percent of the lung cancer burden and 75% of the chronic obstructive pulmonary disease burden were attributable to tobacco smoking (5) (6 p. 8).
People often use the term “drugs” as an abbreviation for “illicit or illegal drugs”. Accordingly, there is a strong association between the term “drugs” and illegal or criminal behaviour. The process of criminalization/demonization of drugs inhibits individuals—who are often hesitant to share that they are using “illegal drugs”—from learning the unique characteristics of individual substances and their associated benefits and risks in an intelligent and educated way. One could argue that any process within a society that inhibits, prohibits, or represses an honest conversation is not good for the given society. In my clinical practice, I have often been surprised by how little drug users know about the effects of the substances they take. Research shows that the youth are eager to have more education about the quality of the substances they take (7). Indeed, it is of great importance for drug users to know about the characteristics of their drug of choice to reduce the chances of addiction, overdose, and associated harm. Marijuana, for example, is associated with the development of psychosis in some teenagers and daily users with underlying vulnerabilities (8), but it could be fairly harmless for a large portion of the society. (9 p. 511) Psilycybin, the active ingredient in magic mushrooms, has been shown in randomized controlled studies to have a positive therapeutic effect in the treatment of depressive and anxiety symptoms in cancer patients. (10 p. 2)MDMA, a party drug similar to ecstasy, has been shown in randomized controlled trials to have a positive therapeutic effect in the treatment of PTSD. Psilycybin and MDMA exhibit a very low chance of dependency or addiction. Heroin is extremely addictive, with a high rate of mortality due to variation in its potency (11 pp. 32-33). And in my personal clinical experience, no substance matches the destructive impacts of methamphetamine on an individual’s well-being. If we use the same terminology to lump marijuana, MDMA, cocaine, LSD, heroin, and methamphetamine into one group, should we really expect our society to take our advice on drug use seriously?
The third related problem is that such categorization results in ineffective drug policies at the government level. This could include disproportionate allocation of money for combating drug-related problems or resistance against sensible harm-minimization programs, such as pill testing, which occurs when dance party and music festival attendees are given the opportunity to voluntarily provide samples of their recreational drugs for testing at these events. For example, the Drug Policy Modelling Program reported that in 2010, out of 1.7 billion dollars spent on strategies to minimize drug-related harms, only 2.2% was spent on harm-minimization while 64% of the budget was spent on law enforcement. Resistance against effective harm-minimization programs, such as pill testing, is probably one of the most tragic consequences of our misconceptions around drugs (12). From September 2018 to January 2019, five individuals aged between 19 and 23 years lost their lives to drug-related overdose at music festivals (13). I am deeply concerned, wondering whether implementing pill testing in Australia would have reduced the likelihood of these deaths. Is there anything more important than saving innocent human lives?
The majority of people who attend festivals are recreational drug users (14 p. 2). There is evidence to suggest that most recreational substance users could be considered relatively unproblematic and, in some ways, might not differ much from non-substance users, with the exception of a higher propensity for novelty-seeking and impulsivity (15 p. 1). Another recent survey described recreational substance users as young, highly educated users with excellent employment opportunities, who mainly use substances for expansion of their own experiences (16 p. 4). For this population of drug users, the focus of addressing recreational patterns of drug use is more associated with toxicity, as opposed to dependency or withdrawal symptoms.
The concept of drug testing was introduced as a new harm-reduction strategy aimed at recreational drug users across Europe and the United States. The first country to utilize drug testing for this purpose was the Netherlands, where the government adopted the Drug Information and Monitoring System (DIMS) in the early 1990s. Its task was to monitor the new and existing drug markets with respect to dose, composition, adulterants, and availability. Through this nationwide system of stationary testing facilities, users are able to hand in their drugs voluntarily for chemical analysis of composition and dose(17 p. 3). Drug users will be alerted about dangerous test results by the drug-testing systems instantly and through warning campaigns. These warning campaigns have been very successful in reducing accidental overdose and deaths at festivals and nightclubs. In the Netherlands in December 2014, for example, DIMS-tested pink ‘Superman’ logo pills were found to contain 173 mg PMMA. PMMA is a highly toxic alternative that is often mis-sold as MDMD or ecstasy (18). Theyissued immediate red alerts on national television, and as a result, no deaths occurred. In the UK, by comparison, four people died after taking similar pink ‘Superman’ pills containing PMMA within a fortnight of the DIMS alert undertaken in the Netherlands (2); (17 p. 5). This suggests that the red alerts likely prevented deaths in the Netherlands. Pill testing saves lives.
In 2016, the UK implemented a pilot study in which they practiced pill testing (under the name of “Drug Safety Testing Service”). The program also aimed to reach, access, and engage directly with “harder to reach” and “first-time drug using” groups. The results were extremely encouraging; there was only one drug-related hospital admission from a particular festival in 2016, a 95% reduction when compared to previous years. Festival-goers were willing to submit substances of concern for analysis and to engage productively in healthcare consultations when offered the opportunity. Approximately 1 in 5 drug users received harm-minimization messages informed by test results, with an estimation of a much higher percentage of the impacted population becoming aware by word of mouth. Drug users reported an intention to take smaller quantities of substances spread out over a longer time period, and to be more careful about poly-drug combinations, with a small number requesting signposting and connection to drug services to continue a dialogue with healthcare professionals after the festival. (17 p. 3)
The results also provided interesting information relating to the policing of similar festivals and how such procedures could potentially decrease the risk of a drug overdose at these events. Recent studies suggest that high visibility policing and drug detection dogs at entry points can drive some people to buy drugs within festival grounds rather than before entry (19 pp. 91-100). Substances bought onsite were more than twice as likely to be mis-sold as those bought offsite, and they were nearly twice as likely to be disposed of at the disposal service. This suggests that entry security procedures combined with onsite dealing practices could significantly increase drug-related harm. Moreover, there is also evidence that such procedures increase the possibility of drug overdose, as attendees are more likely to consume their drugs from the fear of encounter/being caught by the detection dogs (20 pp. 583-603). I am personally aware of persons who have admitted to taking twice as much MDMA as they would normally have done, because they—educated, taxpaying professional Australians—feared being caught with the substance at a festival.
In Australia, we have failed to introduce pill testing in spite of its intuitive and scientific appeal. A common concern against the idea of pill testing is that it encourages drug use; provides a false sense of safety for users; increases the potency of drugs, or works as quality control for drug users. More than two decades of research, however, provides no evidence of increase in drug prevalence, initiation, or mortality rates in European countries that have introduced such measures, compared to European countries that have not (21), (22 p. 16); moreover, countries that have implemented those strategies, such as the Netherlands, have shown some of the most stable, steady patterns of drug use over the past two decades.
From a more personal perspective, I find the whole idea that people are being arrested for drug use to be absurd. In Australia, we are used to it, and so do not notice it. For me as an immigrant, however, this aspect of Australian culture is painfully familiar.
As I mentioned earlier, I am from Iran, an Islamic country where drinking alcohol is illegal. Could you imagine for a second if people in Australia were to be arrested for drinking alcohol? Yet it is a highly addictive drug, the use of which is socially acceptable.
I moved to Australia 13 years ago, and immediately felt welcomed here. I was treated by people and the government with respect and dignity. I admire many aspects of Australian society: how everyone is treated equally; how basic human rights are the foundation of the society; how it is generally accepted that you should give everyone a fair go. Yet somehow, when it comes to drug use, all of a sudden Australia feels strikingly like home – Iran. People who drink alcohol there could face severe penalties. They might even get sentenced to 80 lashes—administered in public—if proven to have alcohol in the blood. While everyone in Australia agrees that such practices are repressive, even barbaric, it is striking that many cannot see the parallel with the repressive laws in Australia. I am all too familiar with repression in my homeland, and in my opinion, we have to be careful about censorship or repression here in Australia, as well. It would be quite an indictment on this nation if those fleeing from repression elsewhere were to face repression—albeit in different forms—here.
If we simply imagine treating Australians who smoke marijuana or take MDMA with the same repression that Iran treats those who drink alcohol, perhaps we can see how unjust this kind of censorship is. Just like it should not be the government’s prerogative to determine whether someone can drink a beer in my homeland, law- and policy-makers here should not try to legislate what individuals consume. A better approach would be to ensure that individuals are educated about the possible consequences of consuming certain substances so that they can make their own informed decisions. Far be it from us to try to determine that a substance is “bad” because it is culturally unfamiliar to us, while accepting other substances as “good” because we are used to them.
There is no doubt that problematic drug use is a major health concern in Australia and around the world. The truth is that we will probably never be able to eradicate drug-related health problems from our society, just as we would never be able to eradicate obesity from our society. People will continue to be interested in substances that change their conscious experiences, because such substances are inherently interesting and, under the right circumstances, quite fun. Without proper knowledge and awareness, we only increase the burden of drug use on individuals and society. This is a universal problem, because more or less every country in the world is taking the same approach. Our aim, as a progressive country, should be educating the nation about healthy/less harmful/safe patterns of drug use, including recreational drug use, in order to minimize the associated harm, including accidental over-dose or addiction. The same way that the government has a responsibility towards keeping certain standards for the food industry, it is reasonable to expect our government to take a more proactive role in dealing with individuals’ choice of drug use. We need a system that increases awareness of drugs based on their risks and not their legal status. The evidence is in: pill testing saves lives! Our reluctance to accept this reality is deadly! How much would you pay to save a young person’s life?
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