Letters to the editor – Feb issue

Quadruple bypass

America’s opioid epidemic has been big news for a while now, but amongst all the headlines and documentaries and think pieces one issue seems to be consistently overlooked – and it’s an issue that’s a bit of an inconvenient truth for the ever-more powerful and vocal legalisation lobby.

According to the US Centers for Disease Control, the number of drug overdose deaths rose from just under 17,000 in 1999 to nearly 67,000 in 2016 – i.e. it quadrupled. And according to the presidential commission on the crisis, ‘not coincidentally’ the level of opioid prescribing quadrupled over the same period (DDN, September 2017, page 5).

There were 950,000 Americans reporting heroin use in 2016, but that number is dwarfed by the number misusing prescription opioids, at 11.5m (DDN, November 2017, page 5). What’s more, according to a recent Economist article on a major study of the crisis, a huge number of these deaths are happ­en­ing in relatively affluent communities, rather than the populations usually decimated by drug harms. ‘The epidemic is caused by access to drugs rather than economic conditions,’ it says.

So the only conclusion to draw from all this is that the argument endlessly trotted out by all the usual suspects – that a legal, regulated market would drastic­ally reduce levels of harm – is, as many of us have always said, utter nonsense.

Paul Bennett, by email


Pedantic semantics

Despite no longer working in the field, thank God, I like to keep up with the latest pronouncements of the thought police, and so it was with increasing incredulity that I scrolled through the Global Commission on Drug Policy’s new report about language and stigma (see news, page 5).

All very laudable in intention, obviously, but in it we learn that there was a ‘moral panic’ about crack use in the US in the ’80s and ’90s, based on a ‘misconception’ that use was ‘exploding’. That this was a ‘misconception’ may come as surprise to people who lived in deprived American inner city areas during those years, but what do they know, eh? A bunch of rich people in Switzerland are happy to put them right.

My favourite part, however, is the table on page 30 that explains which language is OK and which is no longer acceptable. ‘Drug user’, bad; ‘Person who uses drugs’, good. ‘Drug habit’, bad; ‘Substance use disorder’ or ‘Problematic drug use’, good. Not to be pedantic, but according to the commission’s own criteria aren’t ‘disorder’ and ‘problematic’ more stigmatising than the innocuous-sounding ‘habit’?

‘Recreational, casual or experimental user’ are all bad, we discover, and instead we must use ‘person with non-problematic drug use’ (trips off the tongue). That’s in order to distinguish them from – and therefore stigmatise, I’d venture – someone with ‘problematic’ use. Then it starts to get truly deranged. Despite being used by almost every agency I ever encountered, ‘opioid replacement therapy’ is now unaccept­able, and you would be a fascist to use it, while ‘opioid substitution therapy’ is fine. So that’s that cleared up then.

It’s also good to see commission member Nick Clegg offering his opinions on all this in the pages of the Guardian and the Mirror. One can’t help thinking, however, that if he was so concerned about the welfare of drug users – sorry, persons who use drugs – perhaps he should have thought twice before en­ab­ling a Tory government that went about slashing treatment budgets to the bone.

Molly Cochrane, by email