HARM REFUSAL
Making
Peace with Cocaine, and Advancing from Harm Reduction to Harm Refusal
Peter Cohen*
I'm sorry that I cannot speak in Spanish. I will try to be clear in
English. But first I want to say in agreement with Marco that I am very happy
to be here and thankful for the invitation of Mama Coca. My speech will try to clarify
a few items around cocaine use. What is cocaine, more precisely: how is it used
and how we apply theories to describe the use of cocaine? A second topic that I
want to hit on is the topic of discrimination. How drug policy constructs
itself as a tight schedule of discrimination. And the third topic that I want
to touch is how can we use concepts of harm reduction and what are the
limitations of harm reduction. Maybe we have to ask ourselves how to widen our
visions on harm, and include concepts around harm refusal.
Let
me start with the use of cocaine. Yesterday Anthony Henman
spoke about making peace with Coca, with the leaf of Coca. We cannot make peace
with the leaf of Coca if we also do not make peace with cocaine, which is an
alkaloid contained by the coca leaf. And in order to make peace with cocaine,
we have to sit back for a moment and look at how we evaluate and talk about the
use of cocaine; what scientific data are available and how we could enable
ourselves to make peace with cocaine, with peace in our hearts. In order to
illustrate how we look at the use of cocaine, I will use two contrasting
examples from the scientific literature.
The first example is a book that was published about two years ago by
a Belgian criminologist, Tom Decorte.[1] A fat book, almost 500
pages, in which he discusses all the research that is available in the world
about the use of cocaine among people that are recruited from the general
populations, users we can find amongst us in everyday life. There is a lot
of research; in the Netherlands, in Belgium but there is also research
on cocaine use in the populations of Canada, Australia, the United States, and England. He puts all this together
and, what are his conclusions? His conclusions are that the large majority
of cocaine users use the substance for a relatively short period of time.
They use cocaine mainly as amplifiers of social pleasures. So this means that
cocaine is used to go out to the disco, or to chat with your friends, or as
a desert for dinner. Most cocaine users use moderate to small amounts of cocaine
because otherwise the pleasure of cocaine becomes distorted. For most users
much cocaine is not pleasurable; it's a little bit like alcohol. For most
users to use much alcohol is not pleasurable. Decortes
conclusions are quite complicated and, if you really want to know more about
it, read that book. What he says is that the disadvantages and the dangers
of cocaine seem to have been described in a very highly overstated way. Decorte doesn't touch on the question why this is so; why
has science overstated the dangers of the use of cocaine for such a long time?
And that is a question that I want to touch upon after referring to a second
example from the scientific literature. There has been a psychiatrist, H.Kleber, working in United States with F.Gawin, who has been publishing work on the use of cocaine.
In contrast to the samples of users that are described in Decorte’s over view, Gawin and Kleber have done research on users who ended up in the clinic-
system of the United States, in the drug treatment
system[2].
Now it is evident that if you look at drug users that have ended up
somehow in the treatment system, you focus on patterns of use, and motivations
of use, that are completely different than for the bulk of the users of the
drug. Looking at clinical samples, you come to completely different conclusions
about the effects and possibly ‘dangers’ of the use of cocaine than when you
focus on general population samples of cocaine users. Basically, what I say
here is that the dominance of medical and psychiatric perspectives on the use
of the drug has created types of research focused on clinical cases that
has completely distorted our capacity to look at general population types of
use of cocaine. The same has been true with opiates but I will not discuss the
type of opiate research.
In
other words, we see what we want to see. Or, we see what we are made to see,
determined by the type of ‘scientific eyes’ that make it to the public. And
what we see is to a high degree determined by preset ideological ideas that
we have about the use of the drug. If we have learned, and most of us have
learned this all our lives, that cocaine use can be highly dangerous, we will
immediately refer to research that tries to legitimize those prejudices. The
research that comes from clinical settings is usually able, both by its sample
and by the type of questions it presents, to legitimize preset ideas about
the dangers of cocaine. If you work as a sociologist, I am a sociologist,
and you want to see cocaine use as a much wider phenomenon than only limited
to clinical cases, you see a completely different image of the use of cocaine.
For instance, in the many projects that my center (CEDRO) initiated on research
on cocaine-use patterns over time we included research on how people use cocaine
over a 10-year period; we do not see anything that you see in clinical research.
We see that after 10 years, 60 percent have stopped using cocaine because,
we assume, their lifestyles have changed. The functionality, the usefulness
of cocaine in a socially outgoing lifestyle has diminished, or even disappeared.
Sixty percent of cocaine users have quit after 10 years in
Amsterdam; and in other cities
the figures are similar. So we have to depart and have to rectify our images
of the use of cocaine and see it as only a very limited risk for a very limited
period in a users life. I say this because we need to have this knowledge
and have to apply this knowledge, if we somehow want to make peace with cocaine
and not only with Coca. Of course, if cocaine would be available as a licit
drug, we might see the development of other use careers or more users. However,
the availability of cannabis in the Netherlands as a semi legal substance
has not made the Netherlands into an area with the
highest level of use in Europe.[3] Ergo, culture and economic
conditions determine use levels of a drug much more than ‘legal’ availability.
I said that I would speak about discrimination and, since
Cartagena, I'm told, has been
one of the centers of the Spanish Inquisition in Latin America, I would like to use
the example of Inquisition to describe how we philosophically create the
phenomenon of discrimination. In the theory of the Inquisitors, people who
would deviate from the road of ‘rightly’
speaking to God, and from how to ‘rightly’ interpret the Bible, or from the
‘correct’ road to acquire God's grace, those people intentionally or not
intentionally dehumanized themselves. Their soul could no longer be saved; they
would not be able aspire for the highest goal of a human, that is, to accept
God’s grace and in the afterlife be in paradise. So these people could be
treated as non-humans! And we see in the whole history of discrimination in the
world, be it around race, around class, around faith, the dehumanizing of the
other is one of the central aspects. Dehumanizing the other is the most
essential process to understand how some sorts of discrimination can become so
violent. On the basis of highly selective images of cocaine users and highly
selective types of research, we could say that we have chosen to treat cocaine
users as people who have intentionally or unintentionally deviated from the
highest aspirations of humankind.
Our modern ideologies about what is the highest goal for human person
are no longer to accept the grace of God but to realize one’s ‘individual
potential’. We have learned to look at cocaine use as a deviation from that
highest aspiration. The possibility of so-called addiction makes cocaine users
into human beings who no longer aspire for this highest goal: individual
autonomy and individual responsibility. So we are able to take away one of
their most basic aspects of their human characteristics and this is even more
valid for people who sell cocaine. People who sell cocaine are seen as evil
agents. They have induced others to lose their highest individual qualities. We
can dehumanize them; we can do anything to them. Cocaine producers, exactly the
same applies. As long as we apply these highly discriminatory philosophies to
users of cocaine, or dealers of cocaine, or producers of cocaine, we somehow
create a legitimization for the awful and medieval policies that in some of our
countries we apply to these people.
In the United States, the average number of
prisoners per hundred thousand has quickly risen since the 1980s from around
120 to over 700. Over 700 people per hundred thousand are in jails and prisons
in the United States for just an average of
around a 100 in the European Union. The scale in which the American government
imprisons people on the basis of crime politics, and on the basis of a
particular vision on drug use, is simply incredible. We have to realize that
these North American procedures of discrimination that give rise to idiotic plans
like Plan Colombia do not only endanger
the security and the human rights of people outside the United States but that also inside
the United States. These philosophies of
dehumanization have created incredible legal conditions for the US population as a whole,
and certainly for its minority populations.
Where does this lead me? I was asked to discuss something about harm
reduction as well today. As you all know, harm reduction has been a very
fashionable philosophy around setting up drug policies. But looking at highly
discriminatory characteristics of drug policy, we could also say that harm
reduction is too limited to meet the political problems that drug-policy based
discrimination creates for us. Maybe we have to move to a different philosophical
position and say that some of the harms that are created by our discriminatory
drug policies can no longer be accepted and included in a scheme to reduce
these harms. I would say that the incredible amount of imprisonments of the
population of the United States is one of those harms
that we cannot accept. The incredible damages that are inflicted on the people
that produce drugs only to try keep these drugs out of the United States or the European Union;
these damages are simply not acceptable. We have to develop ideas about harm
refusal. Human Rights are of course the philosophical background against which
we could judge those harms and I think we should go there. Harm reduction is
relevant for certain social conditions and for certain political contexts.
However, the power of the police in the United States is incredible, as is
the harm done by them; the power of military forces enforcing drug laws in
countries in Asia and here in Latin America is simply
unacceptable. In some areas of drug politics we have to move from harm
reduction to harm refusal.
The history of harm reduction in Europe is a long one.
Originally harm reduction was an expansion of the thinking in the area of
public health. Once you accept drug use, and some of its effects, as public health
problems, you can attack them as public health problems. As an infectious
disease is made into a public health problem, you can try to reduce the rate of
infection. Making the disease into a crime problem would be very strange and
only understandable in a moralistic understanding of infection. The background
of syringe-exchange programs is: reduce the rate of all sorts of infection. In
the Netherlands, harm reduction has
gone a little further. By refusing to chase smalltime dealers in heroin, in the
Netherlands the price of heroine decreased quickly in the
1980s The Netherlands became the country where heroin was the cheapest in all
of Europe. And this created the
possibility for people who were using heroine, which were not very many, at
maximum half percent of the population, to switch from injecting to smoking
heroine. The whole market changed. By allowing the conditions to exist to make
heroine cheap, it was no longer necessary to inject that heroine; it could
simply be smoked. And by the acceptance of the cultural habit to smoke heroine,
a whole area of risk behavior simply no longer existed. All the problems of
injecting were highly diminished. But there is a limit to this type of harm
reduction. Still, people can be brought to prison in the Netherlands for heroin related
crime and the answer to that was, at a certain moment in the 1990s, to say
"OK let's take away the possibility of people ending up in prison, being
arrested for dealing, or smuggling or stealing. Let us no longer accept the
harm of criminalization and imprisonment. Let's give them heroine." So at
the moment, heroin distribution and heroine maintenance is the latest policy
innovation in the Netherlands in the area of heroin
use. But, where do we go from there? If we allow users to get heroin from a
legal source, either buy it or get it for free, haven't we legalized
heroin? In a certain sense we have. If
you look at the progression in harm-reduction programs in the Netherlands and
in some other European countries, you can say that the evaluation of the
concept of harm and the refusal to accept particular types of harms,
have logically lead to semi legalizations.
If we stopped trying to reduce some types of harms but evolve into not
accepting them (however reduced), we will logically end up by finding schemes
for legalizing the use and the production and the distribution of these drugs
and we will be forced to look at the use and production of those drugs with
more realistic perspective and more generalizable
scientific theory.
Thank you very much.
Transcribed
by Mama Coca