Legalise drugs, get rid of addiction

Rajendra P Jindal

TWO different news, apparently unrelated, made it to the newspapers a fortnight or so back. The first of these appeared, possibly, in The Tribune, with the headline  “81 lakh lesser tobacco consumers since 2010”. The other news item appeared the very next day, and was titled "Punjab Inspector held for drug trafficking" The same evening, it was prominently splashed on all television channels. It continued to be followed in the media for the next couple of days until it was drowned by similar news.

An ordinary reader may be excused for not seeing any relation between these two. But let us take them one by one. It may be news to most readers that tobacco (nicotine) is a drug too, albeit a legal one, in all the senses of the word that “drug” conveys. Until a few years ago, rich and powerful tobacco companies in the US, most of the medical researchers and doctors (the latter too on the payroll of tobacco companies) refused to admit that tobacco is a drug. It was contended that it is, at worst, a habit-forming substance only. 

With the help of PET and MRI scans, it has been conclusively proved that nicotine creates the same biochemical and molecular effects in the brain as any other drug such as cocaine and heroin and many other activities such as a kiss, a hug or a word of praise. This effect is known as elevation of a neurotransmitter substance (a chemical which carries messages from one micro part of the brain to the other) called “Dopamine”. The surge in the level of Dopamine produces a feeling of pleasure, at least initially. 

This effect is not common to the same degree in everybody; probably it is modified by a genetic factor. Therefore, whereas some people can "take it and leave it", others become addicted. Smoking or chewing tobacco is as addictive as any other drug and as difficult to get rid of. It gives the same sense of pleasure and the physical ill-effects are much more than any other drug. No other drug causes fatal cancers, heart and chest problems and many serious ailments.

The interesting question that arises is: how were 81 lakh people able to give it up without even a single one ever being arrested or put into jail? No amount of tobacco was confiscated and no police officer or politician was ever accused of dealing with tobacco. One reason is that unlike other drugs, tobacco was never prohibited. Secondly, it is the education by various means and at various fora about the ill-effects of tobacco that has worked the miracle. In school and college textbooks, on radio and television as well as cigarette advertisement boards and even cigarette packets, ill-effects of smoking are prominently displayed. Most people seem to know that smoking causes the cancer of the lungs, even if they know nothing else. Therefore, compared to many more than those who have given up smoking are those who want to and are trying to give up smoking.  

As far as the other news that a Punjab Police Sub-inspector was held for drug trafficking, nobody should have trouble believing that the episode is only the tip of the iceberg. A junior police officer cannot run a drug empire without the collusion of  colleagues and seniors. In the run-up to the Punjab Assembly elections, the chiefs of at least two of the political parties declared that they will totally abolish the drug menace from Punjab within a month of coming to power. The one who is now the Chief Minister, sotto voce, scaled the peak of rhetoric and ignorance when he declared that “the back of the drug trade has been broken”. As the subsequent events, including the news in discussion have revealed, the demon called drug trade is healthy and well, thank you. Are these leaders innocent, ignorant, naive or plain simpletons? The drug trade will persist as long as our approach to handling it remains archaic.

For some unknown reason, in contrast to smoking and consumption of alcohol, consuming drugs has always been considered a character flaw, a criminal activity. The dopamine hypothesis has proved that drug addiction is a disorder of the brain no different from that caused by nicotine and alcohol. It is a mental illness of similar nature. The right place for a drug addict, therefore, is a hospital and not a prison and the way to deal with drugs is not to prohibit them but to legalise them just as it is in the case of tobacco and alcohol. Why are we so keen and insistent on prohibiting drugs and not tobacco and alcohol, while the latter two are more harmful? It obviously cannot be because we are a nation with knee-jerk puritanism. In that case, we would prohibit alcohol also. There are two reasons for the insistence on drug prohibition. The drug trade will exist as long as there is prohibition that generates exorbitant profits for the drug lords like our Sub-inspector and his seniors as well as politicians. Also, we inherently want to punish narco-trafficking, not eradicate it. 

However, the most novel reason for drug prohibition so far has been propounded by the American author Barbara Ehrenreich. She feels that we cling to prohibition for the same reason one clings to so many other self -destructive habits like nicotine, cocaine and heroin: because of the way it makes us feel — good and self righteous. If we surrender now, it will send the wrong message. Says she, “Legal drugs, even if heavily taxed and extensively regulated would no doubt be cheaper than illegal ones. This could mean more people sampling them out of curiosity. This danger has to be weighed against the insidious marketing dynamics of illegal drugs whose widely inflated prices compel the user to become a pusher and a recruiter of new users”. 

It is time to try a new approach to the drug problem. The people who want to use drugs know where to get them and no law has yet dissuaded people from using them. Legalise, regulate and tax drugs to the hilt. Take the money that would have gone towards preventive laws and spend it on education, healthcare and rehabilitation. 

A word about rehabilitation too. Dopamine-related research has shown that abstinence, if maintained, not only halts the physical and psychological damage wrought by drugs but also reverses it in large measure. A majority of the rehabilitation centres, mushrooming all over and uniformly lacking sufficient staff with enough expertise (psychiatrists and psychotherapists) and dedication (nurses and helpers), are worse than prisons. An addict needs long treatment, perhaps running into months. During this period, there are failures but their rate is no different from that for other chronic diseases. Nearly half the recovering addicts fail to maintain complete abstinence after a year, about the same proportion of patients with diabetes and hypertension who fail to comply with their medication regimens. Therefore, occasional relapse only means that more treatment is required, not that the addict be imprisoned. Alcoholic Anonymous and Narcotic Anonymous are the two organisations which probably have the highest cure rate because their members never refer to themselves as “cured”; they always call themselves “recovering addicts”. We could begin with a drug like marijuana and see how abolishing prohibition works. Then, we could move on to more drugs. Doesn't it sound like an idea that might catch on?

The writer is a surgeon at the Guru Gobind Singh Medical College and Hospital, Faridkot