Harm reduction

There's a short article at The Economist on harm reduction strategies for drug use in Europe.

As usual, Portugal is held up as a shining example, but at least the magazine explains a bit more than the usual shorthand of "yay, they legalised drugs" used by many drug liberalising proponents here:

At the height of the epidemic in the 1990s, authorities estimated that about 100,000 Portuguese, or 1% of the population, were heroin users. “It cut across all social classes. Nearly every family had someone,” says Dr João Goulão, head of sicad, the agency that directs Portugal’s addiction programmes. That generated the political will to take the fight against drugs out of the justice ministry and give it to the health ministry. Under the law of 2001, illegal drugs remain illegal and dealers are prosecuted. But possession for personal use is an administrative offence, not a criminal one. Anyone caught with a 10-day supply or less is ordered to visit the local Commission for Dissuasion of Drug Addiction. Rehabilitation programmes and opiate substitutes, such as methadone, are available to all users who want to quit.

Since then, the number of problem heroin users has fallen to about 33,000. The government can claim only partial credit; drug epidemics tend to fizzle. But decriminalisation and treatment helped cut Portugal’s overdose rate to one of the lowest in Europe. As for America, in 2016 it had 63,600 fatal overdoses. In Portugal there were 27.

Portugal’s policies are based on “harm reduction” approaches pioneered in countries such as Switzerland in the 1980s. The idea is to emphasise treatment and prevention more than punishment, says Brendan Hughes of the European Monitoring Centre for Drugs and Drug Addiction (emcdda). Most European countries now have some form of harm-reduction policy, though the east is more conservative.

Surprisingly, though, apparently Portugal doesn't have safe injecting rooms:

Américo Nave, head of crescer, criticises Portugal’s government for failing to create safe injection rooms and barring outreach workers from carrying the drug naloxone, which can save heroin users who have overdosed. Last December, Ms Correia says, she watched a man die, knowing that naloxone might have saved him. Still, that is one of just a few dozen such deaths in Portugal in the past year. In Sweden, there may be ten times as many.

As usual, it's odd the way different countries have different types of drug problems:

But lately Europe is facing different drugs. Cocaine use is up; in Barcelona, residues in wastewater suggest it more than doubled between 2011 and 2018. Most overdose deaths in the Netherlands are caused not by opiates but by party drugs like amphetamines or synthetic cannabinoids, or by ecstasy, which can cause dehydration. The drug ghb raises your libido, but can knock you out; it accounted for two-thirds of Dutch drug-related emergencies in 2016.

For stimulants like these, notes the emcdda’s Andrew Cunningham, “there are no substitute treatments like methadone”. The same goes for methamphetamines, rare in most of Europe but common in the Czech Republic and Slovakia. (They are still known there as “Pervitin”, a brand of amphetamines distributed to Nazi soldiers.) In the past few years Czech meth has spread across Germany, mainly in paste form. The more dangerous crystal variant has popped up as well, often sold at t-shirt stands along the German border. 

Which all brings us to the pill testing question in Australia.

I find it easy to be sympathetic to harm reduction strategies for opiates, because of how they are used and the difficulty of getting off them.   (I am reminded, however, how Theodore Dalrymple argued that thousands of US military members indulged in heroin while in Vietnam, and then dropped the habit without excessive drama when they had to return to their homes and families.  He thinks we are too indulgent even of heroin use:  a pretty uncommon view.)   It's harder to feel as much sympathy for the true party drug scene - harm reduction for many of them feels more like encouraging mere repeated self indulgence.