by Marc REISINGER

BELGIUM - Psychiatrist, anthropologist an researcher at the University Hospital "Brugmann" in Brussels, specialist in pharmaco-dependence, and author of numerous publications on the treatment of heroin addicts with buprenorphine.

ABSTRACT: The failure of drug prohibition makes anti-prohibition a logical choice. However, such a policy cannot be ethically justified unless it leads to a reduction in drug demand. As for heroin, the first thing to do is to install an efficient care system for heroin users where substitutes like methadone and buprenorphine could be used. The inherent characteristics of heroin would probably not permit its unrestricted sale.

("THE COST OF PROHIBITION ON DRUGS", Papers of the International

Anti-prohibitionism Forum, Brussels 28th september - 1st october 1988; Ed. Radical Party)

Liberalisation, legalisation or regulation - whatever the term that best expresses the anti-prohibitionist proposal, the basic principle is the same : to replace the illegal supply of drugs with a legal supply, according to procedures yet to be established.

The justification for that proposal lies in the fact that the gigantic profits deriving from drug trafficking make it impossible to control it. Indeed, it is known that large-scale trafficking is carried on by international organisations, the real bosses of which probably never touch either the drugs or the money involved. Those arrested for drug trafficking are the underlings, or at most, mid-level managers of the system. They are easily replaceable and generally don't even know who their employer is. The profits from drug dealing, estimated at around 100 million dollars per year, are recycled into the international economy, through companies that seem to be increasingly irreproachable as they become increasingly powerful and as the traces of those profits disappear.

It is easy to understand that such a sophisticated financial machinery cannot be stopped by police forces. This is no doubt what led Mr. Ralph Salerno, former police chief of New York, to abandon all hope of succeeding through a policy of repression and to adopt the anti-prohibitionist view.

According to this view, replacing the illegal supply of drugs with a legal supply would bring about a drastic decrease in the prices of narcotics and, consequently, result in a lessening of the interest in trafficking on the part of criminal organisations. These organisations would thus cease investing in and stimulating drug trafficking.

Such a proposal involves a change in the supply of narcotics, not a reduction. In the anti-prohibitionist view, a reduction in the supply can only result in a reduction in the demand.

But how can we predict how the demand for narcotics will evolve in non-prohibitionist circumstances? How will drug addicts (and others) react to the prospect of legal and relatively inexpensive narcotics? This question has been posed several times during this seminar, and supporters and opponents of prohibition are divided over the answer.

I think that this question is fundamental. It embodies the ethical dimension of the proposal, and any policy that does not take account of this dimension cannot be justified.

Let us not forget that reducing the power of the Mafia is not the goal of anti-prohibition, but only a means to an end. The basic objective is and must remain to reduce the suffering caused by drugs, to reduce the number of drug addicts, and thus to reduce the demand for drugs. And if anti-prohibition were to have the opposite effect, it would be a failure and should be renounced.

Yet, there is no reason why abandoning the prohibition of narcotics should spontaneously lead to a reduction in the demand for drugs. It would be naive to think that just because they are no longer illegal, drugs would completely lose their appeal for young (and less young) people. It would be to disregard the importance of the particular effects of narcotics; as stimulants, relaxants, etc. The decrease in the price of narcotics might even be an additional attraction for the young, as the example of crack has demonstrated.

Is there no way out of this impasse? Are prohibition and its consequences inevitable? I don't think so, but it will be necessary to go through a preliminary phase before the eventual legalisation of drugs, at least as regards heroin, which is what I shall confine myself to here.

I believe it is indispensable to develop first a public health policy, which would enable us to halt the increase in the consumption of heroin, and possibly to reduce it.

The United States has succeeded in doing this with methadone treatment. Methadone is a substitute product, of a morphinic type. It has been administered to some 80,000 persons per year since the early 1970s. An epidemiological study carried out in Chicago demonstrated that the number of heroin addicts decreased markedly in those neighbourhoods where methadone treatment centres were set up (Hughes, Behind the Wall of Respect, University of Chicago Press, 1977). The development of such centres is probably the major factor explaining why, according to recent epidemiological studies :

- the number of heroin addicts does not seem to have increased during the last fifteen years in the United States;

- the average age of heroin addicts is increasing and it has been shown to constitute an essentially stable group, with very few new recruits; rather it is composed of individuals who began to take heroin at the end of the 1960s, or the beginning of the 1970s, and who are now beginning to grow older. They are, in statistical jargon, the "earlier use cohort" (N. J. Kozel, "Epidemiology of Drug Abuse : An Overview", Science, Vol. 234 21/11/1986).

The epidemiological situation as regards heroin can thus be considered, at the present time, to have stabilised in the United States. Improvements in the system, by increasing the number of methadone dispensaries, reducing the waiting period for heroin addicts who wish to enter treatment, and simplifying admission formalities, would probably enhance the system's effectiveness even more.

It should also be recalled that the British practice of treating heroin addicts with heroin is what has probably kept Great Britain from falling prey to the European heroin epidemic for many years (see Arnold Trebach's The Heroin Solution, Yale University Press, 1982).

To conclude, I would quote Paul Watzlawick in saying that one should not believe that, "if something is bad, its opposite must be good" (Ultrasolutions. How to Fail Most Successfully, 1986). Legalisation is not the opposite of prohibition. Contrary to the opinions expressed by several of the participants of this seminar, I think that legalisation should be considered on a case by case basis, care systems should be created, drawing on the experience acquired in various countries and including flexible and diverse maintenance programs, using methadone, buprenorphine (Temgesic), or heroin itself.

This would give those who have had enough of taking drugs (and there are more of them than one might think) the opportunity to free themselves of their addiction, instead of increasing it. In such circumstances, proselytism by heroin addicts would decrease, all the more so in that a small handful of ageing heroin addicts holds little attraction for the younger generation.

This gives me the opportunity to express an idea that I consider very important, concerning prevention, which has been mentioned here several times. I believe that the treatment of heroin addicts is a form of prevention, probably the most effective form, more effective than any propaganda, be it spoken, written or graphic.

Setting up such a health policy already represents an objective sufficiently important to mobilise all our efforts. What is more, it will make it possible to establish a connection between the current situation and a prospect that too many people perceive as utopian (see Marco Pannella's communique' regarding Pierre Jox, 29/9/1988). It would also enable us to acquire a better idea of where we are going and to evaluate along the way the effects of the experiment.

I must confess, however, that I am not convinced of the advisability of going beyond these initial measures in the legalisation of heroin. As I have seen at close hand the effects of this substance, it is difficult for me to conceive of its being sold freely on every street corner.