![[personal profile]](https://www.dreamwidth.org/img/silk/identity/user.png){kind=small}
fandomnumbergenerator) wrote2014-04-03 03:28 pm
Notes about legalization vs decriminalization
"The trust necessary for good treatment is hard to achieve because if your counselor is also in charge of sending you back to prison for not following rules, honesty isn’t exactly the best policy for self-preservation."
Maia Szalavitz
(in reference to this article: Why Addiction Treatment Is a Disaster, By Maia Szalavitz, the fix)
A lot of Szalavitz’s writing is about the lack of evidence-based standards in drug treatment, whether you want to call it medicine (and subscribe to a disease model) or not. She also writes a lot about the abuses (particularly against women and teens) that occur in an unregulated, self-declared-expert systems. I want to think that these kind of reports actually have an effect. But that’s probably naive.
---
I think part of the appeal of the medical model is tactical, to make a human rights argument for decriminalization and sterile syringe distribution and supervised injection facilities and more flexible and humane opiate substitution therapy and treatment on demand that mirror’s MSF’s Access to Essential Medicines campaign. And, of course, the flaw in that logic is that even if harm reduction advocates are comparing drug use to diabetes or heart disease, what everyone else hears is drug use as mental illness, which is also stigmatized, and has its own consequences in terms of human rights and civil liberties. (Not to mention the question of whether there’s actually any data to back up the various neurotransmitter-based mechanisms that people claim as part of the medical model.)
I also think that Maia Szalavitz experienced her own drug use as very compulsive and out of control, and that she found antidepressants really helpful when she quit, and has caught a lot of flack for that, so she may just be defensive.
---
I think that there are two different-but-overlapping issues. One is the disease model, which is based on a lot of iffy research out of the NIDA. I have never really liked the brain chemistry model of either addiction or psychiatric disorders. And I think Carl Hart very eloquently lays out the biases, fuzzy thinking, lack of class-analysis and vested interests that perpetuate a lot of the hysteria and hyperbole. I don’t think anyone knows how psychiatric drugs really work, and just because a serotonin reuptake inhibitor makes me less anxious, that doesn’t mean that I necessarily have some kind of serotonin-based disease. As far as I understand it, there’s no coherent data beyond the fact that certain drugs change people’s behaviors and self-reported mood. And while I do believe that everything about how we think is mediated by chemicals (because the only other option is a non-corporeal soul), I don’t think “chemical-imbalance” theory has anything useful to tell us. And, yes, the disease model makes addiction (and to varying degrees all intoxicant use) into a form of mental illness. And any time you combine police power or other kinds of coercion with psychiatric treatment, you’re asking for a humanitarian disaster.
But I also think there’s a medical model of how to deal with problematic drug use, which does not depend on any particular details of the disease model, but which basically says, legalize drugs and have doctors and therapists deal with problematic intoxicant use (as experienced by the person themselves, and not by criminalization). The dark side of this, of course, is that when something is so stigmatized, you can’t trust doctors to deal with it humanely or even to use evidence-based treatments. Just look at the way that high BMI is equated by so many doctors with diabetes and heart disease. But I feel like in a lot of ways a medical model would be an improvement over what we have now, and I think that’s what Maia Szalavitz is getting at. She has written a lot about coercive and unregulated drug treatment programs, particularly those aimed at minors. Things that would never be allowed for the treatment of, say, cancer. Or the use of drug courts to coerce treatment. Or look at the inhumane way that the NAOMI trail in Canada was ended — with no options for the participants, who had significant improvements in quality of life on prescription heroin vs. methadone, to continue on heroin. Instead they were all dumped back into the methadone programs (the failing of which was a requirement for joining the trail). A lot of people in the harm reduction community, including users unions, have pointed out that other drug trials would have been conducted more humanely. And similar arguments have been made for sterile syringe distribution and supervised injection sites. A medical model would ideally be evidence based (looking at the current state of the art without overweighting sensationalist reports), and would take into account people’s quality of life. If NA works well for someone, that’s great. But if suboxone or prescription heroin works for another person, that’s great too. And something like ibogaine, which apparently has a very high risk of death, would have to be looked at carefully to see if the risks were balanced by the rewards for that particular person.
I don’t know. I think I’m sounding really naive. I just wanted to distinguish between two things that I think are different.
----
Weirdly, I think legalization and decriminalization mean very different things (or at least have very different connotations) in drug policy vs. sex work. As I have heard it described, drug decriminalization means turning possession for personal use into a misdemeanor and leaves dealing as a criminal offense (and includes the Portuguese model). I will try to find a reference for that.
Also, I am in no way a neuroscientist. Pretty much all my information on chemical imbalance theory comes from lay sources. I do have some expertise in parsing media reports of scientific discoveries, so I can at least add that. I need to find the details, but I heard a story recently about a false advertising claim against an antidepressant manufacturer for using the chemical imbalance model in an ad (because there is no data supporting it). I will try to find that reference too.
---
http://harmreduction.org/publication-type/podcast/ninety-two/
As I understood the gist of it:
-dealing is still criminalized in Portugal (and the way that small-time dealers are distinguished from users seems very problematic) and small time dealers are still used by the police to work their way up to bigger dealers
-decriminalization means that police spend less time harassing drug users, since they cannot use small busts to inflate their arrest numbers
-Portugal put a lot of effort into housing and jobs programs and other social safety net stuff, and other countries are not paying attention to how important that work is to the success of decriminalization
-It sounds like if the drug court judge (different from US drug court because it does not give you an arrest record) decides you’re an addict as opposed to a casual user, you do start losing civil liberties
I would be curious to know how the Portuguese model affects child custody and prenatal care
In terms of the nomenclature, I think “decriminalization” will probably always come with fewer strings attached than “legalization” because it sounds less politically scary. So decriminalization may offer a certain benefit from being seen as not as big of a change, but has the problem that it still leaves some people in a legal grey area. And the difference between drug use and sex work may relate to the way that all dealers are seen as predatory, as opposed to just another part of the underground economy.