When it comes to media coverage of drugs and alcohol in the press, it is fair to say that good news stories just don't cut it. That tendency for a dialogue that focuses on drug-related harms and diagnosable disorders is repeated across heath care and research. Unfortunately, terms such as harm minimization and harm reduction, although well-meaning, don't really go very far in engaging the people who could most benefit from heeding such advice: People who like taking drugs.
As a doctor who works with those with serious drug and alcohol problems, I work with the minority of drug users and drinkers for whom their use of substances is devastating. My dialogue is almost exclusively driven by the very real need and desire to reduce drug-related harms such as drug overdose and blood-borne disease.
Anyone who has tried to talk to someone with a serious drug or alcohol problem has learned the hard way that the two sides might as well be speaking different languages. Yet we have done very little to get at the route of that gap in understanding. Is it any surprise then that people who drink and take drugs and enjoy these activities as part of happy and successful lives tend to ignore so much of what is written and laid down as policy and consider much of the medical profession as an irrelevancy? Useful drug education gets lumped in with reefer madness and dismissed outright. The consequence is that those most at risk -- the young, the vulnerable and the disenfranchised -- get swept up in dismissing the good things that well-crafted public health policies can create. To do a better job, we all need to broaden our spheres of interest in people who use drugs and be accepting of the function that drugs play in their lives. We also need to shout down media headlines that consider people who use drugs as merely reckless or stupid. You can find these people everywhere -- stupidity is not choosy about where it finds a home.
While I am slowly learning, it must be hard for those seeking election to broaden their spheres of interest and to enter into an honest dialogue about drugs and alcohol. This is reflected by government policies which are driven by the drug use consequences of the minority of users who develop drug dependence. Don't get me wrong: drugs -- legal, illegal and prescribed -- can ruin lives and governments must provide treatment services and information. But the discourse almost always fails to explicitly and openly discuss drug-related harms in the context of the real driver behind most drug use, which is not dependence but drug-related pleasure.
I am gradually learning that if you want to engage people in a conversation about drug-related harm and how to reduce the risk of them (and people do want to avoid them), you need to start the conversation by accepting that drug use is not exclusively negative. If it were, nobody would ever use drugs a second time and there would be no need for laws, regulations or even a debate. While the findings from the Global Drug Surveys consistently identify a minority of people who develop acute and more longstanding problems with drugs, whether they be legal or illegal, the not-very-newsworthy story is that most people who use drugs do so without encountering significant harm and make sensible decisions around their use of drugs. Many more might do so if provided with information and education in a way that was personally meaningful and did not get in the way of them using and enjoying their drugs.
If we want to reduce the harm that drugs do to our societies, providing support to people who choose to use drugs wisely and safely is a fine and ethical starting point. While there is much talk about harm reduction, there has been little research into what messages are most effective, how they are best communicated, and how acceptable currently recommended approaches are to users of emerging drugs. This is one of the major areas that this year's Global Drug Survey will focus on. This is even more important for the most commonly used illicit drug, cannabis, as the puffs of decriminalization waft over many states in the USA.
What we need to help governments craft really smart public health policy is quality data from people who drink and use drugs as part the broader tapestry of their lives so that the government can have policy informed by the masses, not just the minority. Having a drug policy driven by the minority is like dressing for summer in London all the time -- a daft idea -- you'll get caught in a downpour.
You can participate in the Global Drug Survey here.