How are illegal drugs harmful? Please define your conception of soft and hard drugs.

Illicit drugs are harmful on all our significant levels of functioning. First of all they are harmful physically, with the most serious physical consequence being death by overdose.

They are harmful psychologically, because the personality of the person who is addicted to them deteriorates, and they can cause or precipitate severe mental illness such as depression or psychosis. They are also harmful on a social level, because the addict ceases functioning effectively on a social level and is also easily tempted towards criminal activity to finance his habit.

The particular manifestations of these harmful consequences are different for each individual, depending on his personality and environment and on the particular substances that he abuses. Drugs are classified as hard or soft, generally depending on the harm that they cause, with soft drugs presumably being less harmful.

For me this is a misnomer, because while it is true that overall, for example, heroin (a hard drug), is more harmful than cannabis or ecstasy (a soft drug), the effect of soft drugs on a particular individual can also be devastating. For example the supposedly soft drug ecstasy can lead to death, and the supposedly soft drug cannabis can precipitate psychosis resulting in an admission to a mental hospital or suicide.

How do illegal drugs compare with legal drugs, say alcohol or tobacco, both in terms of statistics and bodily harm?

Both alcohol and tobacco are used much more than illegal drugs. Addiction to alcohol can be as damaging on all the levels mentioned above as illegal drugs. In my opinion, the problem of alcohol in our country is as big, if not bigger, than that of drugs. Tobacco is more damaging physically than socially or psychologically.

Are we being successful in the struggle against drugs locally?

It is very difficult to define success in this area. If success means that the use of illicit drugs by the population decreases, than we definitely are not successful. But I am sure that if in Malta we do nothing about the drugs problem, abuse would be much more widespread.

Thus in this respect we are successful. In Malta we also have very good therapeutic centres, with both governmental and non-governmental agencies reaching levels of excellence. The opportunities available for addicts in Malta to receive treatment compare very well with those of most developed countries.

A growing number of European countries are focusing their efforts on harm reduction rather than supply reduction. Is this a good strategy? If it is, why? If it is not, what alternatives do you suggest?

In my opinion, the way forward is not a choice between harm reduction and supply reduction, but a synergistic application of both approaches.

What about prevention: how do we fare in this area?

We need to do more. To be more effective, we must start focusing our prevention efforts on more vulnerable localities and age groups. I believe that one can be most effective by what is known as “secondary prevention”, which is applying preventive strategies to those individuals who have already used small amounts of drugs. The aim is to help prevent them degenerating into harmful abuse or addiction.

Some people question the present drug legislation. What are your views on the matter? Do you agree with decriminalisation or legalisation and why or why not?

My opinion is that the use of illegal drugs must remain a criminal offence. But the penalty must be treatment programmes and community work rather than imprisonment. We need to differentiate more between victims of drugs and drug traffickers. I am immensely pleased to see the Nationalist and Labour parties are agreeing on this.

Most of those who strongly oppose decriminalisation argue that such legislation sends the wrong message to users. What is your position with regard to this claim?

The damage caused by drugs is so great that I could never agree with telling someone that it is OK to use drugs. Thus I believe that if we now decide that abuse of drugs is not a criminal offence, we will be sending the wrong message. But we also need to send the message that we are ready to help in a non-judgmental and caring way all individuals who are victims of addiction, and ensure that the law is not used to punish addicts but to lead them towards treatment.

Another recurring argument is that soft drugs serve as a platform from which users move on to harder drugs, and also that hard drugs are instantaneously addictive. Is it the case?

Hard drugs are not instantaneously addictive. There are individuals who use them, but do not become addicted to them. Becoming an addict or not is the result of interplay between the individual’s genetic composition, his psychological makeup and social environment.

But no one can safely presume that he is immune from becoming an addict. The use of soft drugs does not cause a physical predisposition to the abuse of hard drugs. But their use can provide the circumstances that increase the opportunity of one experimenting with the use of hard drugs.

Biography

Dr Anton Grech is 36 years old, and

graduated as a medical doctor from the University of Malta. He then proceeded to London to specialise in psychiatry at the world-renowned Maudsley Hospital and Institute of Psychiatry, where he eventually became a clinical academic lecturer. He is a Member of the Royal College of Psychiatrists and has an MSc in Psychiatry from the University of London. He did extensive research on the influence of cannabis on schizophrenia and on families of individuals with schizophrenia.

This research was published and presented in international journals and conferences. He is a consultant psychiatrist with the Health Department. He is an honorary lecturer at the University of Malta. He is a member of the National Commission on the Abuse of Drugs, Alcohol and other Dependencies . He is married and has two children

How are illegal drugs harmful? Please define your conception of soft and hard drugs.

Dividing substances into hard and soft drugs is a popular concept but holds little validity, since all substances have the potential to cause harm. However the effects of a substance result from an interaction between the substance, the person and the setting in which the substance is taken.

Goode (1999) cites two examples of marijuana use. Jim and Jamie, 35, are married, ambitious, successful professionals with two young children. They use marijuana only at weekends, when their children are asleep. It plays a recreational and minor role in their lives, much as drinking wine with dinner.

Tim, on the other hand, is 15, and doing so poorly academically that he is about to drop out. He misses classes and is asleep when he does attend. He is obsessed with marijuana, smoking four or five times a day.

These two examples illustrate the wide spectrum of substance use. Dependency can be both physical and psychological but emphasis is given to the latter. In fact, a host of behavioural addictions have been identified, namely gambling, excessive sexuality and excessive exercise, which do not involve the taking of any substance (Orford, 2001).

How do illegal drugs compare with legal drugs, say alcohol or tobacco, both in terms of statistics and bodily harm?

The distinction between legal and illegal is constructed by society. The World Health Organisation (WHO) defines a drug as: “any substance that, when taken into the living organism, may modify one or more of its functions”. The fact that alcohol and tobacco are legal has little to do with the degree of harm that they potentially incur on those who use them, or their addictive potential.

The 2002 WHO World Health Report ranked alcohol as the third most important factor among the major risk factors for health in developed countries. The issue of legality is a political and financial one. Alcohol is an important contributor to violence, crime, reduced work safety, absenteeism and child abuse, yet it is a legal, socially condoned substance. On the other hand, there is little association between these and the use of marijuana (Goode, 1999).

This is not to say that marijuana use is without risk. The point is that the drug issue is a complex one, influenced by personal and social factors, as well as societal responses. Ideological traditions need to be considered and the challenge is to avoid simplistic answers.

Are we being successful in the struggle against drugs locally?

Both the European School Survey for Alcohol and other Drugs (ESPAD) results (1997, 2001) and the results of the prevalence study conducted by the National Commission on the Abuse of Drugs, Alcohol and other Dependencies (2003), indicate that the use of illegal substances in Malta is not rife. On the other hand, the use of alcohol is disconcerting. The ESPAD reports for Malta (1997,2002) indicate high levels of alcohol consumption among 16 year-olds.

However, while consumption in a lifetime is higher than average when compared to the rest of Europe, drunkenness is lower. The results indicate that, together with Denmark, Maltese youths show frequent drinking behaviour. Malta had the highest consumption of wine, while Malta and Denmark show the highest consumption of spirits. The answer to that question, therefore, depends on one’s definition of drugs/drug abuse.

The struggle against the abuse of substances is being given priority locally. However, assessing whether efforts are being successful requires the setting up of a monitoring system. The National Commission has embarked on a twinning project with Holland to prepare Malta for the technical requirements for joining the European Monitoring Centre for Drugs and Drug Addictions (EMCDDA). Only when such a monitoring system is in place can we make secure assessments regarding the success of prevention/intervention efforts. This is the basis of the current discussion in the EU with regard to the preparation of the new EU drug strategy 2005-2012.

A growing number of European countries are focusing their efforts on harm reduction rather than supply reduction. Is this a good strategy? If it is, why? If it is not, what alternatives do you suggest?

Drug policy may be simplistically and somewhat artificially divided into supply reduction, demand reduction and harm reduction. The three are not mutually exclusive. Supply reduction attempts to reduce the presence of substances. The rationale is that if substances are readily available and easily procured without restriction, they are more likely to be used. However supply reduction is not without its problems.

Among established users, the reduction in supply increases the cost of illegal substances and thereby contributes to increased criminal activity. The emphasis on legal efforts to combat the problem may also result in a class of people being defined as criminal and in the creation of criminal subcultures. Few would deny the value of demand reduction.

Preventing people from wanting to use substances in the first place is always an important goal. However despite efforts at the latter, substance use remains a fact of life. Humans have been ingesting drugs for more than 10,000 years (Goode, 1999). Recognising substance use as a reality is not a defeatist approach; rather it is a realistic approach which eschews a moralistic mentality in favour of a public health one.

An attempt is made to reduce the harm that may present itself with active use. If young people are to use ecstasy at parties, educating them for safer use is a worthwhile intervention. The ultimate message is still that drugs may cause harm, but if people choose to use them, they are informed on how to reduce risks and provided with opportunity to do so. A classic example of harm reduction is needle exchange, which has helped reduce the risk of HIV infection among intravenous drug users.

A combination of all three measures and coordination between all stakeholders might contribute for greater success

Some people question present drug legislation. What are your views on the matter? Do you agree with decriminalisation or legalisation and why or why not?

This is an extremely loaded question. In the UK, Parker and his colleagues (1999) developed a theory of normalisation whereby the new generation of drug user can no longer be seen as mad or bad or from subcultural worlds – they are ordinary and everywhere. They argue that drugs are no longer used as a form of rebellious behaviour, but have been subsumed into wider, acceptable leisure activities.

This climate has prompted the reduction of cannabis from a class B to a class C drug in the UK. The issue is complex, however. In the case of alcohol, countries (such as Malta) which have lax restrictions (if any at all) regarding availability of alcohol to young people, report higher rates of use over a lifetime. However, while alcohol consumption in a lifetime is higher than average, drunkenness is lower than average.

Could it be that because alcohol is not restricted, young people are learning to drink sensibly and avoid bingeing? Once again, the age of the user needs to be taken into consideration. We now know that any substance abuse (including alcohol) by young people has a negative impact on the developing body and brain and might prime the young person for more involved use at a later stage in the life cycle which could seriously impact on learning and have further negative impact on brain development.

On the other hand, the criminalisation of young people because of their experimentation with illegal substances can have very severe consequences for their futures.

Most of those who strongly oppose decriminalisation argue that such legislation sends the wrong message to users. What is your position with regard to this claim?

Criminalising a substance or behaviour will not cause it to disappear. The prohibition of alcohol in the United States in the 1920s was a major contribution to the development of organised crime, as was the prohibition of gambling. On the other hand, unrestricted access to substances, as is the case with alcohol in Malta, may have adverse consequences.

Even in countries where marijuana is decriminalised, there are restrictions regulating its use, especially by minors. The issue of substance use responds best to sensible public policies which are evidence-based and non moralistic.

Another recurring argument is that soft drugs serve as a platform from which users move on to harder drugs, and also that hard drugs are instantaneously addictive. Is this the case?

This is a simplistic argument. It is true that marijuana features as a precursor to heroin and cocaine use (often identified as hard drugs) in the careers of such users. This has been called the gateway theory. However, many people who use marihuana never progress to other substances. The addictive “career” is a process of development, which often takes years. Progress is not inevitable!

The reason for trying a drug for the first time or using it recreationally may differ significantly from the reasons for becoming a fully fledged user or even stop drug using the drug spontaneously.

Interventions must therefore be based on identification of the stage of the career. You cannot put the same label on everybody!

The views expressed here are solely those of the authors and do not reflect those of the organisations to which they are affiliated.

Biography

Dr Marilyn Clark PhD is a

lecturer in the Faculty of Education, University of Malta. She is a member of the National Commission on the Abuse of Drugs, Alcohol and Other Dependencies. Her main research and teaching

interests are addictive behaviour and criminal career development