[ExI] Alcohol meta-analysis

[Emlyn]

2009/6/9 Max More <max at maxmore.com>:
> Thanks for posting that, Emlyn. These researchers (who seem to have several
> meta-analyses of alcohol) did find some protective effect of alcohol for
> coronary heart disease -- but not for anything else.

Somewhat hilariously, cocaine could be safer than we might assume. I
don't think I'll be going there any time soon, but it's interesting to
consider that might be because of an irrational taboo rather than any
rational position.

http://transform-drugs.blogspot.com/2009/06/report-they-didnt-want-you-to-see.html
---
Wednesday, June 10, 2009
The WHO cocaine report the US didn't want you to see

The largest ever study of cocaine use around the globe was carried out
in the early 90's by the UN World Health Organisation (WHO) and funded
by the UN Inter-regional Crime and Justice Research Institute
(UNICRI), but under pressure from the US its publication was
suppressed when it became clear the report's findings were in direct
conflict with the myths, stereotypes and propaganda that prop up the
war on drugs (read the complete leaked report here).

In March 1995 WHO/UNICRI released a briefing kit summarising the key
conclusions, as a curtain raiser to the report's imminent publication.

    * "Health problems from the use of legal substances, particularly
alcohol and tobacco, are greater than health problems from cocaine
use.
    * Few experts describe cocaine as invariably harmful to health.
Cocaine-related problems are widely perceived to be more common and
more severe for intensive, high-dosage users and very rare and much
less severe for occasional, low-dosage users." (pg. 1)

In a classic example of what happens when public health pragmatism
collides with criminal justice dogma, just two months later, at the
48th World Health Assembly, the US representative to the WHO
threatened to withdraw US funding for WHO research projects unless
they 'would dissociate itself from the conclusions of the study' (read
the relevant segment here). He said;

    "The United States Government had been surprised to note that the
package seemed to make a case for the positive uses of cocaine,
claiming that use of the coca leaf did not lead to noticeable damage
to mental or physical health, that the positive health effects of coca
leaf chewing might be transferable from traditional settings to other
countries and cultures, and that coca production provided financial
benefits to peasants...

    "... it [the US] took the view that the study on cocaine, evidence
of WHO's support for harm-reduction programmes and previous WHO
association with organizations that supported the legalization of
drugs, indicated that its programme on substance abuse was heading in
the wrong direction. The press package undermined the efforts of the
international community to stamp out the illegal cultivation and
production of coca, inter alia through international conventions.

    "The United States Government considered that, if WHO activities
relating to drugs failed to reinforce proven drug control approaches,
funds for the relevant programmes should be curtailed. In view of the
gravity of the matter, he asked the Director-General for an assurance
that WHO would dissociate itself from the conclusions of the study and
that, in substance abuse activities, an approach would not be adopted
that could be used to justify the continued production of coca."

It's easy to see why the US would be so opposed to the study being
published as it not only challenges a number of myths and stereotypes
about cocaine use, but it is highly critical of a number of US-backed
policies. The report specifically highlights the criticism that supply
reduction and enforcement policies are not working and that
alternatives needs to be explored;

    "The largest future issue is whether international organisations,
such as WHO and the United Nations Drug Control Programme, and
national governments will continue to focus on supply reduction
approaches such as crop destruction and substitution and law
enforcement efforts in the face of mounting criticism and cynicism
about the effectiveness of these approaches. Countries such as
Australia, Bolivia, Canada and Colombia are now interested in
examining a range of options to legalize and decriminalize the
personal use and possession of cocaine and other related products.
There needs to be more assessment of the adverse effects of current
policies and strategies and development of innovative approaches."
(pg. 30)

    "The studies identified strict limitations to drug control
policies which rely almost exclusively on repressive measures. Current
national and local approaches which over-emphasize punitive drug
control measures may actually contribute to the development of
heath-related problems. An increase in the adoption of more humane,
compassionate responses such as education, treatment and
rehabilitation programmes is seen as a desirable counterbalance to the
overreliance on law enforcement measures." (pg. 29)

The study also points out that 'anti-drug' campaigns are not
necessarily effective, especially mass media campiagns based on scare
tactics;

    "Despite a broad range of educational and prevention approaches,
most programmes do not prevent myths but perpetuate stereotypes and
misinform the general public. Such programmes rely on sensationalized,
exaggerated statements about cocaine which misinform about patterns of
use, stigmatize users, and destroy the educator's credibility. This
has given most education campaigns a naïve image and has reduced
confidence in the quality and accuracy of these campaigns…" (pg. 23)

With regards to who uses cocaine, the study says,

    "It is not possible to describe an "average cocaine user". An
enormous variety was found in the types of people who use cocaine, the
amount of drug used, the frequency of use, the duration and intensity
of use, the reasons for using and any associated problems they
experience.’"(pg. 1)

However it does usefully establish a continuum for use, noting that
the majority of harms are accrued by the minority of users at the
extreme of the continuum;

        * experimental use
        * occasional use
        * situation-specific use
        * intensive use
        * compulsive/dysfunctional use

    Experimental and occasional use are by far the most common types
of use, and compulsive/dysfunctional is far less common." (pg. 28)

The study additionally notes - in direct conflict with the accepted
drug war paradigm that all use equals abuse - that:

    "That occasional cocaine use does not typically lead to severe or
even minor physical or social problems ... a minority of people start
using cocaine or related products, use casually for a short or long
period, and suffer little or no negative consequences, even after
years of use. ... Use of coca leaves appears to have no negative
health effects and has positive, therapeutic, sacred and social
functions for indigenous Andean populations."

In addressing the rise in use, the report posits that key drivers are
the drug's illicit status combined with both rising wealth (for
cocaine powder) and increased poverty (for crack cocaine).

    "The increasing attractiveness of cocaine in the past two decades
may be related to:

        * the "glamour" of illicit drug use in general;
        * increased wealth allowing more people access to what they
believe is the most glamorous of all illicit drugs;
        * widespread poverty or social disadvantage in countries such
as the USA at a time when cheap coca preparations like crack have
become widely available." (pg. 14)

The report was never officially published and according to the WHO it
does not exist, however some of the project advisors are now pushing
for it to be formally published. It has only emerged into the public
domain because the relevant documents were leaked and found their way
into the hands of the Transnational Institute drugs and democracy
programme.

The suppression of this detailed, authoritative and independent report
is yet more evidence of how certain governments, most conspicuously
the US, have willfully refused to develop rational drug policy based
on science and evidence - and worse, when evidence emerges that
challenges their political prerogatives and drug war ideologies they
will resort to bullying, threats and censorship to ensure it is
suppressed. This is anti-science drug war posturing of the worst kind,
and can only lead to poor policy development with increased social and
personal costs the inevitable result.

Transform has passed this report on to the forthcoming Home Affairs
Select Committee inquiry on cocaine in the hope that it might usefully
be used to inform policy discussions, albeit only at the UK level for
now, and some 13 years late.


-- 
Emlyn

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