In This Issue

Citation

Stothard, B. (2021), "In This Issue", Drugs and Alcohol Today, Vol. 21 No. 4, pp. 266-268. https://doi.org/10.1108/DAT-12-2021-088

In This Issue

Welcome to the final 2021 issue, a hybrid of regular issue papers and papers on the UK’s Misuse of Drugs Act 1971, now 50 years old.

Our opening editorial Industry needs to be represented to keep prohibition advocates in check by Axel Klein with Blaine Stothard examines and questions assumptions and practice around the presence of industry representative on journal editorial boards and as authors of papers submitted to scientific journals. Residual wariness stems from the history of attempts by the tobacco industry to divert and mis-inform scientific discourse in the interests of profit rather than knowledge. Similar traits have been apparent in the practices of some pharmaceutical manufacturers during the current epidemic of opioid-related overdose deaths in North America. This history demands the utmost attention and awareness on the part of editorial teams and advisory boards. However, the reflex response of denying and denouncing such representation and authorship is increasingly running the risk of becoming a form of complacent censorship, which risks obscuring or censoring points of view and argument which do not conform to what might become an increasingly out-dated and partisan consensus based on out-dated experiences, individuals’ earlier knowledge hardening into prejudice. This becomes increasingly urgent as tobacco alternatives, vaping, the legalisation of recreational cannabis use and gambling become more extant and more commercialised. This necessitates some rethinking of attitude and practice on the part of the publishing community. It is no longer sufficient to reject opinion, research and authors with the response that this paper or this author is funded by big tobacco and pharmaceutical companies or the commercial cannabis lobby. In this respect, censorship in publishing might be compared to prohibition approaches to various substances.

Our Misuse of Drugs Act coverage opens with a user’s perspective of the effects and impacts of the MDA, a voice little heard in the current UK discourse on drugs legislation, although more present in the debate on drug policy reform. This paper is authored by Mat Southwell, a harm reduction specialist, drug user organiser and global advocate on drugs and HIV. Mat led NHS harm reduction and drug treatment services in East London through the 1990s. In 2001, he presented the BBC documentary Chemical Britannia, which provided four drug user activists with the chance to describe the failings of prohibition and celebrate the drug using community. Mat has contributed to the establishing of local, national, regional, and global drug user rights organisations. He works half-time as the Project Executive for the European Network of People who Use Drugs and is Managing Consultant of Coact, a peer-led cooperative that delivers technical support on drugs and HIV in international development.

In the next paper, Gary Potter considers the place of cannabis in the development of UK drugs legislation and the refusal of successive governments to pay heed to scientific evidence and advice about the effects of cannabis use on individuals and the potential benefits for therapeutic and health uses of cannabis derivatives. Gary argues that the prohibition approach of the MDA causes more harm than it prevents in relation to cannabis. The supposed deterrent effects of the MDA and the “messages” which Ministers assert it sends are not apparent in statistics, which show a consistent growth in the import, production and use of cannabis in the UK. This illustrates wider contexts of the ways in which governments have assessed and asserted the harms caused by a range of substances, legal and illegal, in common use in the UK; and the cherry-picking of research by governments, including the failure to commission research in spite of the constant references by ministers to the need for research during the 1970 Misuse of Drugs Bill debates and since.

Toby Seddon reminds us of the origins of the Misuse of Drugs Act in the counter-culture era of the 1960s and 1970s. While not challenging the arguments put forward by current advocates of drug policy reform, Toby questions the current view of the solely prohibition aspects of the MDA and suggests that we should also be looking at the Act from a regulatory perspective and a need to distinguish between regulation and law. This sees the role of legislation as steering the flow of events. The paper acknowledges that the supposed ‘control’ envisaged by the MDA is, de facto, of people and behaviours, not the availability of substances.

Blaine Stothard’s paper also looks at the origins of the MDA but emphasises differing themes and outcomes. Blaine and Toby’s papers can be seen as historically complementary, although Blaine’s paper sees the MDA as the culmination of a series of laws designed to restrict and control the supply and use of what UK governments have determined to be illegal drugs. He describes the sequence of legislation centring on dangerous drugs and poisons, which can be seen to have some relevance to public and individual health, and its re-focussing since the MDA on policing, crime and sanctions, an implicit acknowledgement by legislators that the intended control of supply and use has not been successful. The MDA can be seen as representing an approach which sees passing laws as solving problems, an approach questioned by MP Paul Flynn in the 2015 debate on the Psychoactive Substances Bill: How many bans reduce drug harms and use? The parallel role of practice rather than law is mentioned, as are the insufficiency of funding for treatment (currently high-lighted by the Black reports) and the inadequacy of government responses to research.

The current UK show of diversity of ethnicity in government is not matched by diversity of opinion – indeed, the latter seems to be frowned on, with divergent views subjected to ridicule, dismissal and exclusion. This ‘show’ by Conservative-led governments since 2010 can be further illustrated by the ostentatious display by ministers at the time of Richard Wilkinson and Kate Pickett’s book The spirit level in which the two social-epidemiologists demonstrate the links between health, well-being and (in)equality of income distribution. The disregard by subsequent UK Governments of socio-economic factors in social issues, including substance use, suggests that few if any of those ministers had actually read the book.

On the topic of research, it will be interesting to see if, post-Brexit, UK drug policy will become more evidence-based and, in particular, if the aspiration expressed in the 2017 Drug Strategy for the ACMD to become an internationally recognised centre of drug policy research comes to fruition. This aspiration is weakened by the frequent disregard or dismissal by governments of ACMD reports and recommendations. As Mat Southwell explains, governments’ refusal to accept research findings prolong and promote the harms which the use of and trade in illegal drugs can cause, where alternative approaches and practice are available and evidenced. The Norwegian criminologist Nils Christie, in his 1985 book Den gode fiende (The good, i.e. useful, enemy), summarised: the most dangerous use of drugs is the political – the use of stigmatisation and mis-representation of drug use and users as threatening society is a distraction from more pressing social issues, perhaps because governments don’t have the intellectual capacity or political courage to understand the origins of, and hence realistic responses to, such intractable social issues. In the UK, there has been a lack of evolution in thinking and, it would seem, a failure to recognise that there is a market in and for illegal drugs. Earlier Conservative thinking was that you can’t buck the market. The American academic Carl Hart has referred to the need for “science not stigma” in drug policy.

The four regular papers in the issue start with Tove Sohlberg’s paper from Sweden on risk perception and behaviour change amongst former tobacco smokers, demonstrating some public health responses to the use of tobacco products, but also the ways in which some of the former smokers involved in the study had not become non-users but turned to other substances and methods of ingestion. Her paper can be seen as contributing to the debate on harm reduction, regulation or prohibition – i.e. abstinence – in tobacco control, another conflict between political conviction and public health realism.

Stephanie Taylor’s paper from the USA looks at the mental health and personal safety needs of female prisoners in rural prisons. The sample studied showed high levels of mental health and substance use disorders for a range of offences, including, but not predominantly so, violent offences and offenders, and the importance of responding to them.

Jones, Dulbeco and Cunial’s paper from Argentina considers the impact of religious teachings on morality on the substance using behaviour of individuals attending religious-based treatment facilities – “institutions” in the authors’ words. Treatment agencies mainly adopt heteronormative prejudices and assumptions about their patients’ sexuality and sexual behaviours and thus the conditions attached to their treatment. There appears to be no consistency in treatment practice and approach between the organisations studied, and their minimal positive outcomes.

Jaspal’s paper is a further contribution to the literature on chemsex and gay and bisexual men. It looks at the motivation of gay and bisexual men to engage in chemsex and its role in constructing a positive sense of self and coping with psychological stress - stigma, rejection and homonegativity. This counters the view of some in public health that chemsex is axiomatically dangerous and harmful.

This issue will be the last on which I work as part of the Drugs and Alcohol Today editorial team before I follow Axel Klein in stepping down from an editorial role in favour of a new team co-led by Aysel Sultan and Marta Rychert and a journal retitled Drugs, Habits and Social Policy. I wish you all continued informative reading and encourage you to submit papers.

Best wishes,

Blaine Stothard

Co-editor 2014–2021

September 10.2021.