Chasing the Scream: The First and Last Days of the War on Drugs

by Johann Hari

But what could Bud do? Who would listen to him? He convened a meeting in a hall provided by the local church, and announced that people inside the Downtown Eastside were going to have to fight for change. Nobody was coming to save them. They would have to save themselves.

Gandhi said one of the crucial roles for anyone who wants to change anything is to make the oppression visible—to give it a physical shape.

Many people had believed what Bruce Alexander was taught by Batman and his dad—that addicts didn’t care about their lives, or about anything but their next fix. But here they were, organizing to defend themselves and each other.

And the addicts were starting to look at themselves differently. Bud said, “People would work sixty hours a week” at VANDU. “To see people’s faces and how they changed—they saw, I have worth, I have value. I’m able to help somebody else. I’m no longer just what they call me in the newspapers.”

When you are confronted with historical forces that seem vastly bigger than you—like a war on your people that has lasted nearly a hundred years—you have two choices. You can accept it as your fate and try to adjust to being a pinball being whacked around a table by the powerful. Or you can band together with other people to become a historical force yourself—one that will eventually overwhelm the forces ranged against you.

Milton Friedman, the Nobel Prize–winning economist who was the pope of the neoliberal right, and a leading critic of the drug war. Friedman had grown up under alcohol prohibition in Chicago, where he concluded that prohibition causes more problems than the drug itself. The drug war, he believed, was the ultimate big government program—a criminal waste of money.

In 2012, the results of a decade of changed policies came in. The average life expectancy on the Downtown Eastside, according to the city’s medical health officials, had risen by ten years.

drug-related fatalities were down by 80 percent in this period.

In 2012, the Canadian Supreme Court ruled that drug addicts have a right to life, and that safe injecting rooms are an inherent part of that right and can never be legally shut down.

black men are ten times more likely to be imprisoned for drug offences than white men in Britain, a figure beating both the United States and apartheid South Africa.

And so for two generations, Henry Smith Williams’s policies prevailed in Britain, and nowhere else on earth. The result was that while heroin addiction was swelling into the hundreds of thousands in the United States, the picture in Britain was different. The number of addicts never exceeded a thousand,

“the addict population in England remained pretty much as it was—little old ladies, self-medicating doctors, chronic pain sufferers, ne’er-do-wells, ‘all middle-aged people’—most of them leading otherwise normal lives.”

British doctors insisted there was such a thing as a “stabilized addict,” and they said that when you prescribe, this was ...

Faced with this evidence, John Marks was beginning to believe that many “of the harms of drugs are to do with the laws around them, not the drugs themselves.”

“Heroin use was concentrated in the 25 to 39 group, after which it tapered to very little,” he wrote. Most addicts simply stopped of their own accord. They “mature out of addiction . . . possibly because the stresses and strains of life are becoming stabilized for them and because the major challenges of adulthood have passed.”

Most addicts will simply stop, whether they are given treatment or not, provided prohibition doesn’t kill them first. They usually do so after around ten years of use.

once John Marks knew this, he came to believe his job was a matter of keeping them alive long enough to recover naturally.

Imagine you are a street heroin addict. You have to raise a large sum of money every day for your habit: £100 a day for heroin at that time in the Wirral. How are you going to get it? You can rob. You can prostitute. But there is another way, and it’s a lot less unpleasant than either of them. You can buy your drugs, take what you need, and then cut the rest with talcum powder and sell it to other people.

Here’s why drug use went into reverse in John Marks’s clinic. Prescription, it turns out, kills the pyramid selling scheme, by stripping out the profit motive.

“We’ve got a lot of heat from our embassy in Washington,” he warned. “They’ve got on to [the government] saying, ‘What’s this about somebody in Liverpool giving out crack cocaine? Close it down immediately!’ ”

The Conservative government decided to “merge” John’s clinic with a new health trust, run by evangelical Christians who opposed prescription on principle.

The results came quickly. In all the time Dr. Marks had been prescribing, from 1982 to 1995, he never had a drug-related death among his patients.

Of the 450 patients Marks prescribed to, 20 were dead within six months, and 41 were dead within two years. More lost limbs and caught potentially lethal diseases. They returned to the death rate for addicts under prohibition: 10 to 20 percent, similar to smallpox.

she gathered into her office representatives of the country’s most despised minorities—gays, prostitutes, and junkies—because she suspected that they held not only the problem but also the solution to the AIDS crisis.

She found that sex workers, if you arm them with condoms and information, are actually “very good public health agents. But you have to trust them. You have to accept their job. So prevention begins with respect.”

As a socialist, she had always believed that everyone—no matter how seemingly lost—can be empowered if you do it right.

Belief

“All addicts are in a total confusion.” Suddenly, his constant scrambling for his drugs was taken away, and he had a day ahead of him he had to fill. He tells me patients here “have to reinvent our lives. We have to reinvent the imagination.”

If you are an addict here and you want a higher dose of heroin, you can ask for it, and they’ll give it to you. So at first, most addicts demand more and more, just as Anslinger and his agents predicted. But within a few months, most addicts stop asking for more and choose, of their own free will, to stabilize their doses.

If you give hard-core addicts the option of a safe legal prescription and allow them to control the dose, the vast majority will stabilize and then slowly reduce their drug consumption over time.

Prescription isn’t an alternative to stopping your drug use. It is—for many people—a path to it.

Most addicts here, he says, come with an empty glass inside them; when they take heroin, the glass becomes full, but only for a few hours, and then it drains down to nothing again. The purpose of this program is to gradually build a life for the addict so they can put something else into that empty glass: a social network, a job, some daily pleasures.

If you can do that, it will mean that even as the heroin drains, you are not left totally empty. Over time, as your life has more in it, the glass will contain more and more, so it will take less and less heroin to fill it up. And in the end, there may be enough within you that you feel full without any heroin at all.

Users can stay on this program for as long as they want, but the average patient will come here for three years, and at the end of that time, on...

The people on heroin prescriptions carry out 55 percent fewer vehicle thefts and 80 percent fewer muggings and burglaries. This fall in crime was “almost immediate,” the most detailed academic study found.

The program costs thirty-five Swiss francs per patient per day, but it spares the taxpayer from having to spend forty-four francs a day arresting, trying, and convicting the drug user.

So when people ask “Why should I pay for this?” the pragmatic Swiss answer is: This doesn’t cost you money. It saves you money.

It’s hard, I say to Ruth in her apartment in Geneva one afternoon, to imagine an American president or British prime minister doing what she has done: sitting with addicts, learning their stories, and urging people to help them.

“They should,” she says. “You have to learn and to see with their own eyes.”

Global Commission on Drug Policy, demanding an end to the global drug war.

Oxycontin and Vicodin addictions are indeed spreading in the United States, and they are causing more criminality and overdose.

The cause, everyone seems to agree, is that doctors have prescribed the drugs too freely.

When do the worst problems associated with Oxycontin and Vicodin, the ones you see on the news, start? When do the addicts start to hold up pharmacies to get their next batch, or prostitute themselves, or start overdosing on a massive scale?

They don’t begin when the drugs are prescribed. They begin when the prescriptions are cut off.

The United States, she explained, doesn’t have a Swiss-style policy of prescribing Oxycontin or Vicodin or other opiates to addicts. In fact, it has the precisely opposite policy. If I am an American who has developed an Oxycontin addiction, as...

She is allowed to prescribe to treat only my physical pai...

Remember the transformation Henry Smith Williams lived through. Before the ban, almost all opiate users would buy a mild form of the drug at their corner store for a small price. A few did become addicts, and that meant their lives were depleted, in the same way that an alcoholic’s life is depleted today.

Nobody should dismiss this effect: it is real human suffering.

Then the legal routes to the drug were cut off—and all the problems we associate with drug addiction began: criminality, prostitution, violence.

the prescription drug crisis doesn’t discredit legalization—it shows the need for it.

what does “legalization” mean when it comes to prescription drugs? Some people would argue that they should be openly sold, like alcohol—but I think Switzerland’s heroin experiment shows a better path forward: you could expand the criteria for prescription.