Comments
on the
"Framework for a National Drug Master Plan "
as tabled by the Drug Advisory Board, October 1997
12 December 1997
Fundraising number 09 801 180 000 8
Introduction
This document is intended to introduce Ravesafe to the policy makers and to describe its experiences with the application of harm reduction principles within the dance culture. Ravesafe believes that this information will be of benefit to anyone involved in making drug policy decisions.
Because of time constraints, an in depth analysis and commentary on the original document was not possible. This document will therefore be divided into the following categories:
1. Introduction to Ravesafe
Ravesafe is an organisation that grew out of the need for safer practices within the dance culture. Ravesafe is wholly staffed by volunteers from within the rave community who wish to see it develop in a positive direction.
The guiding principle of Ravesafe is one of Harm Reduction. All of Ravesafe's activities are conducted with this goal in mind. One of Ravesafe's primary functions is the research and distribution of accurate, reliable, honest, salient and relevant information about common street and dance drugs and their effects on the human body and mind, as well as associated issues such as drug abuse and addiction. Ravesafe believes that every individual has the right to this information.
In order to have maximum impact and credibility, Ravesafe strives to ensure that this information completely impartial and objective. Particular emphasis is placed on ensuring that the information is non-judgemental, non-proscriptive and independent of any specific moral viewpoint. Ravesafe respects the right of individuals to make informed decisions about their lives and health.
In addition to drug information, Ravesafe provides information about other topics it deems relevant to the dance culture, such as guidelines for safer sex, suggestions for safer dance venues, and updates about current drug laws. Research is conducted on an ongoing basis, with the aim of ensuring that the information provided remains up to date and relevant to the rave community. Sources include medical journals, other Harm Reduction organisations around the world, Internet web sites and survey data.
Other functions of Ravesafe include provision of staffed stalls at large rave parties, where printed literature; free water and condoms are made available. The Ravesafe stalls also provide a friendly and understanding source of assistance to people who would not be comfortable approaching the authorities for help or advice. Ravesafe volunteers are experienced people who understand the unique situations that arise at dance parties, and are experienced at helping people who are having drug induced 'bad trips'.
Ravesafe also gathers data about drug use patterns by conducting surveys at parties, allowing trends to be identified. Ravesafe uses this information when making decisions about areas of research, thereby ensuring that the information provided remains relevant.
The printed literature, which Ravesafe distributes at parties, is in the form of pamphlets or booklets. The information is presented in a form which is easily accessible to the target audience, often making use of mechanisms such as humour to effectively communicate the Ravesafe message. An example of the literature which Ravesafe distributes is the "Raver's Guide" booklet, which may be found in the appendix. To date Ravesafe has distributed approximately 8000 of these booklets, in addition to numerous other information pamphlets. The printing of these booklets was funded largely from internal donations. Ravesafe has not undertaken any large-scale fund-raising initiatives.
Ravesafe has its own web site (http://www.Ravesafe.org.za) where drug information is published. This site has been operational for almost three years and receives approximately 300 000 hits per month.
Ravesafe works with event organisers, venue managers and paramedic organisations to encourage safer conditions at dance parties.
Ravesafe has centres in Cape Town, Johannesburg, Durban and Port Elizabeth, and has been in operation since June 1995. Ravesafe is a registered fund raising organisation.
Contact information:
Postal address: P O Box 3260; Cape Town; 8000
Pager number: 082 304-6112
Facsimile number: (011) 648-1616
E-mail address: Ravesafe@rave.org.za
Internet home page: www.ravesafe.co.za
2. Harm Reduction
Harm Reduction takes a holistic and pragmatic approach to legal and illegal drug use. It represents a shift from the strategy of use prevention to a strategy of abuse prevention or Harm Reduction. The Harm Reduction approach accepts that drug use has persisted despite all efforts to prevent it and will continue to do so. Measures intended to prevent drug use have often had the unintended effect of increasing the harm associated with drug use, making prevention strategies which take use into account more appropriate. The Harm Reduction approach recognises attempts to minimise the potential hazards associated with drug use, rather than the use itself.
2.2. The Definition of Abuse
Having defined the problem as being drug abuse, rather than drug use, it follows that it is necessary to define drug abuse clearly. We suggest that a new definition should be sought for abuse, based along the lines of the potential harm that it results in.
Distinction can be made between recreational use, habitual use and addiction. The Harm Reduction approach recognises that recreational and habitual use, although they may be considered to lead to abuse, do not constitute a problem unless the use causes harm to self or others. It is thus the area of abuse prevention which should receive targeted attention.
2.3. Minimising Harm to the User
It is necessary to identify the sources of harm to the user, before steps can be taken to reduce this problem.
2.3.1. Misinformation
Accurate information about drugs and their effects allows the user to minimise harm to him or herself. Misinformation therefore increases the potential for harm by denying the user the ability to make accurate and informed decisions based on the risks associated with their drug use.
2.3.2. Criminalisation of the User
There is a limit to the constructive Harm Reduction measures that can be carried out within the confines of the law. The Harm Reduction approach therefore encourages the decriminalisation of the user in order to minimise the harm caused by law-enforcement agencies. Law enforcement agencies are, out of necessity, not focused on Harm Reduction, but rather on the enforcement of the law. The Harm Reduction strategy focused not on illegality, but rather on social consequences. Harm Reduction is therefore most appropriately dealt with by social institutions, such as the Department of Health and Welfare. Care agencies should be in constant contact with addicts and provide support and monitoring services.
2.3.3. Marginalisation of the user
The Harm Reduction approach aims to limit the risks and damage caused by drugs ensuring the integration of drug users in society. One result of criminalisation is the marginalisation of the user. Marginalised people are not likely to contribute positively to the community.
With a reduction in the illegal status of drug use, a better understanding of the extent and nature of drugs is obtainable. As a result, more appropriate strategies for intervention and care can be formulated.
Maintaining drug use within the boundaries of civil society prevents the lifestyle of drug users as being seen by young people as an expression of social or cultural rebellion.
2.4. Distinguishing between drugs
A requirement of the Harm Reduction approach is that a distinction be made between drugs based on the their potential for physical, psychological and sociological damage, rather than on their legal status.
2.5. The strategies for Harm Reduction
Comprehensive, accurate and unbiased information is the corner stone of the Harm Reduction strategy, as it empowers the individual to make informed decisions about drug use.
The state should encourage, permit and support the research into and dissemination of accurate information about drugs.
The testing of black-market drugs and the publication of the results can reduce the harm caused by impurities in such drugs.
Prevention, outpatient care and residential care should reduce the problems which are associated with marginalising users (e.g. poor medical condition). Strategies that are being pursued in this respect, for specifically targeted groups, include needle exchange programmes, substitution programmes and spaces for safe use
An integral part of Harm Reduction must be the decriminalisation of drug use and a new definition for illegal distribution.
The Harm Reduction approach should be customised/tailored to suit the social and economic context in which the drug use occurs in order to be most effective.
3. General Comments on the Drug Policy Framework
South Africa has entered a new phase of its history. Our society is transforming. What was once conventional wisdom in all areas of life is being re-evaluated. We are in a time of fluidity and change, as we define what we want our new society to be.
We have been given the opportunity to reshape our laws and government policies. Our goal is a just, equal, healthy, crime-free and prosperous country. We have a responsibility to ourselves, and to the future of our country, to choose our policies wisely and with our eye on the future, as the policies that we make will influence generations to come.
3.2. Defining the problem
Ravesafe shares the Drug Advisory board’s vision of a country completely free of harm caused by legal and illegal drugs. We realise that this may be an unattainable ideal, but it is worth aiming towards reducing this harm as much as possible.
We believe that the overall aims of this framework should be to
A distinction needs to be drawn between drug trafficking and drug use. The laws against drug use may produce more harm than the use of the drugs themselves, therefor an intrinsic part of Harm Reduction must be a consideration of the decriminalisation of the user.
We see alcohol, tobacco and legal and illegal drug use as primarily a public health concern. Organised crime such as drug trafficking falls outside our main area of interest.
Accordingly, the aims of enforcing drug laws, education towards "rejecting illegal drug use" and reducing levels of drug intake should be not be made primary goals in themselves, but should be considered only as possible means to attain the primary goal of public health.
The trend in the liberal parts of the world is towards a Harm Reduction drug policy. As other countries have made this decision based on solid reasons, we need to ask if it is perhaps appropriate for our circumstances. We find the Framework document to be lacking in evaluation of or even comments upon the suitability of drug prohibition versus Harm Reduction.
The framework makes unwarranted assumptions about the nature of the drug problem, such as assuming that prohibition and criminalisation of the user is the best approach. In failing to distinguish between drugs, the health risk posed by the drugs themselves and the negative impact of making drugs illegal, it is lacking in depth of its analysis of the problems and solutions. It does not present a coherent holistic approach.
The rigid dichotomy between "legal substances" and "illegal drugs" must be avoided. It should be noted that the "war on drugs" approach can be costly and ineffectual. Other approaches must be investigated. Pragmatic Harm Reduction approaches can be cheap and effective in reducing public health problems.
3.4. Specific comments on the Framework
The legal classification of drugs needs to be revisited. A consideration of the unique circumstances in SA is imperative, taking the effect of drug laws on traditional cultures into account. There is a need to do away with US centred conceptions and impositions.
We find the document, in not questioning the reasons behind the existing legality of substances, has unwittingly perpetuated the eurocentricity of the previous regime. For example, South Africans used dagga for thousands of years, before it was criminalised in 1928 by the colonial government to "protect Western civilisation".
3.4.2. Lack of differentiation between drugs.
It is vital to differentiate between substances when talking about drugs. Using the word drugs, especially as a general reference to illegal drugs, puts together stimulants, depressants, hallucinogens, empathogens and anaesthetics. Naturally occurring substances, that have been used around the world for tens of thousands of years, are grouped by this word with synthetic chemicals discovered in the last few decades.
No distinction is made between highly addictive substances and substances with no addictive potential. It groups substances that are toxic to the body with those that are not. The only thing that many of these substances have in common is that they are illegal.
We need a multi-dimensional approach to substances. The harm associated with each drug should be considered individually. Substances can be differentiated in terms of their physical and mental effects, their impact on the life and health of the individual, and the social well being of society.
3.4.3. Prohibition and the War on Drugs
Prohibition is not necessarily the best way to reduce the harm done by drugs. If public health and therefor Harm Reduction is a goal, then blanket prohibition needs to be re-evaluated. The experiences in the USA, where a costly "war on drugs" has failed to reduce the harm done by drugs, and the experience of Holland, where a pragmatic, Harm Reduction approach has been successful, need to be taken into account.
The Dutch model is worthy of much more detailed consideration. It should be noted that the framework does not give any references to articles on Harm Reduction, or any strategies from countries where Harm Reduction has been applied. A broad cross-section of international experiences must be examined to see which work and which do not.
3.4.4. Education
The framework recognises the need for education, but sees it only as a tool towards reducing drug use. The premise on which education should be based is the right to honest and accurate information.
Preventative education is necessary, but the recognition that use occurs must be a pre-requisite. The only way to gain the respect of the youth is to provide accurate, relevant information that recognises that use occurs and attempts to minimise the harm caused.
3.4.5. Legal and illegal drugs
Some illegal substances are highly dangerous or addictive, but others are not. Some legal substances are highly dangerous or addictive. There is a valid argument for the banning of alcohol, but its use is so firmly entrenched in our society that any attempt to make it illegal would fail. Dagga use is so firmly entrenched in our society that the attempt to make it illegal has failed. Illegal substances are not illegal because they are somehow so much worse than legal substances. In many cases the legal status of a drug is simply an accident of history.
We find it to be a major failing of the policy document that alcohol and tobacco are given only passing mention and that the major focus is on illegal drugs. Given the government’s limited resources in terms of money and police, we would think it natural for the national strategy to concentrate on those areas where the most gain can be accomplished using the least resources.
It is stated in section 2.1, "Illicit use of and traffic in drugs in particular, pose a serious threat to the health and welfare of the people of South Africa and adversely affect the economic, cultural and political foundations of society." It is possible that concern expressed about the dangers of using drugs is rooted more in the popular imagination and possibly the political need to be seen to be doing something about the "drug menace", than in any public health concern.
3.4.6. Use and Abuse
The framework’s glossary defines substance abuse as "the misuse and abuse of legal substances … as well as the use of illicit drugs". Section 5.4 states "The abuse of legal substances and the use of illegal drugs are discouraged". The thinking throughout the document seems to be that all use of illegal substances is abusive and unacceptable. We do not believe that patterns of abuse have anything to do with the legality of a substance.
Policy should not be based on the idea that any use of illegal drugs represents an unacceptable risk to society. A drug policy should be defined not by legal precedent, but social reality.
It is not appropriate to make the legality of a substance the primary criterion in establishing if the difference between use and abuse. This puts the responsibility for distinguishing between use and abuse on the law enforcement office, when it rightly rests on a social worker. It puts the policeman in the position of trying to improve community health by arresting users. It is not appropriate to define "abuse" in terms of the legality of a substance within a document that has in it’s scope the possible decriminalisation or legalisation of certain substances. The legality of a substance should follow from it’s potential for abuse, not vice versa.
In order to categorises substance use as "abusive" or not, we would consider the following factors:
We don’t believe that a document on public health should be talking about "use" and "abuse", but rather should be talking about the harm caused by substances, and the relative potential for harm between different substances.
4. Drug Education
The following comment pertains largely to educated, urban youth, between the ages of fourteen and twenty-four.
A comprehensive and all encompassing adjustment to the present system of drug education is tantamount to the future well-being of the community and supports the potential for reduced drug use, abuse, rehabilitation, social and family problems and crime.
Current attempts by authorities in drug education and law enforcement amongst our youth by State and community associated agencies, have shown little, if any success. There is a complete lack of correct and honest information. Police and education authorities are perceived to be enemies rather than benefactors in decreasing abuse.
There is a complete lack of tolerance, knowledge and understanding by educators, police and law enforcement authorities. As a result, those authorities are correctly perceived by drug users to be disassociated from community aid and Harm Reduction. The authorities are hence unable to help drug users, curb drug and substance abuse or combat relevant crime associated with drugs.
Because of the inherent desire for youth to explore alternative resources of pleasure, the concept of prohibition, combined with an equal degree of inaccessible information, that entices rather than discourages drug use, is short-sighted and has proven largely futile.
Based on the premise that youth have an inherent tendency to exploration and adventure, it is recommended that adequate consideration be given to the necessity for transparent, accurate information to be freely available.
Youth at any stage of learning capability have the right to attain accurate and truthful knowledge pertaining to any substance.
To deny youth correct and accurate information, may, as has been consistently proven in the past, cause a situation, whereby youth tend to distrust authority and rebel against its source. This makes policing difficult and has the potential to increase harm to uninformed potential drug users.
Secrecy and evasion of youth in disclosure of drug use, to parents, teachers and authorities, is resultant in greater State expenditure for policing, education and rehabilitation, as well as lack of success in prevention.
A greater risk exists, whereby drug trafficking is open to abuse, neglect and harm to individuals and families.
In the light of the abundant availability of information through the media, particularly that of the Internet, it is clearly apparent that the need for openness and transparency in future drug education is vital. The education system cannot afford to contradict itself, nor can it be seen to be withholding important educational information.
At present, a simply query on any Internet based search engine, pertaining to any substance, irrespective of it's illegality or addictive nature, produces factual information, ranging from the feeling of euphoria, the dangers associated with the substance, its chemical composition and even the method of manufacture.
Disregard of this example alone, would be shortsighted.
The Master Plan Curriculum should address a solution whereby youth should not only be given accurate information pertaining to all substances, irrespective of their legal status, effects and dangers, but should be educated to communicate this knowledge amongst their peers, parents, educators and authorities.
In order to achieve this end, careful consideration need be given to the education awareness of good health of body, mind and spirit and should be combined proactively into the curriculum in a comprehensive manner, in tandem with honest and accurate drug information.
Harm Reduction agencies may be consulted in regard to information dissemination, combined with sound formalised curriculum inclusion of general mental and physical health and Harm Reduction policy.
Based on the premise that youth are entitled to this information and will ultimately take individual educated decisions in response to sound and honest education, regarding quality lifestyle, social relationships and good health, the State has a responsibility to adopt an approach of free dissemination of this information.
Parents should be included in this programme, whereby transparency will give rise to better communication and understanding within family relationships and reduce the risks associated with secrecy and ignorance.
The government, particularly police and health authorities, should be actively engaged in support for this policy so that they can proactively win the confidence of the youth in reducing potential harm and simultaneously combat relevant crime, associated with dangerous drug trafficking and drug abuse.
5. Cost of Health Care Associated with Substance Abuse
Ravesafe aims to reduce the harm that drugs can cause, primarily through the gathering and dispersing of drug related information. Ravesafe has the advantage of high visibility within dance culture. We are largely accepted as an organization whose aim is to help those in need in a non-threatening manner.
Many people will choose to experiment with drugs, regardless of the associated risks. It is crucial that these people have access to information. By educating users with unbiased information, we enable them to make an informed decision about using drugs. In this way, harm is prevented and expensive secondary and tertiary health care costs are reduced.
Many drug users do not trust information that is blatantly against drugs. By explaining how a drug works, what it does, why people take it and the benefits and risks involved with drug use, a drug user will be more open to the information. The user is not being told what he or she should or should not be doing. Instead, the user is made to feel that he has a choice, but the choice has a cost, which must be taken into account. The risks are more easily accepted as a real threat, rather than propaganda.
Much of the danger associated with drugs results from impurities added by suppliers in order to make a greater profit. Proper drug testing facilities are required, in order to detect toxic substances which are often very much more harmful than the drug it is being sold as. A further advantage of testing facilities is the increased control over the substances circulating the market and an ability to monitor the drug use in South Africa to a much higher degree.
By accepting drug users as part of mainstream society, they are more easily able to seek medical assistance for their addiction. As a result, health of addicts can be improved and monitored, reducing the risk
6. Research and Information Systems
The role of Ravesafe in South African drug research will be discussed in addition to research questions.
6.1. Research Questions
In the document "A Framework for a National Drug Master Plan", by the South African Drug Advisory Board, the missing connection between researchers and policy-makers is recognised. This results in 'blind' research, which does not address relevant issues and thus gives little useful information to policy-makers. General aims are needed to direct research, so that those relevant questions relating to the use and abuse of various drugs are answered. It is of little use to try and prevent drug-related problems when basic questions about the use and abuse of drugs remain unanswered.
The following important questions concerning the use and abuse of various drugs remain unanswered:
Drugs are all different in their chemical structure, physiological and psychic effects, associated subcultures, criminal trade and supply elements, and socio-economic well being of users. It is thus important that a blanket approach to drug use is not used.
The people who use ecstasy, for example, are generally different to people who use mandrax. However, very different people may use a common drug. If a multidimensional approach is to be applied, then the differences between drugs, their users and their abusers needs to be recognised and researched. A different policy and research plan is consequently needed for each particular substance. What may be a good policy for one particular drug may be ineffectual for another. Policy-makers need to be properly informed to make realistic policies that are useful and cost effective.
Individuals and institutions are reluctant to get involved in drug research because of the legal status of certain chemical compounds. The decriminalisation of certain drugs will make it possible for more people to be involved in research, which will help to answer important questions more quickly and effectively. It is suggested that the legal statuses of different drugs be examined individually. This would unsure that the research needs of particular substances are identified and can then be addressed.
6.2. Ravesafe - Role player in research
Ravesafe has conducted anonymous surveys at several large raves to determine which drugs the people who go to these parties use. Anonymity is important due to the legal status of some of the substances surveyed and the reluctance of people to give information about their drug use. This reluctance is due to distrust caused by the criminal status of users. Decriminalisation will ease the fear associated with drug use, and will consequently make the data collection process easier because more people will be willing to be surveyed. The more people that are surveyed will result in a more clear and realistic picture of what drugs are being used, and by whom.
Ravesafe has an important role to play in drug research in South Africa. We are a community-based organisation resolving to reduce the harm associated with the use of drugs at raves in the major urban areas. The inclusion of Ravesafe as a role-player will ensure that a more holistic and multidimensional Drug Master Plan is produced. Our involvement in the Drug Master Plan is in accordance with its principles concerning the communities right to information, and the right of the community to receive quality care and service. In addition, our focus on the youth, which is one of the 'high-risk groups' mentioned in the document, makes our work important in community development and justifies Government funding. Moreover because of our experience at raves, Ravesafe can participate in the decision-making process in issues that relate directly to us.
7. Conclusion
Ravesafe volunteers have agreed that the content of the "Framework for a National Drug Master Plan" does address the issue of drug abuse to some extent. Drug addiction and related crime and other implications to society are most certainly problems in this country.
However, as South Africa enters a new era of enlightenment, we feel that, like the development of the new constitution, and as with other policies, such as the Environment Policy, the new Drug Policy should draw influence from the latest and most successful policies of other countries, such as The Netherlands. South Africa is unique in many aspects, especially the diversity of cultures, and this should be considered when adapting policies from other countries.
It is for this reason that we urge the Drug Advisory Board to give careful and complete consideration to the Harm Reduction approach, as proposed by Ravesafe.
We thank you for the opportunity to contribute to the development of a new drug policy for South Africa, and look forward to further participation in this process.
Appendices
Documentation from the Netherlands Ministry of Health, Welfare and Sport
Dr David Duncan, Thomas Nicholson, Patrick Clifford, Wesley Hawkins, Rick Petosa
Report of the Redfern Legal Centre Drug Law Reform Project