“What percentage of countries in the world have drug prohibition? Is it 100 percent, 75 percent, 50 percent or 25 percent?”

I recently asked many people I know to guess the answer to this question. Most people, especially avid readers and the political aware, guess 25 or 50 percent. More suspicious people sometimes guess 75 percent.

The correct answer is 100 percent, but nobody guesses that. Most readers of this paragraph will not have previously heard that every country in the world has drug prohibition. Unusual as it seems, almost nobody knows about the existence of world-wide drug prohibition.

In the last decade of the 20th century, many people throughout the world became aware of national drug prohibition. They came to understand that the narcotic or drug policies of the United Sates and some other countries are properly termed “drug prohibition.” But even as this understanding spread, the fact that drug prohibition covers the entire world remained a kind of “hidden-in-plain-view” secret. Now, in the 21st century, that too may be changing.

“Global drug prohibition” (the term was first used in 1990) has begun losing some of its invisibility. And as it becomes more visible, it loses some of its other powers. This article briefly describes the varieties and uses of world-wide drug prohibition in the 20th century, and explores its prospects in the 21st century.

Every country in the world has drug prohibition. Every country in the world criminalizes the production and sale of cannabis, cocaine and opiates. In addition, most countries criminalize the production and sale of some other psychoactive substances, and they make exceptions for limited medical purposes, especially morphine for pre- and post operative pain management. Most countries also criminalize simple possession of small amounts of some of the prohibited substances, usually an ounce (28 grams) or less.

In Crack in America: Demon Drugs and Social Justice, Craig Reinarman and I suggested that the varieties of drug prohibition can be seen as a long continuum. The continuum extends from the most criminalized and punitive forms of drug prohibition, such as the crack cocaine policy of the United States of America, to the most decriminalized and regulated forms of drug prohibition, such as the cannabis policy of the Netherlands. In this article I want to suggest that the most criminalized and punitive end of the drug prohibition continuum be called “criminalized drug prohibition” and the other end be termed “decriminalized drug prohibition.”

Criminalized drug prohibition uses criminal laws, police, and imprisonment to punish people who use specific psychoactive substances, even in minute quantities. In the U.S., drug laws prohibit even supervised medical use of cannabis by terminally ill cancer and AIDS patients. U.S. drug prohibition gives long, mandatory prison sentences for possession, use, and small-scale distribution of forbidden drugs. U.S. drug laws require mandatory prison sentences that increase for repeated drug offenses. Most U.S. drug laws explicitly remove sentencing discretion from judges, and do not allow for probation or parole. The United States now has nearly half a million men and women in prison for violating its drug laws. Most of these people are poor and from racial minorities. Most of them have been imprisoned just for possessing an illicit drug, or “intending” to sell small amounts of it. The mandatory federal penalty for possessing five grams of crack cocaine, for a first offense, is five years in prison, with no possibility of parole. Criminalized prohibition is the harshest form of drug prohibition.

The cannabis policy of the Netherlands is the best known example of the other end of the drug prohibition spectrum — of a decriminalized and regulated form of drug prohibition. Several United Nations drug treaties — especially the “Single Convention on Narcotics” of 1961 — require the government of the Netherlands to have specific laws prohibiting the production and sale of particular drugs. Therefore Dutch law explicitly prohibits growing or selling cannabis. This is still formally drug prohibition, and the Netherlands does prosecute larger growers, dealers and importers (or smugglers) as required by the U.N. treaties. But in the Netherlands national legislation and policy limits the prosecution of certain cafes, snack bars and pubs (called “coffee shops”) that are licensed to sell small quantities of cannabis for personal use. The coffee shops are permitted to operate as long as they are orderly and stay within well-defined limits that are monitored and enforced by the police. The coffee shops are not allow to advertise cannabis in any way, and they may sell only very small amounts to adults. Like other formally illegal activities, cannabis sales are not taxed. Without a change in the Single Convention and other international treaties, this is probably as far as any country can go within the current structures of world-wide drug prohibition.

The prohibition policies of all other western countries fall in between the heavily criminalized crack cocaine policies of the U.S. and the decriminalized and regulated cannabis prohibition of the Netherlands. No western country, nor most third world countries, have ever had forms of drug prohibition as criminalized and punitive as the United States. And in the last five to ten years, drug policy in Europe, Canada, Australia and elsewhere appears to be shifting even further away from the criminalized end of the prohibition continuum. But all these countries are required by international treaties to have — and still do have — real, formal, legal, national drug prohibition.

Drug prohibition is a world-wide system of state power. Global drug prohibition is a “social fact,” it is a “thing” (to use the terms of the great sociologist Emile Durkheim). Drug prohibition exists whether or not we recognize it, and it has real effects, real consequences.
For many decades, public officials, journalists and academics rarely identified any form of U.S. drug law as “prohibition.” Instead, public officials, journalists, and academics referred to a national and international “narcotics policy.” The international organization that created and still runs global drug prohibition is called the “International Narcotics Control Board.”
National drug prohibition began in the 1920s in the United States as a subset of national alcohol prohibition. The first U.S. drug prohibition enforcement agents were alcohol prohibition agents assigned to handle “narcotics.” American prohibitionists had always worked hard to convince other nations to adopt alcohol prohibition laws; during the 1920s, some savvy prohibitionists (notably an obscure U.S. Prohibition Commissioner named Harry A. Anslinger) realized that the success of U.S. alcohol prohibition depended on support from other countries. However, the campaign to spread American alcohol prohibition to other nations was an utter failure. In 1933, the U.S. repealed its own national alcohol prohibition laws — the 18th Amendment to the Constitution and the Volstead Act — and returned the question of alcohol policy to state and local governments to do with as they wished.
The story of drug prohibition took an entirely different course. Since the early 20th century, the U.S. had found European governments far more willing to consider anti-narcotics legislation than anti-alcohol laws. The founding Convenant of the League of Nations explicitly mentioned the control of “dangerous drugs” as one of the organization’s concerns. In 1930, the U.S. Congress separated drug prohibition from the increasingly disreputable alcohol prohibition and created a new federal drug prohibition agency: the Federal Bureau of Narcotics, headed by the committed alcohol prohibitionist Harry A. Anslinger. In the 1930s, the U.S. helped write and gain acceptance for two international anti-drug conventions or treaties aimed at “suppressing” narcotics and “dangerous drugs.” In 1948, the new United Nations made drug prohibition one of its priorities, and the U.N. Single Convention of 1961, and a series of subsequent anti-drug treaties, established the current system of global drug prohibition.
In the last eighty years, nearly every political persuasion and type of government has endorsed drug prohibition. Capitalist democracies took up drug prohibition, and so did authoritarian governments. German Nazis and Italian Fascists embraced drug prohibition, just as American politicians had. Various Soviet regimes enforced drug prohibition, as have its successors. In China, mandarins, militarists, capitalists, and communists all enforced drug prohibition regimes. Populist generals in Latin American and anti-colonialist intellectuals in Africa embraced drug prohibition. Over the course of the 20th century, drug prohibition was supported by liberal prime ministers, moderate monarchs, military strongmen, and Maoists. It was supported by prominent archbishops and radical priests, by nationalist heroes and imperialist puppets, by labor union leaders and sweat shop owners, by socialists, social workers, social scientists, and socialites — by all varieties of politicians, practicing all brands of politics, in all political systems.
Over the last eighty years, every government in the world eventually adopted drug prohibition. National drug prohibition was one of the most widely accepted, reputable, legitimate government policies of the entire 20th century. Why? Why should this be so?

There is no doubt that governments throughout the world have accepted drug prohibition because of enormous pressure from the United States government and a few powerful allies. But U.S. power alone cannot explain the global acceptance of drug prohibition. Governments of all types, all over the world, have also found drug prohibition useful for their own purposes. There are several reasons for this.

Drug prohibition has given all kinds of governments additional police and military powers that they have been freer to deploy than other kinds of police powers. Police and military narcotics units can legitimately go undercover anywhere and investigate anyone — anybody could be in the drug business. Most of the undercover police in the United States are in narcotics squads (no other crimes require so much undercover manpower). The CIA can only legally operate beyond U.S. borders, and the FBI only within the U.S., but the DEA (the Drug Enforcement Administration) is free to independently stage covert operations domestically and in other counties. Anti-drug units within city, county and state police departments have unparalleled freedom of movement. Police anti-drug units have regular contact with informers and spies; they can make secret recordings and photographs of anyone, and they have cash for buying drugs and information. In the United States, police anti-drug units are sometimes allowed to keep money, cars, houses and other property they seize. Top politicians and government officials in many countries may have believed deeply in the cause of drug prohibition. But other health-oriented causes could not have produced for them so much police, coast guard and military power.
Government officials throughout the world have used anti-drug squads to conduct surveillance operations and military raids that they would not otherwise have been able to justify. Many times these anti-drug forces have been deployed against targets other than drug dealers and users — as was the case with U.S. President Richard Nixon’s own special White House anti-drug team, led by former CIA agents, which later became famous as the Watergate burglars. Nixon was brought down by his squad’s mistakes. But over the years, government anti-drug forces all over the world have carried out countless successful non-drug operations.
Sometimes this use of “anti-drug” justifications for diverse military and police activities has been fairly obvious. The U.S. has long justified the military support provided to anti-democratic governments and factions it favored in Latin America by asserting that the military hardware was being given to “fight drugs.” Nearly everyone who writes seriously about U.S. foreign policy takes it for granted that the “anti-drug” justifications have been transparent but politically useful cover stories.

Drug prohibition has also been useful for governments and politicians of all types because it has required at least some anti-drug crusades and what is properly called drug demonization. Anti-drug crusades articulate a moral ideology that depicts “drugs” as extremely dangerous and destructive substances. Under drug prohibition, police, the media, and religious and health authorities tend to describe the risks and problems of drug use in extreme and exaggerated terms. “Drugs” are dangerous enemies. “Drugs” are called evil, vile, threatening, and powerfully addicting. Politicians and governments crusade against them, declare war on them, and blame them for many unhappy conditions and events. Anti-drug crusades and drug scares popularize images of “drugs” as highly contagious invading evils. Words like plague, epidemic, scourge, and pestilence are used to describe psychoactive substances, drug use, and moderate, recreational drug users.
Government officials, politicians, the media and other authorities have found that the enemies described in the language of drug demonization can be very useful. These enemies can be blamed by almost anyone at any time for long-standing problems, recent problems, and the worsening of almost anything. Theft, robbery, rape, malingering, fraud, corruption, physical violence against men, women or children, disrespect, juvenile delinquency, sloth, sloppiness, sexual promiscuity, low productivity, and all around irresponsibility — anything at all — can be and has been blamed on “drugs.” Almost any social problem is said to be made worse — often much worse — by “drugs.”
Consider the case of crack cocaine and the still active U.S. “War on Drugs.” In the 1980s, the Reagan and Bush administrations helped popularize the image of crack cocaine as “the most addicting drug known to man.” They then used that image to explain the deteriorating conditions in America’s impoverished city neighborhoods and schools, and they warned that crack addiction was rapidly spreading to the suburbs. In effect, Presidents Reagan and Bush said: “Our economic and social policies did not make those urban problems worse, addiction to crack cocaine did, and now crack is spreading to young people in the suburbs.” Democrats in Congress happily joined with Republicans and voted major increases in funding for police, prisons, and military to fight the War on Drugs.
Even if crack was as bad as Republicans, Democrats, and the media said, it probably still could not have caused all the enduring problems they blamed on it. But the truth about crack cocaine is even more startling than the myths. Crack cocaine, “the most addicting drug known to man,” turned out to be a drug that almost nobody liked to keep using. Many Americans tried crack, but very few people continued using it heavily for a long time. Mainly this is because most people cannot physically tolerate, much less enjoy, frequent encounters with crack’s brutally brief, extreme up and down effects. Crack use in America is now so low that the U.S. government does not even include crack use in its press releases about the prevalence of drug use. Nor has crack become popular anywhere in the world. Heavy, long-term crack smoking appeals only to a small number of deeply troubled people, most of whom are also impoverished. Because frequent bingeing on the drug is so unappealing, there was never any danger of an epidemic of crack addiction spreading across America, especially not to middle-class families in the suburbs.
Nonetheless, the contradictions between the drug war’s myths about crack and the reality of crack cocaine’s very limited appeal have not affected the credibility and legitimacy of the War on Drugs. Most politicians have not regretted spending hundreds of billions of dollars to save America’s children from addiction to crack cocaine and other drugs by running an expensive, punitive, utopian crusade to make America “drug free.” In the presidential election of 2000, both George W. Bush and Al Gore promised more funding and more prisons to make America “drug free.” Here in the 21st century, U.S. politicians continue to justify the enormous expenditures and imprisonment; they still insist that less criminalized and punitive drug policies will lead to a mass epidemic of drug addiction and substantially increase every social and economic problem. In this respect, drug war propaganda is like the propaganda from other wars: many otherwise reasonable people continue to believe in it even when the drug demonization and pro-drug war claims are patently false, or do not make logical sense.
Drug demonization also endures because it is useful to at least some important individuals and institutions. In a war on “drugs,” as in other wars, defining the enemy necessarily involves defining and teaching about morality, ethics, and the good things to be defended. This content varies somewhat by place and time, but in the U.S. anti-drug messages, especially those aimed at children and their parents, have recognizable themes. Currently these include messages about: individual responsibility for health and economic success, respect for police, the value of providing the police with information about drugs, resisting peer-group pressure, sexual abstinence outside of marriage for health reasons, the value of God or a higher power in recovering from drug abuse, parents knowing where their children are, sports and exercise as alternatives to drug use, why sports heroes should be drug tested, low grades as evidence of behavioral problems including drug use, and parents setting good examples for their children. Almost anyone can find some value that can be defended or taught while attacking “drugs.”
In the U.S., newspapers, magazines and other media have long found that supporting anti-drug campaigns is good for public relations; they have also found that anti-drug stories are good for their business — they attract customers. The media regularly editorially endorse government anti-drug campaigns and favorably cover anti-drug efforts as a “public service.” For doing so, they are praised by government officials and prominent organizations. There is no doubt that many U.S. publishers and editors have believed in the War on Drugs and in defending the criminalized, prison-centered tradition of U.S. drug policies. But only some of the causes that people in the media believe in can be shaped into compelling “read all about it” and “more details at eleven” type news stories. Only some causes can be turned into scary front page stories that are simultaneously good for public relations and very good for business.
For many decades, the top editors in the news media have clearly recognized, as an economic fact of their business, that a scary front page drug story will increase sales of magazines and newspapers — especially when it is about a potential drug epidemic threatening to destroy middle-class teenagers, families and neighborhoods. Editors know that a scary story about a new, tempting, addicting drug attracts more TV viewers and radio listeners than most other kinds of news stories, including non-scary drug stories. In short, whatever their personal values, publishers, editors and journalists give prominent space to frightening drug articles because they know the stories attract customers.
When one demon drug loses its ability to scare people, then politicians, the media, and drug enforcement agencies shift to another. At this moment (the spring and summer of 2001), they are focusing on prescription narcotics, methamphetamine, and ecstasy. Each demon drug comes with its own distinctive story about the ruin it causes including brain damage, psychological destruction, moral collapse, and sometimes death. The many anti-drug news stories and public education campaigns implicitly (and sometimes explicitly) suggest that nearly all social problems can be reduced at least somewhat by attacking “drugs.” And to a remarkable extent, pro-drug war politicians in the U.S. have an easier time getting elected, and expensive anti-drug programs pass without much debate. In the U.S., during economic good times and bad, funding grows for “anti-drug” courts, police, prisons, and military operations, while schools, housing, medical care, and other social services are under-funded or cut back.
Because U.S.-style criminalized prohibition is so extreme, it allows us to see the continuing political usefulness and viability of prohibitionist policies and anti-drug campaigns for governments in third world countries, and for many governments in Western democracies (including currently for Blair, Clinton and Gore “third way” politicians). Drug prohibition has powerful sources of support because of its usefulness to politicians, to the media, and to many other important institutions and constituencies. As a result, in the coming years, “drugs” will continue to be attacked with guns, soldiers, police, courts, and prisons in the U.S. and many other countries. “Drugs” will also be attacked with words, pictures, grave commentary, editorials, and uncountable anti-drug stories and ads on TV and radio, in newspapers and magazines, and in videos, movie trailers, and glossy booklets taught to children in school. All of this will further help justify drug prohibition, and help maintain public support, especially for the more criminalized and punitive varieties of drug prohibition.

In many countries, popular support for drug prohibition also has been rooted in the uniquely 20th-century faith in the capacity of the state to penetrate and benevolently control many aspects of daily life for the “common good.” The hope of global drug prohibition, of the people who created the system, was the hope of using the powers of a nearly omnipotent state to do good and suppress evil. This romantic vision itself was very much part of a distinctly 20th century utopian hope or dream. Unlike, say, the “founding fathers” who wrote the U.S. Constitution and Bill of Rights, and unlike many political movements in the 19th century, in the 20th century liberals, conservatives, fascists, communists, socialists, populists, right-wingers and left-wingers usually shared this romantic vision of the benevolent state. Twentieth-century political movements disagreed violently about how the state should be used. Drug prohibition was one of the few things they could all agree upon. Drug prohibition was part of what I think it is appropriate to call the 20th century’s “romance with the state.”
Because politicians in many countries, from one end of the political spectrum to the other, shared this positive, romantic view of the powerful, state, they could agree on drug prohibition as good non-partisan government policy. In the U.S. during the 1980s and the 1990s, Democrats feared and detested Presidents Reagan and Bush, and Republicans feared and detested President Clinton, but the parties united to fight the “War on Drugs.” They even competed to enact more punitive anti-drug laws, build more prisons, hire more drug police, expand anti-drug military forces, and fund many more government sponsored anti-drug messages and “drug-free” crusades. Opposing political parties around the world have fought about many things, but until recently they have often endorsed efforts to fight “drugs.”
Finally, drug prohibition has enjoyed widespread support and legitimacy because the United States has used the United Nations as the international agency to create, spread, and supervise world-wide prohibition. Other than the government of the U.S., the U.N. has done more to defend and extend drug prohibition than any other organization in the world. The U.N. currently identifies the goal of its anti-drug efforts as “a drug-free world.”

In the 20th century, drug prohibition spread from the U.S. to every country in the world. I have suggested a number of reasons this. First, drug prohibition has spread so successfully because of the enormous political influence and economic power of the United States. Second, many different kinds of governments throughout the world have supported drug prohibition because they have found that drug prohibition’s covert and open police and military powers can be used for many non-drug related activities. Third, drug prohibition has also gained substantial popular support in many countries because its drug demonization crusades and anti-drug ideology have been rhetorically, politically and even financially useful to many politicians, the media, schools, the police, the military, religious institutions, and some elements of the medical profession. Fourth, the spread of drug prohibition has been aided by the 20th century’s romantic or utopian ideologies about coercive state power, making the fight against “drugs” the one topic about which politicians of all stripes could usually agree. Finally, drug prohibition has gained great legitimacy throughout the world because it is seen as project of the United Nations.
All forms of drug prohibition, from the most criminalized to the most decriminalized, have probably involved at least some explicit drug demonizing. In general, drug demonization and drug prohibition reinforce each other. But it is important to recognize that drug demonization existed before global drug prohibition, and drug demonization will certainly continue long after world-wide drug prohibition has passed away.

New Study: Punishing Drug Users Does More Harm Than Good

Friday, October 19, 2001.

New research suggests that punishing drug users could increase the likelihood that they will continue using drugs. Howard B. Kaplan, a sociologist and director of the Laboratory for Social Deviance at Texas A&M University, said that punishment lowers self-esteem, thus increasing the likelihood of continued deviant behavior.

“When a person is punished by society for a deviant behavior such as drug abuse, he or she is stigmatized and alienated, and this increases the likelihood of that person becoming motivated to act against social conventions,” said Kaplan.

He explained that when people are subjected to “negative social sanctions,” such as arrests or expulsions from school, they feel isolated from conventional society. As a result, they become unable to escape their past.

The low self esteem caused by such stigmatization, Kaplan notes, increases a person’s likelihood of continued deviant behavior. As a result of experiencing self-rejection, a person loses motivation to follow the rules of the society that has condemned him or her. Not only is there this loss of motivation, but there is a gain of motivation to continue deviant behavior, he explains.

Kaplan, whose research is funded by the National Institute on Drug Abuse, says even as stigmatized people experience self-rejection, the need for them to feel good about themselves is always present and causes them to redefine their deviant behavior as acceptable, or even good, he explains. In what social scientists refer to as “secondary deviance,” the person continues to behave in the deviant manner as a means of defense against the societal reaction to the initial behavior, he adds.

Kaplan recommended that sanctions be created that include a component emphasizing societal acceptance. He explained that sanctions must be imposed in a context where giving up deviance, such as drug use, will be rewarded by conventional society

U.S. NARCOTICS CAMPAIGN COSTS MORE THAN GULF WAR

National Post (Canada)

19 Apr 2001

By Peter Morton

Effectiveness Unknown

WASHINGTON – Governments in the United States spend twice as much each year
on combating illegal drugs as the country spent on the 1991 Gulf War, a
White House-ordered report says.

But despite the US$30-billion annual cost to federal, state and municipal
governments, there is little research on whether the crackdown on illegal
drugs is effective, said the National Research Council, which did the study.

“It’s pretty distressing,” said Charles Manski, a professor of economics at
Northwestern University who was chairman of the study committee.

“Neither the necessary data systems nor the research infrastructure to
gauge the usefulness of drug-control enforcement policies exists,” he said
yesterday.

“It is unconscionable for this country to continue to carry out a public
policy of this magnitude and cost without any way of knowing whether, and
to what extent, it is having the desired result.”

The United States began its crackdown on drug trafficking and usage about
20 years ago, launching such programs as “zero tolerance” and DARE, an
acronym for Drug Abuse Resistance Education. It has also stepped up
eradication programs in such drug-producing countries as Colombia, where it
has pledged US$7.5-billion to try to wipe out coca production.

Federal government spending alone has increased tenfold since 1981 to
US$19-billion a year, resulting in 1.6 million people being arrested for
drug use in 1999, triple the number in 1980. Another 289,000 drug offenders
were sent to state prisons, 12 times the number in 1980.

But Mr. Manski said little effort is made to establish whether
incarcerating drug users and traffickers is an effective deterrent.
“Prevention is always better than incarceration, but no one knows whether
anyone was dissuaded from using drugs because of the current penalties,” he
said.

Only 15% of the US$780-million spent on researching drug policy goes toward
examining the effectiveness of imprisonment, says the report, which has yet
to be released.

Simple research such as comparing unemployment rates to the proliferation
of drug dealers in inner cities has yet to be done. “Do teenagers sell
drugs because they don’t have other jobs?” Mr. Manski said. “No one knows.”

The committee found existing drug-use monitoring programs somewhat useful,
but “strikingly inadequate to support the full range of policy decisions
that the nation must make.”

It found little work — and little government money — is being used to
understand drug use. As well, there is very little information on drug
pricing, although one of the goals of increased enforcement is to drive up
drug prices to make them too expensive.

There is even less known about some of the high-profile drug prevention
programs launched during the presidency of Ronald Reagan. No research has
been done, the report found, on whether “zero tolerance” drug enforcement
programs have had an effect on slowing drug shipments into the country.
What little research was done found the DARE program has had little impact
on illegal drug use, it added.

DEBATTEN om SFs forslag om at lade læger ordinere he-roin til de hårdest belastede narkomaner slingrer frem og tilbage.
Også modstanden i Folketinget er mildest talt diffus og bygger meget langt hen af vejen på højtflyvende moral-ske principper.

Det er let nok, at sidde i de plysbetrukne stole og være moralsk og bedrevidende, men det er blandt andet for-an Mariakirken i København det virkelige liv og den virkeli-ge død foregår. Det er en verden som de færreste har kendskab til og bør gøre sig kloge på.

Jeg tror det er vigtigt at lægge mærke til, at en markant støtte kommer fra Brugerforeningen af Aktive Nar-komaner. Altså fra folk der har et indgående kendskab til konsekvenserne af et misbrug.

Der er bare en ting galt med debatten. Og der er, at medens de kloge diskuterer og videnskabsmændene for-sker, så lever og navnlig dør mennesker i Danmark under forhold som ville være forbudt PA et svineslagteri.

DET ER RIGTIGT, at videnskaben ikke kender nok til virkningerne af heroin.
Men findes der overhove-det nogen der tør påstå, at det er bedre at sprøjte stoffet blandet op med vaskepulver, i en møgbeskidt port med en kanyle inficeret med hepati-tis, hiv og andre sygdom-me?
Så hvis valget står mellem to onder (og det gør det), så må det være et spørgsmål om at redde menneskeliv.
Så må den høje moral kom-me i anden række.
Jeg tror ikke, at én eneste tilhænger ville modsætte sig at fjerne den lægeordinerede heroin i samme øjeblik der dukker et videnskabeligt underbygget alternativ op der virker.
Men medens vi venter på miraklet, må og skal vi koncentrere os om i det mindste at holde de belastede i live og give dem så tålelige levevilkår som overhovedet muligt.

Hvordan kan et dansk heroinforsøg udformes og hvad vil man opnå ved det, spørger centerleder Jørgen Jepsen fra Center for Rusmiddelforskning bl.a. i denne opsummering af heroindebatten.

Efter publiceringen af WHO’s moderate vurdering af de schweiziske heroinforsøg er diskussionen om et eventuelt dansk

heroinforsøg blusset op igen. Desværre bærer mange af debatindlæggene og medieomtalerne præg af forvirrede og kategoriske opfattelser og udtalelser, f.eks. at det drejer sig om “fri heroin”, “heroin til unge” osv., osv.. Der er i dag behov for en afklaring af, hvad diskussionen bør dreje sig om, hvad meningen med et dansk heroinforsøg i det hele taget kunne være og hvordan det kunne tilrettelægges bedst muligt. Det følgende er et personligt forsøg på at udrede nogle af trådene og lægge op til en mere omtænksom afgørelse, uden på forhånd at tage absolut stilling den ene eller anden vej.

Resultater fra Schweiz

De schweiziske forsøg har vist, at det har været muligt at uddele heroin til hårdt ramte opiatmisbrugere uden problemer for omverdenen og med et etisk og praktisk forsvarligt arrangement. Ifølge forsøgsrapporterne har de deltagere, der er blevet i forsøget, opnået bedre fysisk og psykisk helbred, en bedre social situation (bolig- og arbejdsmæssigt og mht. økonomi), reduceret deres kriminalitet og nedsat forbruget af nogle illegale stoffer. De har også i betydelig grad afviklet deres kontakter med stofmiljøet – men ikke fået nye, positive omgangskredse uden for dette.

Disse resultater – der anerkendes af WHO og de fleste nuancerede eksperter – er baseret på de pågældendes egne oplysninger, men de er i et vist omfang – f.eks. mht. kriminalitet – støttet på uafhængige undersøgelser. Men der er en hel del problemer i den bredere tolkning og vurdering af disse resultater.

Allerførst: Den ønskede reduktion i dødeligheden blandt de stofmisbrugere, der deltog i forsøget, er ikke klart bevist, omend den er sandsynliggjort. Den er på ca. 2 pct. – hvad der stort set svarer til f.eks. den danske dødelighed blandt narkomaner, i og uden for behandling – 2.4 pct. (Sundhedsstyrelsen, 1999). En del af dem, der døde i forsøgsperioden, var i øvrigt forinden smittet med HIV. Men intet forsøg af den størrelsesorden, der har været tale om – og som kunne komme på tale i et dansk forsøg – kan med rimelig sikkerhed bevise en reduktion i dødeligheden. Dertil er tallene for små og den statistiske usikkerhed følgelig for høj.

Heri ligger også uundgåelige begrænsninger for et evt. dansk heroinforsøg.

Det må erkendes, at det ikke lykkedes i de schweiziske heroinforsøg at fastholde en del af de allerdårligste misbrugere. Dette gjaldt især dem, der havde det dårligst psykisk og nogle personer med et højt sideforbrug af kokain. Men andre af dem, der forlod forsøget, gik over til mere traditionelle former for behandling, heriblandt metadon(støttet) behandling eller stoffri do.. En del har formentlig ikke kunnet eller ikke villet deltage i den psykologiske behandling, der var en del af forsøget som en forudsætning for at være med overhovedet. (I øvrigt så det ud til, at de ‘dårlige’ misbrugere i de schweiziske forsøg ikke gennemsnitligt var så dårlige, som den dårligste gruppe af danske stofmisbrugere).

For det andet: Det er usikkert, i hvilket omfang de opnåede resultater skyldes heroinen som sådan eller den ledsagende psyko-sociale behandling. Det er i dag en udbredt opfattelse blandt eksperter, både de schweiziske og udenlandske i øvrigt (fremgik f.eks. af et møde i Bern i marts 1999), at det ikke med det anvendte design er muligt at påvise årsagen. Men det vil det næppe heller være med noget andet, anvendeligt design. Spørgsmålet er formentlig forkert stillet. Realiteten synes at være, at heroin fungerer som ‘lokkemad’, der får folk ind i og i nogen grad fastholder dem i behandlingen, således at de øvrige tiltag kan få en chance for at fungere. Disses nærmere karakter og omfang er imidlertid utilstrækkeligt belyst i de schweiziske rapporter.

Men principielt er det den gamle historie om ægget og hønen.

Forsøgsdesign og videnskabelighed

Problemet i den forbindelse handler afgørende om, hvilken form for videnskabelighed, man mener er nødvendig i forbindelse med sådanne forsøg. De schweiziske forsøg blev kritiseret for, at de ikke anvendte det traditionelle bio-medicinske design (der normalt anvendes ved afprøvning af lægemidler og andre stoffer) med en eksperimentalgruppe og en kontrolgruppe og med statistisk tilfældig (“randomiseret”) placering i den ene eller den anden gruppe. Gerne i øvrigt sådan, at man anvender to forskellige behandlingsmåder/stoffer – f.eks. metadon og heroin – samtidig med at en tredje gruppe får ‘placebo’, dvs. et uvirksomt stof (f.eks. kalktabletter), således at man kan kontrollere for effekten af dette, at personer blot får opmærksomhed i forbindelse med, at de deltager i et forsøg (noget der erfaringsmæssigt i sig selv kan give en vis positiv virkning – den såkaldte “Hawthorne-effekt”).

Et sådan design blev delvist anvendt i nogle mindre, isolerede dele af de schweiziske forsøg, især for at måle forskelle imellem heroin og morfin. Men denne del af forsøgene gik skævt – hvilket imidlertid ikke rokker ved de øvrige resultater.

Resten af de schweiziske resultater blev søgt belyst gennem et andet design, nemlig med en efterfølgende opstilling af sammenligningsgrupper. Her viste det sig, at de schweiziske resultater med heroin var bedre end i sammenligningsgrupperne med metadon. Disse sammenligninger kan konkret kritiseres på metodologisk grundlag, men at man anvender denne metode er ikke i sig selv kritisabelt – det er faktisk i denne forbindelse det eneste realistiske design, omend man kan lave sammenligninger fra starten af et evt. forsøg, i stedet for efterfølgende. Man kan så gøre mest muligt for at sikre sig, at grupperne ligner hinanden i de væsentlige henseender – men helt sammenlignelige som ved et egentligt experimentelt design kan de aldrig blive. Selv kritikere af de schweiziske forsøg – som f.eks. Dorrit Schmidt i en kritisk artikel i bladet “Stof” nr. 4, jan. 1998 – anvender denne sammenligningsmetode. D.S. sammenligner i stedet blot med en gruppe metadonbehandlede i Hamborg, der viste bedre eller lige så gode resultater som i det schweiziske forsøg. Men heller ikke her var der tale om helt sammenlignelige grupper. Og i øvrigt nåede gruppen, der analyserede forsøgene i Hamborg, frem til, at heroin ville være et ønskeligt supplement til metadon-behandlingen for visse grupper.

Det er også bemærkelsesværdigt, at man i Danmark har iværksat forsøg med substitutionsstofferne LAAM og Buprenorphin (i stedet for metadon), uden at man har fulgt det experimentelle design, de samme sundhedspersoner ellers kritiserer de schweiziske forsøg for at mangle.

En del af forskellen hænger sammen med, at heroinforsøgene går ud fra en intravenøs brug af heroinen. Da denne har en kort halveringstid, må der indsprøjtninger til flere gange om dagen for at holde abstinenserne væk. Kritikere finder dette meget betænkeligt. Men de glemmer, at man taler om personer, der – uden forsøget – alligevel ville sprøjte sig flere gange om dagen, blot under meget mere betænkelige omstændigheder: usterilt, på gaden, jagtet af politiet og med stof af ukendt styrke i sprøjten. Heroinforsøgene er i den forbindelse et klart skadesreducerende tiltag, uagtet om folk holder op eller ej, og rent faktisk viste det sig, at en del af forsøgsdeltagerne nedsatte antallet af daglige fremmøder til indsprøjtning fra tre til to eller en enkelt gang – i nogle tilfælde fik de så metadon med hjem for at kunne klare sig indtil de mødte næste gang. Igen et praktisk orienteret, skadesreducerende tiltag. Det ødelagde måske det strikte bio-medicinske experimental-design – men det virkede.

Heroinforsøg i Danmark

Der er herefter to grundlæggende spørgsmål i forbindelse med et evt. dansk heroin-forsøg: Hvilket forsøgsdesign skal der bruges – og hvad er det man vil opnå?

Det sidste spørgsmål er egentlig det væsentligste, men har været stort set forsømt i den danske debat. I stedet har denne været reduceret til et simplistisk ‘for eller imod’. Men for eller imod hvad?

Der henstår en række spørgsmål efter de schweiziske (og de nystartede hollandske) forsøg. WHO peger således på, at man ikke uden videre kan anvende de schweiziske resultater i andre lande og kulturelle sammenhænge, hvorfor man anbefaler forsøg i andre lande (!). Men man må også kunne stille andre, væsentlige og mere præcise spørgsmål end i de andre forsøg.

Opnåelse af målsætningen at reducere dødeligheden vil man ikke kunne bevise i evt. et dansk forsøg, selvom man lagde det op på et (højt) niveau på f.eks. 1000 deltagere. Men om man kunne “få fat på” en meget tung gruppe og fastholde denne med fornøden indsats var vel værd at undersøge. At forsøgene vil kunne udføres i praksis og være etisk forsvarlige anser selv WHO for at være godtgjort af de schweiziske forsøg.

Men hvem skal forsøget rettes imod? Hvis det kun er en lille gruppe, meget ringe stillede, bør der vies særlig opmærksomhed til rekruttering og fastholdelse – noget man ikke gjorde så meget ud af i Schweiz. Man fandt i øvrigt, at det blev i stigende grad vanskeligt at finde egnede forsøgsdeltagere, så vi behøver ikke at være bange for, at et dansk forsøg – med de fornødne krav om deltagelse i psyko-social behandling – skal virke som en magnet på danske stofmisbrugere og rykke dem væk fra den stoffri behandling.

Men skal man evt. gå ned i graderne og søge at inddrage misbrugere, som endnu ikke er nået alt for langt i deres karriere – og derfor kan inddrages i en behandling på et tidligere tidspunkt, hvis man kan få fat på dem? Dette er en politisk og etisk afgørelse, der ikke er noget videnskabeligt svar på på forhånd.

Mht. undersøgelsesdesign forekommer det, at et egentligt kontrolleret eksperiment hverken er etisk forsvarligt eller praktisk gennemførligt. Hvis nogle deltagere skal have metadon, hvor de i stedet havde håbet på heroin – som andre får – vil de stemme med fødderne, og dermed invalidere forsøget. Nogle kritikere hævder, at stofmisbrugerne ikke kan kende forskel på, om de får metadon eller heroin. Men de selv hævder, at der er klare forskelle, og de fleste foretrækker heroin. Men ikke alle. En nyligt rapporteret, canadisk undersøgelse viste, at 34% af en gruppe misbrugere, som fik tilbudt valget mellem heroin eller et andet substitutionsstof (for det meste metadon), valgte heroinen fra.

Dersom man vil forlange et klassisk forsøgsdesign som grundlag for et dansk forsøg, kan man lige så vel opgive på forhånd. Det vil simpelthen ikke virke, eventuelle slutninger fra det ville være begrænsede, og der vil være store etiske problemer i det. Men der er andre anvendelige designs. Problemet er, at debatten hidtil hovedsagelig har drejet sig om dette design, uanset om det er uegnet i andre sammenhænge end dem, hvortil de er udviklet (se dog kritik mv. i: Netværk for Samfundsvidenskabelig Sygdomsforskning, 1996). Det er altså en usikkerhed om den rette videnskabelige model. Et forsøg baseret på på forhånd opstillede, videst muligt sammenlignelige grupper vil være mere relevant. Men ingen af designene giver “videnskabelig vished”,

kun en vis sandsynlighedsgrad inden for hver deres forudsætninger. Den, der kræver vandtæt bevis, har på forhånd afskåret sig fra videre overvejelser og viderebragt en illusion om videnskabelighed.

Vil vi overveje et dansk heroinforsøg, må man derfor først afgøre de nævnte spørgsmål om målgruppe og design. Man kan ud fra en etisk betragtning sige, at man først bør udbygge systemet med en adækvat anvendelse af de behandlingsmuligheder, vi allerede kender. Samstemmende beretninger tyder på, at vi ikke for alvor i Danmark har afprøvet og gennemført en metadon-understøttet behandling med fuldt tilstrækkelige, supplerende tilbud om psykologisk og social støtte. Det burde man måske gøre, inden man går videre. Når denne behandling er tilstrækkeligt udbygget landet over, kan man så bedre forsvare evt. at gå videre med eventuel heroinunderstøttet behandling.

Men man kunne også – da det lige opstillede mål næppe vil blive realiseret inden for en overskuelig tid – lave et heroinforsøg baseret på sammenligningsmetoden.

Stofmisbrugernes valg

Man kunne vælge i ét område at tilbyde heroin med krav til deltagerne om, at de samtidig indgår i en intensiv psyko-social behandling – og til behandlere, administratorer og politikere om, at de stiller denne behandling til rådighed. Samtidig kunne man i et andet område tilbyde tilsvarende intensiv behandling, men knyttet til metadon som substitutionsstof i stedet for heroin. Og endelig kunne man finde et tredje område, med “gængs”, ringe eller ingen supplerende psykosocial behandling, men blot metadon som hovedstof. En sammenligning mellem sådanne tre modaliteter kunne give os en betydeligt større indsigt. De tre områder bør været klart geografisk adskilt, og kun misbrugere med bopæl inden for det pågældende område bør kunne deltage i det lokale forsøg. Det vil være et problem, at de kulturelle rammer og de ikke-institutionelle faktorer vil være forskellige, og dette bør man drage særlig omsorg for at belyse.

I virkeligheden er det egentlige spørgsmål, hvilken behandling den enkelte stofmisbruger vil foretrække, og her er der ikke på forhånd nogle sikre svar. Nogle vil vælge det ene, andre det andet. Og det ville vel være godt nok, hvis ikke vi kom med rigide krav om bevis for noget, der ikke kan bevises. Men hvad vil der være etisk og politisk galt med at lade misbrugerne selv vælge, hvilken behandlingsform de vil foretrække? Ligesom andre patienter i princippet har frit sygehusvalg og kan være medbestemmende om valget af behandlingsform.

Når mange er modstandere af heroinforsøg, er det tildels udtryk for en puritanistisk holdning, at folk ikke skal have, hvad de ønsker. Man vil f.eks. ikke give gratis alkohol til alkoholikere. Rent bortset fra, at vi tillader alkoholikere at bruge bistandshjælpen til alkohol, er der den væsentlige forskel, at alkohol er et yderst giftigt stof, medens man kan indtage heroin i årevis og føre en rimeligt normal tilværelse, hvis man ikke er udsat for de risici og den forfølgelse fra omgivelsernes side, der følger af stoffets illegale status og kontrolsystemet.

Repræsentanter for den stoffri behandling er stærke modstandere af et heroin-forsøg, fordi de mener, dette vil afholde misbrugere fra at søge stoffri behandling. De skal “finde deres bund”, som man så smukt kalder det – “helt ned med nakken”, siger andre mere bramfrit. Men i betragtning af, at kun 34-36 pct. af personer, der har påbegyndt en stoffri behandling, gennemfører denne (se Mads Uffe Pedersen, CRF, 1998 og 1999), og at kun 40-60 af disse er stoffri et år efter udskrivningen – altså en total successrate på max 20 pct. (mindre for de helt unge og for dem over 40), kan man ikke påstå, at den stoffri behandling er svaret for alle. De økonomiske og ideologiske interesser, der præger dette område, har imidlertid ført til voldsomme udfald mod anderledes tænkende.

Økonomi og politik

Et sidste synspunkt går ud på, at et heroinforsøg vil være dyrt og trække ressourcer fra de øvrige, hårdt tiltrængte indsatser på stofmisbrugsområdet. Det er rigtigt, at det vil koste udlæg af en ikke ubetydelig størrelsesorden og stille en række prioriteringskrav til systemerne. Derfor bør Folketinget ikke iværksætte heroinforsøg, hvis man ikke er indstillet på at bevilge de fornødne, særskilte midler hertil. Noget andet er, at man kunne overveje at lade forsøgsdeltagerne betale for den heroin, de får i forsøget. Hvorfor ikke – når alkoholikerne kan betale for deres alkohol? Gør man det – det drejer sig om ca. 250 kr. om dagen, siger man i Schweiz – vil der for samfundet være en nettobesparelse som følge af mindre kriminalitet fra denne gruppe med færre belastninger af rets- og fængselssystemet. Men man får ikke en massiv afskaffelse af kriminalitet på denne måde. Penge er trods alt et af de allermest afhængighedsskabende stoffer.

Problemet med at inddrage denne besparelse er i virkeligheden rent bevillingsteknisk – at overføre penge fra Justitsministeriets område til social- og sundhedssektoren. Og dette er måske et af de politisk vanskeligste – men en besparelse er jo en besparelse, uanset hvor den posteres på finansloven. Hovedopgaven er altså at bevilge de penge til forsøget, som skal til, uden smålig nedskæring på området i øvrigt. Til gengæld kan man så mere rationelt undersøge, hvad man egentlig får for de penge, man investerer på stofmisbrugsområdet. Udredningen heraf er først begyndt for nylig og politikerne står famlende over for opgaven: At blive mere rationelle.

Den hidtidige form for heroindiskussion har desværre gjort det vanskeligt at træffe sådanne rationelle valg. Politikerne må derfor overveje mål og midler mere grundigt, inden de træffer en afgørelse. Der er ingen lette svar, hverken den ene eller den anden vej.

F:

Bern: International Symposium: Heroin assised treatment for dependent drug users: State of the art and new research perspectives, (Bern, 10-12. March, 1999)

Netværk for Samfundsvidenskabelig Sygdomsforskning (1996): Kontrollerede Kliniske Undersøgelser – forsvar, kritik og refleksioner (Dorte Gannik og Laila Launsøe, red.)

Pedersen, Mads Uffe (1999): Stofmisbrugere efter behandling. Rapport nr. 5, CRF, Aarhus (1998): Stofmisbrugere i døgnbehandling. Delrapport nr. 3, CRF, Aarhus

Schmidt, Dorrit (1999): Heroinforsøgene i Schweiz – alternativ til hvad? Narkotikarådets blad “Stof” nr.4, jan. s.4-10.

Sundhedsstyrelsen (1999): Nye tal fra Sundhedsstyrelsen, 3/3: Dødelighed og dødsårsager blandt stofmisbrugere indskrevet i behandling i Danmark. Skøn over antal dødsfald blandt stofmisbrugere og over antal stofmisbrugere i Danmark

Harry J. AnslingerDirector of the Federal Bureau of Narcotics

1930 – 1967General References to Anslinger

The History of the Marijuana Laws in the United States by Charles Whitebread – A Speech to the California Judges Association 1995 annual conference An excellent, and funny history of how we got our current drug laws.

The Forbidden Fruit and the Tree of Knowledge: An Inquiry into the Legal History of American Marijuana Prohibition by Professor Richard J. Bonnie & Professor Charles H. Whitebread, II — The first major study ever done of the legal history of the marihuana laws.

The History of the Marihuana Tax Act of 1937 by David F. Musto, MD

From the National Commission on Marihuana and Drug Abuse, 1972

· History of Marihuana Legislation
From The Marihuana Tax Act Page
· Conference on Cannabis Sativa L. January 14, 1937 — Room 81 Treasury Building, 10:30 AM
· Statement of H. J. Anslinger, Commissioner of Narcotics, Bureau of Narcotics, Department of the Treasury.
· Additional statement of H. J. Anslinger (includes “Marihuana as a Developer of Criminals”, by Eugene Stanley, district attorney, parish of Orleans, New Orleans, La.)
· Statement of H. J. Anslinger, Commissioner of Narcotics, Bureau of Narcotics of the Treasury Department
· Marihuana Conference of 1938
Correspondence about the legal status of hemp 1930 – 1938
· Letter from Harry Anslinger – September 29, 1936
· Letter from Elizabeth Bass – September 30, 1936
· Letter from Elizabeth Bass – October 6, 1936
· Letter from Harry Anslinger – November 2, 1936
· Letter from Elizabeth Bass – November 3, 1936
· Letter from Elizabeth Bass – November 5, 1936
· Letter from Elizabeth Bass – November 6, 1936
· Report of the Marihuana Investigation – Summer, 1937
· Letter from H. W. Bellrose, October 12, 1937
· Letter from H. W. Bellrose – October 12, 1937
· Letter from H. W. Bellrose – October 14, 1937
· Letter from Brien McMahon – October 26, 1937
· Letter from Will S. Wood – November 6, 1937
· Letter from Frank Ridgway – January 21, 1938
· Letter from Elizabeth Bass – March 5, 1938
· Letter from Elizabeth Bass – March 5, 1938
· Letter from Elizabeth Bass – March 10, 1938
· Report of Survey Commercialized Hemp Crop (1934-35 Crop) in the State of Minnesota, by H.T. Nugent, Federal Bureau of Narcotics, Field Supervisor, October 22, 1938
Hemp Around Their Necks — Chapter 3 of Harry Anslinger’s 1961 book “The Murderers”. – Among other things he tells how the La Guardia Committee Report gave children a signal to light up as many reefers as they want.

STATEMENT OF H. J. ANSLINGER,

COMMISSIONER OF NARCOTICS, BUREAU OF NARCOTICS OF THE TREASURY DEPARTMENT

MR. ANSLINGER: Mr. Chairman and distinguished members of the committee, we are having a great deal of difficulty. Last year there were 338 seizures of marihuana in some 31 states involving several hundred tons of growing plants, bulk marihuana, and cigarettes.
The states are asking for our help. We are trying to give it to them, but we are rather limited in our ability at the present time.
I have made a statement before the Ways and Means Committee, which is in the record, but since that time I want to point out to the committee an incident which occurred on June 28, at Abingdon, Va. There was a marihuana farm at that point, and the man who was growing those plants had been connected with a family that was engaged in smuggling narcotic drugs into Atlanta penitentiary some years ago. When we heard Dewey Doss was engaged in the production of marihuana, we went after him, and we got the state officers to make a case against him. We could not do anything about that, although the information came to us first.
A month or so ago, down in Texas, a man was arrested on a Missouri Pacific train going north with a quantity of cannabis, and another man was arrested in the vicinity of this place, called Raymondsville, Texas. They had both stripped the plants on a hemp farm.
SENATOR BROWN: You mean they had taken the leaves off?
MR. ANSLINGER: They had taken the leaves off and the flowering tops.
I received this letter from an attorney at Houston, Texas, just the other day. This case involves a murder in which he alleges that his client, a boy 19 years old, had been addicted to the use of marihuana.
SENATOR BROWN: Shall we read this into the record?
MR. ANSLINGER: Yes, sir; I shall be very glad if you will.
(The letter is as follows:)
Houston, Tex., July 7, 1937
H. J. Anslinger
United States Commissioner of Narcotics
Washington, DC
Dear sir:
Your article on Marihuana appearing in the July issue of the American is very useful as well as interesting.
this subject strikes close to home because of a client II have who not so long ago murdered in a brutal way a man who had befriended him in giving him a ride. This client is a boy 20 years of age and he explained to me he has been smoking marihuana for several years. I would like to have about 1 copies of your article and will gladly pay any necessary charges. I would appreciate an early reply.
Yours Truly,
Sidney Benbow
MR. ANSLINGER: I have another letter from the prosecutor at a place in New Jersey.
It is as follows:
The Interstate Commission on Crime
March 18, 1937
Charles Schwarz, Washington, DC
My Dear Mr. Schwarz:
That I fully appreciate the need for action, you may judge from the fact that last January I tried a murder case for several days, of a particularly brutal character in which one colored young man killed another, literally smashing his face and head to a pulp, as the enclosed photograph demonstrates. One of the defenses was that the defendant’s intellect was so prostrated from his smoking marihuana cigarettes that he did not know what he was doing. The defendant was found guilty and sentenced to a long term of years. I am convinced that marihuana had been indulged in, that the smoking had occurred, and the brutality of the murder was accounted for by the narcotic, though the defendant’s intellect had not been totally prostrate, so the verdict was legally correct. It seems to me that this instance might be of value to you in your campaign.
Sincerely yours,
Richard Hartshorne
Mr. Hartshorne is a member of the Interstate Commission on Crime. We have many cases of this kind.
SENATOR BROWN: It affects them that way?
MR. ANSLINGER: Yes.
SENATOR DAVIS: (viewing a photograph presented by Mr. Anslinger) Was there in this case a blood or skin disease caused by marihuana?
MR. ANSLINGER: No; this is a photograph of the murdered man, Senator. It shows the fury of the murderer.
SENATOR BROWN: That is terrible.
MR. ANSLINGER: That is one of the worst cases that has come to my attention, and it is to show you its relation to crime that I am putting those two letters in the record.
SENATOR BROWN: The first letter is also very interesting.
MR. ANSLINGER: This first letter was from an attorney at Houston. In June of this year, at Geneva, an international committee of experts in going over the reports received from all over the world said that the reports thus far indicate that the medical value of cannabis derivatives is very doubtful. There is another report here from Dr. Paul Nicholas Leech.
SENATOR BROWN: That is, to make perfectly clear, its medical value is not very great, and there are many other drugs that may be used in place of it that are fully as good if not better?
MR. ANSLINGER: Yes, sir; it is not indispensable.
SENATOR BROWN: I think some medical men say that if we had no such drug at all the medical profession would not be very greatly handicapped. That is, medical science would not be very greatly handicapped.
MR. ANSLINGER: I think they are pretty generally in agreement that its use could be abandoned without any suffering.
I have a few cases here that I would like to tell the committee about. In Alamosa, Colorado, they seem to be having a lot of difficulty. The citizens petitioned Congress for help, in addition to the help that is given them under state law. In Kansas and New Mexico also we have had a great deal of trouble.
Here is a typical illustration: A 15-year-old boy, found mentally deranged from smoking marihuana cigarettes, furnished enough information to police officers to lead to the seizure of 15 pounds of marihuana. That was seized in a garage in an Ohio town. These boys had been getting marihuana at a playground, and the supervisors there had been peddling it to children, but they got rather alarmed when they saw these boys were developing the habit, and particularly when this boy began to go insane.
In Florida some years ago we had the case of a 20-year-old boy who killed his brothers, a sister, and his parents while under the influence of marihuana.
Recently, in Ohio, there was a gang of very young men, all under 20 years of age, every one of whom had confessed that they had committed some 38 holdups while under the influence of the drug.
In another place in Ohio, a young man shot the hotel clerk while trying to hold him up. His defense was that he was under the influence of marihuana.
SENATOR BROWN: When a person smokes the cigarette, how long does the influence of the drug continue?
MR. ANSLINGER: From reports coming to me, I think it might last as long as 48 hours before the effects of the drug fully wear off.
SENATOR BROWN: I do not know whether it was your article I read, or an article from some other source, but I understand that experiments have been conducted, in which the persons smoking the marihuana have been kept under control after taking the drug. Do you know whether or not that demonstrated how long the effect would be felt?
MR. ANLSINGER: As I remember it, the effects in those cases were something like 48 hours, before they fully returned to their normal senses.
Here is a case in Baltimore, where a young man committed rape while under the influence of marihuana. He was hanged for it. Last fall, about September, we uncovered a field of several acres, growing right outside the city limits of Baltimore. Those men were selling it to New York, sending it all over the country, at $20 a pound.
SENATOR DAVIS: And how many pounds to the acre?
MR. ANSLINGER: That would depend, Senator. If they just took the flowering tops the yield would not be so big, but some of them strip off the leaves and the flowering tops and grind them up.
SENATOR DAVIS: Do the leaves have the same effect as the flowering tops?
MR. ANSLINGER: Yes, sir; one of the Treasury’s chemists is here who can verify that, sir. It has been proved by experts in other countries who have analyzed the leaves. They find that the resin is also present in the leaf. Our experiments have not shown the presence of any drug in the mature stalks, though. A one time we thought that the dangerous principle was only in the flowering top, but that is not true. What led us to the study as to whether there was resin in the leaves was the fact that we had seen so much of this stuff rolled up. In some cases only the leaves had been crushed, and they seemed to be giving the effect. In New Mexico, officers sent us about 4 or 5 pounds of nothing but leaves, and some of that particular shipment had been the cause of the killing of a police officer, and also the killing of a man within the ring. Every day we have such seizures, reports.
SENATOR BROWN: Is the cigarette that is made form the flowering top more potent than the one made from the leaves?
MR. ANSLINGER: Yes, sir, it would be, because the tops have the resin concentrated.
SENATOR BROWN: Do I understand that the seed is ground up, too. and used to any extent?
MR. ANSLINGER: Well, we have heard of them smoking the seed..
SENATOR BROWN: Does it produce the same effect?
MR. ANSLINGER: I am not qualified to say. We have not made any experiments as to that, but we do know that the seed has been smoked. I think that the proposition of the seed people sterilizing the seed by heat and moisture will certainly do a lot to kill this traffic. I think that that one thing might cut this traffic in half, because much of the trouble we encounter is due to the trafficker going to a feed store and buying the birdseed and planting cannabis, and all due to the birdseed being scattered during the winter. Hempseed is thrown out in the garden or in the vacant lot. The following year you have a growth of cannabis. That is what happened in Baltimore, and particularly in Philadelphia. I know of a case there where the State officers got over 200,000 pounds of growing plants, as the result of dissemination by birdseeds. A lot of that growth was being used illicitly. The traffickers knew where to get it. The plant reseeded itself.
The action that will be taken under this bill by the birdseed people in sterilizing the seed should have a remarkable effect in killing the traffic.
SENATOR BROWN: The sterilized seed will not reproduce?
MR. ANSLINGER: It will re-seed itself.
SENATOR BROWN: I am referring to the birdseed. What are they going to do to the birdseed?
MR.ANSLINGER: They are going to kill the germinating power.
SENATOR BROWN: When the seed is then thrown out, what will happen?
MR. ANSLINGER: Nothing will happen.
SENATOR DAVIS: Will it be of any use as a birdseed?
MR. ANSLINGER: Oh, yes. It will still have food properties.
SENATOR BROWN: The birds will sing just the same?
MR. ANSLINGER: There is some question about that. Sterilization is a voluntary act by the birdseed people.
SENATOR BROWN: That is not in this bill?
MR. ANSLINGER: It is not in there. They voluntarily agreed to do that under this act.
MR. HESTER: Yes, it is in the bill.
SENATOR BROWN: I wan to bring out one fact that you have not touched upon yet. As I understand it marihuana is not a habit-producing drug, at least to the same extent that opium is, for instance. It is somewhat easier to break the habit in the case of marihuana than it is in the case of opium smoking?
MR. ANSLINGER: Yes, you have stated that correctly, Senator. It is a very difficult matter to break the opium habit. However, this habit can be broken. There is some evidence that it is habit-forming. The experts have not gone very far on that.
SENATOR BROWN: There is the impression that it is stimulating to a certain extent? It is used by criminals when they want too go out and perform some deed that they would not commit in their ordinary frame of mind?
MR. ANSLINGER: That was demonstrated by these seven boys, who said they did not know what they were doing after they smoked marihuana. They conceived the series of crimes while in a state of marihuana intoxication.
SENATOR DAVIS: How many cigarettes would you have to smoke before you got this vicious mental attitude toward your neighbor?
MR. ANSLINGER: I believe in some cases on cigarette might develop a homicidal mania, probably to kill his brother. It depends on the physical characteristics of the individual. Every individual reacts differently to the drug. It stimulates some and others it depresses. It is impossible to say just what the action of the drug will be on a given individual, of the amount. Probably some people could smoke five before it would take that effect, but all the experts agree that the continued use leads to insanity. There are many cases of insanity.
SENATOR HERRING: Is it every type off hemp that contains this drug, or is it just some particular type?
MR. ANSLIINGER: Yes, sir; there are different forms, but only one species.
SENATOR BROWN: This thought has impressed me: I read with care the supplemental statement which you placed in the record before the Ways and Means Committee, in which you brought out quite clearly that the use, which will be “illicit” if we may describe it that way, in the event this bill becomes a law, has been known to the peoples of Europe and Mexico and the United States for centuries.
MR. ANSLINGER: That is right.
SENATOR BROWN: Do you think that the recent great increase in the use of it that has taken place in the United States is probably due to the heavy hand of the law, in its effect upon the use of other drugs, and that persons who desire a stimulant are turning to this because of the enforcement of the Harrison Narcotics Act and the State laws?
MR. ANSLINGER: We do not know of any cases where the opium user has transferred to marihuana. there is an entirely new class of people using marihuana. The opium user is around 35 to 40 years old. These users are 20 years old, and know nothing of heroin or morphine.
SENATOR BROWN: What has happened to the new dissemination of it? We did not hear anything of it until the last year or so.
MR. ANSLINGER: I do not think that the way against opium has very much bearing upon the situation. That same question has been discussed in other countries; in Egypt particularly, where a great deal of hasheesh is used, they tried to show that the marihuana user went to heroin, and when heroin got short he jumped back to hasheesh, but that is not true. This is an entirely different class.
I do not know just why the abuse of marihuana has spread like wildfire in the last 4 or 5 years.
SENATOR BROWN: Could you give us any estimate of the number of persons that are engaged in this illicit traffic? Please state that as nearly as you can.
MR. ANSLINGER: I can only give you what our records show, Senator. There were about 400 arrests throughout the States in the year.
SENATOR BROWN: That is for violations of State law?
MR. ANSLINGER: For violations of State law. That would not include the arrests in California, where I understand they have several hundred a year; but the figure I am giving you of 400 arrests would be about the average number that are being picked up now, under just a noncoordinated enforcement policy , every State doing its own work, and bringing us in occasionally. When they run into “dope” work, and bringing it to us occasionally. When they run into “dope” we down and say, “It is marihuana and you take the case.”
The state of Ohio recently seized what we call a “plant”. It was a seizure of marihuana. These people had a mailing list of 6,000 customers scattered throughout the States.
SENATOR DAVIS: How were they dispensing it?
MR. ANSLINGER: They were selling it in lots from a pound down, just selling it by mail.
SENATOR BROWN: There was nothing in the law to prevent a man in Columbus, Ohio, using the mail in selling it to a person in Louisville, Kentucky?
MR. ANSLINGER: No, they are doing it every day.
SENATOR DAVIS: Is there anything in the present bill to prevent them using the mail?
MR. ANSLINGER: Under this bill it would have to be tax-paid, and all of that would be illicit, sir.
SENATOR HERRING: You say there are several hundred arrests in California alone, and about that same number throughout the rest of the United States?
MR. ANSLNGER: There are about the same number in the rest of the United States.
SENATOR HERRING: How do you account for that? Is it because of their state law?
MR. ANSLINGER: It is because they have a state enforcement agency there. They vigorously enforce the law. I might say that Pennsylvania is doing important work also.
SENATOR HERRING: It might be just as prevalent in other states; but for the fact that we do not have the law enforced as efficiently?
MR. ANSLINGER: I would not say it is as prevalent, but certainly the use has increased in the last few years. In Pennsylvania the enforcement people are very active today, particularly in Pittsburgh and Philadelphia, and the are constantly calling upon us.
SENATOR DAVIS: Are they endorsing the Harrison Narcotics Act in manner satisfactory to you?
MR. ANSLINGER: Yes, sir; that is satisfactory, but they are asking us for help every now and then when they run into a rather large situation.
SENATOR BROWN: I think that while you are on that point you had better make clear the need for Federal legislation. You say the States have asked you to do that. I presume it is because of the freedom of interstate traffic that the States require this legislation?
MR. ANSLINGER: We have had requests from states to step in because they claimed it was not growing in that state, but that it was coming in from another state.
SENATOR BROWN: And they could not touch that?
MR. ANSLINGER: And they could not touch it and we could not touch it.
There is need for coordinated effort. We are required to report ot the League of Nations, under a treaty arrangement, all of the seizures of marihuana made throughout the United States. It is rather difficult to get, I would say, half of them. One particular reason and one primary reason for this is — usually these complaints come to us first — that there is “dope” being used in a certain place, and that there is a supply of it on a certain street. Our men go and investigate it, and they find that it is marihuana. Well, we have to call in the state officers and there is a lot of lost effort. Very often by the time the state officer comes the case is gone. I would say in most of these cases we get the information first and turn it over to the state officer. Now, we want to coordinate all of that work throughout the states. By state and Federal cooperation we can make a good dent in this traffic.
For instance, all states had narcotics laws before the enactment of the Harrison Narcotics Act, but until the Federal Government stepped in no substantial progress was made.
SENATOR BROWN: What have you to say about the extent of the production of hemp? May it be produced in practically any state in the Union?
MR. ANSLINGER: Yes, sir, it can be produced.
SENATOR BROWN: There is climatically no reason why it could not be produced everywhere in the United States?
MR. ANSLINGER: No.
SENATOR BROWN: Growing as a weed could take place anywhere?
MR. ANSLINGER: Anywhere; yes, sir. That has been demonstrated.
SENATOR DAVIS: A moment ago I asked you what was the yield per acre, and you then told me so much of the flower and so much of the leaves. What is the combined yield per acre of both the flower and the leaves?
MR. ANSLINGER: I would not be able to say that, sir. That would be impossible.
SENATOR DAVIS: Is there any way of getting that information?
MR. ANSLINGER: We are growing an experimental crop over here on the Agricultural Farm. We can find out that way, or we can take a plant and strip the leaves and the flowers, and find out how many plants there are in an acre and multiply it. I think that would give a reasonably accurate estimate. I think I can find that out.
SENATOR DAVIS: I wish you would.
SENATOR BROWN: Now, Commissioner Anslinger, I do not know whether you are the best man to answer this question, or Mr. Hester. What dangers, if any, does this bill have for the persons engaged in the legitimate uses of the hemp plant?
MR. ANSLINGER: I would say that they are not only amply protected under this act, but they can go ahead and raise hemp just as they have always done it.
SENATOR BROWN: It has been represented to me that the farmer might hesitate to grow hemp when he is not only subjected to a $5 tax but also to the supervision by the Government, or what you might call the “nosing” of the Government into his business. What have you to say to this proposition?
MR. ANSLINGER: Well, I would say the answer to that is the fact that they are already controlled under state legislation.
SENATOR BROWN: In practically every state in the Union.
MR. ANSLINGER: Not all the states, but certainly in a lot hemp-growing states they are controlled. In most of the states cultivation is prohibited but in some states they are regulated by license.
SENATOR BROWN: Administratively, it seems you have charge of the administration of the tax and the collection of the tax?
MR. ANSLINGER: Yes, sir.
SENATOR BROWN: Just what would happen? We will take a farmer living the other side of Alexandria, over in Virginia. Just what would happen to him if he wanted to grow 2 acres of hemp? What would he have to do?
MR. ANSLINGER: He would go down to the collector of internal revenue and put down his $5 and get a registration, a stamp tax. That would permit him to grow under the act, and at the end of year —-
SENATOR BROWN: That is a stamp tax similar to the one a doctor gets who uses a narcotic?
MR. ANSLINGER: Yes, sir, the same kind of tax.
SENATOR BROWN: He would hang that up in his house?
MR. ANSLINGER: Yes, sir. At the end of the year we would just ask how much he grew.
SENATOR BROWN: Would you not go down and look his field over, to ascertain whether he was making any illicit use of the otherwise worthless byproduct? As I understand it, there is no legislation about the use of the petals or the flowers or of these leaves.
MR. ANSLINGER: So far very few of these hemp people have been involved. Well, they have not been involved in the illicit traffic at all.. This case in Texas is the only case I know of. We were not going to supervise his crop. It would be impossible.
SENATOR BROWN: I do not mean that, but suppose that some fellow come along and says, “I will give you $100 to let me go in and strip your leaves and top flowers from your hemp crop.” How would you ever cover that? How would you meet a situation of that kind?
MR. ANSLINGER: Certainly under the act, if the farmer agreed ot that, they would both be guilty of conspiracy to violate the act.
SENATOR BROWN: But you would exercise no particular supervision over the growing of that crop?
MR. ANSLINGER: The exercise would be in this way: If we see Mr. Dewey Doss, the photograph of whose place I showed you, go in and pay $5 to the collector, we would watch that. We would be very careful to see what disposition he made of that, but we would certainly know the sheep from the goats without any close general supervision.
SENATOR BROWN: I do not think that you would have any trouble with legitimate manufacturers, because they are dealing with the Government; but the farmer himself might be a little disposed not to grow the hemp, knowing the illicit use that might be made of a part of his crop.
MR. ANSLINGER: It is just an information return. That is all we would be interested in, unless he would conspire with someone else to have the crop stripped. But one saving feature about this whole thing so far as the farmer is concerned is that the crop is cut before the resin reaches the nth state.
SENATOR BROWN: Before it reaches its greatest potency?
MR. ANSLINGER: In other words, before it reaches its greatest potency. There is some resin that comes up through the plant, but if he is a legitimate hemp producer he will cut it down before the resin makes its appearance.
SENATOR BROWN: You had before the Ways and Means Committee two samples of the plant. Do you happen to have any of those samples here?
MR. HESTER: We do not have them here this morning. We can get those samples for you.
MR. ANSLINGER: The plant which I have in my hand now can be easily distinguished as you go along the road.
SENATOR DAVIS. You can see that along all the highways of the country.
MR. ANSLINGER: Well, Senator Davis, that will grow up 16 feet.
SENATOR DAVIS: How high?
MR. ANSLINGER: Sixteen feet.
SENATOR DAVIS: Sixteen feet?
MR. ANSLINGER: Sixteen feet. Of course when they are small like that you cannot distinguish them.
SENATOR BROWN: At what height are they usually harvested?
MR. ANSLINGER: About 14 or 16 feet.
SENATOR BROWN: At that height?
MR. ANSLINGER: Not for hemp production. That is for resin.
SENATOR BROWN: I mean for hemp production.
MR. ANSLINGER: Oh, for hemp production, I would say around 10, 12, 14 feet. But it is certainly before the resin gets up there to do the damage.
SENATOR BROWN: Are there any other questions that any member wants to ask Mr. Anslinger?
MR. ANSLINGER (sic): What is the return to the farmer per acre?
MR. ANSLINGER: I do not know. The hemp people here could tell you what the return is, but I understand it is around $30.
SENATOR BROWN: Does it require intense cultivation?
MR. ANSLINGER: I do not think so.
SENATOR HERRING: It is a weed that will grow, is it not?
MR. ANSLINGER: It will grow without any trouble. In fact, a lot of these illicit traffickers will try to hide their field with corn. They will grow corn all around it. Well, the hemp will shoot right up above the corn and will grow 4 or 5 feet higher.
MR. HESTER: Before we complete our case I think we ought to say one word on the regulations, if I may?
SENATOR BROWN: Yes; we shall be glad to have that.
MR. HESTER: From time immemorial it has been the policy of Congress in imposing taxes and in providing exemptions under certain conditions from the imposition of certain taxes, to provide that the exemption will be made under regulations to be prescribed by the Commissioner of Internal Revenue.
Take for example in this particular case, in the Revenue Act of 1932 they provided that automobile parts and accessories should be exempt from taxes if the manufacturer sells them to a manufacturer who is going to make a complete automobile or truck.
In order to get that exemption the manufacturer who is going to sell that part of an automobile or truck to the other manufacturer, who is going to make a completed truck, cannot get that exemption except under regulations to be prescribed by the Commissioner of Internal Revenue.
The Commissioner merely requires him to obtain a certificate from the other manufacturer that this part is to be used in the manufacture of a completed truck.
In this particular we have exactly the same situation here, and we are simply following the practice, I say, that Congress has followed from time immemorial in revenue acts. The farmer here will not even have to go to the Collector’s office. All he will have to do will be merely to mail in his five dollars, and they will send him the stamp tax and the registration. At the end of the year he will make an information return as to how much land he has under cultivation and what disposition he has made of it.
When he wants to sell his crop off seeds all he will have to do under the regulations of the Treasury Department will be to obtain some evidence from the person to whom he sells it, that that person is entitled to the exemption.
That is the situation with respect to the seed, which is the important item involved here so far as the domestic interests are concerned. Of course, the fiber products are entirely out of the bill.
That completes our case.
SENATOR BROWN: Mr. Hester, what are you going to do with respect to the large number of farmers who are not going to know about this law in its earlier stages of enforcement? It seems to me that with the lack of dissemination of information, a great many of them are going to engage perhaps in a legitimate production of it, not knowing of this law. Are you rather harsh toward those fellows, or can you be reasonable and generous toward them?
MR. HESTER: No, the bill will not become effective for 60 days, and there are not a great many of the hemp producers in the United Sates. Of course the Treasury Department would do everything it possibly could to notify these people. There would be no hardship imposed upon them. This would be administered exactly as any other revenue act is administered, and frequently there are excise taxes imposed where the individual does not know anything about it.
SENATOR BROWN: What legitimate uses are now made of the hemp plant in the United States. That is, what causes the farmer to raise it?
MR. HESTER: Some raise it for seeds.
SENATOR BROWN: Do you mean birdseeds?
MR. HESTER: Yes. They raise the seeds for use in the manufacture of birdseed. They make oil out of it. Most of the seed, however, that is used in the manufacture of oil is imported from Manchuria, but it may develop in this country.
Then after the seed is used for the making of oil, they take that seed and crush it, and make meal and meal cake, and that is sold to cattle raisers.
The oil is used in the manufacture of varnish and paint and soap and linoleum, and then in the case of the mature stalk they use that for making fiber and fiber products. Of course, they are entirely outside the bill.
SENATOR DAVIS: While primarily you are placing a tax, it is for the sole purpose of getting and enforcement of the law, and getting a plan for enforcing it?
MR. HESTER: That is correct.
SENATOR DAVIS: If it should be one dollar, what difference would that make?
MR, HESTER: Well, the situation is simply this: ——-
SENATOR DAVIS: I am only talking from the farmer’s point of view, of charging him one dollar instead of five dollars.
MR, HESTER: I am glad you raised that point, Senator Davis,. When the Harrison Act was first before the Supreme Court the occupational tax was only one dollar, and the vote was 5 to 4. In other words the Supreme Court said, “This is a revenue measure”, although the tax was only one dollar. But the vote was five to four. After that Congress raised the occupational tax and then when the case came before the Supreme Court, the vote was six to three. and the Court said, “We now have more reason to sustain the constitutionality of this act that we had before, because it is more of a revenue act than it was then.”
In the case of the producers, under the Harrison Narcotics Act, although there are no poppies grown in this country, if they could develop it so that they could raise poppies, so that they could get opium from it, the farmer would have to pay $24, but in this case the producer only pays five dollars.
We have left the practicioner at one dollar, because that was the situation of the Harrison Narcotics Act, and that is the real reason why the figures are set in this bill at $24, $5, $3, and one dollar, so that we can have a real revenue raising measure.
SENATOR DAVIS: You charge five dollars an acre under this?
MR, HESTER: Oh no, a year.
SENATOR DAVIS: I meant to say this: You charge five dollars whether he produces on one acre of on one thousand acres?
MR, HESTER: That is right.
Senator Brown: Have you worked out the Canal Zone matter with the Department?
MR, HESTER: We have. They wish to be exempted, and they have agreed not to propose their amendment providing for direct regulation of marihuana in the zone because as I pointed out to you the other day it might indicate on the face of the bill that it is a regulatory measure, but they wish to be exempted, and we have no objection. We are preparing to change that.
SENATOR BROWN: Just one or two more matters. Why should they be exempted?
MR, HESTER: There is no legitimate business in the Canal Zone, and they say they have sufficient control over the marihuana problem in the zone at this time under existing legislation, and they object to general legislation being applied.
SENATOR BROWN: It would probably be considerable duplication of effort down there.
MR, HESTER: There might be some. The Harrison Narcotics Act applies to the Canal Zone, and that is the reason why it was included in this bill. But the Treasury Department has no objection if the Canal Zone goes out.
SENATOR BROWN: Will this entail any considerable increase in personnel of the Department?
MR, HESTER: No, I do not think so.
MR. ANSLINGER: No, sir.
SENATOR BROWN: I understand this measure has the approval of the Treasury Department.
MR, HESTER: Yes, oh, yes. it is strongly recommended by the Treasury Department.
SENATOR BROWN: Is there anything further from the ‘government? Do you desire to have a chemist testify?
MR, HESTER: I think we have finished our case.
SENATOR BROWN: Very well, Thank you, Mr. Hester and Commissioner Anslinger.
The next witness on my list is Mr. Rens of the Rens Hemp Coo. of Brandon, Wis. We would be glad to hear from him.

erfaringer fra Schweiz
Anja Dobler Mikola og Beat Kaufmann, Institut für Suchtforschung, Zürich.
Den 21.februar 1991 blev der i Schweiz vedtaget en lovpakke med det formål at formindske problemerne med narkotika. På denne baggrund blev der udviklet en række videnskabelige undersøgelser af ordination af narkotika til afhængige og herunder også et projekt med kontrolleret uddeling af opiater til indsatte. Projektet blev kaldt KOST og begyndte i 1994.
Det bliver nu evalueret og det følgende er bygget på data fra halvvejsevalueringen.

Oberschöngrün Fængsel ønskede ved hjælp af kontrolleret tildeling af narkotika at tage aktivt del i rehabiliteringen af opiatafhængige indsatte ved at give dem muligheden for at stabilisere sig mentalt og fysisk uden at lide under det stress det er, at skulle skaffe stofferne illegalt.

Fængslet, der er åbent, er det største i sin kanton og har plads til 75 indsatte. Betingelsen for at afsone der er, at man ikke er til fare for andre og ikke skønnes at ville flygte.

Målgruppen for KOST projektet var opiatafhængige indsatte, hvis kriminalitet havde forbindelse med stofafhængigheden. I betragtning af deres fortsatte afvigende adfærd var integration i det almindelige fængselssystem vanskelig.
Alle som tog del i eksperimentet gjorde det frivilligt.
De blev ikke tvunget eller presset, men simpelt hen informeret om muligheden.

Under forsøget blev deltagerne anbragt i separat “fængsel” på et landbrug, der ligger 3 km fra Oberschöngrün. Der højst 8 deltagere i projektet ad gangen og de bor og lever i næsten total isolation fra de øvrige indsatte. Landbruget er baseret på blandet drift med både kvæg og korndyrkning samt bolig for de indsatte.

De indsatte får heroin tre gange om dagen og de injicerer selv stoffet i et kliniklignende lokale, der er specielt indrettet til det.
Der er en sygeplejerske til stede, når heroinen deles ud sammen med en sikkerhedsvagt, der har ansvaret for sikkerheden.
Der er blevet ansat sygeplejersker specielt på grund af heroinbehandlingen. De øvrige ansatte er fra den almindelige fængselstab.

De indsatte er primært beskæftigede med arbejde ved landbruget. De bliver instrueret og superviseret af deres foresatte.
Arbejdstiden strækker sig over alle syv af ugens dage, som det er typisk for landbrugsarbejde.

Arbejdet begynder kl. 5.30, to timer før den første tildeling af heroin.

De første resultater:
Her er kun plads til en kort opsummering af de første resultater, men en mere detaljeret beskrivelse kan findes i halvvejsevalueringen, der er baseret på fokuserede interviews med indsatte og personalet, der blev udført i perioden mellem september 1995 og marts 1996.

Forsøget blev startet den 8. september 1995. Fra september til november blev der gennemført en tre måneders pilotfase med fire indsatte.

Efter introduktionsperioden, hvor alle involverede vænnede sig til den usædvanlige forsyningssituation, fortsatte tildelingen af heroin indtil marts 1996. Der var en enkelt episode med medicinske implikationer, som blev klaret uden alvorlige følger for projektet.

De indsatte var i hovedsagen beskæftiget med landbruget. I begyndelsen kneb det med at få udført det nødvendige arbejde, fordi ikke alle arbejdede effektivt. Ineffektiviteten skyldtes både den sedative effekt af heroinen og det forhold, at de færreste havde lært at arbejde ordentligt, fordi de ikke havde nogen faglig uddannelse og kun i beskedent omfang havde været i arbejde. Efter nogle få uger forbedredes arbejdsindsatsen så meget, at det nødvendige arbejde blev udført uden nogen problemer.

Før forsøget begyndte blev det ofte betvivlet, om indsatte, der fik heroin, overhovedet kunne arbejde effektivt. Man frygtede, at de ville være så stærkt sederede, at de ville være passive og umotiverede for at arbejde på samme måde som andre indsatte. Det er bemærkelsesværdigt, at man med forsøget har kunnet vise, at der ikke er nogen grund til at betvivle, at man kan arbejde normalt, selv om man er i heroinbehandling.
I Oberschöngrün er man ikke i tvivl om, at de heroinbehandlede indsatte arbejder lige så effektivt som andre indsatte, så længe heroindispenseringen ikke resulterer i mærkbar sedation eller fører til abstinenser.

I indkvarteringsområdet havde alle de interviewede i begyndelsen af projektet noteret alvorlige akutte og kroniske konflikter mellem de indsatte.
Konflikterne var typiske fængselskonflikter, som blev intensiveret af forsøget.
Det viste sig afgørende, at forsøget blev udført i et afgrænset område adskilt fra det øvrige fængsel, og at de indsatte slap for det stress, der kommer af at skulle skaffe stofferne illegalt.
Endelig var sammensætningen af gruppen vigtig for udfaldet af eksperimentet, men det var tydeligt, at de indsatte havde svært ved at håndtere deres konflikter konstruktivt.

I et forsøg på at bedre dette blev omsorgen forbedret og der blev givet bedre mulighed for at de indsatte kunne være lidt for sig selv.

Selve uddelingen af heroin var stort set problemfri, efter at den første usikkerhed var overstået. De indsattes adfærd i forhold til sygeplejerskerne var præget af behov for nærhed og regrediering. Det ser ud til at en vellykket tildeling af heroin i fængsel afhænger af et tæt og tillidsfuldt samarbejde mellem sygeplejersker og sikkerhedsvagter.
Kun hvis det er tilstede, kan der gives tilstrækkelig omsorg, uden at sætte nogen af de ansattes sikkerhed på spil.

Spørgsmålet om, hvorvidt det er muligt at give heroinbehandling i fængsler, må besvares med et ja….men. KOSTprojektet har bevist, at det kan organiseres og implementeres, men institutionen har måtte betale dyrt for det.
Adskillige af de ansatte i fængslet forholdt sig meget kritiske til projektet. De, der var involveret i det, var travlt beskæftiget blandt andet fordi der blev fokuseret meget på dem fra organisationens side. Uforudsete begivenheder i pilotprojektet krævede fleksibilitet i forhold til de oprindelige planer, og noget af personalet klagede over mangel på regulering og forudsigelighed i projektet.

For de indsatte forsvandt belastningen med at skaffe heroin. Dette beskrev og vurderede alle som et positivt resultat. Alt i alt var deres fængselsophold blevet betydeligt mere tåleligt på grund af tildelingen af heroin. Og det er et signifikant skridt mod skadesminimering, der blev defineret som hovedmålsætningen.

Ovenstående indlæg, der med forfatternes tilladelse er oversat fra engelsk af redaktionen, blev afleveret som oplæg ved en konference i Amsterdam først i 1997.

Evalueringsrapporten kan rekvireres hos Institut für Suchtforschung, Konradstrasse 32, Zürich 8005, Schweitz. Tlf. 0041 1 273 40 24, Fax. 0041 1 273 40 64.

Af Keld Broksø
En række klare anbefalinger til eventuelt kommende, danske forsøg med heroin, opfordrer Center for Rusmiddelforskning nu til, at forsøg med heroinudlevering skal have sideløbende, sammenlignelige forsøg med metadon, personalet skal være robust, og danske heroinforsøg skal supplere og ikke træde i stedet for andre behandlinger.

Anbefalingerne kommer fra centerleder Jørgen Jepsen, som er tilhænger af heroinforsøg og medforfatter til en rapport som Socialministeriet modtog denne uge om de schweiziske forsøg med heroinuddeling.

Rapporten, som blev til i et samarbejde med Københavns Universitet, endte dog som en såkaldt ikkerapport: Anbefalingerne for eller imod danske forsøg mangler fordi de schweiziske resultater har statistiske mangler, der gjorde det umuligt at konkludere noget.

Personligt bilag.
Jørgen Jepsen har derfor leveret et personligt bilag til rapporten.
Bilaget indeholder blandt andet hans egne indtryk fra forsøget i Schweiz.
I Socialministeriet gør man dog opmærksom på, at det havde man ikke bedt om, og man vil derfor se helt bort fra Jørgen Jepsens egen udlægning af de schwejziske heroinforsøg.

Jørgen Jepsen understreger imidlertid en lang række ting, som bliver aktuelle ved en evt. forberedelse af danske heroinforsøg:
i. Et dansk forsøg skal specialdesignes fordi de schweiziske erfaringer ikke kan overføres direkte.
ii. Danske forsøg bør holde sig til heroin fordi der ikke er så gode erfaringer med kokaincigaretter, morfin m.m.
iii. Heroinforsøg er kun aktuelt for en lille gruppe hårdt belastede narkomaner.
iv. Man må være indstillet på store omkostninger i begyndelsesfasen, men det vil senere give besparelser på grund af mindre kriminalitet.
v. Endelig understrege Jørgen Jepsen. at heroinudlevering ikke løser narko problemet det reducerer kun skadevirkningerne.

Mens danske politikere fortsat mangler en rapport fra Sundhedsstyrelsen, der kan fuldende beslutningsgrundlaget om danske heroinforsøg, har FN i mellemtiden vendt på en tallerken: Generaldirektøren for FNs Narkotikakontrol program, Pino Arlacci, har rost de schweiziske forsøger fordi de var under streng viden skabelig kontrol.

Dermed står Lægeforeningen, Formanden for Folketingets retsudvalg Bjørn Elmquist, formanden for Narkotikarådet, Preben Brandt, og Center for Rusmiddelforskning ikke længere alene i anbefalingen af de schweiziske forsøg og som inspirationskilde til danske forsøg.