INTERVIEW WITH FREDERICK POLAK, MEMBER OF THE ENCOD STEERING COMMITTEE

Source: Comunidade Segura

Author: Lis Horta Moriconi

04/12/2007

In March 2008, four months from now, the United Nations Commission on Narcotic Drugs will meet in Vienna to review the results of the drug policies over the past 10 years. It will be the first time that so-called prohibition drug policies that stipulated the eradication of the coca leaf, cannabis plant and the opium poppy will not be given a blank check treatment, but instead, be scrutinized for efficiency.

“The UN has opposed harm reduction policies with the argument that it would make it easier to use drugs, but there are studies that prove there is no such relation,” said Frederick Polak, whose years of experience as a psychiatrist at the Amsterdam Municipal Health Service’s Drug Department, has led him to advocate for harm reduction and who will be present at the Vienna meeting.

It is also the first time that harm reduction will be openly discussed, and its different tribes will get a chance to enter the public eye. Proponents of harm reduction policies believe that careful regulation of drug use would cause less harm than the current policy of pretending they do not exist or the draconian security apparatus that is thrown against those who use them.

In the interests of public health, for example French magazines have circulated advice to cocaine users, exhorting them to care for their noses ‘use saline solution’ ‘do not share cocaine papers’, and finally ‘if you have a nose bleed, its time to stop’. Spain and the Netherlands have drug user rooms (or Narcosalas in Spain) where illegally bought drugs may be checked for purity and why not, used, in a safe environment.

The highly controversial topic is not always met with equanimity. Interviewed by comunidad segura, Frederick Polak a psychiatrist, psychoanalyst and psychotherapist said that the negative reaction he got from a few interlocutors in Rio de Janeiro was not at all surprising: “Even in the Netherlands, you cannot say that the majority is in favor of legalizing drugs,” said the psychiatrist, adding: “The Vienna meeting will also launch the Year of Reflection, when governments and civil society will be invited to take a more sober look at what it means to use drugs in terms of human health and safety.”

You mentioned there are three main positions on drug policies beyond prohibition, which are they?

There are those in favor of harm reduction, without touching on prohibition. There are those who want to take the coca leaf and cannabis plant out of the list of forbidden plants. And finally, there are those who consider that drugs are dangerous, but that prohibition is even more detrimental to society, leading to crime for instance, and ask for legalization. 2008 will be “a year of reflection” led by the United Nations dedicated to discussing these positions and prohibition so that 2009 will see the birth of a new drug policy.

In your view to teach kids to say no to drugs then, does not work?

According to recent studies, children who took part in the DARE program in the United States are actually more likely to use drugs than those who did not.

More and more drugs seem to be coming in and finding their niche in society. Cannabis, cocaine, heroine, ecstasy, etc… Is that not true?

Yes, perhaps overall that is true. But in some cases there is not an overlay of habits. For example it has been reported that cannabis use diminishes alcohol use, and yet when for example Dutch cannabis users go to France (and cannot take cannabis with them) they will substitute with alcohol.

Drug use in any case varies greatly from country to country. For example, in Greece where there is an established habit of wine drinking cannabis use is low, while in Italy, where there is also the habit of wine drinking cannabis use is high. We do not know how to account for all these variations yet.

Does addiction mean an impairment?

Being addicted does not mean that you cannot stop using a drug, but that stopping is very difficult. You may want to spend lots of money to keep your habit going, go as far as committing crimes. It may mean that you may not feel happy about being without your drug that brings you moments of pleasure and that doing without it does not make sense. But it does not mean that you are impaired in the sense of being unable to have a fruitful life. If you embrace harm reduction, you can be a drug user all of your life, live to 80 and die of other things. One very famous example is the man known as father of American Surgery, Dr. William Stewart-Halstead, who lived to a ripe old age, was a great doctor and, all along, a secret morphine user. (morphine belongs to the family of opiates that is heroine). He used it in a controlled manner.

Has not legalizing cannabis lead to an explosion in consumption in the Netherlands?

People are always afraid of what may happen after legalizing a substance, but in the case of the Netherlands the legalization has not lead to an explosion in consumption. It ranks about average among European countries, behind for example, the UK. But then again, you must understand that legalization does not in any way mean a ‘free for all’, it does mean using it under strict regulation, more controlled for example, than alcohol is today.

What kind of control?

In the Netherlands, if you are an adult, you are allowed to buy small quantities of cannabis, 5 grams, for personal use and you can use them in coffee shops. We use the term cannabis, not marijuana because cannabis includes both marijuana and hashish.

Why is prohibition so successful as a policy?

Those who stand most to benefit are politicians and police officers who can say they need more guns, get training overseas, set themselves important tasks to carry out.

So far, harm reduction is really mostly about research. For it to be applied in the population it would mean a change in the nation’s laws, has that been the case in the Netherlands?

In the Netherlands the Heroin harm reduction program has been created after difficult political discussions. Even so, it is still only accepted as medical research. We are not allowed to prescribe heroin, but only codeine and morphine, to prescribe heroin we would need to change the legislation. The same is also true of Switzerland. Only in Germany has some legislation been changed to apply harm reduction treatments.

Is the Netherlands pro harm reduction today?

In the Netherlands today there are harm reduction studies being carried out on the feasibility of prescribing amphetamines and cocaine, but the political situation changed. Now out of the three leading political parties two are religious and as such prefer to ignore scientific data in favor of what I call “pseudo-ethical” arguments.

There are psychiatrists who object to the legalization of drugs because there is always a percentage of the population that is more vulnerable to psychosis induced by drug use, which leads to a life time of suffering

That is true, but what of prohibition, does that help? Does it not do its own damage?

In the United States, a strong follower of prohibition, there are ample examples of the destructive effects of prohibition as a dominant policy. What of all the people thrown in to prison for being caught with cannabis? What of mothers who lose custody of their babies if they show signs of cannabis use? Students in the US for example, caught smoking cannabis can lose the eligibility for funding. This has led to a number of organizations who think this kind of damage should not go on. Among them are Students for Sensible Drug Policies, Drug Sense, and Leap, Law enforcement against prohibition, to mention a couple.

So talking about the drugs themselves, why did Harm Reduction begin with Heroin?

The health authorities first became interested in harm reduction when it was discovered that heroin addicts were spreading AIDS through contaminated needles. That was an important turning point when the decision was taken to put science first.

But the scope of harm reduction with drugs is very limited, cannabis, heroin. How about cocaine for example, the hard drugs?

There was a small study undertaken in Zurich that approached the feasibility of harm reduction for cocaine use. But the fact is that although those involved stated they were getting positive results and the study coordinator advised for a larger study, it was short lived. It was interrupted by what my colleagues tell me was political pressure against it. There is information on the study available, but in German.

You mentioned that within the same country sometimes attitudes change.

Yes in Germany for example, in the 60’s when drug use was associated with middle class kids and hippie culture it was tolerated. More recently, when drug use was associated with immigrants, with people who encounter more difficulty in moving up in society, with the excluded, the overall attitude has hardened, there has been less tolerance, more repression and as a result, more violence.

What would you say of a bigger country such as Brazil, with an entire segment of the population living in adverse conditions, marginalized?

There are no studies on this. It would be interesting to know.

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