The real horror of drugs stems not from gangs selling them, but from their effects on users, writes Chris Luke
THE WONDERFULLY mischievous Mae West memorably skewered the perennial dilemma surrounding illicit intoxication when she quipped, "To err is human, but it feels divine!" And of course, it is a truth - almost universally acknowledged - that humans love to self-medicate, to seek oblivion and respite from the "grim predicament of existence", with whatever mind-altering substance they can get hold of, be it 21st century psychotropic or ancient herbal concoction.
It seems equally likely that a debate has raged for ever between those who fret about the effects of such intoxicants on humanity, and those who see them as divine anaesthetics, soporifics and tonics.
The problem with contemporary substance misuse is mainly to do with its sheer scale and unnatural geography. These can be attributed to the global trading which took off in the 17th century, and to modern chemistry which led in the mid-19th century to the refining of organic produce into powders and liquids. These could be conveniently consumed by wealthy Europeans and Americans in a variety of oral, smokeable and injectable formulations.
The acceleration, since Victorian times, of mechanised global trading and the dissemination of simplified chemistry kits now means that all sorts of chemical contraband are routinely transported thousands of miles from their source, and are easily and universally available for a small sum.
The illicit drug trade is arguably the most successfully globalised of all. Unfortunately, this enormous commercial success for "drug barons" (and sometimes the difference between life and death for dirt-poor drug-cultivators) has created a global pandemic of substance misuse with immensely problematic consequences.
For the most part, these tend to be viewed through the prisms of crime control and drug addiction treatment, and a remarkable number of commentators are now arguing - as did Dr Paul O'Mahony recently in these pages - for "decriminalisation" as the solution. Their central thesis is that it is the violent drug gangs which cause the main problems associated with substance misuse, and that legalisation would squeeze these menacing middlemen out of the equation.
Sadly, I think that this is extraordinarily naive and completely misses the point.
As a doctor who has been on the "receiving end" of industrial levels of substance misuse for many years (in inner-city hospital emergency departments in Dublin, Edinburgh, Liverpool, and now Cork), I am convinced that the question of "legality" of drugs is largely irrelevant in terms of the hazards of drugs to society in general and people's health in particular.
Putting it very simply, the criminality of users is almost never an issue. It is the deaths, destruction of health and communities and the distraction from the primary function of the emergency department, due to substance misuse, that are of interest to me.
And as for Fintan O'Toole's recent assertion, in The Irish Times, that "there is no great evidence that the demand is actually higher now . . . than it was a century ago", I would point out that there is no funding for research into the healthcare frontline workload. So he will have to take my word that, while the appetite for them may not vary much over time, the intoxicants du jour in Ireland are much more worrisome than they were, say, in the post-war period, adding incalculably as they do, in terms of complexity and labour-intensity, to the existing tobacco and alcohol burdens.
The notions of "legalising", "purifying" and "controlling" once-illegal drugs are frankly laughable in today's risk-averse society. But drug users (including those who consume alcohol and tobacco) are prone to utter hypocrisy and self-delusion when it comes to their own prescriptions.
The fact is that people are no longer prepared to accept even minimal levels of risk when it comes to existing, legal and fastidiously purified pharmaceuticals (thalidomide is notorious but all medicines carry a risk of occasionally tragic adverse effects) and patients eagerly litigate, even after rare and unpredictable complications from the medications they have been prescribed.
The same would immediately apply to consumers of (hypothetically) legalised "hard drugs" like cocaine and heroin - and even cannabis - whose natural (ie "pure") effects will always be unpredictably catastrophic for some individuals and inevitably disastrous for society, as dysphoric or delirious people interact with their hazard-ridden environment, as well as with other individuals who may often be less than sympathetic to their drug-addled fellow citizens.
In addition, just because a commodity is legal doesn't mean that it won't be of interest to criminal gangs: think petrol, tobacco and alcohol and simply look North, after all.
Setting aside such specious reasons for "decriminalising" drugs, it is vital that people grasp the pivotal reality about drug misuse: the hideous and worsening global epidemic of violence - be it in British and Irish cities or Caribbean hotel rooms - is primarily fuelled by the effects of alcohol, cannabis and cocaine on the human psyche, and not by the illegality of the drugs.
Drugs (including drink) derange. That is the whole point of taking them, and those who are easily or already deranged will do terrible things to the people around them as a direct result.
Sadly, "anti-prohibitionists" continue wilfully to forget that before drugs (like cocaine, cannabis or opium) were illegal, they were legal - with violent, woeful consequences. My greatest fear is that the ignorance of this seems invincible.
Chris Luke is consultant in emergency medicine in Cork University Hospital and Mercy University Hospital, Cork