Podcast | Sin City – the redemption

Judith Harvey is recently back from Colombia, which is slowly recovering from decades of violence brought about by its illegal manufacture and export of cocaine.

Twenty-five years ago Medellín in Colombia was the murder capital of the world. The city was in the grip of Pablo Escobar’s drugs cartel. His teenage sicarios – hitmen – killed without a second thought to maintain his control over the politicians, social organisations and the rival Cali cartel. During a brief venture into politics, Escobar initiated a housing programme and the poor loved him for it, but there was hardly a mother who hadn’t lost a husband, brothers, sons, in the narcotraficantes’ guerilla warfare.

Then, in 1993, Pablo Escobar was shot dead in a police raid.

Drugs are a traditional part of Latin American culture. 2,500 miles and 400 years away in Potosí, Bolivia, more than 4000m up in the Andes, men and boys mined silver from the Cerro Rico, the rich mountain, to fill the king of Spain’s coffers. The miners chewed coca leaves to help them survive the long arduous hours of work and the hunger and the pain. Silver is still mined there, and they still chew coca.

Coca numbs a brutal and exhausting life but it doesn’t give users a high. In most traditional communities the use of hallucinogens is privileged to mystics. The counterculture picked them up and the trickle of strongly psychoactive and very addictive drugs into the rich world has become a tsunami stimulated by millions of users who would seem to have every opportunity to live fulfilling lives without drugs.

Prescribed medicines like fentanyl and ketamine migrate into recreational use. Overprescribing of opioids in the USA has led to 150 deaths every day from overdoses – the oxycontin scandal is now in all the papers, and knowing how the Sackler family made its millions, their generosity in endowing art galleries such as London’s Royal Academy takes on a different colour. Chemists in jungles and laboratories manufacture stronger versions of traditional drugs: coca gives rise to cocaine, and cocaine to crack. Cannabis gives way to skunk and spice.

Drugs are ever more readily available. The cost, personal and to society, is massive, and for decades governments have attempted to stem the tide.

You can try to dissuade people from using drugs. But did Nancy Reagan’s Just Say No campaign dissuade anyone? Since Trump doesn’t go in for evidence-based policy-making he will probably ignore the Singapore experience that the death penalty doesn’t reduce the use of drugs. Using drugs is something humans do.

You can make drugs illegal. But it doesn’t work, as prohibition of alcohol in the USA demonstrated. The result was bootlegged spirits and gangland violence. In Britain upgrading cannabis to a class B drug spawned spice: more profit for the same risk. Deaths from legal highs have increased since head shops were driven underground. Drugs are rife in our society. Especially in our prisons.

You can try to eliminate drugs at source. The USA has pumped millions of dollars into eradication programmes in Colombia. The result: coca farmers have been deprived of their livelihood, the herbicides have caused widespread environmental damage and health problems, the narcotraficantes took over and disaffected militias of every persuasion used the drug trade to finance their operations.

The ‘War on Drugs’ is another conflict we can’t win. The alternative is to decriminalise drugs. That means not just private use, but supply, which is where the criminals operate. But social and political attitudes are a big obstacle. I remember an academic who lectured us medical students on the dangers of weed, even though his lifetime of research had failed to demonstrate that cannabis causes significant harm.

Politicians too put their heads in the sand. The 2014 report to the All Party Parliamentary Group on Drug Policy Reform concluded that legalisation in countries such as Portugal had led to a significant reduction in drugs’ personal and societal harms. Home Secretary Theresa May tried to censor it. Many of her colleagues privately favour considering legalisation. But still parliament votes for ever stronger penalties. Except of course for the legislators’ drug of choice, alcohol, which arguably does more damage than any other.

Meanwhile, drugs find their way ever deeper into the web of our society. More users, more suppliers, more crime, more deaths. You don’t have to go to Kings Cross to score, the wreckage of needles and vomit is to be found in quiet cul-de-sacs in my genteel London neighbourhood. Deeply unpleasant and largely a consequence of the criminalisation of drug use.

In Colombia during the decades when drug cartels and vigilante groups controlled the country, it was impossible to get elected, to do business, to provide services, without the support of one or other criminal group. If you resisted, your children were abducted and you risked assassination. Could it happen here? The food and alcohol industries successfully lobby our parliamentarians to weaken legislation which might diminish their profits. If it gets to the point when an honest politician can do nothing without paying someone off, it is hard to eradicate the spreading infection of corruption which, like Japanese knotweed, can invade every cranny of society.

But perhaps not impossible. Since Escobar’s death, Medellín has boomed. A new mayor, community engagement and investment have restored civil society. Now it’s a city people want to live in. The new metro includes cable cars up to the comunas – shanty-towns – which cling to the precipitous hillsides. A 15-minute journey instead of four buses. The plazas, the parks and the cafes are buzzing. Instead of arresting street graffiti artists the city funds them and tourists take tours to marvel at their work. The house where Escobar died on the rooftop is now a language school.

It will take years, decades, before Colombia completely shakes loose the grip of the narcotraficantes. But, as Colombians told me, it is a first step.

Britain isn’t Colombia. But the funding for drug services is being cut and the NHS is overwhelmed. The narcotraficantes are past masters at exploiting political changes to their advantage, and Brexit is a huge opportunity. Whatever fudge we end up with over the border between Northern Ireland and the Republic, it will invite smuggling. Drug trafficking is an international business, but we may sever our links with Europe-wide crime surveillance and the European Arrest Warrant. At the recent trial in Sussex of members of a drug ring it emerged that drugs are being stockpiled in Europe so that when our police and customs are overwhelmed by Brexit, huge quantities may be slipped into Britain. Isn’t it time for politicians to pull their heads out of the sand?

Judith Harvey was a research scientist, ran the VSO programme in Papua New Guinea and taught in a Liverpool comprehensive school before going to medical school. She has been a partner, a salaried GP and a locum, an LMC chair and a long-time supporter NASGP. Her charity, Cuba Medical Link, enables medical students to go to Cuba for their electives.

Judith has now published all her articles from the NASGP website as a new book Perspectives: A GP reflects on medical practice and, well, just about everything…

1 Response

  1. As a GP, and previously as Psychiatry SHO and later section 12 doctor, I have come across a number of patients who HAVE suffered long-lasting adverse psychological effects probably from Cannabis, often because, as they say, they have not used anything else because they know about research saying cannabis never has any permanent adverse effects. From my personal experience with patients, I know that it DOES, and the research -or the interpretation and spin put on it - is WRONG. Alcohol too has dreadful adverse effects, but cannabis is NOT safe, and should be discouraged at every opportunity, (and so should alcohol excess).

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