Making Peace with Cocaine, and Advancing from Harm Reduction to Harm Refusal

Peter Cohen*



I'm sorry that I cannot speak in Spanish. I will try to be clear in English. But first I want to say in agreement with Marco that I am very happy to be here and thankful for the invitation of Mama Coca. My speech will try to clarify a few items around cocaine use. What is cocaine, more precisely: how is it used and how we apply theories to describe the use of cocaine? A second topic that I want to hit on is the topic of discrimination. How drug policy constructs itself as a tight schedule of discrimination. And the third topic that I want to touch is how can we use concepts of harm reduction and what are the limitations of harm reduction. Maybe we have to ask ourselves how to widen our visions on harm, and include concepts around harm refusal.


Let me start with the use of cocaine. Yesterday Anthony Henman spoke about making peace with Coca, with the leaf of Coca. We cannot make peace with the leaf of Coca if we also do not make peace with cocaine, which is an alkaloid contained by the coca leaf. And in order to make peace with cocaine, we have to sit back for a moment and look at how we evaluate and talk about the use of cocaine; what scientific data are available and how we could enable ourselves to make peace with cocaine, with peace in our hearts. In order to illustrate how we look at the use of cocaine, I will use two contrasting examples from the scientific literature.


The first example is a book that was published about two years ago by a Belgian criminologist, Tom Decorte.[1] A fat book, almost 500 pages, in which he discusses all the research that is available in the world about the use of cocaine among people that are recruited from the general populations, users we can find amongst us in everyday life. There is a lot of research; in the Netherlands, in Belgium but there is also research on cocaine use in the populations of Canada, Australia, the United States, and England. He puts all this together and, what are his conclusions? His conclusions are that the large majority of cocaine users use the substance for a relatively short period of time. They use cocaine mainly as amplifiers of social pleasures. So this means that cocaine is used to go out to the disco, or to chat with your friends, or as a desert for dinner. Most cocaine users use moderate to small amounts of cocaine because otherwise the pleasure of cocaine becomes distorted. For most users much cocaine is not pleasurable; it's a little bit like alcohol. For most users to use much alcohol is not pleasurable. Decortes conclusions are quite complicated and, if you really want to know more about it, read that book. What he says is that the disadvantages and the dangers of cocaine seem to have been described in a very highly overstated way. Decorte doesn't touch on the question why this is so; why has science overstated the dangers of the use of cocaine for such a long time? And that is a question that I want to touch upon after referring to a second example from the scientific literature. There has been a psychiatrist, H.Kleber, working in United States with F.Gawin, who has been publishing work on the use of cocaine. In contrast to the samples of users that are described in Decorte’s over view, Gawin and Kleber have done research on users who ended up in the clinic- system of the United States, in the drug treatment system[2].


Now it is evident that if you look at drug users that have ended up somehow in the treatment system, you focus on patterns of use, and motivations of use, that are completely different than for the bulk of the users of the drug. Looking at clinical samples, you come to completely different conclusions about the effects and possibly ‘dangers’ of the use of cocaine than when you focus on general population samples of cocaine users. Basically, what I say here is that the dominance of medical and psychiatric perspectives on the use of the drug has created types of research focused on clinical cases that has completely distorted our capacity to look at general population types of use of cocaine. The same has been true with opiates but I will not discuss the type of opiate research.


In other words, we see what we want to see. Or, we see what we are made to see, determined by the type of ‘scientific eyes’ that make it to the public. And what we see is to a high degree determined by preset ideological ideas that we have about the use of the drug. If we have learned, and most of us have learned this all our lives, that cocaine use can be highly dangerous, we will immediately refer to research that tries to legitimize those prejudices. The research that comes from clinical settings is usually able, both by its sample and by the type of questions it presents, to legitimize preset ideas about the dangers of cocaine. If you work as a sociologist, I am a sociologist, and you want to see cocaine use as a much wider phenomenon than only limited to clinical cases, you see a completely different image of the use of cocaine. For instance, in the many projects that my center (CEDRO) initiated on research on cocaine-use patterns over time we included research on how people use cocaine over a 10-year period; we do not see anything that you see in clinical research. We see that after 10 years, 60 percent have stopped using cocaine because, we assume, their lifestyles have changed. The functionality, the usefulness of cocaine in a socially outgoing lifestyle has diminished, or even disappeared. Sixty percent of cocaine users have quit after 10 years in Amsterdam; and in other cities the figures are similar. So we have to depart and have to rectify our images of the use of cocaine and see it as only a very limited risk for a very limited period in a users life. I say this because we need to have this knowledge and have to apply this knowledge, if we somehow want to make peace with cocaine and not only with Coca. Of course, if cocaine would be available as a licit drug, we might see the development of other use careers or more users. However, the availability of cannabis in the Netherlands as a semi legal substance has not made the Netherlands into an area with the highest level of use in Europe.[3] Ergo, culture and economic conditions determine use levels of a drug much more than ‘legal’ availability.


I said that I would speak about discrimination and, since Cartagena, I'm told, has been one of the centers of the Spanish Inquisition in Latin America, I would like to use the example of Inquisition to describe how we philosophically create the phenomenon of discrimination. In the theory of the Inquisitors, people who would deviate from the road of  ‘rightly’ speaking to God, and from how to ‘rightly’ interpret the Bible, or from the ‘correct’ road to acquire God's grace, those people intentionally or not intentionally dehumanized themselves. Their soul could no longer be saved; they would not be able aspire for the highest goal of a human, that is, to accept God’s grace and in the afterlife be in paradise. So these people could be treated as non-humans! And we see in the whole history of discrimination in the world, be it around race, around class, around faith, the dehumanizing of the other is one of the central aspects. Dehumanizing the other is the most essential process to understand how some sorts of discrimination can become so violent. On the basis of highly selective images of cocaine users and highly selective types of research, we could say that we have chosen to treat cocaine users as people who have intentionally or unintentionally deviated from the highest aspirations of humankind.

Our modern ideologies about what is the highest goal for human person are no longer to accept the grace of God but to realize one’s ‘individual potential’. We have learned to look at cocaine use as a deviation from that highest aspiration. The possibility of so-called addiction makes cocaine users into human beings who no longer aspire for this highest goal: individual autonomy and individual responsibility. So we are able to take away one of their most basic aspects of their human characteristics and this is even more valid for people who sell cocaine. People who sell cocaine are seen as evil agents. They have induced others to lose their highest individual qualities. We can dehumanize them; we can do anything to them. Cocaine producers, exactly the same applies. As long as we apply these highly discriminatory philosophies to users of cocaine, or dealers of cocaine, or producers of cocaine, we somehow create a legitimization for the awful and medieval policies that in some of our countries we apply to these people.


In the United States, the average number of prisoners per hundred thousand has quickly risen since the 1980s from around 120 to over 700. Over 700 people per hundred thousand are in jails and prisons in the United States for just an average of around a 100 in the European Union. The scale in which the American government imprisons people on the basis of crime politics, and on the basis of a particular vision on drug use, is simply incredible. We have to realize that these North American procedures of discrimination that give rise to idiotic plans like Plan Colombia do not only endanger the security and the human rights of people outside the United States but that also inside the United States. These philosophies of dehumanization have created incredible legal conditions for the US population as a whole, and certainly for its minority populations.


Where does this lead me? I was asked to discuss something about harm reduction as well today. As you all know, harm reduction has been a very fashionable philosophy around setting up drug policies. But looking at highly discriminatory characteristics of drug policy, we could also say that harm reduction is too limited to meet the political problems that drug-policy based discrimination creates for us. Maybe we have to move to a different philosophical position and say that some of the harms that are created by our discriminatory drug policies can no longer be accepted and included in a scheme to reduce these harms. I would say that the incredible amount of imprisonments of the population of the United States is one of those harms that we cannot accept. The incredible damages that are inflicted on the people that produce drugs only to try keep these drugs out of the United States or the European Union; these damages are simply not acceptable. We have to develop ideas about harm refusal. Human Rights are of course the philosophical background against which we could judge those harms and I think we should go there. Harm reduction is relevant for certain social conditions and for certain political contexts. However, the power of the police in the United States is incredible, as is the harm done by them; the power of military forces enforcing drug laws in countries in Asia and here in Latin America is simply unacceptable. In some areas of drug politics we have to move from harm reduction to harm refusal.


The history of harm reduction in Europe is a long one. Originally harm reduction was an expansion of the thinking in the area of public health. Once you accept drug use, and some of its effects, as public health problems, you can attack them as public health problems. As an infectious disease is made into a public health problem, you can try to reduce the rate of infection. Making the disease into a crime problem would be very strange and only understandable in a moralistic understanding of infection. The background of syringe-exchange programs is: reduce the rate of all sorts of infection. In the Netherlands, harm reduction has gone a little further. By refusing to chase smalltime dealers in heroin, in the Netherlands  the price of heroine decreased quickly in the 1980s The Netherlands became the country where heroin was the cheapest in all of Europe. And this created the possibility for people who were using heroine, which were not very many, at maximum half percent of the population, to switch from injecting to smoking heroine. The whole market changed. By allowing the conditions to exist to make heroine cheap, it was no longer necessary to inject that heroine; it could simply be smoked. And by the acceptance of the cultural habit to smoke heroine, a whole area of risk behavior simply no longer existed. All the problems of injecting were highly diminished. But there is a limit to this type of harm reduction. Still, people can be brought to prison in the Netherlands for heroin related crime and the answer to that was, at a certain moment in the 1990s, to say "OK let's take away the possibility of people ending up in prison, being arrested for dealing, or smuggling or stealing. Let us no longer accept the harm of criminalization and imprisonment. Let's give them heroine." So at the moment, heroin distribution and heroine maintenance is the latest policy innovation in the Netherlands in the area of heroin use. But, where do we go from there? If we allow users to get heroin from a legal source, either buy it or get it for free, haven't we legalized heroin?  In a certain sense we have. If you look at the progression in harm-reduction programs in the Netherlands and in some other European countries, you can say that the evaluation of the concept of harm and the refusal to accept particular types of harms, have logically lead to semi legalizations.


If we stopped trying to reduce some types of harms but evolve into not accepting them (however reduced), we will logically end up by finding schemes for legalizing the use and the production and the distribution of these drugs and we will be forced to look at the use and production of those drugs with more realistic perspective and more generalizable scientific theory.


Thank you very much.


Transcribed by Mama Coca



[1] The taming of Cocaine: cociane use in European and American Cities, Brussels, VUB University Press, series: criminological studies, 2000, 499p. isbn: 90 5487 284 5.

[2] See for instance FH Gawin and HD Kleber ”Abstinence symptomatology and psychiatric diagnosis in cocaine abusers: clinical observations”Arch.Gen.Psychiat.1986;43-107


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