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US official preaches benefits of “drug courts” in curbing misuse

BMJ 2005; 330 doi: (Published 10 March 2005) Cite this as: BMJ 2005;330:560
  1. Rory Watson
  1. Brussels

    John Walters, director of the US Office of National Drug Control Policy, came to Europe last week to promote his country's “balanced strategy” of measures against drugs misuse. He used the visit to speak out against “harm reduction” policies and to warn about the long term dangers to mental health of heavy cannabis use.

    Addressing a conference organised by the European parliament on European drug policy, Mr Walters pointed out that a combination of effective prevention, treatment programmes, and a clampdown on producers had led to a 17% decrease in drug use among young people in the United States since 2001.

    A central feature of US policy is the use of drugs courts. There are now 1621 such courts in all 50 states, of which more than 400 were created in the past year alone. Individuals are not sent to prison but are sentenced to carefully supervised and monitored treatment programmes.

    Research shows that drug users handled in this way are less likely to reoffend than those sent to prison: a study by the National Institute of Justice indicates that after two years the rate of recidivism was 27.5% in the first group and 58.6% in the second.

    Mr Walters openly challenged the “harm reduction” policies followed in many European countries. These, he said, “offer what is in effect an acquiescing to the disease of addiction and suggest that we turn away from our responsibility to fight against the suffering.”

    Similar criticism came from the International Task Force on Strategic Drug Policy, which issued a statement signed by representatives from 17 countries to coincide with the conference. Harm reduction policies, it stated, “give the message that society has given up on the addict, condones their drug use, and condemns them to a life of drug dependence.”

    Charlotte Cederschiöld, a Swedish Christian Democrat member of the European parliament and organiser of the conference, believes Europe can learn much from the US experience. “I think we should think about using drugs courts, and we should take account of what the US is doing to see how we can weave them into our ideas,” she said.

    Mr Walters' third message highlighted the dangers of cannabis. Far from it being a soft recreational drug, he insisted that the higher potency of the drug now being used could lead to mental problems.

    His assertions are increasingly supported by research. A 25 year study recently conducted at the Christchurch School of Medicine and Health Sciences, University of Otago, New Zealand, showed that daily users of cannabis have rates of psychotic symptoms, such as schizophrenia, that are 1.5 times the rates in non-users.

    In addition, publication of a new report by the Substance Abuse and Mental Health Services Administration confirms that marijuana is now a leading source of drug addiction in the United States. In 1992 the admission rate for marijuana treatment to substance abuse treatment facilities that receive some public funding, such as hospitals and drug centres, for people over the age of 12 stood at 45 per 100 000 people. By 2002 this had increased to 118 per 100 000.

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