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Saturday, July 13, 2013

Public Health versus the Ship of Fools

Let's jump right into it; shall we? The use of illicit and prescription drugs are not and should not be considered criminal. They should not clog our justice and penal systems. Abuse of both illicit and prescription drugs is a public health problem which demands attention but not detention.  

The drug war is a nebulous and misleading war which finds most of it's pitted battles fought on the premise to send addicts to jail. Mention of pharmaceutical abuse and the billion dollar corporate pharmaceutical empire is wholly omitted. Institutions like the Center for Disease Control (CDC )and the World Health Organization (WHO) have each weighed in on the scourge and attempted to reclassify a succincter and more befitting label to the psychosocial phenomenon drugs. They unanimously conclude that it in the realm of public health and not a criminal problem. Moreover, the overarching theme of their research implies that the resources of our morality and finance are withering on the vine with no hope of even vinegar being made from the rotting grapes. We will all suffer the socioeconomic and psychosocial repercussions of this malaise. The choice we have is simple. We collectively pay either on the front or the back end. But pay we shall.

In the industrialize world we have established a morality code which allows us to disengage our conscience by institutionalizing our shortcomings. It's tantamount to the practice during the middle ages in Europe when the ship of fools was ushered down the waterways. A ship laden with degenerates, reprobates, mentally ill and the devilishly insane meandered the rivers of Europe until they stranded on an unsuspecting hamlet. Then they disembarked and fanned out across the village until they moored up again in a large town or city where they were de facto given a travelers respite because of the size of the municipality they found themselves. Soon the populace would discover their misfortunate tidings and the play of ill fecundity would begin again and the unwanted would be corralled and coerced to gain passage on the next ship of fools. Locking away addicts of socially and legally forbidden substances is like condoning a vacuity of empathy; even psychopathic at its extreme.

Michel Foucault details the emergence of the insane asylum with it's relocation of the unwanted, like rubbish, to the outer edges of society and disposing of them in an institution. He outlines his take on the history of western collective moral philosophy in his book “Madness and Civilization”. Foucault chronicles the transition of societal ethos concerning the mentally infirm. There is a disconnect, as he sees it, through etymological changes in how we define madness and insanity. These aberrations allow for the collective moral “ok” needed to legitimize incarceration. Not unlike the ship of fools.

In the WHO's 'Guidelines for the Psychosocially Assisted Pharmacological Treatment of Opioid Dependence' (2009) the problem of drugs is viewed tangibly as a public health concern which has far reaching effects on the economy by way of things like comorbidity. However, the take-away message is summed up here (author's highlights);

“Substance dependence per se should be regarded as a health problem and not a legal one. Given the multiple medical problems associated with opioid dependence and the nature of pharmacological treatment, provision of pharmacological treatment for opioid dependence should be a health-care priority.”

Perhaps the loss of mysticism in everyday life. The shift from sacred to profane as the blinkers of the Enlightenment narrowed our vision. A profundity gleaned from an increasingly detached and spiritually aloof relationship with the deviations of nature. This was one of the root causes. “We can fix it” became the zeitgeist motto. Not because we need to fix it but because we felt it can be fixed. Breaking down the whole into parts which can be modified meant there was a golden ratio both physically and metaphysically in which everything needed to correspond.

The “village idiot” was no longer seen as a wayward court jester. A character among many who had a polished piece of sagacious insight. He would impulsively regurgitate this insight back into the world; bookending it with his disjointed rants.

This was the sacred; much like epilepsy in the west was perceived and recorded as a divine soothsaying gift as far back as Hippocrates. Both petit and grand mal seizures produce vivid and descriptive hallucinations. Of course, this is not an endorsement of nor an advocation for seizures; that would be morally corrupt and ethically perverted. Yet, if we carefully comb through the tangles of what is being said and begin to erect a broader picture of the what is happening socially, we stumble headlong into a public health epidemic of the sacred and the profane.

Unfortunately, The America National Institute of Health (NIH) still maintains that the spearpoint of their campaign to reduce the negative impact drugs have on society is because they spuriously link drugs to crime. Of course, there are those who are recidivistic and are a palpable burden. Largely these people are also without adequate therapy because drug addiction is viewed as a crime and not a public health problem. Ironically, the NIH doesn't feel it necessary to mention the rampant abuse of pharmaceutical opioids, which each community feels viscerally and any law enforcement agent worth his salt tells you engulfs too many resources and too many man hours.

Clearly, this view misses the mark. By suggesting that a significant amount of those incarcerated have substance abuse problems but neglects to address the millions incarcerated for possession of illicit drugs. It is the same old threadbare empty rhetoric of the “stepping stone” or “gateway” hypothesis. Yes, some people behind bars are substance abusers but not all people behind bars who are substance abusers are criminals. Of course they have committed an act of defiance against a particular law but they are prosecuted for a victimless crime. A crime which does not afflict the “personal property” (e.g. body) of another. The repeal of antiquated and draconian sodomy laws by the Supreme Court should have elucidated that principle. Unfortunately, that has not seeped in to the collective pathos of the United States of America.  

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