2014/8/19 「酗酒與毒癮，何者比較危險？」

酗酒與毒癮，何者比較危險？

摘錄自：天下雜誌電子報                        2014/8/19

2013-12-03 Web only  作者：經濟學人

 

圖片來源：flickr.com/photos/omegaequalsone/

好萊塢電影裡的吸毒者通常不會穿西裝打領帶，但最近幾周，幾名高階公職人員皆承認吸食強力毒品。多倫多市長福特（Rob Ford）承認他兩年前曾吸毒快克古柯鹼。佛羅里羅國會議員拉達爾（Trey Radel）持有粉末古柯鹼遭定罪，正面臨辭職壓力。而在英國，合作銀行前董事長佛勞爾斯（Paul Flowers），則在報紙拍到他購買甲基安非他命等毒品後遭到逮捕。如果人類可以一邊吸食強力毒品、一邊掌管大銀行或是加拿大最大的城市，這類藥物究竟有多危險？

 

判斷毒品傷害性的方式之一，或許就是看看法院的處理方式。但毒品法規常存在許多怪異之處。例如，在2010年以前，在美國持有5克的快克古柯鹼，就得直接判處5年刑期，但至少要持有500克粉末古柯鹼才會觸發同樣的刑罰。

英國政府將藥物的傷害力分為A至C級，但政府傾向於利用系統向民眾傳送警示，也就表示熱門藥物有時會高出它們該有的等級。英國近三分之一的成人曾抽過大麻，官方亦認定大麻比約會強暴藥GHB更危險。此外，就算是最健全的法律系統，也跟不上不斷推陳出新、可能會造成傷害的「合法興奮劑」。

研究者曾試圖以更科學的方式，比較藥物的傷害程度。近期最知名的排行，或是就是由前英國政府藥物顧問納特（David Nutt）帶領的研究。其結論為酒的傷害程度比任何禁制藥物都要高──這聽起來可能有些奇怪，畢竟，拉達爾表示，酗酒就是他吸食古柯鹼的成因（暗示古柯鹼比酒精嚴重許多）。

但此研究是考量了使用者和社會所受的傷害，才會作出此結論。要是單只考慮使用者，禁制藥物的傷害確實比酒精高。此研究指出，海洛因和甲基安非他命的傷害都高於酒精（粉末古柯鹼則否）；直接致死率最高的是海洛因和美沙酮，腦部損害最大的則是快克古柯鹼和甲基安非他命。

所以，到底是酗酒的政治人物好，還是有毒癮的政治人物好？酗酒者的死亡機會稍高於吸毒者，但吸毒者判斷力混亂的機會比較高。飲酒的成癮機會也比較低；快克古柯鹼、海洛因和甲基安非他命，上癮機會都比酒精高（但比不上菸草）。

吸毒的公眾人物可能比較難保住選民的信任；吸毒乃違法行為，實在不是法律制訂者該有的特質。亦有證據顯示，特定非法藥物的使用者，歷經個人關係崩解的機會比酗酒者來得高；納特博士的團隊發現，在這方面，甲基安非他命和快克古柯鹼的傷害性最高。

佛勞爾斯似乎證明了這點，許多盟友已與他斷絕關係，先前的合作銀行任命亦受檢視。另一方面，福特則盡全力證明研究者是錯的；福特仍舊在任，也承諾將於明年競選連任。最近的民調顯示，醜聞並未嚴重傷害他的支持率；事實上，三分之一的多倫多人打算再次把票投給他。（黃維德譯）

©The Economist Newspaper Limited 2013

2014/2/15 「毒品除罪化 才能解決濫用問題」

毒品除罪化　才能解決濫用問題

摘錄自：天下雜誌 經濟學人電子報                        2013/2/14

2014-02-11 Web only 作者：經濟學人

 

圖片來源：flickr.com/photos/torbenh/

美國男演員菲利普．西摩．霍夫曼（Philip Seymour Hoffman）於2月2日海洛因過量致死，讓許多影迷為之心碎。藝術家總是有自毀的傾向，也沒有人知道該如何改變此事。不過，毒品濫用專家確實知道如何避免因海洛因而死的人數增加。

過去20年，許多人開始支持以「傷害減少」政策、而非更強硬的執法，來處理海洛因濫用問題，許多政府也已將個人使用除罪化並提供免費療程。然而，還有另外兩種效果已然證明、卻也在政治上更具爭議性的手段：設立安全站讓使用者注射海洛因，並由醫療人員在一旁監控，以及為無法或不願接受療程的成癮者提供免費海洛因。

瑞士和荷蘭在1990年代率先探索了這種「海洛因輔助治療」（HAT）手段，隨後都將它訂為國家政策；西班牙、英國、德國和加拿大也都在進行HAT試驗。證據顯示，HAT可減少海洛因致死和愛滋病感染，原因在於使用者是在醫療人員的監控下注射；HAT還能大幅減少海洛因相關犯罪，因為成癮者不必偷竊或出賣肉體好取購買藥物。瑞士和荷蘭的海洛因使用量皆持續下滑，及至2000年代後期，荷蘭的新海洛因使用者已降至接近零，1970和1980年代的成癮者亦持續減少。

大麻除罪化亦是因素之一，因為此舉分離了大麻與其他更強的藥物。更有趣的是，包含HAT在內的傷害減少政策，似乎會減少非法海洛因消費，部分原因在於政府提供的免費海洛因排擠了私人供應者。正如科技界所說，你無法與免費競爭；有項研究發現，這類政策讓非法海洛因交易減少約30％。

美國人也不再排拒這樣的說法。科羅拉多州和華盛頓州決定將大麻全面合法化後，已超越荷蘭、成為全球軟性藥物政策最自由派的地區之一；推行硬性藥物傷害減少政策，將有助美國對抗最近突增的海洛因致死案例。想讓霍夫曼這樣的名人前往安全站注射海洛因可能並不容易，而且不管政府怎麼做，還是會有人因藥物而死；但如果有辦法減少部分死亡案例，為何不試試看呢？（黃維德譯）

©The Economist Newspaper Limited 2014

經濟學人英文原文

The Economist

Drug policy

Hoffman's habit

By The Economist

From The Economist

Published: February 11, 2014

Feb 8th 2014 | From the print edition

How to make heroin less deadly.

THE death of Philip Seymour Hoffman from a heroin overdose on February 2nd left the extraordinary actor's fans distraught. Artists have always been prone to self-destruction, and no one knows how to change that. Drug-abuse experts do, however, have a good idea of how to stop more people from destroying themselves by injecting heroin.

Over the past two decades many have come to favour tackling heroin abuse through "harm reduction" policies, rather than tougher policing. Many governments have decriminalised personal use and provided free therapy programmes, using drugs such as methadone and buprenorphine that block heroin's high. Two other proven ways to reduce harm, however, are more politically controversial: setting up safe sites where users can inject while monitored by health-care staff, and—for registered addicts who cannot or will not comply with treatment regimes—providing heroin itself free.

Switzerland and the Netherlands pioneered this "Heroin Assisted Treatment" (HAT) approach in the 1990s, and both countries later adopted it as national policy. HAT trials have also been run in Spain, Britain, Germany and Canada. The evidence suggests that HAT slashes heroin-related deaths and HIV infection, since users are shooting up under medical supervision. It also drastically reduces heroin-related crime, since addicts have no need to steal or sell their bodies to get money for their fix. Some studies find that HAT actually works better than methadone or buprenorphine. Heroin use is falling steadily in both Switzerland and the Netherlands; by the late 2000s the Dutch incidence of new heroin users had fallen close to zero, and the ageing population of addicts from the 1970s and 1980s continues to shrink.

Decriminalisation of marijuana use has also played a role in limiting Dutch heroin use, since it separates the use of cannabis from the use of harder drugs. More interestingly, harm reduction including HAT appears to lead to lower illicit heroin consumption, in part because free government heroin drives out private-sector providers. When addicts shoot up in safe rooms monitored by public-health staff, where they are recruited into treatment programmes or (if they fail or refuse) simply receive free heroin, it gradually erodes the market for dealing the drug. As they say in the tech world, you can't compete with free. One study found that such policies cut the illegal heroin trade by about 30%.

Such arguments would once have sounded to Americans like tone-deaf pleas to be more like Europe or Canada, but no longer. The decisions fully to legalise marijuana in Colorado and Washington gave those states some of the world's most liberal soft-drug policies, leaping ahead of the Netherlands. Following up with harm-reduction policies for hard drugs could help America battle a recent spike in heroin deaths related (as Mr Hoffman's apparently was) to painkiller addictions. It might have been hard for someone of Mr Hoffman's fame to use a safe injection site, of course. And whatever governments do, some people will still kill themselves with drugs. But if there are ways to avoid some deaths, why not try them?

©The Economist Newspaper Limited 2014

2014/1/20 「美科羅拉多州 開賣大麻」

美科羅拉多州　開賣大麻

摘錄自：天下雜誌 經濟學人電子報                        2013/1/17

2014-01-09 Web only 作者：經濟學人

圖片來源：flickr.com/photos/elpablo/

 1月1日，美國科羅拉多州正式合法銷售大麻，距離之前公民投票通過大麻合法化後已經是420天，科羅拉多約有37間大麻商店開張，也成為全球第一個大麻合法化的地區（華盛頓特區和20個州允許病人在醫生的建議下購買大麻）。部分顧客遭到商店拒絕，部分商店也被迫暫停營業以補充庫存，但大致來看，這個「綠色星期三」可說是非常成功。科羅拉多的大麻市場究竟如何運作？

於2012年11月獲得55％選民支持的64號修正案，為科羅拉多的大麻管制設下了限制，包括最高稅率、市郡有權拒絕轄區內設立大麻商店等；官員和議員則在2013年訂出了細節。科羅拉多的藥用大麻管制系統十分完善，這不但讓選民更願意支持大麻合法化，也為休閒用大麻產業奠定了基礎。10月之前，唯有領有執照、資格完備的藥局可以販售大麻；科羅拉多的「垂直整合」系統也會維持至10月，亦即零售商必須自行種植大部分它們販售的大麻。

挑戰之一，就是將價格訂在恰到好處的水準；價格太低會鼓勵過量使用和出口，太高則會讓非法販售者有機會生存。市場尚未穩定，但目前的高品質大麻每盎斯約250～300美元；價格高出藥用大麻許多，主因在於沉重的稅負。超過21歲的人，才能在科羅拉多購買、持有和使用大麻，且必須在私人不動產內、獲得主人同意後才能使用，也不可以將大麻攜至州界之外。居民每次可購買1盎斯，非科羅拉多州民則為四分之一盎斯；找地方抽大麻也不容易，因為科羅拉多禁止阿姆斯特丹式的「咖啡店」。

實施這些規定已非易事，但科羅拉多官員還得讓聯邦政府滿意才行，因為1970年的藥物管制法案仍舊將大麻列為非法。8月時，副司法部長柯爾（James Cole）發佈備忘錄，顯示聯邦政府會允許科羅拉多和華盛頓的試驗，只要它們不妨礙販售給未成年人、販售至州外等8項「優先執法事項」即可。不過，鄰近地區現在已經出現源自科羅拉多的大麻了。如果科羅拉多和華盛頓能成功推行大麻合法化，勢必會有更多州跟進；但如果情況完全失控，大麻合法化也將煙消雲散。（黃維德譯）

©The Economist Newspaper Limited 2014

經濟學人英文原文

The Economist

The Economist explains

How does Colorado's marijuana market work?

By The Economist

From The Economist

Published: January 09, 2014

Jan 6th 2014, 23:50 by T.N. | DENVER

ON JANUARY 1st, 420 days after the citizens of Colorado voted to legalise marijuana, around 37 pot shops across the state opened their doors to all-comers. Stoners in Denver and other cities braved freezing temperatures and two-hour queues to be part of this historic moment, for Colorado has become the first jurisdiction anywhere in the world to oversee a legal, regulated market for recreational marijuana (20 states plus Washington, DC, allow patients with doctors' recommendations to buy the stuff). Some customers were turned away, some shops have been forced temporarily to close while they replenish stocks, but "Green Wednesday", as it was inevitably dubbed, was generally considered a big success. How exactly does Colorado's marijuana market function?

Amendment 64, the measure approved by 55% of voters in November 2012, set certain parameters for Colorado's marijuana regime, including maximum tax rates and the rights of cities and counties to exclude pot shops from their jurisdictions. But the details were worked out by officials and legislators over the course of 2013. Unlike many states (including Washington, which has also legalised marijuana but not yet licensed recreational outlets) Colorado's medical-marijuana system is well regulated; not only did that make full legalisation an easier sell to voters, it provided a foundation for the recreational industry. Until October only licensed medical outlets "in good standing" can serve recreational customers, which is why lots of the shops that opened on January 1sthave names like Citi-Med and Medicine Man. Colorado's system of "vertical integration", under which retailers must cultivate most of the stuff they sell themselves, will also remain in place until October; this makes monitoring easier for the state, even if one irritated observer likens it to a supermarket owning apple orchards.

One challenge is to set prices at what Mark Kleiman, an analyst, calls the "Goldilocks point": too low and you encourage excessive consumption and out-of-state exports; too high and you leave room for illicit dealers. The market has not settled in yet, but prices for recreational marijuana, currently around $250-$300 for an ounce of good weed, will be significantly higher than the medical stuff, thanks to hefty taxes: a 15% excise tax levied on "average market rate" and a special 10% sales tax (the state's general 2.9% sales tax will also apply). Only those aged over 21 may buy, possess and use marijuana in Colorado; they may consume it only on private property with the consent of the property-owner, and they may not transfer it across state lines. Residents may purchase up to an ounce at a time; out-of-staters are limited to a quarter-ounce, and, if buying weed rather than edibles, face the extra challenge of finding somewhere to smoke it: Amsterdam-style "coffee shops" are banned. Locals can grow up to six

plants at home, and give away (but not sell) the proceeds. (The full rulebook extends to 136 pages.)

Implementing all this will be hard enough. But Colorado's officials must also keep the federal government happy. Marijuana remains illegal under the 1970 Controlled Substances Act, and the feds have been more than willing to crack down on some medical-marijuana operators in recent years. In August James Cole, the deputy attorney-general, issued a memosuggesting that the federal government will allow the experiments in Colorado and Washington to proceed so long as they do not impede eight "enforcement priorities", including the diversion of marijuana to minors and to other states. But that is not a foregone conclusion: Colorado-sourced medical marijuana has been turning upin neighbouring states. The American public is beginning to rejectprohibition and its attendant injustices. If Colorado and Washington manage not to screw things up, more states will surely follow them in legalising—including California, probably in 2016. But if it all goes wrong, as it may, the whole thing could go up in smoke.

©The Economist Newspaper Limited 2014