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
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| 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
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
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