The year is ending at a gallop. Brexit may have pretty much paralyzed the government in Westminster but in national, regional and local administrations the wheels still turn. Health issues still feature in the media, some, such as rough sleeping and alcohol intoxication, being seasonal fixtures. Universities and experts continue to provide new analysis, information and fresh angles on key subjects. This may all sound very self-evident to colleagues outside the UK, but it is reassuring, at least to me, to take a moment and remind ourselves that the earth has not stopped turning on its axis as issues over the backstop, second referendum, votes of no confidence etc. etc. dominate the news and conversation.
Last week provided a very welcome reminder of the broader world with an invitation to the launch of a new book, Collapse of the Global Order of Drugs. In the interest of openness, I should declare that I have known the editors Axel Klein and Blaine Stothard, as well as some of the contributors, for many years. However, I can assure you that my views on the value of the book were not influenced in any way by the lavish hospitality, as this was entirely absent (not even water!). What the evening did provide was an opportunity to reflect on the fundamental changes that have occurred across the globe in terms of drug reform and the challenge this poses for the current United Nations framework. In the audience were a range of experts including friends, colleagues and a former boss, collectively a wealth of expertise and wisdom.
Most present were in favour of the reforms undertaken in Uruguay, the phenomena of cannabis reform happening within US states and the recently enacted changes in Canada. Within the UK there has also been some movement around the use of medicinal derivatives of cannabis. An increasing amount of evidence is also amassing to suggest that a number of drugs currently seen as substances of abuse may have clinical application (MDMA for example). One of the guest speakers did sound a note of caution and asked us to consider the situation in various countries where governments were not only showing no interest in reform but were pursuing hard-line, draconian policies. While these are likely to see increases in health-related harms (e.g. Blood Borne Virus infection rates) we should not lose sight that in many countries and cultures these policies are popular. What to us in that room is a powerful evidence base which combines human rights, health-based approaches, pragmatism and clear benefits is to others socially corrosive defeatism that leaves the vulnerable abandoned to their fate. The latter view is not one I hold but it’s foolish to ignore opposing views. One element of the support for drug reform that does stand out for me is that many supportive of the moves to legalise cannabis are hostile to proposals that would reduce the harm associated with the use of nicotine. We shall see how this apparent contradiction develops.
Now one attribute I am blessed with is contraryism. Some would say that I am just unnecessarily argumentative (this may also be true) but I can see various sides of most contentious issues. It was a useful skill as a civil servant when preparing briefs for parliamentary debates. It can help advance a cause or position as it allows for approaches beyond the butting of heads with opponents, which rarely changes minds and often leads to deeper entrenchment of opposing views. And its just not people with opposing views we need to engage better with. I have often seen those who should be allies arguing amongst themselves over matters of degree, often based on an internal philosophy or approach that doesn’t adequately value the role of others. Where this is compounded by competition for scarce resources be these financial, political or staff, its recipe which normally hinders or prevents initiatives and delivery. This has often afflicted projects which aim to reduce harm in Night Time Economy settings. The priorities and demands of law enforcement, licensed venues, public health, emergency departments, local authorities, partygoers and residents can all appear an overwhelming mix. However, we have example that with the right mechanisms in place, mutual respect and a willingness to work with others and maybe try something a bit different that real and demonstrable improvements are possible.
So, my Christmas suggestion is that we all make the effort to engage with colleagues from differing fields and backgrounds. Challenge our own understanding and biases, how do they look to those outside our particular silo? Maybe even reach out and engage with opposing views, you don’t need to engage in twitter warfare (at least not over the season of goodwill), just improve your understanding of how other views are sustained. Who knows it may lead to some new allies and fresh advances.
For those celebrating Christmas I wish you a fantastic time. If you get any holiday, I hope you enjoy it. To all of my best wishes and thanks for being part of City Health International.