“Ravaged by drugs”? Let’s spread facts, not fear; science, not stigma

Today the MailTelegraph and others have been featuring the vile and dehumanising "More than Meth" campaign, which invites us to gasp and be disgusted by the faces of Americans arrested for drug related offenses. The campaign shows mugshots of individuals chronologically as their appearance changes.

Unsurprisingly, the ghoulish coverage of this stigmatising campaign omits small-print disclaimer used by its creators that "The deterioration seen in consecutive photos is not necessarily the result of drugs or addiction..." and that "All persons are considered innocent of the crimes they were arrested for until proven guilty".

The uncritical comments below the coverage of this ‘story’ on the Mail Online and elsewhere are pretty depressing, including low points such as “Ewwwww...” and “... it's not [sad], it's their own bloody fault”. The number of people arrested for drug offenses in America per year is not that far off the total circulation of the Daily Mail; out of a pool of one and a half million people, you can presumably select a dozen mugshots that tells any story you want;- that methamphetamine is an elixir of youth, that heroin use leads to steadily curlier hair. Similarly, someone with a different agenda could cherry-pick Mail Online comments from individual readers to form chronological time-series that appeared to show that exposure to Mail articles leads to increasingly reactionary and ignorant views... but that would be equally meaningless.

It is true, and let’s be absolutely clear, that use of methamphetamine, heroin and cocaine (and much more commonly alcohol) can become problematic from the beginning or after years of use, that a significant minority of users can find their control slipping despite seeing damage occurring, and that chaotic drug-centred lives, (especially when eating, sleeping and self-care get neglected) can lead to abnormally fast ageing, collapsing health and death. In fact, crack cocaine, heroin and methamphetamine, followed by alcohol, ranked as the four drugs with the greatest associated harm to the typical user (alcohol leaps ahead in terms of total harm caused due to its vastly higher prevalence) in the ISCD’s famous objective assessment of Drug Harms in the UK.

However, an individual's deteriorating health cannot simply be put down to the illicit substances they use, and separated from context, including the purity of what they use, the way they use it (are they addicted? Do they inject?), their individual biology, their life history, their social environment and the political environment. If it was as simple as these drugs being fundamentally highly toxic substances that automatically make your teeth drop out and your skin break down, amphetamines and opiates would not be widely used and valued as medicines.

Heroin and methamphetamine molecules have fixed physical properties like mass and solubility, and they have intrinsic pharmacological properties, i.e. they cause predictable effects on heartbeat and brain activity according to the dose. But neither they nor any other drugs have a predetermined property that they always take over and wreck the lives and health of everyone who tries them. In reality only a minority of drug users become addicted to drugs, doing so despite their best efforts to cut back and stop using. Addiction is not a failure of moral fibre. Put another way, drug use is neither necessary nor sufficient to tell the story of how any one of the people featured in this campaign reached such a low ebb in their lives. 

The most obvious contextual factors this campaign chooses to gloss over are social and political ones. These photos are not, say, a random sample of people who have used illicit drugs in the past year, which I don’t imagine would be easy to distinguish from a sample matched by age and background. All the photos are mugshots of people getting arrested for drugs offenses; by definition people undergoing harm. Being in and out of prison and having a permanent criminal record does not make it any easier for people with drug use problems to get a steady job and a stable lifestyle, get their problems in hand and look after themselves. Users of methamphetamine and other drugs are very often at the bottom end of America’s ever-more unequal income distribution, and numerous factors exclude them from accessing addiction treatment and health and welfare services.

Alleged drug use by the subjects of these photos seems to have become a convenient excuse to sidestep the question of why the richest country ever allows millions of its citizens to live precarious existences without a decent safetynet. Rather than questioning this, it seems that the campaign is instead telling us “Don’t make yourself worthless like these people have!” If the individuals pictured were considered to be real people with families and futures who could be helped and supported to help themselves, it might be harder for this campaign’s creators to morally justify these stigmatising, humiliating photos which themselves must negatively affect the life-chances of the subjects.

None of this criticism should detract from legitimacy and importance of running campaigns that inform people that by minimising or better still avoiding use of these particularly risky drugs, they can minimise or avoid the risks of collapsing health and death. In the opinion of the ISCD, the success of drug information campaigns should be judged not by their ability to shock or to go viral as ‘clickbait’ in newspapers and blogs looking for a free way to generate traffic, but by their honesty and their effectiveness in reducing the total burden of harm associated with drug use, including the harms of criminalisation and stigmatisation.

The ISCD is a volunteer-led organisation, (neither I nor anyone else in our scientific committee get any money for our time) and funding is tight. Since methamphetamine isn’t widely used in the UK, we’ve so far not published one of our evidence-based information pages on it. But we’ll try to get one up on the website within a month, and you can help us by donating, which pays for office costs and supports our mission to get objective, harm-reducing information out there. 

In the meantime, if you want to find out more on the science and mythology of methamphetamine, you can read a deeper evidence-based critique of meth hysteria from Prof Cart Hart and colleagues here.