I am very grateful to the University of Technology, The University of the West Indies and the National Drug Council of Jamaica and the Diabetes Association of Jamaica for inviting me to speak at this prestigious Conference and the University Diabetes Outreach Programme (UNOPS) for bestowing on me this honour of the Sir Phillip Sherlock Award.
Following in the footsteps of such luminaries as Knox Hagley, David Picou, Sir George Alleyne, Winston Davidson, Ronald Thwaites among others, understandably create for me a level of intimidation and anxiety about living up to the expectations this occasion. I reflect on my good fortune to have had Sir Phillip as a mentor and friend from the time I joined the University of the West Indies in 1969, his co-opting me to give the young scholars lecture to Association of Caribbean Universities (UNICA) symposium in Barbados in 1975 and much later in 1993, his collaborating with me as Pro Vice Chancellor of Development and Alumni Relations and the Guild of Graduates in presenting that memorable event “the gathering of graduates.” Indeed one of my most treasured mementoes is a photograph of Sir Phillip and I sitting on a bench on the Mona campus of UWI shaded by a poui tree after the first plenary session addressed by Derek Walcott who had only three months before been awarded the prestigious prize of Nobel Laureate in Literature. In the souvenir magazine, Gathering of Graduates edited by Cecile Clayton, Sir Phillip wrote under the title UWI our child and father to be:
“How fortunate we all were in our first 33 students and pioneer scholars who with them saw UCWI and its teaching hospital as a cause as well as a place, a centre of scholarship and a source of inspiration. From the very beginning, by reaching out to the little August Town community on their doorsteps they showed that education and especially higher education was no longer a dividing force in the society but a powerful unifying source of ennoblement, empowerment and leadership.
Among the onlookers at the Gathering was a man in his early eighties who had been one of the first locals to be employed as one of the maintenance staff. We spoke afterwards about having seen the undergraduates trying on their scarlet gowns for the first time. Their achievement was our achievement. I understand why his eyes were bright with tears”
Those sentiments portray passion, sensitivity and humility.
And as I grappled for words to describe my experience with this incredible man who, at 95 years, co-authored the magnificent Story of the People of Jamaica with Hazel Bennett, the launch at which I attended in 1997, there came Rex Nettleford to my rescue. I gratefully invoke the spirit and presence of Rex into this gathering today as I draw from his own erudite tribute to Sir Phillip in 2008, in celebration of the 50th anniversary of the Caribbean Quarterly Journal of which Sir Phillip was the founder and first editor:
“Sir Phillip was a great spirit, the avatar of all that gives force, purpose, life, hope and meaning to the turbulence, contradictions and chaos of our multi-sourced existence. He belonged to the chosen few The west Indies was lucky to have had at the helm of its social revolution – the chosen few who believed that the intractable problems of underdevelopment and the attendant immiseration of the mass of the population had to be met by the empowerment of the people through the exercise of their intellect and their creative imagination. So he himself has been poet and historian, policy determiner as well as classroom teacher, social worker as well as philosopher as well as administrator and man of public affairs”.
I am sure that in all these dimensions of his being, Sir Phillip would have been keen on listening and participating in this discourse on which I am about to embark. I have chosen as the title, Preventing drug abuse by interfacing medical, legal and cultural responses with a human rights vision. In the construction of this presentation, I thought it would be useful to place in context the economic realities of our times, then to focus on an understanding of the underlying issues involved in drug abuse; examine the challenges confronting scholars and practitioners as they attempt to balance the role of legal prescripts with human rights imperatives; and finally to actually grapple with implementing and sustaining a human rights agenda.
The Context of the economic reality of inequity
A couple weeks ago I discovered a book by Branko Milanovic, The Haves and the Haves not (2010). It provides a sober message especially to the young and ambitious and is so relevant to the challenges of concern to us. It illustrates that 80 percent of incomes is determined at birth, by our citizenship and the income class of our parents. With intelligence, hard work and luck we can move up in our country’s income distribution but it may do little to improve our ranking among the almost 7 billion people in the world unless our country too forges ahead. The categorization of countries as G8, G20, emerging economies such as Brazil, Russia, India, and China, and then the medium income and developing economies, into which most Caribbean countries fall and including the highly indebted poor countries like Haiti, Dominican Republic and Guyana, summarizes in a nutshell the story behind global inequality. And at a time when according to current World Bank statistics 1.57 percent of earners exceed the bottom 77 percent , it raises all sorts of questions as the role of development, international migration, and the global equality of opportunity.
The data in The Haves and Haves Not demonstrate that while the wealth gap within nations has generally declined from what it was a century ago, inequality between nations has become important. The poorest Danes for example are richer than 82 percent of the population of Caribbean but the richest Ugandan, Malayan or Jamaican is just around the 77 percentile. In other words practically all Danes are richer than all Jamaicans.
The sanguine conclusion from this fascinating study is that: “we need to realize how important it is to have high growth in poor countries because if your country is doing well you are put in a faster lane. If your country goes backward you can run but you won’t move forward globally.”
I use this reference to say that the economic context in which we analyze and make prescriptions about human behavior and the human condition is quite relevant to our discussions on drug abuse, as it is with other drug related disorders. I also think that it helps to advance the case for taking the regional integration process more seriously, since it is the most expedient mechanism for small states of the Caribbean to get in the faster lane of global competitiveness.
While the focus on regional integration must be seen as a topic for another lecture, what is relevant here is the urgent need for a collective and accelerated regional approach to drug prevention and demand reduction for drugs, themselves impediments to sustainable economic and social development. This is especially the case when studies are indicating that an increasing number of our male and to a lesser extent young females are attaching aspirations to the profession of “donship” associated with gangs, guns and drugs as being more lucrative than slogging through a perceived unrewarding education system and contributing to the formal economy of the country and region for marginal returns. Imagine the youth caught in a web of circumstances spawned by poverty, lack of opportunity and the option to make money. The choice between being powerful and continuing to be powerless, defines the risk as worth taking. How do we break this aspirational cycle?
To do so we must first understand the fundamental issues that characterize drug abuse.
Understanding the Issues
Drug abuse is a disorder that is characterized by a destructive pattern of using a substance that leads to significant problems or disease. Prof Ramesh Deossaran (2009) is of the view that this condition effects more than 7percent of the Caribbean population at some point in their lives. Drug addiction encompasses the characteristics of drug abuse but addiction leads to significant problems involving tolerance to or withdrawal from the substance that affect the sufferers either socially or in terms of their work (Dryden Edwards 2011). Most serious is when drug abuse or dependence is accompanied by mental illness in individuals making them more at risk of engaging in violence, being incarcerated or contracting infections, like HIV. The assumption behind much of what I assert in this presentation is that drug addiction is preventable. Although many events and cultural factors influence drug abuse, when youth and adults perceive them as harmful, they reduce their drug taking. Furthermore the most effective prevention programmes are those that focus on the risks of drug abuse and involve families, schools, the community and the media.
The range of drugs that are commonly abused (cannabis, tobacco, alcohol, cocaine, heroin, opium, amphetaime-type stimulants, ecstasy and inhalants including glue) is quite wide. So are the types of abusers that include young and old, male and female, rich and poor. They are also those abusers that are intent on commercial gains and illegal activities and those that are concerned with performance enhancement or “cheating.” While the prevention strategies must be aimed at all elements, this presentation makes a distinction between abuse as an aspect of criminality and abuse as a medical condition. It recognizes the influence of the former on the latter, but is primarily concerned with the drug or substance abuse as a medical condition
Although addictions are chronic disorders there is a tendency for most physicians and for the general public to perceive them as being acute conditions such as a broken leg or pneumococcal pneumonia. In this context the acute care procedure of detoxification has been thought of as appropriate treatment. However contrary to commonly held beliefs, addiction does not end when the drug is removed from the body (detoxification) or when the acute post taking illness dissipates (withdrawal); rather the underlying addictive disorder persists and this persistence produces a tendency to relapse to active drug taking.
Several studies show that addictions are similar to other chronic disorders such as arthritis, hypertension, and diabetes. One that grabbed my attention examines the myths about treating addiction. It is generally perceived that addiction is self-inflicted: “they brought it on themselves.” Yet there are numerous involuntary components that initiate the addictive process, including heredity, peer pressure, price, availability and pleasurable experience. There are others that sustain addiction by producing changes in the brain pathways that endure long after the person stops taking them. “These protracted brain changes and the associated personal and social difficulties put the former addict at great risk of relapse. Treatments for addiction, therefore should be regarded as long terra and a “cure” is unlikely from a single source of treatment” (O’Brien and McLenan 1996, p237)
This reminds me of situation, albeit, apocryphal, that illustrates the severity and protracted nature of brain changes: Two rehabilitating male substance abusers seemingly having an intense conversation on the verandah when the nurse calls: Henry, what are you doing? Answer: Nothing. Nurse: but you said that yesterday. Answer: Yes, but I was not finished.
This is just an illustration of the type of challenges to be confronted.
Confronting the Challenges
The view of addiction as a chronic medical disorder puts it in a category with other conditions like adult onset diabetes, some forms of hypertension and asthma, which show a similar confluence of genetic, biological, behavioural and environmental factors. Therefore it may be argued that substance abuse disorders, like the three diseases may be mitigated even when genetically predisposed, by reducing the high risk environment, establishing relevant behavioral choices and other forms of maintenance treatment (like medication, exercise) What however is to be noted is that effective medications are available for treating nicotine, alcohol and opiate dependence but not stimulant or marijuana dependence (Alan Lesher 1997)
There is another type of challenge: Of particular relevance, is the interminable debate as to whether or not to legalize marijuana? The arguments, for and against, focus on factors such as efficacy, deterrence, health and medical uses and their economic implications. But perhaps the most compelling case for liberalization is made by the Rastafarians themselves on grounds that ganja is the key to a new understanding of self, the universe and even God who is believed to come to man through the use of the holy herb with its special power to loosen up the mind. There are clear parallels with the use of Hashish historically within Muslim mysticism (Suffism) although such practices were always denounced within orthodox Islam.
Bob Marley who adopted Rastafarianism in 1968, was perhaps the most respected proponent of the linkages between oppression of the poor of Jamaica by “Babylon” and the ascendancy of the religious value of the herb. Marley’s Redemption Song calls upon the oppressed to “emancipate yourselves from mental slavery. None but ourselves can free our minds.” His unabashed endorsement of cannabis, variously referred to as “the tree of life,” “spliff,” “ganja” “herb” and “ Kaya,” also the title of an album. In songs like Kaya, ganja is the route to emancipation. He sings: “Feeling irie, ‘cause I have some Kaya now. I feel so high; I even touch the sky, above the falling rain.” In Easy Shanking, Marley sings: “Excuse me while I light my spliff. Good God, I gotta take a lift. From reality I just can’t drift; that is why I am staying with this riff.” Nowhere is the resentment of the official attitudes against marijuana better articulated than in the I shot the Sherriff which is about a” pot “grower hunted by a relentless Sherriff. It is a song written and sung by Marley and popularized by Eric Clapton and you no doubt recall some of the poignant lyrics:
Sherriff john Brown always hates me; for what I don’t know. Every time I plant a seed, he said, kill it before it grow. He said kill them before they grow.
These rhythms to which we dance and the lyrics we so vociferously sing have deep meaning for the discussions we have on the issues of drug abuse. They speak to the fundamental issues of human rights and at the same time raise moral, ethical and legal challenges that are not easily dispelled. The jury is still out but in July 2009, The Italian Court of Cassation, the highest criminal court in the land, overturned drug trafficking conviction of a Rastafarian saying that the amount of marijuana he possessed was consistent with the heavy use that comes with his religious beliefs. The 9th Circuit Court of Los Angeles is currently considering the argument by Ben Makuhana, that Rastafarians are required to carry and use cannabis sacramentally. Therefore his choice is between breaking the law or sinning in the eyes of God. This trend of reasoning accords with the overall view of Rastafarians that ganja has become a “political herb” which it is not. It is instead considered by them as an intensely religious experience and part of a larger ritual system that includes meetings, prayers and biblical interpretations supported by the scriptures.
I recognize that for some in this audience and elsewhere, the trajectory of this discussion is bordering on heresy but it is a relevant debate about cultural responses. After all it was Sir Phillip who as Vice Chancellor of UWI, commissioned the first empirical study of the Rastafarian movement in Jamaica carried out by three outstanding academics M.G Smith, Roy Augier and Rex Nettleford (1966). This Study not only enhanced the understanding of the Government and the public of the fundamentals of Rastafarianism. It stimulated a series of others. Scholars—historians and cultural anthropologists (Chevannes 1999 and Emery 2009) identify the cultural, religious, social and economic contributions of Rastafarians to the Jamaica society and the internationalization and respectability of their faith. Emery finds empirical support for the Rastafari’s claims: For example in:
1. Psalms: 104: 14 “He casuseth the grass for the cattle and the herb for the service of man”
2. Proverbs: 15:17 “Better is a dinner of herb, where love is, than a stalled ox and hatred within”
3. Genisis1: 11-12 or 3: 18 : “ thou shall eat the herb of the field”
4. Exodus: 10: 12 “Eat very herb of the land “
Yet on the other hand, there is the view emanating from research and policy agencies that young people socialized in use of marijuana, tend to graduate to harder drugs, thereby justifying the case against liberalization. I am on record for being a foremost advocate to the youth to say NO to Drugs.
There are other challenges related to drug abuse. Injecting drug use for example is a compounding factor. The practice is on the rise throughout the world. Research suggests that between 10-15 million people in 135 countries inject drugs. Globally, 5-10 percent of HIV infections come from injecting drugs. In some countries the rate is more than 50 percent (UNODC 2008). In the Caribbean a recent study by UNAIDS has indicated that while still insignificant, injecting drug use is increasing gradually.
Yet other challenges involve paying attention to drugs at the work at place, strengthening the public health institutions to cope with an accelerated response, enhancing professional competences to achieve greater impact on prevention, especially focusing on the multidisciplinary linkages between health, education, legal affairs, community development, social welfare, youth and sports. Most pervasive and insidious of all is drug trafficking and its related ills which present one of the most potent threats to democracy and stability in this Hemisphere. This is exemplified in the exponential increase in drug related crimes in Mexico, the spillover effects elsewhere in Jamaica for example and the unabated armed struggles in Columbia financed by the production and sale of cocaine with imitative patterns throughout the Caribbean (CICAD 2010). The characteristics of this form of imitation is that it draws an ever expanding number of innocent, largely young, victims into a net that offers a “ quick rich” fix, resulting in a growing number of addicts, incarcerated and stigmatized.
The Report of the Caribbean Commission on Youth Development co-chaired by Prof Barry Chavannes and presented at the Summit of CARICOM Heads of Government in January 2010, highlights the nature of the drug problem among the youth of the region complemented by a level of hopelessness, apathy and despair voiced by the youth of the region, which is distressing. “What’s the use of conforming when I would hardly live beyond 17 years” is a not an uncommon sentiment reported in that study. They reinforce the situation referred to in The Haves and Haves Not. These are attitudes and values that contribute to the invidious circle in which the causes of drug use is associated with unemployment and low education, peer pressure and adulation of a life style sanctioned by illegality and its effects resulting in escalating crime, the spread of disease like HIV, slow economic development and declines in life expectancy
Grappling with the Solutions
In grappling with the solutions to the challenges of drug abuse, I again turn to Sir Phillip who surprisingly, did not write on this topic but the emphasis that he placed on the regional imperatives and on the rights of youth and the ordinary Caribbean citizens is sufficient to provide guidelines by which we can proceed.
First of all, there are building blocks that have been established within the CARICOM system on which to launch a useful programme for drug abuse prevention. While each country will no doubt establish its own drug control policy, there is sufficient evidence to suggest that implementation would be most effectively achieved, through a process of regional collaboration.
• The Caribbean Cooperation in Health, for example, initiated in 1982, now in its third iteration, includes drug abuse and mental illness, among its 8 priorities.
• CARICOM Countries have begun to implement the 15 actionable recommendations of the Port of Spain Declaration (September 2007) which focuses primarily on uniting to fight the NCDs and includes tobacco control.
• Eleven Caribbean Universities have recently agreed on the priorities in the curricula for undergraduate and graduate programmes in drug abuse and drug prevention accompanied by research and outreach activities.
• They also agreed on policies for human resource development in drug demand reduction that would produce the requisite skills and expertise in collaboration with Latin American counterparts, Brazil, Dominican Republic Mexico and Peru.
• In this regard the UWI online higher degree programme in drug demand reducation and offered by the open campus and coordinated by Dr. De le Hayes is a creative way to bolster the human resource capability required to sustain drug prevention
• The recent launch of the Drug Treatment Courts is another significant initiative which recognizes the need to shift the emphasis from incarceration to prevention
• The initiation of a joint CARICOM/UNODC crime prevention programme aimed at the youth including the involvement of the education, health, culture and youth sectors is a critical element of drug demand reduction,
• The establishment of the Caribbean Basin Security Initiative (CSBSI) in 2009 in collaboration with the US has as its core objective to deal with the threats facing the Caribbean: reducing illicit trafficking, advancing public safety and security, and promoting social justice. The work programme for which US$37M has been promised by the US government is not just about interdiction. CBSI is a ‘whole of government’ approach to citizen safety and places emphasis on partnerships to advance common strategic interests, foster the personal element in security and the links between local, transnational and ‘white collar’ crime.
All this is complemented by the CARICOM Strategic Framework for Drug Demand Reduction, approved by CARICOM’s Council for Human and Social Development 2009; and the Hemispheric Drug Strategy pioneered by the Inter-American Drug Abuse Control Commission (CICAD 2010) in collaboration with the OAS. Both the CARICOM Framework and the CICAD Strategy emphasize institutional strengthening, demand reduction, supply reduction, control measures and international cooperation. They both advocate strict controls to prevent the traffic in illegal drugs and to contain the serious security threat that the criminal enterprise can pose to the state itself.
In addition, CARICOM has established the Implementation Agency for Crime and Security (IMPACS) and has established the Council for Security and Law Enforcement (CONSLE) and has made crime and security the fourth pillar of the Community alongside trade and economic integration, foreign and community relations and human and social development.
Much, therefore, is taking place in the Region. How do we bring them together to truly make a difference? The first is to recast drug abuse as a human rights issue. Human rights include civil and political rights such as the right to be free from torture and from arbitrary execution, as well as the right to vote. Human rights also include social, economic and cultural rights such as the right to health, education, and just and favorable conditions of work. Human right law requires that governments respect, protect and fulfill human rights. A corollary to this is that for the most part the international community and the international drug control bodies, until most recently, because of their focus on drug supply reduction are in a large part responsible for the state’s human rights violations, especially against young people who use and abuse drugs as well as those who are vulnerable to drug abuse. What is required is for the international response to drug abuse to be more effective in terms of the integration of human rights principles with obligations.
Second, taking the lessons learned from other areas, most notable HIV, it seems reasonable to conclude that the most effective result can be achieved when implementation of the respective strategies hinges on principles of universal prevention that address ‘licit’ and illicit drugs together. Studies show that early initiation or intense use of drugs of any kind is the most immediate risk factor. Hence unlike selective prevention that targets vulnerable groups or indicated prevention that targets individuals, universal prevention addresses social, formal and cultural norms about alcohol, tobacco and cannabis, deters or delays the onset of substance abuse by providing individuals the information and skills necessary to prevent the problem, and is applied to all members of the population who share the same general risk for substance abuse , although the risk may vary among individuals (EU 2010).
Third, the rapid developments in ICT are an asset. They foster the interaction between and among countries and programmes and reach out instantly to Caribbean people simultaneous and connect them up with activities in the rest of the World. The power of the social media and the creative zeal of the youth are fully demonstrated as I speak in the Middle East and elsewhere in the globe. We in the Caribbean could harness that type of power to contribute to worthy causes such as the prevention of drug abuse
Universal prevention as a principle converges with human rights, in so far as to respect human rights means that governments cannot violate the rights of individuals and that to fulfill human rights the governments must take budgetary, legislative, administrative and judicial measures to ensure the full realization of the rights of the individual. Clearly then drug use and abuse are human rights issues. Using a human rights framework, it is predictable that the violation, especially of young people’s human rights can increase the use and abuse of substances as well as decrease the chances of appropriate treatment.
There other connections to be made.
i. For drug control efforts to be successful and for human rights to be protected and promoted, functioning legal systems and enforcement of laws must be in place in all countries with clear mechanisms to safeguard and exercise these laws;
ii. If the international community Is serious about reducing drug abuse , adequate funding is required;
iii. The international community must also address the powerful influence of the media on young people and require that the media disseminate material that is beneficial and not harmful to health and development and rights of young people.
At this point I can imagine that if Sir Philip were in the audience, the glean in his eyes and his puckish smile would indicate what he confided in me about 30 years ago when I accompanied him to a distinguished lecture at the Creative Arts Centre, on the Mona campus of UWI. In an audible whisper, he said “Eddie, the lecturer (whose identity will remain undisclosed) has finished but does not know when to done”
Conclusion
Chairman, ladies and Gentlemen, let me now hasten to finish by stating that I remain optimistic that we can achieve Universal Prevention to drug abuse within a defined timeline. But there is need for practical steps toward a collective regional approach around an agreed strategic framework, involving all stakeholders, Universities, NGOs, the private sector and the international partners. There is no better opportunity but to hinge the medical implementation of this task to the establishment of the Caribbean Public Health Agency, the consolidation of five health institutions (CAREC, CFNI, CHRC, CEHI and CDTRL) in to one agency. CARPHA is due to become a legal entity by July 2011. It offers the prospects of being the quintessential illustration of functional cooperation, an underestimated factor in the equation of regional integration. It embraces all the requisite public health functions, including surveillance, response to health emergences, research, training and leadership.
The Caribbean Cooperation in Health the earliest form of functional cooperation triggered joint action which ensured that the Caribbean was the first region in the world to eliminate polio and measles; the Pan Caribbean Partnership against HIV/AIDS, has been declared by the UN as an international best practice, and the landmark Port-of-Spain Declaration (2007) on Uniting to fight NCDs has provided the model that stimulated the planning of the UN High Level Meeting in September 2011.
All these demonstrate the benefits of acting collectively. This was the refrain of the incredible individual in whose honour I have had the privilege to speak with you today. It was central to his role as one of the architects of UWI, as pioneer of educational outreach, as instigator of the Rastafarian study, as patron of the creative arts, as role model for the construction and delivery of regional public goods for which he received the OCC by the Caribbean Community. I could think of no fitting closure but to quote from his scriptural reflection, given at his Eric Williams Memorial lecture in 1986:
“All these were honoured in their generation and were the glory of their times. There be of them that have left a name behind them, but their praises might be reported. And some there be which have no memorial; who are perished as though they had never been and are become as though they had never been born, and their children after them…” (Face of Man 1994)
As I wrote this quote I not could help thinking how Sir Phillip would have relished in a story told to me of a Sunday school teacher who asked her junior class of 6-9 year olds to write to God, each asking him one question Whereupon 7 year old Jessica wrote: Dear God, I am reading the bible and wondering if you and your friends really did speak so funny?
For Sir Phillip these words from Ecclesiastics are like the peal of a great bell sounding across the centuries reminding us that “history is a living garment of a nation” and “the culture and traditions that are imbedded in a people are the very soul and life of a nation”
Sir Phillip’s sentiments are reflected in the picture painted in The Haves and Haves Not. They are also mirrored in the idea that equity can only be achieved by understanding the context, the underlying issues and the challenges confronting us (in this case) in our quest for appropriate strategies for drug demand reduction. I am sure that he would have agreed that universal prevention of drug abuse requires an interface of medical, legal and cultural responses embedded in the principles of human rights. He would no doubt implore us to go forward and implement the plan to elevate the very soul and life of this Caribbean nation, a vision that we must not let rest with Sir Phillip but one that we must awaken.
I am done:
Thank you
