WITH CRACK COCAINE USE, EVERYTHING IS DIFFERENT

Apologies not easily accepted, writes Dr. Mark Tyndall,

The Rob Ford scandal is about crack cocaine. No matter what people think of his politics or his persona, Ford would be going about his City Hall business if it weren’t for that elusive crack video.

After months of denial, Ford finally admitted he had smoked crack. Even if we are to believe that Ford only used crack once during one of his “drunken stupors probably approximately about a year ago,” he is unlikely to get through this with his political career intact. The admission of problem alcohol use, marijuana use, dependency on pain killers, or even snorting cocaine could be ridden out with apologies and promises to abstain in the future, but crack is different.

There are many thousands of people across Canada who use crack — many on a daily basis. These are not the movie-star types who offer cocaine at parties, but the underclass of Canadian society. Even among drug users, “crackheads” are at the bottom rung of the drug use ladder. People to be avoided and demonized. Crack is cheap, readily available, and habit-forming. It is a powerful euphoric agent that can dampen the pain and make troubles disappear. Unfortunately, this is short-lived and within minutes the pain is back, troubles haven’t disappeared, and there is an intense desire to do it all over again.

This does not mean that everyone who tries crack becomes addicted or that people cannot be occasional users. But the vast majority of crack smokers in Canada are extremely marginalized, living in poverty, and spend a lot of their time chasing after crack.

We have been conditioned through the media and by the spread of popular misconceptions that crack is untreatable and a serious threat to our cities. That crack users are a menace to society and that criminal punishment is the only way to curb the problem. The response has been to use the criminal justice system to seek out the dealers and the users and to round them up and put them in jail. All this at the expense of any reasonable dialogue, research, or even interest in prevention, treatment or the social and mental health challenges that got people started in the first place. For the most part, people who smoke crack are the disposable members of our society who have little say in what happens to them, essentially because they are smoking crack.

It is irrational to take the most traumatized, marginalized, and disadvantaged members of our society — crack users — and treat them with such contempt. This has happened in Canada, not because we are callous and vindictive, but because we have failed to understand addiction and have not been open to other approaches for engagement, care, treatment, and recovery. Instead of confronting the health and social problems associated with crack use in Canadian cities, we have left this up to law enforcement that continue to fill up jails with people who are addicted and mentally ill.

It is true that our tools to manage, reduce and eliminate crack use are very limited. Research has shown that the psychological dependency on crack cocaine is intense and that simply insisting on abstinence rarely works. There are currently no pharmacologic interventions available and programs that offer even the most basic psychotherapy are limited. We do know that at the very least, people who are using crack must get out of the environment where they are using in order to avoid the cues that perpetuate their use. This speaks directly to the need for supportive housing programs. We also need to engage communities impacted by crack to find local solutions and encourage new research into alternative approaches to cocaine dependency.

One of the most troubling parts of the Ford crack scandal is the hypocrisy. Ford has been a very vocal opponent of harm reduction and is a “tough on crime and gangs” sort of mayor. This political formula has worked well across Canada despite overwhelming evidence that drug use cannot be managed through tough law enforcement. Canada is quickly slipping behind other Western countries, including the United States, who are finally recognizing that arresting people who are addicted to cocaine is counter-productive and not only ruins people’s lives but makes the problem far worse.

For the most part, our politicians, policy-makers, and even health care professionals, have turned a blind eye to the problem of crack cocaine. The federal government is using drug users to score political points while actively undermining programs and proposals that could actually make a difference.

Crack is by far the most commonly used street drug in Canada. It causes incredible physical suffering to those who are dependent. It destroys families and erodes social supports leading to isolation, hopelessness and homelessness. It is linked to criminal activity and violence. We need a response that goes beyond tough rhetoric from our political leaders and a complete re-think of current approaches. With crack cocaine and all of its serious health and social consequences in full public view, Rob Ford has given us the opportunity to go beyond the personal failings of one individual and to reconsider our approach to crack cocaine use in our communities.