Prisoner of War

Shawn is a heroin-addicted patient of mine who periodically disappears from my methadone practice. One time he was gone for nearly a year, but usually the absences last weeks or months. When he fails to show for his appointment, I know he’s back in prison. He’s a street dweller and petty thief, so his crimes never result in long jail terms. Like most Downtown Eastside petty criminals, he steals or deals to feed his drug habit.

Shawn (not his real name) grew up in a small town in Ontario, the child of an alcoholic father and a much younger, intimidated mother. Like many addicts, he unwittingly began to use cocaine as self-medication for his undiagnosed and untreated attention deficit hyperactivity disorder. His recollection of school life in Kelowna is typical for ADHD: “I was bored and restless waiting and watching the clock until I could get out of the classroom. I felt like I was in a jail cell. I could never pay attention.” Self-medication became addiction, to heroin as well as cocaine, and another criminal was created.

Canada’s war on drugs-or, more accurately, on drug addicts like Shawn-is about to heat up. The Harper government is proposing legislation to increase the penalty for possession of illegal substances. In any war there are enemies-in this case, human beings whose childhood traumas have driven them to find relief in the use of psychoactive chemicals like heroin and cocaine. From a physiological perspective, these drugs are painkillers. As a physician working with drug-addicted people on the Downtown Eastside I can verify what the research literature has made abundantly clear: in the vast majority of cases, injection drug use is the result of overwhelming trauma in early life. Such trauma not only sets up a lifelong psychological craving for chemical relief; it also primes the neurobiological brain circuits that respond to narcotics and other street drugs.

What if we looked at Shawn in a different way? What if we recognized that the injection drug user who turns to criminality is a human being in desperate need of relief from his pain?

And what if we recognized the uncomfortable truth that, at heart, many of us are addicts: attached to behaviours that give relief and pleasure in the short term but cause ourselves or others or the planet itself grave harm in the long term? Cigarette smoking falls into this category. So do food addictions that lead to obesity. Gambling addictions can be devastating. Alcohol addiction is widespread and harmful, sometimes lethal. Shopping addictions have led to personal and family ruin. Workaholism blights many “normal” families. Who has not been affected by such addictions? If we viewed Shawn’s injection drug use as occupying a place along the same continuum of behaviours, would we still favour policies that punish rather than heal?

In an attempt to help Shawn establish a more stable life, his social worker recently sent him to my office with a detailed medical-disability application that, if approved, would get him off the street. It is instructive to see how he describes himself. With his permission I reproduce here, precisely as he wrote them, the words Shawn scribbled at the beginning of the disability form:

In My opinion My life as I no it to the truth. It started when I was about 11-12 yrs old and I was in the wrong crowd of people to associaiate with. Because of that my life as been in jail for approx 18 yrs out of 37.

From being where I have been and seen what I have seen was a big problem and bad influence on my own life and for example at age of 18 seen a coulpe burttle murders happen within 7-8 yards as well people committing suaside.

Plus I have now lived on Vancouver’s worst streets. Skid row and using IV drugs heroin cocaine. Ive lived here homless and in hotel rooms for 15 years minus all the jail time. I have Hepatitus C from IV use. I grew with an alchol addiction from the he would Physicly Beat my Mom as was us kids.

I’m very limited to what I can make extra money from, since all this has happened Ive lost a lot of self esteem and get a mild paranoia from other peers. witch I’m on medication for.

This damaged man-with severe ADHD and learning disabilities, post-traumatic stress disorder, deeply entrenched drug addiction, no employment skills, and no history of successful human relationships-is the enemy we’re fighting in our so-called war on drugs. He’s someone the police devote their energy to investigating and arresting; about whose misdeeds prosecutors gather evidence; whom socially conscious and poorly recompensed legal-aid defenders assist; and whom learned judges repeatedly incarcerate.

The war on drugs is really a war waged against flawed but sacred beings, as we all are. The Harper government’s proposed legislation may, as an election looms, have political benefits, but it is misguided and futile. Like similar laws in the U.S., from which our government draws its inspiration, it may take Shawn off the streets for longer periods.

But it will do so at considerable cost to the taxpayer, and it will have no appreciable effect on his drug trafficking or drug use.