How does cannabis affect your BPD

Intoxication and drugs

The basic assumption of all drug policy is that the handling of certain substances (i.e. their production, trade, consumption and other things) needs to be controlled. The objectives of this control are, however, by no means uniform, but can range from the express promotion or even subsidization of certain (legal) drugs to the prohibition of certain other substances to the implementation of a "drug-free society". Accordingly, drug policy always has intersections with other policy areas, for example with foreign, economic, domestic, social or health policy, and is therefore under the influence of many different actors with very different interests. Such a mixture of different interests determined, for example, the emergence of the global drug ban at the beginning of the 20th century, which still has a major impact on our handling of heroin, cocaine, cannabis and other substances today.

From the opium conflict to the drug problem

The US's urge to expand economically at the beginning of the 20th century was directed, among other things, to the supposedly inexhaustible markets of the East, especially China, to which the US had neither military nor diplomatic connections. In the 19th century, China tried several times to defend itself against the immense opium imports by the British, but in the so-called Opium Wars (1839–1842 and 1856–1860) it failed due to the military superiority of England. The Americans now wanted to take advantage of this: a repressive opium policy, according to the strategy, could on the one hand weaken England's dominant position in trade with the East and on the other hand it would improve relations with China. The goal of the USA was accordingly an international agreement that should explicitly forbid opium. When the US-initiated International Opium Commission met in Shanghai in February 1909, no one would have believed that this would be the first step towards a global ban on a large number of very different psychoactive substances. [1]

Since the Shanghai resolutions were not binding, the necessary resolutions were to be passed at a follow-up conference in The Hague in late 1910 or early 1911. Almost all of the nations invited by the USA had thereupon expressed their willingness to update the results of Shanghai, only England delayed its acceptance of the conference. Probably in order not to be seen as the moral, economic and sole loser in the event of an opium ban, the British ultimately tied their belated commitment to the following condition: All participating powers should undertake, prior to the meeting of the conference, to apply the controls for opium to the same degree of severity Use morphine, heroin and cocaine. With this diplomatic move, the British wanted to hit the German Reich in particular, which at the time was the world's largest manufacturer and exporter of chemical and pharmaceutical products and therefore could not have any interest in restrictive regulation or even a ban on these substances. And this strategy actually worked to the extent that Germany was now delaying a reaction to the British advances, so that the conference in The Hague could not meet until December 1911. [2]

The result of this conference was that the entry into force of the negotiated convention was postponed until all relevant states had declared their accession. Further conferences that took place between 1911 and 1914 did not, however, lead to a universal ratification of the convention, and Germany did not implement it into national law either. "What three conferences were unable to do was ultimately decided by the First World War. The pending German ratification was made part of the Versailles Treaty and, with its signing, the Opium Agreement was ratified." [3]

With the signing of the Versailles Treaty, which came into force on January 10, 1920, Germany undertook to pass its own opium law within a year, which on December 30, 1920 with the law "Implementing the International Opium Agreement of January 23, 1912" also happened. The law made opium and its derivatives as well as cocaine subject to prescription and provided for up to six months imprisonment or a fine of up to 10,000 marks for violations; In 1924 the prison sentences were increased to three years. In the 1929 version of the law on the traffic in narcotics (Opium Act), the agreements made at the second Geneva Opium Conference in 1925 were finally implemented: Opium and opiates (such as morphine and heroin), coca and cocaine and (now also) Cannabis, whereby the possibility was provided to subject the Opium Act to constantly new substances by ordinance. [4] The criminologist Sebastian Scheerer describes this development as "the transformation of the international opium question into the international drug question as the core of the modern drug problem". [5]

The National Socialists used the drug problem in their very own way in the years that followed. For them, drug users were "anti-social elements" that contributed to "harm to public health". They exploited the "drug addiction" "propagandistically as a sign of folk decadence and Jewish decomposition". [6] Drug and alcohol addicts were seen as degenerate; the measures taken against them ranged from forced withdrawal treatments to incapacitation to forced sterilization and deportations to concentration camps. [7] At the same time, workers, and especially soldiers, were provided with the highly effective methylamphetamine pervitin to a considerable extent. According to the author Norman Ohler, the targeted drug use in war has a long tradition and alcohol in particular has been used for centuries to disinhibit and reduce fears, but "the German Wehrmacht [was] the first army in the world, the one synthetic drug used to immediately increase performance and reduce combat inhibition ". [8]

Drug Consumption and Drug Policy in the Early Federal Republic

In the years after the end of the Second World War, not much changed legally at first. At the same time, the number of opium and morphine addicts rose somewhat, but this was mainly due to the fact that those injured in the war had been medically treated with these opiates for a long time and had developed an addiction in the process. [9] According to contemporary historian Tilmann Holzer, the years after 1945 were by no means comparable to those after the First World War, when a veritable "morphinist scene" had developed among veterans and their environment. [10] Rather, the most striking thing about drug use in the period after the Second World War (and until the end of the 1960s) was its low prevalence and its age and social structure: On the one hand, the comparatively few drug addicts included very few people under 30 years of age; on the other hand, these people almost consistently belonged to the "classic morphinists", that is to say to a group of people who had privileged access to the relevant substances. In addition to the war casualties already mentioned, these were mainly people in "healing professions", above all doctors and pharmacists, but also nurses. The "classic morphinists" were people who were socially integrated and at the same time were careful to hide their addiction. Overall, it can be said that until the mid-1960s there was no drug problem in West Germany in the current sense, neither with regard to the number of users nor with regard to the public discourse. [11]

This situation changed fundamentally from the second half of the 1960s, because now a completely new type of consumer caused a sensation: It was no longer primarily integrated adults or war veterans trying to hide their consumption, but primarily about young people who formed a protest movement and wanted, among other things, to set a public sign of rebellion against the established bourgeoisie and the "everyday German culture of their parents' generation, which was shaped by National Socialism" with their drug consumption. [12] But what the adolescents and young adults regarded as a symbol of freedom, large parts of the public, the media and politics increasingly dramatized into a culture war: "The general social conflict was tied to the drug problem, the consumption of marijuana and LSD became a symbol of youth protest and thus stylized as a scapegoat for neglect and moral decay, so that the demands for tougher state sanctions to prevent the expansion of drug use became louder and louder. "[13]

The Narcotics Act (BtMG) was passed in the German Bundestag on December 22, 1971 as one of the measures in the "Action Program to Combat Drug Addiction", which was passed by the Federal Government on November 12, 1970, and replaced the 1929 Opium Act. The reasoning states that the law should stop the abuse of drugs that spread "like an epidemic" in the Federal Republic, or the "drug wave" and thus "prevent serious and often irreparable damage to health and health of young people thus prevent his personality, his freedom and his existence from being destroyed ". [14] The new law included more substances in its scope, expanded the powers of the Federal Health Office and the Federal Opium Agency, increased the maximum penalties for drug offenses from three to ten years imprisonment and restricted the right to postal secrecy and the basic right to inviolability of the home in the event of suspected drug offenses. [15] Ten years later, the BtMG was reformed by the law on the reorganization of the narcotics law, which came into force on January 1, 1982 and increased the maximum penalty from ten to 15 years imprisonment.

With the legislative changes described, which developed similarly in the other European signatory states, a drug policy based on prohibitions and punishments had become established internationally. Of course, this also provided a certain framework for the therapeutic options.

Abstinence paradigm and addiction support

Until the 1920s, it was common practice for doctors to treat opiate addicts by prescribing an opiate. It was not about "substituting" one opiate for another, but rather about "opiate maintenance therapies" or what is now called "original substance allocation". This means that morphine addicts were treated with morphine: "With these opiate maintenance therapies, most patients were symptom-free, socially integrated and able to work." The following are to be admitted to rehab centers: "With morphinists and other people who are dependent on addictive substances, the treatment goal is drug abstinence. The method of choice for the treatment of addicts of the opiate type is always long-term inpatient therapy in closed facilities." [17] Since then, this has been followed in Germany a rigid psychiatric problem definition, which was confirmed by the German Medical Association in 1955.

When, at the beginning of the 1970s, the number of opiate or heroin addicts, and thus also the number of admissions, rose, the traditional psychiatric institutions were completely overwhelmed by the rush of drug users - mostly "unadjusted" ones. Treatment was often limited to "the distribution of sedatives, attempts at discipline and stupid job offers," and relapse rates were estimated at 98 to 100 percent. [18]

As a reaction to the ineffectiveness of traditional psychiatric treatment, so-called release groups emerged in the early 1970s, which pursued emancipatory goals in particular and, above all, provided everyday practical offers: advice and communication centers, overnight accommodation, living and workshop groups, outpatient medical care centers and crisis intervention centers. However, many of these initiatives soon stopped working because they lacked government financial support. Others went through a conflictual "process that was characterized by professionalization, adaptation to the requirements of the judiciary and social services, and an orientation towards rigid US self-help concepts". [19] As a result, the release groups were replaced by the inpatient long-term therapies that were offered by specialist clinics or other specialized facilities - mainly sponsored by the large charities.

In the second half of the 1970s and especially in the 1980s, these facilities were part of the so-called therapeutic chain; Drug-free should be achieved by going through several stages. These goods: First the drug counseling, which provided information about the various therapy facilities and regulated the assumption of costs; Secondly physical withdrawal, mostly in special departments of psychiatric hospitals; third The inpatient long-term therapy, lasting an average of 18 months, which formed the core of the therapy chain and in which a drug-free identity was to be established primarily through behavioral approaches; and fourth follow-up care, i.e. the subsequent care and help with finding a job and apartment.

However, long-term therapies have come under fire since the mid-1980s at the latest. An important point was that those affected were no longer seen as equal collective residents, as was customary in the release groups, but had now become "objects of professional and therapeutic intervention": "The focus was now the person of the drug user. An 'infantile need attitude', 'narcissistic hedonism', 'orally regressive attitude' and 'emotionally ego-centered immaturity' are attested. Often comparisons are made with infants and toddlers. "[20]

Another point of criticism was the legislature's motto "Therapy instead of punishment": Paragraph 35 of the BtMG stipulated that a prison sentence could be circumvented by starting therapy. However, this has now led to 70 to 80 percent of those affected entering into such therapy due to criminal coercion, which is why the accusation was raised that the catchphrase "therapy" was instead of Punishment actually "aims at" therapy as Punishment ". This criticism was underpinned by the provision at the time in Paragraph 36, Paragraph 1 of the BtMG, that corresponding state-approved therapy facilities had to ensure that there were considerable restrictions on the free organization of life in them [21] - a requirement that the facilities fully complied with : Degrading admission rituals, exit and general communication restrictions, contact bans, confrontational methods, pronounced hierarchical structures and systems of privileges and disciplines were reported. [22]

Last but not least, sharp criticism was also leveled at the inefficiency of long-term therapies. On the one hand, the estimated 50,000 to 100,000 opiate addicts had just 2,000 to 3,000 places in long-term therapy; on the other hand, their success rate was only a maximum of 30 percent - based on a total population of 100,000 opiate addicts, the social scientist Horst Bossong calculated a success rate of less than one percent at the time . [23] The selectivity of this form of help was also assessed as problematic because it excluded help in particular for those who could not or did not want to change their consumer behavior. The so-called "junkies" were exposed to growing social and health impoverishment, which, however, was also the declared aim of drug policy at the time: The so-called psychological stress theory assumed that therapeutic treatment could only be promising at the moment when it was healthier and socially, has reached a low point and the life situation has come to a head. [24] In retrospect, one can say that the drug policy of the time was quite successful in terms of creating social and health impoverishment, but it clearly failed to achieve its actual goal of a "drug-free society".

The long road to acceptance

The criticism of the abstinence-oriented and criminalizing drug policy [25] only found lasting resonance when it became increasingly clear in the first half of the 1980s that intravenous drug consumption caused numerous HIV infections: non-sterile injection techniques, shared use of syringes (needle sharing) and a generally desolate physical, psychological and social situation made large numbers of intravenous drug users predestined to be victims of the virus. With simple repression, so began to recognize parts of the drug and addiction aid, it was no longer possible to counteract the misery of those affected, but also the fears in the population: "The threat of AIDS became, so to speak, the liberation of the discussion." [ 26]

In the following years the so-called acceptance-oriented or accepting drug work established itself in addition to the continued abstinence-oriented work. In order to reach those affected earlier and better, but also to keep them longer in the treatment and counseling contexts to be conceived, social workers now sought direct contact with the consumers. These forms of help accepting drug use were conceptually aimed on the one hand at the abolition of exclusion, but on the other hand above all at the avoidance or reduction of health and social impoverishment: "We went under the keywords 'low-threshold', 'addiction-accompanying' or 'accepting' drug work In addition to lowering thresholds that are too high, the aim is to no longer link the granting of help to the will to abstain, but rather to provide 'unconditional' help as a supplement to the drug-free paradigm. "[27] The focus was on ensuring the survival of the clientele and reducing the risks of intravenous drug use (harm reduction). The offers ranged from accommodation and accommodation facilities to the distribution of syringes and condoms to basic medical help, legal and social assistance advice and crisis intervention.

In the second half of the 1980s, opposition from politicians, but also from the German medical profession, to substitution treatment gradually began to crumble. While one had long spoken of "addiction prolongation" and of prescribing doctors as "dealers in white" with a view to substitution, the threat of HIV changed the perspective here too. In 1987, the North Rhine-Westphalian state government decided to introduce the first scientifically supported methadone program in Germany, which comprehensively confirmed the positive experiences that were already known from the USA, Great Britain and the Netherlands: The substitution improved and stabilized the health, psychological and social situation of those affected, reduced the risk of overdosing, HIV and other infections and, to a certain extent, also lowered prostitution and crime. Since the mid-1990s, substitution treatment has become increasingly established, so that in 2019, 2,607 substitution doctors treated around 79,000 registered substitution patients in Germany. [28]

The success of the substitution treatment soon led to the question of whether the allocation of original substances, i.e. heroin (diamorphine) or morphine, might not also be helpful, especially since there were also successful examples from England and Holland. In 1995, Switzerland initially launched a heroin or morphine program with 1,000 places in German-speaking countries, the results of which were promising. From 2002 onwards, the dispensing of heroin was tested in several German cities as part of a model project, which resulted in the "express recommendation" to "include this form of treatment in the standard care of heroin addicts". [29] In May 2009, the German Bundestag approved the distribution of heroin as part of standard care and thus so-called diamorphine outpatient clinics. However, this has not (yet) led to a comprehensive range of services, only ten cities have such registration offices, in which, however, only about one percent of substitution patients in Germany receive treatment with diamorphine. [30]

Another institutionalized form of accepting drug work are the so-called drug consumption rooms (DKR). In these rooms, drugs (heroin, cocaine, crack and others) can be consumed intravenously, inhalatively and nasally under hygienic and controlled conditions. Even if the drugs consumed here still have to be procured illegally, infections and drug deaths are avoided in the protected setting of the DKR, the knowledge of the risks of drug use and the possibilities of one safer use improves and the motivation of those affected to seek further help increases. In addition, the DKR also fulfill regulatory functions by relieving the public space of consumer activities and various symptoms of disorder. The first German DKRs were set up in Hamburg and Frankfurt am Main in 1994 and operated in a legal gray area for the first few years. It was not until 2000 that Paragraph 10a BtMG created the legal basis for the operation of such premises. There are currently 26 DKR in 17 cities in eight federal states. A DKR last opened in Bremen in September 2020.

A measure that has not yet been implemented in Germany is the so-called drug checking. These are possibilities for consumers to have their illegally acquired substances checked for quality and active ingredient content. In the sense of "consumer protection", this is intended to prevent unwanted overdosing and health problems caused by contaminated substances. Corresponding possibilities already exist in some European countries. [31]

Résumé

Today we can say that accepting drug work has established itself in the spectrum of German addiction support over the past three decades. This development can also be seen in the changes in preventive concepts: While in the 1970s attempts were still made to prevent any use of illegal drugs by means of deterrence by means of threats of punishment and one-sided negative and dramatic messages (so-called fear appeals), from the 1980s onwards, Prevention no longer focuses indiscriminately on any consumption of illegal drugs, but above all on preventing addiction. Consequently, legal drugs (alcohol, tobacco and medication) and non-substance addictions were also included. These pathogenetic, ie prevention concepts aimed at the prevention of "illness", were again adopted in the 1990s salutogenic Replaced concepts that aim to promote non-substance specific health - for example by strengthening life skills or showing alternatives to drug consumption.

If one thinks the salutogenic perspective consistently further, then the pathogenetic question of what makes drug users "sick" should be replaced by the following questions: What keeps drug users healthy? Why and how do they manage not to develop excessive consumption patterns? How does socially integrated drug use work? Such questions do not direct their gaze from the negative end of addiction to the "risk behavior" that precedes it and which must be avoided, but to the diverse - existing and possible - unproblematic consumption patterns and the social conditions necessary for this in terms of health promotion, consumer protection and harm reduction to support. Recently, for example, concepts such as "drug maturity" or considerations on "drug-related education" have argued in this direction. [32]

In terms of drug policy, the 20th century was the century of global drug bans. The German drug policy of the 1970s and 1980s aimed at the consistent prevention of any drug consumption and made documented abstinence a prerequisite for assistance. Since the 1990s, the accepting drug policy has gradually been established, the offers of which have impressively shown that less repression and forced abstinence lead to more health among drug users. That, in turn, is one starting point among others, which is also brought up by proponents of legal regulation of drugs. The debate about decriminalization and legal regulation of drugs has also been going on since the 1990s. It is to be hoped that such considerations will shape drug policy in the 21st century.