Strong medicine

06 January 2007: Economist

"Why some people think opium production should be licensed in Afghanistan

How one country's problem could ease the world's suffering

SOPHIE-MARIE SCOUFLAIRE, the chief pharmacist for the French humanitarian agency Medecins Sans Frontieres, has spent a lifetime watching people in disaster-stricken areas of the world writhing in pain and she has put in many hours frantically trying to procure enough opiates to relieve her patients' agony.

That is surprisingly hard. Part of the trouble is that most countries are allowed under a United Nations regime to import only a very small quantity of narcotics for medical use and governments are often slow to apply for an increase in their quotas. Sometimes, sincerely or otherwise, they say they doubt their own capacity to handle increased quantities of drugs. So in a real disaster MSF has to beg the local health ministry to seek an increase. And in places where no government exists, MSF doctors go straight to the UN for permission to import drugs on their own responsibility. But that process is burdensome.

Now compare the dire shortage of medical opiates that afflicts the poorest parts of the world with the deeply unwanted surplus of poppies that has just been gathered in Afghanistan. According to Antonio Maria Costa, director of UNODC, the UN drugs and crime agency, the 2006 harvest was a record; both the acreage sown and total output have risen sharply. Farmers have harvested about 6,000 tonnes, amounting to 90% of total world output.

Afghanistan's President Hamid Karzai, pointing to the links between the resurgent Taliban and the drug business, has called the opium trade his country's "worst enemy". But farmers, flush with cash, have already been planting new crops. In response the American anti-drugs chief, John Walters, said last month that the United States planned to wipe out the crop by spraying the seedlings.

In defence of such an indiscriminate approach, it is pointed out that less drastic measures, aimed at persuading farmers to switch to legal crops, have failed. The farmers earn around three times as much from opium than from other crops; many say that they cannot support their families without the income they receive. And some complain that the Americans have already started spraying.

But a think-tank with offices in Europe and Kabul has made an alternative suggestion. Emmanuel Reinert, director of the Senlis Council, says Western governments should start pilot projects, at least, as a first step towards licensed poppy-growing to make essential medicines. He believes that it will prove impossible to eradicate opium production, and that trying to do so will play into the Taliban's hands. He also believes that by turning opium fields over to medicine production, the current shortage of opium-based medicines will be solved. The statistics cited in favour of this idea are indeed startling. UNODC figures for 2005 suggest that 80% of the world's population had hardly any access to morphine or other painkillers.

There are plenty of counter-arguments: would it ever be possible to offer farmers more money to sell their crop for medical uses than they now get from drug lords? Christopher Langton, an analyst with the International Institute for Strategic Studies in London, thinks licensing could work if it were introduced cautiously, using a mixture of carrot and stick. As he puts it: "If a farmer is faced with the choice of eradication or production under licence, he might compromise." But allocating licences would be a contentious affair, and might add to ethnic strife if badly managed.

Supporters of licensed production cite the example of Turkey, where in 1970 the government faced American demands for complete eradication of poppy farming. Suleyman Demirel, who was then prime minister, retorted that this would be bitterly unpopular, and successfully counter-proposed that the crop should be diverted to medical use.

Perhaps part of the solution might lie in an Australian discovery: a firm in Tasmania has made a variety of poppy in which the synthesis that leads to morphine is interrupted at the last moment. That makes the poppies more useful for the production of pain-killers and less handy for making heroin. If that does not work, here is an even bolder idea: an American security writer, Walton Cook, has argued that simply paying every Afghan farmer not to grow poppies would be cheap compared with the social cost of heroin use."

Have I told you that the hashish crop eradication in Lebanon has been symbolic this year? And that people are ASKING for it to be licensed? But the current government is not even Demirel's. Any way, i'm not for licensing: look at the tobacco regie. The government would create a monopoly that would make the rich richer on the back of the poor farmer. As bad as it is today, the system probably lets more money reach the poor than the institutionalized theft that would come with organizing it under Lebanon's current economic system. You cannot fix only one part of the system.