Wednesday, February 18, 2009

Press the Government to buy the Afghan opium

An exchange has opened up on the "Lords of the Blog" on the subject of buying the opium crop in Afghanistan. Anyone can join in.

Dear Clive

I hope you do not mind my extending this exchange. It is a subject very close to my heart, both as a doctor and as someone who thinks, like you I am sure, that warfare is a problem, not a solution.
Pain relief and dealing with the poppy crop in Afghanistan are issues that are closely related. The unmet need for analgesics for terminal pain in LDCs means that more opium (the precursor for medical heroin and morphine) will be needed. At present the Afghan opium is going to benefit the both Taleban and a chain of assorted criminals leading all the way to our streets and burgled houses.
Controlling output and destination of licit Afghan opium would be a challenge, but not an insuperable challenge. I envisage an operation under the control of the WHO, who would buy the crop, and process it in Afghanistan. This would boost the Afghan economy, and lessen the mass of material to be moved. The WHO would gain experience in establishing and maintaining security of the delivery chain, which could be rolled out to other areas.

The WHO would also have the role of training doctors in LDCs to administer opiates. At present some doctors in LDCs regard opiates as dangerous, and on diagnosing terminal cancer or HIV they simply give the prognosis and tell the patient that nothing more can be done from them. Suicide by hanging or jumping in front of a lorry is not infrequent.

If there are farmers who would rather switch to wheat, then this is very welcome, and could run alongside to poppy/medical undertaking. It need not be an either/or situation.
“Opening some of the protected markets like the EU would involve negotiations between a wide range of states and the international organisations dealing with trade”. I do not grasp why the EU need be involved, except possibly to help fund the medicalisation operation. We need a short supply chain from the Afghan factories to the recipient countries.

There has been a 6% fall in opium production according to UNODOC, but most of that was due to drought. I am unaware of any claim that our presence in Helmand has caused a significant reduction in land under poppy production. I have read anecdotes of our patrols wading through poppy fields, waving to the farmers who are tending the crop.

What is the policy? It seems to be for our troops to turn a blind eye to poppy farming – understandably, because of the need to keep on friendly terms with the locals. If so, what is the mission of our troops? Is it just to create a better trained and deployed army and police force, and to see an improved civil service and (particularly important) the emergence of an effective legal structure for the country? Lord Malloch Brown (who is in correspondence with the Green Party Leader on this matter) says that the aim is to achieve “a reduction” of opium production, but it is unclear when, or if, cessation of opium production in Afghanistan will be successful. I know of no evidence that cessation is an achievable objective, which means that the Taleban and criminals will continue to benefit from the illicit poppy trade for the foreseeable future.

Against this dismal prospect, purchase and medical use of the poppy crop seems an eminently sensible course of action.


Dorothea said...

Well said. It is blatantly wrong that patients in severe pain should be left without analgesia to suffer because of the ignorant prejudices that exist against opiates.

DocRichard said...

Thanks Dorothea. On your linked piece you say, "I am interested to know whether the US has another commercial ulterior motive in trying to eliminate opiates, so that pharmaceutical companies can peddle us some more expensive, patented substitutes that are less effective."

This may be the case. The reasons given by HMG for not buying the poppy crop are so thin that I suspect corruption may be at work as well as standard Government obtuseness, but you may have hit on another component.

The synthetic powerful analgesics are strongly marketed, and I see many patients who have been put on these for no very good reason, when cheaper morphine preparations are available.

I would encourage concerned people to write to their MPs asking that Lord Malloch Brown, the FCO Minister, consider buying the crop. Caroline Lucas has engaged him, and the correspondence is now in its third cycle.