Tag Archives: Drugs

PrEP

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PrEP stands for Pre-Exposure Prophylaxis – a combination of two medicines (tenovir and emtricitabine, sold under the trade name Truvada) that greatly reduces the risk of HIV infection. It is a prescription drug taken daily by people who are at high risk of infection. According to the US Centers for Disease Control (CDC) the risk reduction is at least 90% for sexual transmission of HIV and at least 70% for injected drug use.

I’m in the UK at the moment and a big news story has been the dispute over who should pay for PrEP. The disputants were the National Health Service (NHS) and the local authorities. The NHS argued that it was a public health issue, so the local authorities should pay. The local authorities argued that they couldn’t afford it. The judgement came down against the NHS.

So what is there to get stroppy about? Well, it seems to me blindingly obvious that the cost of PrEP should be born by the individuals who need its protection. The pills cost GBP13 (USD17) per day. This is as much as five café-bought cups of coffee every day. That’s a lot of money, but I’d hazard a guess that a drug habit costs more. And for people at risk of sexual transmission, good old-fashioned condoms are a very affordable alternative.

This point was made in a Radio 4 interview with a lobbyist. She seemed affronted and said that it was not always practicable to use a condom every time one has sex. By way of elaboration she said that people were often too drunk to remember to use a condom. Finally, in words that could have been crafted to create maximum stroppiness, she said that if taxpayers declined to pay for PrEP they would be up for much higher expense to treat HIV-positive people. “That sounds like blackmail,” said the interviewer. The lobbyist disagreed.

Sometimes public policy should not be based simply on cash flow projections. Principles should come into the picture too. Every time a principle – the principle of personal responsibility, for example – is violated in favour of financial pragmatism it becomes harder to invoke that principle the next time.

Victims and Criminals

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A young man died at the electronic music festival recently. The cause of death? Illicit drugs, which are said to be commonly available at such festivals. What makes me stroppy? His family are describing him as a victim and blaming the festival organisers for his death.

Unless he was held down and forced to swallow pills, or an attacker forcibly injected him, he was not a victim. He was a criminal*. And if festival organisers were required to guarantee the safety of every patron who chooses to indulge in dangerous or illegal activities, I suspect the ticket prices would be much higher than they are.

What makes me even stroppier is that the courts seem to put drug dealing on a par with shoplifting. Three young women who were caught selling ecstasy tablets at a nightclub were given 14-month suspended sentences plus 200 hours of community service. One of them was let off the community service because she was pregnant! These people are beyond any reasonable doubt serious criminals and should be punished accordingly.

* Disclaimer: I’m not a lawyer and I don’t know if using the drug that this young man used is a criminal offence in Australia. I’m using the word ‘criminal’ in a non-legal way to mean ‘perpetrator of something that is so morally reprehensible, so socially damaging and so stupid that it ought to be a criminal offence’.

Unintended Consequences

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I have just read a depressing article by Chris McGreal in the Guardian Weekly.  It’s headed ‘Beattyville: abandoned by coal, swallowed by drugs’ and describes the state of impoverishment and demoralisation that followed the closure of coal mines and other industries in Kentucky.

My stroppiness index rose when I read about the ‘pop’ scam, which works as follows. Supermarkets sell discounted cola to poor people, often for food stamps. The poor people sell the cola to smaller shops, cheaply enough to allow for resale at normal prices, and use the money to buy drugs – in particular an addictive pain-reliever called OxyContin that is supposed to be available only on prescription.

Here is a classic case of unintended consequences, though I’m not sure how anyone administering the food stamps programme could have confused fizzy drinks with food.  I’m not sure what conclusion to draw.  Perhaps it’s that no matter how well-intentioned a policy may be, and no matter how carefully it is crafted, people will find a way to subvert it, turn good to bad, and make poor people poorer still.

As it happens much of my recently published opus, The Eeks Trilogy, is about unintended consequences in the realms of robotics, human relationships and space colonisation.