Only those who dare to go too far can find out how far one can go.

Pavel Bem, M.D.

“Only those who dare to go too far can find out how far one can go.” Looking back a few decades, how else can we try to evaluate our efforts to establish reasonable and, so to speak, cost-effective strategies and programmes to tackle the problems ensuing from the use of psychoactive substances? For me, the words of the American poet and playwright T. S. Eliot have become a paradigm which I do not have to think about any more.

To stop means to become fossilised, to fail in the confrontation with the endless rigidity of social systems based on the principle that what is different must be excommunicated beyond the borders of the generally perceived social reality. Human society is unable to rid itself of these rigid patterns of thinking and behaviour, despite the advanced stage of the popular “human-rightsism”, the set of thought and behaviour patterns trying to accommodate a society that would like to be open to various minorities, and human rights in general. The truth is that somewhere deep inside (the “inside” is meant as a deeply personal phenomenon, as well as a social archetype corresponding with the stereotypes of human behaviour, and the numinous content of the unconscious human mind as a whole) we harbour malice against addicts. This malice is projected into the everyday decision making of individuals and the whole community. The “decision makers” and the expert public can only experiment and push back the borders of the perceived reality by unconventional, innovatory, and daring steps or projects. This can be confirmed by everybody who ever tried to establish a reasonable drug programme in their country, their city, or their community. The expression “reasonable” is absolutely spot on here because what else are we after but reducing the morbidity, mortality, or health, social, and/or economic costs related to the interaction of individuals and society?

As a manager, a psychiatrist, and a politician I have had an exceptional opportunity to be one of the “founding fathers” of European, national, and communal drug policies. And one experience I have had – besides the generalisation of the above-mentioned quote from T.S. Eliot – is reflected in the famous Zen kōan: “The path is just under your feet.” Yes, many times when we started to run in circles it was simplicity and intuition that saved us. Looking back, I can dare to say that the effort to establish a rational drug policy is based on the good old values of European Cartesianism – reason, pragmatism, functionality, and provability. That leads me to the optimistic conclusion that all of our “journeys of discovery” have their importance and one day they will become as commonplace as Newton’s theory of gravitation.

The role of cities and local government in the struggle against the impact of drug use is undisputed. There is not a single functional national drug policy which doesn’t have a clear reflection in local drug strategies or programmes. Just like the two sides of a coin or the Eastern philosophy of the balance of the principles of yin and yang. The parametrical “parity” as declared by me can be an object of criticism, but on the other hand pragmatic experience tells me: “Do what proves sensible, functional, and good.” I have seen many good city drug policies and very few good national drug policies…

What does such a “good thing” look like? It is simple, efficient, pragmatic, rational, productive, and low-cost in terms of public finance, and in particular it is humane and effective. That is why we in Prague provide considerable resources for primary drug prevention but we also try to look for addiction-threatened individuals in order to give them quick and effective “first aid”. That is why we create “survival programmes” with a single aim – to offer the chance of a more productive and healthier lifestyle for problem drug users and addicts. At the end of the transformation process there is long-term treatment care with follow-up care and re-socialisation programmes. All this costs money. Some things cost more, some things cost less. And the equilibrium that arises from the appropriate combination of prevention, therapy, harm reduction, and lawful repression is a never-ending process but still enables an advanced society to deal with drug problems over a long-term period. We simply don’t have any other options. On this journey I wish all of you endurance, courage, and a lot of personal joy at your achievements.

Pavel Bem, September 2010