Photo Jonathan Blair

Saturday, December 31, 2016

Overdoses are a problem for dealers too

[The little crocodile is not abandoning Latin America, but while home in Canada, it keeps an eye on local drug markets. Comments are most welcome.]

The overdose epidemic risks killing--literally--the customer base of drug dealers, and they have to know it.

Drug sellers have a vested interest in keeping their customers heavily dependent but also alive. Irresponsible legal prescriptions of opioids have enormously broadened their client base: when doctors end up refusing prescriptions as it becomes clear that their client's requests are driven by addiction, dependent users move to the black market. Hence the quick increase of recent years, which may get even quicker as legal prescriptions are likely to get reigned in given media attention and the public outcry that develops as a result of it.

Cheap, powerful and hard to detect synthetic opioids imported illegally from China make it easy for dealers to satisfy demand. With a high much stronger than heroin or good old oxycontin,  synthetic fentanyl and carfentanyl quickly hooks people, for whom heroin becomes , All this is obviously good for business. Concentration, however, is also a problem as it becomes extremely difficult to get a grip on the strength of particular doses, especially once opioids are mixed with other substances. There lies the root of the current crisis, which will have killed about 800 people in British Columbia alone in 2016.

At that speed, unless doctors keep feeding the addiction pipeline--which at last, they may stop doing, in the face of the disaster that they have wrought--many dealers will run out of clients in a few short years.

So, from their standpoint, what is to be done?

One solution would be to find a way to get a grip on the doses that they hand out. "Safe" products would quickly give their dealers a competitive edge. The technical requirements of doing so in an illegal environment, and the power of the products currently entering the market, however, make this unfeasible.

Another solution is to bet that the public health effort will be ramped up substantially, keeping users alive. Better still would be to piggy back on it, basically exploiting the availability of emergency services to ensure that the essentially unavoidable overdoses become less lethal, ideally not lethal at all. The world-famous Insite supervised injection site delivers just that, with no overdose death since it opened its doors in 2003. It can't keep up anymore with increased use, however, and emergency injection sites have been set up in tents right by the alleys where people procure and inject the drug. With more resources--and they should be coming soon--public policy would basically solve the dealers' problem...

In the meantime they appear to bet on the compromise solution that results from underfunded and desperate efforts of volunteers and overworked emergency workers, setting up shop right by both their customers and the people who can keep them alive: "Outside the tent, street-level dealers sell various drugs to dozens of people injecting in the alley. More than 200 people will access the tent before the last group is hustled out at 10 p.m."

Moral hazard, in sum, meets health hazard...

Now, normalizing overdoses cannot be an acceptable solution from a public health perspective. At the same time, framing Insite and the current desperate effort to keep thousands of dependent users alive as simply abetting--if not encouraging--heavy use and trafficking takes one down a narrow, cruel and ultimately ineffective policy path.

In other words the main implication of the argument just developed is that dealers have a vested interest in getting a grip on the epidemic and, consequently that they can be part of the solution.

Thursday, March 17, 2016

Brazil: Dilma's soft auto-coup

While staying as a figurehead, Brazil’s president has relinquished power and left the government in Lula’s hands.

Brazilian President Dilma Rousseff is handing over effective control of the government to her mentor and former president Luis Inácio Lula da Silva. While on Thursday she formally named him head of the government's non-military affairs (chefe da Casa Civil), it is clear to all that he is now in charge and has become de facto president of the country. Rousseff, who was re-elected barely 18 months ago, thus becomes a figurehead devoid of real power. Institutionally, this development makes short shrift of the Brazilian Constitution, putting supreme executive power in the hands of a man who holds no elected office whatsoever.

Four developments have produced this astonishing turn of events. The first is the utter dereliction of Rousseff's popularity and power. Since her election, and in fact since the large demonstrations of June 2013, she has been unable to effectively govern the country, her utter political weakness in the face of a divided and ever-restive Congress paralyzing the government.

Second, the country is going through a shattering and multi-dimensional crisis. The collapse of the commodity-driven boom of the first decade of the century has plunged Brazil into one of its worst economic crises since World War II, with GDP collapsing by almost 4 percent over the last two years and, over the last 12 months or so, unemployment doubling, the currency dropping by a third, and inflation closing in on 10 percent. A corruption scandal of pharaonic proportion is shaking the whole political class and especially the ruling Workers' Party (PT), with hundreds of millions of dollars diverted from the coffer of the state-controlled oil company, Petrobras. To top things off, years of neglect of mosquito control is now blowing back as massive epidemics of dengue, Chikungunya and Zika fever stretch health resources and confront large sectors of its population, mostly the poor, to difficult and sometimes tragic predicaments. The challenges, in other words, would be overwhelming, even for a strong president.

Third, Lula's involvement in the corruption scandal was about to have him arrested and formally accused. As a member of the cabinet, he now enjoys a degree of immunity through executive privilege, which implies that judicial procedure can only be engaged by the Supreme Federal Tribunal, and under very specific conditions. Recordings of conversations between Lula and Dilma herself, made public by the judge responsible for the corruption scandal, show quite clearly that this was a key reason for his nomination.

Fourth, many analysts had seen the growing reach of the investigation into the Petrobras scandal as a proof of institutional consolidation, primarily around an independent judiciary. However, the growing politicization of the process, already visible in the controlled leaks, strategic timeline of arrests, and showy style of operations—including handcuffs for portly sixtyish businessmen—reached symbolic heights with the early morning arraignment of Lula for a simple questioning, which he had previously acceded to voluntarily, and with the possibly illegal publication of the conversation between Lula and the President the day before his nomination. The legitimacy of the whole endeavour is jeopardized, and the image of the judiciary risks being sullied. In that context, "saving" Lula by giving him power could almost take an air of legitimacy.

Facing huge political challenges and increasingly isolated, even from her own party, Dilma Rousseff is now relinquishing power while preserving it for the PT or more precisely for Lula himself. Implicitly taking the blame for the current mess, she may also offer a relatively clean slate on which her de facto successor can build a support base in Congress and muddle through the last phase of the economic crisis, which should peter out by the end of the year.

All this is bad news. Lula's ability to regain governability will likely depend on the kind of deals that led to the current crisis and feed the cynicism of Brazilians towards their political system. None of the reasons for his return to power can be squared with the country's constitution. Rousseff's legitimate path would have been a formal resignation and her replacement by the vice-president, Michel Temer, but this would have meant handing out the PT's hard won prominence to a man of the Right, wholly steeped in the old clientelistic manners of Brazil's traditional elites. Now, Temer himself could be forced to resign as a result of shadowy electoral financing manoeuvres, and new elections may have to be called. None of these options offer much practical hope in the face of the country's challenges but at the very least, some institutional stability would have been preserved. Roussef decided otherwise and chose political expediency over "formal" democracy. As a result, formal institutions are losing ground and "the streets" are taking ever more central a role in the crisis.

(First published on

Thursday, February 4, 2016

Development experts' heads are stuck in the manufacturing sand

Try to forget industrialization: it's essentially over and it won't happen again. The challenge is to grow rich and not too unequal with service economies.

When you have time (it is 46 minutes-long), check this podcast from Brookings, which features one of their fellows, John Page, a former Chief Economist for Africa at the World Bank. Its hook is that about 85 million of China's "bottom-end" manufacturing jobs will have migrated away by 2030 and that Africa's challenge is to capture as many of those jobs as possible. The point is to plug a book by Brookings, UNU-WIDER and the African Development Bank called "Learning to Compete in Industry."

Now, in 2030, there will be 1.6 bn people in Africa, about half of whom will be older than 15 years old. Among the latter, assuming participation rates similar to todays (70-80%), the region's labour force will be about 600 million strong. This means that while 85 million jobs look like a lot, if Africa were to capture ALL OF THOSE JOBS--an extremely unlikely outcome--that would still represent only 13% of the region's labour force. Adding those jobs to the current paltry levels of industrial employment, in other words, would just not make African countries "successful industrializers." Most likely, in fact, these economies will morph—some already have—from mining and agricultural primary goods producers to service economies, without the historically "standard" industrial episode in the middle.

This study, in other words, like much of current development scholarship, is stuck with the assumption that development and industrialization are synonymous and that the first simply will not happen without the second.

Obviously, that assumption may be right, but if it is, Africa is doomed.  because the very evidence mentioned by promoters of industrialization makes it clear that industrialization on any significant scale will not happen in the region. At the very least, however, we should check, which we are not doing, in spite of all our ritual evocations of "evidence-based" research.

What we may find once we start looking may not be that depressing, by the way. Indeed, there is no theoretical reason why service economies can't become more productive. The most compelling explanation of growth today--endogenous growth--sees ideas as its core driver. Why should ideas only impact productivity in the manufacturing sector? Or, from a research perspective, why should we keep thinking of development as if it could only happen as it did in the past, both old, in the West and Japan, and recent, in China?

Oh, and by the way, the industrialization mirage is not just misleading for Africa, it is even more of an illusion for countries—hello Canada—that have long ago become service economies.

To repeat, the challenge is not to find a time machine to reach back to the 1950s (and call it a "revolution") when the path to industrialization crossed indeed manufacturing land, but to see how service economies can deliver reasonably equitable growth in developing countries.

Wednesday, February 3, 2016

Can Brazil's Olympics survive the Zika emergency?

Nearly overnight, the Zika virus has caught the world’s attention. Will Brazil be able to ease concerns before August?

Jean Daudelin

Three recent developments are changing the Zika crisis: global media awareness, new possible vectors, and doubts — at the epicentre of the crisis — about Brazil's capacity and honesty. Together, they threaten the upcoming Rio Olympics.

At the end of November 2015, I peddled a piece about the Zika/microcephaly crisis that was already severe in Recife, the large Northeastern Brazilian city where I am currently working. No one but this site,, would have it: not the Globe, not the Huffington Post, not Foreign Policy, no one else. Worse still, it took a few more weeks for the global media to catch up: the New York Times, measure of "all things fit to print," published its first piece on Dec. 29.

Today, Zika is front-page news every day the world over. This is mostly good as it keeps prodding governments and the increasingly nimble global infectious disease community. As usual, the danger is that, were the epidemic to be less serious than currently speculated, the overblown coverage could lead to public cynicism and, subsequently, less urgency from politicians, less money for research, and public nonchalance when a truly severe one hits: call this the "swine flu" scenario. Fortunately, public health organizations and experts have become very adept at balancing warnings with caveats. In the face of global infectious diseases, panic is not the default mode any more.

The second development is only bad, as researchers — still tentatively — point to new vectors for the disease. Until now, the Aedes family of mosquitos (aegypti and albopictus) were considered the only culprits, which is already scary given the global distribution of those bugs. Now, however, there is a growing worry that their Culex cousins, who reach farther North and South could also be infected and in turn infect the people they bite. Culex is the family of your "friendly" spring and summer mosquito, but also of the West Nile Virus vector. In addition to expanding the potential range of the infection, this would imply a significant increase in vulnerability as, unlike Aedes aegypti, which is still the main apparent culprit for Zika, many Culex mosquitoes are active in the evening and at night. Perhaps most worrying, there is growing evidence that Zika could be sexually transmitted, thus turning your sexual partners, just back from a trip in the South, into a potential vector even in the middle of Winter, and we don't know yet for how long.

There is no real flip side to the third development either, with growing doubts about Brazil's capacity to deal with the crisis and, most worryingly, to honestly tell the world how bad things are. In the last week or so, both Brazil's Health Minister and President Dilma Rousseff have said that the battle against the mosquito was being lost. Rousseff's declaration was framed as a call to arms, but without a single good news on the eradication front, and with Brazilian microcephaly statistics showing growth rates of five to seven percent per week in suspected cases, one is compelled to take her statement literally.

Worse still, the states of São Paulo and Rio, which are crucial to the national effort, appear to be less than candid about the local scale of the problem. El País revealed recently that the government of São Paulo had lied about the number of microcephaly cases on its territory, not reporting 200 cases and thus conveying the impression that the epidemic was largely confined to the poor Northeast of the country. The fact that Rio is currently refusing to test Olympic waterways for viral infection, while not directly Zika-related, nonetheless conveys a worrying lack of transparency about health risks.

Behind Rio's reluctance, obviously, lies the nightmarish scenarios of an Olympic Games participation disaster or of an unprecedented cancellation of the event. Brazil is clearly lobbying hard to save the Games, but its very efforts reinforce global skepticism: as reported by the New York Times, when the WHO declared Zika a global health emergency earlier this week on Feb. 1 but refused to follow the US Centre for Disease Control and recommend that pregnant women avoid countries where Zika is endemic, "some global health experts contended the W.H.O.’s decision was more about politics than medicine."

In the end, full transparency or deceptive manoeuvring of that sort may not matter much: given the massive press coverage Zika currently receives, the tremendous platform the Olympics would provide for the diffusion of the virus, and the increasingly clear inability of Brazilian authorities to get a grip on the epidemic, many countries may follow New Zealand's lead and, at the very least, support those athletes who decide to stay home. Now, this only makes things worse: a public relations disaster for Brazil, it will increasingly suck up government attention and efforts. All-out cancellation would probably be better: with Olympic distraction out of the picture, all energies could focus on the mundane jobs of eradication, vaccine development, and care for the poor kids who end up crippled by the disease.

[This post was first published by]