An international discussion is desirable

BMJ 1996; 312 doi: https://doi.org/10.1136/bmj.312.7031.635b (Published 09 March 1996) Cite this as: BMJ 1996;312:635
  1. Henk F L Garretsen,
  2. Fred Sturmans
  1. Professor of addiction Addiction Research Institute, Erasmus University, 3062 NM Rotterdam, Netherlands
  2. Professor of epidemiology Municipal Health Service Rotterdam, PO Box 70032, 3000 LP Rotterdam

    EDITOR,—Richard Smith states that wars on drugs are doomed to fail and asks whether it is time to consider “going Dutch,” referring to the fact that the Netherlands is more willing than other countries to experiment with decriminalisation.1 What considerations must be taken into account in the debate on the availability of hard drugs in the Netherlands?

    Many people argue that hard drugs should be freely available. One argument for this is on grounds of “fairness”: why is alcohol freely available and heroin not? But other aspects must also be considered. An argument against prohibition is that it makes international criminal organisations flourish; their activities and economic power are so great that the Dutch government believes that they could constitute a threat to the country's democratic system.2 Another argument hinges on the crimes committed against property by a number of drug users and the annoyance and nuisance that users cause in some city areas. Fourthly, prohibition leads to considerable health problems for the users themselves. They spend a lot of time on drug related activities, which results in an unstable pattern of daily activities. Furthermore, there is no possibility of monitoring the quality of the drugs and the devices used. So prohibition has many drawbacks.

    Smith wonders whether free availability might be the solution. The expected effects of free availability must, however, be put into perspective. Crimes against property would not be completely abolished because not every user would renounce crime. Another consideration is that a “go it alone” policy could harm international relations. Furthermore, drug tourism would probably increase. Another, less widely discussed problem emerges when comparison with alcohol is made. Increased availability of alcohol may result in higher consumption, which in turn may result in more problems related to alcohol. The same is conceivable for hard drugs: problems related to illegal use would be reduced if drugs were freely available, but other problems—for example, at work or with driving—might increase. So free availability has many drawbacks too.

    Partial legalisation would help, but to what extent? Methods of controlled supply to limited groups of users are now being discussed in the Netherlands. More specifically, an experiment is being planned in which heavy users will be prescribed heroin on prescription.2 3 Such experiments are useful, but important questions remain unanswered. For instance, what will the government's response be if the results of these experiments are positive: an extension of the initiatives?

    In all cases an international discussion is desirable.


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