Editorials

Drug policy debate is needed

BMJ 2012; 344 doi: http://dx.doi.org/10.1136/bmj.e2381 (Published 02 April 2012) Cite this as: BMJ 2012;344:e2381

Re: Drug policy debate is needed

While I have great respect for Sir Ian and am totally on his side regarding his endeavours to fight the alcohol problem in the UK, I respectfully disagree with his apparent call for decriminalisation of drugs, a suggestion which, as commissioned editorial, would also be in keeping with the usual editorial bias of the BMJ: enthusiastically and uncritically pro-legalisation of drugs, enthusiastically and uncritically pro-legalisation of euthanasia etc.

Sir Ian wrote: “What would drug reform look like? Most serious commentators call for decriminalisation…” and on several instances in the editorial refers to decriminalisation as a possible answer to the drug problem.

One notes in passing that the reference to “most serious commentators” appears to suggest that those who do not support decriminalisation cannot be taken serious, which I find quite an arrogant suggestion.

When I debated the issue of drug legalisation with him (and others) last year, he was debating for the legalisation of drugs while I took the opposite view. At the time, I challenged him to state clearly which drugs he would want to legalise. Sadly, Sir Ian refused to give a clear answer at that time. May I therefore respectfully invite Sir Ian to state

1. which drugs he would like to see decriminalised and why and
2. which drugs he would not like to see decriminalised.

This is, unless, of course, he has changed his views and no longer supports the decriminalisation of drugs?

Decriminalisation of drugs has of course been tried in a number of countries and territories and usually has being reversed after some years because it has been associated with significant increase in drug use and/or because it fails to achieve the stated aims of the original policy. Everyone knows the Dutch example where The Netherlands introduced the “coffee shop” policy. One of the stated aims was to separate the markets for “soft” and “hard” drugs. However, this aim has not really been achieved. Unsurprisingly, there had been a significant increase in cannabis consumption and the large majority of Dutch coffee shops have now been closed down; a development that appears to have achieved much less publicity. Why repeat the mistakes that others have made?

All this his contrasts with the experience of countries like Sweden and Japan. Both have a very clear societal focus on drug prevention, both have very low rates of substance misuse and good health and societal outcomes; Sweden has among the lowest rates of drug use in Europe (probably even lower than the Portugal so beloved by some) and Japan has among the lowest rates of drug use worldwide, lower than Western European countries.

In my view the “secret” of the low rates of drug misuse in Sweden and Japan has to do with a clear engagement of civic society with the drugs problem. Both Sweden and Japan have for many years realised that decriminalisation is not the answer, but drug prevention/demand reduction on the basis of a societal consensus that aims to have drug misuse as only a marginal phenomenon in society is perhaps the single most important factor.

It would be nice to see if those calling for “reform” and “evidence” and “decriminalisation” were also prepared to take into consideration evidence for example from Sweden and Japan even if it does not suit their apparent agenda.
I tried this with the LibDems mentioned in Sir Ian’s editorial. The individual LibDem politician responsible for the motion calling for the legalisation of drugs did not even acknowledge the substantial evidence challenging his views that I had sent him. It probably didn’t suit his agenda, one would speculate…

If one really wants to make an inroad into the drug problem, one needs a societal consensus that would want to see drug misuse as only a marginal phenomenon in society or – as Sweden has done – to even aim for a drug-free society.

Decriminalising /legalising drugs will undermine such a consensus and simply lead to normalisation of drug use - see the examples of alcohol and tobacco with all the adverse public health consequences that Sir Ian is so very aware of.
Is this what we as society want – to normalise the use of drugs?
Is normalising the use of currently illicit drugs the answer to the health and social problems associated with drug use?
This has not been the case for tobacco and alcohol as Sir Ian knows very well and it will not be the case for currently illicit drugs either.

Competing interests: No competing interests
09 April 2012
DR HC Raabe
GP
Partington Central Surgery
Central Road, Partington M31 4FY
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