An alternative to the war on drugs
BMJ 2010; 341 doi: https://doi.org/10.1136/bmj.c3360 (Published 13 July 2010) Cite this as: BMJ 2010;341:c3360
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Nigel - with apologies for the delay in responding to your points
(partly due to other ongoing correspondence in the BMJ that I have been
waiting to play out and will also endeavor to respond to):
You criticise me because I 'failed to consider data from the United
States as part of [my] analysis but instead chosen to concentrate on much
smaller countries, such as Portugal and Switzerland'.
In fact I to refer to the US (albeit regarding cannabis) once,
Portugal once, and do not mention Switzerland at all.
Regards the fall in cocaine use in the US:
Focussing on a fall in the use of one drug (in one country, over one
period of time) whilst ignoring other trends can dramatically distort the
overall picture of drug use and related harms more broadly.
Simultaneous to the US fall in cocaine powder use since its peak
around 1979 (a fact acknowledged in Transforms 'After the War on Drugs;
Blueprint for Regulation', (p.42) - which I authored which is clearly
referenced as the source text and linked in the BMJ paper) has been the
emergence (and subsequent partial retreat) of a devastating epidemic of
inner city crack cocaine use. Likewise, the use of ecstasy, and more
destructively, methamphetamine, has risen over the same period. The non-
medical (mis)use prescription stimulants has also risen dramatically as
cocaine use has declined.
Why has cocaine use fallen, whist ecstasy and meth use has risen -
when they are all subject to the same punitive prohibitions (all are
shedule 1)? It is evidently not due to supply side cocaine enforcement
success; the price of cocaine has fallen by around 80% during the same
period so cocaine is, by inference, actually more available than
previously. In the UK, by ontrast, ecstasy use has been level or falling
for some years, whilst cociane use has risen sharply (the price of both
has been falling).
so from the US (and UK) experience some general conclusions:
- Overall levels of use often appear to rise and fall independently
of price changes.
- Use of different drugs seems to rise and fall under the same legal
regime, often moving in opposite directions simultaneously.
This suggests that enforcement is a marginal factor in determining
levels of use; which are primarily determined by a complex interplay of
cultural, economic and social variables. The comparative analysis studies
mentioned/referenced in the paper (re cannabis decriminalisation states in
the US and Australia, the Portugal paper in the British Journal of
Criminology, and the international WHO study), are supporting evidence for
this general position.
Whilst levels of use seem to be only marginally related to intensity
of encforcement or punitiveness of sanctions I argue there is more direct
impact of enforcement on harms associated with use; encouraging use of
riskier products, and riskier behaviours in riskier environments - a point
made in the BMJ paper, and in more detail in 'Blueprint for
Regulation'(the emergence of crack and methampahetamine use are given as
examples). I also argue that prohibition is directly associated with the
well documented social harms of the illegal market, domestically and in
producer/transit countries.
It is is these harms that a legal regulation apporach seeks to
reduce, supported via diversion of some drug enforcement resources into
proven public health interventions (including educating people about drug
risks).
regard the crack 'ommission':
This is misplaced and unfair criticism as there is a detailed section
on crack in the stimulants chapter of the full text of 'After the War on
Drugs; Blueprint for Regulation'. The 2000 words in the BMJ obviously did
not allow the detail of a 50,000 word book. I do however refer to:
"Medical prescription model or supervised venues--For highest risk
drugs (injected drugs including heroin and more potent stimulants such as
methamphetamine) and problematic users".
Perhaps if I had said crack instead of methamphetamine you would have
hauled me up for not mentioning methamphetamine? In fact 'Blueprint'
covers both in some detail as part of a wider discussion of stimulant use
and regulation. I would welcome comments on that content once you have had
a chance to read it (the full text of Blueprint is available as a free
download).
Finally, the criticism based on my 'suggestion that heroin addicts
must necessarily turn to crime in order to fund their habit' is a little
baffling as no such link is made anywhere in the BMJ piece.
Competing interests: I am author of the original BMJ paper
A major criticism of Stephen Rolles of the Transform Drugs Policy
Foundation(ref 1) is that he has failed to consider data from the United
States as part of his analysis but instead chosen to concentrate on much
smaller countries, such as Portugal and Switzerland.
Statistics available from the United Nations Office on Drugs and
Crime show that consumption of cocaine has fallen by seventy five per cent
in that country in the last twenty years (ref 2). If we are to conclude
that the war on drugs has been a failure then this needs to be explained.
Another curious omission from the Transform Drugs Policy
Foundation's proposed regulatory framework for psychoactive drugs
of abuse is that crack cocaine. Most law enforcement officials would
probably agree that levels of crime associated with this drug are as much
a consequence of its mode of delivery and pharmacological properties as
they are of the need to fund its purchase. If we are to follow Mr Rolles
suggestion, and make powder cocaine available through "specialist
pharmacies", then by default we have also facilitated the
availability of crack cocaine as the one is easily made from the other.
Finally, the suggestion that heroin addicts must necessarily turn to
crime in order to fund their habit is misleading and probably twenty years
out of date, as I suspect Mr Rolles well knows. A reasonable estimate of
a typical addict's consumption would probably be 30 to 50 gms of heroin a year (ref 3). This would be consistent with
the most reliable estimates of the total UK market(ref 4) and, at current
street prices, would amount to an annual expenditure of £3-5,000;
roughly equivalent to a nicotine habit of two to three packs of cigarettes
per day. And of course we are currently supplementing this with the
provision of large quantities of methadone, freely available on the NHS.
(ref 1) An alternative to the war on drugs. BMJ 2010; 341:c3360
(ref 2)http://www.unodc.org/unodc/en/data-and-analysis/tocta-
2010.html
(ref 3) Reuter et al. The world heroin market; can supplies be cut?
OUP 2009. Page 265
(ref 4) Home Office Online Report 16/06. Measuring different aspects
of problem drug use: Methodological developments (2nd edition). Editors
Nicola Singleton, Rosemary Murray, Louise Tinsley.
Competing interests: No competing interests
Mr Rolles hits the nail on the head when he writes that a "curiously
self justifying logic now prevails in which the harms of prohibition such
as drug related organised crime and deaths from contaminated heroin are
conflated with the harms of drug use. These policy related harms then
bolster the apparent menace of drugs and justify the continuation, or
intensification, of prohibition."
This is exactly the reason why drug prohibition has been so
persistent. The media and the public have great difficulty to make the
distinction between primary and secondary effects. It's all just "drugs."
The difference with the era of alcohol prohibition is that because of
the large number of alcohol users the problems alcohol prohibition gave
were immediate, and everyone could see they were caused by prohibition,
rather than by alcohol itself.
When drug prohibition was first installed there were very few drug
users, and drug prohibition went largely unnoticed. The problems arose
gradually in the twentieth century as numbers of users, and illegal trade,
grew. The origins of drug prohibition now ly so far in the past that cause
and effect are no longer easily attributable by the public and the media.
Drug prohibition has become the great catalyser of the
criminalisation of society. It is an irony of history that it was the
initial lack of drug users that enabled drug prohibition to stealthily
grow into the worldwide scourge that it is today.
Competing interests:
None declared
Competing interests: No competing interests
Why do governments maintain the pretence of possible victory in the
war on drugs?
The retiring president of the Royal College of Physicians, Sir Ian Gilmore
, is reported as saying: “Everyone who has looked at this in a serious and
sustained way concludes that the present policy of prohibition is not a
success” (1) The ex president’s email endorsed the recent BMJ article
from the Transform Drugs Policy Foundation (2) Nicholas Green QC, the
chairman of the Bar Council for England and Wales, said it was “rational”
to consider “decriminalising personal drug use”. (3)
Ken Clarke has recently noted that Prison does not work (4) Personal
observations in Dorset lend
support to this view. A recent undercover police sting led to many arrests
for drug dealing. However the
local supply of heroin is unaffected. The reason is that that people who
use heroin are a mutually
supportive community. When one is broke another whose benefits have
arrived subsidies both. The
favour is returned in due course. An undercover agent penetrating this
network then provides evidence
to convict numerous “dealers”. However the headline tough on crime
convictions are illusory as no
criminal masterminds are involved. Another example from our local Verne
Prison on Portland where half
the inmates are foreign drug mules. Their incarceration for 5 year terms
is futile as Latin America’s slums
yield fresh recruits eager to pay family medical bills or threats of
reprisal from the real drug lords, who
remain safely away from justice.
The medical evidence is that the whole war policy is a costly failure, in
personal illness and national
finances. Why no change in approach?
Perhaps this is part of the great game. The poppy fields have proved
useful in foreign policy ever since
the Opium wars involving British traffickers (AD 1839-42 1856-60) (5).
Occasionally the covert use of
funds is exposed to the light of day. The Iran Contra affair involved drug
deals.(6,7) Truth is stranger
than fiction in this web of intrigue, and the casual dismissal of any
complicated deal as being a
conspiracy theory is exposed and the charges comprehensively
substantiated. The Taliban ceased
the opium trade in 1991 but the UK/US invasion has restored supplies and
increased production. One
explanations could be that the gains to the international and banking
interests of states trumps the clear
warnings of their doctors and judges. Let us hope the forthcoming moves
away from long term harm
minimization to short timescale cures in the UK will not serve to increase
the addiction problem and its
profitability.
1) BMJ 2010;341:c3360
2) Daily Telegraph 20/7/10
3) The Independent 22/7/10
4) Hanes, William Travis; Frank Sanello (2002). Opium Wars: The Addiction
of One Empire and the Corruption of Another
5) Kerry Committee Report
6) McCoy, Alfred W. (May 1, 2003). The Politics of Heroin: CIA Complicity
in the Global Drug Trade. Lawrence Hill Books
7) When Wars Collide: The War on Drugs and the Global War on Terror
Strategic Insights, Volume IV, Issue 6 Naval Postgraduate Institute
8) Source: United Nations,
http://www.unodc.org/pdf/afg/afghanistan_opium_survey_2004.pdf
9)
Opium Poppy Cultivation in Afghanistan 10) 11) Year Cultivation in hectares Production (tons) 12) 1994 71,470 3,400 13) 1995 53,759 2,300 14) 1996 56,824 2,200 15) 1997 58,416 2,800 16) 1998 63,674 2,700 17) 1999 90,983 4,600 18) 2000 82,172 3,300 19) 2001 7,606 185 20) 2002 74,000 3400 21) 2003 80,000 3600 22) 2004 131,000 4200 23) 2005 104,000 3800 24) 2006 165,000** 6100**
Competing interests:
One session a week in NHS clinic supporting people with a heroin replacement programme
Competing interests: Opium Poppy Cultivation in Afghanistan10) 11) Year Cultivation in hectares Production (tons)12) 1994 71,470 3,40013) 1995 53,759 2,30014) 1996 56,824 2,20015) 1997 58,416 2,80016) 1998 63,674 2,70017) 1999 90,983 4,60018) 2000 82,172 3,30019) 2001 7,606 18520) 2002 74,000 340021) 2003 80,000 360022) 2004 131,000 420023) 2005 104,000 3800 24) 2006 165,000** 6100**
It is refreshing to see a reasoned argument about drug
policy given the more usual hysteria displayed when the
topic is debated. But I wonder if the best argument for
decriminalisation is underplayed by Stephen Rolles.
The current government faces the worst public finances for
decades and is desperately searching for ways to save money.
In another refreshing change the Justice Secretary seems to
have abandoned the "lock 'em up and throw away the key"
policy of his predecessors and has decided that fewer people
should be in prison.
Estimates of the direct cost to the UK of the War On Drugs
start about £4 billion and head towards £20 billion.
Possibly half of all crime is drug related and a very large
proportion of the prison population is there, ultimately,
because of drugs.
So, not only would decriminalisation improve public health
by reducing the collateral damage of the "War", but it could
save a fortune in government spending on criminal justice.
That sounds like a compelling argument in the current
climate.
Competing interests:
None declared
Competing interests: No competing interests
The BMJ should be commended for publishing such a logical and well-
referenced analysis of the failure of, and damage caused by, prohibition.
The War on Drugs is lost and alternative policy provisions must be
implemented.
Competing interests:
Founding Member - Hong Kong Alliance for a Sensible Drug Policy.
Competing interests: No competing interests
The costs to individuals, police, courts and government of the
illegal activities relating to trafficking of heroin are over £10 billion.
If action is taken to legalise heroin, the following benefits would be
likely to accrue.
1.reduction of crime.
2.saving of police and court time and reduction in prison places required.
3.practices or clinics could ensure that regular injections of pure heroin
are offered under hygeinic and safe conditions.
4.most addicts would be able to work.
5.part of support will be to help socially and with work.
6.international cooperation would be desirable, or even essential.
7.growing of poppies and manufacture of heroin would become a legitimate
trade, producing taxes for the relevant authorities.
It is not certain that all drugs could be treated in a similar fashion.
Competing interests:
None declared
Competing interests: No competing interests
How good to see this printed in the BMJ. The madness which is drug
prohibition has arguably caused much more damage throughout out the
developed and developing world to users [untreated illness], the public
[crime], the economy [wasted public resources in health, policing and all
areas] and the welfare of countries and their populations like Columbia,
Mexico, Afghanistan etc. It takes a visionary, leading government with the
UN to start the change; but it must and will come. The problem needs to be
tackled, like alcohol, by medicine and public health policy hoding the
'industry' to account with regulation and taxation. Not a free for all,
but regulated supply through pharmacies and the health service. The only
question is how long before common sense makes it happen.
Competing interests:
None declared
Competing interests: No competing interests
A very good study of the main issues and well written article.
I wish to encourage the shift in language away from drugs (ie
objects) to people. Sometimes we forget that the 'criminalisation of
drugs' is flipping the subject and object of control. This seemingly
innocuous shortcut, describing drugs as legal, illegal, calling for
decriminalisation of drugs etc are all examples of the manifestations of
the errors of law and thinking propagated by governments. In my view a
real problem lies with the critical discourse itself; this is because much
of it is couched in the given prohibitionist language paradigms that are
coercive and incorrect.
These expressions actually mean nothing in law or logic, although we
all know what is meant by them. Drugs are not declared illegal or illicit
in law at all - the law provides that property rights in some drugs (these
being ANY that cause social harm) are 'controlled'. This is quite a
different proposition to the one being fed to us that drugs are legal or
illegal.
The [artificial]divide that exists between types of drug users is not
set in stone, alcohol and tobacco [users] are not exempt from the
legislation; they are [users of] drugs that are at this time not included
in the schedules because the government who administer the law choose not
to control them (quite arbitrarily). The explanation from govenment for
not controlling the most harmful drug use is because they are 'legal
drugs' with cultural / historic preferences. This explanation is legally
an entirely untenable in my opinion. The (neutral) law mandates that ANY
drug causing social harm is within the law's purview. The inclusion of a
drug as a scheduled drug does not mean that such a drug then becomes an
'illegal drug' - this goes to the heart of the language deception and
misunderstanding.
Drugs (ie drug users), ought to be proportionately controlled to
reduce the social harm they might cause. Powers exist to make such
possible, distinguishing abuse and misuse from peaceful or amateur use,
all this being possible within the existing legislative framework. But due
to the false meme of 'illegal drugs', the law works like an on/off switch.
Drugs (and of course I mean the users & traders of drugs) being either
criminalised outright, or not so criminalised and given full consumer
protections (drinkers and smokers). This situation of the executive making
errors of law is tacitly perpetuated by the language being adopted by most
reformist groups - they sometimes make the error of de-personalising the
subject of regulation, and effectively accepting prohibitionist policies
as the inevitable expression of the existing law by repeating the mantra
of this conceptual and legal falsehood.
Darryl Bickler
Competing interests:
Founder member of the Drug Equality Alliance
Competing interests: No competing interests
The ideological failure of prohibitionism, a 19th century totalitarianism
Mr. Rolles lays out the most credible, convincing and articulate case
for controlled re-legalization that I have read so far. The 2009
"Blueprint for Regulation" is remarkable and should be required reading
for drug policy makers.
I wanted here to bring an ideological and historical perspective to the
debate.
Originated in the US thanks to its settlement patterns,
prohibitionism is a 19th century totalitarian ideology of coerced societal
transformation. It is just as obsolete as the other major totalitarianism,
communism and fascism and just like them, it lost track of its original
intent. Prohibitionism was soundly rebuked in its original intent of
promotion of virtue and suppression of vice, where vice was alcohol abuse,
gambling, pornography, prostitution and homosexuality. Substance abuse was
added to the prohibitionist agenda almost by accident but it is the last
standing piece of this failed agenda. Drug prohibition survived and
thrived essentially as an alibi for discrimination against minorities and
thanks to an endless succession of moral panics from its onset and up to
this day. It survived and thrived because on its onset, there was no real
substance abuse issue in the US other than alcohol abuse and therefore
these substances didn't have any real constituency to support them.
Drug prohibition started in the US with the American century, and
throughout the century, the US used its growing power to impose its policy
to the rest of the world. Not only did the US invent the war on drugs, the
US is also the main consumer as well as the overwhelming weapon supplier
to the Latin American drug cartels, fueling the evil and violence it is
supposed to combat in the first place.
Prohibitionism violates the fundamental law of supply and demand in a
market economy and therefore, it led to the emergence of a thriving shadow
economy. The war on drugs and drug trafficking grew in symbiosis, feeding
on each other. The ever escalating repression lead to increasingly
sophisticated trafficking modalities in a cat and mouse race where the
drug business quickly adapts to market disruption and enforcement is
always one step behind, further plagued by the law of diminishing returns
which dictates that ever increased resources need to be allocated for
lower and lower results.
Analyzing the war on drugs narrative over its hundred years history,
one can only be struck by its ever escalating intensity, its never-ending
crescendo. 417 grams of cocaine were seized in 1938. 118,311 kg were
seized in 2005! Rothstein's victims could probably be counted on the
fingers of both hands in the 1920s. 500 murders were attributed to Lucky
Luciano's Murder Inc in the 1930 and 40s. That is barely the death toll in
an average month in Mexico alone in 2010. In 1930, Al Capone and his mafia
was ruling Chicago. Ruthless cartels are spreading mayhem and gory over
the planet from Ciudad Juarez to Bamako. Narco-states are growing like
cancer. Drug culture is permeating pop-culture.
After 100 years of ever escalating failures, policy-makers are still
proposing more of the same. The stated goal of the war on drug is still
complete eradication and total abstinence, which is about as realistic as
sexual abstinence as a policy for prevention of STD and teen pregnancy. In
fact, the war on drug is terminally addicted to its own policies and
inextricably tied to its arch-nemesis, its lifeline and its raison d'etre,
narco-trafficking. It would crumble and vanish if narco-traffic were to
disappear.
Narco-trafficking is the creation of the war on drugs, its
antithesis, its arch-nemesis, its own distorted reflection. The mere idea
of legalization poses an existential threat to this highly dysfunctional
scheme.
The most baffling though, is that the awareness is there of the dire
situation we are facing. In the foreword to the 2010 UNODC World Drug
Report, Antonio Maria Costa, Executive Director of the United Nations
Office on Drugs and Crime, states:
"Poor countries have other priorities and fewer resources. They are
not in a position to absorb the consequences of increased drug use. ... We
will not solve the world drugs problem by shifting consumption from the
developed to the developing world. ... We will not solve the world drugs
problem if addiction simply shifts from cocaine and heroin to other
addictive substances."
All that seems to be missing is the political courage to draw the
obvious conclusions.
Voices of dissent are rising louder and louder, including from within
the international community itself, challenging the folly of existing
policies.
Isn't time to ask the simple but fundamental question:
"Can organized society do a better job than organized crime at managing
and controlling psychoactive substances?" After all, the vast majority of
psychoactive substances, including the two deadliest, are already legal
and controlled.
jdhywood@hotmail.com
Competing interests: I am currently writing a book about the war on drug failure and advocating controlled re-legalization with positions similar to Mr Rolles. I don't know if this constitutes a conflict of interest.