What works best in the war on drugs
By Alex Wodak, St Vincent’s Hospital, Darlinghurst (reprinted from the Conversation)
In 1967, the Beatles took out a full-page advertisement in The Times describing Britain’s marijuana laws as “immoral in principle and unworkable in practice”. Almost half a century later, both past and serving political leaders around the world are acknowledging that drug prohibition in the guise of the war on drugs hasn’t worked.
Global drug prohibition slowly evolved during the 20th century with several international meetings culminating in three UN drug treaties and a network of UN agencies to enforce them.
The three treaties – the Single Convention on Narcotic Drugs, 1961, the Convention on Psychotropic Substances, 1971, and the United Nations Convention against Illicit Traffic in Narcotic Drugs and Psychotropic Substances, 1988 – bound their signatories to pass legislation imposing criminal sanctions on those convicted of cultivating, producing, transporting, selling, buying, using or possessing any of the approximately 250 drugs listed by the UN system.
The UN Commission on Narcotic Drugs sets policy, the UN Office on Drugs and Crime implements it, the International Narcotics Control Board monitors national compliance, and the World Health Organization tells the Commission on Narcotic Drugs what to add to the list of illicit drugs.
This approach has been an utter failure.
The drug trade has expanded substantially in the half century since the first international drug treaty; the United Nations Office on Drugs and Crime estimated the total retail value of the global illicit drug trade in 2003 at US$320 billion.
And deaths, disease, crime, corruption and violence have all soared. It’s clearly time to go back to the drawing board.
Drug policies have to be realistic to be effective, and prohibition clearly isn’t. Whatever else drugs might be, they also create powerful markets; in the absence of a legal source, strong demand finds other forms of supply.
After the United States government prohibited alcohol in 1920, for instance, consumption fell. But, within a few years, it started rising again and by 1922, it had surpassed the 1920 level.
Since the start of the war on drugs, governments across the world have allocated most funds to drug law enforcement. But the policy failed abjectly because drug laws cannot be enforced.
Drug traffickers make so much money that they can corrupt or intimidate whoever stands in their way. Prohibition has undermined governments and eroded important civic institutions in both supplier and transit countries, such as Afghanistan and Pakistan.
Indeed, the drug trade is too big, too powerful, and too awash with profit to ever be eradicated. Still, we can do something about it.
To be effective, drug policies have to be based on evidence, rather than intuition about what should or shouldn’t work or public opinion. But while it is a terrible policy for society and public health – it lands masses of people in jail for minor crimes, for instance, and makes the difficult task of controlling blood-borne viruses almost impossible – the war on drugs is often good political strategy. It helps political candidates win elections on a law-and-order platform, providing a disincentive for ending the hardline approach.
Evidence shows drug law enforcement has been an expensive way to make a bad problem worse because it manifestly cannot do what it sets out to do, which is make drugs unavailable.
Health and social interventions, on the other hand, are relatively inexpensive ways of making a bad problem less bad, albeit slowly. Such approaches include harm reduction in the form of needle syringe and drug-replacement programs, and social interventions such as encouraging people who use drugs to get treatment.
Consider Switzerland, which was swamped with drug problems in the 1980s. When increasing funding to police and making penalties more severe failed to halt the soaring crime rate, increases in HIV transmission through needle sharing, and drug overdose deaths, the government turned to a different approach, including improved drug treatment.
A 2006 study in the nation’s largest city Zurich showed the annual number of new recruits to heroin in the city went from 80 people in 1975 to its estimated peak of 850 in 1990, and then dropped to 150 in 2002. It showed similar falls in crime, HIV prevalence, and drug overdose deaths.
The Swiss case illustrates how gains are small and slow rather than heroic and overnight. But slow and small gains are definitely worthwhile in the face of the alternative.
This kind of harm reduction approach is very effective and quite inexpensive. A 2008 UK review of the evidence for the cost effectiveness of needle syringe programs found they were overwhelmingly worthwhile.
The Australian government, for instance, spent A$150 million on such programs between 1988 and 2000, preventing an estimated 21,000 HIV infections and 25,000 hepatitis C infections. The program saved around 4,500 lives that would have been claimed by AIDS and 90 by hepatitis C. And for every dollar the government spent, it saved A$4 in health-care costs and A$27 in the lost economic contribution of drug users and the cost of drug use to the users themselves.
By contrast, reducing drug use remained the priority in the United States, so HIV spread extensively among and from people who inject drugs there.
There are only two studies estimating savings or social and health advantages from drug law enforcement.
A 1994 RAND Corporation report looked at the benefit of every dollar the government spent on coca plant eradication in South America, interdiction of powder cocaine being transported from South to North America, US Customs and police, and treatment of severely dependent US cocaine users.
US citizens benefited 15 cents per dollar spent on the first, and 32 and 52 cents, respectively for the second and third. But the benefit of the last measure, that is, treatment rather than law enforcement was US$7.46 for each dollar spent.
Another report found the annual reduction in total US cocaine consumption for a $US1 million investment was an estimated 13 kilograms for mandatory minimum sentences, 27 kilograms for conventional law enforcement, but over 100 kilograms for treatment of severely dependent users.
Punitive drug policies have turned out to be an expensive waste of time, at great social cost. When newly-elected Mexican president Felipe Calderon assumed office on December 11, 2006, he freshly declared war on drugs. When he left the presidency six years later, around 70,000 Mexicans had been murdered by drug traffickers, the army or the police.
Prohibition also helps more dangerous drugs to push less dangerous ones out of the market.
In the 1950s and 60s, anti-opium policies in Laos, Hong Kong, and Thailand where the drug was traditionally used, turned out to be pro-heroin. Young, sexually active men injecting heroin replaced old men smoking opium, leading not only to a heroin industry but an increase in the price of narcotic drugs and health problems because of parental drug use. It also created the right conditions for an HIV epidemic among injecting drug users.
Another problem with punitive drug policies is they need a lot of law enforcement. This is only good news for people who work in customs, police, courts and prisons.
The number of people incarcerated in the United States, for instance, increased from 500,000 in 1980 to 2.3 million in 2009. Much of this growth was the result of sentences for drug-related offences. Indeed, one estimate puts the number of years of life lost in New York state as a result of the punitive drug laws of the early 1970s was comparable to the number lost as a result of 9/11.
If we approached drug policy with a return-on-investment approach, high cost-low gain interventions such as incarceration and sniffer dogs would be wound down.
Supporters of drug prohibition often insist reform supporters articulate a fully worked-out alternative. But reform should be thought of as a process rather than an event. It should be carried out in incremental steps with further steps adopted if evaluation shows the earlier reforms have been successful and more is required.
The threshold step is redefining the problem as primarily a health and social issue. As shown above, taxpayers clearly get significant benefits from government spending on reducing the demand for and harm from drugs.
Once the problem is redefined, most decisions fall into place. The paramount aim of the reformist approach must be to reduce the adverse health, social and economic costs of both drug use and drug policy, rather than aiming to reduce drug use regardless of consequences.
When the drug market has been brought down to a manageable size using health and social interventions, drug law enforcement may well start to be effective.
The aim should be to regulate the market as much as possible while acknowledging it will never be completely regulated. There will always be a black market for drugs, and the best way of shrinking it is to expand the regulated market.
Drugs can be regulated by prescription controls, pharmacy controls, premises where drugs are sold with consumption occurring on site, and premises where drugs are sold but consumption occurs off site.
Methadone is a good example of a drug regulated by prescription controls across most of the world. It represents a pragmatic compromise between the preference of drug users to keep using heroin and the community, which would prefer drug users to abstain.
This is not a shot in the dark; there are examples of countries that have seen positive results from embracing an alternative to the war on drugs.
In 2001, Portugal set threshold quantities for every type of illicit drug. People found in possession of quantities above the threshold levels are referred to the criminal justice system. Those found in possession of quantities below the threshold are referred to the Commission for Drug Dissuasion where a small panel carries out an interview to determine how the person is functioning as part of the community.
If they are leading a normal life – raising children, for instance, or studying or training, or holding down a job and keeping up with financial commitments – they are reviewed again in a year or so. Those not functioning poorly are referred to drug treatment.
Portugal also improved its drug treatment system as any country must do if it wishes to reduce drug problems. And treatment has be raised to the same standard as the rest of the health-care system. The policy has worked well for the country; overdose deaths, HIV, crime, and problematic drug use have all fallen.
Instead of this way to deal with drugs, most of the world continues with a criminal justice approach and draconian policies despite evidence of its failure.
Clearly, the war on drugs has taken a grave international toll, and not all of it has been discussed here. Many of the nations it affects are in the process of developing and they are often brought to their knees by corrosive effects of drug prohibition.
The first thing to do is publicly acknowledge the failure of the war on drugs. Then we can start reversing the system. This may be difficult, but it is by no means impossible.
This article is the first in a series that will examine the complex problems facing humanity, and assess the evidence on what works best to fix them.
Alex Wodak is president of the Australian Drug Law Reform Foundation.