6 Conclusions

There is clearly value in being able to compare the relative burden of illicit drug use across nations. Doing so enables policy makers to begin considering whether their own government strategy appears to be more or less effective when compared to other countries with similar use rates or harms. However, it is also important to realize that societies’ response to the drug problem generate costs as well, which is why differentiating the costs of drug use from the costs of a society’s response to that use is so important. Only a careful cost-effectiveness analysis of alternative approaches can provide true insights into the relative benefit of specific approaches. The first step in conducting such an analysis, however, is the consistent assessment of the burden of drug abuse across countries. And given the varying forms the burden can take across countries, a monetized metric of all the harms seems to be the most promising way of drawing comparisons across multiple harms.

The current exercise demonstrates, however, that the ability to simply compare monetized harms across countries still eludes us for a number of reasons. First, many nations are not collecting many of the relevant indicators or measures of cost necessary for participating in such a study. Second, even indicators that are regularly reported by countries are not being collected in a manner that is consistent across countries in terms of definition or universe. Some of these differences may not be easily overcome, as they could be the artefact of different national needs or different philosophies. The lessons learned from the European Community can perhaps provide the best guide for how to overcome these sorts of issues more broadly for developed countries. Third, even when fairly good indicator data are consistently collected across countries (e.g. drug-related HIV cases), there is insufficient information from which one could construct a consistent measure of the average costs of these indicators across countries. Cost information either does not exist or it does not reflect the same process across all countries. For example, in the case of HIV, some countries have estimates based on micro simulation models incorporating information on disease progression and the cost of therapies at each stage of the disease while others have estimates of just the average cost of treating a user given the stage of the disease they are at. While both are meaningful measures of costs, they are not capturing the same thing and combining disparate estimates across countries using both methods would lead to incorrect conclusions regarding the relative burden of drug-related HIV.

Steps could be taken in the future to improve the consistency of measurement in some of these areas, but significant work is still needed in other areas. A coordinated effort, like the one currently being undertaken by the EMCDDA for the European Community, is necessary for moving this forward more globally. It is not possible to simply draw on the independent efforts being undertaken within particular nations, as such efforts – while significant and highly valuable to the nations conducting them - will not reflect the need for conformity in measurement that is necessary to enable cross-country comparisons. Thus, the ability to systematically compare the cost of drug use across nations may remain out of our reach for a few more decades.