3 Drug policy

In the paragraphs above we have presented the methodological difficulties of measuring and comparing drug problems. Measuring and comparing drug policies is even more difficult. One problem is that policy papers (representing formal national policy) are frequently unsystematic, thus largely incomparable narratives with incomplete or ill-defined data on problems, backgrounds, targets and measures.

Formal drug policy may be perceived as the pattern of legislation and government actions that aim to reduce the use of drugs and related problems (Kleiman, 1992; Reuter & Stevens, 2007). Scientifically, policy evaluation studies are unable to assess the effects of policies, laws and measures on the targeted problems. This is partly due to the uncertainties involved in various types of quantitative estimates on the drug market, e.g., prices and quantities (Reuter, 2001). Another reason is that there is no accepted method for carrying out an outcome evaluation of national policy in a scientifically correct way, at least not one that comes near to clinical trials for assessing effects of medical interventions. Major limitations are: the absence of a baseline measurement; the absence of a control group; the large number of confounding factors that are involved in national policies; and the impossibility to control this, even more so over time.

Apart from formal policy statements, national expenditures on drug problems can represent an estimate for the amount of actual activity, and enable us to make rough estimates on changes in the annual drug policy effort. Surprisingly, however, the availability of these data is very low. Few countries actually publish estimates of expenditure on drug policies. Data on drug policy expenditures are rare, even in Western countries. Reuter highlighted two main reasons for this: “(…) drug control programs (1) are found in many different governmental sectors, including education, health, policing and border control and (2) are frequently embedded in programs with broader goals.” As a result, most existing estimates are weak (Reuter, 2005). The same observations were made for the Netherlands (Rigter, 2003). The result is that changes in the drug policy budget are rarely traceable. Therefore, international comparison of these changes is severely hampered. When we look at policy measures comparable conclusions can be drawn.

3.1 Supply reduction

Reduction of drug-related crime is an important element in supply reduction. This is probably due to the fact that drug-related crime is a broadly defined concept and the relationship between illegal drugs and crime is complex (Goldstein, 1985; Wilczynski & Pigott, 2004; EMCDDA, 2007); straightforward measurements do not exist. Many national publications cover numbers of drug-related arrests, offences or incarcerations. We have already described several problems with these measures under the title “Drug problems”. Statistics on arrests and incarcerations for drug-related offences are available for many Western countries, but national registration systems differ in their definition of what constitutes an arrest or a drug offence.

Another challenge is the variation in registration and in figures coming from different sources in a country, e.g., the police and the judicial departments. In the Netherlands, for example, figures on crime (e.g., charges, arrests, incarcerations, etc.) sourced from the regional police registrations were largely incomparable. Registration is now easier to compare and, each trimester, figures are uploaded onto a national database as part of a national criminality overview (“Criminaliteitskaart”). In many countries these difficulties are undetectable because registration sources are not mentioned.

Another example is that differences between country figures can be attributed in part to provisions in drug law, e.g., whether drug use as such is a penal offence resulting in imprisonment, or not. In a growing number of countries the consumption of illicit drugs is decriminalised and possession of small quantities for personal use is treated as an administrative offence (see report 4 on drug problems and drug policy).

3.2 Demand and harm reduction

The available information on demand and harm reduction measures taken in different countries does not represent an adequate indicator for international comparison. Available information on drug treatment differs widely between countries, presenting, for instance, in one case, an overview of available interventions and facilities (e.g., types of treatment) or in other cases, numbers of patients in certain forms of treatment, numbers of treatment services, treatment units or beds that are available for drug-dependent clients, and treatment effectiveness.

Moreover, treatment is a broad concept and is measured in various ways, impairing reliable comparisons between countries. In the United States, for instance, the federal government system for counting the number of persons in treatment (Treatment Episode Data System: TEDS) includes only admissions to facilities that receive at least some funding from the federal government; private clinics and general practitioners are missed. Furthermore, there are many different types of treatment (e.g., therapeutic communities, cognitive behavioural therapy programmes, family-based treatment). In many cases it remains unclear what exactly is covered by the term ´treatment´.

For drug prevention, information is collected on types of prevention (school-, family- or community-based programmes, mass media campaigns or telephone help lines) and/or on outcomes measured for these interventions (coverage, knowledge, attitude, etc.). But one type of drug prevention alone may cover major differences in programmes actually implemented. School-based prevention programmes may be specifically focused on prevention of drug use (e.g. the Netherlands Healthy School and Drugs Programme) but may also be more generally focused on health promotion (covering different issues, from the use of illicit drugs to sexual health issues).

The data collected on harm reduction services also differ greatly. Needle exchange programmes can serve as an example of this. The focus of data collection can be on the number of exchange points; the number of clients, the number of syringes or needles exchanged and/or the specific materials provided, e.g., condoms or sterile pads. Moreover, there can be differences in the coverage of the data collected. Many syringe exchange data, for example, do not cover pharmacist distribution/sales, while in some countries these may distribute the majority of the needles exchanged.

In conclusion, it can be said that there is a lot of information available, but that this information does not allow a thorough comparison between countries.

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