Drug Abuse

"Opium smoking among our people is as widespread as whisky drinking among you, and has no more effect on us than whisky drinking on you." Evidently, he (our witness) meant that the Kachin people should have as much right to enjoyment as us Whites.
Eric Ekstrand, head of the Opium Traffic Section and chairman of the League Inquiry into the control of Opium Smoking in the Far East (1929), in his memoirs (translated from the Swedish).

Here we will review the implications of the conclusions of earlier chapters in order to identify fundamental issues and to make recommendations. What has emerged from the Study makes a fairly straightforward case for some of the propositions we are about to make, but others will not derive directly or entirely from our findings. However, we will have due regard for these findings in making our recommendations, and will, where necessary, make known the line of thought on which they rest.

In this study we have described the operations -of the control system and the influences affecting its development. A modest enterprise, it has deliberately avoided some of the broader issues on which the subject impinges. Our study differs from other investigations in its inclusion of alcohol and in its attempt to go behind the formal procedures to actual operations. In doing so we have referred to occurrences in the system's history, finding that despite changes in vocabulary and in the world at large, the system has been so stable, its arguments and underlying views so unchanged, that, without a consideration of the past, one's understanding of it would be incomplete.

Success or Failure?

Until now the system has not been subjected to a comprehen-sive evaluation, nor have we ourselves been capable of performing that task adequately. Ours is a beginning. An overall and final evaluation is not possible in an absolute sense; it is necessarily tied to particular criteria and levels of aspiration, and, depending on these, the conclusions drawn will differ. Nevertheless, com-paring the manifest outcomes with the professed goals of the international drug control system, it is possible to conclude as to where it has succeeded or where it has failed. One can ask, given a set of goals, if the strategies adopted in their pursuit were reasonable and the outcomes satisfactory. We shall, however, momentarily suspend judgments of the correctness of the goals pursued and criteria selected by the international control system.

To begin with achievements: first, the international coopera-tion begun at Shanghai and The Hague does constitute the first positive step towards the regulation of international transactions in drugs. The acceptance by countries of the necessity for such regulation was itself no mean achievement. The adoption later of the principle that a country could export narcotics to other countries only with their permission has helped to prevent the recurrence of the kind of situation exemplified by the Anglo-Indian opium trade. Whatever other factors might have been involved, the pressure of international opinion did contribute to an alleviation of the Chinese problem.

Second, the establishment of the statistical reporting system managed by the Board was a worthy achievement. Although the international organs see this more as a potential means of control, we would accord it a higher value: it is a feature of the information base which must underlie any control machinery.

Third, during the Jellinek era in the 1950s great strides were made in the development of alcohol programs in Europe and Latin America. These included new views on alcoholism, its nature and treatment. This was not accomplished through the creation of a large administration but came about as a result of the combination of Jellinek's talents with WHO's prestige. Even more needed than new resources were new concepts, and these certainly developed in an important way during the period in question.

Fourth, the widespread diversion of narcotic drugs from pharmaceutical houses to illicit markets in the 1920s and early 1930s was reduced to a negligible amount. To what extent this was due to the influence of the international system rather than national self-restraint is difficult to determine. It is evident, however, that there was little sign of voluntary control within the drug industry itself, and that, had it not been for the pressure exerted by some members of the Advisory Committee and the Board, national controls would have been even more tardy. Thus at least one of the goals underlying the provisions in the Geneva Convention governing international trade was fulfilled.

Fifth, there is the limitation, to a small number of countries, of legal opium production for export. Even though ambiguity has often surrounded the question of limitation of production and the means to achieve it, there can be no doubt that the scheme has been brought about by the international control system and that the designation of producing countries has been an obstacle to new countries starting opium production legally for export.

Sixth, the relative stabilization of the number of synthetic drugs of the morphine type on the market is a situation which the international system has been instrumental in sustaining. Without international control, there might have been a proliferation of such drugs on the market, most or all of which would probably not Itave added to the therapeutic benefit of those already being used but which could have constituted an increased risk to public health. The WHO expert committees were mainly responsible for this restraint.

Seventh, the significant decrease in the use of heroin and cannabis preparations for medical purposes can be attributed unequivocally to the effects of international drug control. The groundwork was laid in the League period but its success must be acknowledged to have been due to the joint efforts of WHO, the Board, and the Commission, the first being probably the most influential. The resistance of some countries to this development diminished with time, as revealed by the consumption statistics, and although the idea was propagated by the U.S. government, the international system played a significant part in bringing this situation about.

We turn now to the failures. The first failure is simply that the goal of eliminating the "evil," be it cannabis use, coca-leaf-chewing, or the opium habit, has not been achieved. It may of course be said that the expression of such a goal is mere rhetoric and idealism, and serves only as a spur to action—that such expressions are no more than political maneuvers. Yet there are those within the establishment in whom an acceptance of tactical necessity is combined with at least a partial commitment to this rhetorical goal, and who are thereby led to subscribe to utterly unrealistic expectations and operations.

Second, the international control system has failed to become truly international. Its dominant values tend to favor the interests of one or two countries over those of others in the international community. Of course no one is surprised that there is so little similarity between the ideals of an international organization and what the organization actually does, but the extent to which the drug control system is dominated by U.S. interests and con-strained by "superpower" politics makes it a travesty of interna-tionalism.

Third, the system has been unable to adjust to the changing world situation: the rapid development and increased use of "psychotropics" and the awareness of the problem of alcohol, both by itself and in association with that of other drugs, have not been accompanied by corresponding modifications in the inter-national response. The system has thus lost its social relevance, moral strength, and scientific thrust. Even though there were reasons for neglecting alcohol, this cannot be said of the "psycho-tropics": in contrast to the vigor of efforts to bring new synthetic opiates under control, the process of enacting controls over the "psychotropic" drugs has been marked by hesitation and legalis-tic quibbling.

Fourth, the international administration has failed to meet the demands of its task. The fault lies partly with the international civil servants, who form the core of the permanent administrative machinery. The aimlessness of the whole system may be attribu-ted in part to their inability to confront the actual situation and to make real efforts to explore alternative ways of operating. The Secretariat has not been what the onetime UN secretary-general Dag Hammarskjiild had said it could be: "a living thing . . . it can introduce new ideas. It can in proper forms take initiatives. It can put before Member governments new findings which will influence their actions" (Foote, 1963). It is often admifted by international civil servants in private that the system is not what it pretends to be, but in their official behavior they continue to subscribe to the evasion of reality through defensiveness and the employment of false arguments. However, in extenuation of the apparent inertia of the staff members, it must be said that their work is bound to be affected by the masters they serve, and there have undoubtedly been occasions when constructive efforts and suggestions on the part of the personnel have been rebuffed by the dominant powers in the Commission.

Fifth, the attempts at crop substitution have failed. The failure has occurred on two levels. On one level, substitution programs have simply failed to get off the ground, to either materialize or survive. Technical mistakes, the inadequacy of auxiliary struc-tures (such as marketing arrangements, outlets for substitute products and agricultural training, and so on), the consequences of heavy-handed pressures from outside, and the lack of respect shown for social traditions that were likely to be affected: all these factors operated to render crop replacement unsuccessful. On another level, crop substitution has clearly failed to reduce drug supplies. Although it is possible that reducing drug availability through crop substitution might be an element in an all-round drug policy, it is unlikely to be the all-important one. Treating it as the central policy, as the international system is apt to do, or as representing the fundamental approach underlying all future UN action against "drug abuse," is tantamount to an evasion of the realities of the drug-using world.

The sixth failure is that international control has contributed to the replacement of opium by heroin use in a number of countries. Iran offers an example of the wastefulness and harmful conse-quences of sudden, isolated repressive action; yet the lesson it affords is unlearned and unheeded. The international system continues to press for cessation of opium supplies and to attach opprobrium to countries unable to enforce prohibition.

The seventh failure is the inability of the present system to curb the illicit traffic. No control system is without its costs, and it is obvious that international control has itself contributed to the development of a black market, although even without the existence of international controls the mere fact that countries differ in terms of drug production, availability, and controls is in itself a sufficient condition for smuggling to occur. Several factors militate against effective law enforcement: the fact that illegal sale is not spontaneously reported by the "aggrieved" party but has to be detected through enforcement efforts, the practice of corruption in the narcotics police forces, and the existence of national sanctuaries for production, storage, investment of illicitly gained funds, for the refuge of wanted offenders, and for certain protected roles ( diplomats, political leaders).* The international control system has furthermore abetted a situation where some countries severely punish individual drug offenders when at the same time they tolerate the ready facilities for illicit trafficking afforded by their illegal domestic drug production (for example, cannabis in Lebanon and stimulants in Italy).

The catalogue of seven cases each of success and failure is of course by no means exhaustive. And it will be remembered that they have been judged in terms of the outcomes sought by the system itself.

General Comments

The instances of success have a common denominator: none of them is directly aimed at affecting the individual drug-taker at the behavioral level. Two of the seven cases concern international trade; two seek to influence production; and two have a bearing on medical practices. In four examples commercial interests were affected. The discontinuation of the medical use of cannabis and heroin in most countries stemmed from the pursuit of a policy of prohibition; but, as was the case with alcoholism, the change involved was one of medical custom and perception of norms. In six cases of success, it has been the conduct of professions and private enterprise which has been influenced; and indeed, they appear to be more susceptible to regulation and control than individual behavior.
With regard to the failures it seems possible to distinguish between those due to inherent defects in the system and those associated with unintended or unforeseen consequences of its action, although the difference is by no means clear-cut. The weaknesses of the system include the goal of eliminating all proscribed individual drug use--or supplies catering to 'that demand; the slowness of the control strategies to adjust to Changes in the external drug situation (such as the appearance of problems connected with the use of new psychoactive drugs); and the lack of recognition of cultural diversity. These have their foundation in a more general inability to develop alternative policies of control and to shed the pretence, perpetuated by words and argumenta-tive techniques, that all is well with the control system. The other failures also signify a lack of appreciation of the range of possible action and consequences. They also involve an intrusion into what are considered "problem countries" (which tend to be only the poor and uninfluential), through the exertion of pressure to engage in activities unacceptable to local customs and without sufficient Tegard for the cultural setting. Drug-taking is ap-proached as though it were an isolated phenomenon. An illustra-tion of the failure-to conceptualize the drug problem adequately or broadly enough is the extent to which the skills which are engaged in the work are confined to a narrow range of disciplines and occupations.

The failures are more pronounced in the years after the Second World War, whereas some of the basic achievements occurred earlier. The late 1920s and early 1930s constituted the peak era of international drug control. This is reflected in the fact that very little written in recent years approaches the quality of the report of the Persian Commission of Inquiry or Bouquet's paper on cannabis. The Board, too, was more forthright in its dealings with governments and the pharmaceutical industry, and less reluctant in those days to take an independent stand. Also, underlying the work of the earlier years was a better understanding of cultural heterogeneity, perhaps because many of the active figures had worked in foreign cultures.

In making our recommendations we will be careful not to repudiate the laborious efforts which have gone into the making and acceptance of the present control system. On the other hand, it must be admitted that the defects of the system stem in part from an inability to adjust to new problems as they emerge. To find a balance between continuity and innovation is indeed a difficult matter. It is necessary to make our recommendations on two levels: that of an immediate and more practical order and that which entails changes of a more fundamental and long-range character.

Short-range Recommendations

These recommendations relate to the structure and functioning of the control machinery and are made on the supposition that the goals which are now being pursued will remain unchanged. Although we term these "short-range" recommendations, we are fully aware that their adoption would entail time-consuming reforms of a basic character not only to the bureaucracy but also to the legal framework.

First, we consider that a reorganization of the system is necessary, and we will take each key structure in turn to pinpoint where this should occur.

A reorganized system would still consist of a policy-making body, similar to the present Narcotics Commission, and a secre-tariat service, such as is being provided today by the Division. It is with the Commission and the Division that the information-gathering and goal-setting processes largely begin, and it is in these processes, as they are actually being carried out, that many of the system's weaknesses lie. The Commission's discussiots on goals and programs lack inspiration, direction, frankness, aware-ness of alternatives, and information both sound and relevant to policy-making. It seems to us that expert advisory bodies should be periodically appointed to assist the Commission in its policy-making functions. Such bodies could prepare repertories of goals and alternatives from which the Commission could then make its choice; they could make predictions of costs and evaluate the consequences of adopting various courses of action. Very little work of this kind has hitherto been undertaken by the Commis-sion. At present, the materials for decision-making are prepared by the Division, but analysis and evaluation of data in relation to decisions prior to their employment by the Commission can usefully be carried out by bodies with more specialized knowledge and greater diversity of viewpoints.

One of the weaknesses of the Division lies in the recruitment and composition of its personnel. As the Jackson and Bertrand studies tell us, the exclusion of youth, independence of thinking, and vigor from the ranks of the professional staff is a general characteristic of the UN administration. The persistence of the status quo in the Narcotics Division may owe much to the practice of retaining past or retired officials as "consultants" to programs. Thus the ideas and atmosphere of yesterday continue to inform the policies of today. Avoidance of misguided and obsolete action calls for a change in the selection criteria of personnel so as to ensure a bureaucracy receptive to new ideas and modes of operation.There ought also to be a greater readiness to contract work out to, or at least cooperate with, universities and national research institutions. Indeed it was Dag Hammarskjeild's policy, when he was secretary-general, that this should be so, at least insofar as research undertakings were concerned (Symonds and Carder, 1973: 73, 81).

When we look closely at who sets the tone of operations in WHO, we see that the balance of emphasis has always tipped strongly towards pharmacologists and the medical profession. WHO is performing a necessary function with respect to the pharmacological evaluation of drugs and the promotion of pre-ventive programs, but because its role in recommending the level of control of drugs necessarily involves it in the shaping of drug policies, it should diversify the professional composition of its Drug Dependence Expert Committees to include other than pharmacologists and physicians. Hitherto there has been a tendency for the same people to make pronouncements on drug effeqs, on treatment, and on control measures, without sufficient recognition of the necessarily limited perspectives they bring to bear on these subjects. There has also been a tendency of late for the expert committees to involve themselves in matters having little to do with their drug-classifying obligations under the international treaties. So that these widened horizons will not overtax the expert committees—characterized as they have been by a fairly narrow professional base--we suggest that they differentiate between the technical task of evaluating drugs for control on the one hand, and the consideration of broader matters of policy, research, and social concerns on the other, with a concomitant division of work between differently composed committees.

So much for the professional basis of policy-making. In looking at organizational structure and performance, we see that the chief problem is one of obsolescence. The continued existence of a laboratory within the Division is not justifiable. It conveys the erroneous impression that the scientific basis of international action is narrowly chemical and botanical. It also lends an unwarranted aura of broad scientific expertise to the Division.

Since its role is that of coordinating, rather than actively engag-ing, in research, many of its functions can be absorbed by the Division proper and by WHO. Its collection of drug literature can be incorporated into the drug section of the general UN Library, and developed into an information resource available (more freely than it is now), to all research workers and to the public. Consideration should be given to the possibility of developing a research program by the Division which will yield information helpful to the Commission in its policy-setting task.

With regard to the Board, its creation, given the circumstances in the 1920s, was not without justification, and its earlier performance appears also to have been effective. But we have seen that its "independence" is more and more of a myth, and the "still, small voice" it purports to be has become louder and louder with regard to matters beyond its ken. Interest in its own survival has made the Board timorous where it should be bold, bold where it is ill-informed. Its members are increasingly political, rather than independent technical appointees. Unless these trends are reversed, it seems to us that there is increasingly less justification for having the Board at all. It would anyhow be preferable tastrip the body down to its statistical functions and incorporate the secretariat, which would then be concerned only with statistical matters, within the structure of the Division. The Board itself should cease to be a separate institution, and we suggest that the parties to the treaties consider suitable amendments to bring about its termination. The Board's members could, however, serve as independent experts in the Commission which, though at present composed entirely of government representatives, could in fact be transformed by ECOSOC into a mixed organ of govern-ment representatives and experts (UN Commentary, 1973:7).

This raises the question of the future of the estimates system, which has hitherto been operated by the Board. We have already discussed the limitations of the system, but would point out that its effectiveness and relevance have not been adequately studied by an impartial outsider. It has been the international control system's answer to the question of how to maintain drug supplies at a level comparable with the desirable level of consumption, and it is conceivable that if it were inserted into the Vienna Conven-tion, it could be of value in the initial stages of the treaty's application as a means of affecting the volume of "psychotropic" drugs prescribed. But its continued worth with respect to the Single Convention should be critically assessed; rigorous study of the system is called for.

The setting up of the UN Fund has so far had more negative than positive consequences. It has provided wide opportunity for the pursuit of narrow national and organizational self-interest. Coordination of activities between "rival" agencies, already difficult, is now even more of a problem. Instead of facilitating action on a broader base than that on which UN intervention has hitherto rested, the Fund has stiffened, through selective financial infusions, the mold in which UN drug programming has tradi-tionally been cast. A large proportion of the money allocated to the Fund's various programs is in fact spent on supporting an ever-expanding bureaucracy to administer these programs. Indeed many of the Programs appear to serve no purpose other than to provide occupation for the enlarged secretariats. If this is the case, then one is prompted to suggest that, in order to avoid wastage, such programs should be relinquished. We view with skepticism the Thailand program and the Papaver bracteatum project. Our earlier suspicions of the unfeasibility of the project to discoyer means of waging biological warfare on drug-bearing crops have been confirmed, as it has now been abandoned as being unworkable. Behind such questions as how to obtain larger contributions to the Fund, or how to persuade Burma to join in the fight against the illicit traffic, there lie the larger ones. How can priorities for international action be set? What are the effects of international aid for drug programs on the recipient country? With regard to the latter, little thought has been given to the manner in which aid can distort—through upsetting national priorities and the choice of allocation of national investment between sectors and regions—the economic and social develop-ment of a country. Crop replacement programs have been justified by their advocates on the grounds that they have the instrumental and independent value of bringing about economic progress and raising living standards, but is it not equally possible that opium-growing by a poor country may contribute more to general economic development by increasing foreign exchange earnings? If so, the problem is to see the proper distribution of those earnings beyond the privileged class of criminals and their police and political supporters.

We suggest the transfer of the Fund to the United Nations Development Program (UNDP). Under UNDP proper considera-tion can be given to a country's real aid and development requirements. The Commission's role under this arrangement might be that of initiating proposals and making recommenda-tions regarding the choice of projects to be embarked upon. The expert advisory groups earlier suggested might also be involved in helping to identify needs, formulating programs, and evaluating the long-term effects of implementing them.

While all this pruning of the international control organs is taking place, the question of the illicit traffic is obviously lurking just offstage. Present efforts to combat this traffic have tended to concentrate on making seizures and apprehending dealers. But an alternative course may lie in employing international relations to effect changes in previously overlooked or underplayed facets of the illegal trade, such as the acquiescence of governments, on political or economic grounds or both, to facilities on their soil for illegal production and distribution, and for the holding of profits (for example, in Swiss banks). A key aspect of the illicit traffic is the existence of the profitable market for drugs in the U.S. The demand which exists in the U.S. makes it a problem country of the first magnitude. We believe that no appreciable impact can be made on the illicit traffic until the international community tackles the problem of how to ease the American drug situation with a view to alleviating the world situation. A first step in this direction might be the initiation of an independent, "outside" study of the American drug problem: an analogy which comes immediately to mind is Gunnar Myrdal's classic study (1944) of race relations in the U.S. One might even envisage a latter-day Commission of Inquiry such as the one that was sent to Persia by the League of Nations. In fact, the Commission should direct the energies it has hitherto applied to studying problems in develop-ing countries to Western industrialized ones; and the U.S., being the most problematic, should be the first to be studied. The need for this is all the more urgent because the world is more affected by the domestic policy of the U.S. than by that of any other coun-try, and so far none of the nations which have accepted the American definition of the problem and its solution has had a chance of judging how compatible the policy of the U.S. is with its own situation.

Finally, we question the appropriateness of inserting manda-tory penal provisions relating to drug possession and use in the text of international treaties. It provides fuel for national punitive action bordering on infringement of the code of human rights. Penal legislation and enforcement have been put to work in situations patently calling for other kinds of intervention: pro-vision of better housing, welfare, work, and so on. These factors have worked to reduce confidence among many groups in drug control in general; the inclusion of the criminal sanction in the Vienna Convention, for instance, had the effect of dissipating support for it. And there is evidence that, in some countries, criminal policies have been a costly failure.

The recommendations contained in the foregoing pages may be summarized as follows.

1. We propose that the Commission reorganize its use of informa-tion and expertise to (a) allow external research institutions to be drawn into the process of data collection and analysis and (b) have ad hoc advisory groups to help formulate and evaluate policies.

2. There should be a clearer differentiation between the WHO Drug Dependence Expert Committees' drug evaluation respon-sibilities and their work on broader questions; the professional composition of their membership should correspondingly be diversified.

3. We recommend that the UN Laboratory be dismantled and its functions distributed among the existing units. International research efforts should in any event be deflected to areas of higher priority and relevance.

4. The structure of the INCB might, by suitably amending the Conventions, be changed as follows: the members might be absorbed by the Commission as independent experts, and the secretariat should be incorporated in such a way as to form a statistical-technical branch of the Division.

5. We propose that a thorough study of the estimates system be carried out by impartial outsiders to judge its continued useful-ness in regard to Single Convention drugs on the one hand, and its applicability to drugs yet to be controlled on the other.

6. The Fund should be integrated into UNDP; the Commission's function vis-à-vis the Fund should be that of originating and evaluating project proposals prior to their acceptance, while the final decisions on the allocation of money should rest with UNDP. The Fund's programs should anyhow be critically appraised and some of its current endeavors relinquished.

7. We urge a shift of emphasis in the international organizations' conceptions of "problem countries" from developing nations to industrialized ones, and we suggest that this change of empha-sis should first alight upon the U.S. The Commission should seriously consider the problem of demand in America and promote the undertaking, by an impartial external group, of an inquiry into its international ramifications.

8. Penal provisions should not be detailed in international drug treaties in a way that would lead to their adoption by countries where their application is unsuitable.

Basic Issues

These proposals for adjustments to the system have been arrived at on the basis of an assumption that events will run their course without a major departure from the original, officially endorsed goals. But should these goals be perpetrated, consider-ing what has emerged from our study? Is there no alternative choice of future controls? We believe that there is, if one takes a longer view in formulating one's recommendations. However, before such recommendations can be made, a number of issues and matters of principle must first be resolved. These issues do not appear here for the first time, but so far they have only been touched upon obliquely, and no stand has explicitly been taken on them. These issues, which we will now briefly discuss, are the following: national versus international control; the inclusion of alcohol under international control; the goals of the control system; and, finally, the relation between drug dependence control and the broader concerns of agricultural policy and drug consumer-protection in general.

There exist contrasting views on the necessity for international, as opposed to purely national, controls. In our introductory chapter we offered reasons for having controls as such, but took no stand as to whether these should be at the domestic level only, or set up internationally. One frequently encounters assertions that alcohol control is a national matter, but that cannabis is of international concern. And in the earlier discussions on ampheta-mines in WHO, the expert committees advocated national, rather than international, measures of control. Yet we know of no published work dealing at any length with this fundamental issue.

The controversy between those who consider international controls necessary and those who think otherwise cannot be resolved without resort to historical evidence. When seen in a historical context, it does not appear likely that whatever has been achieved in the way of regulated trade could have come about through the enforcement of national controls alone. It is also difficult to argue that the need for international controls is decreasing; increased trade in alcohol and other drugs between countries points in the opposite direction, and, in a world of economic integration and multinational corporations, national control is encountering more and more hindrances to effective enforcement. We think that some form of international control is indispensable (later we will discuss in what respects such control should differ from that which is currently being exercised), but we also accept the argument, often advanced in the Commission, that national controls are a necessary complement to interna-tional ones.

The next issue is: how does one perceive alcohol control in relation to the control of other drugs? We have seen that the international organs have paid little attention to alcohol and that only in one key organization, WHO, has there been formal recognition of the usefulness of a unitary view of alcohol and other drugs. The other organs, being more constrained by the treaties than WHO in what they can do, are less able, all of a sudden, to consider alcohol in the same light or within the same legal framework. The situation today is understandable from a historical point of view but is otherwise scarcely defensible. After all, the consensus of opinion today holds that alcohol has considerable harmful effects and that its use gives rise to serious public-health problems. The need to control alcohol is widely recognized, as is evidenced by the efforts of many countries; the need to do so on the basis of international cooperation is, on the other hand, less readily admitted. Nonetheless, in the report of a WHO Expert Committee on Mental Health, we find this state-ment (1967:41):

While recognizing that there are important differences between types of drug dependence, the Committee recommends that problems of dependence on alcohol and dependence on other drugs should be considered together, because of similarities of causation, interchangeability of agent in respect of maintenance of dependence and hence similarities in measures required for prevention and treatment.

If an international body has gone as far as recommending the above, the question that one is led to ask is: why not proceed even further and bring alcohol under international control? The case for placing alcohol under international control could be argued on the following grounds:

—it satisfies the criterion of "dependence liability" and, contrary to earlier notions, does not constitute a "special case" separate from the other drugs;
—the dependence-producing drugs under international control are a motley group and adding alcohol would not undermine their homogeneity;
—alcohol gives rise to more problems than any of the other drugs;
—the phenomenon of multidrug use and of the substitution of one drug for another makes it imperative to consider all the drugs involved as a totality;
—alcohol is an item of international trade the increase of which has not been accompanied by an internationalization of the measure designed to control it; it is also a commodity which figures prominently in internationnal life, as witness tourism and diplomatic activity.
—alcohol smuggling across national borders occurs.

There are, on the other hand, strong counterarguments, such as its near universal use and the integration of its use into the customs of many cultures. But the objections to international control of alcohol arise mainly from a particular way of looking at international controls. In proposing that alcohol be internation-ally controlled we are not thinking in terms of adding it unreserv-edly to the existing control schedules, or of an extension of the present control regimes to cover it. The mechanisms we do envisage will become apparent as we tackle the next issue.

The stands we have taken on the foregoing two issues are predicated on the presumption of a redefinition of the goals of international control. The present system aims at fighting "abuse" and "dependence" and at the suppression of all use other than for medical and scientific purposes. As "abuse" has in any case been identified with nonmedical and nonscientific use, there is no practical distinction between these two concepts. The terms "abuse," "dependence," and "nonmedical use" carry with them connotations of the approaches which have strongly influ-enced the development of international controls, namely the moralistic, the pharmacological, and the medical. The present formulation of goals does not relate drug control to broader social policy and leaves little room for the expression of cultural differences. Policies spawned by these goals are apt to focus narrowly on one or two drugs and to be careless of the all too likely drug substitution effect, which, as we have seen, has manifested itself as one of the by-products of international control. In pursuit of the absolute goals set by the system, countries are under a certain constraint to entertain unrealistic aspirations and to lay claim to achievements where in fact none obtains. A case in point is the rule under the Single Convention that nonmedical use of cannabis must be prohibited by the end of 1989; the onus is on India to say on that date that it has abided by its international obligations and has prohibited cannabis use, regardless of what this means in practice. The absoluteness of the present goals is such that, to uphold them in the face of diminishing credibility, all manner of distortion and falsehood is coup,tenanced by the system, whether in the information it receives on the workings of the system in individual countries, or in the information it gives out to the unsuspecting public.

The ultimate purpose of any social policy is presumably to reduce human misery; a drug control policy inspired by this end might therefore be primarily directed at minimizing the harmful effects of drug use. In preferring to address the harmful effects of drug use, we are underlining the need to specify, with some concreteness, what these effects might be. Similarly, our prefer-ence for the term "drug use" over "drug abuse" and "drug dependence" stems from our wish to avoid using obscure con-cepts in formulating the objectives of control. Moreover, we reject the view that what is to be controlled is a uniform phenomenon. Drug use is something quite variable after all; it may, for example, serve medical needs or, alternatively, it may be compul-sive or recreational. By the phrase "minimizing harmful effects" is implied the necessity of giving due consideration to the negative effects of control itself. Although we do not think that such effects are amenable to a strict cost-benefit estimation, we must nevertheless acknowledge the persuasiveness of the scientific school which has drawn attention to these effects (Becker, 1964; Linde-smith, 1965). A goal conceived under such a perspective and formulated in terms of the minimization of harmful effects can thus be translated into a broad strategy which takes account of the possible and unintended consequences of its implementation which, though not always predictable, can at least be anticipated sufficiently early in many cases for irrevocable mistakes to be avoided.

Use of drugs can be viewed as risk-taking behavior. Individual reactions to drugs, affected as they are by personality, mood, social setting, and experience, can be difficult to predict. It would be futile to direct control efforts at individual reactions; they must work on a more general level. A starting point might lie in a way of thinking to which many research workers in the alcohol field subscribe today, and this is the notion that the rate of alcoholism in a given population is related to the general level of consttmp-tion in that population, so that measures aimed at lowering the general consumption will also diminish the harmful effects. Although this view is not without opposition there is accumula-ting evidence which lends it credence (de Lint and Schmidt, 1971; MRkeli, 1972; WHO/FFAS, 1974).

If harmful consequences of drug use are related to overall use—and the empirical evidence yielded by alcohol research is strongly suggestive of such a relationship—then one of the things which a drug control policy might seek to do is to decrease overall consumption. Although there is much to be learned still about the relationship between rate of use and degree of risk, we neverthe-less consider that at the present stage of knowledge this proposi-tion provides a useful and pragmatic starting point for the further elaboration of an international drug control policy.

It would be wrong to exaggerate the difference between the goal which we have been criticizing and the goal which we are now trying to insinuate in its place. There is indeed little conflict between these two goals, and most of the successes and failures of international control earlier enumerated can be judged as such independently of which goal is being used as a yardstick. Never-theless, because the goal we propose is more clearly defined and lends itself more readily to an operational definition on the practical plane, it will be easier to evaluate the outcome of policies directed at achieving it, and thereby to detect mistaken strategies, not perpetuate them. Furthermore, our goal is compatible with the system's past successes in that it focuses on institutional rather than individual actions.

The last issue is the relationship of psychoactive drug control to such broader concerns as agricultural economic planning and drug consumer-protection in general. Should we not see opium and alcohol production as a matter falling within the province of agricultural development policy, and control for drug dependence and for drug "misuse" as part of the larger area of ensuring drug safety and efficacy? We have seen that reduction of opium and alcohol production can, without any element of conscious drug control strategy, follow naturally from changes in general agricul-tural policy. An expanded and inclusive view of control encom-passing drug safety, efficacy, dependence, and other matters might also be possible on the common basis of acknowledging the desirability of increased responsibility on the part of drug manu-facturers. And indeed, there has been a perceptible move among some members of the international community to extend interna-tional controls to the elaboration of consumer protection proce-durés aimed in the long run at making the pharmaceutical industry adopt more cautious and responsible attitudes to drug production, marketing, and use. The protection of public health does call for the international supervision of standards for drug purity, safety, efficacy, labelling, advertising, and so on, particu-larly in importing countries which rely for their supply of drugs on the pharmaceutical industries of other countries. It would be advisable, in the case of some drugs, for these controls to be coor-dinated with the responsibilities which the international organs already have for the control of production and trade. On the other hand, consumer protection measures are more applicable to industrial pharmaceuticals, while many psychoactive drugs are used in their natural form. Also, the intoxication-seeking factor in psychoactive drug use is an added argument for distinguishing between psychoactive drug control policies and consumer protec-tion measures. Nevertheless, the feasibility of coordinating mea-sures subsumed under these two types of control is a matter deserving further exploration.

Long-range Recommendations

Our earlier discussion of the issue of goals has already provided us with our first recommendation, which is that the goal of the international control system be reformulated as: the minimiza-tion of the harmful effects of drug use. The ensuing reorganiza-tion of the scheme of control would entail two essential changes: first, the rejection of "medical usefulness" as the authoritative standard against which drugs are to be evaluated for purposes of control (and therefore the old antithesis between medical and nonmedical use); and second, the inclusion of guarantees that controls will be flexibly adjusted to differences between societies. Before we move from generalizations about goals to more con-crete proposals, we should dwell a little on the distinction between the national and international planes. Although it has been generally agreed that the ultimate responsibility for determining controls must lie with the individual state, in practice interna-tional legislation is the textual source and point of departure of many national laws. Although we have argued for international controls to buttress national ones and vice versa, we have aigued also for international controls that are sensitive to national needs. But there is no inevitable dilemma in these two requirements, for we see the primary function of international control as the regulation of transnational trade. Domestic drug policy becomes a matter of international concern as soon as drugs cross national borders. Since control over export trade cannot be sustained by isolated individual effort there have to be organized systems of mutual self-discipline between and among countries, which ensure that drugs travel across national borders only under specific conditions, conditions which would vary however, from drug to drug. The elaborate system of control set up for narcotics could not, for instance, be adapted to the regulation of alcohol trade. Yet it should be within the capacity of an international body to see to the working of the principle of maintaining the vol-ume of trade in a particular drug at an agreed level, or of a gradual diminution of trade such as was exemplified by the arrangement between the British and the Chinese for a one-tenth annual reduction of the Indian opium trade. Control of the quantity and range of drug imports is likely to bear on drug use in two ways: in the case of a consuming country with a perceived drug problem, the restriction of supplies provides a breathing space while the country tackles its problem on other fronts simultaneously; in countries where there is no already existing demand, it militates against the creation of new, and possibly artificial, needs.

We are on more uncertain ground when we come to the ques-tion of controls over production. Such controls would give added strength to those established enterprises which are already enjoy-ing the benefits of a monopolistic market (Arndt and Lind, 1973). Yet as drug manufacturing industries and distilleries grow and gain access to overseas markets, they will try to extend the geographical reach of their distribution network (cf. the Report of the Committee to Study Problems of the Pharmaceutical Indus-try, 1972). Some world regulatory authority which matches these enterprises in geographical reach and which is capable of collec-tively considering the interests of all the countries affected is necessary. Multinational corporations characteristically establish foreign subsidiaries when their export position is threatened; to reduce costs they may situate their production units closer to their foreign markets; to penetrate and compete in these markets they usually have to increase the tempo and range of their production. International agencies have a responsibility for tempering such expansion and for ensuring that an interest in satisfying human needs, as opposed to creating them, remains, on balance, in the
foreftont.

More specifically, possibilities for control in the following areas should be considered: marketing techniques; advertising; differ-ing standards of responsibility observed by manufacturers and distributors in different countries (these tending to be lower in poor countries); conditions for new product introduction and the prescribing of psychoactive drugs whose indications are highly equivocal. A standard regime under the Single Convention includes the requirement of governmental authorization for parti-cipation in all phases of the narcotics trade; such a requirement may be met either by licensing or by state ownership. The premise on which this rests is clear: public-health needs are better served by governmental ownership and control. A matter which deserves debate, say in the Commission, is whether the displacement, by governmental intervention, of the need of private drug industry in general to make profit (often at the expense of public health), might not in the long run better the chances of effective drug control. We do not assume that governments are necessarily more mindful of the health interests of the drug consumers of other countries than private industry, but we do assume that such questions are pertinent to international drug control work. Fur-ther questions worth considering are: the sale of duty-ftee alcohol in international airports, and whether there might be an analogy between access to exceptionally cheap liquor by diplomats and easy access to other drugs by the meçlical profession.

All this must be accompanied by the collection of sound data on an international scale. Because of the worldwide structure of drug and alcohol economies, reporting should be an international obligation, and the statistical office of the Division to which an earlier recommendation referred could become the clearinghouse for such data.

Forms of drug use and distribution which occur outside legitimate formal organizations—such as are typical of cannabis, coca leaf, opium, and heroin today—should be of lesser concern to the international system, not only because that concern is now exaggerated, but also because the effective capacity of interna-tional agencies to influence the situation is severely limited. It will be remembered that opium and heroin were more susceptible to control when their circulation took place in legitimate institu-tional structures. There is room, nonetheless, for innovations in international arrangements for the control of illegal drug activi-ties (see Blum, Kaplan, Lind, and Tinklenberg, 1974).

We do not mean by all this to undermine the importance of cultural setting and other informal influences on drug use behavior. The informal systems of drug supply, such as through peer groups and friends, do merit attention, but international action, lacking the means of reaching such groups, probably has to limit itself to such circumscribed tasks as the promotion of local research, and advice-giving. Earlier we suggested that control measures might fare better if they were addressed to the social milieu rather than to the individual within it. Indeed, individual self-control is grounded in socialization, and formal agencies of control are relatively unimportant, compared to the power of social norms, in enforcing self-control. To influence demand by social norms requires long-term action—not specifi-cally directed at drugs or drug use--encompassing the whole range of social planning for child-rearing and family life, for work opportunities, leisure-time activities, improved living standards, and community life. Such long-range social reforms are necessary if the aim is to influence individual demand permanently. Some agencies in the UN family have already ventured into such fields as social development and organization of work and public services, and may have experiences, expertise, and administrative resources to share with the national social planner. However, even though these matters are, in practical terms, more directly the concerns of organs other than the drug control ones, the latter's conceptualization of the problems of drug use should always include consistent awareness of them.

However, we must make a reservation here about international technical assistance. We share the skepticism expressed in many quarters about the "international expert" who is sent on a mission to a foreign country for a few weeks and returns with a report and a set of recommendations for action. When we suggest an international flow of expertise, we are thinking of people able and prepared to carry out penetrating investigations and work at the local level for long periods. As to the help they give, this might bear on treatment, pricing pplicy, questions of drug availability and substitution, and so on. Tc) be in a position to assist nations, international bodies must have at their disposal a new and broad'er range of competence. They must be able to turn from pharmacologists to social anthropologists, from clinical medicine to social medicine, from law to sociology and economics, and from specialists to generalists.

A long-term program geared to a revised set of ends can only be roughly outlined at this elementary stage; detailed elaboration can only come after more and better disclosure of facts and after the various issues have been allowed to surface and have been thoroughly debated. There is a great deal of work to be done, and we will end by summarizing some of the tasks ahead.

1. The overall goal of international drug (including alcohol) con-trol should be scrutinized by the Commission. We suggest that efforts be directed at the minimization of the harmful effects of drug use rather than of "drug abuse" or "drug dependence."

2. The international system should develop the habit of discussing drug problems against a background of other social problems; in prescribing controls, emphasis should be laid on the need to set these within the broader context of social policy in general.

3. Cultural differences in drug use should be respected in devising international controls.

4. Drugs should not be prohibited on the grounds of medical unserviceability.

5. The primary target of control efforts should be international trade conducted through legitimate, organizational channels.

6. Production for the purpose of overseas distribution should be closely watched by international agencies so that proper restraint can be applied in time to marketing practices tending to generate new demands by the enterprises of one country among the population of another.

7. Since, under its terms of reference, the Commission may consider all drugs whose use constitutes an international problem, it should discuss the problems posed by the use of alcohol and consider measures to alleviate them.

* The sanctuary problem is basic to many forms of international crime. As Blum, Kaplan, Lind, and Tinklenberg (1974) have recommended, it requires a more integrated international approach. They have suggested that international law enforcement in the drug area constitutes an opportunity and a test case for general coordination in the international administration of justice.

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