Drug Abuse

1. Break the taboo. Pursue an open debate and promote policies that effectively reduce consumption, and that prevent and reduce harms related to drug use and drug control policies. Increase investment in research and analysis into the impact of different policies and programs.25

Political leaders and public figures should have the courage to articulate publicly what many of them acknowledge privately: that the evidence overwhelmingly demonstrates that repressive strategies will not solve the drug problem, and that the war on drugs has not, and cannot, be won. Governments do have the power to pursue a mix of policies that are appropriate to their own situation, and manage the problems caused by drug markets and drug use in a way that has a much more positive impact on the level of related crime, as well as social and health harms.

2. Replace the criminalization and punishment of people who use drugs with the offer of health and treatment services to those who need them.

A key idea behind the ‘war on drugs’ approach was that the threat of arrest and harsh punishment would deter people from using drugs. In practice, this hypothesis has been disproved – many countries that have enacted harsh laws and implemented widespread arrest and imprisonment of drug users and low-level dealers have higher levels of drug use and related problems than countries with more tolerant approaches. Similarly, countries that have introduced decriminalization, or other forms of reduction in arrest or punishment, have not seen the rises in drug use or dependence rates that had been feared.

DECRIMINALIZATION INITIATIVES DO NOT RESULT IN SIGNIFICANT INCREASES IN DRUG USE

Portugal

In July 2001, Portugal became the first European country to decriminalize the use and possession of all illicit drugs. Many observers were critical of the policy, believing that it would lead to increases in drug use and associated problems. Dr. Caitlin Hughes of the University of New South Wales and Professor Alex Stevens of the University of Kent have undertaken detailed research into the effects of decriminalization in Portugal. Their recently published findings26 have shown that this was not the case, replicating the conclusions of their earlier study27 and that of the CATO Institute28.

Hughes and Stevens’ 2010 report detects a slight increase in overall rates of drug use in Portugal in the 10 years since decriminalization, but at a level consistent with other similar countries where drug use remained criminalized. Within this general trend, there has also been a specific decline in the use of heroin, which was in 2001 the main concern of the Portuguese government. Their overall conclusion is that the removal of criminal penalties, combined with the use of alternative therapeutic responses to people struggling with drug dependence, has reduced the burden of drug law enforcement on the criminal justice system and the overall level of problematic drug use.

Comparing Dutch and US Cities

A study by Reinarman, et. al. compared the very different regulatory environments of Amsterdam, whose liberal “cannabis cafe” policies (a form of de facto decriminalization) go back to the 1970s, and San Francisco, in the US, which criminalizes cannabis users. The researchers wished to examine whether the more repressive policy environment of San Francisco deterred citizens from smoking cannabis or delayed the onset of use. They found that it did not, concluding that:

“Our findings do not support claims that criminalization reduces cannabis use and that decriminalization increases cannabis use... With the exception of higher drug use in San Francisco, we found strong similarities across both cities. We found no evidence to support claims that criminalization reduces use or that decriminalization increases use.”29

Australia

The state of Western Australia introduced a decriminalization scheme for cannabis in 2004, and researchers evaluated its impact by comparing prevalence trends in that state with trends in the rest of the country. The study was complicated by the fact that it took place in a period when the use of cannabis was in general decline across the country. However, the researchers found that this downward trend was the same in Western Australia, which had replaced criminal sanctions for the use or possession of cannabis with administrative penalties, typically the receipt of a police warning called a ‘notice of infringement’. The authors state:

“The cannabis use data in this study suggest that, unlike the predictions of those public commentators who were critical of the scheme, cannabis use in Western Australia appears to have continued to decline despite the introduction of the Cannabis Infringement Notice Scheme.”30

Comparisons Between Different States in the US

Although cannabis possession is a criminal offense under US federal laws, individual states have varying policies toward possession of the drug. In the 2008 Report of the Cannabis Commission convened by the Beckley Foundation, the authors reviewed research that had been undertaken to compare cannabis prevalence in those states that had decriminalized with those that maintained criminal punishments for possession. They concluded that:

“Taken together, these four studies indicated that states which introduced reforms did not experience greater increases in cannabis use among adults or adolescents. Nor did surveys in these states show more favorable attitudes towards cannabis use than those states which maintained strict prohibition with criminal penalties.”31

In the light of these experiences, it is clear that the policy of harsh criminalization and punishment of drug use has been an expensive mistake, and governments should take steps to refocus their efforts and resources on diverting drug users into health and social care services. Of course, this does not necessarily mean that sanctions should be removed altogether – many drug users will also commit other crimes for which they need to be held responsible – but the primary reaction to drug possession and use should be the offer of appropriate advice, treatment and health services to individuals who need them, rather than expensive and counterproductive criminal punishments.

3. Encourage experimentation by governments with models of legal regulation of drugs (with cannabis, for example) that are designed to undermine the power of organized crime and safeguard the health and security of their citizens.

The debate on alternative models of drug market regulation has too often been constrained by false dichotomies – tough or soft, repressive or liberal. In fact, we are all seeking the same objective – a set of drug policies and programs that minimize health and social harms, and maximize individual and national security. It is unhelpful to ignore those who argue for a taxed and regulated market for currently illicit drugs. This is a policy option that should be explored with the same rigor as any other.32

If national governments or local administrations feel that decriminalization policies will save money and deliver better health and social outcomes for their communities, or that the creation of a regulated market may reduce the power of organized crime and improve the security of their citizens, then the international community should support and facilitate such policy experiments and learn from their application.

Similarly, national authorities and the UN need to review the scheduling of different substances. The current schedules, designed to represent the relative risks and harms of various drugs, were set in place 50 years ago when there was little scientific evidence on which to base these decisions. This has resulted in some obvious anomalies – cannabis and coca leaf, in particular, now seem to be incorrectly scheduled and this needs to be addressed.

 

4. Establish better metrics, indicators and goals to measure progress.

The current system of measuring success in the drug policy field is fundamentally flawed.34 The impact of most drug strategies are currently assessed by the level of crops eradicated, arrests, seizures and punishments applied to users, growers and dealers. In fact, arresting and punishing drug users does little to reduce levels of drug use, taking out low-level dealers simply creates a market opportunity for others, and even the largest and most successful operations against organized criminals (that take years to plan and implement) have been shown to have, at best, a marginal and short-lived impact on drug prices and availability. Similarly, eradication of opium, cannabis or coca crops merely displaces illicit cultivation to other areas.

A new set of indicators is needed to truly show the outcomes of drug policies, according to their harms or benefits for individuals and communities – for example, the number of victims of drug market-related violence and intimidation; the level of corruption generated by drug markets; the level of petty crime committed by dependent users; levels of social and economic development in communities where drug production, selling or consumption are concentrated; the level of drug dependence in communities; the level of overdose deaths; and the level of HIV or hepatitis C infection among drug users. Policymakers can and should articulate and measure the outcome of these objectives.

The expenditure of public resources should therefore be focused on activities that can be shown to have a positive impact on these objectives. In the current circumstances in most countries, this would mean increased investment in health and social programs, and improved targeting of law enforcement resources to address the violence and corruption associated with drug markets.35 In a time of fiscal austerity, we can no longer afford to maintain multibillion dollar investments that have largely symbolic value.

5. Challenge, rather than reinforce, common misconceptions about drug markets, drug use and drug dependence.

Currently, too many policymakers reinforce the idea that all people who use drugs are ‘amoral addicts’, and all those involved in drug markets are ruthless criminal masterminds. The reality is much more complex. The United Nations makes a conservative estimate that there are currently 250 million illicit drug users in the world, and that there are millions more involved in cultivation, production and distribution. We simply cannot treat them all as criminals.

To some extent, policymakers’ reluctance to acknowledge this complexity is rooted in their understanding of public opinion on these issues. Many ordinary citizens do have genuine fears about the negative impacts of illegal drug markets, or the behavior of people dependent on, or under the influence of, illicit drugs. These fears are grounded in some general assumptions about people who use drugs and drug markets, that government and civil society experts need to address by increasing awareness of some established (but largely unrecognized) facts. For example:

• The majority of people who use drugs do not fit the stereotype of the ‘amoral and pitiful addict’. Of the estimated 250 million drug users worldwide, the United Nations estimates that less than 10 percent can be classified as dependent, or ‘problem drug users’.36

• Most people involved in the illicit cultivation of coca, opium poppy, or cannabis are small farmers struggling to make a living for their families. Alternative livelihood opportunities are better investments than destroying their only available means of survival.

• The factors that influence an individual’s decision to start using drugs have more to do with fashion, peer influence, and social and economic context, than with the drug’s legal status, risk of detection, or government prevention messages.37, 38

• The factors that contribute to the development of problematic or dependent patterns of use have more to do with childhood trauma or neglect, harsh living conditions, social marginalization, and emotional problems, rather than moral weakness or hedonism.39

• It is not possible to frighten or punish someone out of drug dependence, but with the right sort of evidence-based treatment, dependent users can change their behavior and be active and productive members of the community.40

• Most people involved in drug trafficking are petty dealers and not the stereotyped gangsters from the movies – the vast majority of people imprisoned for drug dealing or trafficking are ‘small fish’ in the operation (often coerced into carrying or selling drugs), who can easily be replaced without disruption to the supply.41,42

A more mature and balanced political and media discourse can help to increase public awareness and understanding. Specifically, providing a voice to representatives of farmers, users, families and other communities affected by drug use and dependence can help to counter myths and misunderstandings.

6. Countries that continue to invest mostly in a law enforcement approach (despite the evidence) should focus their repressive actions on violent organized crime and drug traffickers, in order to reduce the harms associated with the illicit drug market.

The resources of law enforcement agencies can be much more effectively targeted at battling the organized crime groups that have expanded their power and reach on the back of drug market profits. In many parts of the world, the violence, intimidation and corruption perpetrated by these groups is a significant threat to individual and national security and to democratic institutions, so efforts by governments and law enforcement agencies to curtail their activities remain essential.

However, there is a need to review our tactics in this fight. There is a plausible theory put forward by MacCoun and Reuter43 that suggests that supply reduction efforts are most effective in a new and undeveloped market, where the sources of supply are controlled by a small number of trafficking organizations. Where these conditions exist, appropriately designed and targeted law enforcement operations have the potential to stifle the emergence of new markets. We face such a situation now in West Africa. On the other hand, where drug markets are diverse and well-established, preventing drug use by stopping supply is not a realistic objective.

DRUGS IN WEST AFRICA: RESPONDING TO THE GROWING CHALLENGE OF NARCOTRAFFIC AND ORGANIZED CRIME

In just a few years, West Africa has become a major transit and re-packaging hub for cocaine following a strategic shift of Latin American drug syndicates toward the European market. Profiting from weak governance, endemic poverty, instability and ill-equipped police and judicial institutions, and bolstered by the enormous value of the drug trade, criminal networks have infiltrated governments, state institutions and the military. Corruption and money laundering, driven by the drug trade, pervert local politics and skew local economies.

A dangerous scenario is emerging as narco-traffic threatens to metastasize into broader political and security challenges. Initial international responses to support regional and national action have not been able to reverse this trend. New evidence44 suggests that criminal networks are expanding operations and strengthening their positions through new alliances, notably with armed groups. Current responses need to be urgently scaled up and coordinated under West African leadership, with international financial and technical support. Responses should integrate law enforcement and judicial approaches with social, development and conflict prevention policies – and they should involve governments and civil society alike.

We also need to recognize that it is the illicit nature of the market that creates much of the market-related violence – legal and regulated commodity markets, while not without problems, do not provide the same opportunities for organized crime to make vast profits, challenge the legitimacy of sovereign governments, and, in some cases, fund insurgency and terrorism.

This does not necessarily mean that creating a legal market is the only way to undermine the power and reach of drug trafficking organizations. Law enforcement strategies can explicitly attempt to manage and shape the illicit market by, for example, creating the conditions where small-scale and private ‘friendship network’ types of supply can thrive, but cracking down on larger-scale operations that involve violence or inconvenience to the general public. Similarly, the demand for drugs from those dependent on some substances (for example, heroin) can be met through medical prescription programs that automatically reduce demand for the street alternative. Such strategies can be much more effective in reducing market-related violence and harms than futile attempts to eradicate the market entirely.

On the other hand, poorly designed drug law enforcement practices can actually increase the level of violence, intimidation and corruption associated with drug markets. Law enforcement agencies and drug trafficking organizations can become embroiled in a kind of ‘arms race’, in which greater enforcement efforts lead to a similar increase in the strength and violence of the traffickers. In this scenario, the conditions are created in which the most ruthless and violent trafficking organizations thrive. Unfortunately, this seems to be what we are currently witnessing in Mexico and many other parts of the world.

LAW ENFORCEMENT AND THE ESCALATION OF VIOLENCE

A group of academics and public health experts based in British Columbia have conducted a systematic review of evidence45 relating to the impact of increased law enforcement on drug market-related violence (for example, armed gangs fighting for control of the drug trade, or homicide and robberies connected to the drug trade).

In multiple US locations, as well as in Sydney, Australia, the researchers found that increased arrests and law enforcement pressures on drug markets were strongly associated with increased homicide rates and other violent crimes. Of all the studies examining the effect of increased law enforcement on drug market violence, 91 percent concluded that increased law enforcement actually increased drug market violence. The researchers concluded that:

“The available scientific evidence suggests that increasing the intensity of law enforcement interventions to disrupt drug markets is unlikely to reduce drug gang violence. Instead, the existing evidence suggests that drug-related violence and high homicide rates are likely a natural consequence of drug prohibition and that increasingly sophisticated and well-resourced methods of disrupting drug distribution networks may unintentionally increase violence.”46

In the UK also, researchers have examined the effects of policing on drug markets, noting that:

“Law enforcement efforts can have a significant negative impact on the nature and extent of harms associated with drugs by (unintentionally) increasing threats to public health and public safety, and by altering both the behavior of individual drug users and the stability and operation of drug markets (e.g. by displacing dealers and related activity elsewhere or increasing the incidence of violence as displaced dealers clash with established ones).”47

7. Promote alternative sentences for small-scale and first-time drug dealers.

While the idea of decriminalization has mainly been discussed in terms of its application to people who use drugs or who are struggling with drug dependence, we propose that the same approach be considered for those at the bottom of the drug selling chain. The majority of people arrested for small-scale drug selling are not gangsters or organized criminals. They are young people who are exploited to do the risky work of street selling, dependent drug users trying to raise money for their own supply, or couriers coerced or intimidated into taking drugs across borders. These people are generally prosecuted under the same legal provisions as the violent and organized criminals who control the market, resulting in the indiscriminate application of severe penalties.

Around the world, the vast majority of arrests are of these nonviolent and low-ranking ‘little fish’ in the drug market. They are most visible and easy to catch, and do not have the means to pay their way out of trouble.48 The result is that governments are filling prisons with minor offenders serving long sentences, at great cost, and with no impact on the scale or profitability of the market.

In some countries, these offenders are even subject to the death penalty, in clear contravention of international human rights law. To show their commitment to fighting the drug war, many countries implement laws and punishments that are out of proportion to the seriousness of the crime, and that still do not have a significant deterrent effect. The challenge now is for governments to look at diversion options for the ‘little fish’, or to amend their laws to make a clearer and more proportionate distinction between the different types of actors in the drug market.

8. Invest more resources in evidence-based prevention, with a special focus on youth.

Clearly, the most valuable investment would be in activities that stop young people from using drugs in the first place, and that prevent experimental users from becoming problematic or dependent users. Prevention of initiation or escalation is clearly preferable to responding to the problems after they occur. Unfortunately, most early attempts at reducing overall rates of drug use through mass prevention campaigns were poorly planned and implemented. While the presentation of good (and credible) information on the risks of drug use is worthwhile, the experience of universal prevention (such as media campaigns, or school-based drug prevention programs) has been mixed. Simplistic ‘just say no’ messages do not seem to have a significant impact.49

There have been some carefully planned and targeted prevention programs, however, that focus on social skills and peer influences that have had a positive impact on the age of initiation or the harms associated with drug use. The energy, creativity and expertise of civil society and community groups are of particular importance in the design and delivery of these programs. Young people are less likely to trust prevention messages coming from state agencies.

Successful models of prevention have tended to target particular groups at risk – gang members, children in care, or in trouble at school or with the police – with mixed programs of education and social support that prevent a proportion of them from developing into regular or dependent drug users. Implemented to a sufficient scale, these programs have the potential to reduce the overall numbers of young people who become drug dependent or who get involved in petty dealing.

9. Offer a wide and easily accessible range of options for treatment and care for drug dependence, including substitution and heroin-assisted treatment, with special attention to those most at risk, including those in prisons and other custodial settings.

In all societies and cultures, a proportion of individuals will develop problematic or dependent patterns of drug use, regardless of the preferred substances in that society or their legal status. Drug dependence can be a tragic loss of potential for the individual involved, but is also extremely damaging for their family, their community, and, in aggregate, for the entire society.

Preventing and treating drug dependence is therefore a key responsibility of governments – and a valuable investment, since effective treatment can deliver significant savings in terms of reductions in crime and improvements in health and social functioning.

Many successful treatment models – using a mix of substitution treatment and psycho-social methods – have been implemented and proven in a range of socio-economic and cultural settings. However, in most countries, the availability of these treatments is limited to single models, is only sufficient to meet a small fraction of demand, or is poorly targeted and fails to focus resources on the most severely dependent individuals. National governments should therefore develop comprehensive, strategic plans to scale up a menu of evidence-based drug dependence treatment services.

At the same time, abusive practices carried out in the name of treatment – such as forced detention, forced labor, physical or psychological abuse – that contravene human rights standards by subjecting people to cruel, inhuman and degrading treatment, or by removing the right to self-determination, should be abolished. Governments should ensure that their drug dependence treatment facilities are evidence-based and comply with international human rights standards.

10.The United Nations system must provide leadership in the reform of global drug policy. This means promoting an effective approach based on evidence, supporting countries to develop drug policies that suit their context and meet their needs, and ensuring coherence among various UN agencies, policies and conventions.

While national governments have considerable discretion to move away from repressive policies, the UN drug control system continues to act largely as a straitjacket, limiting the proper review and modernization of policy. For most of the last century, it has been the US government that has led calls for the development and maintenance of repressive drug policies. We therefore welcome the change of tone emerging from the current administration50 – with President Obama himself acknowledging the futility of a ‘war on drugs’ and the validity of a debate on alternatives.51 It will be necessary, though, for the US to follow up this new rhetoric with real reform, by reducing its reliance on incarceration and punishment of drug users, and by using its considerable diplomatic influence to foster reform in other countries.

UN drug control institutions have largely acted as defenders of traditional policies and strategies. In the face of growing evidence of the failure of these strategies, reforms are necessary. There has been some encouraging recognition by UNODC that there is a need to balance and modernize the system, but there is also strong institutional resistance to these ideas.

Countries look to the UN for support and guidance. The UN can, and must, provide the necessary leadership to help national governments find a way out of the current policy impasse. We call on UN Secretary General Ban Ki-moon and UNODC Executive Director Yury Fedotov to take concrete steps toward a truly coordinated and coherent global drug strategy that balances the need to stifle drug supply and fight organized crime with the need to provide health services, social care, and economic development to affected individuals and communities.

There are a number of ways to make progress on this objective. For a start, the UN could initiate a wide-ranging commission to develop a new approach; UN agencies could create new and stronger structures for policy coordination; and the UNODC could foster more meaningful program coordination with other UN agencies such as the WHO, UNAIDS, UNDP, or the Office of the UN High Commissioner for Human Rights.

11. Act urgently: the war on drugs has failed, and policies need to change now.

There are signs of inertia in the drug policy debate in some parts of the world, as policymakers understand that current policies and strategies are failing but do not know what to do instead. There is a temptation to avoid the issue. This is an abdication of policy responsibility – for every year we continue with the current approach, billions of dollars are wasted on ineffective programs, millions of citizens are sent to prison unnecessarily, millions more suffer from the drug dependence of loved ones who cannot access health and social care services, and hundreds of thousands of people die from preventable overdoses and diseases contracted through unsafe drug use.

There are other approaches that have been proven to tackle these problems that countries can pursue now. Getting drug policy right is not a matter for theoretical or intellectual debate – it is one of the key policy challenges of our time.

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