Addicted to dangerous policy: drug prohibition has not worked
OPINION: Alex Wodak
The Australian
January 15, 2011

IT'S getting hard to find credible people in Australia prepared to defend drug prohibition.

Who can now say confidently that drug prohibition is the most effective way of responding to illicit drugs?

Has drug prohibition made illicit drugs hard to obtain? Hardly. The proportion of Australian drug users reporting that illicit drugs were very easy or easy to obtain in 2009 was 90 per cent for heroin, with similar results for cocaine (81 per cent), methamphetamine (81 per cent) and hydroponic cannabis (90 per cent).

Illicit drugs are getting easier to buy worldwide. The global price of street heroin and cocaine fell 80 per cent between 1981 and 2002. So if prohibition was meant to limit production and consumption and make drugs expensive and hard to buy, it's been a failure.

The collateral damage from drug prohibition is also rising. Thirty-six people were killed in recent years in Melbourne in gang wars over the lucrative methamphetamine market. These included execution-style murders of police informants, suggesting high-level criminal penetration of the police investigation.

Recently a gang leader was allegedly murdered in one of the most secure prisons in Victoria, and a senior law enforcement official awaits trial over his alleged involvement in a $120 million methamphetamine operation. Extensive police corruption is one consequence of failed prohibition.

Australian troops in Afghanistan face bullets, mortars and improvised explosive devices partly funded by the obscenely inflated profits the Taliban makes selling opium and heroin.

Since Mexico embarked on a war on drugs in December 2006, an estimated 28,000 people have died. Should these deaths be attributed to the pharmacological properties of heroin, cocaine and cannabis, or are these unfortunate deaths more accurately attributable to drug prohibition?

When strong demand for prohibited drugs persists in the absence of a legal source, other supplies inevitably emerge. But these supplies are then controlled by criminals and corrupt police. When drugs are provided medicinally, benefits are generally substantial, far outweighing any negatives. We have to not only think of the harm resulting from drugs because of their pharmacological properties but also the harm resulting from their supply by the black market.

Conversely, deaths and disease resulting from legal drugs such as alcohol and tobacco correlate with the amounts of these drugs consumed at either the individual or societal level. But the pharmacological properties of injected illegal drugs are a poor guide to the harm they cause. This is because most of the harm results from the inevitable uncertainties of dose or unhygienic self-administration that occurs when drugs are supplied by the black market. This is why it's more the case that drugs are dangerous because they're prohibited than prohibited because they're dangerous.

Rigorous scientific trials in six countries in the past 15 years have showed that providing severely dependent heroin users, who haven't benefited from their many previous treatments, with closely supervised therapeutic heroin and considerable psycho-social support is effective and safe. There are huge benefits for the individuals, their families and the community. Yet a recent British study found heroin was one of the most harmful of 20 drugs for individuals and the third most harmful drug for communities when distributed by the black market.

Prohibition changes the nature of the illicit market, perversely encouraging more concentrated, and thus generally more dangerous, drugs to drive out less dangerous drugs. For example, beer disappeared soon after US alcohol prohibition began in 1920, only to be replaced by wine and spirits.

Also, the heroin-boosting effect of banning opium smoking was noted in Asia before the AIDS epidemic was first recognised. The banning of opium smoking worsened a public health catastrophe in an area accounting for half the world's population.

If drug prohibition has so clearly failed and cannot be made to work, why does it survive? About the only way drug prohibition has worked is politically. A great way to smash your political opponent has been to accuse them of being soft on drugs. That doesn't work so well any more. But there's no doubt the simplicity of drug prohibition is easier to pitch to voters than the messy alternative health and social responses.

These days we have an increasing number of retired senior politicians and retired senior law enforcement officials admitting drug prohibition doesn't work and can't work. Further, younger voters are more realistic about the options than voters who grew up in a world without illicit drugs. Drug prohibition hasn't made drugs scarce but it has certainly made them more dangerous.

In May 2009, UN Secretary-General Ban Ki-moon said in addition to criminalising HIV transmission, many countries impose criminal sanctions for same-sex sex, commercial sex and drug injection. Such laws constitute significant barriers to reaching key populations with HIV services.

Those behaviours should be decriminalised and people addicted to drugs should receive treatment. The UN has established a Global Commission on HIV and the Law to assist countries that want to make HIV control a little less difficult by reforming their laws on same-sex sex, commercial sex and drug injection. This year we will also hear more of the UN Commission on Narcotic Drugs, featuring former presidents from four countries. As Herb Stein, former adviser to US president Richard Nixon, said, things that can't last forever, don't.
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Alex Wodak is a physician and director of the Alcohol and Drug Service at Sydney's St Vincent's Hospital.