Drugs: Science, not Stigma

On 2nd June the Global Commission on Drug Policy released a report which began with the words "The global war on drugs has failed". Whenever I consider the failure of drug policies I think of fetid bodies and dead flesh. If you want to know what drug abuse smells like, ask a homeless heroin user to show you his legs. If you're lucky, you'll see a tennis ball sized crater near his groin, where he used to inject, and it will reek of decaying tissue. Yet necrotic legs are only the pungent tip of a macabre iceberg. Were I a resident of, say, Mexico or Columbia, then my association of the war on drugs with death would be starker. Quite apart from being deadly, the war on drugs is absurd; no rational being could square it with the evidence. So it is encouraging to see that the Commission argues for an end to "the criminalization, marginalization and stigmatization of people who use drugs but who do no harm to others". While such an argument is not exceptional, the list of commissioners is: former UN Secretary General Kofi Annan; former US Secretary of State George Schultz; former Chairman of the US Federal Reserve Paul Volcker; Virgin boss Richard Branson; former Presidents of Switzerland, Colombia, Mexico and Brazil, and the current Prime Minister of Greece. The list goes on. What follows is a brief discussion of the report. After that, Prof. David Nutt, former chair of the Government's Advisory Council on the Misuse of Drugs, gives us his impression of the report. Next month we'll have a related interview with Mike Trace, chair of the International Drug Policy Consortium and an advisor to the Commission. The Report At only 14 pages, the Commission's report is judiciously brief and worth reading. It begins with some arresting figures. The United Nations estimates that between 1998 and 2008 global opiate consumption increased by 34.5%, cocaine consumption by 27% and cannabis consumption by 8.5%. This sets the scene for the characterisation of the war on drugs as a disastrous enterprise, with the remainder of the report outlining principles that could guide drug policies, backed up by examples of best practice. The Swiss example is particularly instructive. In Switzerland they have for years treated heroin addiction as a matter of public health, providing addicts with prescription heroin and a safe injecting environment. Between 1990 and 2005 the initiative saw "a 90% reduction in property crimes committed by participants" and "substantially reduced the consumption among the heaviest users". Perhaps most importantly, it diminished the viability of the market, reducing the number of new addicts by over 80%. For anyone who has worked with heroin addicts, this will be unsurprising. As with any business, dealers are incentivised to develop their customer base, and they do so by targeting the most vulnerable. Once hooked, users have a habit to fund and a dealer to finance. The user's life deteriorates and, increasingly, he commits crime to acquire money. By this time his social circle is comprised of addicts, so quitting becomes an isolating and painful challenge, actively discouraged by his dealer. It does not take an economist to compute that the addition of free prescription heroin into this destructive mix - for existing addicts only - would undermine the market, which would reduce the number of dealers and in turn make it more difficult to acquire heroin. Though heroin addiction is a dominant concern of the report, its recommendations have wider applicability and can be summarised by the following extract: "Begin the transformation of the global drug prohibition regime. Replace drug policies and strategies driven by ideology and political convenience with fiscally responsible policies and strategies grounded in science, health, security and human rights...Ensure that the international conventions are interpreted and/or revised to accommodate robust experimentation with harm reduction, decriminalization and legal regulatory policies." As the chief economics commentator at the Financial Times, Martin Wolf, wrote: "None of this is new. But from such a group it is surely revolutionary". So, how likely is it that we in the UK will experience a drug policy revolution? A Drug Policy Revolution For the UK a drug policy revolution is sorely needed, yet the chances of it are remote. This is how the Home Office responded to the report's publication: "We have no intention of liberalising our drugs laws. Drugs are illegal because they are harmful - they destroy lives and cause untold misery to families and communities". The problem with this response is that it does not make sense. "Drugs are illegal because they are harmful" is a logical non sequitur; not everything that is harmful is, or should be, illegal. For example, cannabis is less harmful than alcohol, which is legal. To argue that cannabis destroys lives and causes "untold misery to families and communities" is to conflate the consequences of use with the consequences of the organised crime that thrives on the fact that cannabis is illegal. The main harm is, quite clearly, contingent on the illegality itself. The statement "Drugs are illegal because they are harmful", in order to be defensible, must presuppose that continuing illegality is the best practicable way to limit or reduce harm. As the evidence reveals, and as politicians are well aware, this is absolutely not the case; a public health response is significantly more effective than a criminal law approach and costs a good deal less. That said, despite the current evidence, a criminal law approach is understandable. At the inception of the war on drugs, roughly 40 years ago, policy makers believed it would work. Since that time, a prohibition mentality has entrenched itself in global thinking. What the policy makers had not reckoned was that, in parallel with this entrenchment, a body of evidence would grow to reveal the war as a mistake. Politicians are now widely aware of the evidence, but are confounded by the challenge of dislodging the misconceptions, particularly as attempting to do so risks exposure to the charge of being soft on drugs. Yet many of the most enduring British achievements were challenges to accepted beliefs. While some of these were motivated by greed or religion and, by happy coincidence, were allied with reason - such as Magna Carta or the Glorious Revolution - others were grounded more keenly in reason alone, such as Locke's and Paine's rejection of tyranny, which stimulated revolutions on both sides of the Atlantic. The legacies of these achievements persist because they are way points bound to a path of reason that runs through history. Our Government stands able to lay another of these way points, and though whoever leads the charge might not be remembered in the same breath as Paine, there is at least a chance of recollection alongside Beveridge or Bevan. As the Commission's report so clearly puts it, it is time for political leaders to "...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". An Expert Opinion from Professor David Nutt In 2009 I wrote about the sacking by the Home Secretary, Alan Johnson, of the chairman of the Advisory Council on the Misuse of Drugs, Professor David Nutt (Now Then #21). The ACMD was established by the Misuse of Drugs Act 1971, with a duty to provide "advice on measures (whether or not involving alteration of the law) which in the opinion of the Council ought to be taken" for preventing the misuse of drugs. Prof. Nutt audaciously fulfilled his statutory duty by providing evidence-based advice, and was dismissed for, as Johnson cravenly put it, acting "in a way that undermined the Government rather than supporting its work". I caught up with Prof. Nutt to get a brief opinion on the report, and I am both grateful to him and perfectly content to end this article with his final comment. The main argument of the report is for an end to "the criminalization, marginalization and stigmatization of people who use drugs but who do no harm to others". It encourages a public health response to the drug problem rather than a criminal law response. Do you agree with these messages? I fully support the message - to criminalise someone with a drug addiction is immoral as it is an illness; to criminalise someone for using a drug almost always results in greater harm to that person than the drug would. Remember the ideas of John Stuart Mill - in a freedom-loving society no conduct by rational adults should be criminalised unless it is harmful to others. The commissioners involved in the report include a number of former world leaders. Do you think the backing of the report by these people marks a turn in the debate on drugs? To some extent. It has been clear for some time that most thinking politicians are aware that the war on drugs can't work, but few have had the courage to share these thoughts. Now that so many senior people have come out it will make others less scared (I hope). British governments have traditionally shied away from challenging stigma about drugs. Do you think the publication of this report offers a worthwhile opportunity for a change of approach? Yes. David Cameron was very rational about drugs when a back bencher; of course he has personal experience of them. If he had courage to go with his knowledge then things could change, especially as the Liberal Democrats have always had a mature view of drugs and have been very supportive of my stance. Any other comments? Lobby your MPs. globalcommissionondrugs.org/Report )