'Drug Policy Doesn’t Work' – Says Leader in The Times

In its leader today The Times calls for a ‘radical rethink’ of drug policy. Under the title ‘Drug Policy Doesn’t Work', the leader concludes:

“This is a complex issue. If there were an obvious answer it would have been found by now. One thing, though, is clear — a radical rethink is needed. Drug abuse ruins so many lives and a policy based on prohibition, although comprehensible in its own terms, is not succeeding in reducing either usage or harm. There are some examples, in Switzerland, for example, of heroin being offered in a controlled and prescribed way for addicts. There are a number of intermediate points between prohibition and legalisation, and it is time to start exploring them.”

The paper will include a follow up column on the issue tomorrow.

The Times is to be congratulated for making such a clear call. The leader shows now that the issue of the need to explore alternatives is very much in the political mainstream. The paper's economics editor, Anatole Kaletsky called for legalisation in his column, back in August 2007.

Unfortunately the online paper requires a subscription, but if you want to see the whole thing, it’s here.

Security experts discuss ending the war on drugs

There can be no question that global security is fundamentally compromised by the world’s commitment to the war on drugs. Could this fact be instrumental in bringing an end to the global prohibition?

As has been demonstrated by the recently launched Count the Costs campaign, the war on drugs detrimentally impacts on numerous policy areas – Crime, Development, Security, Health, Expenditure, Stigma and Discrimination, Human Rights and the Environment. Some of these policy paths have been well-trodden by reformers; others have witnessed almost no footfall. Whilst all of them have the potential to engage policy makers, the question we have been asking is, which of them has the potential for the most engagement and concern? We have come to the conclusion that demonstrating the negative impacts of the war on drugs on security, and bringing security and intelligence agencies into the debate, has substantial untapped potential tomove the debate forward. When current and former military and intelligence personnel critique the war on drugs or indeed, explicitly call for reform to the status quo, formerly uninterested policy makers are likely to pay attention.

Up until relatively recently it had been received wisdom that drugs, crime and insecurity were inextricably linked. As the reform agenda gains traction, it is increasingly understood that the drugs/crime nexus is created, not by primarily by drug use/misuse, but in substantially part by the the prohibtionist policy environment; the war on drugs itself.

In 2008 even the head of the UN Office on Drugs and Crime conceeded in a discussion paper that prohibition had created a series unintended negative consequences, including 'vast' criminal market. However, there is relatively little engagement in the public debate with the fact that, along with the vast criminal market there are whole regions of the world whose national security is fundamentally compromised by the war on drugs.

There have been lone voices – for example David Passage (former director of Andean Affairs at the US State Dept), Eliza Manningham Buller (former Director General of MI5), and there is some literature. Notable amongst them is Chasing Dragons. But now the security issue is emerging, blinking into the sunlight. In October 2010, (entirely by coincidence) NOREF, the Norwegian Peacebuilding Resource Centre and the International Institute for Strategic Studies (IISS) both ran workshops exploring the connection between drug trafficking and security.

Papers from NOREF are available here, here and here.

Transform took part in the IISS project, which consisted of two workshops and will culminate in an IISS Adelphi publication. The first workshop involved an exploration of the security issues for key geographical regions involved in production and trafficking. As a contribution to the discussion, Transform (and PhD student Emily Crick) produced a paper exploring drugs and security using the International Relations theory of Securitisation. This theory helps demonstrate that there are in fact two drug wars being fought – one ostensibly fighting against ‘drugs’ and ‘drug abuse’ because of their ‘threat’ to mankind; the other, fighting against organised crime (whose power is based on the opportunities created by the primary securitisation) because of the ‘threat’ they present to nation states (see previous blog on securitisation)

Workshop 1, 5 October 2010: Participants and agenda

A wide ranging discussion explored the scope of the drugs and security connection, including contributions from Dr. Mohammed Zafar Khan, Former Deputy Minister, Afghan Ministry of Counter Narcotics, Sanho Tree from the Institute for Policy Studies, the Colombian Ambassador to the UK, and others. The discussion effectively took place on two levels with some engaging wholeheartedly with the question of the impact of prohibition upon security and others remaining in their comfort zone by effectively giving country reports of security impacts.

The second workshop was intended to provide participants with the opportunity both to critique the status quo and to engage in some blue skies thinking around the impact of ending the overwhelmingly security oriented approach. To help facilitate dialogue Emily Crick presented a critique of the securitised approach and Danny Kushlick of Transform demonstrated the various policy options that are made available under a de-securitised regime of legal regulation and control. (The Transform/Crick papers on securitisation and de-securitisation are being disseminated to intelligence agencies, security/strategic think tanks and the military both in the UK and beyond)

Workshop 2, 19 April 2011: Participants and agenda.

It attracted participants from a wide range of countries, organisations and agencies, including representatives from the UK (Serious and Organised Crime Agency, FCO), Russia, China, and Mexico. Many participants found the blue skies element challenging (as you would expect from officials who spend their lives working within the prevailing paradigm of prohibition).

Despite being invited the Americans were notably absent from the workshops – a glaring gap, given the US’s deep and abiding commitment to maintaining the status quo.

There are many potentially fruitful policy veins that remain untapped. For example the development world has been reluctant to involve itself in the reform agenda. But members of the security field appear only too willing to get stuck in and are to be congratulated for doing so.

There are those who have expressed concern that engaging in the security agenda has significant risks, not least of which is that it could further solidify the security-oriented regime and discourse. We are not naïve enough to forget that some significant security and intelligence fiefdoms are predicated on and resourced by the commitment to a global war on drugs. Indeed for some it is their very lifeblood. However, our experience thus far is that some in the security and intelligence world are willing to play their part in exposing the tragic irony of the overwhelmingly negative impact of the war on drugs on national, international and human security.

Sinn Fein initiates reform in Ireland

Sinn Féin, Ireland’s fastest growing political party, has taken several steps to encourage a more effective, evidence-based approach to tackling the problems of drug addiction and drug-related crime.

In its most recent drug policy document, Sinn Féin demonstrates a welcome and pragmatic understanding of the factors influencing drug abuse, stating:

“Harmful drug use has a complex relationship with class, inequality and poverty. Unless poverty and inequality are tackled, the scourge of drugs will continue.”

The party’s reasoned stance on drug use continues with the call for a drug policy which is founded on facts rather than ideology:

“The administration of criminal justice as it interacts with drug-related crime should be reviewed, reformed and tailored to more effectively address and reduce systemic crime, economic compulsive crime and psychopharmacological crime. A broad societal debate considering every possible approach and all relevant evidence from other jurisdictions including those that have experimented with decriminalization and/or legalization is warranted to this end.

“New approaches must be informed by the most credible emerging evidence and international best practice.”

Sinn Féin has further indicated its willingness to embrace drug policy reform with the introduction of a bill to regulate the sale of ‘legal highs’. Presented to the Irish Parliament in April this year, the bill proposes the establishment of a Non-Medicinal Psychoactive Substances Regulatory Authority, whose main functions would be:

• To formulate and publish rules for the issuing of licenses to those involved in the retail, distribution, import and production of non-medicinal psychoactive substances
• To establish and maintain a publicly available register of those licensed to engage in the sale, importation, distribution and production of non-medicinal psychoactive substances
• To conduct or otherwise instigate inspections of licensees’ premises, products and any property connected to the sale, distribution, importation and production of non-medicinal psychoactive substances

In the explanatory memorandum to the bill, the Sinn Féin spokesperson for Justice, Social Welfare and International Affairs, Aengus Ó Snodaigh, highlighted the futility of adopting a purely prohibitive stance on the trade of these substances via ‘head shops’:

“The current system of identifying and banning substances has proven ineffective in dealing with these dangerous substances. Through cynical labelling and the masking of active ingredients the head shops have managed to establish an increasingly lucrative industry to the detriment of public health and well-being.”

In contrast, Ó Snodaigh rightly claims that by taking a regulatory approach to the sale and distribution of legal highs, the new bill will help to “protect public health and reduce the risk of harm from such products and substances”.

Ó Snodaigh further highlighted his party’s commitment to establishing a more effective drug policy by putting a parliamentary question to the Irish Minister for Foreign Affairs, Micheál Martin. After being made aware of the proposal by Transform, Ó Snodaigh asked the Minister for his views on carrying out a transnational impact assessment of drug policy, a measure initially advocated in a briefing paper by the International Drug Policy Consortium.

Martin’s response to the question was typically evasive and dismissive, stating that he was “not aware” that the IDPC’s proposals for an impact assessment of drug policy had been raised in any relevant international forum.

As Transform is proposing, impact assessments of drug policy are a vital step in establishing a fairer and more successful solution to the challenges of problematic drug use and the illegal drug trade. Without such non-partisan evaluations of drug policy, drug war ideology, knee jerk responses to media panics and populist law and order posturing will continue to underpin governmental approaches to drugs. Bad policy can be the only result and the plight of the most vulnerable members of society will continue to worsen.

Drug warriors coming in from the cold? Calls for legal marijuana to be strictly regulated

With US support for the legalisation of cannabis/marijuana fast approaching the 50% threshold  (California's Prop 19 legalisation ballot measure recently polling the highest ever US support, at 46.1%), and a string of new referendums and Bills coming up in the next couple of years, the debate is moving from if marijuana is legally regulated, to how to regulate it properly. Arguably it was concerns about the legislation in practice rather than priciple that led to Prop 19 falling short. 

US views on marijuana laws - from Nate Silver's fivethirtyeight blog

An interesting sign of the changing debate is that even a year ago it would have been unthinkable for a historically prohibitionist US organisation like National Families in Action to launch “But What About the Children" campaign. In their own words this is:

“…a campaign to hold a legalized marijuana industry accountable for ensuring that children will not have access to the drug if any law is passed to legalize the drug. The campaign holds that any marijuana legalization law should incorporate provisions to avoid what medical science has learned about alcohol and tobacco use in order to prevent marijuana use and addiction among children.”

In other words, whilst NFIA remains adamantly opposed to marijuana legalisation, it recognises it is now on the cards, and if it happens, then production and supply should be properly regulated. It is particularly interesting to see the 'imperilled child' narrative - so long used to argue against drug law reform - now being used as the basis for a call for more effective market regulation (based in significant part on lessons learned from mistakes with alcohol and tobacco regulation). Quite right too.

Given research shows steadily increasing availability and falling price, and that 80-90% of US 12th graders have easy access to cannabis, (many finding alcohol harder to get), amongst the many benefits of legal regulation of the currently criminal trade, regulation presents an obvious opportunity to protect children and young people. Below are NFIA’s suggestions for how regulation should function, with some added commentary and quotes from the relevant sections of Transform's recent 'Blueprint for Regulation (pdf)', (see in particular the chapter on cannabis regulation, page 110).

10 Provisions to Protect Children if States or Local Communities Legalize Marijuana

 1. No Advertising - An advertising ban on legal marijuana.

 From Blueprint (p.48):

"Links between the advertising and promotion of alcohol and tobacco products, and increased levels of usage of those products, are well established. Such advertising and promotion could easily drive a similar expansion in psychoactive drug usage. 

Therefore, the default position of any licensing regime should be a complete ban on all advertising, promotion or marketing of all drugs, with any exceptions made only on a cautious case by case basis by the relevant authorities. This ban should include any alcohol and tobacco marketing activities. A default ban should also exist on political donations from any commercial opera­tors in the drugs market. 

The distinct nature of drug risks relative to most other commodities, and the particular need to protect vulnerable groups from exposure to these risks, justifies this stringent restriction of standard commercial freedoms. These controls should extend to point of sale advertising, and the external appearance and signage for outlets.

Such controls should be as strict as possible, within the context of local legal regimes. For example, in the US, a free speech argument can be made against such a ban. However, even though the Supreme Court has extended a degree of ‘free speech’ protection to commercial speech, such speech is still subject to various controls and limitations."

Interestingly the NFIA site specifically discusses the free speech point here.  In Blueprint there is some additional detailed discussion on how this ban might operate for cannabis specifically on page 114 (see also - point 4 below).   

 2. A Penalty Fee - on the marijuana industry for every underage user.

Retailers selling to those underage should face a hierachy of penalties including fines and loss of licenses, potentially even criminal sanctions, as should producers found to be colluding in this practice. However it would be unfair to fine legitimate producers and retailers meeting their legal duties. There is no obvious equivalent to this suggestion in alcohol and tobacco policy, although taxes (sometimes described as 'sin taxes') could be seen as a parallel despite generally being argued as a form of dissuasion and/or income generation.  Blueprint does, however, call for vendors to have 'Shared responsibility re: nuisance in the immediate environment, litter, local enforcemetn costs'

3. Automatic Repeal of marijuana legalization if underage marijuana use exceeds certain levels.

Presumably the NFIA does not think prohibition should be repealed if use hits a certain level! Drug policy should be based on evidence of what works best for society, not arbitrary levels of use. Levels of use and misuse are influenced primarily by a complex interplay of social economic and cultural variable (for which the industry is not responsible)  not drug policy or legislation. However, Blueprint does, none the less, urge caution (p.68):

"This [cautious phased introduction] approach should be, by default, based on a precautionary prin­ciple, particularly where evidence from existing policy is thin, or specific high-risks are identified. New models will thus initially err towards stricter, more intrusive regulation, with lower restriction levels only subsequently coming into play. A precautionary and incremental approach allows for key concerns, such as availability to youth, increase in high risk behaviours or other specific public health concerns, to be closely monitored. If problems do arise, policy can take a step back, be refined and adjusted, and alternative or additional regulatory tools can be deployed."

4. No Product Placements, sponsorships, point-of-purchase marketing, or depictions in entertainment venues.

Broadly speaking we support this. The discussion of cannabis regulation in Blueprint (p 114) suggests that:

"Cannabis use is embedded in much popular culture. Cannabis products and product  iconography are generally non-branded and generic, so a blanket prohibition of anything that might constitute promotion or advertising of cannabis would therefore be impractical. Reasonable controls on exposure to children and young people may be easier to put in place, but would remain difficult to globally define and enforce. However, best practice and evidence from existing controls already widely applied to references to drugs—legal and illegal—in youth media and advertising can be more widely applied.

 Clear lessons can be learnt from experiences with restrictions on promotions and marketing of alcohol and tobacco. Areas where cannabis advertising promotion controls are more realistic include:

Advertising for venues for commercial sales could be limited both in content and scope—for example, to specialist publications, or adult only venues. A complete ban on advertising for promotion of venues is not realistic. Dutch coffee shops are not allowed to advertise but do to some extent—the prohibition in practice acts as a moderating influence, rather than a total ban

Restrictions could be placed on appearance and signage of venues/outlets. In the Netherlands, coffee shops are not allowed to make external references to cannabis, or use related imagery. Rastafari imagery, a palm leaf image, and the words ‘coffee shop’ have become the default signage.

Restrictions could be placed on advertising for certain types of paraphernalia that contain drug references."

5. An Industry-Financed Fund from marijuana profits to pay for the damage legal marijuana will do, so that taxpayers won’t have to pick up the tab.

There is a mistaken presumption here that legal marijuana will do more damage, and incur more cost, than illegal marijuana - the tab for which taxpayers already pay - as well as the huge enforcement tab. The industry should be taxed at an appropriate level to balance the potentially conflicting interests of maximising returns, influencing use levels and minimising the illegal markets (see price controls discussion in Blueprint on page 41) .Any tax income (and it is assumed this would be significant given the scale of the market) could support proven public health interventions including treatment, education and prevention, as well as helping to address some of the underlying social drivers of problematic use. 

6. A State Agency to Tax and Regulate the marijuana industry, including marijuana purity and potency.

We agree. It is vital that a state agency, or agencies should regaulate all relavant aspects of production and availability. On purity and potency specifically, from Blueprint (page 113):

"Controls could manage the strength/potency of herbal or resin form cannabis, based on relative proportions of active ingredients (that is, ratio of THC [tetrahydrocannabinol] to CBD [cannabidiol]). Maximum and minimum % content could be specified." 

7. Licensed Growers, Distributors, and Retail Sellers Marijuana sold only in licensed retail stores where no other products are sold.

We agree on strict licensing including of retail outlets, though we also envisage Dutch-style licensed "coffee-shops", that could sell food and non-alcoholic drinks too. From Blueprint:

"The basic models would involve various forms of licensed sales, for consumption on premises or for take-out—these would be conditional on controls outlined below, and would not preclude a potential pharmacy sales model.

A regulated market model (see: page 27) might be an appropriate incremental step as legal supply infrastructure and outlets were established. A key task of any regulatory body would be to manage supply so as to prevent the emergence of branded products and limit all forms of profit driven marketing and promotions."

Blueprint also considers how the inevitable small scale growing for personal use could be catered for in a new legal system (p. 214).

8. No Drugged Driving - A ban on driving with marijuana in the systems of drivers or passengers.

We agree that no one should drive with levels of any drug in their system sufficient to impair their performance - and, to be fair, no one arguing for reform has ever said different. Just as with alcohol, the detail of what level that is needs setting in law - there is ongoing debate whether it should be zero (it varies between jurisdictions). Technical issues exist with cannabis as, unlike alcohol, it is detectable in the system long after any impairment is evident. Until these issues are resolved it may be that impairment testing (possibly in support of more conventional drug testing) is the most effective  response. This is a developing field and should be guided by evidence of what is effective at reducing drug impaired driving and its negative consequences.

We disagree with a ban on passengers with drugs in their system, and even the NFIA gives no justification for including them. It might prove impossible to enforce - would the resposibility for drug free passengers be with the driver? What about buses, trains, planes?

9. No Drugged Employees or Students - A ban on people coming to work or school with marijuana in their systems.

No one should be going to work or school intoxicated so that it impairs their performance, particularly for safety critical responsibilities, but this should be dealt with consistently for all substances (including alcohol) through existing practices, contracts and agreements. We would caution against over-intrusive testing regimes that do not focus on impairment – which have generally shown to be unjustified and ineffective.

10. Smoke-Free Laws Apply - No marijuana use where tobacco smoking is banned.

We agree (see page 61) - although there should usefully be a caveat, detailing different rules for non-smoked cannabis.

2 More Provisions to protect children if Congress legalizes marijuana.

11. Marijuana Controlled by FDA. Marijuana placed under the control of the U.S. Food and Drug Administration, like tobacco is now.

We agree. This seems sensible - unless a separate agency is established as suggested in point 6 above.

12. A Surgeon General’s Report on the impact of legal marijuana.

We agree, but as part of a much broader ongoing evidence-based evaluative process of all aspects of the approach taken to drugs at the national and international levels.


So...


Essentially we agree in whole or part with the majority of the regulatory measures the NFIA is suggesting, many of which could have been taken from Transform's “Blueprint for Regulation”. Whether they have been reading it or not doesn't matter, indeed if they are reaching the same conclusions without reading it that is probably a good sign that when people think sensibly about regulating drugs they will tend to come to similar conclusions. And there are plenty of sensible people advising this campaign initiative.

We look forward to genuinely trying to find a common platform that all groups and individuals interested in regulating drugs properly can support in any post-prohibition world.

Leading International Scientific Body Supports Call for Legalisation and Regulation to Reduce Cannabis-Related Harms

 
October 7, 2010 [Vancouver, Canada] – The International Centre for Science in Drug Policy (ICSDP) today released a new research report that demonstrates the clear failure of U.S. marijuana prohibition and supports calls for evidence-based models to legalize and regulate the use of cannabis. The British Medical Journal, one of the world’s most influential medical journals, published a supportive commentary to coincide with the report’s release today.

The new report, entitled "Tools for debate: U.S. federal government data on cannabis prohibition", uses 20 years of data collected by surveillance systems funded by the U.S. government to highlight the failure of cannabis prohibition in America. The report has deep relevance for California as the state prepares to vote on the Regulate, Control and Tax Cannabis proposition and, potentially, legalize cannabis.

“Data, collected and paid for by the U.S. government, clearly shows that prohibition has not reduced cannabis consumption or supply. Since prohibition is not working, we need new approaches to better address the harms of cannabis use,” says Dr. Evan Wood, founder of the ICSDP. “Scientific evidence clearly shows that regulatory tools have the potential to effectively reduce rates of cannabis-related harm.”

Despite dramatically increased law enforcement funding, the U.S. government’s data demonstrates that cannabis prohibition has not resulted in a decrease in cannabis availability or accessibility. According to the US Office of National Drug Control Policy, federal anti-drug expenditures in the U.S. increased 600% from $1.5 billion in 1981 to over $18 billion in 2002. However, during this period, the potency of cannabis increased by 145% and the price of cannabis decreased by a dramatic 58%.

According to U.S. government funded reports, in the face of increasing enforcement expenditures over the last 30 years, cannabis has remained almost “universally available” to young Americans. Cannabis use among U.S. grade 12 students increased from 27% in 1990 to 32% in 2008 and approximately 80-90% of grade 12 students say the drug is “very easy” or “fairly easy” to obtain.

“From a public health and scientific perspective, the evidence demonstrates that cannabis prohibition has not achieved its intended objectives,” states Dr. Carl Hart, a co-author on the report and Associate Professor of Psychology at Columbia University. “The fact that cannabis prohibition has also enriched organized crime groups and fueled violence in the community creates an urgency to implement evidence-based alternatives that may be more effective at controlling cannabis supply and access.”

In addition to describing the failure of cannabis prohibition, the report notes that legalization combined with the implementation of strict regulatory tools could be more effective at controlling cannabis use and reducing cannabis-related harms. Research demonstrates that similar regulatory tools have been successful in controlling the harms of tobacco and alcohol when strictly enforced.

The report also discusses the regulatory tools available to governments, including conditional licensing systems; age restrictions; product taxation; retailer operating and location limitations; marketing prohibitions; and packaging guidelines.

While the report urges an evidence-based approach to cannabis regulation and notes the comparative successes several European countries have had in decriminalizing cannabis use, it also notes the limitations of models in place in Netherlands and Portugal. People who use marijuana in these two European countries do not face prosecution, but the production and distribution of cannabis remains illegal and largely controlled by organized crime.

“Legalization and strict regulation are more likely to be effective at eliminating the role of organized crime in marijuana production and distribution, because the profit motive is effectively removed,” said Dr. Wood.

In his commentary published in today’s British Medical Journal (bmj.com), Dr. Robin Room notes that regulatory tools developed at the end of alcohol prohibition in the 1930s can also be used today to successfully control cannabis.

“The evidence from Tools for Debate is not only that the prohibition system is not achieving its aims, but that more efforts in the same direction only worsen the results,” says Dr. Room, Professor of Social Research at the University of Melbourne. “The challenge for researchers and policy analysts is to now flesh out the details of effective regulatory regimes.”  

Dr. Wood is one of the six international illicit drug policy experts who authored the report, which has been endorsed by over 65MDs and PhDs in 30 countries who are members of the ICSDP Scientific Network.

The full report is available online at www.icsdp.org.

A related ICSDP report released in April 2010 demonstrates that the illegality of cannabis clearly enriches organized crime and drives violence, as street gangs and cartels compete for drug market profits. In Mexico, an estimated 28,000 people have died since the start of the drug war in 2006. U.S. government reports have previously estimated that approximately 60% of Mexican drug cartel revenue comes from the cannabis trade.

The full 26-page report, “Effect of Drug Law Enforcement on Drug-Related Violence: Evidence from a Scientific Review,” is available online here.

-----

International Centre for Science in Drug Policy

ICSDP is an international network of scientists, academics, and health practitioners who have come together in an effort to ensure illicit drug policies are informed with the best available scientific evidence.  The ICSDP aims to be a primary source for rigorous scientific evidence on illicit drug policy in order to benefit policymakers, law enforcement, and affected communities. To this end, the ICSDP conducts original scientific research in the form of systematic reviews, evidence-based drug policy guidelines, and research collaborations with leading scientists and institutions across diverse continents and disciplines.

Note: Transform's 'After the War on Drugs, Blueprint for Regulation' is cited in the report and Transform provided peer feedback on a draft of the text.

The Independent becomes the latest national UK newspaper to back legalisation

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Does the media follow public opinion or lead it? Probably a bit of both, but it is clear that the climate around drugs policy is changing in the public political and media spheres, and the momentum for change is building.

As we described yesterday, quite aside from the unabating stream of supportive op-eds, The Observer, The Guardian and Sunday People, (and the Daily Record in Scotland) have now all recently taken editorial lines in their leaders critical of the drug war and supportive of  moves towards the legal regulation of drugs.

Today it is the turn of The Independent in a leading article "Mexico's stark reminder of the cost of prohibition" which details the now familiar horrors of the War on Drugs before saying:

"The President was obliged to send in the troops because the poorly paid Mexican police had been infiltrated by the cartels; even so, reports suggest that in some areas the latter's power is, if anything, growing. By this reading, the violence suggests merely that turf wars are becoming more vicious, for a larger slice of an ever more lucrative market. In short, Mexico and the US are losing the drug war...

Which brings us back to the root of the problem. If Americans lost their taste for drugs, the Mexican cartels would be out of business. That, however, will not happen; indeed the forbidden nature of drugs may make them more attractive. So why not legalise them? The argument has been powerfully made before and will be so again, but probably to no avail. Sadly the barbaric drug wars will continue."

This is backed up by a front page and double page spread, with an excellent opinion piece by Johan Hari; "Violence breeds violence.The only thing drug gangs fear is legalisation" which concludes:

"Yet Mexico is being pressured hard by countries like the US and Britain – both led by former drug users – to keep on fighting this war, while any mention of legalisation brings whispered threats of slashed aid and diplomatic shunning.

Look carefully at that mound of butchered corpses found yesterday. They are the inevitable and ineluctable product of drug prohibition. This will keep happening for as long as we pursue this policy. If you believe the way to deal with the human appetite for intoxication is to criminalise and militarise, then blood is on your hands.

How many people have to die before we finally make a sober assessment of reality, and take the drugs trade back from murderous criminal gangs?"

The Independent editorial's pessimistic appraisal that "the barbaric drug wars" will inevitably continue is misplaced. They will not; no policy as self evidently counterproductive as the drug war can stand the sort of scrutiny it is now receiving for ever. Like the targets of many of the large scale social justice movements of the last century, what once seemed immovable can unravel far more quickly than anyone expects once a tipping point is reached.

Four national UK newspapers have adopted unambiguous pro-reform editorial positions within three weeks. We could be nearer the tipping point than you imagine.

Media Review: Prof Ian Gilmore calls for decriminalisation and regulation to be considered

Transform issued a press release last Monday about Sir Ian Gilmore's comments in his final Newsletter as president of the Royal Society of Physicians:

"I feel like finishing my presidency on a controversial note. I personally back the chairman of the UK Bar Council, Nicholas Green QC, when he calls for drug laws to be reconsidered with a view to decriminalising illicit drugs use. This could drastically reduce crime and improve health. Drugs should still be regulated, and the argument for decriminalising them is clearly made by Stephen Rolles in the latest edition of the BMJ."

The press release led to a huge amount of media coverage and debate in print and broadcast media over the following days, with Transform at the heart of much of it; having broken the story and with the BMJ piece on Transform's 'Blueprint for Regulation' specifically cited. Amongst the coverage detailed below, especially in the following days, were some very significant developments. 

Print coverage on the day included:

• Cocaine should be legal, says top doctor - front page coverage in the Telegraph (mentions BMJ piece and quotes Transform's Danny Kushlick), story also ran on Fox news website
• Legalise heroin and cocaine to cut crime and improve health, top doctor says in the Daily Mail (included quote from Danny and an online poll that asked 'should we legalise drugs in a bid to cut crime and improve health'  currently running at 56% in favour, 44% against. Also well worth looking at some of the 284 comments the story attracted - the most up-voted being supportive, the most down-voted against)
• There was also coverage in the Guardian (quoting both Danny and Steve), as well a coverage in the Times, Independent, the Herald Scotland, the Mirror, and many other regional papers.

during the following days:

• The Guardian ran an excellent leader editorial that cited Transform and the BMJ piece 'The War on Drugs: bring out the peace pipe', effectively joining the Observer in its critique of drug war and call for consideration of both decriminalisation and regulation:

"Politicians could prepare public opinion for change by a public assessment of what Britain's war on drugs has achieved. It should ask whether better results could have come by a less damaging route. A policy that results, via the Afghanistan poppy harvest, in financial support for the Taliban, boosts international organised crime and is the underlying problem for more than half of the UK prison population will require some defending.

Decriminalisation would not be an answer in itself. Legalisation is no quick fix. But prohibition's defenders need to show how, against its dire results, their policy can still be justified."

• Arguably more significantly was the interest of the tabloids: Gilmore had a very welcome opportunity to speak to a wider audience when given space for an editorial piece in the Sun, titled 'treat addicts like patients, not cirminals' (when it first appeared online, missing the point entirely, it was daftly titled 'treat junkies like patients, not criminals' - we are not sure which ran in the print version)
• At the weekend the Sunday People - hardly famed for its progressive position on drug policy - went further, dedicating a two page spread to the drug law reform debate, quoting Transform, listing famous supporters of reform, and detailing Portugal's experience with decriminalisation. Better still, they joined the Observer and Guardian in taking a clear editorial position in favour of reform,  their 'Voice of the People' leader column titled 'Time for a new look at drug laws':  

"When the Misuse of Drugs Act was passed in 1971 our politicians, lawyers and medical experts still dreamed of creating a drug-free society.

If we locked up all dealers and users the market would dry up... wouldn’t it?

Forty years on it is clear that the war on drugs was a naive policy that failed miserably and injured more people than it protected.

The huge profits of the international drugs trade fund terrorism, drive crime, and wreck lives across the globe.

But jailing users does nothing to break the cycle of those who commit crime to fuel their habit.

Now, at last, the Government is ­looking at the bigger picture and considering radical plans to decriminalise hard drug use. As we reveal today, 12,000 addicts could be moved out of jails and into hospitals to be treated as patients and not criminals.

Top doctors believe it is the only way to cut crime, improve health and save public money. But it will be a hard pill to swallow for the thousands of victims of druggie muggers and burglars who steal to fund their habit.

It’s a bold move. But if Ministers are finally having a “mature debate” on drug strategy they then need to discuss the “L” word. Legalisation. Criminalising some drugs while ­allowing a free market in others, such as alcohol and nicotine, makes no sense.

Our leaders need to think the ­unthinkable and consider bringing the entire drug industry, from production to use, out of the shadows and under ­legitimate controls.

Could we allow adults to buy limited supplies of drugs from licensed and regulated outlets and tax them as ­highly as possible without creating a black market?

Legalisation may spark an initial ­increase in the number of adults who use drugs, albeit in safer and healthier circumstances. But should adults be ­allowed to make that choice – when many already choose to wreck their lives, quite legally, with alcohol?

Tough questions – but the Government must seize the moment and ask them."

OK, so not exactly how Transform might argue it but we have to welcome the fact that this -mostly reasonable- editorial appeared in a national paper new to the reform position and, like the Sun coverage, is reaching much wider audience than the same Guardian and Observer readers, most of whom are already sympathetic to the drug law reform position. The positive tabloid coverage in particular is a sure sign that this debate is moving into the mainstream and moving in a positive direction.

Broadcast media 

On the Tuesday the story broke, Steve did 17 broadcast interviews and Danny did 10, in addition to the various interviews Gilmore himself gave, and a further 7 picked up by our colleagues over at Release. Highlights of Transform's coverage included appearances on

• BBC Breakfast TV (live interview)
• SKY breakfast news (pre-recorded interview for news segment)
• BBC Radio 4's Today program (quotes and Today audio clip on BBC coverage)
• 5 Live breakfast (pre-record for new segment), and 5 live morning debate (with David Raynes)
• BBC News Channel (debate with Neil McKeggany)
• SKY lunchtime news
• Talk Sport radio
• BBC Radio Wales (debate with Ian Oliver)
• BBC World Service (international broadcast)
• BBC News International TV (international broadcast - debate with David Raynes again)

The following day there was an additional appearance on CNN International, a 'Connect the World' half hour special on drug policy and law reform, with Steve debating former DEA agent Bob Stutman.

In addition there was plenty of blog action around the issue, all attracting many comments (mostly positive) - notably including:

• Fergus Walsh's BBC Blog 'Would decriminalising drugs work?'
• Mark Easton's BBC blog, writing about the 'British System'
• Tom Chivers' Telegraph blog Another top doctor has backed a rethink of drug policy. Maybe it's time to listen
• CNNs Connect the World blog 'should we decriminlize drugs?
• Tory peer Lord Norton calling for Royal Commission on the drug laws 'decriminalising drug use' on Lords of the Blog (a very interesting Lordly debate ensuing)

There was also a steady stream of op-eds, including efforts from:

• Antonia Senior (call for legalisation/regulation in the New Statesman and the Times - unfortunately now behind a paywall),
• Libby Purves, also in the Times (supportive of decrim)
• Paul Thomas in the New Zealand Herald 'drug decriminalisation makes sense'
• James Bell in the Guardian 'why not tax my drug addicts'

And even some satire from the Daily Mash legalise drugs, says some crazy president of the Royal College of Physicians.

Critical voices were, of course, also in evidence but curiously muted - the sense being that the media were struggling to find many. If there were pro drug war op-eds in any of the nationals we must have missed them. There were some quotes in the news coverage, however; In a widely quoted comment by Keith Vaz MP he stated that the legalisation of drugs "would simply create the mistaken impression that these substances are not harmful, when in fact this is far from the truth". This rather facile misconception about what a public health approach to drug regulation would entail is exactly the same one that he carried through the mostly awful 2010 Home Affairs Select Committee report on cocaine.

The Home Office response was even more inadequate, and missed the point to a such a staggering degree as to not deserve or warrant any further scrutiny:

'Drugs such as heroin, cocaine and cannabis are extremely harmful and can cause misery to communities across the country. The government does not believe that decriminalisation is the right approach. Our priorities are clear; we want to reduce drug use, crack down on drug related crime and disorder and help addicts come off drugs for good.'

 In a Mirror news piece (nominally about a separate 'legal highs' story that this blog will return too at a later date) we also learn that:

Leading doctors argue prohibition of heroin and cocaine has failed and they should be decriminalised and allowed for use under licence and tomorrow the Government will launch a major review of Britain's drugs laws. Home Office Minister James Brokenshire will rule out new legalisation but call for a more "mature debate" on how to control drugs.

You can only laugh (somewhat bitterly) at the Minister's concept of what constitutes a 'mature debate', one in which entire policy arenas he does not approve of are closed down before the debate has even begun. This despite the genuinely mature debate - one in which all options are on the table - that is happening in the real world (note links above for example), and being encouraged by the President of the Royal College of Physicians (not to mention the President of Mexico), and indeed Broke nshires own Prime Minister (albeit a while back). For the record decriminalisation of personal use, certainly non-prosecution of users, was also in the Lib Dem manifesto. They have been strangely and disappointingly silent during all this.

There was a predictably critical blog post from Kathy Gyngel from the Center for Policy Studies, but it is a lacklustre and scatter gun affair by her standards (see the comments for some critique of the factual analysis). 

Overall - this has been a hugely positive few days for the UK debate. Its always hard to gauge how much impact events like this have; maybe it was just a silly season story on a slow news day.  But it feels like part of a much more significant shift in the debate that has taken place over the last couple of years and appears to be accelerating- one in which the law reform arguments are being increasingly well understood for the principled pragmatic position they represent. Even Drugscope, usually very cautious in the debate, this week made a welcome call (in the Times) for decriminalisation to be considered (repeating a call they made back in 2001 but have been very quiet about since).

Small steps as ever, but the direction of travel is the right one. 

On domestic and international fronts, reform calls gather mainstream support

There have been two very positive developments for drug law reform in the last few days: On Sunday, The Observer newspaper ran a series of pro reform news and comment features alongside arguably the most unambiguous call for a debate on alternatives to the drug war, including regulation, yet to emerge from a UK broadsheet. Meanwhile, the previous week witnessed the debate making a significant step forward in Mexico when President Calderon joined calls for a debate on legalisation as a response to the country's growing crisis, followed by a clear call for legalisation and regulation by his presidential predecessor Vincente Fox - both statements receiving massive international media coverage.

• The Observer.

The first piece in the news section united these recent developments. Titled 'War on drugs: why the US and Latin America could be ready to end a fruitless 40-year struggle', with the subheading: 

'Mexico's president Felipe Caldéron is the latest Latin leader to call for a debate on drugs legalisation. And in the US, liberals and right-wing libertarians are pressing for an end to prohibition. Forty years after President Nixon launched the 'war on drugs' there is a growing momentum to abandon the fight' 

The coverage then describes some of the developments in the Americas, from the Mexican president's recent comments through to the growing cannabis law reform activity in California and elsewhere in the US.

A second piece in the Observer is a drug law reform op-ed (also using the Mexican presidential comments as its launch pad) titled 'Drugs: the problem is more than just the substances, it's the prohibition itself' by Maria Lucia Karam, a retired Brazilian judge and board member of Law Enforcement Against Prohibition (LEAP). Using examples from Brazil she argues that:

'Prohibition consigns the drug market to criminalised actors not subject to oversight of any kind. Legalisation would mean regulation and regulation is the best way to control the dangers of drug use, while cutting the cartels off at the knees'.

and that:

'Latin America is advancing the debate, but even in the US there are efforts to undo the damage of prohibition, the most prominent being California's effort to legalise marijuana
.
Hopefully, the thousands of Mexicans, Brazilians and people from other parts of the world who have been killed in the insane "war on drugs" will not have died in vain. Their deaths are already showing that it is time to put an end to all the pain and harms caused by drug prohibition; it is time to legalise and regulate the production, the supply and the consumption of all drugs.'

Finally, and most significantly, the sentiments in the two features are endorsed in a powerful leader editorial  titled 'A unique chance to rethink drugs policy' aimed squarely at the UK's coalition government, its subtitle clearly stating that 'Mr Cameron and Mr Clegg are perfectly placed to launch a national debate on whether we should try legalisation'. It begins with a withering critique of the drug war: 

'If the purpose of drug policy is to make toxic substances available to anyone who wants them in a flourishing market economy controlled by murderous criminal gangs, the current arrangements are working well.

If, however, the goal is to reduce the amount of drugs being consumed and limit the harm associated with addiction, it is surely time to tear up the current policy. It has failed.

This is not a partial failure. For as long as courts and jails have been the tools for controlling drugs, their use has increased. Police are powerless to control the flow. One recent estimate calculated that around 1% of the total supply to the UK is intercepted.

Attempts to crack down have little impact, except perhaps in siphoning vulnerable young people into jails where they can mature into hardened villains. When a more heavyweight player is taken out, a gap opens up in the supply chain which is promptly filled by violent competition between or within gangs. Business as usual resumes.


The same story is told around the world, the only difference being in the scale of violence. Writing in today's Observer, retired judge Maria Lucia Karam describes the grim consequences of a failed war on drugs in the cities of Brazil: thousands of young people murdered every year by rival dealers and police.


Few nations are untouched by what is, after all, a multibillion pound global industry. Importing countries, such as Britain, must cope with the social effects of addiction and end up squandering the state's resources on a Sisyphean policing task.


But that suffering is mild compared to the destructive forces unleashed on exporting countries. Mexico, from where cartels supply a range of drugs to lucrative US markets, has paid an extraordinary price for the illicit appetites of its rich neighbour. The border region has become a militarised zone with violence at the level of a guerrilla insurgency.

The editorial shows an unusual level of insight for a media discourse more often preoccupied with populist parochial concerns:

'Prohibition entails a double dishonesty. First, there is the pretence that the supply and demand can be managed by force. But anyone who has experienced addiction knows that banning a substance restricts neither access nor desire. Usually, it makes matters worse, bringing otherwise law-abiding people into contact with professional criminals. Most addicts, meanwhile, say their problems start with the need to annihilate feelings of despair or memories of trauma. Prosecuting them for those problems solves nothing.


The second pretence of prohibition is that drugs can be addressed within single national jurisdictions. Plainly, they cannot. The UK hosts a retail market for products that are cultivated and processed around the world. Around 90% of the heroin on British streets starts out as poppies in Afghanistan. So revenue from UK drug use funds corrupt officials, warlords and the Taliban, undermining Nato's military operation. Rarely is the connection made in public.'

before ending with a direct appeal to the UKs new leaders:

'By its very nature as a coalition, encompassing a broad spectrum of political views, the new government is well placed to inaugurate a free-thinking national debate on an issue that has been constrained by policy blinkers.


Neither David Cameron nor Nick Clegg seems much in awe of political taboos. Both men, in fact, seem to take pleasure in breaking them. But their ability to do so with impunity lasts for as long as there is goodwill towards their project.


This is a moment in which a political leader could steer the drugs debate out of its current dead-end track and towards something more meaningful and more likely to deliver what the public ultimately wants: safer, healthier, happier communities.


It is far from certain that decriminalisation, regulation or legalisation would work. But they should be examined as options, for it is absolutely certain that prohibition has failed'.

The position is a useful and pragmatic one, acknowledging the failure of the current policy and inviting an evidence based debate on alternatives, much as the IDPC  call for Impact Assessments of drug policy supported by Transform, has done over the past year.  David Cameron, it is worth repeating, made a not dissimilar call in 2001 when on the Home Affairs Select Committee he supported the recommendation 'that the Government initiates a discussion within the [UN] Commission on Narcotic Drugs of alternative ways—including the possibility of legalisation and regulation—to tackle the global drugs dilemma'. Meanwhile the Liberal Democrats have long been far more pragmatic and forward looking on drug policy. So as the Observer editorial notes 'The unthinkable is creeping into the realm of the plausible', continuing;

 'American society is slowly coming to terms with the fact that drugs are part of its everyday reality and that control might be more effective if use was allowed within the law, not forced outside it. That debate must be opened in Britain and the recent change of government provides a rare opportunity.'

We should perhaps not hold our breaths, but the mere fact that such a discourse is taking place in the mainstream media, with language and analysis now routinely being deployed that would have been seen as extreme and radical only a few years ago, shows how far we have moved.

• Mexico

The statement by president Calderon is particularly significant. Whilst he has distanced himself from actually supporting legalisation and regulation (unlike his predecessor), the fact he called for a debate is still critically important - he simply would not have done this were it not a real option."It is a fundamental debate," he said, adding that  "You have to analyse carefully the pros and cons and key arguments on both sides."  (This is, of course, precisely what an Impact Assessment approach would deliver). Bear in mind that this statement comes from a Mexican president receiving 100s of millions in US military and financial assistance to fight the cartels (albeit alongside the drug-money-funded river of illegal small arms flowing South across the.border that are fuelling it).Tragically it has taken  the catastrophic failure of his flagship policy to spur him to this latest concession, all visualized in horrific detail in this excellent blog post by Diego Valle

Sources: Homicide data from INEGI, population data from CONAPO.
2009 estimate based on execution rates

Even Calderon's qualifying comments that followed the initial statement days later are revealing. He stated that "If they [drugs] are not legalised in the world, or at least the United States, it's absurd because the price of drugs is not determined by Mexicans, it's determined by consumers in Los Angeles, New York, Chicago or Texas,".

This is a long way from saying that legalisation and regulation  is absurd in principle. Rather he is qualifying the call by saying, rightly, it would be problematic to move unilaterally given the centrality of the US market to Mexico's illicit trade. This very clearly leaves the option open regards bilateral reform with the US - something no longer a complete fantasy given the movement towards cannabis law reform in much of the US, particularly California, which holds a referendum on legalisation and regulation of non-medical cannabis this November.

It is also worth bearing in mind that despite contradictory noises from the new New US administration (progressive on public health in some respects, but still hawkish on supply side enforcement) Obama is on the record saying that 'the War on Drugs has been an utter failure'. 


The endorsement of legalisation and regulation by Calderon's predecessor Vincente Fox has only added further weight to the calls for a debate. He says (as reported by Reuters):

"Legalization does not mean that drugs are good ... but we have to see (legalization of the production, sale and distribution of drugs) as a strategy to weaken and break the economic system that allows cartels to earn huge profits,"

"Radical prohibition strategies have never worked."

 Vincente Fox

Read the whole thing - in Spanish - on his blog. Again it is welcome to see prohibition rightly being positioned as the radical solution, and the term 'legalisation' being associated with regulation. Interestingly, these comments are not dissimilar to ones he made in 2001 whilst president, although like Calderon he caveated his analysis by highlighting the difficulties of a unilateral move.

This is about more than the growing line of ex-presidents though - Cameron, Clegg, Obama, Calderon; all give a clear sense that the intellectual journey, accepting the failure of the drug war and need for reform, has been travelled - the concerns are political ones rather than practical or philosophical ones. As the environment becomes increasingly hostile to  profligate and counterproductive drug war expenditure, and the case for reform gains increasing mainstream traction perhaps the political climate will soon allow for real change to happen, and the Observer is right that we really do have a unique chance to rethink drug policy.


 It has also been welcome to see Transform's 'After the War on Drugs, Blueprint for Regulation' getting extensive and positive coverage in one of Mexico's leading newspapers El Universal; see here in original Spanish, and (not brilliant) Google translated English version.  Transform were also invited to contribute a comment piece on Blueprint to one of Mexico's most influential Policy Magaznes, Nexos, earlier this year.

Transform in the British Medical Journal: 'An Alternative to the War on Drugs'

The British Medical Journal this week publishes a special edition on drug titled: 'Drug users and HIV: treat don't punish'. the cover feature includes a special commentary section on drugs, HIV/AIDS and harm reduction to coincide with the huge AIDS 2010 conference in Vienna that kicks off this Sunday (see this blog for details and Transform's involvement in the Global Village's Drug Policy Networking Zone).

The special edition of the BMJ features five commissioned commentaries, including; 'Alternatives to the war on drugs' by Transform's Steve Rolles, one of the first detailed explorations in a mainsteam medical journal of legal regulatory models as alternatives to existing unregulated criminal drug markets, specifically from a public health perspective. The full text (also available on the BMJ site here, with rapid responses here) is copied below as it appears online.

The issue also includes Professor Tim Rhodes, Anya Sarang, Peter Vickerman, and Professor Matthew Hickman, on ‘Policy resistance to harm reduction for drug users and potential effect of change’; Richard Hurley on ‘How Ukraine is tackling Europe’s worst HIV epidemic’ and an editorial on ‘Evidence based policy for illicit drugs’ by Prof Evan Wood (who was on BBC R4's Today program this Friday discussing these issues and talking about the Vienna Declaration). These are all now available in full online.

In a significant endorsement, the editor of the BMJ Fiona Godlee, in an editorial titled 'Ideology in the ascendant' , concludes by noting that:

"In a beautifully argued essay Stephen Rolles calls on us to envisage an alternative to the hopelessly failed war on drugs. He says, and I agree, that we must regulate drug use, not criminalise it."

Also of note is that two other leading journals, the Lancet and Science, are running special editions on drugs and harm reduction this week. The Lancet is due to lead with the publication of the Vienna Declaration calling for science based drug policy and the decriminalisation of drug use. It is the declaration being adopted by the AIDS 2010 conference and supported by a growing list of public figures from political and scientific establishments.

The BMJ has also produced this excellent short film (below) by Martin Freeth, titled 'HIV shoots up', to go with its special edition. It features Alex Stevens, Tim Rhodes, Gerry Stimson, Steve Rolles and Elzabeth Pisani.

Published 13 July 2010, doi:10.1136/bmj.c3360
Cite this as: BMJ 2010;341:c3360

Analysis

An alternative to the war on drugs

Stephen Rolles, senior policy analyst

¹ Transform Drug Policy Foundation, Bristol BS5 0HE

steve@tdpf.org.uk

Stephen Rolles argues that we need to end the criminalisation of drugs and instead set up regulatory models that will control drug markets and reduce the health and social harms caused by current policy

Consensus is growing within the drugs field and beyond that the prohibition on production, supply, and use of certain drugs has not only failed to deliver its intended goals but has been counterproductive. Evidence is mounting that this policy has not only exacerbated many public health problems, such as adulterated drugs¹ and the spread of HIV and hepatitis B and C infection among injecting drug users, but has created a much larger set of secondary harms associated with the criminal market. These now include vast networks of organised crime, endemic violence related to the drug market,² corruption of law enforcement and governments, militarised crop eradication programmes (environmental damage, food insecurity, and human displacement), and funding for terrorism and insurgency.^{3 4}

These conclusions have been reached by a succession of committees and reports including, in the United Kingdom alone, the Police Foundation,⁵ the Home Affairs Select Committee,⁶ The prime minister’s Strategy Unit,⁷ the Royal Society of Arts,⁸ and the UK Drug Policy Consortium.⁹ The United Nations Office of Drugs and Crime has also acknowledged the many "unintended negative consequences" of drug enforcement,¹⁰ increasingly shifting its public rhetoric away from its former aspirational goals of a "drug free world," towards "containment" of the problem at current levels.

Problems of prohibition

Despite this emerging consensus on the nature of the problem, the debate about how policy can evolve to respond to it remains driven more by populist politics and tabloid headlines than by rational analysis or public health principles.


The criminalisation of drugs has, historically, been presented as an emergency response to an imminent threat rather than an evidence based health or social policy intervention.¹¹ Prohibitionist rhetoric frames drugs as menacing not just to health but also to our children, national security, and the moral fabric of society itself. The prohibition model is positioned as a response to such threats,^{12 13} and is often misappropriated into populist political narratives such as "crackdowns" on crime, immigration, and, more recently, the war on terror.


This conceptualisation has resulted in the punitive enforcement of drug policy becoming largely immune from meaningful scrutiny.¹⁴ A curiously self justifying logic now prevails in which the harms of prohibition—such as drug related organised crime and deaths from contaminated heroin—are conflated with the harms of drug use. These policy related harms then bolster the apparent menace of drugs and justify the continuation, or intensification, of prohibition. This has helped create a high level policy environment that routinely ignores or actively suppresses critical scientific engagement and is uniquely divorced from most public health and social policy norms, such as evaluation of interventions using established indicators of health and wellbeing.

Emerging change

Despite this hostile ideological environment, two distinct policy trends have emerged in recent decades: harm reduction¹⁵ and decriminalisation of personal possession and use. Although both are nominally permitted within existing international legal frameworks, they pose serious practical and intellectual challenges to the overarching status quo. Both have been driven by pragmatic necessity: harm reduction emerging in the mid-1980s in response to the epidemic of HIV among injecting drug users, and decriminalisation in response to resource pressures on overburdened criminal justice systems (and, to a lesser extent, concerns over the rights of users). Both policies have proved their effectiveness. Harm reduction is now used in policy or practice in 93 countries,¹⁶ and several countries in mainland Europe,^{17 18} and central and Latin America have decriminalised all drugs, with others, including states in Australia and the United States, decriminalising cannabis.¹⁹


Decriminalisation has shown that less punitive approaches do not necessarily lead to increased use. In Portugal, for example, use among school age young people has fallen since all drugs were decriminalised in 2001.²⁰ More broadly, an extensive World Health Organization study concluded: "Globally, drug use is not distributed evenly and is not simply related to drug policy, since countries with stringent user-level illegal drug policies did not have lower levels of use than countries with liberal ones."²¹

Similarly US states that have decriminalised cannabis do not have higher levels of use than those without. More importantly, the Netherlands, where cannabis is available from licensed premises, does not have significantly different levels of use from its prohibitionist neighbours.¹⁹

New approach

Although these emerging policy trends are important, they can be seen primarily as symptomatic responses to mitigate the harms created by the prohibitionist policy environment. Neither directly tackles the public health or wider social harms created or exacerbated by the illegal production and supply of drugs.


The logic of both, however, ultimately leads us to confront the inevitable choice: non-medical drug markets can remain in the hands of unregulated criminal profiteers or they can be controlled and regulated by appropriate government authorities. There is no third option under which drugs do not exist. The choice needs to be based on an evaluation of which option will deliver the best outcomes in terms of minimising the harms, both domestic and international, associated with drug production, supply, and use. This does not preclude reducing demand as a legitimate long term policy goal, rather it accepts that policy must also deal with the reality of current high levels of demand.


A historical stumbling block in this debate has been that the eloquent and detailed critiques of the drug war have not been matched by a vision for its replacement. Unless a credible public health led model of drug market regulation is proposed, myths and misrepresentations will inevitably fill the void. So what would such a model look like?


Transform’s blueprint for regulation²² attempts to answer this question by offering different options for controls over products (dose, preparation, price, and packaging), vendors (licensing, vetting and training requirements, marketing and promotions), outlets (location, outlet density, appearance), who has access (age controls, licensed buyers, club membership schemes), and where and when drugs can be consumed. It then explores options for different drugs in different populations and suggests the regulatory models that may deliver the best outcomes (box). Lessons are drawn from successes and failings with alcohol and tobacco regulation in the UK and beyond, as well as controls over medicinal drugs and other risky products and activities that are regulated by government.

Five basic models for regulating drug availability22 Medical prescription model or supervised venues—For highest risk drugs (injected drugs including heroin and more potent stimulants such as methamphetamine) and problematic users Specialist pharmacist retail model—combined with named/licensed user access and rationing of volume of sales for moderate risk drugs such as amphetamine, powder cocaine, and methylenedioxymethamphetamine (ecstasy) Licensed retailing—including tiers of regulation appropriate to product risk and local needs. Used for lower risk drugs and preparations such as lower strength stimulant based drinks Licensed premises for sale and consumption—similar to licensed alcohol venues and Dutch cannabis "coffee shops," potentially also for smoking opium or poppy tea Unlicensed sales—minimal regulation for the least risky products, such as caffeine drinks and coca tea.

Such a risk guided regulatory approach is the norm for almost all other arenas of public policy, and in this respect it is prohibition, not regulation, that can be viewed as the anomalous and radical policy option.


Moves towards legal regulation of drug markets depend on negotiating the substantial institutional and political obstacles presented by the international drug control system (the UN drug conventions). They would also need to be phased in cautiously over several years, with close evaluation and monitoring of effects and any unintended negative consequences.

Rather than a universal model, a flexible range of regulatory tools would be available with the more restrictive controls used for more risky products and less restrictive controls for lower risk products. Such differential application of regulatory controls could additionally help create a risk-availability gradient. This holds the potential to not only reduce harms associated with illicit supply and current patterns of consumption but, in the longer term, to progressively encourage use of safer products, behaviours, and environments. Understanding of such processes is emerging from "route transition" interventions aimed at encouraging injecting users to move to lower risk non-injecting modes of administration by, for example, providing foil for smoking.²³ This process is the opposite of what has happened under prohibition, where a profit driven dynamic has tended to tilt the market towards ever more potent (but profitable) drugs and drug preparations, as well as encouraging riskier behaviours in high risk environments.


The oversight and enforcement of new regulations would largely fall within the remit of existing public health, regulatory, and enforcement agencies. Activities that take place outside the regulatory framework would naturally remain prohibited and subject to civil or criminal sanctions.


Regulation is no silver bullet. In the short term it can only seek to reduce the problems that stem from prohibition and the illicit trade it has created. It cannot tackle the underlying drivers of problematic drug use such as inequality and social deprivation. But by promoting a more pragmatic public health model and freeing up resources for evidence based social policy and public health based interventions it would create a more conducive environment for doing so. The costs of developing and implementing a new regulatory infrastructure would represent only a fraction of the ever increasing resources currently directed into efforts to control supply. There would also be potential for translating a proportion of existing criminal profits into legitimate tax revenue.


Different social environments will require different approaches in response to the specific challenges they face. Transform’s blueprint does not seek to provide all the answers but to move the debate beyond whether we should end the war on drugs to what the world could look like after the war on drugs. It is a debate that the medical and public health sectors have failed to engage with for far too long.


Cite this as: BMJ 2010;341:c3360

---

Contributors and sources: SR is the author of After the War on Drugs: Blueprint for Regulation. The book is published by Transform Drug Policy Foundation, which actively campaigns for drug policy and law reform, and is available free online (www.tdpf.org.uk/Transform_Drugs_Blueprint.pdf).


Competing interests: The author has completed the unified competing interest form at www.icmje.org/coi_disclosure.pdf (available on request from him) and declares (1) the writing and production of SR’s book, including a contribution to his salary, were funded by the J Paul Getty Jr Charitable Trust and the Glass House Trust; (2) no financial relationships with commercial entities that might have an interest in the submitted work; (3) no spouses, partners, or children with relationships with commercial entities that might have an interest in the submitted work; and (4) no non-financial interests that may be relevant to the submitted work.
Provenance and peer review: Commissioned; externally peer reviewed.

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(Accepted 3 June 2010)