12 heads of state who support drug policy reform

The commitment of heads of state is crucial in pushing for drug policy reform since they have the power to challenge the current prohibitionist framework at its political roots.

Sadly, when in office many key players like Barack Obama and David Cameron seem afflicted by post-election amnesia when it comes to rethinking the War on Drugs. Indeed, historically, the issue has been taboo and thus it was that was only former presidents were willing to speak out.

Nevertheless, in the absence of much significant engagement on the side of Western consumer countries, Latin and Central American presidents have taken the lead in challenging the prohibitionist status quo. And what is increasingly encouraging is that more and more incumbent political leaders are now daring to challenge the prevailing orthodoxy. Below is a selection of some of the more prominent past and present heads of state who are not afraid to champion reform, divided up into 'Incumbents' and 'Formers'.

Incumbents

José Mujica, ‘the world’s poorest president' who famously donates 90% of his salary to charity caused quite a stir back in October 2012 when he declared that Uruguay will be legalising the production and supply of cannabis under monopoly state control. When asked about his motives he replied that "The traditional approach hasn’t worked [...] Someone has to be the first”. 

Since then, he has announced that the plan has been delayed due to lower than hoped public support in ongoing polling. Nevertheless he remains committed to the reform and the Bill continues to make its way through the Uruguayan parliament.

He hopes to go ahead with this groundbreaking policy when the population understands the intent of the measure, underlining that "The majority has to be in the street and the people have to understand that with shootings and putting people in prison we are giving a gift to drug traffickers."

Juan Manuel Santos. Colombia’s president is an increasingly vocal proponent of reform, who, since coming to power, has drawn significant attention to the suffering of Latin American producer countries, the unintended consequences of current interenational drug control. He is now a major advocate calling for a rethink of the failed War on Drugs. 

In contrast to his Uruguayan counterpart, he rules out any possibility of unilateral action on the issue on Colombia’s side, instead calling on the international community to address the obvious failure of the War on Drugs and stressing that responsibility has to be shared among producing, transit and consuming countries. In his calls for a debate he is much bolder than other politicians, bringing up both the legalisation of cannabis and perhaps even cocaine as a subject for international discussion. 

Laura Chinchilla, president of Costa Rica, joined the group of incumbent presidents calling for a rethink of the prevailing prohibitionist approach stating that drug legalization in Central America merits a 'serious' debate in order to reduce the crime and violence spreading through the region, even if it runs up against U.S. opposition; once more drawing on the fact that Central Americans “have the right to discuss it” because “we are paying a very high price”. 

Otto Pérez Molina of Guatemala is another Central American president leading the debate on a need for a global shift in drug policy and challenging the U.S to move in the same direction.

"I believe that as he is entering his second term, [Obama] is going to be more open to this debate. In the end, this is the direction we all have to move in. There is going to be a change away from the paradigm of prohibitionism and the war against drugs, to a process that will take us towards regulation. I would expect a more flexible and open position from President Obama in his second term." 

Molina’s engagement with the issue is a welcome development, though his role as an advocate of reform may be overshadowed by the serious (though unconfirmed) allegations of human rights abuses that he faces.


Evo Morales, the Bolivian president, now serving his second term, hasn't endorsed wider drug policy reform, but has instead focused on the legalisation of the practice of traditional coca leaf chewing in Bolivia. In his campaign he dared to withdraw the country from the 1961 UN Convention on Narcotic Drugs, and despite objections from several countries later managed to re-accede to the convention with a special dispensation recognising the practice as legal in Bolivia, effectively renegotiating the UN conventions to allow for more progressive reforms. 

Morales has also been highly critical of the broader 'war on drugs' paradigm - which he views as failed and counterproductive. See, for example, this speech at the UN Commission on Narcotic Drugs earlier this year.

Formers

Ruth Dreifuss. Former president of Switzerland, member of the Global Commission on Drug Policy (which supported an experiment with legal market regulation of cannabis and other drugs), and pioneer of innovative harm reduction strategies. She introduced heroin-assisted treatment whilst she was Minister of Home Affairs for Switzerland and she frequently speaks out for decriminalisation and a public health approach to drug policy.

Dreifuss was also a special guest at an event held by the global Count the Costs initiative, of which Transform is a leading supporter. 

César Gaviria. The former president of Colombia, and a former Secretary General of Organization of American States, recently reiterated his support for drug policy reform, writing a joint letter with Fernando Henrique Cardoso, Ricardo Lagos and Ernesto Zedilla on the new, groundbreaking report by the OAS that recommends exploring alternatives to the war on drugs:

“The OAS and countries across Latin America are positively contributing to the breaking of the taboo that blocked for so long the debate on more humane and efficient drug policy. It is time that governments around the world are allowed to responsibly experiment with regulation models that are tailored to their realities and local needs."

Gaviria, a longstanding proponent of fundamental change in global drug policy also wrote the foreword to the Spanish edition of Transform’s 'Blueprint for Regulation': 

“The world needs, and deserves, a control regime that is not corrupt, that has genuine integrity – that is sound, complete and whole – that is democratic, and delivers security, development and health within a human rights framework. I am realistic. I believe it could take another ten years to turn this ‘Blueprint’ into reality. It is a tragedy that in the next decade many thousands more will die using dirty drugs or trying to stop, or fighting over the spoils of, the illegal trade. At the same time we will collectively waste another trillion dollars on the global war on drugs."

George Papandreou who served as Greece’s Minister of Foreign Affairs and later became Prime Minister, is another member of the Global Commission on Drug Policy who was a serving head of state at the time of publication and as such was therefore possibly the first head of state to publicly back legalisation/regulation. He has long advocated the need for a rethink of the current global drug policy framework.

Speaking at a High-level Conference on Drugs entitled "Towards an effective drug policy: Scientific documentation, everyday action and political choices", which was organized during the Greek presidency of the EU in 2003, Papandreou said:

"I do not hide that I personally have from time to time supported the need to see the addict as someone in need of treatment rather than a criminal, the need to make full use of the conclusions of a number of bold pilot projects, regarding the supervised administration of substitute narcotics in an organised way, including by the State itself."

Fernando Henrique Cardoso, former president of Brazil, and Chair of the Global Commission on Drug Policy, has been one of the most prominent former leaders calling for radical changes in drug policy:

“There is still a long way to go. The trend towards decriminalisation for possession helps to empower a public health paradigm. It breaks the silence about the drug problem. It enables people to think in terms of approaching drug abuse in a way that is not first and foremost a matter for the criminal justice system. Reducing the harm caused by drugs goes hand in hand with reducing consumption."

In a joint letter written with Cesar Gaviria and Ernesto Zedillo he reasserts their support for the legal regulation of the drug market:

“The full enforcement power of the state and the social and cultural pressure of society should be aimed at a relentless fight against organized crime -- rather than persecuting people in need of treatment.

Our second core recommendation -- which is more complex but just as important for ensuring peace and public safety -- is to encourage experimentation with different models of legal regulation of drugs, such as marijuana, in similar ways to what is already done with tobacco and alcohol.

Research has consistently demonstrated that marijuana is a less harmful drug than tobacco or alcohol. Regulation is not the same as legalization. This is a critical point. Regulation is a necessary step to create the conditions for a society to establish all kinds of restrictions and limitations on the production, trade, advertising and consumption of a given substance to deglamorize, discourage and control its use."

Jorge Sampaio. The former Portuguese president was at the beginning of his second term when his country became one of the pioneering EU countries introducing a decriminalisation policy in July 2001.

The pioneering law was introduced in response to Portugal’s growing drug abuse problem, and meant drug possession/use was no longer treated as a criminal justice issue. Instead, it would now be dealt with as a purely administrative violation. This legal refrom, alongside a more fundamental realignment of policy from punitive enforcement towards public health interventions. , resulted in a decline in problematic drug use, drug-related mortality rates and drug-related disease transmission. Twelve years after the law was enacted there is widespread political consensus in Portugal in favour of decriminalisation.

Ernesto Zedillo, the former Mexican president, and another member of the Global Commission, has also been a co-author of previously mentioned letters calling for alternatives to prohibition to be explored. Zedillo is also the Director of the Yale Center for the Study of Globalization. In one of the Center’s publications entitled ‘Rethinking the War on Drugs through the US - Mexico Prism‘ he writes that:

"Of course, we must believe that the architects and subsequent followers of the ‘war on drugs‘ strategy though that they were acting on behalf of the public interest, but that is hardly a reason not to examine the basis for and the results of their policies. In this process, we should not ignore the possibility that their idea of public interests might have been distorted by a sense of short-term political urgency."

Aleksander Kwasniewski, former president of Poland who joined the Global Commission last year seems to be a good illustration of the short-termism that Zedillo wrote about. In 2000, as president, Kwasniewski signed the bill introducing a prison sentence of up to 3 years for the possession of any amount of illicit drugs, no matter how small. Not surprisingly, the result was a drastic increase in numbers of arrests, more than half of them under the age of 24. 

Such an approach hardly merits a place on the list of top reformers, however what is interesting is that he publicly admitted that introducing those policies was a serious mistake. In an op-ed published in the New York times in May last year he declared:

"It is my hope that political and community leaders in other countries, especially in Eastern Europe, will learn from Poland’s experience in criminalizing drug possession, a move that clearly fell short of its goals. Such a policy failure should not be repeated anywhere else in the world."

"East European leaders should press for a halt to incarcerating people for possessing small amounts of drugs for personal use and should start treating drug addiction as a public health issue." 

A Q&A: Drugs, Legal Regulation and Brazil

Transform's Steve Rolles and Lisa Sanchez were interviewed by Willian Vieira for the Brazilian magazine Carta Capital. As only a few sections of the interview were used in the final printed feature (and it was in Portugese) we have copied the complete interview below in English.

Carta Capital: Even the U.S., who has supported war on drugs policies for the last decades worldwide (Colombia is the best example), has seen a shift, at least in terms of population approval. New polls suggest Americans are tired of spending so much money and having such poor results. Is it a sign of change for the rest of the world, that tend to follow American policies? Will it have an impact on UN? 

In the US there is now a majority that supports legalisation of marijuana for the first time, and more than 70% think the war on drugs is not working. These are hugley important shifts, particularly in the context of historic and ongoing bi-partisan opposition to substantive reforms such as legalisation. But the changes go beyond public opinion - rhetoric from the White House and ONDCP has notably shifted away from the more hawkish 'war on drugs' tough-talk towards a greater emphasis on health and treatment. Even though policy change has yet to match this rhetoric it is striking that the US Drugs Tsar has said that he 'ended the war on drugs' and Obama has said legalisation is now 'a legitimate topic for debate'.

It is also more than just debate. As well as 14 states decriminalising possession of marijuana and 18 allowing provision of medical marijuana, Washington and Colorado states have become the first jurisdictions anywhere in the world to legalise and regulate non medical cannabis production, sale and use. So the US, even though it is the spiritual home of the 'war on drugs' is ironically now also leading the way on drug law reform, at least for cannabis. It is adding to the global momentum for change but also following the wider global trend in looking for alternatives to the historic failings of the punitive enforcement based approaches. 

The reforms in the US are creating space for long held views critical of the status quo and supportive of reform to be publicly aired in high level political forums around the world, and this is nowhere more true than in Latin America. With challenges to prohibition unfolding within US borders, the authority of the U.S. to impose its 'war on drugs' in its bilateral relations, in regional forums, and at the UN are dramatically diminished. We can already see this dynamic playing out - objections to Latin state reforms are now much more muted than a decade ago; the OAS has undertaken the first ever review of alternatives approaches; at the request of Latin governments the UN has agreed to a General Assembly Special Session in 2016 to look at the impacts of the current system and consider alternatives. Calls for change from Latin countries are becoming more frequent, vocal and confident- and are no longer just the preserve of former presidents. Now it is sitting presidents getting directly and publicly involved. 

Carta Capital: In its 2008 World Drug Report the UNODC acknowledged that choosing an enforcement-based approach was having a range of negative "unintended consequences", including the creation of a vast criminal market, displacement of the illegal drugs trade to new areas, diversion of funding from health, and the stigmatization of users. Its costs are soaring. But when Uruguay defended its new policy in the UN, the answer was lukewarm, if not negative. Why has UN been so afraid of taking action? Why international agencies like UNODC are so cautious about changing its policies, policies that so clearly don't work? 

These comments in the 2008 WDR were a hugely significant acknowledgement, even if they were lost on page 216 of a huge report and have only recently found broader exposure. Whilst the UNODC can generate this sort of analysis, ultimately is duty bound to reflect the will of member states - and whilst the consensus behind global prohibition is fracturing, it still just about remains in place. The global drug control system has created its own bureaucracy, interest groups and power structures - many of which intersect with other geopolitical and strategic interests. These groups are unsurprisingly now defending those interests, but their ability to stifle dissent is rapidly evaporating in the face of ever growing public discontent with expensive failure. 

The 'war on drugs' paradigm has, however, become deeply entrenched in the political system and it is very difficult to challenge. By adopting a narrative based around the 'evil' of drugs that we have a duty to 'combat' (this is the language used in the preamble of the 1961 UN convention on drugs) any questioning of that system is seen as weakness, surrender or somehow being 'soft on drugs'. The harms of drug misuse and addiction have also become confused and conflated with the harms of drug law enforcement; the negative 'unintended consequences' the UNODC and NGOs such as www.countthecosts.org have identified. This single amorphous 'drug threat' fuels a circular logic in which harms created by the drug war are used to justify its continuation or intensification. 

It is important to acknowledge that like the US, the rhetoric of the UNODC has started to shift - while they still oppose treaty reform the have spoken of the need to make the treaties 'fit for purpose', acknowledging that they were drafted in a world very different to today (the key 1961 treaty was drafted in the 1940s and 50s). UNODC rhetoric has also increasingly emphasised the need to focus on public health and human rights and has given tacit if not explicit approval to decriminalisation of drug possession and use. 

Uruguay and other reform minded countries are not attempting to undermine or overthrow the global drug control system, but instead preserve its undoubtedly useful functions - including regulation of medical drugs - whilst introducing flexibility for states or regions to experiment with alternative models of drug control including regulated markets. Demand for drugs exists whether we like it or not; we can choose to have the markets that meet this demand controlled by governments or gangsters - there is no third option in which drugs magically disappear.

It is also important to be clear that, as the UNODC has acknowledged (in the 1997 WDR - under the then UNDCP), the drug treaties 'are not written in stone'. As with all treaties, mechanisms exist for their renegotiation and reform. More importantly perhaps is that to effect such reform would require a critical mass of states to demand they are updated to make them more appropriate to the challenges we are facing today. The importance of Brazil in any such process cannot be understated. It is also worth noting that New Zealand is introducing new legislation this year that allows for Novel Psychoactive Substances (NPS) not covered by existing international legislation to be legally brought to the market if they meet certain safety criteria and are produced and sold within a very strict regulation framework. When this model was proposed at the UN - framed as a tough response to an intractable problem - it was met with a surprising level of support, including from the UNODC. In many different ways it is clear that the groundwork is being laid for a more fundamental reform of the international drug control regime. The days of of an inflexible dogmatic global prohibition model are numbered. 

Carta Capital: The "After the War on Drugs: Blueprint for Regulation" offers specific models for regulating drug offer, with a 'hierarchy' among different drugs and specific systems to offer and control its use. Some specialists talk about a different violence level here and deeper social problems. How possible would it be to apply such a system in Brazil and other Latin American countries, for instance? 

It is important to be clear that we are not talking about an overnight revolution but a period of phased change over a number of years. This process will be defined by a gradual shift from punitive enforcement to more pragmatic health and social interventions. In practice it is likely to begin with wider decriminalisation of possession, more innovative harm reduction responses, and experiments with cannabis market regulation. It will involve pilot studies and careful evaluation to test the validity and impacts of different models and can be informed by experiments elsewhere in the region, and the world.

The possibilities for regulation of certain stimulants - at some stage potentially including cocaine - will proceed cautiously but are likely to be informed in particular by innovative emerging models for NPS ('legal highs') regulation such as those in New Zealand. Reforming the laws to allow decriminalisation or legalisation and regulation of certain drugs is not a panacea, but it could bring significant benefits to Brazil, the region and indeed the world as drug profits for organised crime reduce, and the crime, violence and corruption problems associated with those markets contract as well. There is potential for the substantial resources currently spent on futile and counterproductive enforcement to be redirected into other policing priorities, proven health interventions and social programs, and building the institutions that will be needed to regulate drugs in a post prohibition world.

No regulation model can be perfect - but any level of government regulation seems preferable to the current situation where market control defaults to violent organised crime networks. Institutional capacity will need to be strengthened and this will be a challenging process, but the reality is that the crime and corruption fueled by the war on drugs actively undermines institutions; moving towards greater market regulation and disempowerment of organised crime creates an environment in which institution building becomes possible, as well as freeing up resources to facilitate the process. 

Carta Capital: Brazil has its peculiarities. It has major drug trafficking gangs controlling whole areas (selling cocaine, mostly) and has a crack problem, that afflicts mostly poor areas and poor people. Would legalising marijuana (and other drugs) possession for users make possible to spend better the money on fight the social problems of drugs, like crack addiction? And also diminish the gangs influence? What could be the best model to adopt, the Portuguese, the Dutch, the Uruguayan? 

For the specific challenge Brazil is facing with crack, innovative harm reduction responses can be explored as a starting point, based on evidence and pragmatism rather than populist enforcement responses. An example may be experimenting with cannabis as a substitute for crack that is now being tried in Bogota. In the longer term the key will be to use market regulation to progressively change the nature of drug using culture - this could involve, for example, making less risky stimulants more available, and putting increasingly heavy restrictions on the more risky products. The illegal market does the exact opposite - creating incentives to market the most potent, risky but profitable products to the most vulnerable members of society. There are no perfect solutions but we can do better if we think creatively, have the courage to experiment and are willing to follow the evidence. It is vital that Brazil more actively engages with regional and global debate on drug policy reform. With its power and influence Brazil can be a potent advocate on the international stage in highlighting the tragic failure of the war on drugs and leading the debate around alternative approaches that can help deliver our shared goals of a safer healthier society.

Transform note for the HASC drugs inquiry on Novel Psychoactive Substances ('legal highs') and non-medical use of prescription drugs.

Danny Kushlick from Transform gave oral evidence to the Home Affairs Select Committee's Drugs Inquiry on 10th July 2012. He was asked about how the arguments being made for drug law reform related to ’legal highs’ and non-medical use of prescription drugs by Lorraine Fullbrook MP, but given time constraints was unable to offer a full answer. The Chair, Keith Vaz MP invited Transform to submit additional evidence relating to this question in writing. Transform have therefore prepared and submitted the following suplementary notes on policy and legal responses to novel psychoactive substances (‘legal highs’) and non-medical use of prescription drugs. 


Summary points

• The market for legal novel psychoactive substances (NPS), and non medical use of prescription drugs has emerged due to high and resilient demand for certain prohibited drugs. Both phenomena can therefore be seen as an unintended consequence of drug prohibition and the corresponding absence of any legal supply route to meet demand.
• The legal NPS market is associated with significant risks that directly relate to the lack of market regulation. Prohibitions on NPS can, however, have unintended consequences; creating a void in the market for new NPS, creating an illegal market for established NPS, or displacing use back to illegal substances for which legal NPS may have been substitutes.
  
• Until demand reduction efforts prove more effective, the reality of demand as it currently exists must be dealt with pragmatically. Recent experiences show that prohibitions do not eliminate the problem and may increase harms.
• Policy responses should seek to reduce the health and social costs associated with the use of drugs, and the markets that supply them. Leaving an unregulated legal market, or blanket prohibition (in all likelihood resulting in an unregulated criminal market) as the only options is blinkered and irrational.
• There are a range of regulatory models that can be considered, allowing controls over products, vendors and availability – these offer potentially significant reduction in the harms associated with NPS and it would be negligent to rule them out. They have been experimented with in some countries, and are being considered by the current European Commission impact assessment of NPS.
• Such developments might appear at odds with the prevailing prohibitionist ethos – but they may in fact offer a unique opportunity for a controlled experiment; guiding drug policy by pragmatic health principles rather than ‘tough on drugs’ posturing or knee jerk populism.

Background and context

Transform aims to support development of the most effective models for the regulation and control of non-medical drugs. The aim is to reduce the health and social harms associated with use of drugs, as well as wider social harms associated with the drug markets.

To this end we advocate both:

• The establishment of appropriately regulated markets for adult use of currently illegal drugs (as detailed in our 2009 publication ‘After the War on Drugs; Blueprint for Regulation’[i]) and,
  
• Improved regulation of currently legal drugs , most obviously including alcohol and tobacco; including controls on price/taxation, packaging, age controls, branding and advertising etc (See ‘After the War on Drugs; Blueprint for Regulation’ chapter 5).

The goal of both processes is to establish the optimal model of regulation to achieve the shared goals of minimised health and social harms (see points 2.1 and 2.2 in our earlier submission[ii]). Both involve increased levels of regulation, even if the starting point is different: the former in which regulation has effectively been abdicated to unregulated criminal profiteers, the latter which has seen historical under-regulation and corresponding over-commercialisation.

Transform’s position on the non-medical misuse of prescription drugs and the recent emergence of a range of novel psychoactive substances is informed by the same rationale.

It is vital that both trends, and responses to them, are seen in the context of

• historically rising demand for non-medical drugs under a legal/policy framework which strictly prohibits most of those in greatest demand.
• the fact that drugs with similar effects – whether stimulants, psychedelic or depressant effects are easily substituted by users.
• the reality that there are a range of factors that influence drug user choices between one drug and another – these include relative cost, availability, quality (purity/reliability), perceived risk and legal status.

Novel Psychoactive Substances

These are sometimes referred to in political and media discourse as ‘legal highs’ – a term initially coined by those marketing them, and then latched onto by the media, but one that is increasingly unhelpful, not least because many of them are no longer legal (alcohol and tobacco are curiously never included under this moniker). ‘Novel Psychoactive Substance’ (NPS) is a more accurate and focused term. There are a range of substances that come under this broad NPS heading, including a number of psychedelics[iii], but the majority of the market (and correspondingly, concern amongst the drugs field and policy makers) has been and remains made up of synthetic stimulants, such as BZP, mephedrone, and naphyrone. These drugs meet the demand for stimulants that has historically been met by more familiar illegal drugs including cocaine, ecstasy/MDMA and amphetamines. An additional group of products are made using synthetic cannabinoids that mimic the effect of cannabis.

Focusing on the stimulant grouping; as an alternative to the more familiar illegal drugs, there are a number of reasons why the legally available NPS may be perceived as preferable:

• they are often relatively cheaper
• they are more consistent in quality/strength (for context cocaine and ecstasy has been deteriorating in purity and consistency over the last decade)
• they are effectively freely available from online suppliers or local ‘headshops’, thus avoiding the risks and pitfalls of engaging with the criminal market place
• Whilst there is little evidence to suggest illegality is a significant deterrent, legal NPS still have the relative advantage of not being associated with the risk of arrest, prosecution and a criminal record.

Amongst the stimulant groups of NPS there has been an observable trend of new products emerging, establishing a market, and then being prohibited – often following a burst of high profile media around their risks. BZP was the first notable example in the UK, growing in popularity around 2004-6 before being prohibited for sale (but not importation and use) under the Medicines Act in 2007 and then prohibited outright under the Misuse of Drugs Act in 2009.

Mephedrone emerged rapidly during 2009-2010, arguably, to some extent filling the void in the ‘legal high’ market created by the BZP ban. Mephedrone was then prohibited under the Misuse of Drugs Act in late 2010. Following this ban a large number[iv] of other synthetic stimulants have subsequently emerged onto the market.

The market is effectively unregulated, creating a series of risks:

• There no quality controls. Whilst the quality (in terms of purity) of BZP and mephedrone before their respective bans, appears to have been quite high and reliable, more recently quality of legal NPS seems to have become more variable. Recent research[v] based on analysis of test purchases (published in July 2012) suggested that many of the substance being sold online as ‘legal highs’ contained substances other than those advertised , often including prohibited substances . Studies have suggested that some users now accept the unpredictability of what they are consuming – referring to what is sometimes called ‘bubble’, an unspecified/unidentified white powder that will have some level of psychoactive effect[vi].
• Because these products cannot be sold for human consumption they are sold for other purposes – such as ‘research chemicals’, ‘bath salts’ or ‘plant food’. This means appropriate levels of information are not being available on packaging concerning content, dosage, and risk/harm reduction information.
• There are no age controls for purchase. Whilst most ‘head shop’ sales have some (often inadequate) voluntary age controls in place, online sales have little or none – meaning these products are effectively available to anyone able to purchase online. For younger or novice users the unregulated legality - when viewed alongside strict prohibitions on other drugs - may give the inaccurate impression that the legal status and availability implies relative safety[vii]. There is some evidence that as well providing a substitute for illegal drugs some NPS have been gateways to initiation of some younger first time drugs users.

The rapidly changing nature of the NPS market creates additional challenges for the police – who are unable to identify substance; forensic services – who have to test for them; emergency services – who have difficulty identifying what substances an individual in an emergency situation may have taken, and drug service providers – who have little information on how to deal with problematic use of such drugs, assuming they can be identified.

Discussion points

• The ‘legal’ NPS market has largely emerged in response to demand for the effect the drugs provide in the context of historic prohibitions on such products. When legal products arrive that compare favourably to their illegal counterparts in terms of effect, risk[viii], quality and price – it is unsurprising that they become popular, and to some extent displace some illegal drugs. This phenomenon, and the specific challenges created by the rapid emergence of multiple NPS with unknown risk profiles occurs largely because of the lack of legal availability of more familiar and well understood drugs such as cannabis, ecstasy/MDMA, cocaine and amphetamines.

• The emergence of NPS can therefore be seen as driven primarily by the prohibitionist legal environment. There would have been, for example, no demand or market opportunity for products like ‘Spice’ (one of the popular brand names for - now prohibited - synthetic cannabis products) if cannabis were legally available. Whilst demand remains for a particular drug (or drug effect), the profit opportunity this creates means that the market will always find a way to meet it - whether legal or illegal.

• Just as the emergence of NPS are an unintended consequence of historic prohibitions, so prohibiting a particular NPS can then have significant unintended consequences. Especially when demand for a given substance has been established, a ban is likely to have one or more of the following impacts:

1. Create a void in the legal NPS market into which one or more new substance will move (the net health impacts of which are impossible to predict)
2. Divert users back to the illegal substances the NPS are likely to have been a substitute for (exposing users to the risk of the illegal market and criminalisation over and above the risks of the drug use)
3. Lead to the emergence of criminal market for the formerly legal NPS – in which it is likely that the quality (in terms of purity and reliability) of the product decreases and the cost increases.

Illustrative of this is that all of these impacts have been observed to some extent in the wake of the 2010 mephedrone ban.

What can be done?

New powers now exist to establish a 12 month ban on importation and sale of drugs following advice from the ACMD – to allow for an appraisal of risks, and decide on what course to take (notably, possession of these ‘banned’ drugs is not criminalised).

Whilst the ACMD are well qualified to provide a risk assessment (at least with what limited evidence is available) the problem they face is translating this analysis into effective policy recommendations given the lack of options available to them. Currently the options, once any temporary import and sale ban expires, are limited to either an outright ban under the MDA, or unregulated legal free for all. As this briefing makes clear, both scenarios are highly problematic.

There is an urgent need to explore options that occupy the middle ground between blanket prohibition and unregulated free market. These could allow regulatory tools be deployed that offer a degree of control over products, vendors, and availability.

Some limited potential exists for using trading standards legislation or medicines legislation[ix], but neither are adequate in the long term – what is needed is dedicated legislation and a regulatory model, custom made for the purpose of controlling non medical use of potentially risky psychoactive drugs. International law (the UN drug conventions) has been a barrier to exploration of such models for currently illegal drugs – but no such barrier exists for NPS. As such they provide an opportunity to explore regulatory alternatives to the obvious failings and counterproductive nature of blanket prohibitions.

Clearly no substance should be allowed into any commercial market without at least a basic level of risk evaluation so a default prohibition on commercial sale of any new NPS is justified. However, such bans on emerging products will only be effective if there is a regulated outlet of other products that can meet pre-existing demand. Without some form of legally regulated supply the problems outlined above will inevitably continue, and in all likelihood get worse. Some form of regulated availability does not, of course, preclude increased investment in evidence based prevention and risk education that targets vulnerable populations – indeed, such interventions should form part of any drug policy.

In the longer term any regulated models for legal availability of NPS (as happened in New Zealand for BZP) are likely to create a problematic inconsistency between legal and illegal drugs – not least in terms of perception of risk. There is a need to explore models of regulation for all currently illegal drugs as well to create a level playing field – the rationale for which is explored in more detail in Transform’s previous submission.

Prescription drugs

The non medical use of prescription drugs is also primarily demand driven and is unlikely to be substantially reduced unless alternative supply routes that meet demand are established, or demand can be reduced in the longer term. The ready availability of certain drugs, such as benzodiazepines, opiates, and amphetamines is a by-product of their extensive medical use. A strong argument can be made that many are either overprescribed, or that prescribing controls are inadequate. Increasing restrictions may appear an obvious solution, but there may again be unintended consequences in terms of displacing users to higher risk illegal drugs. Recent experiences in the US of an increase in heroin use following clampdowns on availability of some prescription opiates are illustrative of this risk[x]. The pragmatic solution would involve regulated supply of drugs that meets demand for non medical use in the short term, combined with longer term efforts to reduce demand.

As with NPS the choice is: unregulated legal markets, regulated legal markets or illegal markets controlled by criminal entrepreneurs; there must be no pretence that drugs can be eliminated altogether.

Recommendation:

Detailed examination of options for regulation of NPS may be beyond the scope of this inquiry. However, the committee should recommend that such options be explored by the appropriate body. Reference can be made to the Impact Assessment of options for NPS currently being undertaken by the European Commission, as well as work undertaken by UKDPC/Demos, and the experiences of New Zealand in regulating sales of BZP.

Further reading:

• Novel psychoactive substances report. ACMD (2011)
• Winstock, A., Wilkins C ‘‘Legal highs’ The challenge of new psychoactive substances’ Transnational Institute 2011
• 'Taking drugs seriously: a Demos and UKDPC report on legal highs’ UKDPC/Demos 2011

References


[i] Available online here: http://www.tdpf.org.uk/Transform_Drugs_Blueprint.pdf

[ii] Available online here http://www.tdpf.org.uk/Transform-HASC-submission-2012.pdf

[iii] Whilst some pharmaceutical preparations have psychedelic properties, most of the ‘legal’ psychedelics market is dried plant products, notably including dried fly agaric mushrooms and dried peyote cactus. Neither are actually ‘novel’ having been consumed for 1000s of years.

[iv] Estimates suggesting as many as 40 last year. http://www.guardian.co.uk/society/2011/oct/25/legal-highs-automatically-banned
[v]Ayers, T., Bond, J. ‘A chemical analysis examining the pharmacology of novel psychoactive substances freely available over the internet and their impact on public (ill)health. Legal highs or illegal highs?’ BMJ Open 2012, Vol 2, Issue 4. http://bmjopen.bmj.com/content/2/4/e000977.full

[vi] Measham, F., Moore, K., Østergaard, J. Mephedrone,’ ‘‘Bubble’’ and unidentified white powders: the contested identities of synthetic ‘‘legal highs’’’ Drugs and Alcohol Today VOL. 11 NO. 3 2011, pp. 137-146, http://bit.ly/PPy5vv

[vii] Sheridan, J., Butler, R.‘“They’re legal so they’re safe, right?” What did the legal status of BZP-party pills mean to young people in New Zealand?’ International Journal of Drug Policy, Volume 21, Issue 1, January 2010, Pages 77–81

[viii] In the absence of any formal evaluation, health risks are largely unknown, leaving knowledge on short and medium term risks to be established in an ad hoc, inadequate and dangerous fashion by experimental users and early adopters.

[ix] See ‘Taking drugs seriously: a Demos and UKDPC report on legal highs’ UKDPC 2011 http://85.13.242.12/publication/demos-ukdpc-legal-highs/

[x] Cicero, T. Et al. ‘Effect of Abuse-Deterrent Formulation of OxyContin’ New England Journal of Medicine 2012; 367:187-189July 12, 2012 http://www.nejm.org/doi/full/10.1056/NEJMc1204141

The War on Drugs: An Endangerment Racket

This comment piece was first published on OpenDemocracy, under the title: ‘It is time for a post-drug war Marshall Plan’, 1 August 2012

If prohibition was a genuine protection racket, at least we would be protected from harm. But it isn’t. It is much worse than that. It is effectively an “endangerment racket”, argues Danny Kushlick

Fifty years ago almost every United Nations member state signed up to support a global prohibition on the non-medical use of certain drugs. Ever since, citizens all over the world have repeatedly voted for governments that proclaim the virtues of fighting a “war on drugs”. Through taxes we pay governments to enforce drug laws to protect us, our children, our communities and our countries from the all too real harms of drug misuse.

However, the regime of prohibition (the criminalisation of production, supply and use) has been applied only to certain drugs. It has rarely been applied to tobacco and alcohol. But who does this prohibition protect?

In a classic protection racket, a racketeer threatens damage to a business, or harm to an individual, unless the victim pays the racketeer “protection” money. The 1961 UN Single Convention on drugs, to which the UK is a signatory, frames its approach in terms of a concern for the “health and welfare of mankind” and a desire to “combat” the “serious evil” of “addiction to narcotic drugs”. It then places an obligation on signatories to put in place a blanket prohibition (and thereby eliminate use and eradicate supply) in order to protect us from this “evil”.

The threat, as articulated, is that if we do not support the prohibition, the “evil” will take over and we will no longer be “protected” from addiction. But the global prohibition – the “war on drugs” – has singularly failed to stop people using drugs. The reality is that worldwide there are up to 300 million users. All the evidence shows that the level of law enforcement has little or no correlation with levels of drug misuse.

Not only has law failed to regulate drugs misuse, like alcohol prohibition, the war on drugs has gifted the multi-billion pound trade to drug-trafficking organisations and unregulated dealers, who are genuinely dangerous to all of us, our children and our communities. In 2008, The UN Office on Drugs and Crime conceded that the “drug control system” (a euphemism for prohibition) itself fuels the $320 billion a year criminal trade, describing it as one of five major “unintended consequences”. The recently published Alternative World Drug Report gives an even more comprehensive exposition of the harms caused by the war on drugs.

Governments use this “unintended consequence” - the creation of the second largest money earner for organised crime globally - as a further pretext to demand more “protection” money. However, this second payment, now apparently spent on fighting organised crime, does nothing to stop drug trafficking organisations. In fact, it serves as a price support mechanism, turning simple agricultural products into commodities literally worth more than their weight in gold. An understanding of basic economics tells us that squeezing the supply of any trade that has a high and resilient level of demand will serve only to raise the price (notwithstanding the fact that prices are further hiked by virtue of the risk undertaken throughout the supply chain). And so a self-perpetuating vicious circle is created, whereby control of the market by unregulated suppliers is used to justify continuation or escalation of the war.

These two “rackets” (the one built upon the other) have not only failed to protect communities and children, but have also brought entire nation-states to their knees. Prohibition has turned Guinea Bissau, for example, from a fragile state to a narco-state within months of the cocaine trade crossing its borders.

Prohibition has also brought the law into disrepute around the world, as millions break an unenforceable law mastly using whatever drugs they want, whilst the vast criminal profits are used to corrupt officials at all levels. Prohibition has made the drugs trade as dirty and dangerous as it could possibly be; unregulated dealers sell adulterated drugs to minors and violent criminals control much of the trade, and more than 50,000 Mexicans have died in drug-related violence since 2006. Year after year the Afghan poppy crop supplies the majority of the raw material for the manufacture of illegal heroin.

If prohibition was a genuine protection racket, at least we would be protected from harm. But it isn’t. It is much worse than that. It is effectively an “endangerment racket”. The first payment we make creates plentiful money-making opportunities for organised crime. The second payment provides the budgets for those given the task of “fighting organised crime” – FBI, CIA DEA, SOCA and many others around the world. The second payment of “endangerment money” distracts us from the fallout from the first racket and further serves to perpetuate the overarching prohibitionist regime.

However, there is good news. Governments are not organised crime groups. We can stop paying “endangerment money” any time we like, by voting for an individual or party that is seeking alternatives to global prohibition, and the endangerment racket that accompanies it.

We can stop governments spending our money on a regime that ultimately endangers those who are most vulnerable and at risk, and press them to reassign the vast sums involved to a “post-drug war Marshall Plan”. Around the world we are seeing the beginning of more pragmatic approaches to legalisation and regulation. As citizens we have a choice. We can use our vote for peace – or for war.

Latin America: Crucible for a new approach to drugs?

The debate on drug law reform continues to gather momentum in Latin America with another statement from the Colombian President on legalisation. As told by Colombia Reports:

Santos and Nicaraguan writer and former vice-President Sergio Ramirez discussed the possibility of legalizing drugs and the impact on Latin America, during a debate at the literature and arts Hay Festival in the coastal city of Cartagena.  "I know that this can't be the opinion of a state or the president of the republic, but I am a normal citizen, so I can [say it]. The solution is decriminalizing drugs. It must be decriminalized," Ramirez was quoted by Colombia's presidential website.

"I am not against this," Santos responded. "And I am saying this as president of the republic. This decision would be acceptable for Colombia if taken by the entire world." "Colombia maybe the country that has suffered most fighting drug trafficking. It has cost us our best leaders, our best journalists, our best judges and our best policemen," Santos added.

There is some confusion here (perhaps an issue of translation) between 'decriminalisation' (generally referring to personal possession/use) and 'legalisation' (generally referring to exploring regulated markets) although it is safe to assume, from previous comments made by Santos, that he is talking about the latter*.

In fact Santos is clear in his statements that he supports not only a debate on legalisation but that he would not oppose legal regulation of some drugs - notably marijuana and possibly cocaine - if it was a multilateral initiative. His reluctance to act unilaterally is understandable given not only the international nature of both the trade and the legal framework, but the serious diplomatic and political flak Colombia would risk attracting from the US and others.

He has also said he does not want to lead the debate, but is in effect doing just that with his regular comments on the subject. He is no doubt fully aware of the media impact they have, especially given Colombia's profile and influence, and its unique place in drug war history. It is hard to avoid the conclusion that he is making a considered and deliberate effort to push this issue forward on the domestic and international stage.

That he is a sitting head of state makes these comments especially significant. Many former Latin heads of state have made similar statements, not least in last year's Global Commission on Drug Policy.  One of his predecessors, Cesar Gaviria, recently wrote the foreword to the Spanish Translation of  Transform's 'After the War on Drugs: Blueprint for Regulation'.

These comments have served the useful function of creating political space for others, including recently Mexico's President Calderon, and Guatemalan President Molina, to start speaking out too.

Comments from multiple sitting presidents are far harder for other governments to brush aside. Compare the US' cursory dismissal of the Global Commission report with the more diplomatic statements from the US ambassador to Colombia who acknowledged that legalisation was 'on the table' and 'had to be addressed'. Or the comments this week from U.S. Undersecretary of State Wendy Sherman that she 'respects' the call for a debate despite not supporting legalisation.

Progress then, in taking the debate forward at least. But are we edging towards something more concrete?

In Colombia itself Santos' leadership on this issue ontinues to spark debate, support and opposition, but interestingly may have also prompted the creation of a national steering committee led by former General Secretary of the PDA party Bula Camacho, and former Attorney General Gustavo de Greiff's Office. they are proposing to run; "a vast campaign at the international level at UNASUR, the OAS and the UN....to move from the "timid proposal" made by President Juan Manuel Santos to take concrete steps for the international community to decide on decriminalization [probably meaning legalisation given the context] as a means to counter the scourge of drug trafficking.". This grouping is led by Santos' leftist opponents - but notably they are trying to outflank him as reformer,  rather than the more familiar rhetorical drug war posturing in opposing such moves seen elsewhere, including the UK. 

It remains to be seen who else gets involved, and with what resources, but getting the issue of legally regulating drugs on the agenda of the organisations Camacho mentions would be a major step forwards. And domestic pressure to speak up at the OAS, UNASUR or CELAC  may be exactly what Santos wants.

With the ever growing confidence and assertiveness of the region, building a coalition of Latin American countries on the way to calling for increased policy flexibility at the UN level (that would atleast allow exploration of decriminalisation / rregulation models) really would be that over used phrase - a game changer.

Useful background coverage from Colombia Reports here 

*decriminalisation of personal use is less controversial in Latin America - already being in place in a number of Latin American Countries, including Mexico and Colombia - although the Colombian situation is in legal flux. See Drug reform in Latin America

Home Affairs Select Committee announces major new drugs Inquiry

The Home Affairs Select Committee today announced a major new Inquiry into the UK's drug policy. The terms of reference are as follows:

"DRUGS

The Committee will undertake a comprehensive review of drugs policy in the new year. The Committee will examine the effectiveness of the Government’s 2010 drugs strategy and the UK Government’s contribution to global efforts to reduce the supply and demand of illicit drugs. Specifically, the Committee will consider:

• The extent to which the Government’s 2010 drug strategy is a ‘fiscally responsible policy with strategies grounded in science, health, security and human rights’ in line with the recent recommendation by the Global Commission on Drug Policy
• The criteria used by the Government to measure the efficacy of its drug policies
• The independence and quality of expert advice which is being given to the government
• Whether drug-related policing and expenditure is likely to decrease in line with police budgets and what impact this may have
• The cost effectiveness of different policies to reduce drug usage
• The extent to which public health considerations should play a leading role in developing drugs policy
• The relationship between drug and alcohol abuse
• The comparative harm and cost of legal and illegal drugs
• The impact of the transfer of functions of the National Treatment Agency for Substance Misuse to Public Health England and how this will affect the provision of treatment
• The availability of ‘legal highs’ and the challenges associated with adapting the legal framework to deal with new substances
• The links between drugs, organised crime and terrorism
• Whether the UK is supporting its global partners effectively and what changes may occur with the introduction of the national crime agency
• Whether detailed consideration ought to be given to alternative ways of tackling the drugs dilemma, as recommended by the Select Committee in 2002 (The Government's Drugs Policy: Is It Working?, HC 318, 2001–02) and the Justice Committee’s 2010 Report on justice reinvestment (Cutting crime: the case for justice reinvestment, HC 94, 2009–10).”

Organisations and individuals interested in making written submissions are invited to do so by Tuesday 10 January 2012. Submissions should be no longer than 2,500 words. Further advice on making a submission can be found below."

It is a very wide mandate (perhaps too wide?) but the content of the questions is significant, with a clear focus on some of the key themes in the drug policy and law reform debate raised by the groundbreaking 2002 HASC drugs inquiry, and those that have developed subsequently.

Of note is the fact that the Global Commission Report (that made a range of pragmatic recommendations including decriminalisation of drug possession and an experiment with legalisation/regulation) - is mentioned at the outset, and the previous inquiry's final recommendation specifically alluded to at the end. This was:

We recommend that the Government initiates a discussion within the Commission on Narcotic Drugs of alternative ways—including the possibility of legalisation and regulation—to tackle the global drugs dilemma  

So there is a clear focus on the harms of prohibition and the law reform debate - obviously directly reinforced by a number of the other questions.

On past experience it's clear the Committee would not be raising these issues if it wasn't genuinely interested in them, and one senses the positive change in the political climate around this debate, in the media, in mainstream politics, in the public, and in Parliament have all laid the foundations for what could, potentially, be a very important piece of work.

A note of caution should come from the the last time the Committee tackled the drug issue - 2010's report on cocaine - which was very poor, disappointing on almost every front.  It's not clear who is driving this latest move, but it's welcome that it is happening and, as with the previous inquiries, we encourage interested parties to provide evidence, particularly those beyond the usual suspects.  The Count the Costs initiative provides a steer as to who they might be. Do contact us for help.