Wednesday, March 18, 2009

UNintended Consequences - side effects and contra indications of global prohibition

They may be the UNintended consequences of the drug ‘control’ system, but they show that the entire prohibitionist apparatus should come with an explicit health warning.

The UN Commission on Narcotic Drugs completes its marathon session on evaluating the ‘success’ of the drug control system tomorrow, and the ‘coalition of the willing (and not so willing)’ march out of the building, not quite in lock step, but maintaining de facto support for the global war on drugs. It is timely to examine whether these ‘unintended’ consequences, can still be seen as 'unanticipated'.

In March 2008 Antonio Maria Costa, Director of UNODC published ‘Making drug control ‘fit for purpose’: Building on the UNGASS decade’

It was a groundbreaking document. Whilst the conclusion still calls for prohibition to be implemented better, some of its critical analysis is spot on:

“The drug control system has succeeded in containing the drugs problem to less than 5% of the adult population (aged 15-64) of the world. This refers to annual prevalence: those who have used drugs at least once in the year prior to the survey. Problem drug users are limited to less than one tenth of this already low percentage” p.3
Which means that he concedes that 90% use non-problematically.

“The ways in which the drug control system has been implemented have had several unintended consequences: the criminal black market, policy displacement, geographical displacement, substance displacement and the marginalization of users.” P.20
It also identifies the enforcement of prohibition as responsible for:

  • A criminal market worth $320 billion that is destabilizing entire nation states and filling prisons the world over

  • Public health is marginalized in favour of enforcement, to the extent that 1 in 3 of those (outside Africa) who are infected with HIV/AIDS, contracted it through needle sharing

  • The balloon effect – meaning that where the Golden Triangle once supplied the opium trade, it is now Afghanistan and where the Caribbean once carried much of the transit of cocaine, now West Africa suffers from its corrupting effect

  • The discrimination that users suffer throughout the world because their drugs are prohibited and therefore they are demonised
This first dig at the reform movement doesn't appear until page 14!
“Vacillation is also prescribed by more than one tract on drug policy reform, exhorting the world to renounce ‘prohibition’ and espouse ‘legalization.’ The temptation to find a simple solution, the proverbial ‘silver bullet’ is timeless, but ultimately chimerical. Improving the performance of the control system is however both necessary and possible.” p.14

Amazingly, despite his realistic analysis, he still repeats the drug free world nonsense again.

“We need, first and foremost, to ‘finish the job’ on heroin and cocaine: a job we began a century ago and reiterated at UNGASS. The Political Declaration adopted at UNGASS, committed States Members [to]:

“…to developing strategies with a view to eliminating or reducing significantly the illicit cultivation of the coca bush, the cannabis plant and the opium poppy by the year 2008.” P.15
He also notes that:

“Unless we make strategic choices, prioritizing those areas where we have real competency and comparative advantage, and where we can leverage resources and expand partnerships, we risk wasting public money and delivering ineffective programmes.” P.16


[the paper] ends with an appeal to the States Members of the United Nations, and through them, to those who are enshrined in the first words of the Charter, “the peoples of the United Nations”: we must work together to solve the world’s drug problem, not by losing ourselves in pointless debates from extreme positions, but by occupying the centre– the proverbial ‘middle ground’ – which is wide enough to accommodate all of us and solid enough to bear our weight as we step forward into the next decade.” P.20
Oh dear, a pointless debate… maybe he should take a look at our extensive archive of those calling for change in our voices for reform.

In March 2009, in advance of the High Level Meeting in Vienna, Costa published ‘Organized Crime and its Threat to Security – Tackling a disturbing consequence of drug control’. This paper is a much more focused document on opportunities for organised crime that arise from the implementation of the drug “control” system. But it also comes with a much more pointed smear of those who differ from the UNODC line on enforcement. This is the first sentence of the summary:

“crime and corruption associated with the drug trade are providing strong evidence to a vocal minority of pro-drug lobbyists to argue that the cure is worse than the disease, and that drug legalization is the solution.” P. i
Clearly the aim is to inure the UNODC against charges of complacency by recognising that there are negative consequences of global prohibition, and absolving themselves of responsibility by labelling them as ‘unintended’. At the same time, it attempts to undermine claims by Transform and others in the reform movement (we are as pro-drug, as UNODC is pro-mafia) that these consequences call into question the entire apparatus of global prohibition.

The identification of harms caused by global prohibition is nothing new. A devastating critique was published by the UK Prime Minister’s Strategy Unit in 2003 (eventually leaked in full to the media in 2005). However, the March 2008 paper was the first real admission from the UN that there were huge unintended consequences.

The use of the term 'unintended consequences' is very similar to the phrase ‘collateral damage’, used in military situations as a euphemism for dead and injured civilians. What we are talking about here are drug war casualties.

It is unquestionable that these consequences are both undesirable and unintended by UNODC. No UN bodies want to enrich the Mafia, for example. However, should they have been unanticipated, given what we knew about alcohol Prohibition?

It is also interesting to compare this with the way that doctors describe ‘Side Effects’ of drugs – effects from treatments that are unwanted, and have a negative effect on patients’ health. The issue of side effects from medical treatments is dealt with in a very different way than Mr Costa deals with the unintended consequences he identifies. Side effects are a significant issue of discussion between patient and doctor as part of a comprehensive exploration of a treatment package. What takes place is effectively a cost-benefit analysis of a particular intervention or series of interventions.

As result of the knowledge of side effects, all treatments carry a health warning. I don’t remember seeing one of those on the UN Conventions.

WARNING – Enforcing the Drug Control System causes more harm than drugs

In the UK we operate the Yellow Card system whereby doctors, and importantly patients and carers, can report negative effects to a body of oversight. Genuine civil society involvement in global drug policy development, anyone? How about reporting unintended consequences as part of the feedback of member states to the annual UN World Drug Report?

Last, but by no means least, orthodox medical interventions are also accompanied by a list of situations in which the treatment is contra-indicated. One can only wonder at the extensive list of places where global drug prohibition would be contra-indicated:-

  • Fragile states – Afghanistan, Colombia, Guinea Bissau

  • Governments of transit countries with a propensity for knee jerk military enforcement responses – Mexico

  • Industrialised countries with high levels of inequality, disenfranchised non-white populations, and draconian criminal justice systems – US and UK

  • Anywhere with established organised criminal gangs and high levels of demand for drugs that fall under the prohibition – Too many to mention
What doctor would prescribe a one-size fits-all treatment for so many countries for whom prohibition is contra-indicated – Dr Costa of course and his prohibition-friendly group of world leaders.

What are the indications that the regime’s side effects are outweighing the benefits?

  • The existence of ‘narco states’ involved in production and supply

  • Cocaine and heroin cost more than their weight in gold (but use still rising)

  • Large prison populations made up of significant proportion of drug related offenders

  • Black people and other marginalised groups over-represented in prison populations

  • Reactive enforcement costs that outweigh proactive ones

  • A blanket refusal from senior politicians to debate the issue

  • Challenges to status quo coming from across the political spectrum

  • Policy makers who call for reform when they leave office (Mo Mowlam, Julian Critchley etc)
One of the key issues here is that of critical self-evaluation. In order to move beyond the current impasse in drug prohibition, key UN member states (E.g. G20 countries) and the UN bodies that oversee prohibition, must make the entire edifice subject to normative examination, including a full and frank articulation of the costs as well as benefits of the regime.

As a scientifically based primer that explores why we find it so difficult to self evaluate critically, I strongly recommend: ‘Mistakes were made (but not by me)’ Why We Justify Foolish Beliefs, Bad Decisions, and Hurtful Acts

If the UN drug agencies cannot collectively admit that a war on drugs is a singularly inappropriate treatment regime for us all, then we will need to find another forum to develop global drug policy that is effective, just and humane.

For more on Transform's take on the Vienna process, see:

Thanks to Ben Goldacre for advice on side effects and the Yellow Card System
Thanks to
wordle for the word montage


Anonymous said...

Excellent Danny...a devastating summary of where we are. Overly powerful governments gone wild on an anti-drug crusade, regardless of the consequences... irresponsible anti-drug use!

The world and its children cannot afford this. The pain and suffering must stop.

The fatuous, delusionary messages from Vienna show UNODC out of time and out of step. They must be challenged and the war must end.

Dante Cymru

Anonymous said...

I agree with much of this. But I think the one issue where Costa does have a point is the tendency of the reform movement (including Transform, I would say) to suggest that reforming the drug laws would solve most or all of the problems we currently have - what he calls the 'silver bullet' view. I have seen, for example, some absurd over-statements of the proportion of overall crime in the UK that is 'drug-related' - and hence claims about the impact on crime that drug law reform would have.

Steve Rolles said...

we've always been very clear its not a silver bullet - that is just Costa trying to paint the reform movement as extremists or fantasists - which is ironic given his support for global prohibition and his belief that it can create a drug free world. The UK government have done exactly the same -trying to paint prohibition as some rational middle ground - which it clearly isnt. Even if you throw in a bot of harm reduciton and treatment, its still prohibition, which is by its nature an absolutist extreme and inflexible position based on punitive law enforcement.

just for the record from our report 'After The War on Drugs, Options for control' (Transform 2005)

"What legalisation and regulation
cannot achieve

Despite the many benefits of regulating drug markets outlined above, this is not a panacea for
‘the drug problem’, however it is conceived. Whether drugs are legal or not, a small minority will continue to use them irresponsibly, some will be harmed and some will die. Legalisation and regulation can only get rid of problems associated with prohibition and the criminal markets it has created."

Anonymous said...

It is unfortunate that many of the indications that the regime’s side effects are outweighing the benefits would be cited in different arenas as successes eg each person in jail is a victory, the high price represents the success in reducing levels and politicians in office doing what it takes to stay in office therefore responding to democratic pressures. All total fantasy of course but what happens when people come from a fixed point of principle - I often wonder if they are actually lying (for self-interest or fear of opening floodgates), in some sort of denial where they can't face facts, stupid or insane. All very troubling. Niall.

Steve Rolles said...

John Walters, former US Drugs Tsar, went as far as saying that all the deaths in Mexico demonstrated that they must be doing something right.

Anonymous said...

Of course there will always be problematic use of drugs.

The point about ending prohibition is that we could have this particular problem at a much lower cost to society.

Indeed by ensuring maximum harm in drug use and empowering criminal gangs, prohibition certainly makes things worse.

Anonymous said...

Allthough the soundbites from the prohibitionists speak of stopping the cultivation and trade of narcotics, their position certainly goes a long way in maintaining the power of corporate monopolies in the drug trade..

Why should opium poppies and cannabis plants grown by pharmaceutical companies be tolerated, whilst those grown by anyone else, including the consumer, be illegal and dangerous?

The current laws protect the trade and profits of just a handfull of manufacturers and traders...

Rather than the term "prohibition", I think "protectionism" is far clearer.