Once the war on drugs is over, then what?

INTERVIEW / Steve Rolles

To persecute drug users, punish drug traffickers and incinerate enormous quantities of illegal drugs has not been enough to end the world demand for illegal drugs over the past 40 years. To the contrary,  drug use for the majority of the illegal drugs has been stable and the illegal drugs market is enjoying excellent health. As with any support group, recognizing the problem is the first step to finding a solution, and the most world leaders have recognized that the war on drugs has failed.

What now then? Steve Rolles, a researcher at the Transform Drug Policy Foundation in the United Kingdom has launched his book 'After the war on drugs: a Blueprint for regulation', at the British parliament. A book that answers this question with the proposal for a detailed regulation of all drugs.

Steve spoke to Comunidad Segura about the regulation of the production, sales and use of all drugs. “The most efficient way to reduce to the minimum the damaging effects of drugs is regulation”, said Rolles.

Where does the idea of writing Blueprint come from?

The debate on the drug laws has been raging for years. There is growing consensus that a punitive war on drugs has been a counterproductive failure – to a large extent that much of the argument has been won. But moving the debate forward has been difficult as no clear vision of what a post drug war world would look like has been proposed. Without this myths and misunderstandings tend to fill the void. ‘Legalisation’ – which describes a process not a policy end point – has often been misrepresented as an unregulated commercial free for all, with heroin and crack available to children in sweet shops and so on.

We felt it was important to demonstrate that regulated markets are possible, practical and indeed normal for almost all other forms of risky products or behaviours. Regulation is not a radical policy – it is the rational response to managing risk, and one of the primary roles of governments. To us it seems obvious that Governments and public health experts should be controlling drug markets not criminal profiteers. 

Could you describe the methodology used to come up with the document?

The document is based around research, discussions and debates we have been having for the last 12 years. We have largely based the models on best practice with existing models for regulating currently legal drugs and pharmaceuticals, as well as learning from regulation of other potentially harmful products and activities, such as gambling for example. We have also used an extensive international expert peer review group to provide input and feedback into various drafts of the text. 

It is detailed in the book, but would you explain in short the advantages of the five models to regulate drug supply?

The book details a menu of options for controls over products (dosage, preparation, price and packaging), vendors (licensing, vetting and training requirements), outlets (location, outlet density, appearance), who has access (age controls, licensed buyers) and where and when drugs can be consumed. Choices would be guided by careful ongoing evaluation and evidence of effectiveness on key public health and criminal justice indicators.

If implemented intelligently such differential application of regulatory controls could create ‘risk/availability gradient’ that holds the potential to not only reduce harms associated with illicit supply and patterns of consumption as they currently exist but, in the longer term to encourage patterns of use to move towards safer products, safer behaviours, and safer using environments.  This is the precise opposite of what has happened under prohibition, where the economic dynamics of an unregulated market controlled by criminal profiteers has tended to shift the market towards ever more potent, but profitable, drugs and drug preparations.

The five basic models for regulating drug supply that we propose are as follows: Medical prescription and supervised using venues for the highest risk drugs (notably injectable opiates) and the most problematic users; A specialist pharmacist sales model, combined with named/licensed user access and volume sales rationing for mid-risk drugs, such as amphetamines, powder cocaine, and ecstasy; Various forms of licensed retail, and licensed premises for sale and consumption (familiar with pubs and Dutch-style cannabis coffee shops); Unlicensed sales for the least risky products such as caffeine drinks, or coca tea.

There are examples of practical measures taken by local and national governments (California State, Portugal, Iran) regulating illegal drugs, does this mean we already have the necessary foundations for an international regulatory system?

There are some good examples of different drugs being regulated across the world that are explored in the book. In terms of drug production the models are very strong, but for supply, particularly non-medical supply, we have less to work with.

In terms of currently illegal drugs we do have some interesting medical prescription models for some opiates and amphetamines, particularly for injectable drugs. But whilst these demonstrate how a prescription model can work effectively in the arena of drug use associated with most harms, they only usefully apply to the small minority of users who we define as problematic and in need of medically supervised interventions. At the other end of the drug-risk spectrum we have many useful models functioning for cannabis, both medical use and the quasi-legal non-medical supply model that exists in the Netherlands.

It is the drugs generally seen as moderately risky, the widely used hallucinogens and stimulants, with which we have comparatively little experience to draw on, and it is here that the book has necessarily needed to be more speculative.

What is the strongest argument for drug regulation? Which are the main arguments against it?

I think the strongest argument is that demand for drugs has been remarkably resistant to any attempts to eradicate it. Given this reality – some people want to use drugs whether we like it or not - we have choice; either Government’s can regulate and control drug production, supply and use, or that control defaults to the criminal profiteers of the illegal market. There is no third option in which there are no drugs. The main argument against regulation is that use of drugs would increase. Whilst we obviously can’t rule out this possibility we believe that if regulation is implemented responsibly that the nightmare scenarios suggested by some opponents of reform are not realistic. There is little to suggest that the current punitive system is an effective deterrent, or that it has meaningfully prevented supply – if anyone wants to use drugs now, they can, and they do. We also argue that the huge resources being poured into demonstrably failed and counterproductive enforcement measures would be much more productively redirected towards public health interventions we know can be effective: educating people about drug risks, treating people with drug problems, and in the longer term addressing the underlying social causes of problematic use; social depravation, inequality and so on.

How to address a black market that would eventually emerge after regulation?

Under any regulatory system, activities that occur outside of that system will remain prohibited and subject to legal sanctions. Clearly if demand remains where use is prohibited the potential for a profit opportunity and an illicit trade remains. This could apply, for example, to children – whom would not have legal access to most drugs under any regulated system; any right of access would only apply to consenting adults. The proposed regulatory system would, however, cater the large majority of demand, and would thus leave a dramatically reduced market and more realistic enforcement prospect for the police.

We have to be realistic and acknowledge that no regulated system will eliminate all illegal drug market activity.  Illegal markets still exist for alcohol and tobacco for example, as indeed for many other goods. But a market that is mostly legal and regulated is still far better than one that is entirely criminal controlled. The illegal market is so destructive and socially corrosive that any reduction in its scale would still be a hugely positive step.

Besides cultural mindsets, we could argue that perhaps one of the greatest practical challenges for a world post-war on drugs is the UN Convention on narcotic drugs. How can governments and social organizations move towards regulating illegal drugs?

The consensus in support of the rigid prohibitions enshrined in the conventions is crumbling rapidly – their utopian ‘drug free world’ prohibitionist ideology now being systematically challenged both by the pragmatism of the harm reduction movement and the reality of decriminalisation of personal drug use now taking place across much of Europe, Latin America and elsewhere.  Even the UN drug agencies are now openly discussing the ‘unintended consequences’ of international drug control and talking about reforming the treaties to make them ‘fit for purpose’. 

The UN single convention on drugs was being drafted in the 1940s and 1950s; it is from a time when the drug using environment was entirely different to the challenges we face today. There is a growing acceptance that the treaties need to be revisited and made more flexibl.

In a ‘post war on drugs’ scenario, should Blueprint recommendations be followed internationally? Should a global agreement on core issues come first, or do you see some countries taking the initiative individually?

There should be some basic ground rules, although we would argue these already exist in the form of international human rights law. But whilst some of the worst punitive excesses of the drug war, such as use of the death penalty, coerced treatment, or incarceration of drug users are clearly not compatible with international legal norms,  the detail of how a sovereign state decides how to regulate their own drug markets should be for them to democratically determine. The drug war has often been imposed on countries from outside – we would not want drug reforms to be forced on countries in the same way. 

Once the positive impacts of a more pragmatic public health approach and legal regulation are demonstrated to be effective in one country or region it is likely gather its own momentum. We have already witnessed this  phenomenon with harm reduction measures and decriminalisation of personal use. The drug war is essentially a political programme now, and once its political power is removed - by exposure to evidence of effective alternatives – the public will no longer support it and governments will no longer be interested in it.

As stated in Blueprint’s executive summary, in a regulatory system, traditionally drug producing countries such as Afghanistan and the Andean Region might face particularly challenging issues in local development. How could such countries deal with issues like the dependence of small farmers on illicit crop cultivation?

Illicit drug production does provide a valuable source of income for a significant population and we should not ignore these groups when we discuss reform. Whilst there has been a great deal of focus on ‘alternative development’, there has been almost no engagement with the idea that illegal drug market is a direct consequence of international drug control policy, and this policy choice is directly creating a huge obstacle to development and is a significant source of conflict and instability in already underdeveloped regions. It is a policy choice however, and not an immutable reality that has to be negotiated around.

We have suggested that Western consumer countries whose demand has historically  fuelled the international drug trade should assume some responsibility for the regions and populations devastated by that trade, potentially redirecting a proportion of their enforcement spend into regional development funds, a sort of post-drug war ‘Marshall Plan’. 

Regulation, on the whole, would take the control of drug markets out of the hands of criminals. Who would be most qualified to control drugs? Some say that regulation would transfer the money generated by the drugs market to the pharmaceutical industry, creating other problems…

New regulatory models will essentially be being developed from a blank slate, so the opportunity exists to develop them appropriately, learning lessons from the success and failures of historical drug regulation, most obviously the alcohol, tobacco and pharmaceutical trades. All of these industries have at various times, in various places, behaved unethically with disastrous outcomes. However, there is a crucial difference between these industries, however flawed, and criminal cartels; they are subject to the law, and are held to account by Governments, regulatory agencies, unions, and consumer groups.

It is the responsibility of policy makers to make sure that any newly developed systems are appropriate to the challenge, and the responsibility of the electorate to make sure they do so.

It is also possible for regulatory models to be nearer to state monopolies – like legal coca production in Bolivia, or alcohol supply in Sweden for example. We have also explored a model that has been proposed for tobacco in which a state agency sits between producers of the raw material on one side and retailers in the other. Commercial activity takes place on both sides but the state agency controls the product itself and all related marketing activity.

One of Blueprint’s proposals is to set a scale or classification of drugs depending on its level of risk. Who should create such a scale? Is a worldwide consensus necessary, or should every country have its own classification?

Information and analysis on drug risks and harms can usefully be collated and disseminated internationally via both national institutions and international agencies. The World Health Organisation officially assumes this role and serves its function fairly well, although it is not beyond criticism. The real problem, however, is not really with the science of drug risks, which is well developed, but how this analysis is translated into policy.

Under a punitive prohibitionist system drug risk rankings are used primarily to determine the severity of penalties associated with a particular drug, or related offence. Yet there is little or no evidence to show this is an effective system that delivers useful outcomes. There is no evidence, for example, to show that drug rankings, or changes in drug rankings, have an impact on levels of use or overall harms, or that drugs associated with harsher penalties are used less. So we have excellent science at one end of this equation, in terms of evaluating drug risks, and a complete void of science at the other end of the equation, in terms of policy outcomes when translated through punitive laws.

Drug harm evaluations and rankings are useful for two purposes; firstly to inform policy makers in their decision making, and here local variables clearly do need to be taken into account, as drug risks are significantly determined by environmental factors and localised behaviours. The second use is to help educate the public about drug risks to help them make informed and responsible choices. The current 3 or 4 tier generalised rankings are not very useful for either of these purposes as they fail to capture the complexity of variables that influence drug harms. The risk of a particular drug depends on dosage, frequency of use, method of administration, poly-drug use, personal metal and physical health, and using environment. We think drug harms need to be described in a far more sophisticated way and be entirely de-coupled from any hierarchy of criminal penalties.

Cannabis seems like a logical starting point to try a regulatory system, because of the significant scientific literature available. Where could be this tested first and why? Is it possible for a country to do this without breaking international laws?

Cannabis is already the test case for regulatory supply models, both with the de-facto legalisation of supply in the Netherlands’ coffee shops, and the various models for medical cannabis provision in US and Canada. These systems operate in a legal grey area at the fringes of what is allowed under the conventions, bit do show how both production and licensed premises can be appropriately regulated. Because cannabis is so widely used, and reform of cannabis laws already enjoys majority support amongst many key populations it is likely that it will be the first – but quite how this unfolds is hard to predict.

It will probably involve a single country making a move on legal non-medical production and thus forcing the issue at UN level. Surprisingly it may well be the US, where certain states, including California,  are now seriously talking about taxing and regulating non-medical cannabis use. This may be a challenge for the US Federal government, but you sense that the Obama administration, despite their tough rhetoric, are not interested in expending huge political capital on fighting state governments on this issue. If things change regards cannabis in the US it will bring down the whole house of cards internationally – for those countries, like the Netherlands and Switzerland for example, who want to reform but have felt constrained by international pressure. 

Steve Rolles is head of research for Transform Drug Policy Foundation and author of ‘After the War on Drugs: Blueprint for Regulation’ which is available as pdf download from www.tdpf.org.uk. Spanish and Portuguese translations of the executive summary are also available.