Heroin, cocaine, ecstasy, cannabis, prescription and over-the-counter medicines, alcohol, tobacco, coffee, tea – we are all people who use drugs. Our refusal to acknowledge this comes from a deep-seated fear that ‘we’ might become, or be seen as, one of ‘them’. What we really need to focus on is the difference between drug use and drug addiction or dependency. Global prohibitionist drug policy continues to focus efforts primarily on the substances alone. This is wrong.
Of course, the harms associated with some drugs are worse than others. Sometimes these are due to the degree of addictiveness of a particular drug. But most of the harms are due to the way that a particular drug is acquired (for example, in a dark alley versus from a pharmacy), the way in which it is used (as a pill, for example, versus smoking, snorting or injecting), and, even more importantly, the way in which society treats people who use drugs. The vast majority of the horrific harms associated with drug use—crime, HIV and other blood-borne infections, violence, incarceration, death—are clearly fuelled by the prohibitionist drug policies our governments pursue.
The use of non-medical drugs, and more importantly the ‘War on Drugs’ itself, have had a profound influence on the global HIV epidemic over the past 25 years. Today, injecting drug use accounts for 30% of HIV infections worldwide outside of sub-Saharan Africa. In the Eastern Europe/Central Asia region as a whole over 60% of HIV infections are due to injecting drug use.
Global normative guidance on HIV prevention, treatment, care and support for people who inject drugs emphasises the use of a comprehensive set of evidence-based interventions aimed at reducing the harms associated with drug use. This normative guidance, as endorsed by the World Health Organization, the United Nations Joint Programme on HIV/AIDS, the International AIDS Society and other organisations, is in direct contrast to global drug control policy, as set out in the three major UN drug conventions of 1961, 1971 and 1988. These call for a strict prohibitionist stance on the production, distribution and use of non-medical drugs.
It doesn’t take a rocket scientist to show that criminalising drugs and drug use has directly and indirectly led to a dramatic increase in drug-related harms, and that controlling and regulating the production and distribution of all drugs would go a long way towards reducing those harms. So long as we continue to define the drug user as ‘other’ and define the drug itself as the problem, we will be trapped in our misguided and harm-inducing programmes and policies.
‘After the War on Drugs: Blueprint for Regulation’ lays out, for the first time, a set of practical and pragmatic options for a global regulatory system for non-medical drugs. It comes at a critical time. A number of Latin American governments, including Argentina, Brazil, Ecuador, Bolivia and Mexico have moved, or are moving, towards decriminalisation of drug possession and are shifting to a public health model to prevent and treat misuse of drugs. They are no longer able to tolerate the damage done to their societies by the War on Drugs. Portugal decriminalised possession of all drugs in 2001.
There are signs that the US government, under the new US ‘Drug Czar’ Gil Kerlikowske, is ready to review its position on the War on Drugs. Given that prohibitionist policy has been dominated by the US, and to some extent Russia, Japan and Sweden, any shifts in US policy could have dramatic effects at the global level.
This is not a radical book, nor does it posit radical approaches to global drug policy. In fact, as it points out, the prohibitionist model is the radical approach, in that it is based exclusively on a moral judgment against drug use and drug users and not on an evidence based approach to reducing drug-related harms. Underscoring a century of prohibitionist policy is a deep-seated fear that moving from prohibition to a regulatory approach will lead to a ‘free-for-all’ situation vis-à-vis drug availability and use. ‘Blueprint’ outlines clearly that this fear is irrational and that reform of any kind will be vastly superior to the status quo.
Reform will not happen overnight. In fact, as ‘Blueprint’ makes clear, it will be important that changes are phased in gradually and closely monitored through intensive policy research that comprehensively documents health and other outcomes. The book proposes a number of regulatory options for each class of drug. Various approaches currently in use for the regulation and management of alcohol, tobacco, cannabis, and pharmaceutical medicines can be adapted for regulating non-medical drugs and drug use.
There often appears to be a vast gulf of irreconcilable differences between those of us advocating for harm reduction approaches to drug use, and those in the anti-drugs movement. To bridge the gap between these movements, harm reduction advocates must not be coy about the horrific problems that can be associated with drug use. Individuals in the anti-drugs movement are motivated too by their experience of these
harms. Discussing these experiences openly and without prejudice could lead to a common language we can all share. If we are not able to reach out to the anti-drugs movement and find common ground, then our evidence will never overcome their fear. We must aim towards a unified voice where public health and human rights are two sides of the same coin.
‘Blueprint’ envisages a world in which non-medical drug supply and use is addressed through the right blend of compassion, pragmatism, and evidence-based interventions focussed on improving public health. These have been missing from the debate for too long. The time for change in global drug policy is long overdue. Nothing less than the future health of individuals, families, communities and societies is at stake.
Craig McClure, Former Executive Director, International AIDS Society
1.1 An ethics of effectiveness 3
1.2 No-one wants anarchy 5
1.3 Being radical? 6
1.4 Our proposals 7
1.5 Knowing the limits 10
1.6 A starting point, not a conclusion 11
2 Five models for regulating drug supply
2.1 Regulation, prohibition and free markets 15
2.2 Defining the five basic regulation models 20
2.3 Prescription 20
2.4 Pharmacy sales 23
2.5 Licensed sales 24
2.6 Licensed premises 25
2.7 Unlicensed sales 26
3 The practical detail of regulation
3.1 Production controls 31
3.2 Availability controls 37
3.3 Product controls 40
3.4 Supplier and outlet controls 48
3.5 Purchaser and end user controls 52
4 Making a regulated system happen
4.1 A cautious, phased introduction 67
4.2 Assessing and ranking drug harms 70
4.3 Legislating globally, nationally and locally 81
4.4 Effective research for effective policy 82
4.5 Broader social, political and economic impacts 84
5 Regulated drug markets in practice 99
5.1 Alcohol 100
5.2 Tobacco 105
5.3 Cannabis 110
5.4 Stimulants 117
5.5 Psychedelics 146
5.6 Depressants 156
Appendix 1: Reforming the UN drug control system 165
Appendix 2: Current legal production frameworks
for opium, coca, cannabis and pharmaceuticals 193
Read it: Transform_Drugs_Blueprint
(It is a little bit above 200 pages)