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Transform Seminar: Options for Control: Drug Supply 26.02.04
Discussion notes

The following text based on notes made during seminar discussions. It is not a briefing and does not necessarily reflect the views of Transform.

Considering the aims of an effective drug policy

Transform suggested that an effective drug policy would:

1. Reduce drug related ill health
2. Reduce drug related crime and conflict
3. Increase democratic regulation and control of the drugs trade
4. Extend provision of honest and effective drug education and information
5. Maximise effectiveness of drug-related expenditure and taxation of drug trade
6. Protect civil rights of drug users and non-users
7. Encourage inclusion of civil society in drug policy formation

 It was noted that this list mixed fundamental policy outcome objectives and process objectives. Health for example is an outcome – whilst extending information and education is a process and inclusion of civil society is not even a process, more a general aspiration. It was suggested that distinctions should be made and with specific aims in terms of reducing harms/costs of drug use and policy clarified.

 It was suggested that the list is missing the goal of reducing drug use. The question was raised as to whether this was a legitimate aim of a drug policy: Is a society that consumes less drugs a better society? It was argued that there was a distinction between reducing problematic and non-problematic drug use, and that there is no argument over the aim of seeking to reduce the former. It was noted that other transform documents that break down performance indicators under the health heading do include prevalence measures.

 It was noted that the UN only recognises abuse as a concept and that there was a research need to establish more clearly the levels of misuse/ abuse/ problematic use.

 There was discussion over whether seeking user and non-user rights was contradictory and about incorporating the rights and responsibilities of both groups.

 The ‘inclusion of civil society’ aim was criticised for appearing ‘woolly’ and vague. It was suggested that it was unclear whether this was an aim or a basic principle for all policy making. Transform explained how it was intended to highlight the gap between citizens and International drug control bodies.

 A need was identified to make a clearer distinction between policy in the West and in developing countries in particular major producer countries, and the need for identifying harms specifically related to drug production. It was suggested that the current list focuses on consumer country harms, and that it should be more flexible to the needs of different populations.

 It was also argued that civil society might not necessarily create a better policy, or lead to significant reform - prohibition enjoys widespread public support in many countries.

 It was suggested that different populations might have different hierarchies of harm and hence policy priorities. UK policy makers should focus on what was appropriate for the UK. It was argued, however, that progress couldn’t be made unilaterally.

 It was suggested that effective policy should build social cohesion, and that reductions in crime and reductions in conflict should be separate aims.

 It was suggested that reducing unnecessary harm, of whatever forms, should be an overarching aim that could include crime and health. Drug (injecting) litter was cited as an example of a harm.

 It was suggested that the future could bring new drugs and technologies that could dramatically change the policy landscape.

Breakout 1

Considered possible regulatory frameworks for opiate based drugs including poppies, opium preparations drinks, opium, heroin (powder and prepared for injection).

 It was suggested that there was a need to clarify some basic principles regarding the objectives of drug policy: Is it the role of the state to protect individuals? Is it harm reduction of the drug or the policy (or both) that is the aim?

 It was suggested that policy should not simply seek to reduce harm but also to increase benefits.

 It was suggested that the plant itself should be in no way criminalised, and left unregulated, as experience showed it was unworkable in practice to attempt to ban a plant. The example was given of Laos where a law has been introduced allowing poppy cultivation for personal use.

 The issue was raised of whether production should be local (with consuming country) or international. Local production was suggested as the preferable option. Technological developments such as GM might change the picture (e.g. to facilitate growing of coca in Europe).

 It was noted that (unlike cannabis) it was fairly impractical for individuals to grow their own opium in the UK.

 Concerns were raised over the possible role of big profit motivated corporations in drug production and supply. There was a need to avoid some of the problems associated with corporate control of the alcohol and tobacco market - regarding aggressive marketing and corporate lobbying skewing policy priorities.

 It was noted that the legal opiates market was bigger than the illegal opiates market. (The US for example gets 80% of its morphine from India). This was suggested as a useful model of legal regulation that was already in place and functioning effectively.

 It was questioned whether heroin/opiate use can ever be seen as recreational or non problematic, and in this context should it automatically be seen as a medical issue? What are the limits of the medical model? (It was noted later in the day that research is being undertaken into the extent of non problematic heroin use)

 It was noted that prohibition had distorted patterns of use towards more dangerous behaviours, such as injecting.

 It was suggested that it was important not to forget the bigger picture in terms of policy impact on developing producer countries. Would, for example a 10% rise in drug use be outweighed by the benefits to developing countries post legalisation?

 It was suggested that reducing drug use alone would not necessarily be an indicator of success. Whilst it is a desirable to reduce the number of drug users (questioned by some) there was a need to also look at harm associated with individuals use. Multiplying these would give overall harm. Overall harm could fall if individual harm fell (due to e.g. better education, safer supply), even if total number of users increased under legalisation.

 It was also suggested that changing patterns of drug use between drugs needed to be taken into account, rather than focusing on impact on use of a single drug. For example a fall in alcohol use could be accompanied (and causally related to) a rise in cannabis use, or vice versa.

 It was suggested that it was important to look at the whole life of the individual user not just their drug use. Did they, for example have a family who were effected by their use? It was suggested that checks such as individual licenses to purchase could address these concerns.

 Family planning clinics were suggested as an example of regulated pragmatic harm reduction measures.

Breakout 2

Considered possible regulatory frameworks for coca products (including coca leaves, coca drinks, cocaine powder and crack), and ecstasy.

 It was noted that we had to decide for which country were we considering regulatory frameworks?

 The problems associated with prescription as a method of supply were identified. The role of the medical profession was changing from ameliorating disease to enhancement of ease (viagra and plastic surgery were given as examples), but it was difficult to imagine medical provision as a main stream supply route.

 It was suggested that existing drug supply frameworks such as alcohol formed a useful precedent, in particular establishing models for production. It was also noted that there was the possibility of introducing new regulatory models that did not currently exist. The example of the ‘druggist’ was given (see transform briefing).

 The question of how supply options would impact on demand and prevalence of use was raised on a number of occasions. It was suggested that the issue of craving and addiction made drugs a unique product with unique questions for supply control, and that impacts on levels of use were the £64K question.

 The example of relative rates of cannabis use under different regimes (UK and Holland) was raised. It was suggested that policy makers would have to be prepared for an initial rise in use following legalisation even if it was not long term. Harms associated with possible increased use would have to be balanced against other benefits. There was a need identified for modelling on this to be undertaken.

 It was suggested that taxation and price controls could be used as a tool to control consumption. The issue of ‘what is wrong with an addiction’ was raised, assuming that no significant harms were occurring. Is the end of addiction per se in society a valid aim in itself? It was suggested that some individuals can manage an addiction with relatively little harm to them or their communities.

Regarding coca

 South American countries were presented as an example of where coca leaf chewing is legal and regulated. Coca tea is freely available in some countries and is regulated much as coffee is in the West. It was noted that there is little research on the levels of addiction and related harms related to coca leave or coca drinks in countries like Bolivia where the practice is legal and widespread.

 The possibility was suggested that greater availability of weaker preparations of drugs (such as coca leaves/tea or opium) might dilute the demand for stronger variations (cocaine powder, crack, heroin). It was suggested that the illegal market had to some extent helped create and expand the market for stronger preparations that were more profitable to transport and sell. Changes from opium to heroin use in Iran and Afghanistan were given as examples.

 It was questioned whether there was any regulatory framework that could be imagined for crack. It was suggested that if cocaine powder were available, people who wanted to convert it into smokable crack could do so easily.

 Moving on from this it was suggested that weaker preparations could be available through some form of licensed outlets and if problematic use developed then users could go through the ‘medical portal’ to potentially access prescribed supplies of stronger versions (this was in reference to opiates as well). Again the scenario of prescribing crack was seen as problematic and impractical.

 The example of Holland was given of a country where the average age of heroin users is rising and heroin use is frowned upon amongst young people who perceive it as a ‘loser’s drug’. ‘Medicalisation’ of heroin supply might help remove its attraction to some people and its association with an underground scene.

 It was argued that policing an increase in cocaine related anti-social behaviour would be problematic. The point was made that this is already a policing issue and the supply route of the drugs was arguably a separate issue.

Ecstasy

 The drug has a different risk profile to cocaine: being toxic but not addictive. It is not plant based, being entirely synthetic. It was also noted that it is one of huge family (100s) of chemically similar compounds with a range of effects and associated risks, many of which have not been researched to any meaningful extent. Some of these other compounds such as 2CT2 and 2CB have found their way onto the illegal recreational market.

 It was noted that the regulatory system struggled to keep pace with new drugs emerging on the market. At best the registration system to classify a new drug took three years. This made potential policing of future developments difficult.

 The importance of quality controls was identified as a key way to reduce risk. The importance of health information distribution with or at point of purchase was also identified as important (many of the risks associated with ecstasy can are increased by behaviours such as overheating, dehydration, mixing with other drugs etc). Increasing the role of the entertainment industry in health promotion was suggested.

 The ‘druggist’ model of supply was suggested as a possible best option, allowing controlled availability combined with access to information/expert advice. Again the issue of impact on prevalence was raised.

 Another suggested possible tier of regulation would be to have a ‘pilots licence’ to purchase. It would follow a health check (to establish individuals risk) and a requirement to show an understanding of dangers/ safer use etc.

 Fears were expressed as to the role of pharmaceutical companies in drug manufacture. The profit motive threatened to create incentives to interfere in policy making to reduce regulations as, it was argued, has happened with alcohol.

Plenary

The issue of impact of supply models on prevalence of use emerged in both groups and was discussed in the plenary session. It was suggested that some mathematical modelling would be useful. The work of Maccoun and Reuter was indicated as providing the best analysis of the impact of different policy regimes. The extent of this work meant that moves to different models were a ‘jump in the twilight rather than a leap in the dark’. Regarding cannabis it was suggested that it was not even a jump in the twilight, it was very clear.

Strengths and Weaknesses exercise:

The strengths and weaknesses of prohibition were discussed. Ideas were noted and have been divided below (with subdivisions to make it clearer - at the suggestion of a delegate)

Prohibition strengths:

Achievements on its own terms

 Enjoys majority support
 New resources to treatment (arguably at the cost of alcohol treatment)
 UN drug conventions effectively regulate production and movements of medical drugs
 Could (arguably) have prevented use being higher, and prevented expansion of some drugs markets.

Benefits (to individuals/groups)

 War on drugs creates an enemy facilitating otherwise hard to justify political actions (in the manner of the war on terror or the war on communism)
 Prohibition industry/vested interests (drug testing, prisons, customs, increased resources to enforcement, enforcement technology, departmental budgets)
 Lets ministers sound tough and decisive
 Can work for users – dugs are available
 Illegal market creates economic activity

Sustaining factors

 Appeals to fear
 Political simplicity – it is easy to argue and justify in terms of a moral battle.
 Diplomatic consensus
 Brings unity and resources to the UN.

Prohibition weaknesses:

Failure on its own terms

 Increased drug availability
 Decreasing price
 Increasing quality/purity
 Increasing use and misuse
 Increasing trafficking and drug related crime

Costs

 Increasing levels of harm to users and non users
 Creates criminal opportunity at different scales
 Violence and guns associated with the illegal trade
 Professional hegemony – treatment and enforcement dominate policy making.
 Marginalisation/social exclusion of users, especially problematic.
 Lost tax revenue, increased social costs
 Pushes drug use underground
 Environmental damage (unregulated production, chemical eradication)
 Corruption using illegal profits
 Interferes with economic development in producer countries
 Ethnic and socio-economic imbalance in impact of enforcement
 Close links to sex industry

Undermining factors

 Most of the above +
 Ignores economic realities
 Growing prison population
 Public confusion
 Engenders disrespect for the law/police

Next steps.

Short presentations were given by individuals describing ongoing campaigning work and policy research in different arenas. There was then some general discussion and suggestions regarding what the reform movement required to move forward productively:

 There was a need for the UN to recognise the failings of prohibition. Encouraging effective evaluation of policy was vital. There was a need for the UN and reformers to clearly state objectives and develop credible methods of policy analysis

 There was a need to articulate coherent alternatives to current failing policy models. There was a need for modelling and scenario planning of different alternative policies, so that they did not seem ‘pie in the sky’. Looking at experiences in other countries would be key. There was a need to have solid answers and research to counter arguments that focus on prevalence.

 There was a need for govt policy to be continually and comprehensively evaluated. This process has arguably begun but needs to go further. It was suggested that there was political reluctance to have effective evaluation because it would expose policy makers to criticism.

 There was a need to cultivate sympathetic media contacts, as this was key to exposing the public to informed debate. Public opinion had a direct and powerful influence over elected officials in particular.

 European alliances should be cultivated. The possibility of having a group of European/ Western countries join forces to challenge some UN legal structures was suggested (such as, in the short term cannabis decriminalisation, or more controversial harm reduction measures)

 Developing a simple message around benefits to the public

 Various areas of research need were identified: Impact of different models on key indicators specifically prevalence and financial costs/savings/revenues.