Policy > General > Options for Control: Demand

Background Briefing for the Transform 'Options for Control – Managing Demand' seminar - May 2004

Note: this is an edited version of a discussion paper prepared by Transform for seminar delegates

This briefing will:

 suggest the need to redefine the ‘drug problem’
 suggest that harm reduction and prohibition are in direct conflict
 explore the possible impact that ending prohibition and managing supply legally would have upon the demand for drugs
 explore what affects the demand for drugs
 suggest that the wider costs of prohibition vastly outweigh the benefits of the attempt to reduce prevalence

What is the ‘drug problem’?

The overarching paradigm in current global drug policy (prohibition) is that illegal drugs are bad and that the most important goal is the significant reduction, or elimination, of their use. On this basis, prevalence measures assume central importance in all drug policy discussions to the exclusion of most other measures.

For the social scientist the effectiveness of drug policy is evaluated with a broader range of indicators that cover public health, crime, civil rights, community safety, international development and so on. Prevalence of use is one of a number of health indicators, and health is one of a number of policy areas that need to be evaluated. This broader perspective also has the broader aim of reducing harm, of any form, to individual users and the communities in which they live (including the international community). It is being increasingly recognised that prevalence of use is overemphasised as an indicator in current drug policy formation.

The primacy of prevalence reduction in prohibitionist thinking follows naturally from the conceptualisation of the drug problem as drug use per se, rather than drug related harm. This harks back to prohibition’s origins in the temperance movement - partly a well-intentioned public health intervention and partly a religiously motivated moral crusade that promoted ideas equating alcohol and other drug use with sin and depravity.

‘Ready, Fire…..Aim’

The first of the UN drug conventions that establish prohibition in its modern form across the world was enacted in 1961. Some of the text was actually written in the 1940s, just a few years after the end of alcohol prohibition and the death of Al Capone! UN drug agencies still maintain a rhetorical, if not genuinely ideological, commitment to a drug free society. In 1998 the UN General Assembly Special Session on drugs gathered the leaders of the world in New York to pledge commitment to the motto “A drug free world, we can do it!” and the fanciful aim of eliminating coca, opium and cannabis from planet earth by 2008.

Fanciful it may be, but this aim remains at the heart of most domestic and all global drug policies. It is the collision of the increasing prevalence (particularly of problematic users) with the immovable object of prohibition that has led to the creation of illegal markets that are spawning much of the chaos that contemporary policy makers are now seeking to reduce. These unintended consequences of prohibition have expanded in proportion to the ballooning demand for illegal drugs over the past three decades. Policy related harm now vastly exceeds the harms of the drugs themselves.

It is of supreme importance that we return to the drawing board to redefine exactly what the ‘drug problem’ is, reassess the aims and objectives of policy and plan appropriate interventions based on evidence of effectiveness. Until we do this our interventions (including treatment interventions) may miss the mark entirely, interfere with achieving other policy objectives, or in the example of punitive law enforcement, create more problems than they solve.

Prohibition and harm reduction

The differing views of what constitutes ‘the drug problem’ has meant that the harm reduction movement is fundamentally at odds with the prohibitionist establishment. The harm reduction paradigm accepts the reality of drug use and aims to reduce the harm it causes, whereas prohibition aims simply to prevent production, supply and in particular, use. The incorporation of harm reduction policies (e.g. needle exchanges), into the prohibitionist framework of UK and UN policy, sets up a profound contradiction: prohibition creates harm (crime, unsafe drug use, civil and military conflict, social exclusion etc), which harm reduction policies, running concurrently, attempt to mitigate against.

At UN level there are increasing tensions between the health agencies, (the WHO and UNAIDs) which emphasise harm reduction concepts, and the drug agencies, (the CND, INCB, and UNDCP), which emphasise the prohibitionist vision of a ‘drug free world’. The UNGASS 2001 on HIV/AIDS adopted a declaration that called for "harm reduction efforts related to drug use" and "expanded access to essential commodities, including [..] sterile injecting equipment". By contrast the UN drug control bodies are extremely wary of the 'harm reduction' concept considering it "controversial in many environments" and stating that the term "has been used as a flag for a variety of causes and, as such, has been given disproportionate attention".

There has also been a problem for some time now that harm reduction policies are almost exclusively health interventions focused on problematic users. Such interventions are not geared toward the majority of drug users or the non-using population. This point highlights the differences between the harm reduction movement and legalisation movement. Whilst there is clearly some cross over, harm reduction thinking operates largely within the confines of prohibition, thereby restricting its definition of harm and consequently, the scope of interventions.

‘Drugs are bad and legalisation would open the floodgates’

The prohibitionist argument against legalisation is largely based around the premise that drug use would rise following legalisation. Removing the deterrent of criminality, it is repeatedly said, would ‘send out the wrong message’ or ‘give the green light to drug use’. The UK Updated Drugs Strategy 2002 says: "...we will prevent young people from using drugs by maintaining prohibition which deters use…". The Home Office submission to the Home Affairs Select Committee (HASC) stated that :

“Drugs are controlled because of their harm potential and the law and its sanctions help to limit experimentation. As some people would seem to be attracted to experiment with controlled drugs because of their illegality (eg "forbidden fruits"), the evidence suggests that a great many are deterred by the law. 19 per cent of children and 30 per cent of adults surveyed by MORI on behalf of the recent Police Foundation Inquiry, mentioned the law as the reason for not taking drugs. And the respective prevalence rates for controlled drugs and alcohol and tobacco are also illustrative.”

The Home Office argument seeks to demonstrate, from a prohibitionist perspective, that a prediction of rising drug use provides sufficient argument against legalisation. The HASC rejected decriminalisation and legalisation for this same simple reason (for the time being at least). Whilst the prediction of rising use is not necessarily incorrect, it ignores the wider spectrum of harms created by prohibition that would be reduced or removed following legalisation and regulation. It is this limited analysis that underlies the problems with contemporary prohibitionist thinking.

Criminality and deterrence

In reality, research into drug taking motivations, specifically why people don’t take drugs and the extent of deterrent effects of law enforcement relative to other variables, is very scant.

The Home Office has offered little evidence in support of the deterrent effect that is at the heart of the policy. In oral evidence to the Home Affairs Select Committee (HASC), and in a recent letter from Caroline Flint MP (minister with the drug brief) to Lord Cobbold, the only research presented has been the Police Foundation Mori poll and the 1998-99 Youth Lifestyle Survey (64% of respondents who had never taken cannabis before agreed with the statement “I do not take cannabis because it is against the law”). Interestingly, other submissions to the HASC used the Police Foundation Mori poll evidence to argue against a strong deterrent effect.

MacCoun and Reuter (2001) note that of the research that has been done into drug use and deterrence has been focused on cannabis use and “suggests that deterrence theory is at best a partial explanation of drug use decisions”. The effects of deterrence “are quite modest in size, generally accounting for 5 to 10 percent of the variance in marijuana use reported in perceptual deterrence surveys”. (p.83).

Even less evidence has been collected on the deterrent effect on patterns of use of other drugs, particularly problematic or dependent users of heroin and cocaine, whom the government state are the primary focus of its drug policy efforts.

What variables effect demand?

There are a number of variables that effect demand for drugs to some extent. These include:

 Socio-economic variables
 Trends, fashion, culture, music
 Advertising and promotion
 Availability of drugs
 Price of drugs
 Legality/criminality/enforcement - deterrence
 Perception of risk involved with drug use
 Availability of alternative activities

Potential positive and negative pressures on demand following legalisation:

Positive

 Removal of criminal deterrent
 Knowledge that drugs would be better quality
 Fall in price
 Increased (or less problematic) availability
 Advertising and commercial promotion

Negative

 Removal of underground mystique (forbidden fruits) – medicalisation, de-glamorisation
 Removal of user-dealers aggressively targeting new users
 Reinvestment of enforcement budgets into treatment and rehabilitation, education, prevention and urban redevelopment.

We can only speculate as to the overall impact of these different and conflicting pressures. However there is a great deal that can be learnt from looking at the impacts of policy changes in other countries, other eras and on other activities such as gambling and prostitution. MacCoun and Reuter (Drug War Heresies, Learning from other Vices, Times & Places) have done the most thorough investigation into the likely effects on prevalence of both decriminalisation and legalisation.

It is clear from this work that:

 There are a large number of variables that affect drug taking decisions.
 The deterrence effect of enforcement and criminality clearly exists but the extent of its impact is unclear, probably marginal, and will vary greatly between different drugs and drug using groups.
 The importance of the deterrent effect relative to other variables is also unclear and under researched.
 The simplified figures for levels of drug use and subsequent analysis often presented in the political arena and in the media frequently obscure a great deal of complexity. Headline figures of reported use give no indication of the intensity or frequency of use and specifically do not measure problematic use or levels of harm associated with use. A rise in prevalence does not necessarily equate to a rise in harm.

Within these potential shifts in patterns of use are a number of dynamics that need to be considered in the policy making process:

 The nature of drug use would change under a legally regulated system. The drugs themselves would be safer as they would be of known and guaranteed strength and purity and would come with health and safety information, warnings and guidance.

 Rise in use of newly legalised drugs might be accompanied by falls in use of alcohol, tobacco, inhalants and other currently legal drugs.

 Just as prohibition has pushed users towards ever more concentrated forms of certain drugs, post legalisation is likely to witness a shift back towards use of less concentrated variants of certain drugs. For example opium use could increase at the expense of heroin use, and coca based drinks could replace some use of snorted or smoked cocaine/crack.

For all these reasons it is important that headline prevalence figures are not allowed to obscure more subtle dynamics. Rising use of certain drugs could in reality be accompanied by a decrease in overall harm. This is a bewilderingly complex policy area that does not lend itself to the black and white oversimplifications and absolutes of the current political and media debate.

The debate around potential increases in use must include an exploration of the difference in policy responses to so-called ‘recreational use’ and so-called ‘problematic use’. This briefing does not attempt to define the two, rather highlighting the need to make some kind of distinction in order to implement the most effective strategies.

Discussion and Conclusions

At its simplest level the question that needs to be asked is this: do the benefits of prohibition’s deterrent effects outweigh the negative consequences (in terms of other harms) that prohibition inevitably creates?

In the moves toward a more effective, just and humane system of regulating drug markets and managing drug use, reformers will undoubtedly have to be sensitive to the political environment which has deeply ingrained misunderstandings arising from almost a century of ideologically driven prohibitionist propaganda.

However, fears of rising use following moves toward legally regulated drug markets, whilst undoubtedly overemphasised in political discourse, are none the less legitimate and do need to be responded to. The rational way to do this is to examine the conflicting pressures described above and consider how policy interventions can respond to these in ways that achieve the desired outcomes. This might, for example, include bans on advertising, investment in proven education/prevention programmes, providing young people in deprived communities with alternative activities and leisure facilities, reducing poverty and inequalities of wealth and so on.

Such undertakings will be required to facilitate the transformation of policy in the coming years, reassuring the public and placating the inevitable political and media opposition. There comes a point where the policy costs of attempting to reduce use become unacceptably high, as a century of prohibition has all too clearly demonstrated.

References

MacCoun and Reuter 2001 “Drug War Heresies, Learning from other Vices, Times & Places” Cambridge University press

Home Affairs Select Committee Drugs Inquiry – Memoranda.