Free drugs or drug free?

Photo: Alessandro Scotti7 December - Should drugs be legalized? Some people think so, like a recent article written by Ethan Nadelmann in Foreign Policy magazine. The Executive Director of UNODC, Antonio Maria Costa, put forward his views on the topic to a meeting in New Orleans hosted by the Drug Policy Alliance. Here is a full text of the speech:

Ladies and Gentlemen,

From both sides of the aisle, there have been noises about my presence here. Is it right to invite this fellow, the so-called drug czar of the United Nations, to our annual conference?   Indeed, in some of the pro-legalization literature I am depicted as a die-hard prohibitionist, a drug control Taleban, a naive proponent of a drug free world, even a general in the war on drugs.

I have heard similar complaints from the opposite front: what is the point of the UNODC Executive Director joining the caucus of those who ask for the end of drug control, mixing with drug legalizers, the radical fringe of the pro-drug lobby, pressing for a world of free drugs that will never come?

I am glad that eventually we all decided that this exchange of views could be constructive, and help public opinion understand better a century-old drama: drug abuse, and the damage that it causes.

Is there some common ground between those who insist on a world free of drugs, and those who propose a world of free drugs ? By the time this session is over, I hope we will all be able to answer in the affirmative. Here are a few pointers:

  • First, health and security have to be protected when we talk about society, including when we talk about how society deals with drugs.
  • Second, as a corollary, we can all agree on the need to reduce the harm caused by drugs -- by preventing their use, by treating those who abuse them, and by limiting the damage they cause to the individual and society.
  • Third, I hope we also agree on the need to ensure that drug policy is evidence-based, not the result of political considerations or ideological preferences.
  • Fourth, I submit that the dichotomy prohibition vs legalization is a misnomer. Such a confrontation is too simplistic for scientific deliberations, nor does it help those whom we all wish to assist: our brothers and sisters, the drug addicts.
  • Fifth, and finally, I hope you also agree that it is more accurate to refer to our divergence as a difference about the degree to which addictive substances (drugs, alcohol and tobacco) should be regulated. 

If these points are accepted, the discussion is to be centred on  where the bar is set , how to define the degrees of regulation. In other words, instead of accentuating our differences, I hope we build on the ground we share.

Let me begin with the world drug situation: where do we stand?

The world drug situation

In a recent article Ethan Nadelmann wrote: "it is dangerous when rhetoric drives policy". I agree.  Res, not verba, [actions, not words] my ancestors the Romans, would have said. So let's begin with the facts. 

A growing body of evidence, including recent UNODC World Drug Reports, shows that the drug market has stabilized over time and space. [Opium in Afghanistan is mostly an insurgency issue (4/5 of the cultivation takes place in the areas controlled by the Taliban).]

On the basis of this evidence, I can state that, since a few years, for all drugs there are signs of world market stability (for opiates, cocaine, cannabis, and ATS). What I mean is that in every component of the drug business (cultivation, production, consumption), aggregate totals have lost the upward momentum they had in the 1980s and '90s. Of course, world aggregates hide improvements in some countries and for some drugs, offset by deterioration elsewhere. Yet, the global totals are stable. This is what I like to call containment.

This finding refers to the past few years. Hopefully, in the period ahead evidence to support this claim - over the long term - will become statistically and logically incontrovertible.  

Next question: how did this market change come about? Is this the result of the UNGASS process? I see correlations over time and space, but evidence of causality is hard to come by (social sciences are generally poor in proving cause/effect relations). Drug trends respond to a wide range of factors, especially changes in society's revealed preferences. Yet for me, the result is what counts. If you have evidence to refute our data, I would like to see it.

Despite evidence of containment the world still has an enormous drug problem. There are some 25 million problem drug users. But let's keep this in perspective - that's less than 0.6% of the world's population. Even if you take into account the number of people who take drugs at least once a year (approximately 200 million people), this is still below 5% of everyone on the planet.

By comparison, 50% of the world's population uses alcohol, and 30% smoke. Alcohol, we know, kills 2.5 million people a year. More than half of all homicides and road-accidents, and most domestic violence, is alcohol-related. Tobacco kills 5 million people a year, because of cardio-vascular diseases and cancer -- two of the greatest killers of our time.

What is my conclusion? There is growing public and medical pressure to tighten controls on the consumption of alcohol and cigarettes. That's right. So why increase the public health damage caused by drugs by making them more freely available: drugs whose damage -- thanks to the controls -- is limited to 1/10th the casualties caused by tobacco? Why ignore the knowledge that we have gained from our experience with other addictive substances? 

If dreams come true…..

In order to show where I like to set the drug control bar, let me begin with the slogan so many of you have ridiculed:  a drug free world. Wait, wait: hold on to the tomatoes -- I am not the author of this slogan. While in my life time I would certainly like to see a world without drugs, I have never used this slogan. Actually, you will not find it in any of my speeches, nor in any of the official United Nations documents, starting from the most relevant of them: the conventions (of 1961, 1971, and 1988) that created the UN drug control regime, and the General Assembly resolution about drugs (most notably from the UNGASS, 1998).  

Yes, of course, several years ago (ie BC, before Costa) my Office put out posters with that slogan screaming across the page.   While I never used this concept, personally I see nothing wrong with it. Is a drugs free world attainable? Probably not. Is it desirable? Most certainly, yes. Therefore I see this slogan as an aspirational goal, and not as an operational target - in the same way that we all aspire to eliminate poverty, hunger, illiteracy, diseases, even wars.

So let's move on. I start with a series of (hypothetical) situations that I deem useful to set priorities in drug policy. I present them to you as dreams.

First , I invite you all to imagine that this year, all drugs produced and trafficked around the world, were seized: the dream of law enforcement agencies. Well, when we wake up having had this dream, we would realize that the same amount of drugs - hundreds of tons of heroin, cocaine and cannabis - would be produced again next year. In other words, this first dream shows that, while law enforcement is necessary for drug control, it is not sufficient. New supply would keep coming on stream, year after year.

So let's dream a second time. Let's dream that, by some miracle, we can convince farmers around the world to eradicate the thousands of hectares of drug crops, replaced by the fruits of development assistance (in Afghanistan, Colombia, Morocco, and Myanmar). A great dream of course, but yet again one that would not on its own solve the world drug problem. Why? Because when we wake up after this second dream we would realize that other sources of supply would inevitably open up somewhere else on the planet, to satisfy the craving of millions of drug users around the world.

So we come to a third dream which is the real challenge of drug policy: to reduce the demand for drugs. Prevention, treatment and reintegration, combined in a single health based programme, must be our priority. Of course the world's supply of drugs needs to be reduced, but lower demand for drugs is the requiredcondition to make drug policy realistic and pragmatic.

I hope you agree on this sequence, to separate the three elements of the drug chain, and their primary agents:  supply, by farmers in need of assistance;  trafficking, by criminals deserving retribution; and demand, by addicts in need of health care. At the UN, governments have captured this concept nicely in the expression shared responsibility

Our Office focuses on the first and third part of this trilogy, namely the farmers and the drug users. Going after the traffickers is the role of law enforcement agencies. We help indirectly in this endeavour by promoting criminal justice and counter-narcotics cooperation. I take this opportunity to salute the work of counter-narcotics officials around the world whose important work is often carried out at the cost of their lives: please recognize that they deal with loathsome predators who exploit human vulnerability for the purposes of profit.

Health and Security  

With two building blocks of my argumentation in place (namely, stability of the world drug market and the priority of reducing drug demand), let me now turn to the issues of health and security.

Some people say that drug use is a personal and private choice - and nobody else's business.

I have a few problems with this argument. First, there is a health issue. A growing body of scientific evidence shows that drug abuse is a disease affecting the brain, as much as any other neurological or psychiatric disorder. It is both triggered by vulnerability, and, in turn, deepens vulnerability. This has consequences both for the drug user and society as a whole. 

Second, if people don't care about the dangers to themselves, what about the dangers that drugs cause to others: like road accidents or crimes committed by people under the influence of psycho-active substances, or the spread of blood borne diseases to others? The pharmacological effects of drugs are independent of their legal status. Drugs are not dangerous because they are illegal. They are illegal because they are dangerous. No wonder that public outcry against the collateral damage of drug use is building, just like successful campaigns against passive smoking or drunk driving. 

Third, drugs threaten security - not only public safety in inner-cities, but the security of states -- think of Central America, the Caribbean and West Africa, caught in the cross-fire of drug trafficking.

I know your argument on this last point. Prohibition causes violence and crime by creating a lucrative black market for drugs: so, legalize drugs to defeat organized crime. Thus far, as an economist, I agree with you. But this is not only an economic argument. Legalization may reduce the profits to organized crime, but it will also increase the damage done to the health of individuals and society. Evidence shows a strong correlation between drug availability and drug abuse. Let us therefore reduce the availability of drugs - through tackling supply and demand - and thereby reduce the risks to health and security.  

In short, drug policy does not have to choose between either (i) protecting health, through drug control, or (ii) ensuring law-and-order, by liberalizing drugs. Democratic governments can and must protect both health and safety.

Besides, just because something is hard to control doesn't mean that its legalization will solve the problem. For example, it is hard to stop human trafficking - a modern form of slavery. This is a multi-billion dollar business. Because the problem is out of control, would you equally propose that we accept it?

Let's Not Condemn People to a Life of Addiction  

In order not to condemn people to a life of addiction, my Office is putting a strong emphasis on drug prevention and treatment. This goes back to the roots of drug control. The 1961 Convention on Narcotic Drugs is based on the premise that health is the first principle of drug control. This becomes more relevant every day as a growing body of medical and scientific evidence shows that drug addiction is an illness. So let's treat it that way. There are no ideological debates about curing cancer or diabetes. So why have them about drug addiction? People to the left or right of the political spectrum are not divided on the need for preventing or treating tuberculosis and HIV/AIDS. So why with drugs?

Scientific evidence has proven that drug dependence is a health and social issue, the result of nature and nurture. People are vulnerable to addiction because of a mix of genetic, personal and social factors:

gene variants , namely genetic predisposition to addiction,

childhood, pre-natal stress and inadequate parental care, neglect, abuse, low school engagement, lack of bonding, and

social conditions , marginalization, exclusion, poverty, latent or overt psychiatric disorders as well as popular culture and peer pressure.

There is a double jeopardy at play here: not only are such people more vulnerable to addiction, but addiction deepens their vulnerability. As a result, the disadvantaged are pushed even further away from society.

If drugs were legalized, these people would be condemned to a life of dependence. The privileged can afford expensive treatment for their drug habits, or those of their kids. But what about the less fortunate who lack the same means and opportunities?

Now extrapolate the problem onto a global scale. Imagine the impact of unregulated drug use in developing countries where no prevention or treatment are available. This would unleash an epidemic of drug addiction and all the social and health consequences that go with it.

Instead of reducing harm, there would be increased damage to individuals and communities because of drugs. Will you share the responsibility for the overdoses, HIV, and broken lives? 

Beyond 2008 

Ladies and gentlemen, if you really want to rethink drug policy, then help rebalance global drug control in favour of prevention and treatment. You are an outspoken Alliance. Be more radical. Go beyond handing out condoms, clean needles or a bowl of soup. Offer all drug addicts a comprehensive package that includes prevention, treatment and reintegration, not only harm reduction gadgets. Join me as an "extremist of the centre". We have been hearing about a balanced approach for a quarter century. It's time to turn it into reality.

If you want to shake things up, if you want to break the vicious circle of dependence and disadvantage, then:

Do not only:

- prevent the spread of diseases that precede and accompany drug use, like HIV and hepatitis.

This is a noble aim that we all share. But let us go further and:   

- devote more attention to prevention and early detection of drug vulnerability;

- reach out to people who need treatment, on a non-discriminatory basis;

- support the mainstreaming of drug therapy into high-quality and accessible public health and social services.

Let us also:

- promote alternative measures to prison for drug addicts, offering them rehabilitation programmes;

- treat all forms of addiction. There is no consolation for stabilizing drug trends if people turn instead to other substances; 

- finally, and most importantly, make drug control a society-wide issue.

Drug policies are too important to be left to drug experts like you and me, and to governments alone. It is a society-wide responsibility that requires society-wide engagement. This means working with children, starting from parents and teachers, to ensure that they develop self-esteem. Support family-based programmes, because prevention begins at home.

Schools teach life-skills. They should also teach the dangers of drugs. Help young people engage in healthy activities, like sports and culture, to prevent social isolation that leads to drugs and crime. Invest in better understanding, preventing and treating the illness of addiction.

People can be steered away from drugs. And those that do suffer the misery of addiction can be brought back into society. This is the true meaning of harm reduction which goes far beyond its usual narrow definition. My Office promotes this approach, together with the World Health Organization.

Ladies and Gentlemen,

The strength of the international drug control system is its universality, with all governments solidly behind the United Nations drug conventions and strongly supportive of my Office. I hope I have won you over as well. If not, any change you would like to make to the existing drug control regime must be done by governments. You can influence the process. The review of UNGASS is a golden opportunity.

We all want to help the poor farmers - to switch from crops to sustainable livelihoods. We all want to help the drug addicts - to save them from a life of misery. We all want to reduce the violence and crime associated with the drug economy.

So let's build on this common ground to make a safer and healthier world.

Thank you for your attention.

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