Containing Substance Abuse: Lessons from Drug Control

International Council on Alcohol and Addictions

Jubilee Conference

Stockholm, 10 June 2007

Antonio Maria Costa

UNODC Executive Director

Ladies and Gentlemen,

Congratulations to the International Council on Alcohol and Addictions for its Golden Jubilee! This Council is one of the oldest international NGOs preventing substance abuse. Indeed, you are slightly older than the world drug control regime itself which dates back to the first meeting of the International Opium Commission in Shanghai in 1909.

The theme of this opening session is "Global Perspectives". I would therefore like to provide you with a broad overview of the history of drug control, and an indication of how effective it has been. I would also like to present you with evidence of how the world drug problem is being contained, and what implications this has for other forms of addiction.

Evidence of Containment

Let's look back a century ago to when your Council was formed. At that time, the big problem was opium: world production was estimated to be around 30,000 metric tons. Thanks to international drug control efforts, a century later we are down to around 7,000 metric tons a year - a drop of 75%.  To look at it another way, at that time, there were 25 million opium addicts in China alone: there are now 16 million in the world: major reduction if you consider that the world's population has tripled in the last century.

But progress was neither inevitable nor linear. While opium consumption fell dramatically in the first half of the 20 th century, after the Second World War a new drug epidemic broke out as addiction rates moved much higher in North America and Western Europe. Cannabis in the 1970s, crack cocaine in the US in the 1980s and '90s, heroin consistently throughout Europe, and, more recently, a wave of synthetic drugs have threatened public health and security and brought misery to millions of drug abusers.

To fight this epidemic, Member States adopted two important drug control Conventions (in 1961 and 1971). As a result, national drug control strategies were introduced and international cooperation was strengthened. A third Convention (in 1988) recognized the links between drugs and crime and introduced measures to fight drug trafficking and set up the first control regime against precursors and money laundering. 

Ten years ago, in recognition of the shared responsibility between countries of supply and demand, UN Member States took a fresh look at drug control and set targets for reducing supply and demand by 2008.  We refer to this process as UNGASS, as it was launched by the General Assembly that met in a special session dedicated to drug control.

In the past few years, we have seen evidence that these efforts are paying off. On average and on the global scale, the drug problem has stabilized - whether we talk about cultivation, production or consumption. And it has done so for practically all major types of illicit drugs. Hopefully, within the next few years this trend will become even clearer.  

This does not mean that the drug problem has been solved or that we can become complacent. Nor is the good news universal. Progress made in some areas is often offset by negative trends elsewhere. But overall, we seem to have reached a point where the world drug situation has stabilized and has been brought under control. As a result, we like to say - albeit cautiously at this point - that the world drug problem is being contained.

The first encouraging sign is that coca cultivation in the Andean countries continues to fall, driven by significant declines in Colombia. Global demand for cocaine has also stabilized, although the decline in the United States is offset by alarming increases in some European countries.

Secondly, the production and consumption of ATS has levelled off, with a clear downward trend in North America and, to a lesser degree, Europe. 

Thirdly, the health warnings on higher potency cannabis that have been made over the past few years, including by my Office, seem to be getting through. For the first time in years, we do not see an upward trend in the global production and consumption of cannabis.

Fourthly, opium production, while significant, is now highly concentrated in Afghanistan's southern provinces. Indeed, Helmand province is on the verge of becoming the world's biggest drug supplier, with the dubious distinction of cultivating more drugs than entire countries such as Myanmar, Morocco or even Colombia.

Another source of good news is that drug law enforcement has improved: almost half of all cocaine produced is now being intercepted (up from a quarter in 1999) and more than a quarter of all heroin (against 15% in 1999).

These positive developments are not attributable to a single specific factor: drug trends respond to long-term policy and to changes in society at large, not to individual causes. Yet chronologically there is a clear correlation between UN-led drug control efforts and the current recession in the drug economy.

Nevertheless, the situation is fragile. Progress could be undone by an increase in production of any type of drug, or the opening of new trafficking routes, and new markets.

I therefore make a plea to all governments - hold the line. Drug control can work and is working. Do not heed the Siren voices of a vocal minority that call for a relaxation of drug control or a renegotiation of the drug Conventions. Why undo all of the progress that has been made?

Yes, there is a price to pay in terms of law enforcement, development assistance and drug treatment - drug control is not cheap. But if we take our foot off the brake now, the costs will be much higher:

-       in terms of human lives (through overdoses or drug-related violence);

-       human misery and a greater burden on health care budgets (because of more drug abuse and accidents); and

-       the cost to society because of anti-social and dysfunctional behaviour (for example absenteeism, more money spent on policing and prisons). 

That being said, let's make sure that drug control is a means to an end and not an end in itself. After all, the objective is to safeguard public health - to protect people from the evil of drug addiction.

That means further reducing the world's supply of illicit drugs and increasing the percentage of drug seizures: imagine if we could achieve a 100% success rate in both!

But it takes something more because even with a 100% success the problem would not be solved. Why not? Because those drugs are being produced and trafficked to supply a market - to feed addiction. Therefore, the key to success is to reduce the strength of this pull factor: to reduce the demand for drugs. 

An Overview of Illegal Drug Use

Let us therefore look at the front end of the problem, the biggest challenge to drug control, namely reducing demand. How great is the demand for drugs? Last year, the total world population was approximately 6.4 billion,  of whom 4 billion people are between the ages of 15 and 64. Of those 4 billion, roughly 200 million (less than 5%) take drugs ever year. Only a small share of these, around 25 million people, can be considered problem drug users. 

25 million problem drug users is certainly a large number. But it pales in comparison to the number of people addicted to other substances. For example, 30% of the world's population (>15 yrs) uses tobacco, and 5 million people die from smoking-related diseases every year.  That means there are ten times more  smokers than drug users, and 25 times more deaths per year from tobacco than from drugs. We could make a broadly similar order of magnitude to compare alcohol abuse and drug abuse.

This leads me to the following three observations.

First , proportionally, drugs kill more than other addictive substances [200,000 deaths per year out of 200 million annual users vs 5 million deaths from 2 billion smokers]. That is why they are controlled.

However, and second , there are not millions of deaths every year from drugs - unlike tobacco - because the drug control regime has worked, keeping abuse relatively low.

Third , the rapidly growing restrictions imposed on tobacco smoking and alcohol consumption demonstrate that there is a broad consensus on reducing the threat posed by all forms of addiction. This is important because there is no point in celebrating progress in drug control if people are instead becoming addicted to other substances - like prescription drugs, solvents, and alcohol.

Therefore, we should be looking at ways to treat addiction and promote good health across the board, as the International Council on Alcohol and Addictions has been doing for the past century.

Parallels between Drugs, Alcohol and Smoking

To contribute to this process, let me highlight some lessons learned from a century of drug control which, in many ways, complement efforts to regulate the use of alcohol and tobacco. 

First, policies should be based on evidence. Drugs, alcohol and smoking are issues that have spawned ideological debates, powerful lobbies, and slick public relations campaigns. But at the end of the day, policies and public opinion are swayed by facts. 

Already in the 1950s, scientists discovered links between tobacco consumption and lung cancer. It took some time for the world to catch up: some national anti-smoking campaigns began in the 1980s, others - for example in Europe - are only now picking up steam. The World Health Organization's Framework Convention on Tobacco Control is the means to make this campaign global. This campaign has gained momentum thanks to a mounting body of irrefutable evidence that smoking is bad for your health, and the health of those around you.

The same thing has happened with drugs. The UN drug control regime - based on 3 Conventions - came into force in large part due to concern over health risks associated with drug use.

Not everyone has been convinced of the risks posed by all types of drugs, for example cannabis which is the most widely used controlled substance in the world. Almost 4% of the global population between the ages of 15 and 64 use cannabis at least once a year. Until recently, popular opinion was that cannabis is a relatively harmless substance. When I was at Berkeley in the 1960s flower children used cannabis as a way of tuning out. THC content of joints at that time was 2-3%. Some advocates - and not only in my Alma Mater - even called for its legalization.

But opinion is changing, because cannabis is changing. The supply of cannabis herb is being influenced by bio-technologies, some indoor, that are increasing its potency and its yields by many multiples. The THC content of joints sold in, for example, Canada, the US and the Netherlands is now sometimes as high as 15-20%. Pot smokers are not getting mellow - they are getting sick. Evidence of the damage to mental health caused by cannabis use - from loss of concentration to paranoia, aggressiveness even outright psychosis - is mounting and cannot be ignored. Emergency-room admissions involving cannabis are rising, as is the demand for rehabilitation and treatment.

Based on this evidence, attitudes and policies are changing. Coffee shops in the Netherlands that sell marijuana are closing down. Advocates, who just one decade ago called for the decriminalization of cannabis, are changing their stance 180 degrees and calling for greater prevention and treatment to deal with a drug that is clearly bad for your health.

Second, there should be society-wide engagement. Drug control is too important to be left to drug experts and governments alone. It is a society-wide responsibility that requires society-wide engagement.

To help young people make the right choices in life, it is important that they get a good start in life, and good guidance at home. We all have a responsibility as parents, friends, co-workers and good citizens to ensure that people we know and love do not ruin their lives because of drugs and other forms of addiction. We need to help people take control of their lives.

There is growing evidence to suggest that susceptibility to drug dependence is a mixture of nature and nurture. It seems to be related to individuals psycho-biological patterns, increased or triggered by environmental factors such as traumatic and adverse experiences during childhood and adolescence, neglect and abuse, marginalization and social deprivation. This deserves further study: we need understand better what factors put young people at risk.

We should also try harder to make sure that those triggers are not pulled by taking early action in response to warning signs: like behavioural problems, psychiatric disorders, poor parenting, and marginalization. These characteristics do not automatically mean suffers from drug abuse, but they are often the antecedents. That suggests that more should be done to support family-based programmes to strengthen family bonds to provide the first line of defence against substance abuse. Indeed, this has benefits not only for the children, but also their parents who themselves may be vulnerable to addiction.   

Schools can help by teaching life-skills and discussing with young people the effects of drug use, and warning about the health risks of smoking and alcohol. Selective prevention in schools could identify and assist students at risk. Specialists can help develop social and problem-solving skills.

Community groups can provide young people with after-school activities like sport and the arts that enable them to spend their time in a fun, challenging, healthy and constructive way.

Peer groups and civil society organizations can help engage people who may feel left out by society. I have just come from Japan where young people volunteer to raise money to help people their age around the world escape from drug abuse. 

The media has an important role to play. Young people in particular are susceptable to images - in movies, videos, or on TV. Instead of glamourizing the drug problems of celebrities, the media could play a more informative role in explaining the dangers of drug use - as it has done quite successfully in campaigns against smoking as well as drinking and driving.  

Cities can learn from each others experience in drug control, and provide technical assistance where needed, for example through twinning programmes.

Science can help us better understand and prevent drug abuse and addiction. I would like to see Europe, and other continents, create research centres on the model of the American National Institute on Drug Abuse to help unlock some of the mysteries of drug abuse and discover evidence-based remedies.

Third, public security and public health. Modern society does not have to choose between protecting health through drug control or security through liberalized drugs. Punishment versus legalization is a false dichotomy. Governments can and must ensure health and security - this can be done at the same time by effective drug prevention and treatment.

No one wants to be killed or maimed by a drunk driver. So society accepts police controls to check if someone has been drinking. Is this an encroachment on privacy, even civil liberties? Maybe if you are sitting in your garage. But my freedom to get behind the wheel of a car while under the influence of alcohol ends when my actions encroach on someone else's freedoms - and even threaten their life. For example, in my country, Italy, more than half of all fatal accidents are attributed to drivers under the influence of psychoactive substances, including alcohol.

Slowly, public opinion is waking up to the fact that some people are driving cars, public transport, operating heavy machinery or even flying airplanes while on drugs. I applaud efforts by the United States, the United Kingdom, Australia, and  some EU countries to introduce drug testing to curb drug abuse on the road, in sensitive industries, and in situations where substance abuse may hurt oneself and others. Road testing works for alcohol; it will work for drugs. 

The motto for drug abuse prevention should be primum non nocere (first, do no harm) - to yourself and to society. For those who succumb to addiction, there should be adequate treatment facilities.

It is often said that drug addiction spreads where drugs are available, affordable and acceptable. If that is so, let us use the same logic to improve access to treatment. Let us make treatment  more available by increasing the number and visibility of treatment centers. Let us ensure that good health and social care are not limited to the well-off. And let us make sure that people are supported rather than punished for seeking treatment.

Treatment should be properly sequenced, comprehensive and integrated into mainstream public health and social services. There should also be greater intervention to prevent the spread of diseases (like HIV/AIDS and hepatitis) through drug use.

Seeking Ecstasy  

Ladies and Gentlemen, I think you would agree with me that the biggest challenge for all of our work is to better understand why people become addicted in the first place.

Why do people seek ecstasy? No, I am not talking about the synthetic drug of that name, but the Greek word ekstasis meaning - "to stand outside/or move beyond oneself", or to "put someone out of their senses". This is a metaphysical question that has fascinated humanity since its creation, and I don't presume that we will come up with an answer at this Conference.

Yet we should be concerned at the tendency of society to try to escape the mundane by artificial and potentially dangerous means. Whereas in the past religion, meditation, music and dance, sport and nature have all been used by mankind to transcend worldly life for the sake of spiritual enrichment, today too many people take a short-cut to bliss by popping pills and drinking themselves into a coma. For most, rather than moving from dread to delight, they achieve the opposite: misery instead of ecstasy.

I am reminded of a disturbing passage from Aldous Huxley's novel Brave New World published in 1932. As you may recall, in order to keep people calm in this futuristic society they were offered a pill called "soma" [the Sanskrit word for bliss]- as Huxley wrote "to give you a holiday from the facts".

Let us work together to keep such scenarios what they are - works of fiction. And let us continue to better understand, prevent and control addiction, particularly drug abuse, in order to save people from the misery that is causes.

Thank you for your attention and keep up the good work