Addiction Research 7:1-16, 1999. (references updated)
DRUGS IN A GLOBAL PERSPECTIVE:
THE INTERNATIONAL CONTROL
SYSTEM'S BEST FOOT FORWARD
: Robin Room[1] and Pia Rosenqvist[2]
ABSTRACT
With the World Drug Report, the United Nations Drug Control
Programme offers a textbook on global trends and developments in drug use and
in the illicit market, theories and interpretations of drug use, health and
social harms from use, counterstrategies and programs, the drug control
structure, and "regulation-legalization" debates. Country profiles for 8 countries summarize
available data, making use also of two problematic comparative indices. Harms from alcohol and tobacco figure heavily
in the arguments for maintaining drug prohibition, but these drugs are
otherwise excluded from consideration.
The report highlights deficiencies in available data, particularly on
adverse consequences of drug use, though they are the premise for the drug
control system. The report's picture of
trends in drugs use and in the illicit market is realistically gloomy, and its
presentation of the effectiveness of counterstrategies is usually appropriately
cautious. The report is often internally
inconsistent in its premises and arguments, but is true to its aim to
"de-sensationalize the drugs issue". De-sensationalizing drugs may,
however, undercut the justification for a drug control system of such
extraordinary ambitions and scope.
With the
publication of the World Drug Report (UNDCP, 1997), the United Nations
Drug Control Programme (UNDCP) joins a trend among international agencies in
publishing a substantial report on the global situation in its area of
work. As the Secretary-General of the UN
notes in a Foreword, “many entities of the UN system have begun to present
global analyses of developments and trends in their areas” (p. 6). Like other such reports, the World Drug
Report has substantial production values, with careful layout and
multicoloured maps and photographs.
Unlike other such reports, it is more a textbook than a statistical
compilation; detailed statistics are given only in the eight “country profiles”
in the last quarter of the volume.
Prepared with financing from the governments of Italy, Spain and Sweden,
the report is attributed to a 6-person “editorial team under the supervision of
the Policy and Methodology Branch”. The
contributions of six other named staff, and of many not named, are also
acknowledged, and the book includes also 6 authored “boxes” on specific topics
by authors outside the agency.
The report is clearly
intended to put the international drug control system's best foot forward. In a press release on another matter, a UNDCP
spokesperson stated that "UNDCP believes that the drugs issue is best
discussed on the basis of objective, factual and scientific analysis. Our World Drug Report ... has been widely
praised for doing just that" (Tucci, 1998). The report itself sets as one of its
principal aims “to de-sensationalize the drugs issue, to replace jargon and
slogan with a serious analysis of what is known and, just as important, to
highlight what is not known” (p. 9).
After an Introduction
addressing the question "Why a World Drug Report?" and terminological
issues, the main body of the book is organized in six chapters, on global
trends and developments; theories and interpretations of illicit drug use; the
health and social consequences of drug abuse; the illicit drug industry; drugs
and drug policy (including "the regulation-legalization debate"); and
strategies and programs for prevention, crop substitution and treatment. In the last 90 pages, country profiles are
given for eight countries: Australia, Colombia, Italy, Pakistan, Sweden,
Thailand, the U.K. and the U.S.
THE DATA BASE AND ITS HANDLING
Concerning global
trends, the overall picture is clear: "in recent years, illicit drug
consumption has increased throughout the world" (p. 29). But the hard data base for any assertions
below this level of generality remains very scanty. The chapter on global trends and developments
is filled with colourful maps and charts, but most of the data in it is derived
from police seizure data, primarily on heroin, cocaine and cannabis. Although it is estimated that there are many
more abusers of "sedative-type substances" than of other types of
illicit drugs (p. 32), these drugs are otherwise uncharted and unmentioned in
the chapter. There appear to be some
errors: for instance, neither Sweden nor Japan are indicated as having abuse of
"amphetamine-type stimulants" prior to 1970 (p. 30).
The country profile
section includes some attempt to offer a comparative picture across drugs and
across countries, using two indices calculated for each country: a Drug Abuse
Index (DAI) and a Drug Abuse Trend Index (DATI). In these indices, seven drug classes --
cannabis, cocaine, depressants, hallucinogens, inhalants, opiates and
amphetamine-type stimulants -- are ordered in terms of the magnitude on each of
four general dimensions of indication: extent of use (usually the population
rate of use on a lifetime basis); number of injection users; number in
treatment or hospitalized; and number of deaths. For the DAI, the highest-rate drug class on
each dimension of indication is assigned a “7”, the next highest a “6”, and so
on for the classes for which data is available.
The DAI for the drug class in a particular country is then the sum of
its ordinal position on the four indicators.
The Report’s text
acknowledges that “the method does not address the question of the `size’ of
drug-related problems in relation to other countries” (p. 243); it only
provides a relative ranking of drug-related problems within a given
country. Even in these terms, however,
its utility can be questioned. In the
U.S. results, for instance, the cannabis DAI outranks those for depressants and
stimulants. Cannabis’ top rank for
lifetime use outweighs the fact that both depressants and stimulants outrank it
for injecting and mortality. The result
is also influenced by the fact that cannabis still receives a 3 in the US
compilation for drug-related deaths, although it is not an important source of
mortality: hallucinogens and inhalants are even more trivial in the death
statistics.
The computation method
for the Drug Abuse Trend Index (DATI) is yet more problematic. Drug classes are ranked by the magnitude of
change in each of the four dimensions of indication, again on a scale stepping
down from “7” for the drug category with the greatest change. For a change indicator, of course, lifetime
use as an indicator is a particularly troublesome and insensitive
variable. Then the ranking value is
assigned a plus or minus for the direction of change, and the resulting values
are summed. In terms of the net sum
score, such an index could easily have odd results. However, in using the DATI, the Report
actually orders drug classes only by the positive components of the DATI --
i.e., the upward changes. Thus, in the
DATI scores for Italy, Opiates appears alongside Depressants, since they both
have positive scores of 5 (higher use for depressants, higher treated population
for both depressants and opiates), although opiates also have negative scores
totalling 11, reflecting decreases in lifetime prevalence and in deaths (p.
275).
The two indices, then,
are of questionable utility even for rankings of different drug classes within
a given country. They are essentially
useless in terms of what is needed for a global drug report: comparable
indicators of the levels of and trends in public health problems from different
drugs in different places.
"Speculative" would be the kindest term which can be used for
the report's use of summations of the rankings for "drug problem
profiles" and trends (pp. 246-248).
The country case
studies themselves follow a common format of statistics and then text sections
on background, extent and patterns of drug use, the illicit drugs market, and
crime, law enforcement and drug policy.
There is nevertheless considerable variation in what is covered; for
instance, Colombia’s "background" section includes a brief account of
drug issues in national politics and of US pressure on Colombia on drug issues,
issues not covered in Australia's "background" section. Even for these eight exemplary cases, chosen
partly as countries which "regularly collect and publish data on illicit
drugs", the overall impression is of the paucity of data, and particularly
of data on trends in use and drug-related problems which would be
internationally comparable. The
statistics page for each case includes 30 or so drug-related indicators, all of
which are available for the US. For each
of the other seven cases, data are missing for at least one indicator; for
Colombia, data are missing on 17 indicators.
"DRUG" VS. "SUBSTANCE"?
The report attempts to
defend the indefensible in terms of which psychoactive substances are included
in and which excluded from its scope.
Noting the definition of "drug" by the 1992 World Health
Organization expert committee would include alcohol and tobacco, the report
continues that "alcohol and tobacco, considered as substances rather
than drugs, are only dealt with here in as much as they relate to the
principal focus of this report, namely the unauthorized or non-medical use of
drugs which, because of their potential for causing dependence, have been
brought under international control" (p. 10). Despite this rationale, the report does deal
with a number of psychoactive substances which are not under international
control. We have already seen that inhalants
are included in the book's abuse and trend indicators. Khat, betel and peyote also receive some
discussion (pp. 34-37). This quixotic
division of what is included and what excluded is continued in the discussion
of health and social consequences of drug abuse, where khat and betel nut are
mentioned under stimulants, but alcohol is not mentioned under depressants (pp.
74-77), and tobacco is mentioned only as a reference point for the respiratory
risks of smoking cannabis (p. 77).
There is one context in
which alcohol and tobacco are notably brought back in: the discussion of the
“regulation-legalization debate” uses the extensive scope of harms from alcohol
and tobacco use, and the limits of regulatory controls of them, as principal
justifications for maintaining prohibition for the controlled drugs. In concluding this section, it is noted that
"the discussion of regulation has inevitably brought alcohol and tobacco
into the heart of the debate and highlighted an apparent inconsistency whereby
use of some dependence creating drugs is legal and of others is illegal."
(p. 198) The inconsistency, it might be
added, extends to the framing of the book itself.
INTERPRETATIONS OF DRUG USE
Part 2 of the report,
"theories and interpretations of illicit drug use", is an unusual
section to find in the status report of an international agency. Written from a social-science perspective,
the chapter spends considerable energy on trying to understand and convey the
functionalities of drug use for the user.
The result, inevitably but somewhat surprisingly in the context, is a
somewhat normalized view of drug use.
However, the tone does waver: a discussion of four forms of drug use --
ritual/cultural, medical/therapeutic, social/recreational, and
occupational/functional -- continues with a discussion of a “more problematic
form of use” without explaining how it might fit into or relate to the four
functional forms. The chapter also
includes a sympathetic discussion of such matters as risk-taking and
sensation-seeking. Boxes around the text
quote literary sources on the functions of drug use; four of the five
quotations present drug use in attractive terms.
A theme in the chapter,
as elsewhere in the book (pp. 34-37), is a contrast between “good” premodern
use patterns and “bad” industrial ones.
Psychoactive substances have
been used since antiquity within well-defined and socially integrated practices
of medicine, religion and ceremony....
These traditional patterns have been largely broken down in the course
of the last century and, stimulated by profit-seeking criminal organizations,
have been replaced by unassimilated, culturally degenerate forms of use. (p.
45)
The use of psychoactive
substances has been absorbed into many cultures through ceremony, tradition or
functional usage when, far from being `deviant’ behaviour, drug use has been integrally
bound to the spiritual and social life of the inhabitants. The observation of controlled drug use in
primitive societies raises questions of social equilibrium, self regulation and
cohesion, and about what transforms the `good’ (or acceptable) drug use of
responsible moderation, enshrined in rules and ritual, into the `bad’ drug use
of uncontrolled excess and social degradation. (p. 53)
The report thus falls easily into the romanticized idealism of an
Arcadian myth about consumption of psychoactive substances in traditional
societies. It is a recurrent myth,
comforting for those from various parts of the political spectrum with a
critical attitude to modernity. But it will
not bear close examination as a representation of reality. On the one hand, there are too many instances
in the ethnographic and historical literature of traditional patterns of use
which are quite problematic. Consider,
for instance, a Jesuit missionary's account of nicotine addiction in 1634 among
aboriginal Canadians:
The fondness they have for
this herb is beyond all belief. They go
to sleep with their reed pipes in their mouths, and they sometimes get up in
the night to smoke.... I have seen them
gnaw the stems of their pipes when they had no more tobacco, I have seen them
scrape and pulverize a wooden pipe to smoke it. Let us say with compassion that
they pass their lives in smoke, and at death fall into the fire. [When the
supplies of travel companions ran low,] I had no more peace.... All the others acted as if they wanted to eat
me, when I refused them. (quoted in von Gernet, 2000)
Or consider the descriptions of drunken comportment which is both
customary and problematic collected by MacAndrew and Edgerton (1969). And on the other hand, there is a
well-developed line of analysis in the tradition of the classic American study
of "becoming a marihuana user" (Becker, 1953) which emphasizes the
cultural integration of many nontraditional forms of drug use. The myth of the golden age of aboriginal drug
use, in contrast to the degraded forms of modernity, fits within an archetypal
line of cultural criticism in Western thought, but often does not comfortably
fit reality.
Not all the authors of
the volume have their hearts on the side of the ancients rather than the moderns. The box on stimulant use, for instance, is on
the side of modernity: "the
refinement of natural products by the extraction/isolation of the active
ingredients ... was clearly an advancement over using multi-ingredient natural
mixtures" (p. 39). A more basic
problem with the report's implicit justification of the international drug
control system as aimed at degraded modern patterns of use is that the system
does not exempt traditional patterns of use; instead, the system provided for
them to be "phased out" over a period of 15 or 25 years (p. 36). If the control system's laws were obeyed, it
would thus halt the traditional use which is described in such glowing
terms. On the other hand, chapter 5
notes that this is not going to happen in a hurry; in “countries where ... drug
use was [traditionally] an integral part of, and generally confined to,
indigenous cultures, creating a new anti-drug culture is especially difficult”
(p. 156).
THE PICTURE OF PROBLEMS
The chapter on
"the health and social consequences of drug abuse" is an odd
mixture. It starts with a description of
major drug classes and their effects, with an emphasis on the most adverse
possibilities, but few indications of their probability or prevalence. This is followed without explanation by
general discussions of drug use and gender and age roles -- in the family,
among women, and among young people. The
chapter finishes with disparate discussions of the role of drugs in particular
categories of consequences. The section
on HIV and other consequences of injecting drug use is in an epidemiological
mode, complete with maps and charts. The
discussion in the remaining sections is curiously in the shadow of
alcohol. While the discussion of drugs
and crime avoids strong claims for illicit drugs as pharmacological causes of
crime, a box by Paul Goldstein notes his findings that "alcohol is the
only substance in which consumption at the time of the injury was related to
violent injury" (p. 119). A
discussion of drugs and work concludes that "there is little scientific
evidence with which to analyse the impact of illicit drug use on the
workplace", but invokes studies on alcohol as providing "ample
warning". A final section on economic
cost-of-illness studies in Australia and the UK reverts to an assumed causal
link between drug use and crime, but notes in passing that illicit drugs
accounted for only 9% or so of the calculated costs of drug abuse in Australia,
with tobacco and alcohol accounting for the rest.
Except with respect to
AIDS, the picture of drug problems which emerges from the chapter is
surprisingly abstract. This reflects the
sorry state of the epidemiological literature on social and health harms
related to illicit drug use. In line
with the prevailing social framing, drug use itself has been defined as the
harm, and the result in study after study has been questions about frequency of
use but not about the experience of problems from use. These harms are the rationale on which the
whole edifice of international drug control is premised, but they remain
largely unmeasured.
THE ILLICIT MARKET
The discussion of the
illicit drug industry starts with an interesting discussion placing it in the
context of general economic analysis.
This includes estimates of the size of the global market for illicit
drugs (larger than for iron and steel or for automobiles; smaller than for
textiles; p. 124) and a discussion of price elasticity of demand for drugs (US
demand for cannabis is less elastic than demand for heroin -- the price of cannabis
being so low outweighs any effect on elasticity of the addictiveness of
heroin). In considering the production
of the raw materials, the discussion lays out the basic problem of crop
substitution: that no other crops can be produced on the same land in Pakistan
or Bolivia, for example, as profitably in as short a time as coca and opium
poppies (pp. 127-128). The discussion of
trafficking and distribution mentions another problem for the international
control machinery: the traffickers’ response to moves to control precursor
chemicals has been to identify and substitute precursor chemicals which are not
regulated.
The chapter includes a
long discussion of money laundering, including a variety of techniques which
are used to evade controls of money transfers.
Lastly, a section argues for the adverse “impact of illicit income on
national economies”. It is interesting
to reread this analysis substituting into it a legitimate commodity instead of
drugs. Finding an oilfield, say, creates
very much the same distortions in an economy as are described for drugs -- as
is implied by the invocation of the “so-called `Dutch disease’, [referring] to
a market distortion resulting from a boom in an isolated sector of the economy
which causes stagnation in the other core sectors” (p. 143). The report outlines a number of distortions
and difficulties created by this situation.
What it does not point out is that it is difficult to think in recent
history of a country which has rejected such a bonanza when it occurs with a
legitimate commodity. Governments
attempt to manage the distortions and difficulties, but do not throw away the
chance at the bonanza. It is not clear
that we may expect governments to behave differently when the bonanza is based
on an illegitimate product.
Associated with the
chapter are two boxes. One, a pitch to environmentalists, tells a harrowing
tale of the adverse environmental effects of illicit crop cultivation. But it does not offer any evidence that these
effects are worse for illicit crops than they would be for alternative uses of
the lands. The final paragraph, in fact,
acknowledges that “the environmental damage caused by illicit drug production
is minimal compared to that produced by other causes such as the production of
chlorofluorocarbons” (p. 149).
The other box, on
corruption and organized crime by Professor Amartya Sen, offers an interesting
philosophical discussion of the possible beneficial effects of corruption and
illegal transactions as potentially serving some higher good, particularly if
they are in response to governmental overregulation. It would be somewhat curious to see this
discussion in the global status report of any international agency. In the context of a document putting the best
foot forward for the international drug control structure -- the most
far-reaching effort at international regulation yet attempted -- its inclusion
seems bizarre.
STRATEGIES AND PROGRAMS
The chapter on strategies and programs includes sections
on education, on drug testing, on treatment and rehabilitation, and on
prevention on the supply side. The
education section offers a fairly balanced approach, with a tilt towards
“pro-health” messages and away from “negative, gloom-and-doom warnings”. A brief review of the outcome literature for
educational approaches is realistic about the difficulties of showing lasting
positive effects, and points out the potential challenges to such approaches
from countervailing messages from a counter-culture or popular performers and
media. Short sections are interpolated
on provision of alternative activities as a strategy (without mention of the
difficult time these have showing outcome effects), and on workplace-connected
drug-testing (with a balanced presentation of the practical and ethical
arguments for and against).
The section on treatment and rehabilitation points out
the multiple goals which treatment can have, and gives short descriptions of
detoxification and residential therapeutic community as modalities. A rather longer section on “substitute
prescribing” discusses methadone and other substitutes for illicit opiate use,
including substantial mention of trials of heroin and injectable opiates in
England and Switzerland. The tone of
this section might be described as Europe-oriented, in contrast with the more
restrictive approaches characteristic of the U.S. Short considerations of needle exchanges and
of compulsory treatment are followed by a rather longer section on treatment
and harm-reduction approaches in prisons, potentially including condom and
needle provision, and a section on traditional-healing forms of treatment,
mostly focused on Asian examples. A
section on evaluation outcomes for treatment notes that “there is no agreement as
to whether outcome rates for compulsory treatment are significantly higher or
lower than for voluntary treatment” (p. 219), and reports positive findings for
methadone outcomes and (a little more guardedly) for needle exchanges.
In the section on eradication, substitution and
alternative development, eradication is given a relatively skeptical review,
particularly focused on Bolivia and Mexico.
The proportion of the world’s cultivation eradicated in a given year is
estimated to be quite low for opium poppies (6.4% in 1994) and coca bushes (3.1%). Rather more attention is given to crop
substitution, particularly when it is set in a frame of “integrated rural
development”. Generally positive
examples are reported from Laos, Bolivia and Pakistan. Though the text is careful to point out many
of the pitfalls of crop substitution, it gives an unrealistically positive cast
to the general results of such programs.
Elsewhere in the volume, a more realistic estimate is given: in the
context to Peru, it is remarked, substitution of illicit opium poppy
cultivation for coca plants is “the only successful case of crop substitution
to date” (p. 119). The basic problem, as
pointed out in the chapter on the illicit market, is that alternative crops are
unlikely to be as lucrative. A
diplomatically-phrased paragraph also points out that “the UNDCP’s experience
of alternative development programmes in the past suggests that their viability
depends to a considerable extent” on the national government’s “financial and
political commitment to national integrated rural development”, and that there
will be a need to make “a move away from the benefactor/recipient model that
has been the basis for many previous programmes” (p. 224).
The control of the psychopharmaceutical market and
prevention of illicit manufacturing and diversion is of course at the heart of
the tasks of the international control system.
The report points out how ambitiously the tasks of this system have
grown: “the problem of preventing diversion has become ever more complex as the
number and diversity of substances under international control has risen. For instance, between 1971 ... and 1995, the
sedative-hypnotic and tranquillizer categories under international control
increased four-fold, while taken together, the number of scheduled stimulants,
anorectics and ecstasy group drugs increased nearly five-fold” (p. 228). Beyond this is a new control system on 22
precursor chemicals, which it is claimed is “beginning to show its first
positive results”. The added
difficulties involved in this initiative can be judged from the fact that the
success-story offered as a case study actually involves a chemical that is a
precursor to a precursor, and not itself under control (pp. 229-230). The report offers no other evaluation of the
success of the system in these tasks, although the next section, on preventing
trafficking, estimates that global interception rates are around 10-15% for
heroin and 30% for cocaine in recent years (p. 231). A section on money-laundering again relies
primarily on a case-study as in indicators of potential success. An overall consideration of outcomes for
supply reduction notes that ultimately such strategies “must be judged by how
they affect consumer demand, through the decreased availability of drugs,
through increase in price or through the deterrent effect of the criminal
law. In this domain the outcome is
undoubtedly less than satisfactory” (p. 237).
The section closes with a quote from Edmund Burke which essentially
argues that ineffectiveness is not an argument against the system: “all that it
takes for evil to triumph is for good men to do nothing”. “In the end”, the report adds, “perhaps this
is what drug supply reduction is all about” (p. 238).
Except for its optimism about crop substitution, the
chapter is realistic and balanced in its view of the effectiveness of the
various strategies. Particularly in its
discussion of treatment modalities, it pushes the envelope beyond what will
please hard-line drug warriors in its consideration of harm reduction and drug
substitution therapies.
THE DRUG CONTROL SYSTEM
The chapter on drugs and public policy opens with a tone
of high philosophical seriousness about the function of law, briefly invoking a
variety of ideals and thinkers -- the ancient Greek polis, Aquinas,
Kant, Bentham and Mills. A discussion of
factors and trends in national drug policymaking continues this tone in a
somewhat skeptical spirit, citing several comparative studies that suggest that
different national drug policies have little to do with trends in actual drug
use. Drawing on a box by David Musto,
the history of international drug controls is then briefly reviewed, starting
with the interesting comment that "drug control legislation may be unique
in that it originated at the international level -- from a confluence of world
power concerns at a given historical moment -- and was subsequently promulgated
at the national level, rather than the converse" (p. 162). The rest of the chapter is occupied with a
dispassionate descriptive account of the instruments and agents of
international drug control.
No evaluation of the system is included in the
chapter. The relevant evaluation, that
with respect to supply reduction strategies "the outcome is undoubtedly
less than satisfactory", is contained in the chapter on strategies and
programs. In that context, the
optimistic and pluralist view of human nature with which the discussion of
public policy started gives way to a darker and more paternalistic vision: "realistically,
we have to accept that human beings are imperfect, and therefore that drug
problems and drug abuse which have been with us for centuries, albeit in milder
form, are likely to remain for the foreseeable future.... But what we can do is try to prevent the
exploitation of these vulnerable conditions by criminal greed" (pp.
237-238).
THE REGULATION-LEGALIZATION
DEBATE
Annexed to the chapter on the drug control system is a
16-page section on "the regulation-legalization debate". The discussion sensibly starts out with the
observation that the "`legalization debate' is in many respects a
misnomer", since the debate is really about degree of regulation. The attempt clearly is to present the chapter
as a dispassionate balancing up of accounts.
It is certainly worth reading as a sustained effort in logical
argumentation, one which goes a long way in presenting arguments on both sides
of the various divides. In fact, the
main missing voice in its arguments is the full-throated cry of the moral-entrepreneurial
drug warrior, the "`zero-tolerance' lobby" as the chapter labels this
position at one point (p. 198).
Positions which are considered, besides the status quo, include harm
reduction, cannabis legalization, and legalization of all drugs.
The rhetorical cloak slips at times. Those calling for relaxation of prohibition
are variously referred to as "numerous pressure groups", the
"harm reduction lobby" and the "legalization lobby" (pp.
184, 189, 197). The arguments are not
always complete. For instance, it is
presumed that legalization would increase access for teenagers. But this is not necessarily the case: there
is no minimum-age limit for a commodity which is illegal, and sellers of it
have little interest in avoiding sales to minors, while licensed sellers could
be constrained from this by their interest in keeping their license.
The arguments concerning the potential adverse impacts of
legalization in developing countries are especially interesting. The drug cartels, it is argued, could become
"newly `enfranchised' captains of industry", and their efforts to
influence politics could move from covert corruption to "blatant, overt
lobbying" (p. 191). Or the
"multinational pharmaceutical companies" could "establish a
virtual monopoly over the manufacture and distribution of formerly illicit
drugs", and transfer cultivation to more efficient locales in developed
countries: "California might become the world center of cannabis
cultivation, for example" (p. 191).
Both these scenarios are indeed somewhat plausible. But, in the era of the triumph of capitalism
and the open markets, it is somewhat breathtaking to see an international
agency putting forward the argument that an international control system is
justified as a way of keeping the Kennedys and Bronfmans of our generation from
moving into pluralistic politics, or as a protectionist device for poor opium
and coca farmers.
In this section, as we have mentioned, alcohol and
tobacco put in a notable appearance as ghosts at the feast. "Many prohibitionists would admit that
the attempt to curb the supply of illicit drugs has substantially failed",
it is noted. But "prohibitionists
believe that the absence of prohibition would have created problems even
worse than its presence, perhaps analogous to the health consequences of the
abuse of the legal drugs, alcohol and tobacco.... Legalizers who use as an `argument' that the
currently legal drugs are associated with proportionately more harm than the
illegal ones, may simply be shooting themselves in the foot" (p. 189).
In other contexts, the international drug control system
has resisted comparisons of the harm of licit and illicit drugs. About an effort "to compare what is
known about the health effects of cannabis to the health effects of a variety
of licit and illicit drugs with psychoactive effects such as alcohol, tobacco
and opiates", for instance, it was concluded that "the reliability
and public health significance of such comparisons is doubtful" (WHO,
1997:30-31). From this perspective, the
most important step forward in the report's discussion of regulation and
legalization may be the recognition that the discussion inevitably brings
"alcohol and tobacco into the heart of the debate".
CAN THE SYSTEM SURVIVE
DESENSATIONALIZING?
Overall, the report is a document which is worth taking
seriously. In terms of the global base
of data, it is certainly indicative about how much is not known, though not all
of the lacks are "highlighted".
In summarizing evaluative experience with efforts to reduce drug
marketing, use and problems within the context of the present control system,
it is for the most part realistically pessimistic. It is at its most interesting in the various
expositions of ideological and conceptual frames which are scattered through
the book, but the overall impression this aspect leaves is of
inconsistency. It is as if a number of
clever essayists were each asked to construct a rationale for the status quo
which might convince their social circle, and the results were simply
aggregated together.
The report takes it as an explicit aim “to
de-sensationalize the drugs issue”. In
general, it succeeds in this aim. The
kind of rhetoric which is a routine feature of national presentations at the UN
Narcotics Commission -- rhetorical flourishes about drugs as a global scourge
or menace (Room, 1999) -- is generally absent from the text. The arguments in the text are generally
pitched at the level of rational discussion, rather than emotional appeals.
Beyond this, the arguments
seem generally pitched to a liberal left-of-centre audience -- in fact often,
some might consider, to an audience of “bleeding hearts”. Thus the box on the environmental effects of
drug cultivation assumes that the reader values preserving natural ecology over
land-clearing and exploitation of natural resources. Punishment is almost unmentioned in the
chapter on strategies and programmes, and the only mention of the death penalty
is in the case studies. There is a short
section on “prisons”, but it is about treatment in prisons, and mentions such
non-“zero tolerance” approaches as making needles and condoms available in
prisons. The discussion of educational
approaches is clearly tilted away from “negative, `gloom and doom’ warnings”
(p. 205) and towards positive “pro-health” messages. The text generally presents a sympathetic
rather than an antagonistic view of the drug user, as in the discussion in the
second chapter of the functionality and functions of drug use for the
user. This sympathetic view extends on
occasion even to the drug courier: “for an unemployed woman or agricultural
worker in West Africa with a large family to support, what seems like a
low-risk adventure holds the promise of wealth beyond her wildest dreams” (pp.
82-83).
De-dramatizing the drugs issue may well make the issue
and the system more palatable to audiences which are concerned about drugs
without being “drug warriors”. But a
problem for the international control system is that it threatens in the end to
undercut the moral and juridical basis for such an extraordinary system. Can such a system be justified and sustained
if the drugs issue is "de-sensationalized”?
ACKNOWLEDGEMENTS
We thank the Norwegian National Institute for Alcohol and
Drug Research for its hospitality while some of this work was done. Opinions expressed are those of the authors
and not necessarily of any institution with which they are affiliated.
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