Addiction Research 7:1-16, 1999. (references updated)
DRUGS IN A GLOBAL PERSPECTIVE:
THE INTERNATIONAL CONTROL SYSTEM'S BEST FOOT FORWARD
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”?
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.
Becker, H.S. (1953) Becoming a marihuana user, American Journal of Sociology 59:235-242.
MacAndrew, C. and Edgerton, R. (1969) Drunken Comportment. Chicago: Aldine.
Room, R. (1999) The rhetoric of international drug control. Substance Use and Misuse 34:1689-1707.
Tucci, S. (1998) Statement to the press, 27 February. Vienna: UN Office for Drug Control and Crime Prevention.
United Nations International Drug Control Programme (1997) World Drug Report. Oxford, etc.: Oxford University Press.
von Gernet, A. (2000) Origins of nicotine use and global diffusion of tobacco. Pp. 3-15 in: Roberta Ferrence et al., eds., Nicotine and Public Health. Washington: American Puboic Health Association.
World Health Organization (1997) Cannabis: A Health Perspective and Research Agenda. Document WHO/MSA/PSA/97.4. Geneva: WHO Programme on Substance Abuse.