Prohibition, substance use and abuse: Facts, major issues, reviews of potential solutions
Abstracts from: “World War-D: The case against prohibitionism, A roadmap to controlled re-legalization”, by Jeffrey Dhywood
Paperback version: 448 pages, 6×9
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Abridged timeline of global prohibition and the War on Drugs
1909: 13-nation conference of the International Opium Commission in Shanghai, China, convened by the US.
January 23, 1912: First international drug control treaty, the International Opium Convention, signed at The Hague during the First International Opium Conference. The Convention provided that “The contracting Powers shall use their best endeavours to control, or to cause to be controlled, all persons manufacturing, importing, selling, distributing, and exporting morphine, cocaine, and their respective salts, as well as the buildings in which these persons carry such an industry or trade.”
1919: The International Opium Convention is incorporated into the Treaty of Versailles under US pressure, going into force globally.
January 16, 1919: Ratification of the 18th amendment of the United States Constitution, along with the Volstead Act, establishing alcohol prohibition in the US.
December 5, 1933: Twenty-first Amendment (Amendment XXI) to the United States Constitution repealed the Eighteenth Amendment to the United States Constitution, the only amendment to the US Constitution to ever be repealed.
1961: Single Convention on Narcotic Drugs
1971: Convention on Psychotropic Substances
June 17, 1971: Nixon famously declare the War on Drugs
1972: Protocol Amending the Single Convention on Narcotic Drugs
1988: Convention against Illicit Traffic in Narcotic Drugs and Psychotropic Substances, setting a 10-year goal for the eradication of drug trafficking.
1998: The United Nations General Assembly Special Session (UNGASS) to review and strengthen the global drug control system set out another 10-year plan to eliminate the illicit production and use of drugs.
June 2, 2011: Publication of the Global Commission on Drug Policy Report, signed by Kofi Annan, former UN Secretary General; Paul Volcker, former chairman of the US Federal Reserve; Ernesto Zedillo, former president of México; George Papandreou, former prime minister of Greece; César Gaviria, former president of Colombia; Fernando Henrique Cardoso, former president of Brazil; George Shultz, former US Secretary of State; Javier Solana, former EU High Representative; and Virgin tycoon Richard Branson.
February 11 2012: Guatemalan President Otto Perez Molina declare his intention to present a proposal for drug legalization at the Sixth Summit of the Americas (April 14-15, 2012).
Illegal drugs
The term “illegal drugs” generally refers to marijuana, cannabis and derivates; opium, heroin and other opiates; cocaine; amphetamines and amphetamine-like stimulants (ATS); hallucinogens (LSD, psilocybin, mescaline, etc). They are often described as psychotropic or psychoactive substances. In order to have any meaningful discussion on the subject, illegal drugs must be viewed in the wider context of psychoactive substances.
What are psychoactive substances?
Psychoactive substances are substances “that, when taken, have the ability to change an individual’s consciousness, mood or thinking processes” … they “act in the brain on mechanisms that exist normally to regulate the functions of mood, thoughts, and motivations.” (2004 WHO report “Neuroscience Of Psychoactive Substance Use And Dependence”)
Use of these substances is defined into three categories according to their sociolegal status:
- First, many of the substances are used as medications … in relieving pain, promoting either sleep or wakefulness, and relieving mood disorders. Currently, most psychoactive medications are restricted … through a prescription system. In many countries, as much as one-third of all prescriptions written are for such medications. … [S]ome of the substances are also often used as “self-medications” to relieve distress from mental or physical disorders, or to alleviate the side-effects of other medications.
- A second category of use is illegal, or illicit, use. Most nations have bound themselves to outlaw trade in and non-medical use of opiates, cannabis, hallucinogens, cocaine and many other stimulants, and many hypnotics and sedatives. … Despite these prohibitions, illicit use of psychoactive substances is fairly widespread in many societies, particularly among young adults… The fact that it is illegal may also add an attractive frisson, and thus strengthen the identification of users with an alienated subculture.
- The third category of use is legal, or licit, consumption, for whatever purpose … not necessarily connected with the psychoactive properties of the substance. For instance, an alcoholic beverage can be a source of nutrition, of heating or cooling the body, or of thirst-quenching; or it may serve a symbolic purpose in a round of toasting or as a sacrament. However, whatever the purpose of use, the psychoactive properties of the substance inevitably accompany its use.
The most widely used psychoactive substances are the following: caffeine and related stimulants, commonly used in the form of coffee, tea and many soft drinks; nicotine, currently most often used by smoking tobacco cigarettes; and alcoholic beverages, which come in many forms, including beer, wine and distilled spirits. … While inhalants are also widely available, they are mostly used for psychoactive purposes by those below the age of easy access to alcohol, tobacco and other psychoactive substances.”
The vast majority of psychoactive substances are legally available, usually with restrictions.
What is the origin of prohibition?
The US imposed prohibitionism to the rest of the world throughout the 20th century. The origin of prohibitionism in the US can be traced to the rise of the temperance movement in the late 18th century, as a reaction to the real epidemic of alcoholism, which may have affected up to 50% of the male population in some Western countries, caused by the advent of industrial distillation and mass-production of hard liquors. Prohibitionism originally targeted alcohol, gambling, prostitution, pornography and homosexuality.
What was the status of illegal drugs before drug prohibition?
When they were discovered in the 19th century, morphine, heroin and cocaine were touted as panacea and prescribed indiscriminately for almost every condition under the sun. They were also often incorporated in potions sold by snake-oil doctors from the back of their wagon. This resulted in an epidemic of addiction which mostly affected middle-aged housewives. Cocaine users included several popes, Queen Victoria and Sigmund Freud.
Abusers started abusing mostly by ignorance; addicts were accidental, unsuspecting addicts. Over-prescription by careless physicians was the major cause of addiction. The vast majority of users, which was pretty much the entire population, never abused and the vast majority of abusers kept on living normal, productive lives.
Addiction receded rapidly around 1900 as physicians and users became more educated about the potential dangers of addictive substances, which may indicate that some of these substances were not that addictive after all. Truthful labeling helped a lot of course.
Why were drugs attached to the prohibitionist agenda?
The first drug prohibition laws in the US were motivated by racial prejudice: Opium prohibition targeting Chinese immigrants, cocaine prohibition targeting African-Americans and Marijuana, targeting Mexicans. To this day, prohibition mostly targets African-American and Latino communities in the US. The US then imposed its prohibitionist agenda to the rest of the world, starting by incorporating it to the Versailles Treaty at the end of World War I.
Why are certain psychoactive substances illegal?
The legal status of psychoactive substances is not related to their harm potential. The motivation behind the current Western-inspired War on Drugs was and still is largely cultural, as the customs and uses of foreign cultures have been widely ignored or demonized, a process that has been repeated over and over throughout history whenever a dominant culture is in expansion mode. Other than for the dominant psychoactive status of alcohol and tobacco, there is no logical rationale for the moral acceptability of some substances versus others. If the Incas had colonized Europe, instead of the other way around, European would probably be chewing coca leaves.
“Alcohol is inherently no less dangerous or harmful than the drugs included in the international conventions. … Dependence on nicotine in tobacco is associated with more death and ill-health than dependence on other psychoactive substances.”
Why prohibitionism cannot work in a market economy?
As they have since the dawn of humanity and whether we like it or not, people will use mind-altering substances commonly labeled “drugs,” both legal and illegal, and drug trade will take place, both legal and illegal. Making some of these “drugs” illegal just worsens the drug problem. In its attempt to violate the law of supply and demand in market economies, prohibitionism creates an illegal marketplace and leaves control of the production and trade to organized crime.
Prohibition is not practically and efficiently enforceable
If there is any lesson to be learned from the 100 years history of drug prohibition, it is that prohibition is not practically and efficiently enforceable. Ultimately, it is a destructive exercise in futility. Even countries with extremely stringent drug policies such as the death penalty for drug trafficking still have a drug problem. Drug prohibition must resort to increasingly intrusive methods for ever-diminishing returns. Except for those policies that impose restrictions on individual freedom and civil liberties that are so severe as to be incompatible with even the most restrictive democratic or semi-democratic societies, all previous attempts at prohibition of psychoactive substances have failed.
- Solvents, gasoline and glue, which are among the most damaging psychoactive substances, cannot be efficiently regulated as drugs.
- Marijuana production is out of control thanks to hydroponics and small-scale production. Amphetamine-type stimulants (ATS) are also out of control worldwide. ATS use now surpasses cocaine and opiates combined and is growing alarmingly.
- New designer drugs pop up on the market like mushrooms.
- Technological innovations make conceivable devices that would cause mind alteration by stimulating specific brain centers within the pleasure/reward system. How would prohibition handle such a challenge?
Prohibitionism is mostly kicking the can around in what is called the balloon effect. When pressure increases on the cocaine trade, there is an explosion of methamphetamines, which is actually far worse. Prescription drugs abuse replaces heroin abuse. Central America replaces Colombia. And on and on! Short of turning the planet into a huge police system with entire populations under constant surveillance, prohibitionism is not enforceable.
Unintended consequences of drug prohibition:
At the root of all the evils unleashed by drug prohibition and the War on Drugs are the illegal trade and the illegal marketplace it has created and nurtured. The War on Drugs nurtured powerful criminal organizations and greatly increased drug-related violence, corruption and crime. This is of course the major harm caused by prohibition, out of which all other harms derive. Turning drug use into a criminal issue has had terrible consequences:
- Takeover of the drug trade by powerful and ruthless drug cartels,
- Narco-violence has resulted in over 200,000 deaths in Latin America alone over the past decades, a large number being innocent bystanders. Even though many of the victims were criminals, they still leave behind spouses, children and broken families.
- Destruction of the lives of millions of harmless drug offenders through incarceration,
- Unnecessary exposure of children and teenagers who are consistently targeted as easy prey and often foot soldiers by drug gangs in developed countries and even more so in emerging countries.
- The prison system has turned into a brutal recruiting and training facility, a university in crime, churning out repeat offenders and career criminals. Most people are far more dangerous when they get out of jail than when they went in. Jail becomes a rite of passage in some communities.
- Emergence of subcultures revolving around drug trafficking. The first job offer to an unqualified youngster in Sinaloa or Chihuahua is likely to be as “sicario”[1] for the cartels; most families there have at least one member involved in the trade. From the West African slums to southeast LA, from the remote Afghan valleys to the Brazilian favelas, drug trafficking is intertwined with and sustains the local economies, often providing seed money, operating finances, lavish customers, and its own version of tax collection and law enforcement.
- Erosion of civil liberties, negation of the rights of minorities,
- Destruction of local economies and eco-systems.
- Privatization of profits to criminal organizations
- Socialization of costs: taxpayers pick up the bill not only for the consequences of drug use, but also for the consequences of their illegal status: violence and crime, corruption, law enforcement, etc., which far outweighs the societal cost of drug use and inflates it considerably.
- Overwhelms the justice and prison systems.
- Stretches states and local budgets, cut into essential expenses such as education budgets, compromising future generations.
Estimates of the total direct and indirect costs of the War on Drugs vary between 200 and 300 billion dollars in the US alone.
Geopolitical consequences of the War on Drugs
Narco-violence and corruption are spreading throughout the world, destabilizing entire regions, from Central America to West Africa and Afghanistan/Pakistan with an ever-growing geopolitical cost.
As a result of their rapid urbanization and the ensuing social dislocation, emerging countries are witnessing explosive epidemics of drug addiction, especially heroin, cocaine and amphetamines.
The problem is especially acute for producing and transiting countries, where drug-related transactions and services are often paid in kind, and the drugs used as payment feed the local marketplace. Drug violence is increasingly related to control of local territories instead of transit routes.
Most developing countries just do not have the resources to fight such a plight; a growing number of countries are being overwhelmed.
The case of Latin America
The lines are blurring between producing and transiting countries as the drug cartels increasingly get into production, especially methamphetamines.
The flow of weapons moving south from the US fuels an incredible level of violence.
In addition, Latin American countries, especially in Central America, are plagued by daunting gang problems. Their gang problem itself is largely the result of the US policy of deportation of illegal immigrants with criminal records to their native countries. As the US prison system is a notorious training ground for criminals, the US has been sending droves of hardened criminals south of their border, with catastrophic consequences for the receiving countries. The infamous Maras are a direct consequence of this US policy of repatriation of criminal elements.
What is at stake for emerging countries?
The longer criminal organizations are allowed to take roots in emerging countries, the harder it will be to root them out, the more difficult violence, corruption and lawlessness will be to dislodge. Postponing the inevitable just worsens the problem.
Alcohol prohibition in the US gave considerable power to the mafia, who not only diversified in their traditional turf of gambling, prostitution and extortion, but also branched out in trade-unions, custom clearance, freight forwarding and garbage disposal, especially hazardous waste disposal (creating huge environmental disasters). The mafias even took over entire territories, such as Nevada and Cuba right after the end of alcohol prohibition. They controlled or greatly influenced politics from New-York and New Jersey, to Chicago and Florida. It took the US over 50 years to reduce the influence of the mafias, whose longevity was substantially increased by drug prohibition.
The same pattern is playing out in Central America, where drug cartels are not only reinforcing their kidnapping, extortion, pipeline diversion, pirating, prostitution and gambling turf, but also diversifying in anything from dairy or organic farming, to retail chains, transportation and even drug rehabilitation centers, that they use as recruiting grounds.
What is harm reduction?
Harm reduction can be defined as “a set of practical strategies, policies, programs, services and actions directed toward reducing or containing the adverse health, social and economic consequences to individuals, communities and society of high-risk activities such as alcohol and other drug use or gambling.”[2]
An extended definition could be “a range of modalities, strategies and policies designed to reduce the harmful health, social and economic consequences of human activities.”
The vast majority of human activities, even things as simple and basic as walking or eating, present a certain level of risk. Some activities, such as heroin injection or over-eating, present a danger mostly to oneself, while other activities such as driving, boxing or certain team sports like football or hockey present a danger to oneself and others. Others, such as firing arms, present a danger mostly to others. Most high-risk activities impose a financial burden on society, which may be at least partially compensated for through the levy of an excise tax.
Transportation is certainly the most ubiquitous human activity with substantial potential harm. Driving is an inherently dangerous activity that can become vastly more dangerous when done while engaged in a variety of distracting activities. This raises the issue of low-risk responsible driving versus high-risk hazardous driving, a rather universal issue when it comes to potentially risky human activity.
Issues to address when trying to design and implement efficient harm-reduction strategies and policies:
- Balancing costs and benefits
- Subjectivity and perception vs. hard facts
- Practical and efficient enforceability
- Entrenched political, economic and financial interests
- Cost to the taxpayer or to future generations
Harms related to illegal drug use[3]
The issue of harms caused by illegal drugs use is quite complex and distinction should be made between harms related to drug use per se and harms created by drug policies. Most of the harms caused by drug use are a direct or indirect consequence of drug prohibition: narco-violence, corruption, accidental overdoses, intoxication caused by adulterants, spread of infectious diseases due to unsanitary administration practices, broken families as a result of incarceration, targeting and use of children and women by drug-trafficking organizations, etc.
The harm caused by drug use can be broken down into primary harms to the user and secondary or societal harms to third parties. The harms to the user can in turn be broken down into short-term acute health harms (intoxication and overdose) and long-term chronic health harms (addiction, long-term effects of use, diseases related to ingestion methods: HIV, hepatitis, etc.). To these we should add harms inflicted by society to the drug user (personal societal harm), mostly as a consequence of prohibition: discrimination, marginalization, incarceration, and the personal stigma of a criminal record.
The societal harm of drug use can be broken down into harms borne by proximate environment (family and close ones), harms borne by the social environment (neighborhood and workplace), and harms borne by society at large (crime, corruption, burden on the justice system, and economic burden).
The following table from the prestigious UK publication “The Lancet” speaks for itself.[4]
Review of the options for drug policy reform
The regulation of psychoactive substances should be stripped of its obsolete ideological foundation and be based on sound evidence-based policies. Substance abuse should be viewed as a public health issue, not a criminal issue. Policies should be founded on respect of individual freedom and human rights with the goal of reducing harm, addressing the public health and public safety concerns without overly encroaching on civil liberties. They should be based on rights and the responsibilities attached to the exercise of those rights. Legislators should stop trying to legislate private lives. What informed consenting adults do to themselves or between themselves without intentionally endangering others is their sole responsibility. As a corollary, they should be held responsible for the potentially though not intentionally harmful consequences of their acts.
The limits of decriminalizationMore and more countries are moving away from the strict US prohibitionist model towards some form of decriminalization. This is the case in most of Europe and Latin America as well as Australia. The United States is particularly schizophrenic on the issue, with the Federal government remaining the world’s prohibitionist in chief while a growing number of states are adopting some form of decriminalization or semi-legalization with a medical marijuana fig leaf. |
|
| Pros | Cons |
| Pushes the limits but doesn’t violate the current international treaties and can be implemented without major international upheaval.Reduces harm to the users, helping them to seek treatment, protecting them from the claws of the justice system,Alleviates pressure on justice system
Allows the reallocation of law enforcement resources towards the fight against drug traffickers and organized crime. Reduces crime related to drugs acquisition. Reduces micro-harms, the harms at the individual and community level. |
Reduces use only marginally at best.No effect on drug trafficking.Fails to address the quality control issue.
Doesn’t reduce hazardous administration practices, unless it is accompanied by other harm reduction practices. Fails to address the far more important supply issue, as well as the most globally damaging effects of prohibition and drug trafficking, the macro-harms, the harms to societies and to nations, chief among them organized crime and its associated violence and corruption.
|
| Decriminalization is really just a patch, a temporary fix that alleviates some problems but ultimately leaves intact or even strengthens the black market, which totally defeats the purpose. Furthermore, just as prohibition was really intended to minimize the impact of illegal drug use on Western countries, decriminalization minimizes the impacts of prohibition on using countries but fails to address the harms imposed on producing and transiting countries by the illegal drug trade. So while it is certainly a small step in the right direction, decriminalization is clearly not the answer. | |
Selective legalization
| Pros | Cons |
| Will legal access to relatively mild psychoactive substances lower the demand for harder substances? | Will legal access to mild psychoactive substances lead to an explosive growth of the black market for hard drugs?Wide availability of alcohol didn’t prevent the dramatic rise in the use of other substances. |
| Users of mild psychoactives get exposed to hard psychoactives mostly through their supply channel, which wouldn’t be the case if soft psychoactives were legalized, resulting in a likely dramatic decrease in exposure to hard psychoactives.Relieve the law enforcement and justice systems | The commerce and use of marijuana generates much lower violence and crime than the commerce and use of hard drugs. Marijuana is produced all over the world. A substantial part of its trade takes place independently of organized crime and within social networks or through small-scale growers/traffickers.[5] Therefore, the impact of marijuana legalization on organized crime might not be as substantial as claimed by marijuana legalization activists. |
| Selective legalization will allow law enforcement to focus on hard drug trafficking, it will also allow organized crime to focus on the same hard drug trafficking. If there are any lessons to be learned from the past, there is no reason to believe in a positive outcome of such a scenario.Selective legalization of the milder psychoactive substances (marijuana/cannabis, coca leaves and preparations, opium in certain countries) is a reasonable first step in the right direction, but its effect on narco-violence is likely to be very limited.It might be prudent to implement controlled legalization in phases, starting with legalization of soft psychoactives in order to refine the model before moving eventually to legalization of hard psychoactives with much tighter control mechanisms. | |
The case for legalization
Legalization would not create a drug problem. WE ALREADY HAVE A DRUG AND SUBSTANCE ABUSE PROBLEM!
Prohibitionists claim that legalization would provoke an epidemic of substance abuse and addiction. Considering that the market is already flooded by an over-abundance of both legal and illegal psychoactive substances, we can reasonably assume that the overall appetite for mind alteration is currently being met, and that the overall pattern of use will remain stable, so that legalization will mostly result in substance substitution. The current explosion of abuse of pharmaceuticals while cocaine use is in decline seems to confirm this analysis. With proper regulations and nudging, such substance substitution may even have overall positive societal consequences.[6]
The vast majority of people do not want to go about their lives in a severely impaired state of mind. The assertion that people would start injecting heroin or smoking crack or crystal methamphetamine if these substances were legally available is plain ludicrous, especially if these substances are properly controlled.
A substantial minority of people is prone to substance abuse, regardless of their legal status. A properly regulated marketplace is far more efficient to manage the potential harm of substance abuse that an illegal and uncontrollable marketplace, without all the unintended consequences of an illegal marketplace. Legalizing adult drug use would be a vast improvement over drug prohibition, which promotes crime, violence and corruption while tens of millions of Americans, hundreds of millions of people worldwide, still use illicit substances.
Legalization would bring in hundreds of billions of dollars in revenues and help stabilize many countries now on the brink of collapse, some absolutely strategic for world peace like Pakistan and Afghanistan. It would create millions of legal jobs to replace the ruthless underground economy of the current drug trafficking, bringing an entire shadow economy above ground. It would finance some effective prevention program and reduce drug use by minors, the most vulnerable population, and a soft and easy target of drug pushers. Most importantly, it would deal a major blow to organized crime and terrorism around the planet, cutting off their main revenue source and depriving them of their government-financed recruiting and training facilities: the prison system itself. The prison system is the prime recruiting and training facility of Muslim extremists and terrorist organizations, as well as organized crime worldwide.
Regulatory options:
The international community must come up with a general framework to efficiently regulate the market, leaving enough flexibility to take into account regional idiosyncrasies. Countries may design the policies that best suit their particularities and allow them some reasonable degree of experimentation. At the same time, there should be enough coordination to discourage the black market, which could still flourish if significant pricing or access disparities exist between neighboring countries.
Compliance should be elective and non-mandatory, not unlike the model adopted at the end of prohibition in the US, where some counties or states elected to stay dry. There are vast differences in alcohol regulations between countries, as many Islamic countries impose some form of prohibition. A similar scheme could be applied to the regulation of psychoactive substances, where all countries who decide to legalize and regulate would agree to adhere to certain rules and principles of harm reduction, taxation, prevention, education and treatment.
The profit maximization mandate of private enterprise undeniably conflicts with the harm minimization objective of substance abuse management. Therefore, the primary challenge of any regulatory scheme will be to remove the profit incentive from the supply chain, or to control it adequately enough that it doesn’t hamper the primary objective of harm minimization.
1. Limits of the pure free market approach
While free market economies excel in managing supply and demand of goods and services, they fail to effectively manage the societal costs attached to any products or services as they lack efficient mechanism for managing said societal costs. A more definitive argument against a pure free market approach is that its chances of being acceptable to the general public are nil. Nobody wishes to see crack-cocaine at the corner grocery store or Walmart.
2. Marketplace-enforced regulation
The most efficient tax collection system in many parts of the world is sales tax collection. Tobacco sales are mostly run by the private sector and tobacco restrictions are enforced by the retailers. In both cases, the various actors in the private sector act as de facto tax collectors and law enforcers, at comparatively very low cost to the government, and the system operates with reasonable efficiency. So, marketplace-enforced regulation is an efficient control method that can be achieved at a relatively modest cost. This approach leaves the door wide open to corruption as offenders could easily bribe their way out of infractions in many parts of the world. This could be mitigated by international monitoring in countries lacking the proper enforcement infrastructure or subject to chronic corruption. It also remains to be seen how such a business model will adapt to severe restriction on advertising and promotion, and how it may attempt to remove these restrictions. Marketplace-enforced regulation is probably the best option for soft psychoactives (marijuana/cannabis, coca leaves), but might be inadequate for hard psychoactives.
3. Non-profit
The restrictions on promotion and sale necessary to reduce the potential harm of psychoactives are inherently incompatible with the primary profit motivation of private enterprise. Restricting the production and/or commerce of psychoactives to non-profit organizations, at least for hard psychoactives, might be a viable option to remove the profit incentive and focus on harm reduction.
4. State control
State monopolies are another option to remove the undue influence of commercial interests from the psychoactive marketplace, as is currently the case in various states and countries for alcohol and/or tobacco. If the primary goal of drug legalization is harm reduction and crime reduction, it may seem immoral that private enterprises profit from that activity; state monopolies would be preferable to private enterprise as the derived profits would benefit the common good, at least in a democratic society. This, of course, assumes that democratic governments are the embodiment of the will of the people and act for the common good. It is fair to say that, in many parts of the world and especially in the US, government is perceived as bloated, wasteful, inefficient, and overly infringing on private lives. There is danger that a purely statist and bureaucratic approach to psychoactive trade and retailing may end up being so constraining and inefficient that it would defeat the purpose and turn users away back to the black market. State monopolies could also become such a critical source of revenues that it might influence public policy to lose sight of the primary goal of reining in substance abuse.
Global legalization of production, consumption and trade
The War on Drugs is a global war that affects virtually every country of the world and that must be addressed globally. Worldwide legalization is the only long-term solution, and the only way to control both supply and demand, to reign-in the associated violence and crime. It is critical to legalize and regulate the entire supply chain: production, transformation, distribution and retail.
It should be noted that there is already legal production of opium and its derivates, coca leaf and cocaine, as well as all kind of amphetamine-like stimulants. Therefore, the international legal framework already exists for the production and trade of the vast majority of currently illicit substances and would just need to be adapted to the realities of the new marketplace.
Farmers already involved in the production of currently illicit crops should be brought into the legal production system and their working conditions should be improved according to fair trade practices. This would have the added benefit of cutting supply to the illegal trade.
Transit countries would be one of the clear beneficiaries of legalization as they wouldn’t be needed anymore, removing a major source of instability, corruption and violence.
Every effort should be made to reintegrate low-level operatives such as mules and street-level dealers back to a legal productive role in society, although preferably not in the legal drug trade.
Controlled re-legalization is the only realistic option for emerging countries
With their rapid urbanization, emerging nations are currently facing an epidemic of substance abuse that needs to be addressed urgently. In Pakistan, India and Central Asia, for instance, the implementation of stricter anti-drugs regulations under US pressure has resulted in opium use being replaced by heroin addiction, which can hardly be viewed as progress.
Emerging countries cannot afford to spare their already stretched resources on implementing an efficient prohibition policy when even developed countries, despite all theirs resources, have been unable to do so.
Pressed to choose between a prohibitionist approach bleeding red ink for the foreseeable future for a guaranteed failure, and a more moderate approach of controlled legalization that can be self-funded and will ultimately yield a more desirable outcome than prohibition, most countries should opt for the latest, even with threats and pressure from the US.
Implementation of controlled legalization is much simpler and can be self-funded. Sales of licenses after proper background checks may be a way to fund the initial cost of implementing controlled legalization, while excise taxes fund operating expenses. As the main enforcement of regulations in a controlled legalization regime is left to the supply chain, a relatively light control apparatus is sufficient to ensure that the various agents of the supply chain, who are clearly identifiable, do indeed abide by the rules that govern them. In contrast, a prohibitionist regime, where all actors are unknown, and virtually the entire population must potentially be controlled, requires an extremely heavy enforcement apparatus, which might not necessarily be unappealing to political regimes with a covert totalitarian itch.
Emerging countries cannot incarcerate out of this problem. The cost of mass incarceration would bankrupt their economy. It would come at the expense of education or health care, which are vital for their future, and produce generations of hardened criminals, further jeopardizing their futures. Emerging countries do not need more inmates, they need more engineers, teachers, doctors and other skilled professionals.
Avoiding the pitfalls of alcohol, tobacco, prescription drugs
Drug policy reform will start with a clean slate and cannot be held hostage at the onset by deep-pocketed entrenched interests at least within its proponents. There is an opportunity to do it right from the start, drawing lessons from alcohol, tobacco, prescription drugs and others. The regulation of alcohol, prescription drugs, and to a lesser degree tobacco, is hampered by deeply entrenched financial, political and commercial interests. One of the biggest challenges of drug policy reform will be to keep at bay commercial interests and making sure that they do not end up hijacking the reform and compromise the primary goal of harm minimization.
Considering the current explosion of abuse of prescription drugs, largely fueled by the reckless pharmaceutical industry marketing apparatus, replacing the drug cartels by the pharmaceutical conglomerates is certainly not the most desirable option. Placing Wall Street in charge of drug production and distribution would probably be almost as bad as the current situation.
To properly rein in economic interests, the activity of companies involved in the production or commerce of psychoactive substances should be limited so that a particular enterprise couldn’t be involved in more than one class of substances (cannabis/marijuana, opiates, amphetamine-like, etc) or one type of trade (wholesalers could be prevented from entering into the retail trade for instance). Pharmaceutical companies could be prohibited from getting into the recreational substance business to avoid potential conflicts of interest. There could also be geographical limitation to limit the emergence of powerful multinational corporations. State monopoly might be the best option to remove profit motivation from the psychoactive marketplace.
Roadmap to re-legalization
Controlled re-legalization will eliminate prohibition-induced harm augmentation. Beyond this, the implementation of adequate mechanisms can result in a net reduction of the societal cost of drug abuse. To that effect, it is imperative that we draw on the lessons learned from harm reduction policies for alcohol, tobacco and prescription drugs as well as in other domain such as driving or obesity. As noted above, removing profit incentives from the supply chain will be key to the ultimate objective of harm minimization.
It is important to first lay out clear and realistic objectives in order to determine the best possible way of reaching these objectives. The primary goal of any substance abuse reform should be black market reduction, which can be marginalized to the point of not being a significant threat with proper international coordination.
There are 4 major area of focus for controlled legalization:
- Dismantling of the illegal drug market, which requires the dismantling of the prohibition system that created it and is feeding it.
- Protection of minors: Control and minimization of access to minors; curving initiation, especially among minors.
- Harm reduction through safe controlled access, abuse prevention, and reduction of societal harm.
- Taxpayers’ protection: reduction or elimination of the financial burden placed on taxpayers by the consequences of drug use (and drug prohibition).
Unlike the fairly rigid prohibitionist model, there should be a lot of flexibility in the application of drug reform to allow for experimentation and adaptation to local realities. Those who wish to use psychoactive substances will go to great lengths to satisfy their desire. It is far more advantageous for society to satisfy their need than to let the black market take care of it. The guiding concern shouldn’t be whether it is moral or immoral to provide psychoactive substances to those consenting adults who wish to use them, but what is the least harmful way to do it. Controlled legalization is not meant to be an endorsement in any way, shape, or form. It is a practical and pragmatic way of establishing effective control and reducing harmful use while respecting human rights and civil liberties. Practicality, efficiency and enforceability should be the guiding factors in drawing legislation.
Functional thresholds of impairment should be established for each substance. Users should be prevented from activities involving public safety issues while impaired: DUI of course, but also operation of any type of equipment that might pose security issues to the public such as transportation or heavy equipment. Nobody should be allowed to operate under the influence. Sanctions could range from temporary suspension to permanent loss of driver’s license or other licenses, mandatory treatment to regain suspended licenses, and similar sanctions. Incarceration should be a sanction of last recourse for dangerous repeat offenders.
No system will be foolproof and determined users will always go a long way to satisfy their needs. Some substances will be diverted, including to minors. Some pharmacists will abuse their position for financial gain or other reasons. Problem users will resist help and treatment; maintenance is often the best that can be achieved with heavy users. All safety barriers are broken sooner or later, which is not a good enough reason to forego them altogether. Extra focus should be placed on curbing initiation and preventing people from becoming heavy users in the first place.
Multi-tier regulatory system
The core of the strategy that I advocate is based on separating soft psychoactives from hard psychoactive, establishing strict separations between the two marketplaces.
A second pillar of the proposed strategy is to separate heavy users and addicts from casual users by placing high barriers of access to casual users and initiates, at least for the most harmful substances, while neutralizing heavy users and addicts through subsidized access. As we have seen in previous sections, heavy users and addicts are often retail dealers and are prolific proselytes. They also are the weakest point of the illegal drug marketplace, representing from 80 to 90% of the market while supplying 80 to 90% of the remaining market (to casual users and initiates). Once they are removed from the supply chain, the illegal marketplace will collapse, as the drug traffickers’ potential market is reduced to new and occasional users, which is a far less profitable and highly unreliable market. Placing high barrier of access to the heavy users would just turn them back to the black market and defeat the purpose, therefore, subsidized access is critical element of controlled legalization.
The primary benefit of subsidized access to heavy users is to remove their proselytizing incentive. It also has the added benefit of establishing contact with a typically extremely marginalized population. Once contact is established, it becomes possible to nudge the problem user towards treatment and bring him back to less harmful behavior and patterns of use or even abstinence altogether. As much as possible, subsidized use should be conditioned to use on premises in order to avoid any possible diversion from subsidized users to casual users.
Therefore, a dual pricing policy with subsidized pricing for registered heavy users and addicts and much higher pricing for new and occasional users can be workable as new and occasional users are more likely to prefer a known, quality-controlled product from the legal market to an unreliable black market product of unknown composition and concentration. Thus, a dual pricing policy shouldn’t hinder the goal of black market elimination while it would greatly reduce initiation and occasional use.
The illegal marketplace for hallucinogens obeys to fairly different rules than the other illegal drugs, and is not generally associated with organized crime or violence; hallucinogens are not considered addictive and their pattern of use differs considerably from other illegal drugs. A single experience can have dramatic consequences and the effects are dependent on set and setting to a large extent. Therefore they should be placed in a different category altogether and could be managed through membership-based licensed premises such as clubs or churches.
The marketplace for soft psychoactives should follow the alcohol/tobacco model, with added restrictions on promotion and advertising. We believe it would be unwise to extend the existing alcohol/tobacco channels to the soft psychoactive marketplace. It is vastly preferable to establish new retail sales channels for harm minimization purpose.
The marketplace for hard psychoactives should follow the prescription drugs model, with total ban on promotion and advertising. The substances should be available exclusively behind the counter through qualified professionals capable of recognizing problem use and giving proper counseling to their customers. They should be offered in single-dose units, pre-packed for a specified administration mode. Venues for subsidized use could be separate from venues for casual use.
I refer my readers to the “Controlled Legalization Table” hereunder for more details.
Excise tax
Anybody can claim a legitimate right to his or her lifestyle choices as long as they do not intentionally endanger others or do not present an inordinate threat or impose an undue burden or cost on society.
Many lifestyle choices and human activities in general present undeniable potential danger to society or result in costs to be borne by society. While single occurrence or individual patterns might be minimally harmful, global patterns place an undeniable burden on society when abuse is accounted for. Ideally, this burden should be compensated through an appropriate excise tax collected on the sale of products or services related to the activity causing the harm.
The excise tax should have two components:
- A compensatory component to cover the economic cost placed on society as a result of the activity; this cost should include education, prevention and treatment.
- A deterrent component proportional to the degree of harm caused by the activity to discourage people from behaviors with the highest potential harm. The deterrent component should only apply to those activities that impose a substantial societal burden.
Taxation should aim to achieve taxpayer neutrality or better, and drug use shouldn’t impose a financial burden on taxpayers. By taxpayer-neutral or positive, we mean that the entire direct and derived costs of the use of psychoactive substances should be covered by the proceeds of the excise tax and licensing fees, possibly with a profit to the taxpayer.
Marijuana should be taxed according to its total THC content, with the tax per total THC content rising substantially with THC concentration. Similar schemes are already in place for alcohol and taxes per total alcohol content are typically much higher for hard liquors than for beer and wine.
Cocaine, heroin or morphine should have much higher taxes and far more restricted access than opium or coca leaf teas and preparations. The psychoactive substances should be prepackaged for a certain type of use, with taxation and restrictions appropriate for the given mode of use. Users should be nudged towards the milder modes of administration, teas or prepackaged drinks at the lower end of the spectrum, then tablet form for oral ingestion rather than powder form for nasal ingestion, inhalation or injection. Injection should obviously be the more severely restricted, but not to the point of sending users back to the black market.
Taxpayer neutrality shouldn’t take precedence over the primary goal of eliminating the black market and its associated crime. Even if tax revenues do not completely cover the societal cost of drug use, at least in the initial phase, taxpayers will be immensely better off than in the current prohibitionist regime where they are stuck with the entire bill not only of the prohibition-inflated societal cost of drug use, but also of the societal cost of prohibition. Meanwhile, all the profits feed a shadow economy that breeds insecurity and instability, generating even more societal costs.
Education & prevention
Tobacco is a great example of how public health policies and public opinion campaigns can successfully help reduce harmful use. A combination of smoking bans in public places and education campaigns has succeeded in bringing down tobacco consumption by over 50% or more in many industrialized countries. More importantly, the cultural perception of smoking changed dramatically as smoking was deglamorized, a change that was partly driven or at least amplified by mass media and global culture. Smoking is just not cool anymore. This happened despite the fierce opposition of the tobacco lobby who threw in the fight every dirty trick in the books, which eventually backfired and turned public opinion against them. Hundreds of millions of people quit smoking worldwide over the past 30 years or so, without throwing anybody in jail! What better proof do we need that regulation and education can and does work?
Intelligent, credible and properly targeted public health campaigns would go a long way towards reducing substance abuse, and the focus should be on abuse. Campaigns targeting the most at-risk populations might be more efficient than generic and often overly simplistic campaigns.
The major improvement brought by controlled legalization will be at the point of sale. While the dealer is crassly and unapologetically pushing his wares, trying to cross-sell and up-sell, never hesitating to peddle his products to minors, legal retailers not only should be prevented from promoting their products in any way, shape or form, but should be required to issue proper warnings, especially concerning the dangers of multi-drugs use.
Treatment facilities should be readily available, unlike the situation currently prevalent in most of the world. Part of the proceeds from the psychoactive excise taxes should be earmarked for treatment.
The issue of under-age substance use and abuse
Early onset of psychoactive use is a strong predictor of problem use in adulthood, and the substance-related damage increases dramatically for younger users. Early substance abuse disrupts brain development in adolescents and young adults. Last but not least, for every substance except prescription drugs, individuals who have abstained by the time they reach the age of 21 are likely to keep abstaining and are very unlikely to ever abuse. [7] Therefore, the mid- and long-term performance of any substance abuse policy is predicated upon postponing initiation and curbing adolescent and youth use. Drug reform policies should place special emphasis on this goal.
The current prohibitionism particularly exposes children and young adults, with disastrous consequences. Paradoxically, under prohibition, children and youths have easier access to illegal drugs than middle-aged or older adults.
Harm reduction to be expected from controlled re-legalization
Only controlled re-legalization can greatly weaken or even virtually eliminate the illegal trade. Provided that controlled re-legalization is properly designed and implemented throughout the entire supply chain with close coordination between the producing and consuming countries, the illegal trade can be virtually eliminated. Legalization would eliminate the need for transiting countries, which are currently the most affected by the illegal trade.
Eliminating narco-violence and corruption would greatly weaken criminal organizations as the proceeds from drug trafficking often represent their major source of income. To quote former US Ambassador to the UN John R. Bolton, “There is no doubt that corrupt activities tied to criminal organizations and the drug trade are mutually reinforcing.”[8] Re-legalization would deal a severe blow to narco-terrorists who would have nowhere to sell their wares, as only licensed producers would be allowed to sell their products under strict restriction.
Controlled re-legalization would help stabilize producing and transiting countries and regions, such as Colombia, Bolivia, Peru, Central America, West Africa, and the Afghanistan/Pakistan conundrum. Many narco-guerillas around the planet would probably not survive.
Controlled re-legalization eliminates drug-trafficking offenses and the attached criminal activity and violence. This will result in a dramatic decrease in drug-related law enforcement, prosecution and incarceration, freeing scarce resources and allowing reallocation of freed resources to fight real crime. This in turn would put more pressure on criminal organizations, further weakening them. Thus, the current downward spiral of diminishing returns for law enforcement can be reversed through legalization, as organized crime would see greatly diminished returns thanks to the loss of drug trafficking revenues. This would lead to further diminishing returns as law enforcement could finally turn the tide and dedicate more focused attention to the most damaging crimes, putting more pressure on organized crime and making it harder and costlier to generate profits. As a result, criminal careers would lose much of their appeal and criminal organizations would dwindle.
Drug trafficking has an incredible competitive advantage over any other type of crime. The best part of it is the abundance of willing and eager “customers/victims.” No other crime can compete as nobody wants to be robbed, extorted, kidnapped, assaulted, raped, etc. As long as crime pays so handsomely, there are plenty of recruits for it. Some criminal elements currently involved in drug trafficking will turn to other forms of crime when drugs are legalized, but many more will just give up their criminal careers altogether if the returns of criminal activity plummet sufficiently.
Controlled re-legalization would drastically cut down enrolment in the university of crime that is the prison system; the prison system in turn would spit out far lower numbers of criminal graduates, resulting in a substantial reduction in criminal activity. Besides, most drug dealers do not consider themselves criminals.
Controlled re-legalization would eliminate accidental overdose and intoxication due to adulterated products, removing the added hazard created by unreliable products of unknown composition and concentration. It would reduce or eliminate the spread of HIV/AIDS among injecting drug users. It would allow reaching out to at-risk and marginalized populations.
Early detection of problem use would nudge users towards early treatment and/or protect children and dependents, greatly reducing the most harmful effects of problem use.
A general amnesty and clearing of criminal records for all non-violent convicted drug offenders would remove the stigma on their personal and professional lives and allow former offenders to reintegrate into society in a productive way.
Proselytizing would be substantially reduced as heavy users wouldn’t need to recruit new users into their network. Psychoactive substances would be available only in authorized retail outlets subject to strict regulations regarding promotion and sale in order to maintain their license, further decreasing proselytizing.
Hard drugs administered in specialized sanitary facilities would eliminate injection initiation by injecting users.
Minors would be better protected as the need for foot soldiers and cannon fodder would evaporate. Sales to minors would be strictly prohibited as offenders would run the risk of losing their licenses.
Taxpayers would be vastly better off. If controlled legalization is properly designed, the use of psychoactive substances should be taxpayer-neutral or even taxpayer-positive instead of being a financial black hole. At a time of accelerating budget deficits in many parts of the world, especially among industrialized countries, re-legalization would contribute hugely to the balance sheets of most countries, to the tune of over $100 billion per year for the US alone once the huge reduction in law enforcement and other War on Drugs related expenditures are taken into account, as well as the proceeds from the excise taxes. The economic benefit would be much higher as revenues currently generated by the shadow economy would be brought into the legitimate economy. Depending on the type of regulation applied, the marijuana industry could develop into something similar to the wine industry, with varietals and the equivalent of wineries and all the related economic activity, employment, taxes, etc. The hemp industry itself could generate substantial economic activity.
Some harm augmentation will actually come from a rather different direction, and it will affect primarily the parts of the world that have most suffered from the War on Drugs: the producing and transiting countries. There, powerful criminal organizations have long been addicted to their immense profits and as they lose their major source of income, they are likely to step up their other criminal activities, such as kidnapping, extortion, armed robberies, etc. Therefore, re-legalization is likely to provoke an explosion of non-drug related violence in these parts of the world, at least initially. The international community should stand ready to help the affected countries to avoid their falling into further chaos. The international community has a duty to help them get out of the semi-permanent state of lawlessness into which the War on Drugs contributed in plunging them.
There is a distinct possibility of an increase in non-drug-related crime in industrialized countries as well in the initial stage as criminal organizations and gangs look to compensate for their loss of income. Industrialized countries are generally better prepared to face these types of challenges, not to mention that freeing up resources from the War on Drugs would allow more focused attention to other crimes.
Transiting countries will also be affected economically as the loss of drug trafficking revenues will significantly disrupt local economies. Farmers currently involved in drug production might be affected as well, although they should be brought into the legal production as much as possible.
Controlled legalization table
| All substances |
|
| Soft psychoactives |
|
| Hard psychoactives |
|
| Psychedelics |
|
| Specially licensed establishmentsDifferent types of sales licenses for different classes of substances | Implementation
Effects:
|
| Levy of excise taxesTaxation and restrictions appropriate for the given mode of useSubstances prepackaged for a certain type of use |
Effects:
|
| Controlled subsidized access for addicts to hard psychoactives |
|
How to build a coalition of the willing to legalize – Expected US opposition to controlled re-legalization and why it may not matter
It is unrealistic to expect any type of reform to come from the US, at least at the Federal level. Reform, if it ever comes, will come from individual states, with California, Washington State, Colorado and New England leading the way. Only through the combination of internal and external pressure can the US prohibitionist agenda be defeated.
The political climate is much more favorable in Latin America and Europe. A Latin American coalition seems to be forming around Guatemalan President Perez Molina and the Central American Integration System (SICA), regrouping Panama, Honduras, El Salvador, Costa Rica, Guatemala and Nicaragua. But nothing can happen without Colombia and Mexico onboard, as the SICA countries are quite aware, who invited Colombia and Mexico to join the Central American debate. A Central American coalition with Colombia and Mexico on board, would likely expand to most of Latin America, especially if Colombia and Mexico decide to take the lead, and they would most likely be joined by Caribbean countries.
Various smaller European countries, such as the Czech Republic, Portugal, the Netherlands or even Spain, could get behind such an initiative, but in order to be successful, the initiative will need the backing of one of the three heads of the EU: UK, France or Germany. Of those, only the UK is a reasonable candidate as David Cameron, the sitting Prime Minister, has stated his support for legalization on various occasions, although he has back-pedaled since taking office. His Liberal Democrats allies are more squarely in favor of legalization. If the Calderon-Santos duo could be turned into a Calderon-Santos-Cameron trio, the momentum would be extremely strong and many more countries could jump in.
In Asia, India would be an outstanding recruit. The use of cannabis is an important part of the Indian religious and cultural heritage. An epidemic of heroin addiction is plaguing the country (as well as all of Central Asia) as a result of opium prohibition. Afghanistan and the Central Asia countries are other potential candidates. If critical mass is obtained with some of the major producers and consumers on board, the movement would be irreversible, leaving the US Federal government in a quandary, as retaliation would be unthinkable.
The War on Drugs started with the American century, just before World War I. America was in expansion mode during most of this century, which allowed her to unilaterally push her agenda onto the rest of the world. The War on Drugs has been one of the pieces of the US hegemonic agenda. History will probably point to the 2007-2009 financial crash and economic crisis as marking the end of the American century. Let’s hope that it will also mark the beginning of the end of the War on Drugs.
The end of the American century means that the US would be powerless if a majority of producing, transiting and consuming countries were to agree on a legalization scheme. A “Kyoto Protocol” for legalization would work, especially if ratified by Canada and México.
Conclusion
Abuse and addiction, whether of psychoactive substances, food, sex, gambling or video-gaming, raise complex but manageable issues with deep socio-economic, human and health implications. By adding a criminal dimension to it, the War on Drugs turned the use of certain psychoactive substances into a dreadful scourge, spreading human, social, economic and geo-political devastation. Narco-corruption and violence are destabilizing an increasing number of countries throughout the world.
Prohibition is the worst possible form of control. By trying to violate the law of supply and demand in a market economy, drug prohibition creates drug trafficking. The so-called “controlled substances” are effectively out of control, or rather, are controlled by the underworld. The bulk of the harm attached to illegal drugs derives not from the use of drugs, but from the perverse effects of their criminalization.
Trillions of dollars have been thrown at this failed social experiment; hundreds of thousands have died, mostly victims of narco-violence in producing and transiting countries; tens of millions have been incarcerated. Constitutional rights have been trampled; civil liberties have been severely curtailed. Children and adolescents have disproportionately paid the price as foot soldiers and cannon fodder or leftovers of war-broken families.
Meanwhile, use has remained stubbornly stable for young adults over the past 40 years in US and the West. Substance abuse and addiction is spreading with epidemic proportion throughout the developing world fueled by rapid urbanization and the ensuing social dislocation. Emerging countries do not have the resources to fight such a plight under current war on drug policies and it would be folly for them to adapt the failed US policies.
Any realistic regulation of psychoactive substances must start by acknowledging the universality of the mind-alteration drive in humans. Likewise, contrary to the war on drug propaganda, substance use doesn’t equate abuse. Use is a lifestyle issue while abuse is a health issue, not a criminal issue. Regulation should focus on: reducing black market and the associated violence and corruption; reducing harm associated to substance abuse with special emphasis on public safety; protection of minors; education, prevention and treatment.
The only sustainable, pragmatic and realistic solution is global re-legalization under a multi-tiers “legalize, tax, control, prevent, treat and educate” regime with practical and efficient mechanisms to manage and minimize societal costs. Far from giving up and far from an endorsement, controlled legalization would be finally growing up; being realistic instead of being in denial; being in control instead of leaving control to the underworld. It would abolish the current regime of socialization of costs and privatization of profits to criminal enterprises, depriving them of their main source of income and making our world a safer place.
Appendix: psychoactive substances & the brain
How do psychoactive substances act on the brain
By definition, substances are psychoactive because of their action on the brain. Psychoactive substances interfere with the natural neurotransmission process and create an artificial neurochemical environment, creating changes in neurotransmitters functions, affecting neural rewiring and gene expression. Such changes are maladaptive responses and may become long-lasting with repeated use. The reward dopaminergic system that is key to adaptation and learning is particularly affected as psychoactive substances typically induce a decreased sensitivity to natural reinforcers.
All psychoactive substances have potential therapeutic applications. Most of them have recreational uses as well.
Upon administration of a psychoactive substance, the rapidity and intensity of delivery to the brain determines the acuteness of the neurochemical disruption and the strength of the adaptive response. Thus, the administration mode is the key determining factor of the severity of the adaptive response.
The legal status of a particular substance has absolutely no bearing on its action on the brain; legal or prescription psychoactive substances can have just as negative side effects on the brain as the ones currently illegal. The potential dangers of illegal drugs are increased tremendously by their illegal status thanks to dosage uncertainty, unknown adulterants and unsanitary administration practices.
Psychoactive substances and the growing brain
Early substance abuse disrupts brain development in adolescents and young adults. Underage substance use, whether legal, prescription, or illegal, is a vexing and thorny issue involving adolescent decision making and risk-taking and must be seen in the wider context of adolescents’ greater propensity than adults for risk-taking behaviors of all kinds.[9]
The issue of initiation
Except for prescription psychoactive drugs, the use of psychoactive substances, whether legal or illegal, typically starts in teenage and young adult years. The likelihood of starting to use psychoactive substances peaks at the end of teenage years and decreases dramatically with age. Moreover, the likelihood of becoming addicted decreases with the age of initiation; people who have never abused by the time they reach 21 are highly unlikely to ever abuse. Therefore, postponing the initiation age is the most efficient way to reduce the harm caused by abuse and addiction.
Prescription psychoactive drugs initiation shows a very different pattern, with a first peak in teenagers, and a second and more dramatic peak in the elderly; women are more at risk than men.
At least 90% of new injection users are being initiated by other users, mostly friends (63% to 85%), family members, and sexual partners; less than 10% are self-taught. Initiation is typically a social event attended by an average of three people, mostly other injecting drug users, usually during a multi-drugs binge. The initiate rarely pays for his or her first injection; he/she typically graduates from other psychoactive substances, mostly alcohol, inhalants or non-injection heroin. Social relationship with other injecting drug users is a key factor as injecting is a contagious behavior; once it has been introduced to a drug-using network, it is likely to spread throughout the network. Anywhere between one third and two thirds of injecting users, depending on the reports, initiate others; those who initiate others initiate between two and three people, although a small number of addicts are serial initiators.
Street youth are a particularly vulnerable sub-population of drug users; for instance, 30% of street youth in Vancouver reported injection drug use within the past month. The injection rate among street youth may be even higher in some developing and third world countries, in places like Mexico City, Rio de Janeiro, Dar es Salaam, Djakarta or Teheran.[10]
A substantial number of initiates do not continue injecting.
Supervised injection within medical facilities bypasses the injecting ritual and reduces peer-to-peer propagation and initiation.
Patterns of use – Drug careers – Use, abuse and addiction
Patterns of use differentiate between use (understood as moderate use), abuse (also called binge use), and addiction, to which is often added problem use. Problem use encompasses both abuse and addiction, but not all abusers and addicts are necessarily problematic users. Functioning alcoholics and controlled dependent heroin addicts are examples of non-problematic addiction. Examples of problem use include binge use leading to accidents, crime, violence, overdose, or other societal and personal harm. Prevention of problem use should be the major focus of a sound drug control policy; it may include promotion of moderate use, as is the case with legal and prescription psychoactives, but is anathema for currently illegal drugs. Patterns of use concern only potentially addictive substances. Hallucinogens have a very different profile and are not addictive.
In order to reduce problem use, it is critical to fully understand patterns of use, their root causes and consequences, and the path leading to initiation, and then from initiation, to abuse and problem use.
Patterns of alcohol use and the health and psychosocial benefits of its moderate use raise the issue of whether other psychoactive substances follow a similar model. It is indeed very likely that the moderate use of cannabis, coca leaf, ephedra or khat has beneficial health and psychosocial benefits. Unfortunately, the current prohibitionist regime has precluded scientific investigation on potential benefits of the moderate use of illicit substances. Likewise, genetic variations may exist between different populations and ethnicities, leading to substantial variations in effects and tolerance, as is the case with alcohol.
Drug use cannot be prohibited because of reckless use any more than driving can be prohibited because of reckless driving, or alcohol can be prohibited because of reckless drinking. On the other hand, government is justified in protecting its citizens from reckless drivers and reckless substance users alike.
The pursuit of pleasure
The pursuit of pleasure and the consequent activation of the brain reward system is a natural component of normal behavior. It is critical to survival and necessary to a healthy and fulfilling life. The ability to derive rewards and pleasure from a wide range of stimuli, behaviors, and activities is probably one of the major factors of human evolution, and a major source of human achievements, from scientific discoveries, to art, music or literature.
The pursuit of pleasure/reward may become pathological, resulting in addiction or compulsion. Virtually any behavior may become addictive. The most common addictions are: eating, work, shopping, TV, Internet, Facebook, video games, gambling, sex, pornography and of course substance use from caffeine to heroin and everything in between. Any stress coping mechanism, especially those linked to artificial stimuli, may become addictive. All addictions involve dopaminergic signaling and the dopaminergic reward pathway, often involving endorphin and endogenous morphinergic mechanisms.
While we constantly engage in potentially addictive behaviors and use potentially addictive substances throughout our lives, the vast majority of people do not become dependent. The reason why some people develop dependence is poorly understood, not to mention that one’s dedication – to relationships, work, athletics, politics, activism or religious practice – may look like addiction. Furthermore, there are no clear thresholds or criteria to differentiate addiction from normal or at-risk behavior. Addiction is in the eye of the beholder to a certain extent. The addict himself is typically in denial. Compulsions, or even addictions, are not necessarily negative, as high achievers are typically compulsive if not outright addicts.
Pathological pleasure seeking involves a loss of control where people place greater reward value on a particular brain stimulus to the detriment of basic needs through self-deprivation and may endanger their very survival. As such, addiction and compulsion can be viewed as motivational toxicity characterized by an alteration of motivational hierarchy where the motivational effect of a particular stimulus increases dramatically, reducing the motivational efficacy of natural rewards.[11]
Addiction
Addiction can be defined as the pathologically increased motivation of a particular behavior at the expense of natural rewards with disregard for adverse consequences. Addiction is above all a maladaptive process; it is how the brain adapts to repeated alterations of its neurochemical environment and causes substantive neural rewiring.
The vast majority of users never become addicts. Intentionality, expectations and attitude play a critical role in the addictive process.
There is little difference between the incidence of abuse and addiction among illegal drug users and users of the legal drugs, alcohol, tobacco or prescription drugs. With the notable exception of tobacco, use of psychoactive substances, both legal and illegal, tends to peak in the early 20s and then most users either give them up altogether or revert to episodic use, while a small percentage develop a lasting pattern of abuse or addiction. Occurrences of addiction are more frequent in the case of tobacco, amphetamines, heroin and alcohol.
The vast majority of addicts, recover naturally from addiction. The success rate of natural remission is about as high, if not higher, than treatment-assisted remission.[12]
What differentiates drug addiction from other types of addictions such as alcoholism, food addiction or compulsive gambling? Is there such a fundamental difference that one type of addiction is merely morally reprehensible while the other is both reprehensible and criminal? Alcohol abuse may lead to a total loss of control which largely rivals the loss of control induced by other substances such as heroin or amphetamines. “Overeating in obese individuals shares similarities with the loss of control and compulsive drug taking behavior observed in drug-addicted subjects.”[13]
Mode of administration and addictivity
The mode of administration greatly influences the dopaminergic response. Injection, which sends the substance almost instantly to the brain, produces the most dramatic reaction, followed by inhalation and nasal absorption, with absorption through the digestive track lagging far behind. The intensity of the dopaminergic response determines the intensity of the reinforcing effect.
Recreational drug users are motivated by the hedonistic reward provided by the substance. For most psychoactives except psychedelics, the intensity of the hedonistic reward depends in large part on the acuity of the peak intensity and the speed to reach this peak. The steeper the peak, the more intense the rush, the more acute and disruptive will be the effects on the brain, causing a homeostatic imbalance which results in chronic dysregulation of the brain reward mechanisms and the brain’s neurotransmission in general.
Routes of administration that result in the rapid entry of a substance into the brain and/or faster rates of delivery have a greater effect on the neurotransmission systems in the brain, especially the reward systems, producing sensitization. Hard liquors are more damaging than beer or wine, especially on an empty stomach. Smoked opium reaches the brain faster and is more addictive than ingested opium. Injection and inhalation of active ingredients such as amphetamine, heroin or cocaine have the quickest entry and fastest rates of delivery, with the most damaging effects.
Set and setting
Set and setting, expectation and intentionality influence the effects of particular substances. Thus, ritualistic use of tobacco where the plant is used with veneration and respect is vastly different from chain smoking of industrial cigarettes. Likewise, chronic pain sufferers under long-term opiate medication can usually discontinue without much problem once their medication is not needed anymore, as the absence of secondary reinforcers probably plays a critical role in preventing addiction. [14] Nowhere is the set and setting more important than in the use of psychedelics.
Secondary reinforcers further increase the motivational value of the substances. Secondary reinforcers include: locations where substances are used (bars, clubs, raves, shooting alleys, crack-houses, etc.); the sight of substances; substance paraphernalia; and positive social reinforcement of substance use (social normalcy of use, peer pressure, dare and other drinking contests, sense of belonging, sub-cultural identity, presence of dealers or other users, ubiquity of exposure, etc.).
Factors that influence vulnerability or resistance to substance abuse and addiction can be broken down into environmental factors (socio-cultural environment: family, peers, sub-culture) and individual factors (genetics, personal history, personality traits).
Cultural and sub-cultural norms and attitudes towards particular substances are some of the major determining factors of use of these substances. The degree of social acceptability can range from normative to strong social stigma. The use of alcohol for instance is normative in Western countries while it bears a strong social stigma in Muslim countries. Marijuana is increasingly tolerated in Western countries and normative in many subcultures. Prescription psychoactive drugs are considered relatively innocuous thanks to the perceived seal of approval conferred on them by their pharmaceutical status. Of course, social acceptability of a substance directly influences availability and ubiquity or rarity, regardless of the legal status of the particular substance.
Subcultures appropriation of Psychoactives – Global youth culture
“Cannabis use has become part of adolescent development in many Western countries.” European Commission Report on Global Illicit Drugs Markets 1998-2007
The global youth culture already operates in a post-prohibition mode where drug culture is part of pop culture and the War on Drugs propaganda has been reduced to background noise, having long lost all credibility. The global youth culture is celebrity-driven; from Michael Jackson to Beyonce and Lady Gaga, from sports, to movies, to music, drug use and abuse are the norm rather than the exception among the youth culture celebrities. Drugs are omnipresent and almost universally glamorized, especially in music.
Casual regular use of psychoactives is the norm in many subcultures, especially youth subcultures. This is the case of subcultures such as street gangs, of course, and bikers, heavy metal, Black Circles, rave, trance, hippies, Rainbow, pagans, occult (Wicca, Satanism, vampirism, Goth) and even the arguably more mainstream clubbers, not to mention many US fraternities and sororities.
The mind alteration drive
Humans seem to have a mind-alteration drive that can be satisfied through a plurality of modalities. Many of the mind-altering modalities can drive to abuse and addiction.
Humans often operate in a mostly mild and occasionally severe state of mind alteration and have done so since the dawn of time. Caffeine is the most commonly used psychoactive substance in modern societies, mostly through all kinds of caffeinated drinks from cappuccino and tea to soft drinks. Most people occasionally seek more drastic mind-altering modalities.
The mind-altering use of psychoactive substances for ritualistic or hedonistic purposes has been part of human life since the dawn of humanity. Every culture since the dawn of history has had ritualized events of collective intoxication typically combining music, dance and substances, be it Solstice or New Year celebrations, bacchanals, Mardi Gras, carnivals[15], Holi, Kumbha Melas[16] or the myriad other pageants and festivals dotting the calendars of every culture. Most celebrations involve the use of psychoactive substances.
Dominant psychoactive substances
Most cultures have a dominant psychoactive substance that acts as social lubricant and facilitator. Alcohol is the dominant psychoactive of Western civilization. Khat is the dominant psychoactive substance in large parts of Africa, coca leaf in the Andean regions, and cannabis in Central Asia, North Africa, and a growing number of subcultures throughout the world. Tea is the dominant psychoactive, social lubricant and facilitator in most of Asia.[17] It is even more ubiquitous than alcohol in Western culture, ingrained into almost every aspect of daily life and an essential part of the Asian greeting ritual, though more social and ritual than festive.
For various reasons ranging from globalization to the proliferation of rebellious dissident subcultures, people increasingly are not satisfied with their dominant psychoactives and seek diversification to satisfy their mind alteration drive.
Alcohol
Alcohol played a key role in the onset and evolution of the Indo-European civilization where wine and beer were almost universally considered an invention or a gift from the gods. Alcohol has compelling religious significance and is a symbol of power, a celebrative agent, a festivity marker, as well as a universal social lubricant and facilitator.
Globalization is rapidly changing pattern of use, affecting both the traditional alcoholic Western European cultures and the newly converted alcoholic cultures, mostly in newly developed and developing countries. As the dominant psychoactive of Western civilization, alcohol played a pivotal role in the War on Drugs, but the psychoactive landscape in general is being radically altered through globalization and the global youth culture. Alcohol is rapidly losing its dominant player position in the psychoactive marketplace, being increasingly perceived as just one of the players by the global youth culture.
[1] Hired gun.
[2] Alberta Alcohol and Drug Abuse Commission (AADAC), Policy On Harm Reduction.
December 2001, Harm Reduction Coalition, “Principles of Harm Reduction,” http://www.harmreduction.org/section.php?id=62.
UK Harm Reduction Alliance, http://www.ukhra.org/harm_reduction_definition.html.
[3] For a detailed discussion of the issue of harm augmentation, see the remarkable book by Judge James P. Gray, “Why Our Drugs Laws Have Failed and What We Can Do About It: A Judicial Indictment of the War on Drugs,” Temple University Press, 2001. I highly recommend this thorough, passionate and courageous book, based on Judge Gray’s personal experience, by a veteran judge of the Superior Court in Orange County, California, and ex-drug warrior.
See also: Robert J. MacCoun and Peter Reuter, “Drug War Heresies: Learning from Other Vices, Times & Places,” Cambridge University Press, 2001.
Rolles S, “After the War on Drugs: blueprint for regulation,” Transform Drug Policy Foundation, 2009, www.tdpf.org.uk/Transform_Drugs_Blueprint.pdf.
[4] David Nutt, Leslie A King, William Saulsbury, Colin Blakemore, “Development of a rational scale to assess the harm of drugs of potential misuse,” Lancet 2007.
[5] Robin Room, Benedikt Fischer, Wayne Hall and Simon Lenton, “Cannabis Policy: Moving Beyond Stalemate,” Oxford University Press, March 26 2011.
[6] Nadelmann, Ethan, “Thinking Seriously About Alternatives to Drug Prohibition,” Daedalus, 1992.
[7] See Chapter 5 – Psychoactive substances and the brain.
[8] Statement by Ambassador John R. Bolton, U.S. Permanent Representative to the United Nations, on Combating Crime and Corruption: The U.S. Partnership with UNODC at Work, in the United Nations Trusteeship Council Chamber, December 15 2005.
[9] Laurence Steinberg, Ph.D., “Adolescent Decision Making And The Prevention Of Underage Smoking,” Department of Psychology, Temple University, Philadelphia, PA, USA, November 30, 2010.
[10] Sources for this section:
http://www.harmreductionjournal.com/content/2/1/2.
Carolyn A Day, Joanne Ross, Paul Dietze and Kate Dolan, “Initiation to heroin injecting among heroin users in Sydney, Australia: cross sectional survey,” Harm Reduction Journal 2005, 15 February 2005.
McCurdy SA, Williams ML, Kilonzo GP, Ross MW, Leshabari MT, “Heroin and HIV risk in Dar es Salaam, Tanzania: youth hangouts, mageto and injecting practices,” AIDS Care , 2005 June, 17 Suppl 1:S65-76.
Alex Harocopos, Lloyd A. Goldsamt, Paul Kobrak, John J. Jost, Michael C. Clatts, “New injectors and the social context of injection initiation,” International Journal of Drug Policy, July 2009.
http://linus.levels.unisa.edu.au/~yalcin/techreports/Heroin.pdf, Heroin Users in Australia: Population Trends.
Will Small,Danya Fast, Andrea Krusi, Evan Wood, and Thomas Kerr, “Social influences upon injection initiation among street-involved youth in Vancouver, Canada: a qualitative study,” Substance Abuse Treatment, Prevention, and Policy 2009.
[11] Michael A. Bozarth, Ph.D., “When Rationality Fails –Modern Theories of Addiction,” www.AddictionScience.net.
[12] Ibid.
[13] Gene-Jack Wang, MD, Nora D. Volkow, MD, Panayotis K. Thanos, PhD, Joanna S. Fowler, PhD, “Similarity Between Obesity and Drug Addiction as Assessed by Neurofunctional Imaging: A Concept Review,” Brookhaven National Laboratory, http://www.bnl.gov/thanoslab/Thanos%20PDF/JAddDisease1.pdf.
[15] Carnivals and Mardi Gras are the descendants of the bacchanals.
[16] Holi is one of the most popular Hindu festivals. Kumbha Melas are gigantic Indian pilgrimages taking place every 3 years in 4 rotating locations, going back to the same location every 12 years. Seventy million people gathered in Prayag (Allahabad) in 2007 over 45 days. Millions of Sadhus, wandering holy men, gather at the Kumbha Melas, often smoking large quantity of charas, a handmade hashish.
[17] For one illustration of this phenomenon, See “Three Cups of Tea: One Man’s Mission to Promote Peace … One School at a Time,” the New York Time bestseller by Greg Mortenson.