Home Affairs Committee - Drugs: Breaking the CycleWritten evidence submitted by Health Poverty Action (DP140)

1.0 Health Poverty Action

Health Poverty Action, first formed in 1984 by a group of doctors, now operates programmes in 13 developing countries worldwide, with an annual budget of £10 million, and 600 staff. We comprehensively improve health care, strengthening health systems while also addressing the social determinants of health. Our work benefits over 15 million people each year, including many impacted or threatened by drug production and trafficking.1

1.1 Our Approach

We prioritise people missed out by almost everyone else, focussing passionately on the most poor and marginalised people in their struggle for health. We have built up long-term relationships and trust with many communities on the edge of society because of any combination of ethnicity, culture, gender, geography, politics, and economics. For these people every day is a fight for life and health, against all the odds—and we are on their side. They never let us forget that a commitment to improving health requires a commitment to ending poverty. So we believe in a comprehensive approach. We don’t just improve health services, but also focus on other factors that impact on health and poverty. It is precisely the kinds of people and communities that we work with that are harmed or threatened most by the War on Drugs, from the China-Burma border, to Africa, and to Latin America.

1.2 Terms of Reference

This submission addresses the following terms of reference for the Committee:

The extent to which the Government’s 2010 drug strategy is a “fiscally responsible policy with strategies grounded in science, health, security and human rights” in line with the recent recommendation by the Global Commission on Drug Policy.

The criteria used by the Government to measure the efficacy of its drug policies.

The extent to which public health considerations should play a leading role in developing drugs policy.

The comparative harm and cost of legal and illegal drugs.

The links between drugs, organised crime and terrorism.

Whether detailed consideration ought to be given to alternative ways of tackling the drugs dilemma, as recommended by the Select Committee in 2002 (The Government’s Drugs Policy: Is It Working?, HC 318, 2001–02) and the Justice Committee’s 2010 Report on justice reinvestment (Cutting crime: the case for justice reinvestment, HC 94, 2009–10).

2.0 Introduction

2.1 Health Poverty Action (HPA) welcomes the Home Affairs Select Committee’s decision to hold a wide ranging inquiry into the drugs issue. This submission summarises the problems created for poor countries by the current approach, drawing on both HPA’s work in South East Asia, Africa and Latin America, and that of colleagues, particularly those involved in the Count the Costs initiative which this paper draws heavily on.2

2.2 “Prohibition is putting money in the pockets of criminals and armed groups. Profits from the illegal trade in drugs are not only used to buy guns, they also buy police chiefs and judges. Corruption is off the scale and, as it grows, democratic accountability, the key plank necessary for poor people to access and defend their rights, is progressively eroded...The families caught up in this nightmare are the victims of an unworkable ‘war on drugs’.”

Jonathan Glennie, Overseas Development Institute Research Fellow
and former Head of Christian Aid’s Colombia Programme, 2010

2.3 The UK Government’s current approach to drugs has a range of unintended consequences that have serious negative impacts on international development and health in the growing number of poor countries affected by the production or transit of illicit drugs. These harms stem from UK policy in two main ways.

2.4 Firstly, demand for drugs like heroin and cocaine in the UK is very high. The UK’s policy in support of global prohibition has led to this demand being met through illicit production and trafficking in the poorest, most fragile states. As Professor Mick Moore of the Institute for Development Studies has summarised:3

“The traffickers can be more confident of a reliable, cheap supply of coca leaf and poppy if government employees, honest politicians and armies can be kept at bay, if farmers have little access to alternative sources of credit, and if they have to pay high prices to transport fertiliser or to ship bulkier non-narcotic crops to market. The processors and traffickers prefer that there be little economic infrastructure in producing areas. They want and create weak states and misrule. They finance separatist and insurgent armies to keep the government at bay, and simultaneously buy off politicians, police, armed forces and customs officers. The illegality of drugs makes it rational for traffickers to lock producing areas—and sometimes whole countries—into multi-dimensional underdevelopment. The same corrosive consequences for governance, public authority and democracy are replicated as traffickers tranship heroin and cocaine through the Caribbean, Central America, Central Asia and, increasingly, West Africa.”

2.5 So traffickers target geographically remote regions and already fragile or failed states, then protect and expand their interests using violence, intimidation, and corruption. This deters investment, restricts the activities of NGO and government agencies, and diverts limited development aid and other resources into enforcement. As the UN Office on Drugs and Crime acknowledges4, such enforcement at best displaces illicit markets and transit routes to new areas, or new countries (for example Guinea Bissau has been turned into a narco-state in just five years by the cocaine trade route shifting to avoid increased enforcement measures in the Caribbean). At worst, it actually increases the violence and harm it is intended to stop. From Myanmar to Mexico, the negative effects of the illicit drug trade fall hardest on the poorest and most marginalised, including indigenous populations and ethnic minorities, young people and women.

2.6 Secondly, the UK plays a central role (alongside the US) in maintaining the current system internationally, and preventing poorer countries from exploring alternatives that might better meet their development and health needs, through blocking reform of the relevant UN Conventions, or even stymieing open debate in UN and other international fora. In a recent interview with the Observer, President Santos of Colombia said:

“A new approach should try and take away the violent profit that comes with drug trafficking… If that means legalising, and the world thinks that’s the solution, I will welcome it. What I won’t do is to become the vanguard of that movement because then I will be crucified. But I would gladly participate in those discussions because we are the country that’s still suffering most and have suffered most historically with the high consumption of the UK, the US, and Europe in general.”

2.7 It is likely that President Santos meant he would attract political, economic and diplomatic flak from countries like the US and the UK, amongst others.

3.0 How the Drugs Trade Harms Development

3.1 Fuelling conflict and violence

(a)Cartels equip private armies and militias, or finance or merge with separatist, insurgent or terror groups, that are often able to outgun state enforcement.

(b)Corruption, combined with intimidation and violence against politicians, police, judiciary, armed forces and customs officers undermines governance and promotes conflict.

(c)Police and military actions can also involve large scale violence against a country’s own citizens.

(d)State interventions that disrupt the existing power balance—for example in Mexico since 2006—can cause a spiral of violence in which the cartels fight back against government forces and each other for control of the trade.

(e)In the longer term, endemic violence can traumatise populations for generations, in particular fostering a deeper culture of violence amongst young people.

3.2 Increasing corruption and undermining governance

The funds drug cartels have at their disposal, their readiness to use violence, and the poverty and weak governance of targeted regions leads to the corruption of institutions and individuals at every level.

“Corruption not only reduces the net income of the poor but also wrecks programmes related to their basic needs, from sanitation to education to healthcare. It results in the misallocation of resources to the detriment of poverty reduction programmes…The attainment of the Millennium Development Goals is put at risk unless corruption is tackled…”

Transparency International5

As the UN Office on Drugs and Crime (UNODC) says:

“The magnitude of funds under criminal control poses special threats to governments, particularly in developing countries, where the domestic security markets and capital markets are far too small to absorb such funds without quickly becoming dependent on them. It is difficult to have a functioning democratic system when drug cartels have the means to buy protection, political support or votes at every level of government and society. In systems where a member of the legislature or judiciary, earning only a modest income, can easily gain the equivalent of some months’ salary from a trafficker by making one “favourable” decision, the dangers of corruption are obvious.”6

3.3 Huge economic and opportunity costs

(a)The negative consequences of a country relying economically on the export of a single product are well understood for legitimate commodities like oil. Similar problems can arise from illicit exports, with the potential threats to development made worse by the lack of taxation and the isolation from legitimate economic and social activity of illicit drug production. A shift of labour and capital to the criminal sector may also undermine long-term development and economic growth.

(b)Other illegal businesses under the ownership or protection of criminal cartels can gain preferential treatment, making it more difficult for legal enterprises to compete, and forcing them to bear a greater burden of taxation and regulation.

(c)The US, and other countries, have diverted development aid from where it would be most effective, blurring it into military spending for its allies in the war on drugs—most significantly in Latin America.

(d)Globally, in excess of $100 billion a year is spent on fighting the war on drugs—roughly the same as the total spent by rich countries on overseas aid. There is a huge opportunity cost from this scale of expenditure on a policy that is not delivering its intended goals when the money could have been invested in everything from health to infrastructure.

3.4 Criminalising poverty

3.4.1 The socially and economically marginalised farmers involved in drug production earn only around 1% of the overall income generated by the global illicit drug trade, with their involvement resulting from a lack of alternative options; the “migration to illegality” driven by “need not greed”.7

3.4.2 Drug control responses in these areas usually take the form of crop eradication, “alternative development” programmes (to encourage the growing of other crops), and the criminalisation of producers. The results, in terms of sustainable reductions in poverty, have been mainly negative. Opium bans and crop eradication programmes in South-East Asia, Colombia and Afghanistan have been linked with increasing poverty among farmers, reduced access to health and education, increased indebtedness, large-scale displacement, accelerated deforestation, and social discontent. They have also resulted in an increase in young ethnic minority women entering the sex trade, often through human trafficking.

3.4.3 Drug control measures can also drive sections of the population to support insurgent groups or work for criminal gangs, further undermining security and governance, and with it the prospects for development.

3.5 Increasing deforestation and pollution

Chemical eradication causes deforestation directly, and pushes drug producers to deforest new areas for cultivation. The past 20 years have seen the bulk of coca cultivation shift from Peru and Bolivia to Colombia, and then from region to region within Colombia, or more recently, back to Peru and Bolivia.

Illicit unregulated production is also associated with localised pollution as toxic chemicals used in crude processing of coca and opium are disposed of in local environments and waterways.

3.6 Fuelling HIV infection and other health impacts

The war on drugs results in a number of health-related harms that impact on development:

(a)The UN’s Millennium Development Goal (MDG) 8 includes “access to affordable essential drugs in developing countries”, yet every year, tens of millions of people in poor countries suffer moderate to severe pain due to legal and political restrictions on essential medicines, such as morphine.

(b)The WHO has listed restrictions on ephedrine and ergometrine as obstacles to achieving MDG 5, which is to reduce by three quarters the maternal mortality ratio.

(c)Levels of drug use and the associated direct health harms tend to rise in the vulnerable and marginalised countries and areas used for producing and transiting drugs, as availability rapidly increases, including from employees being paid in drugs.

(d)Criminalising users and banning syringe/needle provision encourages risky behaviour, such as sharing needles, and hinders measures to help those who have contracted blood-borne viruses via drug injecting by driving them away from HIV prevention and other health services, because they fear arrest or being stigmatised. Established opiate substitution therapy remains illegal in many countries. People who use drugs are also often discriminated against when accessing healthcare and antiretroviral and hepatitis C treatment.

As a result, there are epidemics of HIV and hepatitis B and C among people who inject drugs in many developing countries. Health Poverty Action has a DFID-funded programme aimed at tackling this problem along the border between Myanmar and China, where we are helping vulnerable groups such as drug users and sex workers to avoid HIV and other infections through a needle exchange programme, counselling and distributing condoms

3.7 Undermining human rights, promoting discrimination

Human rights abuses in the name of drug control are commonplace:

(a)State violence including corporal punishment, executions and extrajudicial killings are frequently associated with drug law enforcement.

(b)Disproportionate punishments for minor drug offences can overwhelm criminal justice systems, fuel prison overcrowding and related health and human rights harms. People who use or grow drugs are also easy targets for ill-treatment by police, being subject to violence, torture or extortion of money through threats of detention, or forced drug withdrawal to coerce dependent users into providing incriminating testimony.

(c)Criminalisation of drug treatment and harm reduction activities also remains widespread.

(d)Those arrested for possession of illicit drugs are often subject to arbitrary detention without trial in “treatment” facilities where human rights abuses are common, for periods from a few months to years.8

(e)Chemical spraying can lead to health problems. Legal food plants are often destroyed, and spraying sometimes forces whole villages to be abandoned, while the rapid elimination of farmers’ primary source of income results in economic and social harm.

4.0 Conclusion

4.1 “Developed countries—the major consumers—have imposed harmful policies on the drug-producing countries. These policies have had dire consequences… for the economic development and political stability of the producer countries. The ‘war on drugs’ strategy did not have a significant impact on its goals to increase the street price of drugs and to reduce consumption. Instead…prohibition created economic incentives for traffickers to emerge and prosper; crop eradication in the Andean region helped increase the productivity of the remaining crops; and the fight against the illegal heroin trade in Afghanistan mostly hurt the poor farmers and benefited the Taliban.”

Fernando Henrique Cardoso 34th President of Brazil
Foreword to “Innocent Bystanders: Developing countries and the War on Drugs”, World Bank, 2010

4.2 Essential to delivering good public policy is ensuring it is based on the best evidence and analysis, and considers all the major options available. This is particularly important when the lives of some of the poorest and most marginalised communities around the globe are affected by the choices we make, as is the case where drugs policy is concerned.

4.3 As the US National Academy of Sciences made clear in its 2001 report “Informing America’s Policy on Illegal Drugs; What We Don’t Know Keeps Hurting Us”:

“It is unconscionable for this country to continue to carry out a public policy of this magnitude and cost without any way of knowing whether, and to what extent, it is having the desired result. Our committee strongly recommends that a substantial, new, and robust research effort be undertaken to examine the various aspects of drug control, so that decision-making on these issues can be better supported by more factual and realistic evidence.”9

4.4 The same is equally true of the UK, yet successive governments have failed to properly assess the unintended consequences of their policies in this area, or properly consider the alternatives. As a result UK Government drug policy is actively undermining the Government’s work, most obviously that of the Department for International Development, but also in many other areas. With even debates and papers produced by the World Bank10 , 11now openly discussing the role drug trafficking plays in undermining development, and whether alternative approaches to the drug war might deliver better outcomes, it is time the UK Government engaged properly with this issue for the sake of the poor and marginalised all around the globe.

5.0 Recommendations

Health Poverty Action recommends that:

(a)The UK Government commissions a comprehensive impact assessment comparing the current approach to drugs with all the potential alternatives. This review should include a Health Impact Assessment and a thorough assessment of the implications for international development more broadly.

(b)The UK Government should implement recommendation 24. of the HASC 2002 drugs inquiry report namely: “We recommend that the Government initiates a discussion within the Commission on Narcotic Drugs of alternative ways—including the possibility of legalisation and regulation—to tackle the global drugs dilemma”.

(c)The UK Government should initiate a debate on alternatives to the War on Drugs at other relevant international development and health bodies including the World Health Organization, UNDP and UNCTAD.

(d)The UK Parliament’s International Development Committee should be encouraged to initiate an inquiry into the impact of the current approach to drugs on the ability of DFID and the multilateral agencies and non-government organisations it funds to deliver the UK Government’s development goals.

January 2012

1 www.healthpovertyaction.org

2 www.countthecosts.org

3 www.opendemocracy.net/mick-moore/drugs-towards-global-tolerance-regime

4 Antonio Maria Costa “Making drug control ‘fit for purpose’: Building on the UNGASS decade”, UNODC, 2008
www.unodc.org/unodc/en/about-unodc/speeches/2008-03-10.html

5 Transparency International, “Global priorities: Poverty and Development”
www.transparency.org/global_priorities/poverty accessed Feb 2011

6 United Nations International Drug Control Program, “Technical Series Report #6: Economic and Social Consequences of Drug Abuse and Illicit Trafficking”, New York, NY: UNDCP, 1998, p 39.

7 Jelsma, M, “Vicious Circle: The Chemical and Biological War on Drugs”, Transnational Institute, 2001, p 26.

8 Amon J, “Why Vietnamese don’t want to go to rehab” Human Rights Watch, May 2010.

9 US National Academy of Sciences “What we don’t know keeps hurting us” 2001. Press release and full report online here:
www8.nationalacademies.org/onpinews/newsitem.aspx?RecordID=10021

10 http://wdr2011.worldbank.org/

11 www-wds.worldbank.org/external/default/WDSContentServer/IW3P/IB/2010/03/25/000333037_20100325005015/Rendered/
PDF/536410PUB0Inno101Official0Use0Only1.pdf

Prepared 8th December 2012