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Home Affairs Committee - Drugs: Breaking the CycleWritten evidence submitted by Kevin A Sabet, DPhil (Oxon) (DP148)

Drug policy is the subject of an active debate, with most discussions gravitating toward legalisation (eg the Global Commission) or prohibition. My testimony here is meant to provide some brief context to both of those policies, and in the end I argue that a comprehensive mix of prevention, treatment, recovery, smart law enforcement, and international efforts is the shortest route toward reducing drug use and its many harms. Since I am limited to 2,500 words, the testimony cannot review all of the Committee’s Terms of Reference but I will attempt to provide enough evidence to the committee to show how different drug policies have affected different outcomes. I will specifically focus on cannabis since that is a major point of international policy discussion.

Overview

The theory and practice of drug policy revolves mainly around two prominent frameworks, use reduction, which focuses on reducing drug prevalence, and harm reduction, which focuses on reducing the individual consequences of drug use. I have long argued that both frameworks together are necessary for constructing sound drug policy, and the UK Government’s latest 2010 drugs strategy seems to discuss drug policy in this way. Indeed, the UK Government’s 2010 strategy is considered by many policy analysts as a rich and robust document (eg Keith Humphreys).

Many of the recommendations of the Global Commission can be described as being in line with both UK policy and best practices. The Commission calls for increased prevention and treatment resources, and calls on multiple indicators to be used to evaluate drug policies. The criteria used by the Government to measure the efficacy of its own drug policies are consistent with this spirit, and it is generally agreed upon that the independence and quality of expert advice which is being given to the government in the UK is excellent.

Certainly, public health and public safety must be taken into account when devising and analysing the effectiveness of drug policy. Additionally, the experience of our two legal drugs—alcohol and tobacco—show that legalisation is a simplistic, and indeed dangerous, public policy that is bound to jeopardise both health and safety. The revenue brought in by the (high) use of those two legal drugs pale in comparison to the costs they bear onto society. That is not to say that changes in drug policy cannot and should not be made—indeed 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). These reports show that reforms are desirable and workable, and they also represent the fact that more extreme solutions like legalisation, regulation, or full decriminalisation of drugs are unnecessary and ill-fitted solutions to the drug problem. Since cannabis is often discussed in the context of today’s drug policy debate, the remainder of my testimony will focus on that drug.

Cannabis Control and Policy Measures

Though all governments are signatories to international drug control treaties rendering cannabis illegal, countries around the world have experimented with varying types of cannabis control policies. This section briefly summarises the cannabis policy experiences in the Netherlands, Portugal, and United States. It is not meant to be exhaustive; the references provide greater detail on the issues.

It is critical to keep in mind that in no Western country is a cannabis user at “much risk of being criminally penalised for using cannabis,” as concluded by the RAND (Research ANd Development) Corporation in an exhaustive report about cannabis legalisation.1 Analyses by Kilmer and Room found that the arrest rates for cannabis users who had used the drug in the past year are roughly 3%, and that none of those convicted of possession is incarcerated or receives an administrative fine of more than $1000 US dollars.2 , 3 , 4

Finally, it is important to note that despite media accounts, no country has legalised cannabis. Several other countries than the ones listed above, though several countries, like Argentina, Australian, Belgium, and Mexico, have removed formal penalties for small amounts of personal use. And only in the Netherlands and Australia have there been any formal changes in the criminal status of supplying cannabis (though these have fallen short of full legalisation).

The Netherlands

Perhaps the most infamous policy change on cannabis has occurred in the Netherlands. In 1976, the Dutch approved a formal policy to allow the possession and sale of up to about ninety cannabis cigarettes (thirty grams). The government allowed “coffee-shops” selling cannabis to appear around the country and approved in 1980 guidelines allowing more local control discretion of commercial cannabis practices. As the Dutch got used to the idea of legal cannabis, coffee-shops increased in prevalence and the number of them grew eleven-fold in eight years (nine in 1980 and 102 by 1988).5 In 2001, a lower-end estimate numbers coffee-shops at about 1,200.6

MacCoun and Reuter point out that between 1976 and 1984, cannabis use remained about the same for adults and youth. Thus the early effect of this policy change seemed to have been minimal. From the mid-1980s to the mid-1990s, though, they observe that “surveys reveal that the lifetime prevalence of cannabis in Holland increased consistently and sharply.” They report 15% of 18–20 year olds used cannabis in their lifetime in 1984 turned into 44% by 1996—a 300% increase. Indeed, they also find cite past-month prevalence of 8.5% in 1984 to 18.5% in 1996. MacCoun and Reuter point to “commercialisation” as the reason for this spike in drug use. That is, they contend that during this period between 1984 and 1996, the greater glamorisation and more visible promotion of cannabis lead to an increase in use. Others, like Sabet, suggested that the increase could also be due in part to a greater normalisation of use, as anti-drug attitudes eroded among youth and use became more gradually accepted.7 The discussion of prevalence rates in the Netherlands is a subject of active debate.8

As of late, there has been a kind of “buyer’s remorse” with regards to the lax policy. The government continues to reduce the number of coffee shops, and today the number stands at approximately 700. That means that there is one coffee shop for every 29,000 Dutch citizens—although the concentration in the city of Amsterdam is closer to one for every 3,000 people.9 Current cannabis use in the Netherlands is similar to other European countries but treatment admissions for cannabis are higher in that country than other European neighbours.10 Severe restrictions by the Dutch government have been implemented, including allowing only Dutch citizens to buy cannabis from the coffee shops and continuing to zone areas forbidding coffee shops altogether.

Portugal

Besides The Netherlands, Portugal has attracted a significant amount of attention since implementing its new drug policy, Law 30/2000, which decriminalised the personal use and possession of all illicit drugs. This law allows people to possess up to three days’ supply of any illicit drug, and refers cases of possession of between three and 10 days’ supply to an administrative panel that makes recommendations for treatment and/or monetary sanctions. Trafficking and cultivation of illicit substances, as well as possession of quantities exceeding a ten days’ supply, remain criminal offenses.

Ten years later, there has been a surprisingly few number of rigorous analyses on the policy change. The first analysis to attract any attention, conducted by the pro-legalisation think-tank Cato, unsurprisingly declared the Portuguese experiment an unequivocal success.11 This attracted wide publicity in the mainstream media, although the United States government, for example, publicly questioned Cato’s findings, stating that the report’s analysis was not definitive; that the report failed to recognise other factors that could have contributed to its findings; that adverse data was not reported in the study, and that claims that drug use went down were inconclusive.12

A more thorough report in 2011 by the European Monitoring Center for Drugs and Drug and Addiction (EMCDDA) presented a more nuanced picture.13 EMCDDA concluded that Portugal’s drug policy of decriminalisation is not a “magic bullet” and that “the country still has high levels of problem drug use and HIV infection, and does not show specific developments in its drug situation that would clearly distinguish it from other European countries that have a different policy.”14 The report also went out of its way to argue that the new policy should not be characterised with the label “legalisation.” Rather, the report argued the new policy should be described as a nuanced “public health approach.” With regards to drug use, the report noted that “in terms of trends, school and general population surveys show a stable situation regarding cannabis use in Portugal but a possible increase in cocaine use among young adults.” In terms of drug harms, the report noted that “in contrast to moderate levels of drug use in the general population, problem drug use and drug-related harms are closer to, and sometimes above, the European average.” Clearly, more research is needed before firm conclusions can be made about the Portuguese experience.

United States

The United States outlawed cannabis on a federal level in 1937, with the passage of the Marihuana Tax Act. The subject of decriminalisation and legalisation has been highly contentious since then. In the 1970s, 12 states formally decriminalised cannabis. This meant that persons found to have a small amount of cannabis were not subject to jail time, but rather they would receive a civil penalty, such as a fine. The decriminalisation discussion in the United States is highly complex because even in jurisdictions without a formal decriminalisation law, persons are rarely jailed for possessing small amounts of cannabis. A rigorous government analyses of who is in jail or prison for cannabis found that less than 0.7% of all state inmates were behind bars for cannabis possession only (with many of them pleading down from more serious crimes).15 Other independent research has shown that the risk of arrest for each “joint,” or cannabis cigarette, smoked is about one arrest for every 12,000 joints.16 The discussion about the American experience with decriminalisation becomes even more complicated, and thus less useful, because, as, MacCoun and colleagues argue “‘decriminalisation’” and “non-decriminalisation” states no longer differ in their actual enforcement patterns … or that citizens no longer perceive the difference—perhaps due to the lower salience of the change over time.”17 This probably explains the fact that the literature on early decriminalisation effects on use has been mixed. Some studies found no increase in use in the so-called “decriminalisation” states, whereas others found a positive relationship between greater use and formal changes in the law.18

The more recent discussion about state-level legalisation may provide more insights. In November of 2010 the state of California rejected a measure that would have legalised cannabis and allowed local counties to set tax rates and create production and distribution schemes. Two RAND Corporation reports provide a useful analysis of such a policy. The studies concluded that legalisation would result in lower cannabis prices, and thus increases in use (though by how much is highly uncertain), and that “legalising cannabis in California would not dramatically reduce the drug revenues collected by Mexican drug trafficking organisations from sales to the United States.”19

Conclusions

Most of the recommendations of the Global Commission on Drug Policy—eg a public health oriented approach to drug policy—can and should be integrated with the UK’s current approach. There is also much hope in alternative sentencing schemes and treatment alternatives to incarceration. But the international experience with legalisation, and the current status of alcohol and tobacco in society, give little hope that such a policy would in the end benefit the public health and safety of society.

January 2012

1 Beau Kilmer, Jonathan P Caulkins, Rosalie Liccardo Pacula, Robert J MacCoun, Peter H Reuter, Altered State? Assessing How Cannabis Legalization in California Could Influence Cannabis Consumption and Public Budgets, RAND, 2010.

2 Kilmer, Beau, “Do Cannabis Possession Laws Influence Cannabis Use?” in I Spruit, ed, Cannabis 2002 Report: Technical Report of the International Scientific Conference, Brussels: Ministry of Public Health of Belgium, 2002, pp 119–141.

3 Room, Robin, Benedikt Fischer, Wayne Hall, Simon Lenton, and Peter Reuter, Cannabis Policy: Moving Beyond Stalemate, Oxford, UK: Oxford University Press, 2010.

4 Pacula, Rosalie L, Robert MacCoun, Peter Reuter, Jamie Chriqui, Beau Kilmer, Katherine Harris, Letizia Paoli, and Carsten Schäfer, “What Does It Mean to Decriminalize Cannabis? A Cross-National Empirical Examination,” in Björn Lindgren and Michael Grossman, eds, Advances in Health Economics and Health Services Research, Vol 16: Substance Use: Individual Behaviour, Social Interactions, Markets and Politics, Amsterdam: Elsevier Press, 2005, pp 347–370.

5 Jansen, A C M (1991). Cannabis in Amsterdam: A geography of hashish and cannabis. Muiderberg, Netherlands: Coutinho.

6 MacCoun, R & Reuter, P (2001). Drug War Heresies: Learning from Other Vices, Times and Places. New York: Cambridge University Press.

7 Sabet, K (2006). The (often unheard) case against cannabis leniency. In Pot Politics (Ed M Earleywine). Oxford University Press, pp 325–355.

8 See, for example, Abraham, M D et al (2001). Comparative cannabis use data. British Journal of Psychiatry, 179: 175–177, accessed November 2011: http://bjp.rcpsych.org/content/179/2/175.3.full

9 MacCoun, R J (2011), What can we learn from the Dutch cannabis coffeeshop system? Addiction, 106: 1899–1910.

10 MacCoun, R J (2011), What can we learn from the Dutch cannabis coffeeshop system? Addiction, 106: 1899–1910.

11 Greenwald, G (2009). Drug Decriminalization in Portugal: Lessons for Creating Fair and Successful Drug Policies. Cato Institute.

12 White House Office of National Drug Control Policy. (2010). Drug Decriminalization in Portugal: Challenges and Limitations. Accessed November 2011 at
www.whitehouse.gov/sites/default/files/ondcp/Fact_Sheets/portugal_fact_sheet_8-25-10.pdf

13 European Monitoring Center for Drugs and Drug and Addiction. (2011). Drug Policy Profiles- Portugal. Accessed November 2011 at www.emcdda.europa.eu/publications/drug-policy-profiles/portugal

14 European Monitoring Center for Drugs and Drug and Addiction. (2011). Drug Policy Profiles- Portugal. Accessed November 2011 at www.emcdda.europa.eu/publications/drug-policy-profiles/portugal, page 24.

15 “Substance Abuse and Treatment, State and Federal Prisoners, 1997”. BJS Special Report, January 1999, NCJ 172871. www.ojp.usdoj.gov/bjs/pub/pdf/satsfp97.pdf

16 Beau Kilmer, Jonathan P Caulkins, Rosalie Liccardo Pacula, Robert J MacCoun, Peter H Reuter, Altered State? Assessing How Cannabis Legalization in California Could Influence Cannabis Consumption and Public Budgets, RAND, 2010.

17 MacCoun, R, Pacula, R L, Reuter, P, Chriqui, J, Harris, K (2009). Do citizens know whether they live in a decriminalization state? State cannabis laws and perceptions. Review of Law & Economics, 5(1), 347–371.

18 For a discussion see MacCoun, R, Pacula, R L, Reuter, P, Chriqui, J, Harris, K (2009). Do citizens know whether they live in a decriminalization state? State cannabis laws and perceptions. Review of Law & Economics, 5(1), 347–371.

19 Beau Kilmer, Jonathan P Caulkins, Rosalie Liccardo Pacula, Robert J MacCoun, Peter H Reuter, Altered State? Assessing How Cannabis Legalization in California Could Influence Cannabis Consumption and Public Budgets, RAND, 2010. And see Kilmer, Beau, Jonathan P Caulkins, Brittany M Bond and Peter H Reuter. Reducing Drug Trafficking Revenues and Violence in Mexico: Would Legalizing Cannabis in California Help? Santa Monica, CA: RAND Corporation, 2010. www.rand.org/pubs/occasional_papers/OP325. Also available in print form.

Prepared 8th December 2012