Home Affairs Committee - Drugs: Breaking the CycleWritten evidence submitted by The World Federation Against Drugs (DP 158)

The World Federation Against Drugs (WFAD) is a multilateral community of nongovernmental organisations and individuals. Founded in 2009, the aim of WFAD is to work for a drug-free world. The members of the WFAD (representing Europe, North and South America, Africa, Asia and Oceania) share a common concern that illicit drug use is undercutting traditional values and threatening the existence of stable families, communities, and government institutions throughout the world.

The work of the WFAD is built on the principles of universal fellowship and basic human and democratic rights. We believe that working for a drug-free world will promote peace and human development and dignity, democracy, tolerance, equality, freedom and justice.

The WFAD adheres to the Declaration signed at the World Forum Against Drugs signed in Stockholm, Sweden in September of 2008.

Drug users have a right to the expectation of living drug free and having the opportunity to lead productive, working lives. The WFAD recognises that civil society has the right to fact-based information about the risks and damage caused by drugs. All people have the right to be protected from the harms created by drug use.

The WFAD adheres to Article 33 of the United Nations Conventions on the Rights of the Child that states:

“States Parties shall take all appropriate measures, including legislative, administrative, social and educational measures, to protect children from the illicit use of narcotic drugs and psychotropic substances as defined in the relevant international treaties, and to prevent the use of children in the illicit production and trafficking of such substances.” September 1990

The World Federation Against Drugs (WFAD) supports strategies that seek to reduce illegal drug use and the serious negative consequences that result from drug use. WFAD works to reverse the drug abuse epidemic by supporting the drug-free goal and the drug abuse prevention treaties of the United Nations. This approach is grounded in science, health, security and respect for human rights and dignity.

It deplores the “war” against these treaties and the values they represent.

Submission

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

1. Fiscally responsible drug policies seek to reduce the use of illegal drugs via prevention and recovery, as well as the harms of illegal drug use. In this context the UK’s revised 2010 drug strategy is a fiscally responsible and appropriate response to the drug problem faced by the UK and internationally.

2. In relation to “science”, strategies that seek to normalise drug use and to reduce the “harms” resulting from illegal drug use through legalisation and decriminalisation of illegal drugs are poorly founded and pose a threat to public health and to public safety. The consequence is that illegal drugs becoming more widely and cheaply available, is increased drug-caused harm. This is not simply conjecture. It is based on recent experience: the rapid rise in death rates due to the non-medical use of prescription opioids drugs that parallels their increased availability.1

The rising number of drug deaths in the UK, particularly where methadone is implicated2 (rising from 7.2 to 9.9 per thousand since 2006), also point to the danger of failing to balance “harm reduction” with prevention policies.

The independence and quality of expert advice which is being given to the government

3. WFAD is troubled by the reference to the Global Commission on Drug Policy and that the Home Affairs Committee’s public call for evidence into this inquiry is in line with its recommendations.

4. The Global Commission has mischaracterised current Drug Policy and its report is based on inaccurate information.3

The report states that 40 years ago United States President Richard Nixon declared the “war on drugs.” But Nixon used the word “war” to describe the nation’s efforts to combat the rising tide of drug abuse—specifically to combat the epidemic of heroin addiction.4

The Nixon Administration repealed federal mandatory minimum sentences for marijuana, and on June 17, 1971, for the first time in US history, the long-dominant law enforcement approach to drug policy, known as “supply reduction”,5 was augmented by an entirely new and massive commitment to prevention, intervention and treatment, known as “demand reduction”. When President Nixon announced this new, balanced approach to drug policy it received full bipartisan support. Since that time, the idea of taking a balanced approach has enjoyed strong and sustained support through the terms of the seven US Presidents that followed.

The term “war on drugs” is only used today by those who mischaracterise history and US drug policy.

In fact, US drug policy is rooted in the conviction that singly neither supply nor demand reduction can succeed, but that together they yield significant benefits that neither can achieve alone. A careful look at history shows that it would be more accurate to say that Nixon ended, rather than that he launched, the “war on drugs.”

5. Global Commission claims that there is a “taboo” on debating and discussing alternative drug policy approaches and strategies. On the contrary, the balanced approach of supply reduction and demand reduction has been frequently and fully debated, discussed, and modified over time.

6. WFAD strongly supports the United Nations Office on Drugs and Crime (UNODC) which is committed to coordinated international efforts to reduce illegal drug use with an effective restrictive drug prevention strategy that balances demand reduction (prevention, treatment and research) with supply reduction (law enforcement focusing on illegal drug trafficking). Working with governments, other UN bodies, and international organisations, the International Narcotics Control Board (INCB) works to prevent illicit drug manufacturing, diversion and trade of drugs of abuse while promoting legitimate controlled medical use of these drugs when they medically approved. The drug policy laid out by these UN organisations has been followed in countries across the globe for many decades.

Its success is a stable global adult drug use of less than 5%—by comparison with legal tobacco use at 30%, sharply declining drug use in the US and declining drug use in Western Europe. The Commission however rests its argument on misleading and wrong data of rising global drug use that the UNODC does not recognise.6

7. The Global Commission’s Reckless Proposal Advocating Drug Legalisation—The third recommendation of the Global Commission is to: “Encourage experimentation by governments with models of legal regulation of drugs (with cannabis, for example) that are designed to undermine the power of organised crime and safeguard the health and security of their citizens.”

No description is given of how legalisation would be structured. Please see the issues that the report does not even attempt address in section on legal highs below.

In its 1993 annual report, the International Narcotic Control Board (INCB) of the United Nations asked many similar questions about drug legalisation.8 Since that time, these vital questions have gone unanswered. The Global Commission offers no thoughtful answers, recklessly proposing that countries turn themselves into guinea pigs for “experimentation” with legalisation.7 The unarticulated consequence of the Global Commission’s recommendations is that illegal drugs would become more widely and cheaply available, inevitably leading to increased drug-caused harm.

The Commission report is not a serious, carefully considered proposal, but a simplistic, dogmatic approach to a complex problem that carries with it a host of unintended consequences. The social and economic costs to humanity would be profound, with its greatest impact upon the helpless, the innocent, and the naïve, while serving the causes of negligence and greed. It would be up to a subsequent generation to correct such a folly.

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

8. When the report’s radical calls for new drug policies get down to specifics, the solutions offered involve small numbers of users (eg heroin-assisted treatment, syringe access “and other harm reduction measures”). One can debate the wisdom of such measures, but they do not constitute legalisation and are not scalable to the size of the current drug problem. Nor do they offer hope of rehabilitation to the drug user, only palliative care. Keeping the use of many addicting drugs illegal is a powerful and effective public health strategy.8

The relationship between drug and alcohol abuse and the comparative harm and cost of legal and illegal drugs

9.The High Costs of Drug Legalisation: Lessons from Alcohol and Tobacco—It is true that current drug policy needs to be improved and that both treatment and prevention need to play major roles in future drug policies. However, the mere fact that current policies leave much to be desired does not mean that legalisation is a good idea. If currently illegal drugs were made legal, rates of use, abuse and dependence would increase along with the many related social costs including unemployment and under-employment as well as the costs of health care.

10. The Global Commission strikingly disregards the multiple adverse consequences created by drug dependence itself, including harm associated with marijuana use, by focusing only on the “harms” imposed by the criminal justice system. The notable omission of marijuana’s effects on cognitive, medical, psychiatric, fertility, educational, employment, parenting, workplace and highway and safety leads to the inevitable conclusion that the Global Commission either chose to ignore these long-standing considerations of marijuana policy or lacked the necessary expertise for carving an informed position.

11. When global rates of substance use and their availability are considered, estimates of worldwide alcohol and tobacco use expose the stark difference between use of legal and illegal drugs. An estimated 40% of the world’s population aged 15 and older consumed alcohol in 20049 while an estimated 30% of the world’s adult population smoked tobacco in 2000,10 a drug/delivery system with few psychological, albeit major medical risks. In comparison, about 4.8% of the world’s population (210 million) aged 15 to 64 used any of the thousands of illegal drugs including marijuana in 2009.11

It is difficult to look at these numbers and not conclude that the illegal status of marijuana, heroin, cocaine, and methamphetamine keep use rates far below those of legal drugs. Any one of these drugs, alone or combined with others, has the potential for being as widely used as alcohol and tobacco. Current statistics from the US demonstrate this.. The annual economic social costs to the US for all illegal drug use combined are outweighed by those of legal drugs, including both alcohol and tobacco. Alcohol use costs the US an estimated $235 billion.12

12. Tobacco use costs over $193 billion each year, a combination of $96 billion in medical costs and $97 from lost productivity.13 The cost of all illicit drugs combined is $193 billion annually.14 The majority of these costs come from lost productivity ($120.3 billion), followed by crime including arrest, prosecution and incarceration ($61.4 billion) and health costs ($11.4 billion).

13. It is important to note that crime-related costs comprise only 31% of the total drug costs. Medical conditions are more prevalent in patients (and their families) with a diagnosis of abuse or addiction, and yet these seemingly non-drug related medical sequelae are not factored into the health care burden.

14. Legalising a currently illegal drug does not mean that everyone will become a user of that drug any more than legal alcohol and tobacco mean that everyone uses them. However, there are many ways to successfully reduce drug use in addition to making drugs illegal. While the efforts in recent decades to curb alcohol and tobacco use have resulted in impressive reductions in use and abuse, in both cases legal actions have been prominent in these efforts. In addition, even after decades of education and prevention efforts the levels of use of each of these two legal drugs far surpass those of all illegal drugs combined.

15. If some or all of the currently illegal drugs were legalised the adverse effects of the use of these drugs would be unequal in society. The largest increases in use would likely be among young people, especially teenagers, the disadvantaged, the unemployed, the struggling student, and the mentally ill, all of whom now have higher rates of drug use initiation.

16. Prescription Drug Abuse—The Global Commission ignores the problem of non medical prescription drug use, the defining drug problem of the 21st century. The rapid spread of prescription drug abuse, and the thousands of resulting deaths, underscores the fallacy of the Commission’s core argument for legalisation, and its watered-down sidekick, decriminalisation. The Global Commission suggests that illegal drug use is reasonably safe and that only law enforcement creates large social costs. Further it suggests that it is the illegality of these drugs that promotes their use and creates violence.

Both production and abuse of prescription opioid drugs have risen worldwide, as has the non medical use of prescription drugs. Although these drugs are prescribed to individuals for medical use, they are nonetheless widely diverted for non medical purposes. Prescription drug abuse is the fastest growing drug problem in the US.

17. This simple naturalistic experiment of prescription drugs forcefully refutes the claim of the Global Commission that drug abuse is caused by, or worsened by, the criminal justice system. There is no mafia in the prescription drug abuse epidemic. In reaching a solution to the escalating problem of prescription drug abuse, there are many roles in which the criminal justice system should be involved, from law enforcement, to prevention of physicians from profiting from running prescription “pill mills”, to prohibiting patients from giving away or selling their prescription drugs.

It is impossible to believe that legalisation would reduce the problem of the non medical use of prescription drugs or that the public health and public safety would be promoted by removing the criminal justice system from a balanced effort to reduce the nonmedical use of these drugs. Legalisation or decriminalisation of this menacing non medical drug use would clearly worsen the problem.

The contemporary prescription drug problem reinforces the commitment of the global community and the United Nations to balanced, restrictive drug policies that include both law enforcement and treatment.

The availability of legal highs and the challenges associated with adapting the legal framework to deal with new substances

The existing legal framework has not needed adapting to deal with new substances. In the UK they are progressively added to the list of controlled drugs. The UK government is to be congratulated for being at the fore front of imposing “generic” bans on newer products such through the cathinone ban. The Global Commission by contrast does not address this issue responsibly at all. It does not ask:

Which drugs would be legalised?

Would there be any limits to legalisation, or would the gates permitting use be thrown wide open?

Who could buy drugs?

Would the use by children and adolescents be prohibited, as is currently the policy for alcohol and tobacco products? If so, how would diversion to youth be prevented?

How would young developing brains be protected from currently illegal drugs as emerging brain development neuro science suggests is critical?

Would drug production, regulation, chain of custody and taxation be regulated as are other consumer products?

Could drugs be mixed with other products (eg marijuana in brownies, amphetamines in breakfast cereal, etc)?

Would these drugs be legal only if produced by legitimate facilities, or would anyone be permitted to produce them at home?

What would the policy response be to newly emerging drugs with significant psychiatric or health consequences, such as “Krokodile”, mephedrone, methylenedioxypyrovalerone (MDVP) or naphyrone?

A renewed focus on real prevention and effective treatment is needed

18. Ceasing use of illegal drugs is the optimum public health goal for youth and for all individuals. One quarter of Americans who begin using any addictive substance before age 18 develop an addiction.15 Calls for drug legalisation, based on the premise that the vast majority of drug users are problem-free, contradicts and undermines prevention messages targeting youth. Notably missing from the Global Commission’s policy statement is the promising approach of healthcare procedures that incorporate opportunistic drug screening, brief interventions, and referral to treatment (SBIRT) into regular medical appointments or emergency situations for all age ranges.16

Policies intended to reduce drug use by the government providing drugs to users such as heroin to heroin addicts makes as much sense as a policy to reduce lung cancer by the government providing cigarettes to cigarette smokers.

Conclusion: Teaming Treatment and Prevention with the Criminal Justice System—A Drugs Policy Paradigm for the Future

The Global Commission seeks to remove the criminal justice system from drug policy. This proposal is based on the assumption that the future of global drug policy is a choice between law enforcement and treatment. But the future of global drug policy is finding better, more cost-effective ways for the combining law enforcement efforts with those of prevention and treatment—together achieving goals that none can achieve alone. A strong, balanced drug prevention policy that includes, but does not rely only on the criminal justice system, will effectively reduce illegal drug use. By pitting the criminal justice system against treatment and prevention approaches, the Global Commission shifts the debate into a false dichotomy.

Yet successful innovations in the use of the criminal justice system to reduce drug use include Drug Courts, Hawaii’s Opportunity Probation with Enforcement (HOPE), and the 24/7 Sobriety Project17— programs that provide close monitoring of high-risk repeat offenders in the community, operate strict, comprehensive rules and regulations to help drug-using offenders become and remain drug-free. Drug Courts in the US, from one Court in Miami-Dade County, Florida in 1989 now number over 2,500 in 2010.18

They are just three examples of how the criminal justice system can use leverage to help individuals with drug and alcohol problems become and stay drug-free. This new paradigm holds the promise of changing dramatically the way drug use is approached within the criminal justice system.19

January 2012

1 Paulozzi, L J, Weisler, R H, & Patkar A A (2011). A national epidemic of unintentional prescription opioid overdose deaths: How physicians can help control it. Journal of Clinical Psychiatry, 72(5)589–92. Epub 2011 Apr 19. PubMed PMID: 21536000.

2 www.ons.gov.uk/ons/rel/subnational-health3/deaths-related-to-drug-poisoning/2010/stb-deaths-relatedto-drug-poisoning-2010.html

3 www.globalcommissionondrugs.org/Report

4 Nixon, R (1979, June 17). Special message to the Congress on drug abuse prevention and control. Online by Gerhard Peters and John T Woolley, The American Presidency Project. Retrieved October 26, 2011 from www.presidency.ucsb.edu/ws/?pid=3048

5 Nixon, R (1979, June 17). Special message to the Congress on drug abuse prevention and control. Online by Gerhard Peters and John T Woolley, The American Presidency Project. Retrieved October 26, 2011 from
www.presidency.ucsb.edu/ws/?pid=3048
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www.samefacts.com/2011/06/drug-policy/who-started-the-war-on-drugs/

6 www.cps.org.uk/publications/factsheets/global-commission-on-drug-policy-statistics-wrong-andmisleading/

7 International Narcotics Control Board. (1993). 1992 Annual Report. Retrieved September 9 2011 from
www.incb.org/pdf/e/ar/incb_report_1992_1.pdf

8 United Nations Office on Drugs and Crime. (2011). World Drug Report 2011. Vienna: United Nations Office on Drugs and Crime. Retrieved September 8, 2011 from
www.unodc.org/documents/data-andanalysis/WDR2011/World_Drug_Report_2011_ebook.pdf

9 World Health Organization. (2011). Global Status Report on Alcohol and Health. Geneva, Switzerland: World Health Organization. Retrieved September 8, 2011 from
www.who.int/substance_abuse/publications/global_alcohol_report/msbgsruprofiles.pdf

10 Food and Agriculture Organization of the United Nations. (2003). Projections of Tobacco Production, Consumption and Trade to the Year 2010. Rome: Food and Agriculture Organization of the United Nations. Retrieved September 8, 2011 from
ftp://ftp.fao.org/docrep/fao/006/y4956e/y4956e00

11 United Nations Office on Drugs and Crime. (2011). World Drug Report 2011. Vienna: United Nations Office on Drugs and Crime. Retrieved September 8, 2011 from
http://www.unodc.org/documents/data-andanalysis/WDR2011/World_Drug_Report_2011_ebook.pdf

12 Rehm, J, Mathers, C, Popova, S, Thavorncharoensap, M, Teerawattananon, Y, & Patra, J (2009). Global burden of disease and injury and economic cost attributable to alcohol use and alcohol-use disorders. Lancet, 373, 2223–2233.

13 Centers for Disease Control and Prevention. (2011). Tobacco Use: Targeting the Nation’s Leading Cause of Death, At a Glance 2011. Retrieved September 8, 2011 from www.cdc.gov/nccdphp/publications/aag/osh.htm

14 National Drug Intelligence Center. (2011, April). The Economic Impact of Illicit Drug Use on American Society, 2011. Washington, DC: US Department of Justice. Retrieved September 8 2011 from
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15 National Center on Addiction and Substance Abuse at Columbia University. (2011). Adolescent Substance Use: America’s #1 Public Health Problem. New York, NY: National Center on Addiction and Substance Abuse at Columbia University. Retrieved September 8 2011 from
www.casacolumbia.org/upload/2011/20110629adolescentsubstanceuse.pdf

16 Madras, B K, Compton, W M, Avula, D, Stegbauer, T, Stein, J B , & Clark, H W (2009). Screening, brief interventions, referral to treatment (SBIRT) for illicit drug and alcohol use at multiple healthcare sites: Comparison at intake and six months later. Drug and Alcohol Dependence, 99(1-3)280–95.

17 DuPont, R L, Shea, C L, Talpins, S K, & Voas, R (2010). Leveraging the criminal justice system to reduce alcohol- and drug-related crime. The Prosecutor, 44(1), 38-42.

18 National Association of Drug Court Professionals. (2011). Drug Court History. Retrieved September 8 2011 from
www.nadcp.org/learn/what-are-drug-courts/history

19 DuPont, R L & Humphreys, K (2011). A new paradigm for long-term recovery. Substance Abuse, 32 (1).

Prepared 8th December 2012