Challenging Mr. Costa's opening remarks
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The head of UNODC often claims that the evidence is on his side, calling on his opponents to challenge him. This time we challenge his arguments, focusing on the 6 "hard facts" he presents as the achievements of the drug control system.
“We should be proud of these achievements and advertise them loud and clear: few United Nations Conventions have delivered similarly impressive results. I do not go as far as claiming that these outcomes, especially the ones that occurred in the past 10 years are the result of the UNGASS process. Certainly there is a strong statistical and chronological correlation. Whether this is a coincidence, or a cause-effect relation, as a social scientist I cannot tell. Whatever the cause, the result is what counts – and the evidence shows that for all drugs, there are signs of market stability,” said Mr. Costa.
This statement is a very smart one, at the same time very controversial: it claims the drug control system produces impressive outcomes, without claiming that there is a causal link between the UNGASS process and these results. But actually the evidence neither shows that the statements advertised as “hard facts” are really so impressive, nor that they are produced by the drug control system. I think the real investigation starts at the border Mr. Costa is hesitant to step across:
(1) First, we should see if the relative “market stability” of drugs – compared to licit drugs - is really the result of the international drug control regime or not.
(2) Second, we have to weigh up if the outcomes deserve to be called real achievements (did they improve the lives of people) and if they outweigh the unintended consequences produced by the drug control system.
(3) Third, we should see if there are any alternatives of the current drug control system with more benefits and less unintended consequences, able to contain the prevalence of problem drug use in an acceptable level without violating human rights, creating a huge black market and public health burden.
Here are our comments on the 6 "hard facts" presented by Mr. Costa in his opening speech at the 51st Session of the Commission on Narcotic Drugs (CND).
1. “Illicit drug use has been contained to less than 5% of the world adult population, as opposed to 5 or 6 times this proportion for people addicted to tobacco or alcohol”.
Yes, it is true that illicit drug use is not as much wide spread as the use of some licit drugs, like tobacco or alcohol. There is a lucrative conclusion that these rates are the direct consequences of the prohibition of substances on one side, and the legal regulation of other substances on the other. But his is not the case. First, tobacco and alcohol have been used by a similarly large or even larger proportion of the world population before the creation of the international drug control system than today, and drugs like cannabis, cocaine or heroin have been used by a smaller proportion of the population in most countries before prohibition than today. The starting points and end points are quite different. All these substances have completely different historical, epidemiological and cultural backgrounds, so it is a robust oversimplification of a complex problem to contrast the global prevalence rates of tobacco and cannabis and say that the distinction is the result of different international control schemes introduced hundred years ago. While tobacco smoking was a fairly widespread behavior in Europe in the end of the 19th Century, cannabis smoking was not – even if both substances were legally available. Actually in most developed countries the prevalence of illicit drugs showed a significant and measurable increase in the past decades, especially if we compare them to pre-prohibition rates, while the prevalence of tobacco smoking is decreasing sharply despite its legal availability. Relatively few people injected heroin, snorted cocaine or smoked crack in the beginning of the 20th century, when people had legal access to these drugs, compared to our days, when these drugs are prohibited but millions of people break the law and use them.
Second, it is misleading to define the core of the problem as drug use per se. If we talk about the alcohol problem we don’t refer to people who drink a glass of wine after a tasty Sunday lunch, or drink a bottle of beer after an exhausting day in the workplace. But if we talk about illicit drugs, we fail to make any distinction between simple use and abuse, recreational consumption and addiction, responsible and risk taking behaviors. However, the “hard facts” show us that the vast majority of people who use illicit drugs do not experience significant social or health problems because of their drug use. The controlled, integrated use of mind altering substances is the rule, and not the exception, even in the case of some of those perceived very dangerous by society, like cocaine. This was the conclusion of a report of the experts mandated by the World Health Organization (WHO) to carry out the largest scale study ever done on the social and health consequences of cocaine use (read more about it on the TNI website). No surprise that this study was suppressed by the UN after the U.S. government threatened its officials to cut off funds. How can Mr. Costa call a policy evidence based when it is not based on evidence but on the fear to loose the cash cow? A decent drug control system should target the problems and not create them: we know from research that several harms experienced by drug users and society are not resulted by the psycho-pharmacological effects of drugs, but by stigma, marginalization and criminalization.
Third, Mr. Costa’s argumentation here fells into the category called the “black-and-white-fallacy”: he sees only two ways forward, a total war on drugs or selling drugs from the shelves of supermarkets, tertium non datur. He plays with a dangerous dialectic of “the world free of drugs” and “the world of free drugs” – both of them are nonsense, non of them appear on the agenda of any relevant organizations. Very few people want to create a free, unregulated market of drugs and repeat the mistakes of tobacco regulation, and there are also very few people honestly believe in the prospect of a drug free society. We witnessed a huge increase in tobacco use and related harms in the last century, but not because tobacco was legal but because of the way it was regulated: free trade, aggressive marketing, lack of consumer protection and prevention measures. Countries which introduced legal and public health measures to limit the supply and demand of tobacco also witnessed a more than significant reduction in the use of tobacco in the last decades – not with criminalizing users and prohibiting the sale of the substance, but with changing the taxation system, banning advertising, limiting the space of consumption and providing effective help for those who want to stop. WHO designed a framework for national governments to regulate tobacco without the intention to eradicate tobacco from the earth or push its market underground. This framework seems to work, and there is no reason to suggest that it wouldn’t work mutatis mutandis with cannabis for instance.
Mr. Costa intentionally creates fear in its audience calling its opponents “pro-drug lobby”, generating a feeling that the reform movement wants to set up heroin vending machines on the streets or in schools. He would never mention heroin prescription in Switzerland as one successful alternative of the zero-tolerance approach. He would never acknowledge that Switzerland witnessed a major decrease in the incidence rates of heroin use after it introduced and scaled up heroin maintenance programs, or that in the Netherlands less young people have used cannabis than in the United States. The supermarket-model is actually promoted by a very small minority in the drug reform movement, most of the activists labeled as “pro-drug” are actually very concerned about the social and health risks of drug use and are in favor of strict measures reducing these risks, without stigmatizing and criminalizing the users. The picture is not black-and-white, there are feasible alternatives of zero-tolerance inside and outside of the parameters and perimeters of the drug conventions: the question is if we perceive conventions as holy texts overwriting science and human rights, or we consider them as results of political decisions restrained by the knowledge and prejudices of the age when they were adopted, therefore from time to time we need to adjust them to emerging scientific evidence and human rights needs.
2. “There are no more than 25 million problem drug users – that’s less than 0,5% of the world population. There are more people affected by AIDS.”
The question Costa fails to ask again is the same: how did international and national policies based on drug conventions and related documents influence problem drug use? Without asking this question these numbers don’t mean anything. In the United States, the birthplace of prohibitions, the typical opiate addict was a middle aged, middle class white lady before the prohibition, opiate use in itself was quite limited and mostly appeared in the form of opium smoking. However, after prohibition was introduced, a new, more risky mode of use, heroin injection spread all around the country, and injecting drug users were increasingly marginalized and suffered from ills relatively unknown before: infectious diseases, vein infections, overdose death and so on. Studies on heroin use in the twenties showed that these harms did not appear among the patients of heroin maintenance clinics, and similarly, they are rarely experienced by the clients of current heroin prescription programs based in the Netherlands, Switzerland or elsewhere. The explanation is that many problems contributed to drug use are actually the results of black market insecurity, stigma and marginalization. If the users of very addictive drugs like heroin are socially integrated they have much better chances to avoid these problems and even to quit use in the longer term (30% of the patients participating in the Swiss heroin prescription programs drop out after three years because they choose to enter abstinence-based treatment).
It is hard to call it other than an astonishing impudence to simply compare the number of problem drug users and the number of people living with HIV/AIDS, without mentioning the clear causal relation between repressive drug policies and the spread of blood born infections. There are 14 million injecting drug users in the world, in some countries 90% of them are living with HIV. In some Eastern-European and Asian countries, where access to needle exchange and opiate substitution is denied in the name of the drug conventions, IDUs constitute the vast majority of PLWHA, and the epidemic is spreading with an unprecedented speed. In Ukraine for example, 1.5% of the population is living with HIV/AIDS, the majority of new transmission can be attributed to sharing injection equipment. Instead of condemn these countries for violating the human rights of people who use drugs and urge them to introduce lacking services, Mr. Costa is more concerned about pop stars smoking cannabis or snorting cocaine, as if they would be responsible for an artificial creation of demand for these drugs among young people. He fails to mention that there is a huge gap between treatment demand and access to treatment among problem drug users, especially in developing countries: 80% of problem drug users live in developing countries, but 90% of methadone substitution programs work in developed countries. The self-reported increase in the number of people treated for drug abuse in many countries can be largely contributed to ineffective and/or abusive forms of interventions – no reason to celebrate that.
This gap is not accidental: Russia for example has been opposing to provide legal access to opiate substitution therapy for IDUs on the basis of the drug conventions, and neither INCB nor UNODC challenged or condemned it for doing so. UNODC praises Sweden for its “successful” drug policy without mentioning that IDUs have very limited access to substitution and needle exchange because of repression (there is only one needle exchange program in the whole country), and the rate of problem drug use is two times higher in Sweden than in the Netherlands, a country accused of being “Europe’s Afghanistan” by Mr. Costa. Many countries often mask labor camps as rehabilitation centers, humiliation and abuse as treatment, paternalistic and discriminative surveillance methods as prevention.
3. “Deaths due to drugs are limited to perhaps 200.000/yr, namely 1/10 of those killed by alcohol and 1/20 killed by tobacco.”
The majority of drug related deaths are contributed to licit drugs indeed, and there are many reasons why is it so – but there is no evidence that this is due to the protective power of prohibition, on the contrary, punitive drug policies create a social environment generating higher risk of death for the user. What is the explanation than? First of all, as we mentioned before, much more people used licit drugs for centuries, this very fact accumulated more health damage and death. The use of these substances is embedded to the Western civilization which marketed them aggressively all around the world for hundreds of years.
Second, regular, intensive tobacco and alcohol use is strongly associated with health problems often leading to death (lung cancer, liver cirrosis etc.) – while there are quite few evidence that the majority of illicit drugs can be linked to similar health consequences, even if used for a longer term. There is no strong evidence that the regular use of the most popular illicit drug, cannabis can lead to nearly as severe health damage among healthy adults as either alcohol or tobacco use. The largest study ever done on the effects of marijuana smoking on respiratory health, conducted by Dr. Donald Tashkin (UCLA), could not find a causal link between lung cancer and the even most intensive use of cannabis. It doesn’t mean that the use of illicit drugs is safe (cannabis smoking can increase the risk of bronchitis for example), but it means that the intensive use of alcohol and tobacco belong to the most risky behaviors a human being can be engaged of – and still they are legal. This contradicts the statement made by Costa: “drugs are illegal because they are dangerous”. Why the hell is alcohol and tobacco legal than? We know that once alcohol was also prohibited by the federal government of the U.S., but people realized that banning the substance could not minimize use rates in the longer term, while increasing the risk of death, disease and crime.
There are illicit drugs with higher hazards than cannabis, for example heroin. However, many fatalities among people who use these substances are the result of the black market: there is no quality control, substances purchased in the illicit market can be poisonous, their potency is unknown by the customer, who rarely have access to harm reduction information, peers are afraid of calling the ambulance in case of emergency. The illicit market pushes users to consume more concentrated, more addictive substances (the so called iron law of prohibition), which have a greater potential of overdose.
But overdose is also a controversial issue. Even heroin, the drug perceived as one of the most dangerous substances, has much less potential for an overdose in its pure form than most people think. According to a study published in the prestigious journal Addictions, Darke and Zador argue that heroin very rarely leads to death in itself, the majority of heroin overdose cases can be actually attributed to combined use with alcohol or tranquillizers, and rarely happen with methods of use other than injection, for example smoking (the most preferred form of use before prohibition). A heroin overdose can last for hours, and could be reversed in many cases if medical help arrives in time. Unfortunately people often don’t call the ambulance for their overdosed peers in time because they are afraid of being arrested. Again, in a controlled environment like the supervised consumption rooms operated by many towns in Europe, the risk and prevalence of lethal overdose is almost zero. A question arises from this fact: who kills more people, drug abuse or the abuse of drug policy? We have to add to the number of deaths related to drug policy abuse those killed by violent turf wars and police crackdowns, or by judicial and extrajudicial executions in the name of the drug war. According to a recent report of the International Harm Reduction Association (IHRA), “of the sixty-four ‘retentionist’ countries that continue to use capital punishment, half have legislation applying the death penalty for drug-related offences. Civil and Political Rights (ICCPR) states that the penalty of death may only be applied to the ‘most serious crimes’. Over the past twenty-five years, human rights bodies have interpreted”.
4. “World-wide, drug cultivation has been slashed (with the obvious exception of Afghanistan where the issue is insurgency, more than narcotics)”
According to the data provided by UNODC the cultivation of some psychotropic plants has been slashed indeed in some countries in the past 10 years, for example opium cultivation in the so called Golden Triangle (South-East Asia). However, this doesn’t mean that we are winning the global war on drugs. First, the data provided by the World Drug Reports is based on the self-reports of member states, so professionals often doubt their credibility even in those regions reporting a significant reduction of crop cultivation. It is very questionable for example that coca production has been slashed in Latin-America when we see a huge influx of cocaine to North-America and Europe, increasing from year to year. According to latest reports, drug lords have already built a navy from submarines to transfer the substance to their destinations: this requires incredible resources of cocaine and amazing logistic capacities. The so called Plan Columbia of the U.S., aiming to eradicate coca bush cultivation in the Andean region through aerial spraying, pushed the coca growers to more hidden places, for example national parks, causing substantial damage in the environment. Forced eradication campaigns destroy the livelihood of many poor farmers in Latin-America and Asia, and the so called alternative development programs are often only beauty-spots hiding the desperate lack of real alternatives for indigenous people.
Mr. Costa calls Afghanistan an “obvious exception”, where the problem is insurgency and not drug related. This may sound good for conscience sake, but for God’s sake, how can you call a country exception when this country is responsible for more than 90% of the total opium production of the world? I would rather say that the insurgency and drug problems are interrelated in Afghanistan. After the invasion of Afghanistan every year marked a record harvest, the annual value estimated to be amount to more than 3 Billion USD, and the opium industry employs 12% of the Afghan population. In the 70s the opium cultivation was reduced and regulated in Turkey, but it moved to Burma, after it was eradicated in Burma, it moved to Afghanistan, and you can be dead sure that even if the insurgency problem will be solved in the nearest future (which is not probable according to a report released by World Bank), and a strong central government can eradicate opium cultivation (like the Talibans did), it will find a new region to pop up. Unfortunately, there are many war zones and instable countries all around the world.
This is something researchers call the Balloon-effect: if you slash drug cultivation in one country, it will pop up soon in another one. Why? Because there is a stable demand for these drugs, and you can do whatever eradication campaigns you want, if there are people ready to pay good prizes for these substances on the streets of our cities, there will be always traffickers and cultivators seduced by the promise of big profits. A farmer who faces starvation, poverty, who cannot educate his children or buy cloths for his wife, will always prefer the cultivation of a crop producing much more profit than legal plants. Eradication might work in an ideal world without poverty and despair, but not in this world. And there are other forms of the balloon-effect: traditional drugs can be replaced by new designer drugs, drug use scenes can be replaced by another geographical location, one social group of drug users can replace another etc.
Mr. Costa acknowledges the existence of the Balloon-effect, but he proposes to solve it with the old tough-on-drugs way: “to foster cooperation, for example by promoting counter-narcotic intelligence sharing”. We can learn from history that this is a blind alley, the criminal justice system proved to be unable to suppress the supply and demand for psychotropic substances. The maximum we can do is to regulate and control the access to them, in one way or another. If we don’t do that, criminals are more than glad to do so. Mr. Costa says that he can accept the arguments raised by his opponents as an economist, but he cannot accept the legal regulation as a solution, as “it certainly will increase the damage to health of individuals and society”. He is right that the decision to be made on the future of global drug policies is an ethical decision. But he is not right about the moral value of the global drug control regime, which proved to be unable to protect the health of individuals and society, it became an obstacle to develop a regulation system that can really do so. Some people say our societies are not matured enough for drug policy reform, but I think the world is not matured enough to be drug-free. If we can see – as Mr. Costa sees – that we have to coexist with the markets of these drugs, and it is not feasible for the longer run to suppress the production, trafficking and use of these substances, especially not without causing more harm than good, than the only ethical, morally acceptable solution should be to create a legal regulation system based on the recognition of the legitimacy of the use of these substances. This does not mean that we give up the goal to protect public health, or that we promote the use of these drugs, on the contrary, we take responsibility to regulate, control and limit the drug markets. There are probably several ways to do so, some of them can prove to be effective, others will fail to protect the health and security of people. Probably different drugs need different regulatory systems, just as different societies, cultures, regions do. There is no universal panacea. We have to open space for innovative social experiences to identify best practices in the local, national and international level, utilizing the experiences with legal drugs and commodities, learn from the mistakes of the past.
5. “Adherence to the international drug control regime is practically universal, with the principle of shared responsibility unanimously accepted.”
This may be true to a certain extent, but still, the global drug control regime is not nearly as stable and firm as its proponents like to make it seem. There are some new signs of disagreements and gaps in the regime Costa fails to mention: the Bolivian government for instance, in alliance with other Andean governments, plans to challenge the international regulation of coca leaf, creating a legal market for coca products and abolishing eradication campaigns against indigenous people who grow coca. Some European countries have been experimenting with safer injection sites, heroin prescription and coffee shops for a long time, pushing the envelop of drug conventions. The medical use of marijuana has growing acceptance among health professionals, there are countries and states where it is legally available for patients who need it. Harm reduction as a new philosophy and practice of dealing with drugs and risks came of an age and gains ground among governments threatened by the HIV/AIDS epidemic generated by repressive drug policies as an unintended consequence.
The surface may seem undisturbed, but in the depths of the water there are signs of growing turmoil. If you work in the drug policy field and walk with open eyes and mind, you can obviously observe that the support of the UN drug control regime is fading away in civil society, which is often an indicator of the upcoming earthquake in the governmental level. It is only the question of time that the current system will collapse like alcohol prohibition did, which was seen firm as steel by its supporters a few years before it was abolished. Probably global drug prohibition will need more time to disappear than alcohol prohibition, but we can speed up this process and prevent more sufferings and crime.
6. “The regulatory system of production, distribution and use of drugs for medical purposes, functions well.”
This statement is a far cry from reality, a view from an ivory tower, not to mention that this is a (false) interpretation of the situation and not a “hard fact”. We know from research that 80% of the world population has no access to morphine-based medicines, many of them are dying at this moment in unnecessary pain. As Senlis Council, an international drug policy think thank reports, “in less economically developed and emerging countries, patients’ demands for morphine and other poppy-based medicines are currently significantly underestimated because of a self-perpetuating cycle of medical under-prescription and restrictive regulations which inhibit countries’ ability to import morphine”. The strict and inflexible system created by the UN conventions is responsible for this. Instead of eradicating poppy fields in Afghanistan, they could be licensed and purchased by the government for medical purposes (including the supply of heroin maintenance programs), which could ease the shortage in medicines, cut off the supply and demand of illicit heroin trade and provide safe and legal livelihood for farmers.
It is also very hard to even study the medicinal potential of drugs like marijuana, LSD or MDMA. Although UN conventions acknowledge medical demand for illicit drugs as legitimate, and many evidence show that society could benefit from it, governments often harass patients who use and doctors who prescribe these substances. Governments often challenge the medical potential of marijuana, saying that there is not enough scientific evidence to use this substance as a medicine, but at the same time authorities refuse to fund or arbitrary obstruct research on medical marijuana. In those states of the U.S. that legalized medical marijuana, dispensaries selling the product are threatened or raided by the federal drug agency. Sessa and Nutt in the Journal of Psychopharamacology describe the obstructing impact of politics and regulation on the research on the medical use of MDMA, drawing the conclusion that restrictions may prevent the development of exciting discoveries in psychiatry and neuroscience, including spotting a potential treatment for mental disorders.