ILLEGAL DRUGS: JUST SAY MAYBE

For an Example of How Not to Make Good Health Policy, Consider The
International Debate on Drugs

HOW should the world control the trade in and use of illicit drugs? As
an issue of science and health policy, few questions matter more. In
1998 the United Nations General Assembly held a special session in New
York which pledged the "elimination or significant reduction" of drug
production and use within ten years. An evaluation of the targets set
at that meeting takes place in Vienna this month, at a special
ministerial session of the United Nations Commission on Narcotic
Drugs. This gathering will hear that the world is no closer to meeting
its goals than it was five years ago. But instead of asking such
questions as whether the whole project may be misguided, the meeting
will almost certainly decide to redouble international efforts to
achieve the unachievable.

The framework for global drug policies is set by three UN conventions,
dating from 1961, 1971 and 1988. Between them, these conventions set
rules prohibiting, in almost any circumstances, the production,
manufacture, trade, use or possession of potentially harmful
plant-based and synthetic non-medical drugs, other than tobacco and
alcohol. Crucially, these conventions go far beyond the bounds of most
international treaties in the extent to which they dictate
signatories' domestic policies as well as international relations. For
example, the 1988 convention insists that signatories pass legislation
to make the possession of drugs for personal consumption a criminal
offence. That means they are, on the face of it, prevented from
experimenting with the idea that controlled, permitted use may be less
harmful than the side-effects of prohibition.

Plenty of non-governmental organisations (NGOs) and even some
government ministers (in private, at least) now recognise that these
treaties and the policies they encourage are the wrong way to tackle
drug abuse. Unfortunately, those arguments look unlikely to make any
headway in Vienna.

Turned Off

The arguments for a different approach have grown stronger, not
weaker, since 1998. The failure of the current policy has become much
clearer. There is no sign that government intervention has cut supply,
although it may sometimes divert it. For instance, the opium crop fell
sharply in Afghanistan in 2001, under the Taliban government, but it
rebounded last year after the American invasion (see chart).
Meanwhile, according to Francisco Thoumi, a member of Colombia's
Academy of Economic Sciences, Colombia's aggressive policies, aimed at
wiping out the coca crop, have merely led to an increase in planting
in Bolivia, where a coca grower almost won the recent presidential
election, and in Peru. There is, says Dr Thoumi, no evidence of a
decline in the availability of cocaine in the United States. Instead,
the drug's purity seems to have increased.

There is plenty of evidence of broader failure too. The UN's meeting
in 1998 set no benchmarks by which to judge progress. Success is
judged by which programmes are in place, rather than by what they
achieve. Thus a country that has plans to eradicate illicit crops can
tick the appropriate box, even if the plan eradicates nothing. (And
according to Anthony White, a British drug analyst, many countries
have not even bothered to say which boxes they have ticked.) Back in
the real world, the numbers tell a different story. Some recently
released American figures show that more land in Latin America was
planted with coca in 2002 than in 1998. Figures from the UN's Office
on Drugs and Crime (ODC) show the retail price of heroin falling in
the European Union (see chart overleaf). The use of Ecstasy among
American and Canadian high-school students is rising. And so on.

In the light of this, a few governments--mainly European, but also
those of Canada and Australia--are getting fed up with the treaties'
emphasis on zero tolerance. Instead of prohibition, they are keen to
emphasise "harm reduction": to accept that drug-taking cannot be
prevented, and instead to concentrate on reducing its consequences for
health and crime.

The relentless rise of AIDS in intravenous drug users has been an
important spur to this change of attitude. Switzerland has set up
centres where heroin users can receive daily doses, together with
medical treatment, and has seen drug-related deaths and crime diminish
as a result. Britain may return to prescribing heroin to users, as it
did until 35 years ago.

Britain has also skirted the intent of the treaties by deciding, as an
experiment in part of London, not to enforce the law banning the
possession of cannabis when an individual is carrying that drug for
personal consumption. Jamaica, Spain and Portugal have gone further,
extending such experiments to the whole country. And the Netherlands
has long been noted for its tolerance of soft drugs.

So there is a case for considering change, and for allowing a
coalition of the willing to experiment. Unfortunately, that is
unlikely to cut much ice in Vienna. The main reason is the powerful
anti-change lobby, led by the United States, whose attitudes and
actions sometimes take on the ferocity of a medieval witch hunt.

Tuned Out

The "no-change" lobby's watchdogs are the two bodies that actually
manage the treaties: the ODC, which administers them, and the
International Narcotics Control Board (INCB), which monitors breaches
of them. In its annual report, published in February, the INCB
attacked the "crusade" to encourage harm reduction. It singled out
Britain's approach to cannabis for special condemnation. The INCB did
this despite having recently received legal advice from the ODC that
harm-reduction approaches might conform with the UN treaties. The INCB
attack drew a furious retort from Bob Ainsworth, a British minister,
who complained about "the alarmist language used, the absence of any
reference to the scientific evidence on which that decision was based,
and the misleading way in which the decision was presented by the INCB".

As for the ODC, its culture is inherited from the UN International
Drug Control Programme (UNDCP), which it recently swallowed. That body
was a byword for bad management and internal strife. Two years ago,
one of its senior staff described it as a "snake pit" (and then left).
Pino Arlacchi, its last executive director, was eased out after an
auditors' report exposed serious mismanagement, and a lot of other top
staff have either departed in despair or been pushed out. In one of
several articles on the forthcoming meeting in the latest issue of the
International Journal of Drug Policy, Cindy Fazey of Liverpool
University, in England, describes the power wielded over the
organisation by the main donors, especially the United States. In her
time, she says, "punishment postings were not infrequent, to places
such as Yangon, Myanmar; Lagos, Nigeria; Dakar, Senegal...the result
is that many UNDCP staff are in constant fear of their jobs."

The ODC now has a new director, Antonio Costa, a former
secretary-general of the European Bank for Reconstruction and
Development. So things may change. But whatever the international
agencies think, plenty of countries that have signed the three
conventions are vehemently opposed to any liberalisation.

America is easily the most powerful of these. Under the presidency of
George Bush, says Ethan Nadelmann, executive director of the Drug
Policy Alliance, an American lobbying group, prospects for even modest
reform are bleaker than they were under his father's presidency.
America has the power to make life miserable for any developing
country that does not share its enthusiasm for suppressing drugs, and
does not hesitate to use it.

America is not alone, though. Islamic countries share its hostility
even to the legalisation of cannabis, as do Russia, China and Japan.
Even within the European Union, member states are split in ways that
have made it impossible for the organisation to form a common
ministerial view. Spain, Portugal and the Netherlands may be liberal,
but Sweden has long backed zero tolerance. The governments of Italy,
Ireland and France are also tough-minded. Jacques Chirac, in
particular, is an old anti-drug warrior.

In early March Greece, which currently holds the EU presidency, called
a conference to discuss EU views in advance of the Vienna meeting. It
was composed of a mixture of national representatives, free-floating
experts and NGOs. The conference, at which rationality mainly
prevailed over ideology and rhetoric, ended in anger. The French
delegation savaged the Greek hosts for daring to allow government
delegations to mix with liberal opinions, and for producing a
conference report that recorded both doubt and debate. That bodes ill
for Vienna.

Dropped In?

It is just possible, though, that the impasse can be broken. One
striking change since 1998, notes Mike Trace, Britain's former deputy
drug tsar, is that NGOs have begun to moderate their demands. Five
years ago, these lobbyists clamoured for an end to all restrictions on
drug use and trade, encouraging defensiveness on the other side. Now,
the debate has become more sophisticated, with the lobbyists willing
to explore other, more flexible, approaches.

One possibility, suggests Martin Jelsma, of the Transnational
Institute, a Dutch think-tank, is the creation of an informal alliance
of countries keen on more flexibility. Three groups might come
together: Commonwealth countries such as Britain and Canada that want
a pragmatic approach to cannabis; European countries such as Germany
and Switzerland that are keen on harm reduction and open debate; and
Latin American countries such as Brazil and Bolivia which are
desperate for a better way to deal with the curse of cocaine. But
sooner or later, such an alliance would still have to deal with the
conventions. These have been signed by well over 100 countries, and
cannot lightly be altered or set aside. The path to a rational drug
policy is likely to be a long one.