The challenge for the international community has been to establish a regulatory system that ensures that the legitimate medical and scientific needs for opiates are met, whilst preventing diversion to illicit markets. Its achievement has been to limit worldwide adult illicit drug use to 5% while meeting these needs, says Kathy Gyngell, CPS Research Fellow and author of ‘The Phoney War on Drugs’.
The press reaction to the last week’s INCB annual report revealed just how little understanding there is of the international drugs control system, how it works or and why we need it. Honesty, rather than public relations prowess, is the INCB’s hallmark. As a result, each year, when the Board reports on countries’ compliance with international drug control treaties to the UN, it temporarily makes itself a hostage to fortune.
Last week the media vultures were ready and waiting to pounce. The pro-drugs lobby was prepared to pick on the bad news it inevitably contains and, from it, to make their predictable claim that the so called ‘war on drugs’ has been lost; that it is time to surrender.
It’s the price that Professor Hamid Ghodse, its very correct and internationally respected Chairman, pays for giving us his annual warts and all, unspun, “extraordinary annual snapshot of the illegal drugs sloshing around the globe, from slimming pills to heroin – a tally of who is making them and who is taking them”, as Bronwen Maddox of The Times graphically described it. If it is long on detail and short on recommendation that is because it has no powers other than persuasion.
But though voluntary, the international conventions on narcotic and psychotropic drugs, and the illicit trade in both, on which the drugs control system is based, do enjoy near universal adherence; for few countries, if any, want to grow, trade in or use illicit drugs. And perhaps because it is voluntary the system works; though you would not guess that from the press comment.
Even the more dispassionate of them, like Bronwen Maddox, submit it has 5 success stories to its name – the driving of opium production from Thailand, Laos, and Vietman and cocaine from Bolivia and Peru. Curiously not mentioned by her is the staggering success of Colombia. From failed state to economic prosperity, its economic growth as a post ‘narco state’ at 4-5% must be the envy of the Western world. Instead, she argued that any hope for international drugs control is eclipsed by the failure of policy in Afghanistan.
But the war in Afghanistan is about far more than poppy cultivation. Though the INCB is the first to acknowledge that narco trade undermines development, so too does the demand for heroin from its neighbours, not least the Islamic Republic of Iran, whose high levels of heroin use and addiction precede this latest conflict. Historically a global centre for production and distribution of opium itself, by 1949 one in ten adults used drugs and 1.3 million opium users. Today the number of drug addicts there has been estimated as high as 3 million. UK heroin use is marginal by comparison (under 300,000 opiate users), as is that in the US.
There are no quick fix solutions for Iran or Afghanistan such as the much mooted buying up of Afghan poppy crops. Nor has Afghanistan any economic advantage for medicinal opium production. It simply could not compete with Australia and Turkey’s intensive production of poppy straw. Afghan economics experts like David Mansfield have long argued that such legalised ‘solutions’ would drive the country further into poverty.
Last week’s media crop of critiques of the INCB lacked proper context. It seems not to occur that the present system of control has contained the illicit drug supply and consumption at much lower levels than those achieved by regulated markets for alcohol and tobacco. So while 25% of the world’s adult population smoked tobacco last year, only 5% took an illicit drug at all. The bottom line is that illicit drug use has remained stable at this level over the last ten years and more, too, contrary to well publicised but misleading reporting.
Given the pressure of rising levels of addiction – addiction is the fastest rising of all psychiatric disorders since the second world war* - and given the absence of a war on drugs (see below) this is no mean achievement. The INC system, with national sanctions, by and large protects all but a minority of the international public from substances that are noxious, poisonous and dangerous, as well as addictive. In both America (dramatically) and in Europe too, drug consumption is falling and demand is finally dropping.
The system licenses and ensures sufficient production for the needs of science and medicine. It also protects against (and monitors) diversion onto the illicit market. It has no control however, over prescribed (iatrogenic) drug use and addiction which continues, by contrast with illicit drug use, to rise.
Though the system may be less than perfect, if we did not have it my guess is that we’d be demanding it.
This, after all, was the situation a hundred years ago when our 19th and early 20th century forbears became alarmed by opium’s transition from medicinal remedy to widespread abuse as an intoxicant. When the very first international drugs control treaty - the International Opium Convention - was signed at The Hague and powerful business interests were still pushing its then legal trade in narcotics, narcotics abuse was of an order unknown today.
In fact the scale of the then Chinese opium epidemic is hard to contemplate. Worldwide annual consumption at the beginning of the twentieth century averaged more than 3,000 tons in morphine equivalent - significantly more than the global consumption of both licit (morphine) and illicit of opiates today. Then the world population was only 1.6 billion. Today it is 7 billion.
The Chinese Emperor who said that the economics of addiction set in motion a downwards spiral that saps the user, his family and his community of its wealth, got it in one. It was a problem that could not be ignored.
Today the system is far from cracking, and far from irrational, as critics have claimed. The idea that letting go these controls would in any way diminish or mitigate addiction or crime is naïve. Bar widespread, expensive and ethically unacceptable heroin prescribing, poor addicts would still need to resort to crime to raise money for legally available drugs.
A regulated trade in dangerous 'recreational' substances would still demand sanctions for the inevitable transgression of those regulations. Black markets and crime would continue unabated. The consequences of freely available toxic substances would take a physical and mental health toll on society well beyond what we have now. Prisons would still find themselves housing those on drugs or those who committed drugs related offences.
What those who only see drug harms as stemming from their illegality seem to forget is that addictive behaviour is, by definition, risky and irresponsible. Why else, despite the needle exchange and universal harm reduction measures in the UK, are blood borne viruses – HIV and Hep C and B – going up? Why are so few of the distributed needles ever ‘exchanged’ in reality? How is that methadone, contrary to James Bloodsworth’s rosy view of it, (it is neither liked by addicts, good for their health, nor risk free as rising deaths associated with it now show) fails to stop illicit drug dependence, or crime, though freely available at high dosage levels? How could the pure ‘public health’ approach he advocates be safe or adequate? Sadly as anyone who is acquainted with addicts and addiction knows, drug use as well as the drug itself, that is harmful.
This is not Chris Berg's view. He claimed last week that whether a drug is illegal or not is simply an accident of history. Not so. His reading of history on opium seems selective. His assessment that a century long ‘war’ has definitively and undeniably failed has not one statistical piece of evidence to support it. It rests lazily on that ‘widespread belief in expert circles’ - I strongly suspect those transmitted by the Global Commission on Drug Policy - ‘that the world needs to move towards decriminalisation if we want to minimise the harm of drug abuse’.
Chris believes that we should rethink the justice of a war that, in truth, is not against drugs but drug users. He needs to check the criminal sentencing statistics for drug use by comparison with drugs use prevalence. They simply do not bear this argument out. Proportionately very few drug users suffer criminal, let alone custodial, sanctions.
And though he, like other critics, invokes the word 'war', there has not been one. Nor, for the record, was the term “war on drugs” used in 1971 by Nixon. It is only used today by those who misconstrue the history of current drug policy in the US and here.
Ironically if the term is to be connected to President Nixon at all, it is more accurate to say that Nixon ended, rather than launched, the “war on drugs.” For it was the Nixon Administration that repealed federal mandatory minimum sentences for marijuana. It was the Nixon administration that on June 17, 1971 - for the first time in US history - augmented the long-dominant law enforcement approach to drug policy, known as “supply reduction”, by an entirely new and massive commitment to prevention, intervention and treatment, known as “demand reduction”. Arguably too, it was from this point both in the US and in England, with its own tripartite Misuse of Drugs Act, that the contemporary drug problem emerged, exacerbated by state-sponsored opiate substitution treatment and indiscriminate 'harm reduction'.
It is a problem that now, despite all the odds, the INCB is managing, especially in the last decade, through monitoring and exhortation alone, to successfully contain.
* United States’ cohorts born after the second world war were 15 times more likely to report a substance use disorder than the cohorts born well before the second world war. For further details and analysis see Addiction a Disorder of Choice, Gene Heyman, Harvard University Press, 2010
Kathy Gyngell has a first class honours degree in social anthropology from Cambridge and an Oxford M.Phil. in sociology. She has worked for the former ITV companies, LWT and TV-am as a producer and senior programme executive. A full time mother after the birth of her second son, she founded the voluntary organization Full Time Mothers.
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