The Temptation and the Disillusion

I am glad to be given the opportunity to talk with young people about drugs, especially about the temptation to take addictive substances for fun or need, and the dis-illusion victims inevitably face – unable to overcome personal problems with a few grams of dope. I invite young people to exchange views in an urbane and fruitful manner, in recognition of everybody’s good intentions. This will help us to better understand a century-old scourge: drug addiction and the crime associated to it, and what to do about both.

Many young people, radical as they are (should be?) before professional and family needs settle in, tend to militate in two opposing camps: there are those who pursue a world free of drugs, and those who propose a world of free drugs. The vast majority of youth however, tend to place themselves in between these two fringes, basing their views on common sense:

  • First, health must be protected as a matter of priority, including when we talk about personal lifestyles and their consequences to society.
  • Second, as a corollary, there is an urgent need to reduce the harm caused by drugs – by preventing their use, by treating those who use them, and by limiting the damage they cause to individuals and society.
  • Third, views about drugs must be evidence-based, not the result of political considerations or ideological preferences.
  • Forth, the dichotomy prohibition vs legalization (of drugs) is too simplistic for a civilized debate nor does it help those whom we wish to assist: our brothers, the drug addicts.
  • Fifth, and finally, there is agreement that addictive substances (drugs, alcohol and tobacco) should be regulated – like the other major global killer: privately owned firearms.

I believe these five points are accepted by the majority of young people, and I invite them to review where to set the bar, how to define and set the degrees of drug regulation. In other words, instead of accentuating differences, I invite young people to be rational and draw the appropriate conclusion from these common sense premises.
Let me begin with the world drug situation: where do we stand?

The world drug situation

drugsFor a few years, for all drugs (opiates, cocaine, cannabis, ATS) there have been signs of world market stability. What I mean is that, in every phase of the drug business (cultivation, production, consumption), aggregate totals have lost the upward momentum they had in the 1980s and the 1990s. Of course, world aggregates hide improvements in some countries for some drugs, which are offset by deterioration elsewhere. Yet, the global totals are stable.
This finding refers to the past few years, namely since the early 2000s. Hopefully, in the period ahead evidence to support this claim will become statistically and logically incontrovertible.
Next question: how did this market change come about? Is this the result of successful drug control? Some surely doubt it. I see this as a good sign (the result of correlations over time and space), but yet not as evidence of causality (social sciences are generally poor in proving cause/effect relations). Drug trends respond to a wide range of factors, especially changes in society’s revealed preferences. For me, the result is what counts: the world still has an enormous drug problem, but it is not out of control as it was in the final two decades of the last century. Indeed, it is being controlled.
Problem drug users make up less than 0.6 per cent of the world’s population. Even if you take into account the number of people who take drugs once a year, this is still below 5 per cent of world’s population. By comparison, alcohol is at 50 per cent and tobacco at 30 Per cent. Alcohol kills 2.5 million people a year; more than half of all homicides and road-accidents, and most domestic violence is alcohol-related. Tobacco kills 5 million people a year, because of cardio-vascular diseases and cancer – two of the greatest killers of our time.
As a consequence there is growing public and medical pressure to tighten controls on the consumption of alcohol and cigarettes. That’s right. So why increase the public health damage by making drugs more freely available, drugs whose damage – thanks to the controls – is limited to 1/10 the casualties caused by tobacco? Why ignore the knowledge that we have gained from our experience with tobacco and alcohol? (and fire arms, by the way).

If only dreams came true

I start with a series of (hypothetical) situations useful to set priorities in drug policy. I invite my readers to consider them.

  • First, I invite you all to imagine that this year, all cocaine, heroin, cannabis and synthetic drugs produced and trafficked around the world, were seized: the dream of law enforcement agencies. Well, when we woke up having had this first dream, we would realize that hundreds of thousands of hectares of cannabis, coca and opium would be grown again next year: as a result once again thousands of tons of drugs would be trafficked. In other words, this first dream shows that, while law enforcement is necessary in drug control, it is not sufficient. New supply would keep coming on stream, year after year.
  • So let’s dream a second time. Let’s dream that, by some miracle, we can convince farmers around the world (Afghanistan, Colombia, Morocco, Myanmar for example) to eradicate the drug crops, replaced by the fruits of development. A great dream of course, but yet again, one that would not solve the world drug problem on its own. Why? Because when we woke up after this second dream we would realize that other sources of supply would open up somewhere else on the planet, to satisfy the daily cravings of 25 million hard-core drug addicts around the world.
  • So we are left with a third dream, the real challenge of drug control: to reduce the demand for drugs. This would work: namely prevention, treatment and reintegration, combined in a single health based programme, has to be our priority. Without demand, there would be no supply or trafficking. Demand reduction is the driver to everything else: the necessary and sufficient condition to make drug policy realistic and pragmatic.

I hope the young readers will agree on the sequence I just proposed, to separate the three elements of the drug chain, and their primary agents: supply, by farmers in need of assistance; trafficking, by criminals deserving retribution; and demand, by addicts craving for care.

Health and safety

drugs_03With two building blocks of my argumentation in place (namely, stability of the world drug market and the priority of reducing drug demand), let me now explain how we can contain the harm caused by drugs.
Science has established that drug addiction is a disease affecting the brain, as much as any other neurological or psychiatric disorder. So let’s prevent drug addiction, and treat it, as we would any other illness. There are no ideological debates about curing cancer or diabetes. So why have them about drug addiction? People to the left or right of the political spectrum are not divided on the need for preventing or treating tuberculosis or HIV/AIDS. Yet, they profoundly disagree about drug policy. But why? This is a health issue, not a moral or a political one.
It is a matter of life or death – in terms of the life-expectancy of the drug user and the spread of blood borne diseases to others.
It is damaging to society – by deadly accidents or crimes committed under the influence of psycho-active substances.
It is a threat to the security of states – think of Central America, the Caribbean and West Africa, caught in the cross-fire of drug trafficking.
I know of critical comments against this last point. Prohibition causes violence by creating a lucrative black market for drugs: legalize them to defeat organized crime. I submit: this is surely the antithesis of harm reduction. While legalization may reduce the profits to organized crime, it would increase the damage to the health of individuals and society.
Health and safety go hand in hand. Although critics may construct arguments based on the merits of individual freedoms, including the freedom to harm one-self by taking drugs, I challenge the false dichotomy between health and security. Namely, I reject the argument that drugs are a matter of private and personal choice, and that their legalization would not only sanction such lifestyles, but would also curb organized crime. First, the pursuit of life-styles cannot be detrimental to society. Second, international mafia prosper because there are no convincing measures against it, globally: drugs are only one brand in their portfolio.
In other words, I do not believe that we have to choose between either protecting health through drug control, or ensuring law-and-order by liberalizing drugs. Democratic governments can, and must, ensure both: health as well as security.

Condemning Young People to a Life of Addiction

My next message is about the need to reduce the harm caused by drugs through prevention, treatment and assistance to addicts.
If governments only focus on assistance to addicts through narrowly conceived harm reduction, without engaging in prevention or providing treatment, the result is ghettoization.
Let me explain – based on science, not emotions or ideology.
Scientific evidence has proven that drug dependence is the result of nature and nurture – namely a mix of genetic and social factors. People are more vulnerable to addiction as a result of:

  • gene variants, namely hereditary conditions.
  • childhood, inadequate pre-natal care, poor parenting, neglect and abuse, low school engagement, lack of family and community bonding, and
  • social conditions, marginalization, poverty, and latent or overt psychiatric disorders.

There is a double jeopardy at play here: not only are such people more vulnerable to addiction, but addiction deepens their vulnerability. As a result, the disadvantaged are pushed even further away from society.
The advice of the pro-drug lobby, if listened to, would condemn our brothers, the addicts, to a life of dependence. Rhetorical gymnastics about civil liberties favour the privileged who can afford expensive treatment for their drug habits, or those of their kids. But what about the less fortunate who lack the same means and opportunities?
Now extrapolate that problem onto a global scale. It is one thing to ignore the plight of the less fortunate in our midst who, because of their addiction, fall through the cracks and end up in the city gutters, in prison or in the morgue. Imagine the impact of unregulated drug use in developing countries where no prevention or treatment is available. This would unleash an epidemic of drug addiction and all the social and health consequences that go with it. Is this desirable? Instead of reducing harm, this would increase the damage done by drugs and everything associated with them.

Away from the illusion

Young people: I speak candidly to you all. Press governments to rebalance global drug control in favour of prevention and treatment. Only advocating harm reduction is not radical enough: actually it is a conservative approach, as it would preserve the status quo. Handing out a few condoms or needles to drug addicts is a Band-Aid solution. We need to break the vicious circle of dependence and disadvantage. How to do this? Simple. Just press governments to:

  • devote more attention to early detection of addiction;
  • support an integrated approach for drug treatment, so that drug therapy is mainstreamed in public health and social services;
  • make sure that there is sufficient intervention to prevent the spread of diseases like HIV and hepatitis among drug users;
  • promote alternative measures to prison for drug addicts involved in crimes and provide the same standard of health care in prisons as on the outside.
  • send drug users to rehab, not to jail, in view of curing them;
  • pay greater attention to treating all forms of addiction. There is no consolation for stabilizing drug trends if people turn instead to abusing other substances like solvents, prescription drugs or alcohol.

But, and most importantly, we must make drug control a society-wide issue. Drugs are too important to be left to drug experts and governments alone. Dealing with them is a society-wide responsibility that requires society-wide engagement. This means working with children, starting from parents and teachers, to ensure that they get the love, encouragement and support that they need to develop self-esteem. This means greater support for family-based programmes: prevention begins at home.
Schools can help by teaching life-skills and the effects of drug use. Let’s help those your age engage in healthy activities, like sports and culture, to enhance their well-being and prevent social isolation that leads to drugs and crime. In this way, young people can be steered away from drugs, and those that do suffer the misery of addiction can be brought back into society.

Antonio Maria Costa
Executive Director UNODC (May 2002-Aug 2010)