In the last 40 years the United Kingdom has developed a way of regulating drugs using a complex legislative framework. There are two major acts of parliament regulating drugs; the Medicines Act 1968 and the Misuse of Drugs Act 1971. Many of the drugs controlled under the Misuse of Drugs Act 1971 are also controlled under the Medicines Act 1968 as they are also used in clinical medicine.
There is no known statistically significant correlation between intensity or harshness of prohibitive law enforcement on drugs in different countries and the levels of drug use in said countries. Nevertheless despite massive enforcement efforts likened to a war, the use of “high harm causing drugs” has risen dramatically over the last few decades. A 2008 World Health Organisation study comparing drug use and different enforcement regimes across the world shows the marginal role for enforcement levels in drug taking decisions. The study’s headline conclusion was:“Globally, drug use is not distributed evenly and is not simply related to drug
policy, since countries with stringent user-level illegal drug policies did not have
lower levels of use than countries with liberal ones.”
The main benefits described by supporters of prohibition is that prohibition will reduce levels of drug use, firstly by restricting availability of drugs and secondly through the purposed deterrent effect of the criminal consequences of using illegal drugs. These effects are however poorly supported by evidence. Prohibition protects suppliers by keeping the distribution in the black market and it also creates the risk that makes smuggling illegal drugs very profitable. Therefore after the demand for drugs has been established the profits from supplying such drugs are so great that they incentivize supply despite the risk of criminal consequences. The associated risks end up being factored into the price increase that results from it.
The main benefits described by supporters of decriminalization are based on the hypothesis that the legally regulated supply of drugs will draw its trade out of illegality and therefore reduce crime rates related to such illegal trade. By providing quality-controlled drugs under the guidance and supervision of licensed individuals, the health of the drug users would improve. It is also hypothesized that decriminalization would improve access of and increase uptake of addiction treatment. In Portugal drug use was decriminalised nearly 10 years ago. Despite warnings by the opposers of decriminalization of drug use in Portugal, reported rates of drug usage have been declining. This decline however has not been found in the 19-24 age group as a large proportion of this group had already begun consuming drugs before decriminalization. However, younger people growing up since decriminalization, appear less attracted to illicit drug use when compared to their elders who grew up when possession and use was criminalised. Other statistics demonstrate a similar picture; there was a marked decline in the number of convictions for supply-related offences, the incidence of HIV and AIDS among intravenous drug users declined and newly reported infections of Hepatitis B and C declined. Drug-related deaths have also decreased significantly. Evidence from several different sources all points to decreasing drug use in Portugal since decriminalization rather than the feared increase; a very persuasive argument against decriminalization. The decision to completely prohibit a good or service that is in demand can generally only be justified in economic terms if the net cost of prohibition will be less than the alternative regulatory policy options. Thus the effect of enforcement efforts on drug availability and price, and how they impact on levels of drug consumption, needs to be considered. The market value of illegal drugs increases greatly as they travel along the various links in the supply chain ; the closer it gets to the consumer the more the price increases. There are three main factors that together determine the harm associated with any drug of potential abuse: the physical harm to the individual user caused by the drug, the tendency of the drug to induce dependence, and the effect the drug use has on families, communities, and society. In general drugs that lead to intense intoxication are associated with huge costs; costs to systems of health care, social care, and the police. In 2003 Tony Blair commissioned a report on United Kingdom and International Drug policy from the number 10 Strategy Unit (SU). What emerged in Phase 1 of the reporting process, titled ‘Understanding the Issues’, was a “thorough and clinical analysis by some of the best policy minds in the UK”. It stated that “supply-side enforcement interventions are actively counterproductive”.In summary the SU report demonstrated that:
• Prohibition has failed to prevent or reduce the production of drugs
• Prohibition has failed to prevent or reduce the trafficking and/or availability of drugs
• Prohibition has failed to reduce levels of problematic drug use
• Prohibition has inflated prices of heroin and cocaine, leading some dependent users to commit large volumes of acquisitive crime. Even if such supply interventions could further increase prices, this could increase harms, as dependent users commit more crime to support their habits.
The SU report also noted that patterns of use often rise and fall independently of price. Price changes tend to have different effects on different populations; lower income users will in general be more responsive to price changes, as they have a proportionally bigger impact on disposable income. Dependent users will show consumption patterns that are generally more price in-elastic.
Based on the SU report it can be concluded that prohibitive legislation comes at great financial cost to the United Kingdom. It therefore makes sense to look at the financial costs associated with legal state regulation. The Home Office published a report in 2002 (which was updated in 2006 ) that estimated the economic and social costs of Class A drug use to be ?15.4 billion in 2003/04. The cost of drug-related crime was 90% of this total. The Transform Drug Policy Foundation (TDPF) published a report in April 2009 describing an initial analysis supporting legally regulated drug supply. This TDPF paper on cost-effectiveness estimated that the total crime, health and other social costs of Class A drug use (in this report heroin and cocaine only) in England and Wales in 2003/04 was ?16.785 billion under the current prohibitionist regime. The most striking conclusion of the TDPF report is that “prohibition of drugs is the root cause of almost all drug-related acquisitive crime, and that this crime constitutes the majority of drug-related harms and costs to society.” The Report also states that legal regulation would “deliver substantial benefits to the treasury and wider community, even in the unlikely event of a substantial increase in use.” The TDPF paper on Cost-Effectiveness estimated the net annual benefit of a move from prohibition to legal state regulation and control of drug markets, using four scenario’s varying from a “50% fall in use” to “100% increase in use”, to give a net benefit between ?13.943 billion and ?4.616 billion. So even in the highly unlikely event of heroin and cocaine use increasing by 100%, the net benefit of a move to regulation and control looks to be substantial. These figures do not seem to be widely known though. According to the TDPF Summary and Briefing paper on the SU report, the findings were “not made public because its findings undermined the tenets of global drug prohibition”. The SU report would have put the United Kingdom Government in an awkward position as it is a signatory, and therefore supporter, to the UN’s 1998 10-year drug strategy, whose stated goal is “A Drug Free World – We Can Do It!” The UN Strategy supports prohibition as the way forward in the so called War on Drugs”. The SU report however demonstrates the opposite; decriminalization appears to be, at least financially, a more favorable approach to the problem.A frequently heard argument against legal state regulation is that decriminalisation will encourage drug use and increase use in current dependants. There is however no evidence that when Class A drugs are made available on prescription to dependent users, that levels of use rise. There is however some evidence that other related factors , such as de-stigmatisation and increased access to and contact with service providers, means that prescribed users are in fact more likely to utilise services and thus reduce or even cease use.
In December of 2003 Phase 2 of the SU report, titled ‘Diagnosis and Recommendations’, was produced. The Phase II report focuses on the harms caused by the population of problematic heroin and crack users who are responsible for a disproportionately large number of prohibition-related crimes, rather than questioning how prohibition has created these crimes in the first instance (as identified in the Phase 1 report) . The Phase II report noted that “Supply-side interventions have a limited role to play in reducing harm initiation into problematic drug use is not driven by changes in availability or price. Risk factors, particularly relating to deprivation, are the prime determinant of initiation into problematic drug use; price and availability play a secondary role, and there is no causal relationship between drug availability and incidence.Nevertheless in this Phase II of the report, Phase 1’s critique of supply side interventions was sidelined, and an intensification of demand side measures aimed at high harm causing users (HHCUs) was recommended. The aim was to reduce property crime associated with fundraising to support a habit. This later culminated in recommendations in the new 2005 Drugs Act described by TDPF as “election-time populist”. A similar approach was seen when Professor Nutt published a report in October 2009 in which he stated that alcohol and tobacco were more harmful than many illegal drugs, including LSD, ecstasy and cannabis. The day after publication Professor Nutt was asked to resign as chair of the Advisory Council on the Misuse of Drugs (ACMD). Nutt responded in the press by stating he was; “disappointed by the decision but linked it to political considerations”.The forced resignation of Nutt raised concerns amongst committee members over the independence of advice to the government and triggered five further resignations. Another two committee members resigned in spring 2010 over the decision of the ACMD to make Mephedrone illegal claiming they felt that the decision was “unduly based on media and political pressure”. Early in 2010 David Nutt founded the Independent Scientific Committee on Drugs, the goal of his new committee is to complement and eventually supersede the ACMD by “providing independent advice that is untainted by government interference”. Since the ACMD was set up in 1971, UK governments have nearly always acted upon their advice; in 1978 the recommendation to downgrade cannabis from class B to C was rejected. In 2002 the ACMD looked again at the status of Cannabis at request of the Home Secretary who accepted the recommendation to downgrade Cannabis from B to C. However in 2008 the Home Secretary rejected advice from the ACMD to keep Cannabis at class C, and in 2009 the Home Secretary vetoed the ACMD recommendation that Ecstasy be downgraded from class A. It is therefore not possible for the government to uphold the claim that the UK’s drug policy is evidence based. Nutt goes a step further by stating it is also not based on ‘harm’; in 2010 Nutt et al published a multi-criteria decision analysis which showed that heroin, crack cocaine, and methamphetamine were the most harmful drugs to individuals, whereas alcohol, heroin, and crack cocaine were the most harmful to others. Overall, alcohol was the most harmful drug, with heroin and crack cocaine in second and third places. Based on these findings Nutt et al conclude that” the present drug classification systems have little relation to the evidence of harm.”Conclusion
The decisions taken by successive Governments show that prohibition is being pursued as it is seen as too dangerous politically to promote decriminalisation regardless of the overwhelming arguments to take a different stance. A cost benefit analysis such as described in the different Home Office and TDPF papers is a Utilitarian approach to the problem. It is impossible to ascribe monetary values to what is the heartbreaking suffering of drug dependency and its consequences. Nevertheless as stated in the TDPF report such analysis has its place; it provokes discussion, and also rationalises the debate for policy makers who have to make these seemingly cold and utilitarian policy decisions frequently. The TDPF report concludes that there is a far higher human cost under the current policy of criminally controlled drug markets than would occur under policy alternatives involving state control and regulation. Possibly the time has come for a more utilitarian approach to the human problem of drug-dependency. Given the current economic climate perhaps more politicians will be open to a different viewpoint and solution to a longstanding and to date unresolved problem.
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