Prohibitive Policies Cause More Problems Than Illict Drugs, Say Experts

In Portugal, where all illicit drugs are decriminalized, drug disorders claim the lives of just 0.8 in 100,000 people, a figure that pales in comparison to Brazil, the Philippines – or even the US where the death toll stands at a staggering 18.75 in 100,000 people, or 23 times higher than Portugal.

High death tolls, experts say, are largely preventable through policies rooted in robust evidence and human-rights, yet their adoption remains lackluster from north to south.

Carl Hart, Professor of Psychology at Columbia University and drug advocate

“Drug policy can be done better if we had a desire,” said Carl Hart, Professor of Psychology at Columbia University. “There are great models around the world, if only we cared enough to observe those models and learn from those models.”

“Portugal has decriminalized all drugs. They’re not arresting people for what they put in their bodies. People are allowed a 10-day supply of drugs without fearing criminal prosecution.” 

He was speaking last week on the eve of International Day Against Drug Abuse and Illicit Trafficking, at a panel hosted by the Graduate Institute’s Global Health Centre on the global day of action for the grassroots Support Don’t Punish campaign.

“I am advocating for the legal regulation of drugs,” stressed Hart. “If we legally regulate those drugs, we increase the safety of that activity.” 

“We as a society should invest in people, and not investigate what substance people are ingesting. That isn’t our business.”

His comments come on the heels of a shocking US CDC report that reveals overdose-related deaths in the US increased by nearly 30% between November 2019 and 2020 with over 90,000 deaths during this period, almost double the death toll in 2015.

Aside from the millions of lives that drugs claim every year, drug-related health issues account for 5.5 % of all Disability Adjusted Life Years (DALYs). That equates to 131 million healthy years of life lost due to ill-health and lifelong disability.

Drug overdose deaths in the US rose by nearly 30% between November 2019 and 2020

Drug Problems Relate to Prohibitive, Stigmatizing Policies 

Rather than drugs themselves, prohibitive and stigmatizing drug policies result in unnecessary incarcerations, murder, and the arrest of one American every 25 seconds, or 1.5 million Americans a year.

“Most of the problems related to drugs are related to prohibition,” stressed Hart. “All of these people in jail, all of this murder, all of these horrible things that are often promulgated by the state itself – reverse these policies and then you will deal with a lot of that carnage.”

If drugs were regulated rather than prohibited, a million Americans a year wouldn’t go to jail, he added.

If countries decide to opt for legalization, regulation, and other smart drug policies, thousands of potentially lethal overdoses and accidents could be avoided, said Hart, mainly due to illicit drugs that are more potent than users think and can be spiked with potentially lethal contaminants.

“If we legally regulate those drugs, we increase the safety of that activity, we make sure that those drugs are not tainted with potentially harmful substances and we can control who is allowed to purchase those substances.”

About a fifth of illicit drugs are laced with contaminants that users did not intend to take, surveys from New Zealand and England have found, sometimes with potentially deadly heavy metals, bath salts, or even horse tranquilizers. 

Studies, mainly from New Zealand and England, indicate that cheap policies, like drug-testing programmes at parties and festivals, could prevent drug users from taking contaminated drugs bought on the illicit market.

According to one study of a drug-testing programme at a four-day festival in the UK, drug-related hospitalizations dropped by 95% the year it was introduced. One-fifth of festival attendees used the free testing service, and one-fifth of drugs were contaminated. Strikingly, two thirds of attendees’ whose drugs were contaminated disposed of these drugs. These results suggest that screening programmes have potential to prevent drug users from taking contaminated drugs bought on the illicit market – and to reduce drug-related injuries, deaths, and drug consumption as a result.

Legalizing drugs could also reduce the appetite for synthetics like fentanyl, an opiate that is 50-100 times more potent than morphine, whose rising consumption has been fuelled by the pharmaceutical industry, regulatory failures, but also scarce access to heroin, said Hart.

“There is not a real need for illicit fentanyl,” he said, emphasizing that fentanyl consumption could be reduced if drug users had access to heroin – an opiate they prefer.

“Most heroin users would much prefer heroin to fentanyl, for a number of reasons: the euphoria, in my view, is better with heroin…Heroin is relatively short-acting [and] the hangover effects are minimized.”

In the US, 36 out of 50 states have legalized cannabis products for medical conditions from severe forms of epilepsy, back pain, to nausea and vomiting during chemotherapy. 

And a wealth of studies have revealed that US states who legalized cannabis saw sharp drops in violent crime, fatal traffic accidents, opioid use and opioid overdoses – without leading to a spike in teenage cannabis consumption

Last December, the UN Office on Narcotic Drugs recommended that countries remove cannabis from the “most dangerous” list. 

Switzerland’s Forward-Looking Policies to Address Illegal Drug Trafficking

Should drugs be legalized, policies will need to target low-income groups and young people, especially those who face mental health issues or violence, as they are most at risk from harm as a result of taking drugs, Thomas Zeltner, Chair of the Swiss Research Institute for Public Health and Addiction, told Health Policy Watch in an interview.

Thomas Zeltner, Chair of the Swiss Research Institute for Public Health and Addiction

One way to do that, he explained, is through targeted screening programmes in those groups – instead of screening whole populations.

“Only 1 in 20 kids or young people who use drugs will develop drug issues. And many of those who develop issues are children from divorced single mothers, children who have difficulties in school reading difficulties, and children with pre-existing mental health problems,” he said, adding that the consumption of drugs like cocaine tends to lead to few problems in rich people, at least in Switzerland.

“We’ve done quite a number of studies and shown that giving vulnerable kids intensive support is much smarter than to spend the money on targeting all the kids in a class.”

Once upon a time, Switzerland’s approach on drugs used to be “amazingly open” and evidence-based, emphasized Zeltner.

In the late 90’s, the sale and cultivation of the cannabis plant was legal in the Alpine nation, including plants with the so-called “Tetrahydrocannabinol” (THC) compound that is known to trigger a “high”. That policy, he says, helped cut illegal drug trafficking as well as criminal and social problems.

“In the 80’s and 90’s, 100% of the cannabis market was in the hands of North Africans. Many of them were here illegally, and many of them had no other opportunity than to deal with cannabis. And so we had a lot of criminal and social problems.” 

“But after the Swiss authorities allowed shops to sell cannabis and to grow their own plants to satisfy their needs, what happened was that the cannabis market moved from North Africans to Switzerland, criminality went down and social problems went down.”

Switzerland, added Zeltner, is also well known to have spearheaded research that was ahead of its time, leading to substantial benefits in drug users who did not respond to methadone – an oral drug that is still commonly used for opioid dependence.

“We saw that there were many drug users in the 80’s and 90’s,” emphasized Zeltner. “We could not offer a treatment with methadone, which is the standard treatment for drug-using persons who want to get into treatment but cannot abstain from taking substances, because there were people who actually needed to inject drugs.”

In the mid-90’s, Swiss researchers designed a landmark double-blind trial to address that. Strikingly, the Zurich-based trial revealed that addicts could distinguish between heroin and morphine – and that small doses of heroin were more effective than morphine in treating addicts.

“The results from the double-blind clinical trial in Zurich were clear,” he said. “Drug users could feel the difference between heroin and morphine, even though pharmacologists will tell you ‘that’s not possible’, which was a very interesting finding.”

Those results, said Zeltner, led to a groundbreaking shift in Swiss policy that would eventually position heroin as a standard treatment option for drug users in the country. Today, almost 10% of people with opioid dependence are prescribed heroin in Switzerland –  a unique policy that has only been adopted in a few countries to date, despite robust evidence that it works.

“Heroin is actually a standard treatment in Switzerland,” said Zeltner. “We are one of the very few countries where heroin prescription for drug users is legally allowed and is part of our legal drug policy.”

“At least in the 90s, there was an amazing openness to try evidence-based policies to say – listen, if we want to make a further step forward, we just need to pilot new ideas.” 

Growing Conservatism has Reversed Evidence-Based Policy

In Switzerland, cannabis is considered illegal if its THC content is above 1%

In past decades, however, conservative political winds have reversed Switzerland’s open and evidence-based approach to drug policy, warned Zeltner.

“It used to be possible in Switzerland to have scientific-driven discussions, but this has not been the case in the country,” he said.

He was referring to Switzerland’s current cannabis policy, which considers any cannabis product illegal if its THC content is above 1%.

While that drug policy is progressive in some ways, it has failed to resolve illicit cannabis trade, and reflects increasingly rigid views on drugs that have hampered progress in drug rehabilitation programs, Zeltner said. Cannabis, according to the Federal Office of Public Health, is still the most commonly used illicit drug in the country.

“It’s evident that a large number of people in Switzerland are still buying and smoking illict cannabis with a high THC content,” he said. “These days, it is very hard to get through and we should really get back to evidence-based policy.”

Image Credits: Felix Brönnimann, Wikipedia, US CDC.

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