The Impact of Global Drug Policy on Women : Shifting the Needle

Giavana Margo, Julia Buxton

• Publisher: Emerald Publishing
• Year: 2020
• eBook ISBN: 9781839828843
• Topic: Social Sciences
• Subtopic: Criminology
• Index: Social Sciences

The international strategy of criminalising the cultivation, manufacture, distribution and use of certain psychoactive substances has failed to achieve a 'drug free world'. Examining the impact of drug criminalisation and enforcement on a previously overlooked demographic, this edited collection argues that women are negatively and disproportionately affected by this flawed policy approach.Addressing the lack of attention on the experience of women, this collection details the challenges women face in accessing appropriate treatment and services, the stigmatisation and marginalisation resulting from engagement in illegal drug markets, the violence that women are exposed to, and the punitive sentences imposed on women for drug related offences. Bringing together an international group of academics, advocates, activists and those with lived experience, the editors offer a rounded and realistic view from women's perspectives. In doing so, they facilitate a call for feminist and women's organisations to embrace drug policy reform, and for international and national level drug control authorities to better engage women as stakeholders.

Chapter 1

International Drug Policy in Context

Julia Buxton, Lona Burger

All of our countries share a common strategy on drugs. From Ghana to Russia, Thailand to Ireland, national governments have criminalised the cultivation, manufacture, distribution, possession and use of plant based and synthetic substances deemed harmful to ‘health and well-being’. This stems from international treaty obligations, most saliently the 1961 UN Single Convention on Narcotics Drugs, the 1971 Convention on Psychotropic Substances and the 1988 Convention Against the Illicit Traffic in Narcotic Drugs and Psychoactive Substances. The treaties are interlocking and complementary, building on each other to plug gaps and perceived vulnerabilities to the drug trade ‘evil’ (1961 Convention). The treaties codify international control measures including in relation to those precursor chemicals that are required for the manufacture of controlled drugs (1988 Convention) and they establish a hierarchy (schedule) of drugs determined by their perceived danger to individual and public health. The treaty framework imposes on states the obligation to impose sanctions ‘such as imprisonment or other forms of deprivation of liberty’ for drug-related offences (1988 Convention, Art 3), mandates co-operation in law enforcement efforts and extradition processes and requires the seizure and destruction of illicitly cultivated plants and manufactured drugs.

As detailed by Woodiwiss and Bewley Taylor (2005), drug control is better understood as an international regime, with its own norms, governance structures and administrative, monitoring and reporting systems established by the treaties. Key organs are the Commission on Narcotic Drugs (CND), a 53 member central policy-making body elected on a four-yearly basis and the International Narcotics Control Board (INCB) comprising 13 members elected every five years. The INCB is independent while the CND is intergovernmental, with members elected on a country basis. Fourteen CND seats are held by Western European states, eleven are allocated to African and Asian countries, ten to Latin American and Caribbean states and six to Eastern Europe states, with an additional seat rotating between Asian, Latin American and Caribbean countries.

The role of the CND includes the monitoring of drug trends, decisions on the inclusion or removal of substances from the control system (with advice and recommendations from the World Health Organisation) and the development and implementation of policies ‘to better address the drug phenomenon’, including through recommendations to the United Nations (UN) Economic and Social Council (ECOSOC) and General Assembly (through ECOSOC). The INCB monitors implementation of the conventions and administers the information and data that states are required to provide on national drug trends, including drug use, illicit trafficking, seizures and plant eradication.

The United Nations Office on Drugs and Crime (UNODC) plays an important role in supporting the control efforts of treaty bodies and assisting countries in fulfilling their treaty obligations. It positions itself as a ‘global leader in the fight against illicit drugs and international crime’. Headquartered in Vienna with 20 field offices across 150 states, the UNODC ‘works to educate people throughout the world about the dangers of drug abuse and to strengthen international action against illicit drug production and trafficking and drug-related crime’ (United Nations Office at Vienna (UNOV), n.d.). This includes thorough illicit crop monitoring programmes, alternative development initiatives that seek to transition drug crop cultivators into the formal economy, prevention of crime and terrorism and criminal justice system reform.

The system of international drug control navigates a complex ‘dual use’ dilemma. Substances that can be ‘misused’ for pleasure or which for a minority of people can be dependence-inducing are also vital in medicine and scientific research. This includes plant-based substances such as cocaine (from the coca leaf), cannabis and opiates (opium poppy derivatives such as opium, morphine and heroin) and a range of synthetic, chemical-based substances such as MDMA, LSD and ketamine. The control system aims to achieve a delicate balance: on the one hand ensuring that the cultivation and manufacture of these drugs is sufficient to meet proven national level medical and scientific requirements, while on the other hand preventing leakage into unauthorised and ‘recreational’ markets.

Coercion and Militarisation

Eliminating unauthorised manufacture, distribution, possession and use has been the overriding preoccupation of the post-war (Second World War) system. The United States has been a key source of pressure on the international system to achieve this end, working aggressively within and outside the international control regime to advance more repressive responses to illicit drug markets. In the 1970s, the administration of President Richard Nixon redefined ‘narcotic’ drugs as a threat to US national security, setting the ground for a ‘War on Drugs’ that gained traction under President Ronald Reagan in the 1980s. The domestic front in this ‘war’ saw the introduction of draconian anti-drugs legislation (Anti-Drug Abuse Act of 1986) that was coercively policed and financed by a tripling of the federal drug budget.

At the international level, the Reagan period marked a dramatic expansion of the role of the Department of Defence (DOD) in efforts to eliminate overseas drug cultivation and manufacture and in the prevention of drugs coming into the United States. The DOD budget for interdiction activities increased from US$4.9 million in 1982 to a staggering US$397 million by 1987 (Bagley, 1988, p. 165). This was supported by a sanctions regime that decertified states deemed non-compliant with US drug control efforts (blocking bilateral and multilateral lending). The overseas presence of drug-related personnel (Drug Enforcement Administration, police and judicial actors) was also dramatically expanded during the Reagan era, in turn positioning the United States to influence the replication of its own punitive drug legislation and coercive enforcement practices in countries transitioning to democracy. For Ayling (2005), the ‘listing and certification process has been a critical part of coercive strategies used by the United States to further its drug control policies internationally’. From this perspective, states have been ‘conscripted’ into the US drug war, with those that are un-cooperative ‘threatened with a combination of aid and trade sanctions’.

The Reagan administration was influential in pressing for strengthened international measures against trafficking and action in related areas such as money laundering and transnational organised crime, culminating in the 1988 Convention Against Illicit Traffic in Narcotic Drugs and Psychotropic Substances. For Woodiwiss and Hobbs (2009), the 1988 Convention marked the internationalisation of US drug and crime fighting strategies. It served as a mechanism to re-galvanise and strengthen international commitment to drug control in a period of turbulent geopolitical change, and to institutionalise US approaches for advancing the goal of drug prohibition. As the war on communism came to an end, the war on drugs enabled police, military and intelligence budgets to be sustained and the US geostrategic presence in third countries extended.

Following the adoption of the 1988 Convention, the UN General Assembly held its first Special Session (UNGASS) on ‘the world drug problem’ in 1990. Buoyed by the prospect of enhanced international co-operation in the post-Cold War period, the UNGASS marked the introduction of a Global Programme of Action. This framed 1991–2000 as the United Nations Decade against Drug Abuse. As discussed by Jelsma (2003), this was a bold re-statement of prohibition goals and a pushback against those arguing for a rebalancing of international strategy towards demand reduction rather than the prevailing emphasis on supply prevention. As outlined by the INCB in 1994:

The international community has expressed a desire not to reopen all debates but to build on those commonly defined strategies and broad principles and to seek ways to further strengthen measures for drug control […]. Any doubt, hesitation, or unjustified review of the validity of goals will only undermine our commitment. (Jelsma, 2003)

The Decade against Drug Abuse saw continued high-level exhortations. The slogan ‘A drug-free world – we can do it!’ dominated the 1998 UNGASS, at which states committed to achieve significant and measurable reductions in the supply and demand for illicit drugs within a 10-year period. In an address to the meeting, UN Secretary General Kofi Annan set out his hopes to see the UNGASS ‘go down in history as the time the international community found common ground to take on this task in earnest’ and ‘real progress towards eliminating drug crops by the year 2008’ (Jelsma, 2003).

The Record of Drug Control

After stepping down as General Secretary of the UN, Kofi Annan joined the Global Commission on Drug Policy, an organisation that brings together 14 former heads of government and other eminent figures in an international campaign for drug policies based on scientific evidence, human rights, public health and safety. Following an all too familiar path of officials moving to a critical position on drug policy once out of high office, Annan joined the Commission in 2011 as the body published its first report calling for a paradigm shift from law enforcement to health-based responses to drugs. Subsequent annual publications by the Commission highlighted the rights violations, prejudice, stigma and health harms caused by criminalisation and set out strategies and options for drug policy reform, including decriminalisation and legal regulation of substances.

The work of the Commission draws on an accumulated and sizeable body of evidence suggesting that current drug strategies are ineffective and cause more harm than good. Rather than advancing towards a utopian world free of drugs, the international control system has instead presided over an increase and diversification in types of mind and mood altering drugs available, a reduction in the price of controlled substances and an increase in purity. More people in a wider range of geographical spaces are using illegal drugs than at any point in the history of the control regime. Based on figures for 2017, the UNODC’s 2019 annual World Drug Report estimated that 271 million people (within a range of 201 million to 341 million) between the ages of 15 and 64 had used drugs at least once the previous year, equivalent to 5.5% of the global population aged 15–64. Cannabis is the most commonly used scheduled substance with 188 million users, followed by opioids (53 million), amphetamines and prescription stimulants (29 million), MDMA/Ecstasy (21 million) and cocaine (18 million). By way of contrast to the narrative of generic drug use ‘evils’ (Lines, 2010), the UNODC acknowledges that approximately 85% of drug users consume drugs infrequently and without problems of addiction or dependence (UNODC, 2019a, p. 11), with drug use disorders concentrated within an estimated 13% of total user numbers.

The demography and geography of drug use has experienced dramatic change during this period of increasingly repressive measures against engagement in the illegal trade. A key trend, as analysed by many in this book, is the increase in the number of women using drugs (Arpa, 2017; Measham, 2002; UNODC, 2018a). There are also notable patterns of poly-drug use, a lengthening of the drug using careers of individuals and an increase in consumption in Global South countries traditionally insulated from the trade. Rather than a world simplistically bifurcated and contained as ‘consumer’ Northern and ‘producer’ Southern regions, twenty-first century drug markets are characterised by complex patterns of globalised, regionalised and domestic drug cultivation, manufacture and consumption across, within and between states. As acknowledged by the INCB (2012): ‘To varying degrees, all countries are drug-producers and drug-consumers and have drugs transiting through them’.

Rather than ending illicit drug crop cultivation within a decade, including through aggressive (US led) eradication activities, the cultivation of cannabis, opium poppy and coca has continued to expand in key cultivating states. In 2017, coca cultivation in Colombia reached the highest ever recorded figure at 171,000 hectares, a 17% increase from 2016. As outlined by the UNODC, 80% of coca was grown in the same areas where it had been cultivated over the past decade, and concentrated in the departments of Antioquia, Putumayo, Norte de Santander and Cauca (UNODC, 2017). The prices of coca leaf, coca paste and cocaine hydrochloride fell by 28%, 14% and 11%, respectively, but their trade still generates estimated in-country revenues of US$2.7 billion. Cultivation did fall back in 2018, but only by a modest 1.16%, to 169,000 hectares, with potential cocaine output rising 5.8% on the figure for 2017, to 1,120 metric tons. Similarly, in Afghanistan, the centre for 85% of global opium production, the area under cultivation increased by 63% between 2016 and 2017, from 201,000 hectares to an estimated 328,000 hectares (UNODC, 2018b). As in Colombia, opium poppy cultivation in key growing countries Afghanistan and Myanmar did decrease in 2018, falling 17%, with a 25% decline in opium production levels. However, the UNODC acknowledged in its 2019 Annual Report that the global area under cultivation remained at an estimated 346,000 hectares in 2018, with opium production ‘among the highest in the past two decades’, with continued increases in cultivation in Mexico (UNODC, 2019a, p. 30).

The failure of the control system to reduce the volume of illicit drug supply was amplified by one of the most important trends of recent years: the rise in synthetic drug manufacture and use. The preface to the UNODC’s 2013 World Drug Report sets out that use of amphetamine-type stimulants (ATS) ‘appears to be increasing in most regions’, with crystalline methamphetamine presenting ‘an imminent threat’. As outlined by the UNODC in 2019: ‘The ATS market underwent remarkable changes over the last decade’, including:

increased differentiation of the ways synthetic drugs are sold and consumed (e.g. powder, tablets, capsules, crystals), changes in precursors over time [and...] the discovery of new ways of trafficking (e.g. dark net).

Underscoring this growth trend, the global quantity of ATS seizures increased more than four times, from 60 tons in 2008 to 261 tons in 2017 (UNODC, 2019b).

Running parallel with the growth of ATS markets has been the emergence of new psychoactive substances (NPS). These ‘legal highs’ fall outside of the schedule of controls that apply to 234 substances but they have become subject to some national level regulations. Control efforts, however, are complex (Measham, 2011). Minute chemical modification can automatically take these substances back outside of regulatory frameworks, and many of these substances are dual use and marketed for purposes other than consumption. According to the UNODC, NPS availability increased dramatically after 2008. At the end of 2015, 602 unique substances had been identified, representing a 55% increase from the 388 substances reported the previous year (UNODC, 2015c).

Not only has drug control failed to reduce supply and demand for controlled drugs, the system has demonstrated limited ability to deftly navigate the dual use dilemma. Over recent years, the differentiated systems of national and international controls and regulation of psychoactive substances – from cocaine and NPS to alcohol, tobacco and pharmaceutical medications – has been shown as unworkable, arbitrary and unrepresentative of the actual harms caused by substances. Non-medical use of diverted and fake pharmaceutical drugs is a particular challenge for international and national authorities across the globe. Klein (2019) outlines the particular challenges emerging in relation to the synthetic opioid Tramadol:

Tramadol is […] widely used as an analgesic for alleviating pain of moderate to medium intensity. With potency estimated to be about one-tenth that of morphine, tramadol is considered as relatively safe with regard to poisonings or dependency. Yet there are increasing reports of widespread non-medical consumption of tramadol in North and West Africa.

The United States has experienced a well-documented crisis of opioid fatalities, initially linked to aggressive marketing by pharmaceutical companies in the late 1990s and in a context of deficient and unaffordable public health care and access to pain relief. The US Centre for Disease Control (CDC) highlights three ‘waves’ of opioid overdose between 1999 and 2017, leading to the death of 400,000 people (Scholl, Seth, Kariisa, Wilson, & Baldwin, 2019). The first wave involved an increase in the prescription of opioids in the 1990s (natural and semi-synthetic opioids and methadone). The second wave began in 2010, with rapid increases in overdose deaths involving heroin, with the third wave, dating from 2013, involving the illicitly manufactured synthetic opioid fentanyl. The CDC highlights the dynamics of the illicit fentanyl market, with combinations of heroin and cocaine.

In stark contrast to the lax regulation of pharmaceutical drugs and the inability of the control regime to delimit diversion from pharmaceutical markets, overly robust controls imposed on controlled substances authorised for medical and scientific use and classified as essential medicines by the World Health Organisation has created a ‘global crisis of pain’. As outlined by Bhadelia et al. (2019):

The poor, worldwide, have little or no access to palliative care or pain relief. Approximately 298 metric tons of morphine-equivalent opioids are distributed in the world each year. However, only 0.1 metric tons – 0.03% – are distributed to low-income countries. More than 61 million people worldwide experience serious health-related suffering annually throughout the life course that could be alleviated if they had access to palliative care. More than 80% of these individuals reside in low- and middle-income countries where palliative care is limited or non-existent.

Elaborating on the gross inequalities that have been structured by the system, the authors highlight that in relation to access to opioid analgesics for palliative care:

In Nigeria, less than 1 milligram of distributed opioids is available per patient in need of palliative care per year, enough to meet only 0.2% of need. By contrast […] Canada has 3090% available for distribution per patient in need of palliative care.

For scientists and clinicians wishing to research substances that may have beneficial effects for physical and mental health, including psychedelic and hallucinogenic substances, drug control requires licenses be approved by policing and judicial authorities, not medical councils.

International drug control is intended to serve the ‘health and well-being of mankind’ as set out in the 1961 UN Single Convention and reiterated in subsequent treaties. Moreover, and in a final indictment of the performance of the control regime, access to treatment services remains unacceptably low (Harm Reduction International, 2018). Where services are available, these are frequently inappropriate, underfunded, do not adequately address the problem, and, as highlighted in m...

Table of contents

• Cover
• Title
• Introduction
• Chapter 1  International Drug Policy in Context
• Chapter 2  Gendering Drug Policy
• Chapter 3  Women and the Politics of Pleasure in Critical Drug Studies
• Chapter 4  Fiona’s Story
• Health, Care and Treatment: Stigma, Gaps and Vulnerabilities
• Chapter 5  Nexus of Risk: The Co-occurring Problems of Gender-based Violence, HIV and Drug Use Among Women and Adolescent Girls
• Chapter 6  Risk Behaviours Among Older Women Who Use Drugs
• Chapter 7  Women Who Use Drugs and Mental Health
• Chapter 8  Access Barriers to Health Services for Women Who Use Drugs in Eastern Europe and Central Asia
• Chapter 9  Suzanne’s Story
• Chapter 10  Sex Work, Justice and Decriminalisation: Beyond a Politics of Recognition in Promoting a Social Justice Response to Women at the Margins
• Criminal Justice, Injustice and ‘Criminality’
• Chapter 11  Women Incarcerated for Drug-related Offences: A Latin American Perspective
• Chapter 12  Policing and Sentencing Practices in Russia and their Impacts on Women Who Use Drugs
• Chapter 13  Women, Drug Policy and the Kenyan Prison System
• Chapter 14  Drug Policy and Women Prisoners in Southeast Asia
• Chapter 15  The Increase in Women Who Use Drugs in Zimbabwe
• Chapter 16  Women as Actors in the Drug Economy
• Chapter 17  Women’s Involvement in Organised Crime and Drug Trafficking: A Comparative Analysis of the Sinaloa and Yamaguchi-gumi Organisations
• Chapter 18  From the Colombian Coca Fields: Peasant Women Amid the War on Drugs
• Chapter 19  ‘Las Empoderadas’ Women Coca Growers Building Territorial Peace
• Chapter 20  Unseen and Unheard: The Women in Duterte’s War on Drugs
• Best Practice, Mobilisation and Reform Agendas: Towards Narco Feminism
• Chapter 21  Happy’s Story
• Chapter 22  Women Surviving the Overdose Crisis in New York City: A Glimpse into the Unique Overdose Risks and Prevention Strategies for Pregnant Women
• Chapter 23  Patterns of Recreational Drug Use and Harm Reduction Strategies among Women at Music Festivals: The Case of Hungary and Poland
• Chapter 24  Queer Feminine Identities and the War on Drugs
• Chapter 25  Best Practices in Reaching ‘Hidden’ Populations and Harm Reduction Service Provision
• Chapter 26  A Mother’s Story
• Chapter 27  Drug Users as Stakeholders in Drug Policy: Questions of Legitimacy and the Silencing of the Happy Drug User
• Chapter 28  Improving Drug Policy Metrics and Advancements in Measuring Gender-based Drug Policy Outcomes
• Shifting the Needle: A Gendered Perspective on the Impacts of Global Drug Policy Enforcement
• Chapter 29  Towards an Abolitionist Drug Policy Reform
• Chapter 30  Women Who Use Drugs: Resistance and Rebellion
• References
• Index