Drug Policy

Alison Ritter

• Publisher: Routledge
• Year: 2021
• eBook ISBN: 9781000488630
• Edition: 1
• Topic: Politics & International Relations
• Subtopic: Social Policy
• Index: Politics & International Relations

Taking a multidisciplinary perspective (including public health, sociology, criminology, and political science amongst others) and using examples from across the globe, this book provides a detailed understanding of the complex and highly contested nature of drug policy, drug policy making, and the theoretical perspectives that inform the study of drug policy. It draws on four different theoretical perspectives: evidence-informed policy, policy process theories, democratic theory, and post-structural policy analysis.

The use and trade in illegal drugs is a global phenomenon. It is viewed by governments as a significant social, legal, and health problem that shows no signs of abating. The key questions explored throughout this book are what governments and other bodies of social regulation should do about illicit drugs, including drug policies aimed at improving health and reducing harm, drug laws and regulation, and the role of research and values in policy development. Seeing policy formation as dynamic iterative interactions between actors, ideas, institutions, and networks of policy advocates, the book explores how policy problems are constructed and policy solutions selected, and how these processes intersect with research evidence and values. This then animates the call to democratise drug policy and bring about inclusive meaningful participation in policy development in order to provide the opportunity for better, more effective, and value-aligned drug policies.

This book will be of great interest to students and scholars of drug policy from a number of disciplines, including public health, sociology, criminology, and political science.

1
Drug policy

An introduction

DOI: 10.4324/9781003224501-1

The key question explored throughout this book is what governments and other bodies of social regulation should do about illicit drugs. Illicit drug policy is complex. Firstly, as discussed later, the very notion of ‘illicit drug’ is contested and changes over time. Secondly, the problem of drugs is multidimensional and spans multiple parts of the political system and the associated administrative apparatus (such as portfolios concerned with education, health, policing, and social welfare) as well as civil society. A so-called ‘whole of government’ approach suggests that all these portfolios participate in drug policy making. In practice, responsibility usually resides in a single portfolio. Which portfolio of government is chosen will steer the response in a particular direction; for example, where law enforcement ministries are designated as primarily responsible for drug policy, the policy responses tend to be police-directed. Thirdly, not only are there domestic complexities with the regulation of illicit drugs, drug policy is jurisdictionally multi-level involving international, national, sub-national (state/province), and local (city/municipal) regulatory authorities. Nations are bound by international treaties with expectations for global cooperation in relation to reducing drug trafficking as well as international expectations for their domestic law-making. Fourthly, it is a policy domain characterised by goal conflicts. For some, the appropriate drug policy goal is the protection of individuals who use drugs from harm; for others, it is the reduction of the prevalence of drug use across the population; for some others, it is the protection of the community from the consequences of drug use (such as crime); and for some, it may be some balance between these three contrasting goals. Relatedly, there are strong and often conflicting normative dimensions to drug policy – the view that drug use is morally wrong contrasts with the view that drug use is a normal part of human existence. Drug policy also does not sit in a vacuum but is intimately tied to the social, cultural, and political contexts within any one nation.

These complexities, layers, and challenges make illicit drug policy fascinating. Describing what drug policy is in any one nation brings to the fore both international and domestic authorities, an understanding of the goals of drug policy, and the associated value positions underlying those goals. Evaluating and comparing drug policies require an appreciation of different political, social, and cultural contexts. In analysing drug policy, there are choices about whether to focus on policy rhetoric (the official statements of intent), the actions of governments, or adopt a pluralised governance framework (i.e. analyse social regulation inclusive of both government and non-governmental governing bodies). The choices, and theoretical perspectives, are seemingly endless.

Drawing from four theoretical perspectives on policy: evidence-informed policy, policy process theories, democratic theory, and post-structural policy analysis, this book is concerned with describing and analysing drug policy. Policy is viewed as the intentions of government, as documented in official statements, laws and regulations, and as seen through decisions, such as whether to fund drug treatment and in what ways. Ultimately this book is about how to make better drug policy and how to make drug policy processes better. In this Introduction, I start with identifying the classic drug policy binaries, with a view to leaving these behind and encouraging a more thoughtful and nuanced appreciation of drug policy, drugs, and their regulation.

Overcoming the drug policy binaries

It is common to view drugs and drug policy through binaries: utilising a simple either/or rhetoric. While this is one way to simplify and order this pluralised, complex policy problem, it does not do justice to the multiverse of drugs, drug use, drug policy, and drug policy making. In drug policy, the false binaries include:

• That there are legal (good) drugs and illegal (bad) drugs
• That people either use drugs for pleasure and recreation or because they are addicted or dependent and, therefore, drug use is either non-problematic or always problematic
• That drug use is either morally wrong or it is a normal part of human existence
• That drug policy is concerned with either eliminating drugs or accepting drug use but minimising the harms arising as a consequence
• That drug policy is focussed either on reducing drug supply or on reducing drug demand
• That drug policy is either a criminal justice and law enforcement issue or a health and social welfare issue
• That drug policy is a technical, rational decision-making process or that it is a messy inexplicable political process
• That drug policy should be driven either by evidence or by values
• That drug problems exist independently of their observation and regulation or that they are socially constituted through policy processes
• That drug policy is concerned with either individual rights and freedoms or community and societal rights and freedoms

This book will show that none of these binaries hold up under scrutiny or in practice, despite their presence in much drug policy dialogue.

Drug use is common across the globe. In terms of the traditional illicit drugs – such as heroin, cocaine, amphetamines, ecstasy, and cannabis, the United Nations produces an annual snapshot of the prevalence of drug use across the world (United Nations Office on Drugs and Crime, 2019). In its latest iteration, the 2019 World Drug Report noted that an estimated 271 million people, or 5.5% of the global population aged 15–64 years, had used drugs in the previous year. The most commonly used drug was cannabis (United Nations Office on Drugs and Crime, 2019) estimated at 188 million people, followed by 53.4 million people using opioids, 29 million people using amphetamines and other stimulants, 21 million using ecstasy (MDMA), and 18 million people using cocaine in the last year. While often the focus is on these traditional drugs, over the last two decade, there has been significant shifts in drug types. One example is the growth in the use of the opioid class of drugs. Opioids are the generic category of mu opioid agonist drugs and include both plant-based opiates, such as heroin, and synthetic opioids, such as morphine or fentanyl. Opioids have an important role to play in pain management as a prescribed medication (pethidine, codeine, and morphine are all prescribed opioids). Yet the problems associated with opioids including dependence and overdose, particularly in North America, have been declared a ‘public health emergency’ (Ciccarone, 2019).

A second shift in drug types has been the introduction of the so-called ‘New Psychoactive Substances’ (NPS). These synthetically produced psychoactive substances have variously been called research chemicals, legal highs, designer drugs, and party drugs. NPS is defined by the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) as “a new narcotic or psychotropic drug, in pure form or in preparation, that is not controlled by the United Nations drug conventions, but which may pose a public health threat comparable to that posed by substances listed in these conventions”.

As at November 2018, the European Monitoring Centre was monitoring more than 700 NPS for which they have received notifications.

These two examples (opioids and NPS) serve to highlight that the classic distinction between legal and illegal drugs is no longer useful. As some newly identified psychoactive substances come under international treaty control and hence become illegal (such as 5F-MDMB-PINACA in the USA, Federal Registry, DEA, December 2018) and medications that had been previously largely circumscribed to use for pain relief (such as fentanyl) become widely used outside the prescription system, it becomes apparent that reference to ‘illicit drugs’ is no longer helpful terminology. It also highlights the arbitrariness of the distinction between legal and illegal drugs, which is not, as many people assume, correlated with harmfulness (Nutt, King, & Phillips, 2010).

Just as there are a number of different types of drugs of varying legal status, there are multiple drug use practices and motivations associated with drug use. Broadly speaking, drugs can be used for pleasure and recreation; they can be used for enhancement reasons (physical or spiritual); drugs can be used for self-medication purposes (to manage anxiety, depression, or physical ill-health); and drugs can be used as a result of drug dependence. These four broad categories are not mutually exclusive: they can describe the same individual’s drug use on different occasions, or all contribute in part to the motivation to use on a single occasion. Good drug policy considers all four of these types of drug use.

There are also multiple routes of administration: oral, parenteral (injection intravenously, intramuscularly, or subcutaneously), insufflation (sniffing or snorting), inhalation, sublingual (absorbed through the lining of the mouth), rectal, or transdermal (through the skin). Cannabis, the most commonly used illicit drug around the world, is either inhaled (smoked) or taken orally (such as with cannabis edible products). While heroin, crack cocaine, and methamphetamine are often injected, they can also be administered by other routes. Once again, good drug policy takes into account all the routes of administration.

Understanding the harms associated with drug use requires a consideration of the drug itself, the route of administration, the quantity and frequency of use, and the motivations for use. In addition, the setting in which drug use takes place can have a large impact on the probability of harm. There is a world of difference between the person who injects heroin alone in a dark side alley, and without clean injecting equipment compared to the person who injects heroin in a house, with friends present and using clean injecting equipment. It is not the activity of injecting per se that creates the likelihood for harm, but the combination of the drug, the environment (or setting), and the psychological, social, and cultural contexts surrounding use.

The goals of drug policy

There are four main and contrasting goals usually associated with drug policy:

1. To reduce the supply of drugs
2. To reduce the demand for drugs
3. To reduce the harms arising from drug use and drug supply, and
4. To prevent the commencement of drug use

There are also four domains of policy action:

1. Policing and law enforcement
2. Treatment policies and programs
3. Harm reduction policies and programs, and
4. Prevention policies and programs

There are natural affinities between the goals and the actions: the goal to reduce the supply of drugs is most commonly associated with policing and law enforcement; the goal of reducing demand for drugs is usually associated with treatment. However, it is also the case that actions can contribute to more than one goal. For example, treatment with opioid pharmacotherapy maintenance can reduce both demand (goal 2) and harm (goal 3). Policing and law enforcement can contribute towards demand reduction (goal 2), for example, through referral to treatment at point of arrest. Treatment can contribute to supply reduction (goal 1) in direct ways (such as a client ceasing drug dealing) and in indirect ways (such as removing customers from the market). In an ideal world, the four domains of policy action would synergistically contribute to achievement of the four policy goals. Sadly, it is not that simple. Some actions may support one goal but undermine another. Policing may not only reduce supply (goal 1) but also increase harm (in contravention of goal 3). Drug policy, then, is cast either as a choice between the goals or as achieving some kind of delicate balancing act between the policy actions such that they do not undermine each other. It is this latter path that most nations have chosen.

Most national drug policies address all four goals, but countries vary in the balance between them and relatedly the balance across the policy actions (Ritter, Hughes, & Hull, 2016). The relative balance between goals depends on the national context and the priorities concerned with supply versus consumption. There was a traditional distinction between ‘producer’ and ‘consumer’ countries, the former being countries such as Afghanistan, Mexico, Myanmar, Colombia, and the Golden Triangle region (Lao, Cambodia, and Vietnam) as well as other South American countries. These ‘producer’ countries tended to focus on supply reduction goals. However, this distinction between producer and consumer countries no longer holds up, with cannabis produced worldwide, rises in the availability and use of synthetic drugs which can be manufactured anywhere, methamphetamine production dominated by East and Southeast Asian countries (such as China and Thailand), and increasing rates of drug consumption in places usually better known for production, like Afghanistan.

Reducing the demand for drugs (goal 2) is usually measured on the basis of the population prevalence of drug use (i.e. the proportion of people using drugs). The policy goal is to reduce the number of people who are using drugs, and this has been the focus of attention for most governments for many years. Globally, the prevalence of drug use has remained remarkably (persistently some may say) stable for many years, notwithstanding changes in the types of drugs and forms of drug use, as well as shifts in drug markets. The stable (as opposed to declining) rate of global drug consumption has been both a disappointment to those who are seeking a ‘drug-free world’ and an argument for others to suggest that the current global drug policies are failing. The problem with a drug policy metric of population prevalence of use is that it does not identify either patterns of consumption that may be of concern or the harms associated with use. For example, if the population prevalence of the use of cocaine is 2%, this does not reveal whether those 2% of people have used once in the last year or are using every day. Clearly, there are major differences between infrequent annual use and daily use – and significant differences in the policy implications. This is why measures of consumption, rather than prevalence, including the quantity, frequency, and/or intensity of use are vital to inform policy (Bewley-Taylor, 2017; Kilmer, Reuter, & Giommoni, 2015). For example, in relation to cannabis in the USA, a focus on the population prevalence of use, which appears to show only modest changes, masks a concerning pattern of increases in the intensity of cannabis use amongst some groups (Burns, Caulkins, Everingham, & Kilmer, 2013).

Reducing the harms from drug use and drug supply (goal 3) is not focussed on consumption per se, but rather the harms that arise from consumption (or from supply). One way to reduce the harms from drug use is to reduce consumption, and in that sense goals 2 and 3 are linked. But, in the main, reducing harms is achieved through harm reduction policies and programs that do not focus on use per se. The common harms experienced by individuals consuming drugs are overdose, drug dependence, infection with blood-borne viruses from use practices, and other physical and mental health conditions. There are also harms to others from drug use, including to families and friends. Harms also arise from drug supply, including extreme violence, subversion of the rule of law, corruption, and political power associated with criminal networks and drug trafficking syndicates. Finally, harms can ari...

Table of contents

• Cover
• Half Title Page
• Title Page
• Copyright Page
• Contents
• Acknowledgements
• A note on terminology
• 1 Drug policy: an introduction
• 2 Drug policies to improve health and reduce harm
• 3 Drug policies as laws and regulations, and policing
• 4 Drug policies and research evidence
• 5 Analysing drug policy formation
• 6 Analysing the discursive effects of drug policy
• 7 Influencing drug policy: making change happen
• 8 Democratising drug policy
• References
• Index