Decriminalisation has shown that less punitive approaches do not necessarily lead to increased use. In Portugal, for example, use among school age young people has fallen since all drugs were decriminalised in 2001 27. More broadly, an extensive World Health Organization study concluded:“ 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.” 28
Similarly US states that have decriminalised cannabis do not have higher levels of use than those without. More importantly, the Netherlands, where cannabis is available from licensed premises, does not have significantly different levels of use from its prohibitionist neighbours 19.
New approaches?
Although these emerging policy trends are important, they can be seen primarily as symptomatic responses to mitigate the harms created by the prohibitionist policy environment. Neither directly tackles the public health or wider social harms created or exacerbated by the illegal production and supply of drugs.
The logic of both, however, ultimately leads us to confront the inevitable choice: non-medical drug markets can remain in the hands of unregulated criminal profiteers or they can be controlled and regulated by appropriate government authorities. There is no third option under which drugs do not exist. The choices we make must be based on an evaluation of which option will deliver the best outcomes in terms of minimising the harms, both domestic and international, associated with drug production, supply, and use. This does not preclude reducing demand as a legitimate long term policy goal, rather it accepts that policy must also deal with the reality of current high levels of demand.
A historical stumbling block in this debate has been that the eloquent and detailed critiques of the drug war have not been matched by a vision for its replacement. Unless a credible public health led model of drug market regulation is proposed, myths and misrepresentations will inevitably fill the void. So what would such a model look like?
Transform’ s‘ Blueprint for Regulation’ 29 attempts to answer this question by offering different options for controls over products( dose, preparation, price, and packaging), vendors( licensing, vetting and training requirements, marketing and promotions), outlets( location, outlet density, appearance), who has access( age controls, licensed buyers, club membership schemes), and where and when drugs can be consumed. It then explores options for different drugs in different populations and suggests the regulatory models that may deliver the best outcomes( box). Lessons are drawn from successes and failings with alcohol and tobacco regulation in the UK and beyond, as well as controls over medicinal drugs and other risky products and activities that are regulated by government.
There are five basic models for regulating drug availability 22; Medical prescription model or supervised venues— For highest risk drugs( injected drugs including heroin, and more potent stimulants such as methamphetamine) and problematic users; Specialist pharmacist retail model— combined with named / licensed user access and rationing of volume of sales for moderate risk drugs such as amphetamine, powder cocaine, and MDMA( ecstasy); Licensed retailing— including tiers of regulation appropriate to product risk and local needs. Used for lower risk drugs and preparations such as lower strength stimulant based drinks; Licensed premises for sale and
27 Hughes C, Stevens A. What can we learn from the Portuguese decriminalisation of illicit drugs?. Br J Criminology( forthcoming)
28
Degenhard L, Chiu W-T, Sampson N, Kessler RC, Anthony JC, Angermeyer M, et al. Toward a global view of alcohol, tobacco, cannabis, and cocaine use: findings from the WHO World Mental Health Surveys. PLoS Med2008; 5: e141. CrossRef Medline
1 9 Room R, Hall W, Reuter P, Fischer B, Lenton S. Global cannabis commission report. Beckley Foundation, 2009
29 Rolles S. After the war on drugs: blueprint for regulation. Transform Drug Policy Foundation, 2009. www. tdpf. org. uk / Transform _ Drugs _ Blueprint. pdf
2 2 Rolles S. After the war on drugs: blueprint for regulation. Transform Drug Policy Foundation, 2009. www. tdpf. org. uk / Transform _ Drugs _ Blueprint. pdf
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