consumption— similar to licensed alcohol venues and Dutch cannabis“ coffee shops,” potentially also for smoking opium or poppy tea; and Unlicensed sales— minimal regulation for the least risky products, such as caffeine drinks and coca tea.
Such a risk guided regulatory approach is the norm for almost all other arenas of public policy, and in this respect it is prohibition, not regulation, that can be viewed as the anomalous and radical policy option.
Moves towards legal regulation of drug markets depend on negotiating the substantial institutional and political obstacles presented by the international drug control system( the UN drug conventions). They would also need to be phased in cautiously over several years, with close evaluation and monitoring of effects and any unintended negative consequences. Rather than a universal model, a flexible range of regulatory tools would be available with the more restrictive controls used for more risky products and less restrictive controls for lower risk products. Such differential application of regulatory controls could additionally help create a risk-availability gradient. This holds the potential to not only reduce harms associated with illicit supply and current patterns of consumption but, in the longer term, to progressively encourage use of safer products, behaviours, and environments.
Understanding of such processes is emerging from“ route transition” interventions aimed at encouraging injecting users to move to lower risk non-injecting modes of administration by, for example, providing foil for smoking heroin 30. This process is the opposite of what has happened under prohibition, where a profit driven dynamic has tended to tilt the market towards ever more potent( but profitable) drugs and drug preparations, as well as encouraging riskier behaviours in high risk environments.
' There would be potential for translating a proportion of existing criminal profits into legitimate tax revenue '
The oversight and enforcement of new regulations would largely fall within the remit of existing public health, regulatory, and enforcement agencies. Activities that take place outside the regulatory framework would naturally remain prohibited and subject to civil or criminal sanctions.
Regulation is no silver bullet. In the short term it can only seek to reduce the problems that stem from prohibition and the illicit trade it has created. It cannot tackle the underlying drivers of problematic drug use such as inequality and social deprivation. But by promoting a more pragmatic public health model and freeing up resources for evidence based social policy and public health based interventions it would create a more conducive environment for doing so. The costs of developing and implementing a new regulatory infrastructure would represent only a fraction of the ever increasing resources currently directed into efforts to control supply. There would also be potential for translating a proportion of existing criminal profits into legitimate tax revenue.
Different social environments will require different approaches in response to the specific challenges they face. Transform’ s blueprint does not seek to provide all the answers but to move the debate beyond whether we should end the war on drugs to what the world could look like after the war on drugs. It is a debate that the medical and public health sectors have failed to engage with for far too long.
30
Bridge J. Route transition interventions: Potential public health gains from reducing or preventing injecting. Int J Drug Policy2010; 21:125-8. CrossRef Medline Web of Science revolutionise. it 48