This post has come about because over at Crooked Timber I was outed as one of the authors on this paper, while defending the prohibition of heroin (I’m the third author on that paper, and have a brace like it[1]). I don’t usually like to reveal my identity on the internet, because … well, because the internet is a dangerous place, and also it seems a bit pretentious. But since it came up on that thread, and I didn’t want to do a threadjack (the OP was about “zombie economics,” not “zombie drug policy”), I thought I’d give the definitive Faustusnotes position on the Legalization of Heroin.
First though, in the interests of all this clarity of identity, I thought I’d add that I’m currently teaching this topic in a special lecture at Ritsumeikan Asia Pacific University, on the special topic of Global Crime and Public Health, in which I get to add some of my own theories about the importance of governance and corruption in modern drug policy. My views, of course, don’t represent those of the University or my colleagues, though I sincerely hope that they do reflect those of my students by the end of the course[2] . Also, Professor Quiggin, the author of the original post at Crooked Timber, has a couple of posts about prohibition at his own blog that express a common problem many on the civil libertarian side of politics (whether right or left) have with drug prohibition – even if we accept it is practically a good idea, how can we justify it when we don’t prohibit alcohol or tobacco? I’ll try to answer that on practical grounds in this post as well.
As a final point, I should add that my views don’t represent those of my co-authors, though I think we agree in the main on most of these issues, but it would be wise to assume we differ in various small ways about details of the wide range of issues that fall within the rubric of modern drug policy.
The harm reduction vs. prohibition debate and the war on drugs
As with a lot of modern policy debate, the drug “debate” has been poisoned by the involvement of the US on the prohibition side of things. US prohibition policy – the so-called “war on drugs” – is much tougher and harsher than that in action in other countries of the developed world, and involves a whole series of abuses of freedom that don’t really occur in the rest of the developed world. The US also lacks a coherent national harm reduction policy, which means that the worst effects of the drug trade on its prime victims (the drug users) is not ameliorated or softened effectively by health or welfare agencies. I find when discussing the issue of whether drugs should be legalized that it is best to completely ignore the US experience of prohibiting heroin and cocaine, because it has been done in such a cruel and heartless way that it really doesn’t represent what can be achieved.
It’s also important to ignore the distinction between harm reduction and prohibition, and to assume for a moment that they can a) work side by side, and b) aim for the same goal (improvements in health). We can, at least in theory, argue for prohibition on the basis of its benefits for health.
For the benefit of my American reader(s), harm reduction is a suite of practical policies aimed at reducing the damage drug use does, without attempting to judge the behaviour, and based on the assumption that harmful behaviour occurs regardless of our judgments and even where it is illegal. Because harm reduction doesn’t explicitly try to stop the underlying activity, many people think of it as a kind of “gateway policy” for drug legalization, but in my experience this is a pretty big mistake. Harm reduction is typically represented by policies like Needle Syringe Programs (dispensing free needles), free availability of methadone treatment, and sometimes more radical experiments like medically supervised injecting centres[3] or medical prescription of heroin[4]. Many harm reduction practices do actually attempt to change behaviour, reduce drug use or stop drug use (that’s pretty much what methadone is designed to do), so the claim that harm reduction as a policy suite condones drug use is a bit shallow.
Prohibition, on the other hand, is an attempt to stop the use of drugs, typically by banning their production, sale and/or use. Prohibition has recognized negative effects, the main ones being (and these are all important):
- Criminalization of drug users for their personal behaviour, which generally doesn’t harm others
- Invasion of the rights of non- drug users as part of police activity
- Stigmatization of drug users
- Significant public health effects deriving from the need of users to keep their use secret
Note that stigmatization is important in the era of HIV. Stigmatized people don’t seek health care. This means that there is a risk they will unknowingly spread HIV. Thus stigmatization is practically an important issue even if you, personally, think that the stigma is deserved.
Why Prohibit Heroin?
Heroin, particularly, needs to be prohibited for a simple reason – it is extremely dangerous when used as an injectable drug. It is dangerous for two simple reasons, and neither of these reasons will go away just because the substance is legal. These are:
- Transmission of Blood Borne Viruses (BBVIs): particularly HIV and Hepatitis C (HCV). HCV is now the single biggest cause of liver transplant in Australia, surpassing alcohol-related liver damage, so it’s an extremely costly and unpleasant disease. HIV is a bullet that the developed world largely dodged by good luck and very rapid implementation of harm reduction policy. BBVIs are primarily spread in the developed world through needle sharing by IDUs (in fact, it’s the only way to transfer HCV). To give a sense of how endemic these diseases can be, HCV was around in Australian IDUs in the 70s, before the implementation of NSP and harm reduction policies. Its current prevalence in IDUs is about 60%, and in US areas without NSP it is up above 90%. HIV in Australian IDUs is low, less than 1% in fact, and this is almost entirely due to the provision of clean needles to IDUs before the disease became widespread.
- Overdose: Heroin kills its users, randomly, and rapidly. During the late 1990s in Australia heroin became one of the top killers of young people, with nearly 1000 deaths in 1999. Although overdose is associated with using other central nervous system depressants (especially alcohol and benzodiazepines), the epidemiology of overdose is still not clear and there is pretty strong evidence of at least some randomness in the death rate – autopsies suggest that people who have died from overdose have similar levels of residual heroin in their system to those who didn’t, whether or not they had other substances at the time of death. OD is a random risk that heroin users face.
If heroin were legalized, it would become much more widely available and the rates of BBVIs and HCV would surely climb. There are clear reasons why this will happen, but before I describe them, anyone who has read this far should ask themselves these three questions:
- Have you ever got drunker than you expected from a couple of beers, or experienced greater effects from the amount of alcohol consumed than you expected? i.e. is your experience of alcohol’s potency the same every time you drink the same alcohol?
- Have you ever had unsafe sex when you fully intended to have safe sex, had the condoms with you, and knew the risks? Do you know people who have done this?
- Have you, your partner, or a completely reasonable and sane person you know, ever experienced an unplanned pregnancy? Do you think those people knew the risks? Do you think that the high teen pregnancy rate in the UK is entirely related to lack of availability of condoms?
I present these questions in support of the unasked questions about the behaviour that will flow from legalization. Legalization is not a panacaea that will instantly solve all our drug use problems, and turn previously chaotic, criminally involved addicts into beautiful people. It just means more people will be at risk of these mistakes.
The consequences of legalization
The two main consequences of legalization of heroin are an increase in overdose deaths and an increase in the prevalence of BBVIs. These, I think, are inevitable, because of the reality of injecting drug use.
Increase in Overdose Deaths: heroin does not kill users because it is cut with bad stuff, as many claim. It kills users because it randomly kills people. Some people claim that steady purity will prevent this from happening, because users will know how much they’re taking, but this isn’t necessarily the case. We don’t know the biological causes of overdose clearly, and we don’t clearly understand the relationship between heroin purity and overdose. I am sure it’s well understood in medical settings, but people won’t be injecting heroin in a medical setting – they’ll be injecting it in their loungeroom, with their friends, in the same context that people drink alcohol now. The effects won’t be controlled, and peoples’ behaviour is not so straightforward. There will be people who misjudge the time since they last had a drink, or how drunk they “think” they are, or who think the first shot just isn’t enough and don’t wait long enough for the second one, or who’re feeling particularly nasty today, or… then there will be people (presumably those who map to the 30% of ODs whose residual levels of morphine are lower than in OD survivors) who just die randomly. There will also be people who’ve tried to give up, and come back for a shot but forget their tolerance has gone down; people coming out of gaol or the army or a long overseas trip.
Increase in BBVIs: HCV is not a rare disease that IDUs get through crazy mistakes. It’s an environmental hazard that happens to people who are IDUs. It happens because people shoot up in silly situations, like the toilet behind the restaurant, or the party with 5 of their mates, or 6 times today during a cocaine binge, or… I once watched 10 people in a room at a house party injecting speed, all sharing the drug from the same bag by the light of a couple of candles, most of them drunk, music loud, people passing around various objects, bags, spoons, water… in this situation needles get misplaced easily, people think they’re using their own but they’re not… with 60% prevalence of a virus, this becomes a significant risk of its spread.
It’s also not the case that IDUs in Australia share needles because of the illegality of the drug. Most IDUs in Australia have regular, reliable and uninterrupted access to clean needles and don’t have to share, and sharing rates are generally low. Nonetheless, prevalence of HCV is high. This is because when the majority of people in your community have a disease that is linked to the main behaviour that defines your community, that disease becomes an environmental hazard, rather than an avoidable medical condition (like HIV).
Addiction: The other thing that will happen if the drug is legalized is a lot of people will try it and become addicted. We have evidence from the Vietnam war that when the drug is available young men will try it; if legal in Australia and easily purchased, the number of people trying it will increase and with it the pool of addicted people. Addiction to heroin is associated with poverty – you can’t shoot up 3 times a day and hold down many forms of work. Addiction to heroin is also associated with loss of children (through neglect) and family. Unless the legally available drug is very cheap, it will also lead to crime – an addicted person will be having to spend upwards of $30 a day on their habit, which is worse than most serious smokers do. Having lost their job and family support, where will this money come from?
Many people try heroin and don’t become addicted, but those who do become addicted typically see their lives fall apart around them. We don’t need to expand the pool of people to whom this applies.
Australia’s Prohibition Success
In January 2001 Australia experienced a sudden reduction in the availability of heroin, that led to a marked change in the heroin markets and drove a lot of young people and new users out of the heroin market, probably permanently. There was a sustained 60% reduction in heroin deaths, 70% reduction in ambulance attendances at overdose, and a 15% reduction in cocaine possession offences. There was no long term increase in acquisitive crime, prostitution offences or BBVIs. New entrants to methadone increased, indicating people trying to leave the market; it’s likely that the overall number of new and young users permanently declined. This was a huge public health gain with very little downside, and it occurred through a sustained campaign of harm reduction and prohibition that ramped up, and improved, with the 1997 release of the National Drug Strategy (under the conservative government of John Howard). Increased treatment places, novel harm reduction policies, and improved health services to IDUs, meant that they were sheltered from the worst effects of the shortage; improved coordination of federal customs and police, improved intelligence-gathering and coordination of local police, and significant reductions in police corruption, meant that drug importation stopped being profitable, and the supply side of the market collapsed.
Our argument (in the paper linked above) is that harm reduction was a key part of this success of prohibition, both in reducing demand for heroin (through methadone treatment) and in protecting users from the worst of the effects of prohibition when it happened. The long term reforms of sex work and police behaviour towards petty crime also helped with this – in my opinion, on a local level we saw the lessons of the Inquiry into Aboriginal Deaths in Custody, the Wood Royal Commission into Police Corruption[5], the National Drug Strategy and the Drug Courts all coming together in 2000/2001 to destroy the viability of the market for heroin.
Why we Prohibit Heroin but not Alcohol
There is understandable concern that it’s hard to support prohibiting heroin but not alcohol; and that the bad historical lessons of the latter should inform our decision to try the former. But in fact the two drugs are completely different, and there are practical reasons why even if we wanted to prohibit alcohol we can’t. John Quiggin touches on these in his posts on prohibition, but I think he misses the point a little. We can’t prohibit alcohol for many practical reasons that don’t apply to heroin:
- It has a long-standing tradition of use, that isn’t just window-dressing. Alcohol is an important part of our culture, not something we can just wish away, with a role in festivals and the bonds of social life
- The raw materials are accessible to anyone – they’re in shops down the road
- The production process is well understood and can be done in a back yard, so the prohibition is trivial to avoid
- Declaring alcohol illegal means that the people charged with enforcing the law will be declared criminal overnight, unless they stop a long-term habit (Police do like a drink)
- There is an existing industry with a significant role in society – not something that ever applied to heroin
In addition, we know that alcohol can be used safely, while heroin can’t. So it’s really hard to put up a justification for banning alcohol “for the protection of the user,” while we can do so for heroin. Now, many people object to banning a substance if the only victim is the user, which is why we only ban substances we are sure you can’t use safely; or substances that affect others as well as the user. This applies in spades for heroin, which has no safe level of use, is highly addictive, and whose habitual users commit significant amounts of crime to fund their habit. Heroin is a public order as well as a personal health problem, and the possibility that legalizing it will suddenly cause all those public order problems to disappear rather than worsen is really something that we don’t need to take a risk and find out – especially since we have perfectly good policies in place to prevent prohibition from becoming the vicious, poisonous political problem that is in the US.
A Final Note on Narco-States
It is my firm opinion that drug dealing does not destroy nations (like Columbia or Guinea-Bissau). Rather, states in the process of collapse become havens for drug dealers, which in turn destabilizes parts of those states, and leads to massive corruption problems that further fragment the states. Australia grows lots of opium, but you don’t see Tasmania turning into a narco state. This is because we have a strong state, that can control crime in its borders. There is no causal process from drug dealing to failed states; it’s the other way around.
Conclusion
On civil liberties grounds alone no substance should be banned if it is just bad for the user. But if the drug is randomly fatal, causes addiction and poverty of the kind that inevitably leads people to be tempted to commit crime, and is associated with a significant public health problem like HCV or HIV, then it should be banned if it is possible to do so. It is practically possible to prohibit heroin, we have shown it can be done and that harm reduction can prevent such prohibition from being a threat to health; so I think we should maintain heroin’s illegal status, and do all we can to prevent its production, importation, and use. It should, in short, remain illegal.
—
fn1: including an interesting test of the relative importance of long-term epidemic trends in the heroin market, compared to a sudden shock; and a general method for statistical analysis of imperfectly-dated natural experiments
fn2: Said facetiously, of course…
fn3: One of which I had a small part in helping to set up
fn4: Which I support
fn5: Which I think was hugely important for police corruption in Australia
November 8, 2010 at 10:15 pm
Iiiinnnntttteeeeerrrrreeeeesssssttttiiiinnnngggg.
I come for the WFRP and now I’m commenting for the drugs!
Anyway, my position is largely different than yours but also hugely less educated. One question however – there is an assumption I’m reading in your statements that heroin usage would climb if it were legalised. Do you think that’s actually true? And what’s the evidence? After all, Dutch marijuana use is roughly level with the rest of Europe etc etc etc.
November 8, 2010 at 10:23 pm
WFRP, drugs… Either way, it shows a healthy devotion to chaos.
Marijuana and heroin aren’t really comparable in terms of the degree of effects of prohibition – many European states have pretty lax laws about marijuana, so it’s probably not the same as comparing heroin pre-and post-prohibition. We know that British people travel to Amsterdam for the cannabis, which suggests that they’d be willing to use it if it were more available in the UK, though alternatively it could represent a culture of glorification of legalized drug use – a scary thought if it applied to legalized heroin. We also know that states near the main growing areas, where laws are lax, have huge problems with heroin use – particularly in Thailand, Burma, and the central Asian states. These countries have strong laws about heroin use but weak enforcement, i.e. de facto legalization, and the results are disastrous both for social cohesion and for HIV rates.
We also know that when soldiers in Vietnam were unable to access alcohol but had easy access to heroin, they used it and became addicted. So this suggests that there will be at least some sampling of the drug, though most people who try it will probably switch back to alcohol. Obviously quantifying the numbers who wouldn’t have tried it unless it were legal will prove challenging, though…
November 8, 2010 at 10:40 pm
A persuasive article. That said, I don’t know how Australia handles prohibition- is posession of heroin considered a felony? Possesion of the drug in the UK can lead to a jail sentence, and having too much will lead to posession with an intent to supply. This kind of attitude seems very harmful to me, as punishing users of the drugs is probably counter productive.
Also, whats your opinions on other, less harmful drugs, such as cannabis or ectasy?
November 8, 2010 at 10:46 pm
Excellent post. I agree probably 99%.
My only quibble would be that I don’t agree with the chicken-or-egg question re: narco states, in either direction. I think the point is that organised crime exists in all societies, and in those State that don’t have the capacity to limit the capabilities of organised crime it gets out of control. It’s not that collapsed societies become havens for drug dealers; it’s that drug dealers are at large in all societies and the ones in the collapsed ones get very powerful because there’s no limitation on their growth.
Off-topic, the guy from Crooked Timber who wrote Zombie Economics was interviewed on Econtalk last week. It’s quite a lengthy and detailed interview and well worth a listen. (The host of Econtalk is a libertarian, but he’s a very open and fair interviewer regardless of the politics of the guest.)
November 8, 2010 at 10:59 pm
Noisms, I think that’s a fair point about narco-states, and I didn’t really mean my comment to be taken as a sign that I think drug production groups are like some kind of evil force from outer space seeking a suitable landing pad. They obviously form in states organically in the way you suggest, and when they go looking for a neighbouring state to send their drugs through they look for the same principles – weak government, easily corrupted regional officials etc.
Mister K, possession of heroin is considered a felony (a criminal offence is the phrase, I think) in Australia, but there are efforts in place to reduce the consequences of this for new users. Mainly this involves diversion programs (you go to treatment OR prison[1]); programs to reintegrate prisoners and reduce the damage prison does to ongoing life; and of course prison itself in Australia seems to be a much less serious affair than in the US, and indeed in some ways for hard-core IDUs it can have beneficial effects such as resetting their addiction[2], getting them much-needed treatment and nutritional support. Prison in Australia isn’t nice but it doesn’t constitute the kind of egregious human rights abuse that it appears to be in the US (to this outside observer).
Regarding cannabis and ecstacy, I have mixed views about cannabis because of the smoking/cancer issue (about which I have mixed views); ecstasy I think seems to be almost entirely harmless, and should be downgraded to the same status as cannabis, or legalized entirely. My co-author on the linked paper, Professor Wayne Hall, has a good piece in the MJA (I think) about legalization of cannabis, which argues for its continuing status as a “decriminalized” drug.
—
fn1: this gets a mixed reception because treatment is only successful if you want to be there, and people threatened with prison don’t want to be at treatment, they’re just going because it’s the “easier” option
fn2: a very dangerous thing when they leave if not handled well, since they go back to drugs at an increased risk of overdose due to reduced tolerance
November 8, 2010 at 11:58 pm
Just popped over from CT so to honor the no-threadjack impulse.
There are a couple of concerns I have with your arguments:
1. The idea that we can simply ignore US policy on drugs. As you no doubt are aware, US drug policy isn’t simply a Fortress America type of internal lunacy. On the contrary, US drug policy sets drug policy for most other countries worldwide, through diplomacy, foreign aid and emulation. Saying that we might ignore US drug policy in the context of global drug policy is a bit like saying we should ignore Chinese industry in the context of global industry.
2. Alcohol. I balked at your comment that “alcohol can be used safely, heroin cannot”. Under what definitions of “can” and “cannot” is this true? An enormous number of people die as a result of alcohol consumption. Not only overdoses, which are thankfully relatively rare, but alcohol-related misadventure, alcohol-related homicide, and due to long-term health consequences of moderate over-consumption. If you’re going to make the very strong claim that “legalizing heroin will disastrously increase HCV infection rates” then you have to account for all of the alcohol-related deaths as well. (And it’s not just mortality of course, something like 60% of the people in US prisons & jails were using alcohol at the time they committed the offense for which they were imprisoned. Similarly, the negative effects of non-lethal alcohol over-consumption on family cohesion, educational attainment and career success are well-documented.)
3. While I understand that your main focus is on harm reduction, which is a worthy goal, none of your arguments seem to have any bearing on the civil-libertarian defense of the right for people to ingest whatever they choose. Perhaps you do not believe in any such right or freedom, but you should be up front about that.
November 9, 2010 at 12:15 am
Hi Natilo, thanks for coming to comment. In response…
1. By “ignore” in this context I meant “don’t consider the US experience of prohibition in their own country when discussing whether prohibition of heroin is good.” I didn’t mean to ignore the obvious pernicious role of the US in a variety of international fields relating to harm reduction, which needs to be taken very seriously.
2. there are many definitions of “can” under which alcohol can be used safely. For example, alcoholics can hold down jobs (heroin addicts can’t); young males can drink 2-4 standard drinks per day for 5 days every week without any serious health consequences (heroin users can’t maintain this level of use without entering a pretty deadly spiral, or in fact just dying while using); you can drink a single “unit” (or 10 “units”) of alcohol without the alcohol itself killing you – and you can vary the quantities easily for different effects, which you can’t do with heroin. many of the other concerns you raise about alcohol also apply to heroin use – driving while under the influence of heroin is pretty dangerous, and heroin users commit lots and lots of violent crime too. These statements of “can” aren’t definitive of course – we know full well that alcohol is destructive. But it doesn’t have to be, whereas my argument is that heroin is almost always destructive and doesn’t have safe levels of use.
3. I like to think I made it clear that I support the civil-libertarian defense of the right for people to ingest whatever they choose. But the right to kill yourself stupidly, and spiral into addiction that destroys your family and friends, leads you to commit crime and end up in gaol, is not inalienable. At some point a substance passes some reasonable boundary set by reasonable people beyond which it is no longer in the interests of society to allow its use. Heroin is that substance. Alcohol would be, but we know that managed drinking and safe drinking is possible with education and a bit of legal effort (e.g. random breath testing). This doesn’t apply to heroin. I’ve said above that I support the legalization of ecstasy on exactly the same grounds I support the prohibition of heroin. It’s not that I don’t believe in “any such freedom,” I just think that like most freedoms it is limited by the price society is willing to bear.
November 9, 2010 at 12:23 am
Before I go to bed I’ll make two other tiny points:
1. HCV-related liver transplants now outnumber alcohol-related ones in Australia. Alcohol is used by millions of Australians, heroin by maybe 100,000; yet heroin has outstripped alcohol in one of alcohol’s main long-term health consequences. Also, I’ll add that all good studies of IDU indicate that heroin users have up to 13 times the death rate of their age-equivalent cohort – who are largely drinking alcohol. The majority of that death is from HIV and overdose, so think about expanding that to a population level though legalization.
2. The successful prohibition that occurred in Australia occurred at a time when prohibition activities were increasingly moving away from small-time users and focussing on dealers and networks. So increasingly effective prohibition doesn’t mean increasingly punitive prohibition – an example of why we should ignore the American experience in this instance.
November 9, 2010 at 4:28 pm
As indicated in one of the posts you link, I’m unconvinced by your argument about alcohol. In public health terms, US prohibition was a big success, and the associated criminality, while spectacular, was much less damaging and extensive than that associated with the war on drugs. I don’t favor prohibition, but then I like a drink myself.
As regards health damage, I don’t think it’s possible to make good inferences from outcomes under prohibition, even with a harm reduction focus. I’d be much more interested in your response to claims about the success of decriminalization in Portugal, for example,
http://www.cato.org/pub_display.php?pub_id=12476
November 9, 2010 at 6:00 pm
John, thanks for commenting. In response to your specific points:
– regarding alcohol, alcohol use in America in the early 20th century was very different to now, and it’s unlikely that prohibition of alcohol now would have anything resembling the same effects. Historical estimates of alcohol use in the era of prohibition suggest much greater risky usage than now, I think. Alcohol is highly regulated now, and alcohol adiction better understood. So I don’t think you’d get the same effects from a modern prohibition program.
– I think you can make inferences about the health damage of heroin under prohibition, because some of the consequences are related to the drug or the cultural milieu, and I think the onus should be on people proposing a radical change to explain why they think legalization will suddenly cause the act of injecting heroin to become less dangerous, or why people will suddenly stop sharing needles. We actually understand the risks of heroin use pretty clearly now, and as I said in the OP, HCV particularly is an environmental hazard, not something people can avoid by being careful. I don’t think the causes of HCV transmission in modern IDUs in Australia are the result of people being unable to avoid needle sharing.
Regarding the Portugal drug experiment, that Glenn Greenwald article is quite misleading, in that it doesn’t mention that decriminalization of heroin use in Portugal was a) not actually legalization and b) was accompanied by a massive increase in harm reduction measures. The reduction in overdose deaths, particuarly, occurred against a backdrop of increased methadone teratment. Some points about this:
a) in 1999 Portugal had about 350 deaths in a population of 13 million; Australia had 1000 in a population of 20 million
b) this occurred despite the fact that Portugal had much lower access to methadone – 6500 places in all of Portugal. NSW alone had 16000 places in 2003, and probably about 9000 – 10000 in 1999 (I can’t find the figures). In fact, NSW alone had a higher death rate due to OD in 1999 than Portugal did.
c) Portugal saw a 150% increase in methadone places between 1999 and 2003, and a reduction in deaths of 60%. This is not unexpected, given that it was introducing a massively expanded system of treatment
d) If you look at my reference below, “legalization” in Portugal was more like a decision to introduce a harm reduction policy in a prohibition framework. Particularly, even the personal possession laws (appeared to) involve giving users a choice of treatment, fines, or gaol. So there remains a strong prohibition element to this policy, it’s not a laissez faire legalization program at all. In fact, in many ways it resembles the 1997 Tough On Drugs strategy, plus the 1999 NSW Drug Summit
e) Portugal saw a 60% decrease in ODs from 1999 to 2003, in a herion market that was much less extensive than Australia’s. NSW saw a 60% reduction in deaths under prohibition from 2000 to 2001. The reduction from 1999 to 2003 was more like 80%. This occurred in a more extensive market than Portugal’s, in a much more mature harm reduction environment, i.e. an environment where expanding methadone treatment would have had much more marginal gains than those in Portugal.
f) before the change, consumer possession offences seem to be much higher in Portugal than in Australia, indicating very high levels of street-level intimidation of ordinaryusers, with attendant corruption (this is my guess) and a lack of emphasis on high-level use. I don’t know much about Portugal’s policing practices, but everything in the attached document implies poorly-managed prohibition targeting users in an absence of serious harm reduction measures.
In short, Portugal’s experiment was primarily an expansion of harm reduction, along with some significant changes in the targeting of low level users, very similar to the drug courts introduced at that time in Australia. It doesn’t represent a victory for decriminalization per se, but for harm reduction.
The Portuguese experiment also seems to incorporate some of the high-level anti-trafficking and governance reforms seen in Australia, so it may actually be, somewhat paradoxically, that the “decriminalization” in Portugal also reprsented the first serious attempt to prohibit the drug.
Click to access BFDPP_BP_14_EffectsOfDecriminalisation_EN.pdf.pdf
November 18, 2010 at 1:21 am
I might disagree with you about Clark Ashton Smith but this article was excellent. I’ve forwarded it on to a couple of friends that I’ve had discussions about the legalization of ALL drugs before. The sticking point always seems to be heroin in these conversations.
Cheers
Andrew
November 18, 2010 at 7:59 am
Thanks Andrew. What’s your opinion?
November 18, 2010 at 9:14 am
I only know of two people that havesmoked or do smoke heroin on a regular basis and from what I’m told (friend-of-a-friend admittedly) it seems to effectively take over their lives completely.
So, even aside from the BBVI and health issues you mentioned above, (which, in terms of magnitude I had no idea about) it seems to alter things on a purely personal level to a degree which no policies would ever be able to alter. One of the two works at a (close) family business and regularly steals from it to fund his habit, which seems to me a clear case where legalization would affect nothing. More simplistically, the other (who I believe has now stopped) has stated that scoring was all she thought about and she ceased to be creative in any way (formerly a musician). That might be second hand information, but I have met both of them in person and it got through to me more than any statistics or anti-heroin Motorhead songs did.
Personally I can’t see drugs like marijuana or alcohol affecting lives in the same way for the reasons you mentioned above-even if you take it to the most basic “person by person” view they are both drugs where in a lot of cases somebody can hold down a job, at whatever level suits them.
PS Sorry if this post doesn’t make too much sense, I’m a bit pissed.
November 18, 2010 at 9:25 am
The general argument is that legalization will reduce the stealing and crime because it will reduce the cost of the drug and make it less costly and time-consuming to obtain. I don’t think anyone knows if this is true or not, because we don’t know what it would cost to get on a legal market. Other pharmaceuticals of the same type certainly aren’t cheap (they’re subsidized so that they seem cheap), but one assumes that if morphine and paracetamol are cheap then so would heroin be. However, even if this were true we would still have a situation where people’s lives were being sucked up by the drug and it would remain deadly. In fact, when you see the way that heroin users use morphine or benzodiazepines, it’s pretty clear that pharmaceuticals aren’t a solution to their ills.
In general, the closer people get to the heroin-using world, the less supportive they seem to become of legalization (with a few exceptions). This isn’t true of cannabis – many people spend their whole lives around cannabis users and don’t meet anyone who has suffered from its use. This is also true of alcohol, in that although we all know someone who’s a bit of a sad drunk, and someone else who is drinking at levels that will harm their stomach, we also know many people who regularly get plastered but still hold down a job and suffer few if any health-related consequences. On a personal, individual level, heroin is vastly more dangerous than these drugs, and it’s only through limitations on its use that we can claim it is “less harmful than alcohol.”
The main thrust of modern drug control programs (outside of America) is to recognize this and prohibit the drug without allowing the prohibition to further destroy the life of the user. This has been shown now to be possible, which is good for everyone.
November 18, 2010 at 10:10 am
The other issue with legalization of heroin is that it will take the life-consuming dedication to score out of it. So Andrew’s musician friend of a friend might be able to go back to being creative while continuing to score from the chemists. This si sort of getting off the argument but while alcohol can be life-consuming for alcoholics its not because they have trouble getting it and, as a result, is quite a different thing.
January 20, 2011 at 10:16 am
There’s some comments on the Dutch and Portuguese experiences here:
http://www.economist.com/blogs/democracyinamerica/2011/01/harm_reduction?fsrc=scn/fb/wl/bl/drugs
I hadn’t realised that the Dutch were giving heroin to users who are willing to inject in supervised circumstances but seems like an interesting approach.
January 20, 2011 at 6:11 pm
I pointed out above that the results of the Portuguese experiment are much more to do with the introduction of harm reduction than the end of prohibition, which that economist article recognizes (if grudgingly). But this comment:
is completely wrong, as is the claim underneath that
Both of these statements are wrong. Drug abuse is driven by people getting a chemical addiction to a drug, and their level of access to and ability to cope with the drug is often determined by poverty. Drug addiction – especially heroin addiction – is not actually seen as fashionable at all, and actually constitutes a minority counter-cultural fashion popular, primarily, with the very poor and criminal. It is driven by criminal gangs importing drugs and selling them to vulnerable people. Also, the idea that government can make something unfashionable is just silly. They certainly managed in Australia to make going to war fashionable, even in world war 1 when Australia didn’t have conscription; they made seatbelt wearing into a habit, and somehow managed to convince people to clean up their dogshit. They also seem to have failed to make alcohol abuse unfashionable, despite tightening up the restriction and regulation of that drug considerably. That second sentence just represents the standard Economist recipe – every article has to end by blaming the government.
March 22, 2011 at 10:12 am
SG/Faustus
A number of matters are raised above require quite detailed review. I think it might be better to proceed with these one at a time, so as to keep exchanges manageable. So, in no particular order:
Claim: Heroin should be distinguished in its legal treatment from alcohol because there is no safe usage of heroin but one may use alcohol safely.
I beg to differ. It’s certainly as possible to use a “safe” level of heroin as alcohol. At equivalent levels of intoxication to that of a person staying under 0.05 the amount of pure heroin would be tiny.
Ultimately, the choice to use or not use a mood altering substance in harmful ways is an expression of how well someone has managed their end of the realities of life, rather than a function of the substance.
At the tender age of 19, I had what a friend of mine described as “a taste” — a minuscule amount of heroin — mostly out of curiosity. The effect was powerful and euphoric, but it never occurred to me again that this was something that wopuld fit into my preferred life trajectory, which even then I saw as bound up in political activism. My “supplier” is still in regular contact, has held down a responsible job for the past 15 years, has never to my knowledge been charged with an offence or sacked and AFAIK, is either no longer using or using at safe levels.
Becoming a substance abuser is a reflection of profound and unresolved psychological problems — of being unhappy in one’s own skin and seeking escape. It’s scarcely surprising that US troops in Saigon became seriously addicted to heroin. Let’s face it — their state had turned them into people who had to kill and brutalise without compunction, and that is always going to mess with your head.
It seems to me that in a controlled supply situation, one could deliver very precise quantities of heroin to those seeking it, deliver it other than by syringe (e.g. a patch, one time use inhaler, a tablet) prevent double-dipping and ensure that those who appeared to be wanting greater daily doses than was consistent with their safety could be referred for counselling and treatment.
March 22, 2011 at 10:25 am
Fran, I edited that comment to close a tag.
In describing safe levels of use at the beginning of your comment you are clearly delineating between “enough heroin to get intoxicated” and “enough heroin to be safe.” People don’t use heroin in order to not get intoxicated, and as they get more dependent their tolerance increases so they have to use more – with corresponding risks of variation in dose. You can’t talk about “safe” heroin use separate from intoxication, which part of the problem.
Becoming a substance abuser can be a reflection of profound and unresolved psychological problems. It can also reflect a few silly decisions made early in life. Heroin is strongly addictive, and you only need to make some silly mistakes to get caught up in it. Not every substance abuser is a problem child. Your example of Vietnam veterans shows how badly people want this “psychological problems” explanation to be true but isn’t borne out by the facts. In fact the highest rates of heroin use was amongst non-combatant soldiers. I think I linked to Lee Robins’ groundbreaking work on heroin addiction in this post; I suggest you read it if you want to understand the problem of heroin addiction.
Your final paragraph describes the treatment regimens currently available in Australia. It certainly doesn’t describe a situation that requires legally available heroin for personal, recreational use.
March 22, 2011 at 11:31 am
Thanks for the edit …
True, and the same goes for alcohol, except perhaps at the social wine and cheese do. But as recreation, there aere degrees of intoxication. My own experience with heroin that day was that I actually became a lot more intoxicated than I wanted, but of course, I had no guideposts. It was teenager risk taking. In a legal regime with patches, one might opt for very low level dosage and users might be supplied with agents to suppress craving, if it arose.
Perhaps they simply had greater opportunity.
I didn’t see the Robins link.
The point I was making in my last paragraph is that one could allow a legal regime that would not have the pernicious consequences you assert are inevitable.
March 22, 2011 at 11:44 am
I should add that I start from a basic premise that everyone should be able to do anything they please, and then work backwards as warrants for restraining their conduct are adequately made out. Generally, those warrants need to show that the behaviour, but for the restraint, would prejudice a compelling or at least legitimate claim of another in some measurable way and further, that the attempt at restraint would not inevitably prejudice a compelling or legitimate claim of some person. Where there are mutually exclusive warrants (to restrain or not restrain) then principles of general utility and equity shall apply, as best one can model these.
It seems to me that unless one can show that a coercive regime around heroin usage passes these tests, it ought to be rejected at least until the point where the required coercion has a sufficient warrant in utitlity, equity, protection of legitimate and compelling interests.
March 22, 2011 at 11:56 am
Here’s a link to a publication from Robins’ work:
Click to access 38.pdf
I think the analysis of combat vs. non-combat rates of use is in the official report to the US GOv, which I can’t seem to find online (you may have more luck if you have more time).
The legal regimen you describe (with patches &c) is not a regimen that users who want to get intoxicated will approach; they will choose injecting.
Your experience of teenage risk taking exactly describes the situation I refer to in the OP: no guideposts and no control over your intoxication. THis is also what happens with teenage drinkers (even though the amounts in the alcohol they consume are fixed). Given the risky behaviour teenagers show with alcohol, why should you assume any different behaviour with heroin?
I start from the same basic premise as you, and the OP describes the effectiveness of Australia’s coercive policies on restricting heroin use, while also showing the health benefits of the concurrent harm reduction program. The deadliness of heroin use is not in doubt, and although we have no direct comparable evidence, comparison with alcohol use and historical experience suggests that legalized heroin is deadly.
March 22, 2011 at 2:17 pm
Yes but we had no control group. To the best of my knowledge no substantial trial of a legal mood altering substance supply regime has ever been undertaken, so we don’t really know if, in utility terms the program was optimal.
Really, there are far stronger cases to be made out for other state interventions (e.g. in infancy and early childhood for example; lifestyle diseases associated with overweight and obesity, and alcohol especially) than this and one has to wonder, priggishness and authoritarianism aside, why this one persists.
If you are going to coerce, surely you need better warrant than this.
March 22, 2011 at 2:25 pm
Those trials were undertaken in China and Victorian England; they weren’t so successful. They were also undertaken with alcohol in that period, and resulted in prohibition followed by regulation.
Also, most of the theory about how dangerous heroin is was formulated in the 70s, when heroin was much much weaker than now. Medicinal grade heroin is not something that teenagers can play with safely.
Finally, we know that prohibition reduces deaths. This was researched extensively between 2001 and 2008. You can get huge gains in lives saved through effective prohibition, but the reality is that Australia is the only country that has successfully tried it in an existing market.