Drug policy: getting over the 20th century.
Venue: The lancet. Psychiatry

For the New Scientist article on the Psychoactive Substances Bill see https:/www.newscientist. com/ youre nothallucinating mps really didpass crazy bad drug law One night in 1916, on West Street in central London, two police sergeants spotted a man called Willy Johnson acting suspiciously. He fl ed when they approached, dropping a bag; it was full of cardboard boxes containing cocaine. Johnson, the subject of what has been called London's fi rst drug bust, was brought to trial but acquitted. Even if he had been found guilty of selling the substance, the maximum fi ne would have been PS5. Cocaine was, after all, a drug legally available from chemists. But this was not the end of the matter. There was a backdrop of pre war national and international concern about substance use. And 1916 had seen increasing public alarm over cocaine use in the UK's capital city; it was feared that sex workers would introduce troops to the use of the drug. "It is driving hundreds of women mad" warned the Daily Chronicle. "What is worse, it will drive, unless the traffi c in it is checked, hundreds of soldiers mad." The Defence of the Realm Act authorised a swift crackdown on the cocaine trade. After World War I ended, the Dangerous Drugs Act of 1920 cemented the decisions made in the heat of international confl ict. Substance use was no longer simply a vice, or even a disease: it was a crime. And so it remains, nationally and internationally (the UN Single Convention on Narcotic Drugs followed in 1961) albeit with variation in the harshness of the legal penalties involved, and the availability of health services to help users with harm minimisation or abstention. Last month, in an attempt to get ahead of the problem of socalled legal highs, UK Parliament passed the Psychoactive Substances Bill. The Bill defi nes a psychoactive substance as any substance which "is capable of producing a psychoactive eff ect in a person who consumes it" and makes production, supply, and possession under certain circumstances illegal. The Bill was described as "one of the stupidest, most dangerous and unscientifi c pieces of drugs legislation ever conceived" in the pages of New Scientist. When a journal not usually noted for its countercultural tendencies describes drug policy thus, it is clear that policymakers and scientifi c opinion have diverged considerably. A blanket ban such as this risks repeating the worst mistakes of history, as well as creating new ones for instance, in potentially limiting research into new candidate drugs to treat mental illness. The Series on Substance use in young people published in The Lancet Psychiatry takes a comprehensive and evidence based look at the facts. The potential eff ects of substances on the developing brains and lives of young people are described, as are the global patterns of use. It is a complex and evolving picture. Current legal measures do not address this complexity: as Emily Stockings and colleagues point out, "only weak evidence is available to show that tough sanctions reduce criminal off ending in general or drug use in particular" Moreover, "there are adverse health and social eff ects associated with the prohibition and widespread cultivation, manufacture, and traffi cking of illicit drugs.[these] include the violence that occurs in drug markets in source countries and consumer drug markets" Drug use can cause profound harm, often to society's most vulnerable people. True, a hard line makes it clear that the government recognises the dangers of substance use. But the role of the law should be to mitigate harm, not to exacerbate it. Blanket bans do not make a problem go away; they merely change its form. To revise drug policy such that it protects young people will require not just good science, but a profound historical reassessment of how we got where we are today, and how we might do things differently. In her book The War that Ended Peace, Margaret MacMillan uses an analogy of a group of walkers to describe how the forces of history constricted the decisions made by politicians prior to the World War I. "They start out..on a broad and sunlit plain but they reach forks where they have to choose one way or another..It might be possible to try to find a better route, but that would require considerable effort..Or it is still possible to reverse one's steps, but that can be expensive, time consuming and possibly humiliating." MacMillan's remarks on the road politicians took to military action might also apply to today's national and international drug policy, one of the many products of the 20th century's turbulence. We who have inherited and live with the decisions made over the past hundred years must understand how and why the current limitations on our vision and action came to exist; and then, perhaps, we will be able to overcome them. The Lancet Psychiatry Drug policy: getting over the 20th century