# **2.1. Public Health**

The public health consequences of prohibition are of three kinds. First, prohibition drives drug traffickers – and drug consumption – to countries in which drug consumption would otherwise not be prevalent, and where governments are significantly less able either to curb consumption or to treat drug users. This phenomenon arises as drug traffickers seek friendlier countries through which they can export their product to rich consuming countries. Consumption grows in transit countries because the marginal costs of distributing drugs in transit countries is low, given that traffickers already must build up networks of collaborators to move the drugs through these countries. Even though transit countries are poorer, and drug prices therefore much lower, low marginal costs make even these markets highly lucrative. The link between transit and local distribution networks is particularly evident in the fact that drug traffickers pay local collaborators in-kind (in drugs).

In order to expand their presence in European markets, for example, drug traffickers have opened a beachhead in Guinea-Bissau, where large shipments are bundled into small packages that can be brought into Europe with a lower risk of detection. Anecdotal evidence indicates that cocaine use is now significant in the country (“Route of Evil: How a Tiny West African Nation Became a Key Smuggling Hub for Colombian Cocaine, and the Price it is Paying,” _The Washington Post_ , May 25, 2008, p. A1). More well-known is the case of Central Asia. Drug traffickers have long preferred an overland route through Central Asia to bring opiates from Afghanistan to Europe. As a consequence, Central Asian countries have experienced a dramatic increase in rates of drug consumption. Some (Uzbekistan and Kyrgyzstan, among others) have jumped from almost no drug dependency problems in 1990 to addiction rates close to those of many Western European nations today (Reuter et al, 2004). According to the International Narcotics Control Strategy Report (2006), released by the Bureau for International Narcotics and Law Enforcement Affairs, United States Department of State, <u>http://www.state.gov/p/inl/rls/nrcrpt/2006/vol1/html/62100.htm, around 60 percent of</u> opiate exports smuggled out of Afghanistan bound for the Persian Gulf, Turkey, Russia and Europe pass through Iran. Iran now has an estimated 3 million opiate abusers, as many as 60 percent of who are reported as addicted. Iran is vigorous in its efforts to prevent drugs from reaching its citizens: more than 3,400 Iranian law enforcement personnel have died in clashes with drug traffickers in the last twenty years.

Second, illegality undermines the usual vehicles of quality assurance upon which legal markets rely, ranging from reputation to government quality regulation. This is a cost of prohibition borne in all consuming countries. Though reputational investments in drug retail are possible, there is no open advertising, no investment in the vertical supply chain to ensure quality, and reduced horizon effects associated with the probability of future incarceration or loss of control over the business. In this context, overdoses due to uncertain strength and poisoning due to adulteration are both likely to be more frequent (see Bernardo 2003, Miron and Zwiebel 1995, Cameron and Collins 2006).

Third, illegality impedes efforts to treat drug users and to prevent the spread of disease via drug use. Since consumption is an illegal activity and, because of that, tends to take place under less than ideal conditions, the transmission of contagious diseases becomes more likely. This is clearly the case of heroin consumption through injection, as the spread of AIDS among 4