Drug War Heresies: Learning from other Vices, Times and Places
Authors: Chris Nunn
Journal: Journal of the Royal Society of Medicine (2002)

Doctors, whatever their gender, tend towards paternalism. The effect of this bias on our opinions is often exacerbated by immersion in the seamier side of life. We see many sad schizophrenics whose steps downhill can be measured in ‘joints’; we rarely come across the busy person whose burdens are temporarily eased by a modicum of cannabis. We often meet gaunt, diseased, heroin shooters, but modern Coleridges or de Quinceys are mostly outside our professional experience. As a consequence, our urge to protect people from drugs is strong. Protecting people must surely translate into taking action to reduce the prevalence of drug use. How better to achieve this aim than by banning, or otherwise controlling, the availability of noxious substances? So we tend to think and, having thought, go home to enjoy a glass of whisky. Many politicians and other people reach similar conclusions. The trouble is, as this book shows, aiming to reduce usage prevalence may not be the best option when the welfare of all of the people is considered, while some approaches to drug control may cause more ills than they cure.

MacCoun and Reuter, a psychologist and an economist, are both American. Their main purpose is to explore likely consequences of changes in the present, draconian, American anti-drug legislation. On the face of it, there is certainly need for change. In 1996, for example, 401 000 people were in jail for drugs offences in the US, compared with 68 000 in 1985, while the prevalence of drug use had probably increased slightly over the same period. In pursuit of their purpose, they first look at the histories of attempts to control alcohol, nicotine, gambling and prostitution, as well as currently illegal drugs, then go on to examine the policies and drug experience of some other countries, especially the Netherlands. Their approach is thorough and appropriately cautious. Confidence in their reliability and good sense is quickly engendered.

Perhaps the most important point made here is that very many sorts of harm, in addition to clinical ones, are associated with drugs. At least in the US, a numerically greater proportion of harms arises from the illegal status of drugs, and attempts to enforce the law, than from actual drug use. Therefore, MacCoun and Reuter suggest, the Netherlands' overall policy of aiming for total harm reduction, rather than the more limited goal of usage reduction, may well be sensible. Decriminalization (the authors prefer ‘depenalization’) of possession of small amounts of drugs would seem to be a sensible first step. This has had little effect on usage prevalence in places where it has already been adopted as far as cannabis is concerned, though some increase might be expected for other drugs. Even in Holland, where de facto legalization of cannabis use has occurred, the proportion of people taking the drug is apparently less than in the US. However, legalization, as opposed to the more limited depenalization, needs to be approached with extreme caution since it could so readily result in active and effective promotion of drugs by commercial firms.

All this is quite encouraging for the UK. We can be fairly confident that the proposed relaxation of the law relating to cannabis possession will do no harm, and it may prove beneficial. Are there any grounds for caution? Well, it is possible that the change will have no practical effect since arrest rates for cannabis possession in those US States where possession has already been depenalized are no different from rates in States where it remains illegal. More worrying, though, is the possibility that the evidence considered in this book may be too narrowly based to justify a ‘little or no harm’ prognostication. One of the most striking clinical characteristics of cannabis is its long half-life in the body. This means that chronic intoxication can readily occur even in people who are not daily users. Many of us suspect that intoxication usually manifests, not in any readily detectable clinical syndrome, but in a sort of fecklessness difficult to distinguish from ‘normal’ inner-city or adolescent behaviour. Widespread fecklessness can be expected to have highly non-linear, and hence unpredictable, social consequences. Effects of this sort may already have been seen in a wider historical context than that considered in the book. For instance, the original thirteenth-century assassins were said to have been fuelled by hashish. Colonial administrators in the Middle East eighty years ago regarded hashish as at least as much of a scourge as opium in the Far East. They prided themselves on their efforts to limit its use. Perhaps they were mistaken, or perhaps they had a preview of the sort of nasty surprise that cannabis may have in store for us if social contexts change.