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Against the stream: drugs policy needs to be turned
on its head
Baroness Molly Meacher
BJPsych Bulletin (2018) Page 1 of 3, doi:10.1192/bjb.2018.98
Former Chair, East London NHS
Foundation Trust, UK
Correspondence to Baroness Molly
Meacher (meachermc@parliament.uk)
First received 25 Oct 2018, accepted
1 Nov 2018
© The Author 2018. This is an Open
Access article, distributed under the
terms of the Creative Commons
Attribution licence (http://
creativecommons.org/licenses/by/
4.0/), which permits unrestricted re-
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is properly cited.
Summary Humans have always used mind-altering drugs. However, in 1961 the
United Nations approved the Single Convention, under which the production, sale or
possession of a number of drugs, including heroin, cocaine, ecstasy and cannabis,
became illegal. The prohibitionist regime was then introduced by most countries
around the world and has substantially remained in place ever since. Some countries,
particularly those in Latin America, have never criminalised the use of cannabis.
A small number of countries have introduced more liberal policies. This article
examines the evidence of the consequences of policy liberalisation and argues that
there is now a clear case for every country to examine its drug policies and to
introduce evidence-based policies with a public health focus.
Declaration of interest None.
Keywords Drug policies; drug control policies; approach to controlled drugs.
Human beings have taken mind altering drugs since the Stone
Age, but the current global ‘war on drugs’dates only from
1961. At that time, the addictive qualities of drugs like heroin
and cocaine led the United Nations Member States to
conclude that drastic action had to be taken as they were
‘concerned with the health and welfare of mankind’
1
–the
objective of the United Nations Single Convention on
Narcotic Drugs. The assumption at the time was that a drug-
free world could be created if those who produce, sell, possess
or use certain addictive drugs were severely punished.
Currently, in the UK, those arrested for possession of a
controlled drug (e.g. heroin, cocaine, ecstasy or cannabis)
can have a maximum prison sentence of 7 years under the
UK Misuse of Drugs Act 1971. Producers and suppliers can
be put behind bars for a maximum of 14 years.
A policy objective to advance the health and welfare of
mankind is fine if the policy makers know the consequences
of their proposed policies. In fact, instead of advancing the
health and welfare of mankind, the drug laws that followed
the United Nations Convention have led to untold violence
and corruption in the producer countries, drug-related
deaths, the accumulation of wealth worth billions of dollars
by terrorists and violent criminals, the non-availability of
essential pain-relieving medicines in many developing coun-
tries and the emergence of an extremely dangerous online
market for synthetic psychoactive drugs. Of course, none
of these consequences was predicted in 1961. It is not that
the policy makers at that time were bad, they were simply
ignorant of the consequences of their policies.
For political reasons, two of the most dangerous drugs
widely used across the globe –alcohol and tobacco –were
excluded from the Convention. Although rated as less dan-
gerous than heroin and cocaine on a carefully devised scale
of harm, both these drugs have been rated well above canna-
bis and ecstasy in their potential danger to the individual.
2
A Royal College of Psychiatrists Working Party report
3
con-
cluded that, ‘In the long run, society will only be at ease with
its drug control policies if they are based on a rational
assessment of the risks associated with the different psycho-
active substances and an objective appraisal of the conse-
quences of previous policy changes, rather than on moral
postures, the mistaken assumptions of the past and the acci-
dents of history’(p. 259).
This suggests we need an entirely new approach to con-
trolled drugs. The starting point must be a clear definition of
the objectives of drug policy. The All Parliamentary Group
for Drug Policy Reform
4
proposed the following objectives
to the United Nations:
(a) to ensure the adequate availability of essential con-
trolled medicines to those who need them (relevant
to the many developing nations who have minimal
or no access to morphine);
(b) in production and supply countries, to prioritise edu-
cation, community development, infrastructure devel-
opment and employment in vulnerable communities;
(c) in user countries, to minimise addiction and the
harms associated with drug use.
In 1961 there was widespread consensus that a crimina-
lising approach to the sale and use of heroin, cocaine and
cannabis was appropriate, but this is no longer the case
today. Now, even the Global Commission on Drugs Policy
reports that the prohibitionist approach has failed.
5
Arguments for and against drug prohibition in relation to
heroin and cocaine may be more finely balanced, but there
has been a major swing both among scientists and politicians
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1
toward the view that the illegal status of less harmful drugs,
especially cannabis, does more harm than good.
Considerable concern has been raised concerning the
decriminalisation of cannabis as a result of studies showing
links between ‘skunk’(high-potency cannabis) and the onset
of psychosis. An influential study has shown that people who
use skunk daily are five times more likely to develop psych-
osis than those who do not.
6
However, the same study
showed that, when the effects of low-potency cannabis
were examined, hash users did ‘not have any increase in
risk of psychotic disorders compared with non-users, irre-
spective of their frequency of use’. Further, although it is
now widely accepted that there is a causal relationship
between regular high-potency cannabis users and psychosis,
the possible importance of the effect of confounding factors
makes the significance of even this finding for drugs policy
unclear. It has been estimated, for example, that 98% of
regular cannabis users will not develop a psychotic disorder.
7
Further, decriminalisation would allow much more effective
control, especially of high-potency cannabis, than is the case
at the present time.
The uncertainty regarding the effects of decriminalisa-
tion can only be resolved by examining the effect of decrimi-
nalising legislation where it is occurring elsewhere in the
world. There are now a number of studies examining the
effects of drug law liberalisation, especially, but not only,
in relation to cannabis. A recent review suggested that liber-
alisation of cannabis laws is associated with a slight increase
in use of cannabis among the young.
8
A cross-national study
of 38 countries confirmed this finding, noting that the
increase was only detectable after 5 years and then mainly
in girls.
9
Further, although adolescent use remains crimina-
lised in US states where marijuana use has been legalised for
adults, decriminalisation has led to decreases in possession
and felony arrests among adolescents as well as reduction
of associated juvenile-justice involvement.
10
It has also
been shown in a 20-country comparison that cannabis law
liberalisation leads to increased help-seeking behaviour for
people with drug problems, an encouraging finding suggest-
ing that if some of the savings made as a result of the discon-
tinuation of prohibition policies were put into increasing
and improving drug services, any negative effects might be
significantly reduced.
11
It has recently been suggested that positive experience
from cannabis law liberalisation might lead to some coun-
tries looking more critically at their laws relating to other
potentially more dangerous drugs.
12
There is already some
evidence to suggest this might have beneficial effects. In
2001, Portugal changed its approach to the possession of
all drugs. The drugs remained illegal, so the policy did not
resolve the problem of illegal drug dealers enriching them-
selves by selling contaminated drugs. However, children
and young people who go through a drug-taking phase do
not end up with a criminal record and can much more easily
give up the habit and progress with their education and
employment –the best protections from addiction.
This policy is not ‘soft’on drug users. If a police officer
finds a young person with drugs, they will be taken to the
police station and required to hand over the drugs, they
are then referred to a Commission for the Dissuasion of
Drug Addiction or tribunal including a legal, health and a
social work professional. The tribunal will determine
whether the drug possessor is addicted to drugs. If so, they
will be referred for treatment. The treatment becomes the
basis of a contractual agreement between the drug user
and the tribunal. If the drug user breaks the contract, they
could receive an administrative penalty, although this rarely
happens. Importantly this has no implications for their
future employment. A casual user is sent on their way by
the tribunal and strongly told not to continue using the
drug. Portugal invested heavily in prevention, treatment,
harm reduction and social integration services. The combin-
ation of decriminalisation with improved health and social
care services probably account for the good results.
Importantly the policy has been extensively evaluated.
13
Portugal now has levels of drug use well below the national
European average. The numbers sent to the criminal courts
in Portugal fell from more than 14 000 to 5000–6000 a year
after the policy was introduced. The proportion of offenders
for drug-related offences fell from 44 to 21% between 1999
and 2012. The numbers of addicted children and young peo-
ple has decreased. All the same, critical analysis of studies of
those who claim that the Portuguese drug policy has been a
resounding success or, in contrast, a disastrous failure sug-
gest that the evidence does not support either extreme
view.
14
Switzerland has shown how to replace drug dealers with
heroin treatment services. The services largely cater for poly
drug users. The service has three parts: the drug consump-
tion room (DCR), the heroin clinic and the methadone clinic.
The service providers have an agreement with the police that
anyone approaching the DCR will not be arrested for drug
possession. The DCR is a vital part of the service. A doctor
spends time there each week, treating ulcers and other
health problems, and a social worker is available to help
with housing, financial and other social issues. Addicted cli-
ents who come in offthe street with their illegal drugs are
welcomed and cared for. Over about 3 weeks these two pro-
fessionals encourage the street drug users to come along to
the clinic and have clean heroin in exchange for agreeing
to a demanding contract. These chaotic individuals are
required to hand over their benefits in the early stages, to
make sure their rent and bills are paid. They are given
back the money they need for food or other essentials, but
not enough for them to buy drugs.
The constraints are worth it in return for the clean her-
oin as well as the psychological and social care. The Swiss
heroin treatment programme has been rigorously evalu-
ated.
15
The results are impressive. Until they arrived at the
clinic these individuals were committing an average of 80
crimes a month to feed their addiction. After 18 months in
treatment, one third are entirely drug-free and leading nor-
mal lives; a further third are leading their lives within the
law, but still taking some heroin or methadone. The last
third need more time to achieve their objectives. The savings
to the tax payer and the benefits to the community from
reduced crime levels are huge. The estimate is that for
every franc spent on this service, two francs are saved for
the taxpayer. The cost of the service per person is 15 000
euros. Not cheap but well worth it.
In the meantime, in England, the Durham Police are
beginning to use the Swiss route for users of all narcotic
2
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Meacher Turning drugs policy on its head
drugs and even for low-level drug dealers and traffickers.
16
Their Check Point programme recognises that many who
are arrested for theft motivated by drugs and other less
serious crimes have underlying mental health and social pro-
blems. The programme offers drug-related offenders and
others a 4-month contract. This requires them to engage
with treatment and not to reoffend. If they succeed on
their contract then no further criminal justice action is
taken. If successful in rehabilitating drug users and cutting
reoffending, this will surely be an important policy across
the country. The government will be funding 10 pilots of
Checkpoint and 25 police forces are wanting to apply to be
involved.
To conclude, an independent review of UK drug policies
is urgently needed. Each drug needs to be individually con-
sidered. Regulation of heroin, for example, needs to be very
different from the regulation of cannabis or ecstasy. The
objectives must be to reduce addiction and limit as far as
possible the harms associated with drug use. Drug policy
reform would also dramatically reduce the ill-gotten gains
from the drugs trade of terrorists and violent criminals.
In fact, we need to turn, not just policy about cannabis,
but our whole drugs policy in its head. Opponents of the
legalisation of cannabis, who suggest that this might well
represent a slippery slope leading to the legalisation of
other, currently proscribed drugs are right. But that is
exactly what needs to happen.
About the author
Baroness Molly Meacher is formerly Chair of the East London and City
Mental Health Trust, UK.
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