We Don't Have The Evidence To Justify Our Illegal Drugs Policies

Drug laws are always controversial. Some reform advocates argue prohibition primarily benefits criminals; some health professionals argue that we can't repeat the mistakes of widespread tobacco and alcohol availability with other substances. But whatever side you take, you'll find it hard to argue your case convincingly because we lack clear evidence on the impact of current policies surrounding illegal drugs.

Picture by Phil Walter/Getty Images

The current issue of British medical journal The Lancet includes a series of three articles examining the impact of illegal drugs and the policies surrounding them. A number of prominent Australian researchers contributed to the papers, which cover four key illicit drug groups: cannabis, cocaine, amphetamines and opiods (heroin being the most obvious example in this category).

The papers summarise the existing scientific research which has been done in this area, which makes them a more informed summary than most idle speculation on the topic. But what's striking, given the prominence which the "war on drugs" receives and the large amounts of public money invested in it, is that there is comparatively little actual research to back up the effectiveness of current methods. That lack of rigorous data is a major theme in the Lancet papers, and the issues that causes were repeatedly raised in a media briefing held earlier this week to discuss them.

We don't know what we're doing

The first paper sums up the problem neatly:

Intelligent policy responses to drug problems need better data for the prevalence of different types of illicit drug use and the harms that their use causes globally . . . The illegality of opioids, amphetamines, cocaine, and cannabis precludes the accurate estimation of how many people use these drugs, how many people are problem users, and what harms their use causes.

In other words, since those drugs have been made illegal, working out the impact of that decision has been virtually impossible. And as a result, very little research has been conducted, as the second paper (which examines drug intervention strategies) highlights:

The effectiveness of most drug supply control policies is unknown because little assessment has been done, and very little evidence exists for the effectiveness of alternative development programmes in source countries.

"There are a lot of gaps in the evidence," said Professor Louisa Degenhardt from the National Drug and Alcohol Research Centre at the University of New South Wales. "But it's very clear that cannabis, the most widely used illicit drug globally, causes very few deaths.

The same challenge applies to identifying effective treatment strategies. "The drugs field arouses strange emotions and it's reasonable for us to ask ourselves why does this matter?" said Professor John Strang from the UK National Addiction Centre. "It matters greatly because we risk reaching conclusions that are wrong. We need to look for evidence of treatment effectiveness and then we'd be wise to concentrate our energies on application of these interventions."

"It's been very reassuring to see evidence that treatment works, but it's not good enough to repeat this as some sort of mantra. There are treatments where which make very little difference. We need to know which ones work. It's not enough just to have good intentions."

The final paper, which looks at the impact of global anti-drugs policies, is even more scathing:

Over the past 50 years international drug treaties have neither prevented the globalisation of the illicit production and non-medical use of these drugs, nor, outside of developed countries, made these drugs adequately available for medical use. The system has also arguably worsened the human health and wellbeing of drug users by increasing the number of drug users imprisoned, discouraging effective countermeasures to the spread of HIV by injecting drug users, and creating an environment conducive to the violation of drug users’ human rights.

"The goal of increasing health and well-being by eliminating drug related harm has not been met," said Professor Robin Room from the Centre for Alcohol Policy Research at the University of Melbourne. "The system has been until recently quite hostile to harm reduction."

Could it be done differently?

Picture by Matt Cardy/Getty Images

A common area of contention when it comes to drugs policy is that the impact of legal drugs — alcohol and tobacco — is much greater than that of illegal drugs. Statistics for Australia bear this out, but only partially. "In Australia, alcohol and tobacco from a public health point of view are a greater aggregate problem," said Professor Degenhardt.

The proportion of deaths attributed to illicit drugs in Australia is 1.3 per cent. That is much lower than tobacco (11.7 per cent) but higher than alcohol (0.8 per cent). Given that alcohol is legally available and thus much more widely consumed, it could be argued the impact of illegal drugs is greater.

But does making drugs illegal really cut down on their use? The best available figures suggest that in 2009, amongst Australians aged between 15 and 64, at least one in ten had consumed some form of illegal drug. Cannabis was by far the most common choice, being used by somewhere between 9.3 and 14.8% of people (as we keep pointing out, the figures are rubbery and the actual numbers might be higher). We don't know if that number would be higher if cannabis was legal, but there's some evidence it wouldn't: cannabis use has been decriminalised in South Australia and Western Australia with no evident increase in usage. But again, we don't really have the data to be sure.

In an ideal world, decisions about both public health and social policy would be driven by empirical evidence, not shrill argumentation. But because of current policy we don't have that empirical evidence, and even the authors of the papers in the Lancet recognise that it won't always be acknowledged when it does exist:

The reasoning behind the final decisions for action might be of a non-scientific nature, focused more on what the public and policy-makers deem of value. Nevertheless, important opportunities exist for science to inform these deliberations and guide the selection of policies that maximise the public good.


Comments

    i think there's a case for weed to be legelised but not others.If i could legally buy things like coccaine and esctascy cheaply I would.But more cheap drugs in society means unfortunatly more kids will get their hands on them.

      So you don't want the others legalised but you'd buy them if they were cheap?

      If they legalise and regulate, we probably wont have much less control than right now. You can apply the same penalties as supplying alcohol or tobacco to minors, and divert the cash from taxing it into support programs for those who do have a problem.

      Disclaimer: I know it would never be that easy or turn out that well, but it probably makes as much sense as the current setup.

      Cheap and legal drugs, one would logically assume that more people will be on it. But is that really the case? What about the US states that have legalised marijuana? Has drug use gone up. Not really, http://www.newser.com/story/132539/legalizing-medical-marijuana-doesnt-up-kids-pot-use.html.
      Of course, harder drugs, purely based on their negative health effects, should be to some extent controlled with perhaps strict laws regarding things like driving under the influence.

      Hearing shocking reports that the parts of the US government deals in trafficking and controls some aspects of the drug trade simply further discredits an already epically corrupt US government. The're's money to be made for both sides in the end of the day, and once again, money reigns supreme over justice and truth.
      http://www.brownsvilleherald.com/news/ochoa-87189-charges-fbi.html
      http://narcosphere.narconews.com/notebook/bill-conroy/2011/04/mexican-narco-trafficker-s-revelation-exposes-drug-war-s-duplicity
      http://www.pgr.gob.mx/prensa/2007/bol07/Nov/b58607.shtm
      http://www.nytimes.com/2011/12/04/world/americas/us-drug-agents-launder-profits-of-mexican-cartels.html

        Legalise Cannabis and LSD. Have one government run supplier with fixed low prices but limit the amount that can be sold to an individual per month. Introduce much harsher laws regarding illegal manufacture and sale (including the resale of legally purchased drugs).

        Having a safe and cheap source of 'softer' drugs should deter people away from illegal sources and harder drugs.

    http://www.chomsky.info/interviews/20020208.htm

    Most of the harm done by drugs is a direct result of their illegality. Why do people overdose on heroin? Because they don't know the strength of what they're getting. Why don't they know the strength? Because it's not pure. Why isn't it pure? Because the supply chain isn't controlled because it's illegal.

    In my opinion, the drug problem simply falls away by making drugs legal but offering stiff penalties for antisocial behaviour while intoxicated. This approach empowers individuals and directly encourages responsible behaviour.

      I agree. If drugs were legal and controlled, then people would know exactly what they were putting into their body. You wouldn't get as many OD's because someone got a 'strong batch', and you wouldn't get people admitted to hospital because their pill contained rat poison.
      Sure, you'd still get people going out of control and getting addicted.. but that already happens with alcohol so I don't see the difference. You might get more people 'using', eg; having a few quiet smokes on a Friday night with friends, or take some speed to have a big night out on the town for a birthday.

      I think if drugs were legal and people were educated about it, they would be smart enough to control what (and how much) they put in their bodies. Obviously drugs should be age restricted like alcohol with a 18 or 21 age limit. A little bit of intelligence, self-control and responsibility people... c'mon

    what point in time did we start to create drug policy on the personal beliefs of ancient politicians instead of proven science.

    cannabis has never caused a single death in the history of the world, but bad cannabis drug policy kills tens of thousands of people globally each year.

    Alcohol abuse kills over 1 million people globally each year but the governments happily tell you it's ok to drink the stuff each day, because it keeps the sheeple dumb.

    when will see an Australian politician stand up and actually talk about this instead of ignoring the fact that we spend millions of dollars a year on the policing and arresting of individuals that choose a drug that is safer than aspirin.

      I believe that all drugs should be decriminalised and a different strategy applied to reduce the use of each depending on the level of potential harm that use is likely to cause. Its a health problem not a legal problem.
      But we need to be clear. No drug is harmless. Not even marijuana. I have known many people whose mental development has been impaired by the use of marijuana, people with smoking related illnesses because of marijuana and people who wasted their lives because they were too stoned to get off the couch. I am not saying ban it. I am not even saying don't consume it. I am just saying that all drugs are potentially harmful and that education is the key to harm minimisation. Marijuana is NOT safer than aspirin.

        Aspirin might not be safer, but it's still a drug that causes harm:
        "Each year, use of NSAIDs (Non-Steroidal Anti-Inflammatory Drugs) accounts for an estimated 7,600 deaths and 76,000 hospitalizations in the United States." (NSAIDs include aspirin, ibuprofen, naproxen, diclofenac, ketoprofen, and tiaprofenic acid.)

        You said
        "Not even marijuana. I have known many people whose mental development has been impaired by the use of marijuana, people with smoking related illnesses because of marijuana and people who wasted their lives because they were too stoned to get off the couch."

        Mental development being impaired by Marijuana has never been shown in studies except for back in the Reefer Madness days, Also studies have never shown Marijuana causing lung problems though nearly everyone in Australia mixes it with Tobacco which causes the problems and also the Marijuana did not make people lay on the lounge the people chose to do that themselves sure it makes you tired and want chill back on the lounge but if the people cared about being active they wouldn't smoke it during the day.

          All drugs have side effects, and sadly you can't legislate against stupidity. The benefits of NSAIDs outweigh the very small number of people who don't use the drugs as directed.

      I'm all for legalization of marijuana. I really am. But lets not be retarded here. Smoking weed is bad for you for the same reasons that smoking cigarettes are bad for you. You're inhaling burning carbon and that fills your lungs up with tar. Marijuana inhalers/vaporizers or green butter baked goods might not have ever killed anyone - but joints and bongs will kill you if you smoke heavily enough.

      I have personally enjoyed alcohol, weed, nitrous, oxygen, IV Saline, speed, meth, ecstasy, LSD, Shrooms, ketamine, cocaine, and multiple other drugs.

      I'd most readily support legalization of recreational nitrous. And if you've never tried IV Saline and an Oxygen mask for a hang over cure? Make friends with a nurse immediately. I think on a harm hypocrisy level, weed and shrooms should be legal if cigarettes and tobacco are.

      MDMA? Holy shit I enjoy it. And Speed is pretty much my favorite thing ever. But having really enjoyed both drugs? I think there's a good reason to restrict them. The long term health impacts of amphetamines are well documented - and as much as I enjoy recreational access to them - they're very easy to lose control of and very bad for you over any kind of extended use.

    Yeah mate you are right on....
    except for the ' little " BUT" ' ...
    ...I don't know how much room you've got down under for the ramification effect.... .. but in the States we have bloody sight more than enough issues with blokes wheeling down the avenues in their mighty cars and trucks while they are:
    Drunks,
    watching their directions-nazi instruction screens
    talking, tweeting, twittering, lap-topping, eating .. hey . being 'eaten', spilling, smoking ... an on and on...

    now.. anyone is suggesting that they might include being stoned ?
    sorry but , from my pitiful perspective, having some arrogant zonked-out halfwit zooming through a crowd because he thinks: "Hey, lookit me fly!"
    ....is more than I think I can want to handle just yet.

    best of luck and happy new year to you all
    cheers

      Cool spelling bro.

        Are you aware that the states which have implemented medical marijuana laws have reduced traffic fatalities by 10%? Research into the dangers of driving under the influence of marijuana have shown almost no impairment. The worst thing they could say was, "Stoned drivers believe that they are much more impaired than they really are, so they drive more slowly and cautiously."

    Making drugs legal does not equate to making them cheap. Their. Edu illegality puts them outside he control of regulators, and it is arguable that the illegal drug market is the only real example of a true free
    market we really have. It's likely that illegal drugs are quite close to their true equilibrium (read cheapest) price already. Regulating them, having strict quality controls, minimum wage laws and taxation will allow the price to be set at appropriately high levels just like tobacco or alcohol.

    Weed being illegal is one of the stupidest things in the world, Ecstasy being illegal is also dumb most deaths from Ecstasy happen because of the impurity MDMA is actually quite safe, if it was legal there would be control and we could tell the purity, people will take drugs whether they are illegal or not, they are better off being legal, controlled and taxed so it is safe than let criminals control it and be dangerous.

      What utter nonsense! You can buy a pound of marijuana on the Mexican side of the border for $25. Cross the border into Texas or California and that same pound sells for $525. The only reason for the 2,000% increase in price is the illegality, the "black market bump".

    I am 100% PRO marijuana legislation. I am ANTI all other drugs though. Pot is better for the body than tobacco and alcohol so it doesn't really make much sense for it to be illegal, but all other drugs are illegal for a reason.

      This has to be one of my pet hates when it comes to drug liberalisation talk. Weed is fine but everything else should be illegal...utter rubbish. As Adam noted MDMA (3,4-Methylenedioxymethamphetamine) is actually quite safe when pure. Further the mental health benefits and potential for treating depression and PTSD with MDMA often far out weight the benefits of marijuana. Also what is the reason for the illegality certain tryptamine alkaloids subject to Australia's blanket bans on particular flora? As noted here http://healthland.time.com/2011/06/16/magic-mushrooms-can-improve-psychological-health-long-term/ drugs such as psilocybin can result in long term mental health benefits with no harm. It is incredibly naive to condemn all other drugs whilst remaining pro marijuana...just saying.

    I think that before we legalise drugs, we need to try and take a stab at alcohol and tobacco problems. We need to implement higher penalties on people engaging in antisocial behaviour when drunk and/or give them community service having to clean up after drunks or something. And as for tobacco, we need to make people more responsible for the health effects that their choices create. Increased insurance rates, etc. while increasing funding to help those who want to quit, quit for good.

    If we can't get those two on track, adding a whole new level of substances will only cause death and sorrow.

    It will also help keep things reasonable. I'm sick of lockouts and drink limits and no shots after so and so time. I'm responsible for myself no matter how drunk I am, I've never been in a fight or kicked out of anywhere either and I'm sick of being treated like a criminal because I like to drink and other people do to and can't handle themselves. Those clowns should be made to face some consequences.

    Since the beginning of the Kings Cross injection room during the 1990's, overdoses have dropped 90% in the region. I'd never advocate explicitly legalising drugs, however a policy of decriminalisation and harm-minimization have a strong track record of during drug-related crime and hospitalisations.

    A re-focused effort on convicting commercial drug suppliers and dealers is what's needed, too often there are predatory people in the community who'll target their wares towards those most vulnerable. Often selling a product that is unpredictable by a product of clandestine manufacturing (Backyard drug labs) and no quality control. The result is a product that could at best have no affect and at worse trigger a psychotic episode or death due to toxic additives or an incorrectly supplied dose.
    In short, suppliers are subject to no scrutiny in a substance that has the potential to do serious harm. Not to mention the extreme dangers that are present during manufacture of many of these substances.

    With drug decriminalisation being a taboo topic in public circle, the issue is never really debated. Which is a shame because if it were it'd show the disconnect between politicians and the evidence they should be using to develop policy.
    Though some of this needs to be based off of community input, more specifically, those who council addicts, healthcare professionals and even reformed users. They'll paint a picture that treating a habitual user as a criminal does more social harm than good, that drug supply is often the most dangerous part of illicit drugs and that distributors and suppliers should be the focus of law enforcement. Users and addicts should have access to the means that allow them to break the cycle of drug-use, or allow them to carry out their habit in a manner that reduces potential harm to themselves and their community.

      "A re-focused effort on convicting commercial drug suppliers and dealers is what’s needed"

      We've been trying this for decades and it hasn't worked. What makes you think it suddenly would?

      Getting dealers off the street just creates job vacancies for new ones. Hardly a sensible policy.

      The best way to put drug dealers out of business is for the government to end their policy of drug prohibition so they take control and regulate the supply.

    The personal use of drugs was decriminalised in Portugal in 2001. Since then overall drug use increased (slightly) although contraction of HIV, drug related deaths, and underage usage decreased.

    "cannabis use has been decriminalised in South Australia and Western Australia with no evident increase in usage."
    After googling and being lead to wikipedia.It appears that in WA and SA it's legal to smoke non-hemp cannabis. What exactly does non-hemp cannabis mean? I initially thought that fake cannabis substitute but they have banned that for sale in WA, after people started getting sick from it.

    After almost 20 years of watching friends who habitually smoke marijuana cigarettes (reefers), and even indulging in it a little myself every now and then, I have to say that its effects are no more severe than alcohol IMO.

    In fact, at my age I feel like absolute shit for 3 days after a 12 hour bender on the sauce, but I can smoke weed for a whole day, sleep for 10 hours and I feel fine.

    Sure there are a few people who can lose the plot from smoking weed. But most of those people know they lose the plot, so they just don't smoke it. And its nothing like the aggression I've seen from those who can't handle their piss. Someone who's wasted is much more amiable than someone who's shitfaced.

    I think both have detrimental long term side effects, so they both need to be enjoyed in moderation.

    I also think that weed should be as legal as alcohol: You shouldn't be allowed to blaze up on the town hall steps or on the train, but if you keep it at home you're not gonna hurt anybody. Except maybe yourself, but that should be your own choice to make.

    Legalising drugs wouldn't increase their use by much. When was the last time you heard someone say "I could really go some pot, if only it was legal".

    If drugs are legalised potential recreational users might be more likely to try them due to ease of access but there is nothing wrong with recreational drug users. If you're an adult and want to do some coke to celebrate your birthday who am I or anyone else to tell you not too. The problem is when people abuse drugs and then B&E your house for drug money. But that's not the drugs fault, people abuse drugs because they're trying to escape other problems in their life. The drugs aren't the problem, it's the people, if the drugs didn't exist they would just partake in some other self destructive activity, like joining a religion.

    Caffeine (+Guarana, +Taurine) & Booze seem to be the cause of today's antisocial behaviour but I think the mixture of any stimulant & with any other drug is highly risky.

    The impact of drugs could be better managed as a legal but highly taxed and controlled product in a way similar to the control of tobacco. This could also marginalise the criminal profit & influence of the black market drug "industry".

    I also agree with the sentiment that more should be permissible if done in private but places such as bars/pubs/clubs should also remain as/become a controlled place to mix & imbibe in public.

    IMO if any any illegal dug should/could/would be legalised due to its minimal/beneficial impact it would be MDMA and I think it is an experience that should be on everyones bucket list.

    Aggregating all illicit drugs into a single statistic, then comparing against alcohol and tobacco doesn't make any sense - the stats need to be split into individual illicits before comparison.

    Thanks for letting me know about the current issue of the Lancet. I'm currently doing a subject about Substance Use for my MPH so it looks like this issue will be useful.

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