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.
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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?
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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.