Why does Health Poverty Action support the legal regulation of the drugs trade?

Prohibition has caused untold harm throughout the world.  Legally regulating drugs will take power away from criminals and drug cartels and allow governments to control the trade.  They can regulate to determine who has access to drugs and where and in what quantities they can be sold.  They can also choose to tax them and raise funds for harm reduction and other public services.

Legally regulating drugs is the responsible reaction to years of failed prohibition which has caused untold misery and destroyed lives across the world.  This failed war has destroyed the lives of the poorest people. It is undermining health, wrecking livelihoods and denying access to essential medicines.

What about the short term?

Until this happens governments need to immediately stop the harms of prohibition. This means decriminalising drugs, stopping harmful practices such as crop eradication and addressing the reasons the poorest people often engage in the drugs trade in the first place- such as poverty, inequality, and social exclusion.

How has the so called ‘war on drugs’ failed?

It has fuelled poverty and inequality throughout the world.   From the environmental damage caused by crop eradication to the incarceration of women who disproportionately find themselves locked up for low-level drug offenses.

Imagine being a small, subsistence farmer growing coca or opium poppy as the only source of your family’s income. Imagine then watching as your crops and therefore your family’s security, are destroyed in minutes, by a government crop eradication programme. The loss of income from eradication pushes families further into poverty, making it harder for them to access healthcare or buy food, creating a vicious cycle in which they are increasingly dependent on cultivating drug-linked crops to counter the poverty they are pushed into by eradication.

The war on drugs is often frighteningly literal. It has bred an arms race that has resulted in hundreds of thousands – if not millions – of unnecessary deaths, as cartels struggle for territory and markets in increasingly volatile places. In Mexico alone, 23,000 people were murdered in 2016 as a result of this war on drugs.  It remains a key – although often unacknowledged – factor in the current staggering numbers of killings surrounding the country’s elections.

Strict drug laws have further unintended consequences. Some opioid medicines come from the same family as heroin. This means that governments can make morphine unavailable for those in severe pain. As a result of these policies, 90% of AIDS patients and 50% of cancer patients living in low and middle income countries, have access to just 6% of the morphine used globally for pain relief.

It is also a staggering waste of money. The cost of enforcing the war on drugs is at least $100 billion a year.[i] This rivals the size of the global aid budget (about $146 billion). If redirected, that money could help provide healthcare, education and clean water to people across the world. It’s important to emphasize that this figure is for enforcement alone. If drugs were regulated, controlled and taxed the figure could be mind-blowing.

Is legal regulation the only option?

Whilst we think legal regulation is the best option we are not saying it is the only option – countries like Portugal have pursued other alternatives (decriminalisation) which has been effective for them.

Countries will have to decide for themselves through engaging with affected communities to understand the detail of the reforms that are needed.  However in our opinion some form of legal regulation – and there are many different models that could be used –  is the clearest and most obvious way to reduce the harms and protect people and public health.

How would it work?

There is no one set model of legal regulation – there is a spectrum of options. Countries need to determine -through consultation with affected communities-which model will best support health and wellbeing. Whatever they decide it must be pro poor, protect public health and ensure people engaged at the low levels in the drugs trade will be able to access jobs post reform.  (E.g California’s approach to cannabis legalisation safeguards small-scale farmers and pardons those with previous cannabis related offences.)

What would this look like in practice?

We don’t have a view on exactly what regulation should look like. The best people to decide that are public health experts in each country in consultation with a range of government departments and affected communities to understand the detail of the reforms that are needed.

Examples include Bolivia’s model: Since 2009 Bolivia has developed and implemented its innovative community coca control programme, which allows registered growers to cultivate a subsistence amount of coca leaf for sale to the legal market.  Bolivia’s coca-control programme has prioritised reducing the harm caused my militarised crop eradication, rather than directly preventing drug trafficking.[ii] This programme is a success because it focuses on sustainable livelihoods and community development, investing in social services and public infrastructure, and actively involves the local community in planning and implementing the projects.[iii] Crucially, they allow a subsistence amount of coca leaf to be grown – for consumption and sale to the legal market – legitimising the livelihoods of people who grow coca, empowering farmers and giving them the support and income security to diversify their livelihoods.[iv]

Other options include:

• Prescription drugs – prescribed to a named user by a qualified and licensed medical practitioner. They are dispensed by a licensed practitioner or pharmacist from a licensed pharmacy or other designated outlet.

• Pharmacy model- Pharmacists are trained and licensed to dispense prescriptions. They can also sell certain generally lower risk medical drugs from behind the counter. Such dispensing generally takes place from licensed pharmacy venues.
• Licensed sales – like alcohol and tobacco could be an option for certain lower risk non-medical drugs

[i]   Estimates vary according to what is included but an approximate total indicates well over 100 billion is spent annually on drug law enforcement  (2016 updated alternative world drug report)

[ii] Farthing, L. C. and Ledebur, K. 2015. Habeas Coca: Bolivia’s Community Coca Control. Open Society Foundations: New York.

[iii] Ibid.

[iv] a.) Ibid.

b.) Guidi,R. 2015. ‘Bolivia stands up to US with coca-control policy.’ Al Jazeera. (30 Sept 2015). Available online at: http://www.aljazeera.com/indepth/features/2015/09/bolivia-stands-coca-control-policy-150930085832276.html