Drug Policy Around the World

This is a really interesting time for drug policy as jurisdictions around the world are implementing extreme and widely divergent approaches to recreational drug use that amount to an amazing series of social experiments in how to address drug problems.

Portugal represents one end of a liberalization continuum. Since the early 2000’s they have approached drug use as a health rather than a Justice issue and encourage treatment while still conforming to the WHO treaties on dealing in class A B and C drug categories. The result is that pretty much any drug can be used in Portugal without legal consequences.

Public Health proponents would predict the result would be increased drug use as a result of increased availability. In fact the reverse has been true with most categories of drug use in decline and a significant decrease in both drug related health problems and crime. The health benefits include less overdose deaths (against a world wide trend of increasing OD deaths),

The policy is also credited with achieving a widespread reduction in crime reduction including decreases in drug related violence, theft and road accidents. The resulting openness about drug issues seems to have increased treatment utilization and the approach is widely acknowledged as being effective.

Liberalization has worked in Portugal however these policies may not be able to be exported to other countries, there may be cultural or demographic influences on this, for example the influence of Portugal’s aging population.

The other end the liberalization continuum has to be the Philippines where Rodrigo Duterte the president has a policy of extra judicial killings of drug users and dealers- yes killing without trial.

Some of these assassinations are carried by police and some by vigilante contractors. He must also be the only politician from the last 70 years who has compared himself to Hitler in a positive way as he stated –what’s the big deal- the Nazis killed three million people and I have only killed [15,000 to 20,000] drug users. He later apologized for this remark saying he didn’t mean to insult Jews, (and presumably homosexuals, gypsies and mentally disabled people also killed in the holocaust) by comparing them to drug usersⁱ.

The Philippines is a very extreme example of the war on drugs approach. An approach being abandoned by many states and countries including the US where it has led to a 500% increase in the US prison population. However, liberalization of drug policy is inhibited by the WHO conventions on drugsⁱⁱ, that place drugs into categories that have been politically assessed in terms of drug harm (this differs from the science on drug harmⁱⁱⁱ) and prescribe judicial responses to these categories of drug use or sale.

Many countries are challenging this approach. Canada has started a move to change the WHO drug rules and along with many US states is in the process of legalizing cannabis. Examples are California Minnesota and Maine that voted in favor of legalizing all cannabis use in the Trump-Clinton election. This is legalizing all use- not just cannabis for medical purposes and not decriminalizing but legalizing. Another US example is Colorado where radio, TV and internet advertising of cannabis products is allowed if no more than 30% of expected viewers are under 21.

Further complicating drug policy issues is the worldwide resurgence of opioid overdose use and deaths. This is from both heroin but significantly from prescribed opioids that in the US are directly marketed to the public and were associated with 28,000 US overdose deaths in 2014, a 200% increase since 2000. Half of these deaths were attributed to prescribed opioid pain relievers, in particular oxycodone and hydrocodone. This means that “big pharma” is now a significant dealer in dangerous recreational drugs and with its international political clout, political and policy intervention will be much more difficult.

Finally no discussion of drug policy could exclude the UK 2016 drug laws which are widely acknowledged as the silliest in the world. Any psychoactive substance is categorized as a drug, potentially including foods and vitamins, but notably excluding alcohol (that killed 8,000+ people in the UK in 2016) and nicotine (that killed 80,000 Brits that year).

In Australia the Federal Government is still following the US “war on drugs” approach regarding drugs as a justice rather health issue with the same effects on prison populations as in the US. The government has recently announced another initiative to drug test beneficiaries for a range of drugs (not including nicotine) and impose controlled money cards for two years on people with positive tests.

This is being criticized as a punitive action as it is not embracing evidence from either health or public health and will constitute another huge social experiment adding to the world-wide body of social policy experimentation in drug policy.

There are some interesting results from these social experiments around the world for us to follow and we can only hope they will be able to establish what actually works in drug policy.