Global Commission on Drug Policy: Legalization, decriminalization, and the war on drugs

A commission made up of some big names, though not really any names of addiction or drug researchers I noticed, just released a report that’s making a lot of noise throughout every news channel including NPR (see here, and here for stories) and others (see CNN). They want the debate about the current state of drug regulation expanded, and since I’ve written on the issue before, I figured it’s time for another stab at this.The commission’s report, which is very pretty by academic standards makes some good points and ignores some other obvious ones in its quest to make a splash in the old “should we legalize drugs?” argument. To be fair, the report itself makes a whole slew of recommendations, only some of which are specific, while saying that we need to seriously re-examine our current stance in the fight against drug addiction and abuse. I certainly agree with this last point.

The thing is that the report decides to focus almost solely on the arguments in favor of drug legalization or decriminalization, which makes it lose some credibility. Still, when you get people like Richard Branson, Kofi Annan, and Thorvald Stoltenberg involved you get a lot of people to notice and I’m guessing that was the point to some extent.

A little summary of the commission’s report – objectivity compromised

Opening up with a bold sentence claiming that “the global war on drugs has failed,” the report continues to show ways in which the criminalization of drugs has caused harm without producing much in the way of tangible results. I have written before about the horrible results of throwing non-violent drug offenders into prison en mass, but to say that there have been no results from the criminalization of drugs is to ignore the fact the some of the world’s most devastating public-health issues are the direct result of legal drug use. Alcohol use and tobacco smoking are the underlying causes for more deaths than anything else on earth including pollution, automobile accidents, or anything else people seem so afraid of. No, drinking alcohol moderately is not bad and might even be beneficial, but that’s exactly why trying to nail this argument down as landing on the “good” or “bad” side is too simplistic and makes the report seem like a propaganda piece rather than a balanced, thoughtful… report.

For example, when they show the difference in the number of users of different drugs between 1998 and 2008, the authors fail to mention that the U.S. population grew by 10% during that time, which would mean that marijuana use actually went down. This obviously hurts their argument at least to some extent. Numbers can be manipulated both ways and these guys surely did their part in that regard. When discussing drug dangerousness, the team forgot to include a recent article by Dr. Nutt that claims alcohol is world’s the most dangerous drug. I don’t particularly agree with that piece but it seemed an odd oversight in favor of an older citation. Based on the ranking they do present, the authors suggest that our current classification of drugs needs to be re-examined. This might certainly be true for some drugs (like ecstasy) more than others (like GHB which was outlawed in the U.S. because it was being frequently used in sexual assaults) and it seems strange that the authors don’t make any distinctions here. Again, the report’s ambiguity and lack of specifics in these areas left me wanting a little more.

So should we legalize, decriminalize, or do nothing?

I whole-heatedly agree with the authors’ principles of ending the stigmatization of those who abuse drugs and if you’ve read anything I’ve written, you know I support the notion that we should make every addiction treatment available to those who need help.  This has to include harm reduction (like replacement medications, syringe exchanges, and more) and other methods that are not abstinence-based but I wouldn’t say that taking all criminal-justice measures off the table is necessary or even warranted. For example, Hawaii’s HOPE program, started in 2004 has been shown to be amazingly effective at reducing arrest and drug use while greatly increasing probation compliance by using frequent drug testing and brief incarceration periods.

I don’t have the final word on what the best final solution is when it comes to legalization or decriminalization, but I’m certainly open to talking about options and it seems to me that the authors of this report are open as well. For that, I commend the report’s authors, but I’d like for the discussion about it to try to be a little less black and white and a little more nuanced. The problem we’re dealing with certainly is.

15 Replies to “Global Commission on Drug Policy: Legalization, decriminalization, and the war on drugs”

  1. No, if the number of marijuana users went up, then THE NUMBER OF MARIJUANA USERS WENT UP. The authors are talking about absolute numbers in whole populations, which is the true measure of the drug’s public health significance, not ratios of use. More people quit smoking on their own, but a greater ratio quit with assistance – but this still means that quitting on your own has the greater impact on public health. So it doesnt matter if the population grew by 10% or 1000%, the number of marijuana users went up!

    You also “forgot” (dont use this snide term, you know fine well they didnt forget) to mention that the US Office of National Drug Control Policy has so far been the only national drug body of any country to reject the Commission’s findings. Europe, South America, Africa, and Asia have all acknowledged the report as credible and something to look into. But the US has rejected it outright, refusing to even consider decriminalisation. Why is that? I assume because the US’ current system is working so well that alternatives dont need to be entertained. The rest of the world is wrong (as usual)? Is it not worth telling your readers that your former Secretary of State, George Schultz, stated that the US has failed miserably and needs to abandon its criminalisation stance?

    Third, you say that there arent any recognisable addiction researchers in this report. So what? The report has examined a legal matter and so the Commission should be made up of mostly legal minds, which it is. You should point out that the Commission was made up of high ranking economists, public health stategists, and former Presidents for goodness sake. Hardly a bunch of hippies.

    1. Ah, someone got upset while talking about this topic? No way!

      Firstly, you should really read my other articles on this topic before you start spewing off as if I somehow support the status quo. Secondly, your argument about the number of marijuana smokers makes absolutely no sense from a statistical standpoint. The whole point is that is they did use a ratio they’d have shown nothing for marijuana. The number of men also went up in that same period, probably by 10%, what does that tell me about anything other than the fact that the number of everything that changes along with population counts went up by 10%? Nothing, that’s what.

      You were obviously out looking for pieces against the report to comment on. That’s not what this is. I NEVER called them hippies (who the hell would call the ex U.N. Secretary-General a hippie?!) and actually said that there were some strong important personalities. When I pointed out that there were no researchers I didn’t ask for American researchers, just anyone actually involved with drug abuse researchers, which includes a whole host of people who study policy issues.

      I showed respect and what I think is a fair critical evaluation of the commission’s report, specifically saying we need to open this up for discussion. You just went out to call “bullshit” on anything that didn’t agree with your view. Good for you.

  2. Firstly, I judge you on what you’ve written here – I havent read every Charles Dickens book, but I think Im entitled to an opinion on the books I have read.

    Second, if you dont think absolute numbers in whole populations means anything then I fear for our profession. Read “The global research neglect of unassisted smoking cessation” (2010) by Simon Chapman. In terms of dollars and pennies, numbers going up means a lot. If you cant appreciate the public health significance of absolute numbers of drug users, then Im going to call you out on every mention of an absolute number in your posts, e.g. Im sure you will have mentioned that alcohol use costs to society in dollars. If ratios are so important then I assume you will also tell your readers how much money is made from alcohol use and discuss only the net difference, which by the way, will show a net profit of alcohol use in the US. My point: dont use absolute numbers to demonise in one situation then say they dont mean anything in another situation. I dont care what you position is on an issue – I care that stats are not used to mislead.

    I never said you supported the status quo, I never said you called them hippies, and I never said that you asked for American researchers. Please criticise me for what I did write, not what I didnt write. I hate it when people dont read whats written.

    I am not making a case for or against decriminalisation – I am taking issue with some mischaracterisations and omissions in your reporting on the report. If you dont like my assessment of your writing then I suggest it is you who is calling bs on me for not being happy with how youve commented on the report.

    “Good for me” – doesnt sound like respect for a reader’s contribution.

    1. Okay – if you’re talking dollars, you have to adjust for inflation right? Otherwise you’re inflating estimates. You have to do the exact same thing when you’re talking about population numbers, adjust for growth. If you find an article where I omitted such an adjustment do please point it out to me. I try to be careful about that always.
      And as long as you’re upset with quoting, I didn’t say that you said I support the status quo, what I said was that “you should really read my other articles on this topic before you start spewing off as if I somehow support the status quo.” I stand by that statement as your comment sounded to me as an attack on someone who is against the report’s conclusions. You have the right to disagree with my assessment of your comment.

      I’m calling BS on your characterization of my writing because it doesn’t take the whole piece into account but only the parts you disagree with. I’m also calling BS on your statistical logic because it’s wrong. And I show respect for reader contributions that are tactful, not ones that come out attacking. I bite those back. Again, if you don’t like it…

  3. Just out of curiosity, have you ever considered any attack on you to be ‘tactful’? You strike me as defensive and stubborn when you could have just said “yep, fair enough, Ill take that on board”. This isnt a contest.

    No, youre still missing the point. If 10 out of 100 people use drugs in city A, and 5 out of 20 people use drugs in city B, which city has the greater drug problem (assuming drug use is a bad thing of course)? City A. It doesnt matter that the city B use-to-population ratio is double that of city A, city A has twice the number of users and therefore twice the costs of city B. City A will always have twice the number of people in addiction treatment or in jail for drug-related offences. Ask the budget ministers of each city which ratio they’d like to be working with!

    And to show that this isnt me just “spewing” again, this article in The Lancet explains this perfectly.

    http://tobacco.health.usyd.edu.au/assets/pdfs/tobacco-related-papers/Lancet-InverseImpactLaw.pdf

    1. I would think “attack” by definition is not tactful when talking about academic matters… You can point out disagreements, and supporting materials do help indeed. YOU were the one that injected the word “hippies” after I specifically lauded the people involved in the report. How exactly that is a tactful contribution to anything is beyond me.

      When you say I’m missing the point, are you saying you would not adjust for inflation when giving changes in costs at different time points? And the example you’ve given me (the lancet paper) uses nothing but percentages… How is that supporting your view that using raw numbers somehow makes sense? If you could point out a specific portion of the piece I should be looking at that would be extremely helpful. All I found was ratio targets for reduction, actual outcomes, and a table full of percentages.

      And by the way, unlike your theoretical arguments, I actually work on program evaluations that specifically assess prevalence in terms of ratios and adjust costs for current dollar values. I don’t know many people who would agree with your simplistic assessment of the city example since it takes absolutely NO other factors but the raw count into account… But if you can point out to me someone who does agree with you I’ll be happy to look at it.

  4. “Disciples of the law are preoccupied with success rates, when success numbers are what really matter in public health. Extrapolating from Californian data for 1996,12 of 1 million smokers attempting to quit, I calculate that nearly twice as many smokers (60 999) quit unaided than with any form of help (33 014), despite many years of NRT availability (table)”

    See the table – look at the bracketed raw numbers – higher quit numbers, lower quit rate. If you could see me right now youd see me pointing to someone who agrees with me.

    If you respond, Ill write back later.

    1. But the denominator in both those cases is completely different and comes from different groups?!?!? The comparison should be based on the same overall population (i.e., smokers who try to quit). The issue isn’t the number or rates – it’s the inappropriate comparison group the rates were generated out of. In the report, the number is marijuana smokers for the U.S. therefore the denominator there should be the relevant U.S. population not some set of sub-populations.

      If 50 smokers quit in year 1 of a study when there were only 100 participants and then in year 2 51 smokers quit but there were now 10,000 people in the study you would call year 2 the success? Okay. You hold onto your way of doing things and I’ll hold onto mine.

    2. and btw, we could have a pretty lengthy discussion specifically about whether in the example you cite (smokers quitting alone or with help) the author’s point is a valid one. If you’re talking about overall prevalence of quitting I would say he is but if the question is which quitting method works best, it’d be hard to justify in my opinion.

  5. No, the denominator is not important because it is not the ratio that is important, thats what he is arguing. And he is arguing that unassisted quitting IS the most successful method because thats how most people quit. The quit ratio is much higher among assisted smokers but his point is that, by virtue of the fact that more people try to quit unassisted than do try to quit assisted, there are far more unassisted quitters than assisted quitters. and from a public health perspective, this makes unassisted quitting the most successful method of quitting.

    In the Commission report, the numbers of marijuana smokers may increase because the population has increased, but in absolute terms, it doesnt matter why it has increased – the Commission have only pointed out that the number has increased and therefore is costing more money to society.

    In your example I would say that in terms of absolute costs, years 1 and 2 are statistically equivalent. In ratio terms, year 2 is clearly the success. But when we’re talking about 832,000 smokers quitting without assistance and 168,000 quitting with assistance, then regardless of the population size differences, unassisted quitting has the greatest impact on public health.

    I know what you’re saying, but as the author mentions,I think too many people have been brought up to look at ratios as the index of success, not the numbers in whole populations. Im sure you would agree that anything published in The Lancet is worth taking note of.

    1. Okay. We’re probably just going to disagree on the report’s numbers and their appropriateness – I’m okay with that.
      Lancet publications are certainly note-worthy but I don’t have to agree with everything they say 🙂 Like I said, if the question is which method produces the most quitters, the answer is self-quit; if the question is which method produces the highest success rate it’s assissted quitting. It all depends on what you ask. Will assissted quitting necessarily produce equal quit rates if everyone tried to quit that way? Not necessarily but that’s an empirical question left to randomized trials and the ones I’ve seen have an obvious selection bias (people who enroll in these studies are looking for help in quitting). Another researcher here at our center gave a talk that put this very simply when talking about criminal-justice treatment – Ask people what form of treatment they want and then give it to them. It will likely produce the highest success rates.
      And BTW, those numbers you cited are the smokers attempting to quit by each method, not those quitting.

  6. youre right, it is ok to agree. and I really appreciate the points you raise about the treatment seeker selection bias.

    oh yes,sorry I looked at the wrong column – I should have said 60,999 quit without assistance and 33,014 quit with assistance. So I stand by the conclusion that unassisted quitting has the greatest public health impact. If you ask which method produces the most quitters, the answer is by far unassisted quitting. The question is: On the basis of this evidence, would you recommend to your readers that they try to quit on their own rather than seeking professional help? I dont want to pre-judge your answer, the author’s point is that no public health campaign carries these statistics and no doctor is told to advise smokers to quit on their own, while the author says that “it ought to be embraced as the first choice method that over decades has consistently assisted far more than any other approach”.

    No you certainly do not have to agree with them, I did not mean to imply this.

    I dont wish to continue this point much further. I appreciate the debate and that different opinions are held by many and I by no means hold myself to be the authority on this matter. So thank you for your insights.

  7. “Alcohol use and tobacco smoking are the underlying causes for more deaths than anything else on earth including pollution, automobile accidents, or anything else people seem so afraid of.”

    The high risk associated with alcohol and tobacco use is not representative of ‘drugs’ or ‘illegal drugs’.

    Why do governments make some risky behavior illegal but not other kinds of risky behavior?

    Why is it legal to risk death climbing a mountain but illegal to risk addiction using a drug? Why this arbitrary distinction between alcohol and cannabis? If drugs are really a health crisis and the proponents of the anti drug rhetoric are correct about the devastation caused by drugs and the methods to reduce that devastation, how could they possibly justify keeping alcohol and tobacco legal since they are the most widely used? The drug warriors spout off about how to stop drugs and then do the absolute opposite when it comes to the drugs that are causing the most problems.

    1. Preaching to the choir Brandon… I don’t think our current solution is the right one and I don’t believe that outlawing risk makes sense. I still see a difference between full on legalization and decriminalization and I think the options need to be weighed and that trial programs need to be set up to assess the actual, and not perceived or intended, consequences of both.
      The answer to the final sentence in your comment is money… sad but true.

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