Trevor Hancock: The ‘Great War’ on drugs: Time for re-think

In this centenary of the Great War, it is worth considering the lessons to be learned as we contemplate the current war on drugs.

One of the distinctive features of the First World War was that the military leaders constantly reinforced failure, simplistically believing that a larger and harder push would succeed where others had failed. Many lives were pointlessly lost in the process.

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Fast-forward to our present war on drugs. Clearly, it has not been working, yet the federal government insists on reinforcing failure, rather than pausing to re-think its options. One would think that we might have learned the lesson of prohibition in the 1920s; it doesn’t work. But as in the Great War, the rigid adherence to a failed strategy simply causes more harm and more deaths, to little purpose.

A current election briefing from the Canadian Public Health Association begins with the recognition that “the prohibition and criminalization of psychoactive substances are not achieving their intended objectives of reducing drug use and associated harms.” It then lists the many ways in which the war on drugs, and in particular prohibition, has failed.

These include the institutionalization of organized crime as a powerful force; the spread of HIV, hepatitis and other infectious diseases; more deaths because people are driven away from prevention and care services by enforcement, and because the unregulated illegal drugs can be much stronger or contaminated; increased property damage and criminal activity by addicts who need to support their habit; and other harms too numerous to list here.

In the face of all these harms, and little evidence that the war on drugs is being won, we need a more rational, humane and evidence-based approach that would reduce the harms resulting from our current failed policies. The common thread is to recognize that drug use is best dealt with as a public-health issue, not a criminal issue.

Fortunately, the public-health association has done a good job of bringing together the evidence and putting forward sensible policy options. These are available in its 2014 report, available on the association’s website. The report describes a vision:

Criminal prohibition of illegal psychoactive substances has been replaced by a public-health-oriented regulatory program to manage the production, sale and distribution of substances. Product promotion is restricted, and exposure of youth to product promotion is prohibited. Retail models that allow access while protecting public health are in place.

If this sounds an impossible and undesirable state, think again. The report notes that countries such as Switzerland, Norway, Portugal, Australia and New Zealand have implemented at least some of these steps. In particular, it notes: “In 2001, Portugal decriminalized possession of all drugs and shifted their emphasis to addressing health issues. This change led to reductions in problematic substance use, drug-related harms and criminal-justice overcrowding.”

For a “soft” drug such as marijuana (which I do not use), it is hard to see a reason to treat it differently from alcohol. I have never seen the difference between people smoking a joint after work and people having a beer or glass of wine. In fact, alcohol causes far more health problems than does marijuana. The legalization of marijuana in Washington, Colorado and Uruguay shows it is possible.

As to heroin, as a medical student in London in the early 1970s, I saw that legally prescribing and providing heroin through a clinic could enable at least some people who have this terrible addiction — a disease, not a crime, just like alcoholism — to lead a fairly normal and productive life.

The stubborn adherence to a failed strategy, the demonization and vilification of those who advance an evidence-based, humane and rational alternative, and ongoing efforts to shut down and prevent the replication of the successful Insite model for safe injection — all do more harm than good.

It is time for a re-think.

 

Dr. Trevor Hancock is a professor and senior scholar at the University of Victoria’s school of public health and social policy.

thancock@uvic.ca

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