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The War On Drugs: 50 Years Later

After 50 years of the war on drugs, 'what good is it doing for us'.

During the War on Drugs, the Brownsville neighborhood in New York City saw some of the highest rates of incarceration in the U.S., as Black and Hispanic men were sent to prison for lengthy prison sentences, often for low-level, nonviolent drug crimes. Spencer Platt/Getty Images hide caption

During the War on Drugs, the Brownsville neighborhood in New York City saw some of the highest rates of incarceration in the U.S., as Black and Hispanic men were sent to prison for lengthy prison sentences, often for low-level, nonviolent drug crimes.

When Aaron Hinton walked through the housing project in Brownsville on a recent summer afternoon, he voiced love and pride for this tightknit, but troubled working-class neighborhood in New York City where he grew up.

He pointed to a community garden, the lush plots of vegetables and flowers tended by volunteers, and to the library where he has led after-school programs for kids.

But he also expressed deep rage and sorrow over the scars left by the nation's 50-year-long War on Drugs. "What good is it doing for us?" Hinton asked.

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As the United States' harsh approach to drug use and addiction hits the half-century milestone, this question is being asked by a growing number of lawmakers, public health experts and community leaders.

In many parts of the U.S., some of the most severe policies implemented during the drug war are being scaled back or scrapped altogether.

Hinton, a 37-year-old community organizer and activist, said the reckoning is long overdue. He described watching Black men like himself get caught up in drugs year after year and swept into the nation's burgeoning prison system.

"They're spending so much money on these prisons to keep kids locked up," Hinton said, shaking his head. "They don't even spend a fraction of that money sending them to college or some kind of school."

Aaron Hinton, a 37-year-old veteran activist and community organizer, said it's clear Brownsville needed help coping with the cocaine, heroin and other drug-related crime that took root here in the 1970s and 1980s. His own family was devastated by addiction. Brian Mann hide caption

Aaron Hinton, a 37-year-old veteran activist and community organizer, said it's clear Brownsville needed help coping with the cocaine, heroin and other drug-related crime that took root here in the 1970s and 1980s. His own family was devastated by addiction.

Hinton has lived his whole life under the drug war. He said Brownsville needed help coping with cocaine, heroin and drug-related crime that took root here in the 1970s and 1980s.

His own family was scarred by addiction.

"I've known my mom to be a drug user my whole entire life," Hinton said. "She chose to run the streets and left me with my great-grandmother."

Four years ago, his mom overdosed and died after taking prescription painkillers, part of the opioid epidemic that has killed hundreds of thousands of Americans.

Hinton said her death sealed his belief that tough drug war policies and aggressive police tactics would never make his family or his community safer.

The nation pivots (slowly) as evidence mounts against the drug war

During months of interviews for this project, NPR found a growing consensus across the political spectrum — including among some in law enforcement — that the drug war simply didn't work.

"We have been involved in the failed War on Drugs for so very long," said retired Maj. Neill Franklin, a veteran with the Baltimore City Police and the Maryland State Police who led drug task forces for years.

He now believes the response to drugs should be handled by doctors and therapists, not cops and prison guards. "It does not belong in our wheelhouse," Franklin said during a press conference this week.

Aaron Hinton has lived his whole life under the drug war. He has watched many Black men like himself get caught up in drugs year after year, swept into the nation's criminal justice system. Brian Mann/NPR hide caption

Aaron Hinton has lived his whole life under the drug war. He has watched many Black men like himself get caught up in drugs year after year, swept into the nation's criminal justice system.

Some prosecutors have also condemned the drug war model, describing it as ineffective and racially biased.

"Over the last 50 years, we've unfortunately seen the 'War on Drugs' be used as an excuse to declare war on people of color, on poor Americans and so many other marginalized groups," said New York Attorney General Letitia James in a statement sent to NPR.

On Tuesday, two House Democrats introduced legislation that would decriminalize all drugs in the U.S., shifting the national response to a public health model. The measure appears to have zero chance of passage.

But in much of the country, disillusionment with the drug war has already led to repeal of some of the most punitive policies, including mandatory lengthy prison sentences for nonviolent drug users.

In recent years, voters and politicians in 17 states — including red-leaning Alaska and Montana — and the District of Columbia have backed the legalization of recreational marijuana , the most popular illicit drug, a trend that once seemed impossible.

Last November, Oregon became the first state to decriminalize small quantities of all drugs , including heroin and methamphetamines.

Many critics say the course correction is too modest and too slow.

"The war on drugs was an absolute miscalculation of human behavior," said Kassandra Frederique, who heads the Drug Policy Alliance, a national group that advocates for total drug decriminalization.

She said the criminal justice model failed to address the underlying need for jobs, health care and safe housing that spur addiction.

Indeed, much of the drug war's architecture remains intact. Federal spending on drugs — much of it devoted to interdiction — is expected to top $37 billion this year.

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The U.S. still incarcerates more people than any other nation, with nearly half of the inmates in federal prison held on drug charges .

But the nation has seen a significant decline in state and federal inmate populations, down by a quarter from the peak of 1.6 million in 2009 to roughly 1.2 million last year .

There has also been substantial growth in public funding for health care and treatment for people who use drugs, due in large part to passage of the Affordable Care Act .

"The best outcomes come when you treat the substance use disorder [as a medical condition] as opposed to criminalizing that person and putting them in jail or prison," said Dr. Nora Volkow, who has been head of the National Institute of Drug Abuse since 2003.

Volkow said data shows clearly that the decision half a century ago to punish Americans who struggle with addiction was "devastating ... not just to them but actually to their families."

From a bipartisan War on Drugs to Black Lives Matter

Wounds left by the drug war go far beyond the roughly 20.3 million people who have a substance use disorder .

The campaign — which by some estimates cost more than $1 trillion — also exacerbated racial divisions and infringed on civil liberties in ways that transformed American society.

Frederique, with the Drug Policy Alliance, said the Black Lives Matter movement was inspired in part by cases that revealed a dangerous attitude toward drugs among police.

In Derek Chauvin's murder trial, the former officer's defense claimed aggressive police tactics were justified because of small amounts of fentanyl in George Floyd's body. Critics described the argument as an attempt to "weaponize" Floyd's substance use disorder and jurors found Chauvin guilty.

Breonna Taylor, meanwhile, was shot and killed by police in her home during a drug raid . She wasn't a suspect in the case.

"We need to end the drug war not just for our loved ones that are struggling with addiction, but we need to remove the excuse that that is why law enforcement gets to invade our space ... or kill us," Frederique said.

The United States has waged aggressive campaigns against substance use before, most notably during alcohol Prohibition in the 1920s and 1930s.

The modern drug war began with a symbolic address to the nation by President Richard Nixon on June 17, 1971.

Speaking from the White House, Nixon declared the federal government would now treat drug addiction as "public enemy No. 1," suggesting substance use might be vanquished once and for all.

"In order to fight and defeat this enemy," Nixon said, "it is necessary to wage a new all-out offensive."

President Richard Nixon's speech on June 17, 1971, marked the symbolic start of the modern drug war. In the decades that followed Democrats and Republicans embraced ever-tougher laws penalizing people with addiction.

Studies show from the outset drug laws were implemented with a stark racial bias , leading to unprecedented levels of mass incarceration for Black and brown men .

As recently as 2018, Black men were nearly six times more likely than white men to be locked up in state or federal correctional facilities, according to the U.S. Justice Department .

Researchers have long concluded the pattern has far-reaching impacts on Black families, making it harder to find employment and housing, while also preventing many people of color with drug records from voting .

In a 1994 interview published in Harper's Magazine , Nixon adviser John Ehrlichman suggested racial animus was among the motives shaping the drug war.

"We knew we couldn't make it illegal to be either against the [Vietnam] War or Black," Ehrlichman said. "But by getting the public to associate the hippies with marijuana and Blacks with heroin, and then criminalizing both heavily, we could disrupt those communities."

Despite those concerns, Democrats and Republicans partnered on the drug war decade after decade, approving ever-more-severe laws, creating new state and federal bureaucracies to interdict drugs, and funding new armies of police and federal agents.

At times, the fight on America's streets resembled an actual war, especially in poor communities and communities of color.

Police units carried out drug raids with military-style hardware that included body armor, assault weapons and tanks equipped with battering rams.

President Richard Nixon explaining aspects of the special message sent to the Congress on June 17, 1971, asking for an extra $155 million for a new program to combat the use of drugs. He labeled drug abuse "a national emergency." Harvey Georges/AP hide caption

President Richard Nixon explaining aspects of the special message sent to the Congress on June 17, 1971, asking for an extra $155 million for a new program to combat the use of drugs. He labeled drug abuse "a national emergency."

"What we need is another D-Day, not another Vietnam, not another limited war fought on the cheap," declared then-Sen. Joe Biden, D-Del., in 1989.

Biden, who chaired the influential Senate Judiciary Committee, later co-authored the controversial 1994 crime bill that helped fund a vast new complex of state and federal prisons, which remains the largest in the world.

On the campaign trail in 2020, Biden stopped short of repudiating his past drug policy ideas but said he now believes no American should be incarcerated for addiction. He also endorsed national decriminalization of marijuana.

While few policy experts believe the drug war will come to a conclusive end any time soon, the end of bipartisan backing for punitive drug laws is a significant development.

More drugs bring more deaths and more doubts

Adding to pressure for change is the fact that despite a half-century of interdiction, America's streets are flooded with more potent and dangerous drugs than ever before — primarily methamphetamines and the synthetic opioid fentanyl.

"Back in the day, when we would see 5, 10 kilograms of meth, that would make you a hero if you made a seizure like that," said Matthew Donahue, the head of operations at the Drug Enforcement Administration.

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"Now it's common for us to see 100-, 200- and 300-kilogram seizures of meth," he added. "It doesn't make a dent to the price."

Efforts to disrupt illegal drug supplies suffered yet another major blow last year after Mexican officials repudiated drug war tactics and began blocking most interdiction efforts south of the U.S.-Mexico border.

"It's a national health threat, it's a national safety threat," Donahue told NPR.

Last year, drug overdoses hit a devastating new record of 90,000 deaths , according to preliminary data from the Centers for Disease Control and Prevention.

The drug war failed to stop the opioid epidemic

Critics say the effectiveness of the drug war model has been called into question for another reason: the nation's prescription opioid epidemic.

Beginning in the late 1990s, some of the nation's largest drug companies and pharmacy chains invested heavily in the opioid business.

State and federal regulators and law enforcement failed to intervene as communities were flooded with legally manufactured painkillers, including Oxycontin.

"They were utterly failing to take into account diversion," said West Virginia Republican Attorney General Patrick Morrisey, who sued the DEA for not curbing opioid production quotas sooner.

"It's as close to a criminal act as you can find," Morrisey said.

Courtney Hessler, a reporter for The (Huntington) Herald-Dispatch in West Virgina, has covered the opioid epidemic. As a child she wound up in foster care after her mother became addicted to opioids. "You know there's thousands of children that grew up the way that I did. These people want answers," Hessler told NPR. Brian Mann/NPR hide caption

Courtney Hessler, a reporter for The (Huntington) Herald-Dispatch in West Virgina, has covered the opioid epidemic. As a child she wound up in foster care after her mother became addicted to opioids. "You know there's thousands of children that grew up the way that I did. These people want answers," Hessler told NPR.

One of the epicenters of the prescription opioid epidemic was Huntington, a small city in West Virginia along the Ohio River hit hard by the loss of factory and coal jobs.

"It was pretty bad. Eighty-one million opioid pills over an eight-year period came into this area," said Courtney Hessler, a reporter with The (Huntington) Herald-Dispatch.

Public health officials say 1 in 10 residents in the area still battle addiction. Hessler herself wound up in foster care after her mother struggled with opioids.

In recent months, she has reported on a landmark opioid trial that will test who — if anyone — will be held accountable for drug policies that failed to keep families and communities safe.

"I think it's important. You know there's thousands of children that grew up the way that I did," Hessler said. "These people want answers."

A needle disposal box at the Cabell-Huntington Health Department sits in the front parking lot in 2019 in Huntington, W.Va. The city is experiencing a surge in HIV cases related to intravenous drug use following a recent opioid crisis in the state. Ricky Carioti/The Washington Post via Getty Images hide caption

A needle disposal box at the Cabell-Huntington Health Department sits in the front parking lot in 2019 in Huntington, W.Va. The city is experiencing a surge in HIV cases related to intravenous drug use following a recent opioid crisis in the state.

During dozens of interviews, community leaders told NPR that places like Huntington, W.Va., and Brownsville, N.Y., will recover from the drug war and rebuild.

They predicted many parts of the country will accelerate the shift toward a public health model for addiction: treating drug users more often like patients with a chronic illness and less often as criminals.

But ending wars is hard and stigma surrounding drug use, heightened by a half-century of punitive policies, remains deeply entrenched. Aaron Hinton, the activist in Brownsville, said it may take decades to unwind the harm done to his neighborhood.

"It's one step forward, two steps back," Hinton said. "But I remain hopeful. Why? Because what else am I going to do?"

• drug policy
• war on drugs
• public health
• opioid epidemic

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Race, Mass Incarceration, and the Disastrous War on Drugs

Unravelling decades of racially biased anti-drug policies is a monumental project.

• Nkechi Taifa
• Cutting Jail & Prison Populations
• Social & Economic Harm

This essay is part of the  Brennan Center’s series  examining  the punitive excess that has come to define America’s criminal legal system .

I have a long view of the criminal punishment system, having been in the trenches for nearly 40 years as an activist, lobbyist, legislative counsel, legal scholar, and policy analyst. So I was hardly surprised when Richard Nixon’s domestic policy advisor  John Ehrlichman  revealed in a 1994 interview that the “War on Drugs” had begun as a racially motivated crusade to criminalize Blacks and the anti-war left.

“We knew we couldn’t make it illegal to be either against the war or blacks, but by getting the public to associate the hippies with marijuana and blacks with heroin and then criminalizing them both heavily, we could disrupt those communities. We could arrest their leaders, raid their homes, break up their meetings, and vilify them night after night in the evening news. Did we know we were lying about the drugs? Of course we did,” Ehrlichman said.

Before the War on Drugs, explicit discrimination — and for decades, overtly racist lynching — were the primary weapons in the subjugation of Black people. Then mass incarceration, the gradual progeny of a number of congressional bills, made it so much easier. Most notably, the 1984  Comprehensive Crime Control and Safe Streets Act  eliminated parole in the federal system, resulting in an upsurge of  geriatric prisoners . Then the 1986  Anti-Drug Abuse Act  established mandatory minimum sentencing schemes, including the infamous 100-to-1 ratio between crack and powder cocaine sentences.  Its expansion  in 1988 added an overly broad definition of conspiracy to the mix. These laws flooded the federal system with people convicted of low-level and nonviolent drug offenses.

During the early 1990s, I walked the halls of Congress lobbying against various omnibus crime bills, which culminated in the granddaddy of them all — the  Violent Crime Control and Safe Streets Act  of 1994. This bill featured the largest expansion of the federal death penalty in modern times, the gutting of habeas corpus, the evisceration of the exclusionary rule, the trying of 13-year-olds as adults, and 100,000 new cops on the streets, which led to an explosion in racial profiling. It also included the elimination of Pell educational grants for prisoners, the implementation of the federal three strikes law, and monetary incentives to states to enact “truth-in-sentencing” laws, which subsidized an astronomical rise in prison construction across the country, lengthened the amount of time to be served, and solidified a mentality of meanness.

The prevailing narrative at the time was “tough on crime.” It was a narrative that caused then-candidate Bill Clinton to leave his presidential campaign trail to oversee the execution of a mentally challenged man in Arkansas. It was the same narrative that brought about the crack–powder cocaine disparity, supported the transfer of youth to adult courts, and popularized the myth of the Black child as “superpredator.”

With the proliferation of mandatory minimum sentences during the height of the War on Drugs, unnecessarily lengthy prison terms were robotically meted out with callous abandon. Shockingly severe sentences for drug offenses — 10, 20, 30 years, even life imprisonment — hardly raised an eyebrow. Traumatizing sentences that snatched parents from children and loved ones, destabilizing families and communities, became commonplace.

Such punishments should offend our society’s standard of decency. Why haven’t they? Most flabbergasting to me was the Supreme Court’s 1991  decision  asserting that mandatory life imprisonment for a first-time drug offense was not cruel and unusual punishment. The rationale was ludicrous. The Court actually held that although the punishment was cruel, it was not unusual.

The twisted logic reminded me of another Supreme Court  case  that had been decided a few years earlier. There, the Court allowed the execution of a man — despite overwhelming evidence of racial bias — because of fear that the floodgates would be opened to racial challenges in other aspects of criminal sentencing as well. Essentially, this ruling found that lengthy sentences in such cases are cruel, but they are usual. In other words, systemic racism exists, but because that is the norm, it is therefore constitutional.

In many instances, laws today are facially neutral and do not appear to discriminate intentionally. But the disparate treatment often built into our legal institutions allows discrimination to occur without the need of overt action. These laws look fair but nevertheless have a racially discriminatory impact that is structurally embedded in many police departments, prosecutor’s offices, and courtrooms.

Since the late 1980s, a combination of federal law enforcement policies, prosecutorial practices, and legislation resulted in Black people being disproportionately arrested, convicted, and imprisoned for possession and distribution of crack cocaine. Five grams of crack cocaine — the weight of a couple packs of sugar — was, for sentencing purposes, deemed the equivalent of 500 grams of powder cocaine; both resulted in the same five-year sentence. Although household surveys from the National Institute for Drug Abuse have revealed larger numbers of documented white crack cocaine users, the overwhelming number of arrests nonetheless came from Black communities who were disproportionately impacted by the facially neutral, yet illogically harsh, crack penalties.

For the system to be just, the public must be confident that at every stage of the process — from the initial investigation of crimes by police to the prosecution and punishment of those crimes — people in like circumstances are treated the same. Today, however, as yesterday, the criminal legal system strays far from that ideal, causing African Americans to often question, is it justice or “just-us?”

Fortunately, the tough-on-crime chorus that arose from the War on Drugs is disappearing and a new narrative is developing. I sensed the beginning of this with the 2008  Second Chance Reentry  bill and 2010  Fair Sentencing Act , which reduced the disparity between crack and powder cocaine. I smiled when the 2012 Supreme Court ruling in  Miller v. Alabama  came out, which held that mandatory life sentences without parole for children violated the Eighth Amendment’s prohibition against cruel and unusual punishment. In 2013, I was delighted when Attorney General Eric Holder announced his  Smart on Crime  policies, focusing federal prosecutions on large-scale drug traffickers rather than bit players. The following year, I applauded President Obama’s executive  clemency initiative  to provide relief for many people serving inordinately lengthy mandatory-minimum sentences. Despite its failure to become law, I celebrated the  Sentencing Reform and Corrections Act  of 2015, a carefully negotiated bipartisan bill passed out of the Senate Judiciary Committee in 2015; a few years later some of its provisions were incorporated as part of the 2018  First Step Act . All of these reforms would have been unthinkable when I first embarked on criminal legal system reform.

But all of this is not enough. We have experienced nearly five decades of destructive mass incarceration. There must be an end to the racist policies and severe sentences the War on Drugs brought us. We must not be content with piecemeal reform and baby-step progress.

Indeed, rather than steps, it is time for leaps and bounds. End all mandatory minimum sentences and invest in a health-centered approach to substance use disorders. Demand a second-look process with the presumption of release for those serving life-without-parole drug sentences. Make sentences retroactive where laws have changed. Support categorical clemencies to rectify past injustices.

It is time for bold action. We must not be satisfied with the norm, but work toward institutionalizing the demand for a standard of decency that values transformative change.

Nkechi Taifa is president of The Taifa Group LLC, convener of the Justice Roundtable, and author of the memoir,  Black Power, Black Lawyer: My Audacious Quest for Justice.

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Drug Legalization?: Time for a real debate

Subscribe to governance weekly, paul stares ps paul stares.

March 1, 1996

• 11 min read

Whether Bill Clinton “inhaled” when trying marijuana as a college student was about the closest the last presidential campaign came to addressing the drug issue. The present one, however, could be very different. For the fourth straight year, a federally supported nationwide survey of American secondary school students by the University of Michigan has indicated increased drug use. After a decade or more in which drug use had been falling, the Republicans will assuredly blame the bad news on President Clinton and assail him for failing to carry on the Bush and Reagan administrations’ high-profile stand against drugs. How big this issue becomes is less certain, but if the worrisome trend in drug use among teens continues, public debate about how best to respond to the drug problem will clearly not end with the election. Indeed, concern is already mounting that the large wave of teenagers—the group most at risk of taking drugs—that will crest around the turn of the century will be accompanied by a new surge in drug use.

As in the past, some observers will doubtless see the solution in much tougher penalties to deter both suppliers and consumers of illicit psychoactive substances. Others will argue that the answer lies not in more law enforcement and stiffer sanctions, but in less. Specifically, they will maintain that the edifice of domestic laws and international conventions that collectively prohibit the production, sale, and consumption of a large array of drugs for anything other than medical or scientific purposes has proven physically harmful, socially divisive, prohibitively expensive, and ultimately counterproductive in generating the very incentives that perpetuate a violent black market for illicit drugs. They will conclude, moreover, that the only logical step for the United States to take is to “legalize” drugs—in essence repeal and disband the current drug laws and enforcement mechanisms in much the same way America abandoned its brief experiment with alcohol prohibition in the 1920s.

Although the legalization alternative typically surfaces when the public’s anxiety about drugs and despair over existing policies are at their highest, it never seems to slip off the media radar screen for long. Periodic incidents—such as the heroin-induced death of a young, affluent New York City couple in 1995 or the 1993 remark by then Surgeon General Jocelyn Elders that legalization might be beneficial and should be studied—ensure this. The prominence of many of those who have at various times made the case for legalization—such as William F. Buckley, Jr., Milton Friedman, and George Shultz—also helps. But each time the issue of legalization arises, the same arguments for and against are dusted off and trotted out, leaving us with no clearer understanding of what it might entail and what the effect might be.

As will become clear, drug legalization is not a public policy option that lends itself to simplistic or superficial debate. It requires dissection and scrutiny of an order that has been remarkably absent despite the attention it perennially receives. Beyond discussion of some very generally defined proposals, there has been no detailed assessment of the operational meaning of legalization. There is not even a commonly accepted lexicon of terms to allow an intellectually rigorous exchange to take place. Legalization, as a consequence, has come to mean different things to different people. Some, for example, use legalization interchangeably with “decriminalization,” which usually refers to removing criminal sanctions for possessing small quantities of drugs for personal use. Others equate legalization, at least implicitly, with complete deregulation, failing in the process to acknowledge the extent to which currently legally available drugs are subject to stringent controls.

Unfortunately, the U.S. government—including the Clinton administration—has done little to improve the debate. Although it has consistently rejected any retreat from prohibition, its stance has evidently not been based on in- depth investigation of the potential costs and benefits. The belief that legalization would lead to an instant and dramatic increase in drug use is considered to be so self-evident as to warrant no further study. But if this is indeed the likely conclusion of any study, what is there to fear aside from criticism that relatively small amounts of taxpayer money had been wasted in demonstrating what everyone had believed at the outset? Wouldn’t such an outcome in any case help justify the continuation of existing policies and convincingly silence those—admittedly never more than a small minority—calling for legalization?

A real debate that acknowledges the unavoidable complexities and uncertainties surrounding the notion of drug legalization is long overdue. Not only would it dissuade people from making the kinds of casual if not flippant assertions—both for and against—that have permeated previous debates about legalization, but it could also stimulate a larger and equally critical assessment of current U.S. drug control programs and priorities.

First Ask the Right Questions

Many arguments appear to make legalization a compelling alternative to today’s prohibitionist policies. Besides undermining the black-market incentives to produce and sell drugs, legalization could remove or at least significantly reduce the very problems that cause the greatest public concern: the crime, corruption, and violence that attend the operation of illicit drug markets. It would presumably also diminish the damage caused by the absence of quality controls on illicit drugs and slow the spread of infectious diseases due to needle sharing and other unhygienic practices. Furthermore, governments could abandon the costly and largely futile effort to suppress the supply of illicit drugs and jail drug offenders, spending the money thus saved to educate people not to take drugs and treat those who become addicted.

However, what is typically portrayed as a fairly straightforward process of lifting prohibitionist controls to reap these putative benefits would in reality entail addressing an extremely complex set of regulatory issues. As with most if not all privately and publicly provided goods, the key regulatory questions concern the nature of the legally available drugs, the terms of their supply, and the terms of their consumption (see page 21).

What becomes immediately apparent from even a casual review of these questions—and the list presented here is by no means exhaustive—is that there is an enormous range of regulatory permutations for each drug. Until all the principal alternatives are clearly laid out in reasonable detail, however, the potential costs and benefits of each cannot begin to be responsibly assessed. This fundamental point can be illustrated with respect to the two central questions most likely to sway public opinion. What would happen to drug consumption under more permissive regulatory regimes? And what would happen to crime?

Relaxing the availability of psychoactive substances not already commercially available, opponents typically argue, would lead to an immediate and substantial rise in consumption. To support their claim, they point to the prevalence of opium, heroin, and cocaine addiction in various countries before international controls took effect, the rise in alcohol consumption after the Volstead Act was repealed in the United States, and studies showing higher rates of abuse among medical professionals with greater access to prescription drugs. Without explaining the basis of their calculations, some have predicted dramatic increases in the number of people taking drugs and becoming addicted. These increases would translate into considerable direct and indirect costs to society, including higher public health spending as a result of drug overdoses, fetal deformities, and other drug-related misadventures such as auto accidents; loss of productivity due to worker absenteeism and on-the-job accidents; and more drug-induced violence, child abuse, and other crimes, to say nothing about educational impairment.

Advocates of legalization concede that consumption would probably rise, but counter that it is not axiomatic that the increase would be very large or last very long, especially if legalization were paired with appropriate public education programs. They too cite historical evidence to bolster their claims, noting that consumption of opium, heroin, and cocaine had already begun falling before prohibition took effect, that alcohol consumption did not rise suddenly after prohibition was lifted, and that decriminalization of cannabis use in 11 U.S. states in the 1970s did not precipitate a dramatic rise in its consumption. Some also point to the legal sale of cannabis products through regulated outlets in the Netherlands, which also does not seem to have significantly boosted use by Dutch nationals. Public opinion polls showing that most Americans would not rush off to try hitherto forbidden drugs that suddenly became available are likewise used to buttress the pro-legalization case.

Neither side’s arguments are particularly reassuring. The historical evidence is ambiguous at best, even assuming that the experience of one era is relevant to another. Extrapolating the results of policy steps in one country to another with different sociocultural values runs into the same problem. Similarly, within the United States the effect of decriminalization at the state level must be viewed within the general context of continued federal prohibition. And opinion polls are known to be unreliable.

More to the point, until the nature of the putative regulatory regime is specified, such discussions are futile. It would be surprising, for example, if consumption of the legalized drugs did not increase if they were to become commercially available the way that alcohol and tobacco products are today, complete with sophisticated packaging, marketing, and advertising. But more restrictive regimes might see quite different outcomes. In any case, the risk of higher drug consumption might be acceptable if legalization could reduce dramatically if not remove entirely the crime associated with the black market for illicit drugs while also making some forms of drug use safer. Here again, there are disputed claims.

Opponents of more permissive regimes doubt that black market activity and its associated problems would disappear or even fall very much. But, as before, addressing this question requires knowing the specifics of the regulatory regime, especially the terms of supply. If drugs are sold openly on a commercial basis and prices are close to production and distribution costs, opportunities for illicit undercutting would appear to be rather small. Under a more restrictive regime, such as government-controlled outlets or medical prescription schemes, illicit sources of supply would be more likely to remain or evolve to satisfy the legally unfulfilled demand. In short, the desire to control access to stem consumption has to be balanced against the black market opportunities that would arise. Schemes that risk a continuing black market require more questions—about the new black markets operation over time, whether it is likely to be more benign than existing ones, and more broadly whether the trade-off with other benefits still makes the effort worthwhile.

The most obvious case is regulating access to drugs by adolescents and young adults. Under any regime, it is hard to imagine that drugs that are now prohibited would become more readily available than alcohol and tobacco are today. Would a black market in drugs for teenagers emerge, or would the regulatory regime be as leaky as the present one for alcohol and tobacco? A “yes” answer to either question would lessen the attractiveness of legalization.

What about the International Repercussions?

Not surprisingly, the wider international ramifications of drug legalization have also gone largely unremarked. Here too a long set of questions remains to be addressed. Given the longstanding U.S. role as the principal sponsor of international drug control measures, how would a decision to move toward legalizing drugs affect other countries? What would become of the extensive regime of multilateral conventions and bilateral agreements? Would every nation have to conform to a new set of rules? If not, what would happen? Would more permissive countries be suddenly swamped by drugs and drug consumers, or would traffickers focus on the countries where tighter restrictions kept profits higher? This is not an abstract question. The Netherlands’ liberal drug policy has attracted an influx of “drug tourists” from neighboring countries, as did the city of Zurich’s following the now abandoned experiment allowing an open drug market to operate in what became known as “Needle Park.” And while it is conceivable that affluent countries could soften the worst consequences of drug legalization through extensive public prevention and drug treatment programs, what about poorer countries?

Finally, what would happen to the principal suppliers of illicit drugs if restrictions on the commercial sale of these drugs were lifted in some or all of the main markets? Would the trafficking organizations adapt and become legal businesses or turn to other illicit enterprises? What would happen to the source countries? Would they benefit or would new producers and manufacturers suddenly spring up elsewhere? Such questions have not even been posed in a systematic way, let alone seriously studied.

Irreducible Uncertainties

Although greater precision in defining more permissive regulatory regimes is critical to evaluating their potential costs and benefits, it will not resolve the uncertainties that exist. Only implementation will do that. Because small-scale experimentation (assuming a particular locality’s consent to be a guinea pig) would inevitably invite complaints that the results were biased or inconclusive, implementation would presumably have to be widespread, even global, in nature.

Yet jettisoning nearly a century of prohibition when the putative benefits remain so uncertain and the potential costs are so high would require a herculean leap of faith. Only an extremely severe and widespread deterioration of the current drug situation, nationally and internationally—is likely to produce the consensus—again, nationally and internationally that could impel such a leap. Even then the legislative challenge would be stupendous. The debate over how to set the conditions for controlling access to each of a dozen popular drugs could consume the legislatures of the major industrial countries for years.

None of this should deter further analysis of drug legalization. In particular, a rigorous assessment of a range of hypothetical regulatory regimes according to a common set of variables would clarify their potential costs, benefits, and trade- offs. Besides instilling much-needed rigor into any further discussion of the legalization alternative, such analysis could encourage the same level of scrutiny of current drug control programs and policies. With the situation apparently deteriorating in the United States as well as abroad, there is no better time for a fundamental reassessment of whether our existing responses to this problem are sufficient to meet the likely challenges ahead.

Governance Studies

Hanna Love, Amy Liu

September 12, 2024

Beau Kilmer, Roland Neil, Vanda Felbab-Brown

September 10, 2024

Kelebogile Zvobgo

September 9, 2024

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Rethinking Drug Laws: Theory, History, Politics

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This book develops a new way of understanding what global drug prohibition is, the origins of the prohibition system, and the possibilities for alternative futures. The first part explores the intellectual resources available for analysing and explaining drug control. By framing drug control as a form of market regulation, it sets out a new theoretical approach, using the notion of exchangespace . The second part explores the historical origins of global drug prohibition. Drawing on original archival research, it argues that recentring China in the origin story allows us to see important new aspects of the emergence of prohibition. The third part considers the political dimension of drug control. It argues that rather than politics or ideology being barriers to drug law reform, in fact radical reform will require serious engagement with the politics of drug control. The book concludes by arguing that finding a path to better alternative futures will depend on recognising that the question of how we should regulate drugs is, at its heart, a question of how we should regulate world capitalism. In the Asian Century, answers will only be found if we step outside Western-centric ways of thinking and of seeing the world.

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Drug Legalization and Decriminalization Beliefs Among Substance-Using and Non-using Individuals

Associated data, objectives:.

There has been advocacy for legalization of abusable substances, but systematic data on societal beliefs regarding such legalization are limited. People who use substances may have unique beliefs about legalization, and this study assessed whether they would be in favor of drug legalization/decriminalization. It was hypothesized that those who use particular drugs (especially marijuana) would support its legalization/decriminalization, but that this would not be the case across all classes (especially opioids and stimulants).

A nationwide sample of 506 adults were surveyed online to assess demographic characteristics, substance misuse, and beliefs regarding drug legalization/decriminalization. Legalization/decriminalization beliefs for specific drugs were assessed on an 11-point scale (0=strongly disagree; 10=strongly agree).

For persons with opioid misuse (15.4%), when asked about their agreement with: “heroin should be legalized,” the mean score was 4.6 (SEE= 0.4; neutral). For persons with stimulant misuse (12.1%), when asked about their agreement with: “cocaine should be legalized,” the score was 4.2(0.5). However, for persons with marijuana misuse (34.0%), when asked about their agreement with: “medical marijuana should be legalized” the score was 8.2 (0.3; indicating agreement), and for “recreational marijuana” the score was also 8.2(0.3).

Conclusions:

These results suggest that persons who used marijuana strongly support the legalization of both recreational and medical marijuana, whereas persons who primarily have opioid or stimulant misuse have less strongly held beliefs about legalization of substances within those respective categories. By including those who misuse drugs, these data assist in framing discussions of drug legalization and have the potential to inform drug policy considerations.

1.0. Introduction

Substance use is a major concern in both the United States (US) and abroad, with important consequences related not only to morbidity and mortality, but legal and economic concerns as well. In 2010, the Global Burden of Diseases, Injuries, and Risk Factors Study found that mental illness was the leading cause of years living with disability worldwide, with illicit substance use disorders (SUDs) and alcohol use disorders (AUDs) accounting for 11% and 10% of disability-adjusted life years within that category, respectively ( Whiteford et al., 2013 ). The 2016 National Survey on Drug Use and Health (NSDUH) estimates that 7.8% of adults in the US had a SUD during that year ( Center for Behavioral Health Statistics and Quality, 2017 ).

While much drug use remains illegal, there are growing efforts to legalize and/or decriminalize certain drug classes (such as marijuana and heroin), despite international drug treaties prohibiting the non-medical use of marijuana, cocaine, amphetamines, and heroin ( Hall, 2017 ). This is related, in part, to evidence that drugs such as marijuana or heroin, which had been previously categorized as having no medicinal value, may have potential medical benefit. These efforts are also premised upon the experiences of countries like Portugal, which decriminalized all illicit drugs in 2001 and reported subsequent decreases in drug-related societal problems, as well as support for legalizing drugs like marijuana for non-medical use in countries such as Canada and Uruguay ( Room, 2014 ; Goncalves et al., 2015 ; Cox, 2018 ). Several European countries and Canada have now endorsed the use of medicinal injectable and oral heroin (diacetylmorphine or diamorphine) as an effective medication for heroin use disorder among persons who are not otherwise responding to treatments ( Ayanga et al., 2016 ).

The US is beginning to demonstrate varied support for drug legalization and decriminalization. For instance, although not formally supported by the US federal government, eight states and the District of Columbia have legalized recreational marijuana, and twenty-nine states have legalized medicinal marijuana. However, systematic data on the opinions of Americans regarding the legalization/decriminalization of marijuana are lacking, and attitudes regarding the legalization/decriminalization of other substances are even sparser. Data show that the public’s opinions about marijuana seem to have changed over time ( Carliner et al., 2017 ), with 12% of the public supporting legalization in 1969 (based on survey data), compared with 61% per an online poll conducted in 2017 ( Geiger, 2018 ). Another recent online poll of registered US voters found that a modest majority (68%) was in support of legalization of marijuana for medical purposes, with 52% supporting its legalization for recreational purposes. However, this sample was vastly opposed to the legalization and decriminalization of other drugs (including cocaine, heroin, and methamphetamine), for both medical and recreational purposes ( Lopez, 2016 ).

Opinions about drug legalization/decriminalization can differ based on whether a person has a personal history of substance use and as a function of demographic and ideological characteristics (such a religious or political preference); these associations have only been evaluated in a few studies. The first such study was conducted in 2002 among 188 out-of-treatment persons who used substances, and persons who did not use substances, from low income, high drug-use sections of a US urban setting (Houston, TX), and reported that persons who used substances (marijuana, heroin, cocaine, or methamphetamine) were more likely to support the legalization of marijuana (68% in favor) than persons who did not use substances (33%), while each group showed little support for the legalization of heroin (12% vs. 8%) or cocaine (14% vs. 8%, respectively; Trevino and Richard, 2002 ). More recently, an online poll reported that Americans identifying as Democrats were more likely to be in favor of marijuana legalization (69%) than Republicans (43%). Also, white mainline Protestants were more in favor of marijuana legalization (64%) than white evangelical Protestants (38%) or Catholics (52%), while those who were not affiliated with any religion showed the highest support (78%; Geiger, 2018 ).

These polls have various limitations, and have not focused upon the attitudes and beliefs of people who use drugs. This population may have unique beliefs about legalization and/or decriminalization of a drug - either their drug of choice, or illicit drugs more broadly. The direct experience of using a drug might predispose a person to support more ready availability of that drug or, conversely, might make a person more cautious about decreasing barriers to its use. Survey data have demonstrated that opinions on drug legalization/decriminalization can differ based on the person’s belief system, such as varying as a function of political or religious affiliation. Persons who are generally more conservative may not be in favor of legalizing or decriminalizing substances. Surprisingly, there is little information on attitudes regarding legalization/decriminalization of drugs that systematically evaluates these domains. This study aimed to address this gap by surveying both persons who used substances and persons who did not use substances about their opinions regarding legalization and decriminalization of drugs, and to also evaluate whether differences in these attitudes were associated with different religious and political affiliations, or the lack thereof, as a secondary outcome. It was hypothesized that individuals who use marijuana would support the legalization and decriminalization of that drug, but that this would not be the case for heroin or cocaine among persons who used opioids or stimulants, respectively.

2.0. Methods

2.1. participants.

The sample was recruited online between July and November 2017. Participants (N=506) were registered as “workers” on the Amazon Mechanical Turk (AMT) platform ( Paolacci et al., 2010 ; Bartneck et al., 2015 ), which is an online forum where workers can anonymously complete tasks (such as surveys) assigned by “requestors” for a wage. Workers receive requestor approval ratings based on the quality of their work and completion time, which serves as an index of credibility and reliability ( Peer et al., 2014 ). To take the present survey, workers had to have an average requestor approval rating of 90% (as a quality control measure) and be located in the US. A short screening survey was given to ensure that participants were at least 18 years old, and it included other demographic questions, such as sex and race, to distract from the subject of the survey. The screening survey also limited the number of persons per category of primary substance used (including no use) using quotas, with a goal of obtaining at least 60 people in each primary substance category. A total of 2,672 persons attempted the screening survey, and 545 persons completed the primary survey. Those who were not eligible to continue on to the primary survey received $0.10 for completing the screening survey. After providing consent by agreeing to participate in the survey, those who answered questions in the primary survey received a bonus of two dollars, for a total of $2.10. The following quality control questions were included: 1) “Have you taken this survey before?” and 2) “Is there any reason for which we should not use your responses? For instance, you weren’t paying attention, you did not answer honestly, you had major computer issues, etc.” Those who answered “yes” to either of these questions were not included. The survey was hosted on Qualtrics (Provo, UT). The Johns Hopkins University Institutional Review Board approved the use of AMT for this survey research.

2.2. Measures

Demographic and drug use characteristics:.

Primary survey questions included demographic information such as education level, employment status, and income, as well as characteristics related to religious and political affiliations and whether the participant or someone close to them had ever experienced legal consequences related to substance use ( Table 1 ). Participants were asked whether they identified with a particular religion and to choose which major political party they identified with most among a list of the most common options; the options “none” and “other” were also provided. Additionally, participants were provided a list of substances and asked which they had used in the past year (including a write-in “other” option); for each substance they reported using, they were then asked to characterize use based on the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) SUD criteria ( American Psychiatric Association, 2013 ). Answering “yes” to two or more symptoms was operationalized as meeting criteria for a SUD for that substance. Participants who indicated using more than one substance in the past year were asked to identify which substance they would consider their primary substance; this was the basis upon which they were categorized for the remainder of the survey analyses.

Participant demographic data (N=506) 1

Decriminalization and Legalization Questions:

Participants were provided with definitions of legalization and decriminalization, and were then asked to rate their level of agreement with statements about legalization and decriminalization of heroin, cocaine, medical marijuana, and recreational marijuana on an 11-point scale with 0 representing “strongly disagree,” and 10 representing “strongly agree.” Some statements were worded in support of legalization/decriminalization of the substance while others were worded against legalization/decriminalization, to ensure participants were maintaining attention. Responses to the latter were reverse coded for consistency in reporting.

2.3. Statistical analyses

Participants were categorized into groups based on their self-reported primary substance used in the past year, with heroin and prescription painkiller misuse (taking pills other than how they were prescribed) collapsed into the “opioids” group; cocaine, methamphetamines, prescription stimulant misuse, or other stimulant use collapsed into the “stimulants” group; marijuana products, including synthetics, making up the “marijuana” group; any alcohol use included in the “alcohol” group; and no substance use in the “none” group. The degree to which demographic characteristics were associated with ratings for decriminalization/legalization was also assessed. Some demographic characteristics with multiple subgroups were dichotomized given limited numbers in some subgroups, including marital status (never married vs. ever married), race (minority vs. Caucasian), employment status (employed full time vs. other), education level (associates degree vs. less education), household income (less than or equal to $45,000 vs. more than $45,000) and political affiliation (Democrat vs. other).

Opinions on drug legalization and decriminalization as a function of primary substance used served as the primary analyses, while all others were secondary analyses. Categorical data, including demographics and SUD categorization were analyzed with chi-square analyses. Continuous data, such as age and drug legalization/decriminalization ratings, were analyzed with ANOVA or ANCOVA as appropriate. ANCOVAs controlled for those demographic variables that were significantly different among groups and showed a significant relationship with the outcome measure (see Table 2 ). Between-group planned comparisons of drug legalization/decriminalization ratings were compared between the primary substance categories, and then as a function of the group for whom the rating was deemed most relevant (e.g., ratings for heroin among persons who primarily used opioids, for cocaine among persons who primarily used stimulants, and for medical/recreational marijuana among persons who primarily used marijuana). Analyses used Type III sums of squares and planned comparisons among the primary substance use groups, and Pearson’s correlations to evaluate the relationship between legalization/decriminalization ratings. The primary outcome variables (legalization and decriminalization ratings) were not normally distributed. For the analyses in which we needed to control for certain demographic variables, ANCOVA were used as the main analyses, based on support for analyzing Likert data with parametric statistics ( Lubke and Muthén, 2004 ; De Winter and Dodou, 2010 ). The analyses by primary substance were significant when analyzed with Kruskal-Wallis tests, indicating that parametric and nonparametric statistics are approximately equivalent for these data. There were minor exceptions among the secondary analyses, but not the primary analyses. All analyses were performed in SPSS version 24.0. Statistical tests were considered significant at the p < 0.05 level.

Level of agreement with statements as a function of primary substance used 1

3.0. Results

3.1. participant characteristics.

A total of 506 participants completed the survey ( Table 1 ). Over the time of enrollment, the screening process targeted participants to ensure there were at least 60 subjects for each primary substance category. The final population had a mean age of 33.6 years old and was 53.0% male, 45.5% single (never married), and 25.9% racial minority (i.e., not Caucasian). Sixty-two percent of participants were employed full-time, 59.1% had at least an Associate’s degree, and 50.4% had a yearly household income of $45,000 or less. Among the total population, 36.4% of persons had experienced a legal consequence related to substance use among themselves or someone close to them. This was significantly more common among persons who used opioids (35.9%), stimulants (39.3%), marijuana (43.0%), or alcohol (36.4%), compared to those without substance use (19.5%). Participants were located in 43 states and the District of Columbia. For those persons who self-reported a primary substance used in the past year (N=429; 84.8%), a substantial proportion within each substance category reported symptoms meeting criteria for a SUD, including OUD (33/78; 42.3% of persons with opioid misuse), stimulant use disorder (25/61; 41.0%), marijuana use disorder (35/172; 20.3%), and AUD (39/118; 33.1%).

3.2. Preference for drug legalization and decriminalization of specific drug categories ( Table 2 )

3.2.1. heroin.

Overall, participants were not in favor of legalizing heroin (mean 3.8/10 for the total sample). However, persons whose primary substance was an opioid tended to have higher ratings (reflecting more positive attitudes) towards legalizing heroin (4.6/10) than persons who were classified as having primarily stimulant (3.3/10) or alcohol (3.4/10) use, as well as persons with no past-year substance use (3.4/10). The ratings of those with primary opioid misuse were similar to the ratings of persons with primary marijuana misuse with respect to attitudes towards heroin legalization (4.2/10). Ratings among all groups for decriminalization of heroin were even lower (total mean 2.9/10) indicating general lack of support. Persons who primarily misused opioids rated heroin decriminalization at 3.1 on average, which was not significantly different from other groups.

3.2.2. Cocaine

Similarly, the total sample of 506 persons was not in favor of cocaine legalization (3.8/10) or decriminalization (3.3/10). Persons with stimulant misuse rated cocaine legalization (4.2/10) and decriminalization (3.5/10) in a comparably low manner. Those who primarily used marijuana rated their agreement with cocaine decriminalization significantly higher (4.4/10), compared to those with primary alcohol use (2.8/10) and those with no use (2.8/10).

3.2.3. Marijuana

The total group of 506 participants was generally more in favor of the legalization and decriminalization of both medical (means for legalization = 7.2/10 and for decriminalization = 8.3/10) and recreational marijuana (legalization = 7.2/10 and decriminalization = 7.4/10), compared to legalization or decriminalization of heroin and cocaine. When examining the specific substance use groups, persons without any past-year substance use had lower ratings regarding legalization and decriminalization of marijuana, compared to other primary substance use groups. Conversely, persons with primary marijuana use had higher ratings for marijuana legalization (medical and recreational both = 8.2/10) and decriminalization (medical = 9.2/10 and recreational = 8.4/10).

3.3. Ratings as a function of primary substance used

This study hypothesized that respondents who identified a particular substance as their primary substance of use over the past year might be more inclined to see that substance legalized and/or decriminalized (particularly for marijuana). Results demonstrated that participants categorized as having primary opioid or stimulant misuse rated legalization and decriminalization of heroin and cocaine, respectively, at significantly lower values (indicating less endorsement) when compared to how those with primary marijuana use rated legalization and decriminalization of both medical and recreational marijuana (see corresponding cells of Table 2 ).

3.4. Religious characteristics

Whether persons identified with a particular religion or not proved to be an important variable among demographic characteristics, as well as legalization/decriminalization ratings (with religion serving as a covariate for those analyses). Thirty percent of participants identified with a religion. A significantly lower proportion of persons who used marijuana (21.5%) identified with a religion, compared to those who primarily used alcohol (37.3%), stimulants (36.1%), or no substances (37.7%). Similarly, those who identified with a religion were significantly less likely to report primary marijuana use (23.7%) than those who did not (38.6%). However, those persons who identified with a religion and used substances were significantly more likely to endorse 2 or more criteria on the DSM-5 SUD checklist (37.8%) than those who used substances but did not identify with a particular religion (27.8%).

There were statistically significant, though weak, negative correlations between identifying with a religion, and all drug legalization/decriminalization ratings (see Supplemental Table 1 ). Participants with a self-reported religious affiliation had significantly lower mean legalization/decriminalization ratings compared to those without any religious affiliation ( Figure 1a ).

Mean drug legalization/decriminalization ratings as a function of (a) religious or (b) political affiliation 1

1 Scales rated from 0–10, with 0 being strongly disagree and 10 being strongly agree. Unadjusted mean differences between groups were assessed with one-way ANOVA, with Tukey’s post hoc comparisons among political groups. Asterisks indicate p < 0.05 (b). Error bars indicate standard error of the mean (SEM). Asterisks indicate p < 0.05 when comparing persons who identify as republicans to those who identify as Democrats or have no political affiliation. Abbreviations: L- legalization, D- decriminalization, MMJ- medical marijuana, RMJ- recreational marijuana

3.5. Political characteristics

Political party affiliation (or the lack thereof) was also a significant factor among the demographic makeup of this population, their substance use, and opinions on drug legalization/decriminalization (making it a covariate for these analyses). The majority of persons surveyed (88.7%) were registered to vote. Fifty-one percent of participants identified with the Democratic Party, and the proportion of persons who used marijuana and identified as Democrats (60.5%) was significantly higher than those who primarily used alcohol (44.1%) or no substances (42.9%). Those who identified as Democrats were significantly more likely to use marijuana (40%) compared to non-Democrats (27.6%). Among those persons whose primary substance was alcohol, Democrats were significantly less likely to have an alcohol use disorder (12.7%) compared to non-Democrats (19.1%). Persons who identified as Republicans had significantly lower legalization/decriminalization ratings for each substance compared to those who identified as Democrats and those without any political affiliation (see Figure 1b ).

3.6. Ratings as a function of having a DSM-5 SUD vs. no SUD within primary drug categories

It is also possible that people with a more severe pattern of use (i.e., a SUD) would be more supportive of legalizing and/or decriminalizing the substance they use. However, there were no differences in ratings for legalization and decriminalization for any substance when comparing persons who use a substance but did not fulfill the DSM-5 SUD criteria, with those within that substance category who did meet the DSM-5 SUD criteria (data not shown).

3.7. Correlation of medical marijuana ratings to ratings of other substances

The use of medical marijuana is becoming more acceptable across the US, and it is possible that people who support the legalization/decriminalization of medical marijuana may also be open to supporting the legalization/decriminalization of other substances. We found a significant, though at times weak, positive correlation between how much participants agreed that medical marijuana should be decriminalized with ratings on heroin decriminalization (r=0.13, p=0.003), cocaine decriminalization (r= 0.15, p=0.001), recreational marijuana legalization (r=0.37, p=0.000) and recreational marijuana decriminalization (r=0.39, p=0.000). There was a significant, positive correlation between how participants rated medical marijuana legalization, and decriminalization of cocaine (r=0.09, p=0.038), legalization of recreational marijuana (r=0.43, p=0.000) and decriminalization of recreational marijuana (r=0.28, p=0.000).

4.0. Discussion

The current study provides new insights into opinions regarding the legalization and decriminalization of heroin, cocaine and marijuana. This study is unique in examining attitudes as a function of past year drug use, and hypothesized that persons who used substances would have differing drug legalization/decriminalization ratings for their self-reported primary substance, especially when comparing persons who primarily used marijuana to those who primarily used opioids and stimulants. Our hypothesis was supported by these findings, as persons who primarily used marijuana rated both the legalization and decriminalization of this drug favorably, but persons who primarily used opioids and simulants rated their support for both the legalization and decriminalization of heroin and cocaine relatively low, respectively. We found that overall most respondents were in favor of the legalization and decriminalization of marijuana (both medical and recreational), but not heroin and cocaine. These findings are consistent with the limited data that is currently known about opinions on marijuana legalization and decriminalization ( Lopez, 2016 ; Carliner et al., 2017 ; Geiger, 2018 ) as well as, heroin and cocaine ( Trevino and Richard, 2002 ; Geiger, 2018 ), though this is the first hypothesis-driven study of its kind since recent changes in marijuana laws have been made. Of note, while the concepts of legalization and decriminalization are fundamentally different, and were asked about separately in our survey, we found that they tended to track together (i.e. for each drug the mean ratings were either low, or below five, as in the case of heroin and cocaine, or above 5, as in the case of both recreational and medical marijuana). Thus, we will discuss the attitudes about both together.

These findings are particularly important because persons who misuse legal or illicit substances often have had interactions with the legal system, which may influence their attitudes and beliefs. Over a third of our participants had experienced legal consequences related to substance use themselves or through someone close to them. Data from the 2002–2008 NSDUH survey provides corroborating evidence of this relationship between drug use and legal consequences by showing that among those who had past year illicit drug dependence or abuse, 18% and 36% had been arrested once or more than once that year, respectively. Within the subsample of NSDUH respondents reporting past year alcohol dependence or abuse, these values increased to 38% and 52%, respectively ( Lattimore et al., 2014 ). The estimated prevalence of SUDs among incarcerated persons, while largely varied across studies, is substantial within both female (30–60%) and male (10–48%) prisoners ( Gerstein and Harwood, 1990 ; Mason et al., 1997 ; Lo and Stephens, 2000 ; Fazel et al., 2006 ). The high prevalence and comorbidity with SUDs indicates that legal issues are a significant factor in the current climate of substance use in the US.

The majority of our participants were not in favor of legalizing nor decriminalizing heroin and cocaine, even if they or someone they knew had suffered legal consequences related to substance use, or if they themselves met criteria for a SUD. These findings suggest that this population would not support policy changes related to heroin and cocaine legalization/decriminalization, which may reflect their own experiences, making them more cautious about increasing availability of these drugs. This sample was generally supportive of legalization and decriminalization of both medical and recreational marijuana. However, persons without any substance use in the last 12 months had significantly lower ratings than other groups, and were mainly neutral about marijuana legalization/decriminalization. The exception was that persons with no primary substance use had a higher rating on decriminalization of medical marijuana (mean 7.1/10) compared with their other ratings, perhaps because this was the most conservative marijuana option given. Interestingly, there was a positive relationship between agreement with decriminalizing medical marijuana, and decriminalizing heroin, cocaine, and recreational marijuana among our total population, suggesting an openness to minimizing criminal consequences associated with medical marijuana tracked with openness to the same for other drugs.

Understanding attitudes and associated characteristics towards drug legalization and decriminalization is important, especially in the currently changing social landscape, as several states in the US have passed laws legalizing and/or decriminalizing marijuana. For example, a study involving persons who voted on the initiative to legalize marijuana in Washington state reported that once marijuana stores began to open, persons who previously voted against the initiative were more likely to change their vote, if given the chance, compared to those who had voted in support of it ( Subbaraman and Kerr, 2016 ). Given the current changing environment, it is timely to determine whether persons continue to support legalization/decriminalization of marijuana and, more broadly, whether they would support legalization/decriminalization of other illicit drugs. Additionally, with other countries conducting research on heroin as a treatment for OUD ( Ayanga et al., 2016 ), it is important to consider how this may be perceived in the US and whether attitudes vary as a function of demographic and/or ideological beliefs.

There are several limitations to this work. The use of an online survey through AMT involves some selection bias, and resulted in a population which, while diverse, is not completely representative of the US population as a whole though it is demographically consistent with other studies involving AMT workers ( Chandler and Shapiro, 2016 ). Additional studies conducted within a representative sample of the US population would be helpful to determine the impact of demographic characteristics, as well as legal status of marijuana in the state of residence, on perceptions of drug decriminalization/legalization. The fact that self-reported substance use was not verified, and was from an anonymous population, is another limitation, in addition to the fact that all persons who used opioids or stimulants were grouped together, due to small numbers, instead of being able to assess those who used heroin and cocaine, specifically. We were also unable to look at how the use of multiple substances (especially those with primary use of alcohol, a legal substance, in addition to illegal substances) affected attitudes toward drug legalization/decriminalization.

This study appears to be the first to systematically study opinions of persons from across the US who use substances, and those who do not, about the legalization and decriminalization of multiple substances, and results have relevance for current and future policies. Legalization/decriminalization of marijuana was supported, but not in the case of other drugs, despite changes in apparent attitudes in other countries. As more information is learned about potential health benefits of certain substances that may drive policy changes in favor of their legalization/decriminalization, it is critical that persons who are directly affected by any policy changes (i.e. those who use substances) be included in these discussions to provide their unique perspectives. Studies among persons in SUD treatment, or those with varying SUD severity, are also warranted, as they may prove even more insightful to inform policies on legalization/decriminalization and the use of currently illicit drugs as treatment for SUDs. It is also important to monitor and track the evolution in changes in attitudes and beliefs over time. These nuances may impact public health messaging and the ability to target certain groups.

Supplementary Material

Supplemental table, conflict of interest and source of funding:.

This work was supported by internal funding from the Johns Hopkins University School of Medicine. No conflicts declared.

• American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders (DSM-5®) . Arlington, VA: American Psychiatric Pub; 2013. [ Google Scholar ]
• Ayanga D, Shorter D, Kosten TR. Update on pharmacotherapy for treatment of opioid use disorder . Expert Opin Pharmacother 2016; 17 : 2307–2318. [ PubMed ] [ Google Scholar ]
• Bartneck C, Duense A, Moltchanova E, Zawieska K. Comparing the similarity of responses received from studies in Amazon’s Mechanical Turk to studies conducted online and with direct recruitment . PloS one 2015; 10 : e0121595. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Carliner H, Brown QL, Sarvet AL, Hasin DS. Cannabis use, attitudes, and legal status in the US: A review . Prev Med 2017; 104 :13–23. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Center for Behavioral Health Statistics and Quality. Results from the 2016 National Survey on Drug Use and Health: Detailed tables ; 2017. Retrieved from https://www​.samhsa.gov/data/ . Accessed May 22, 2018.
• Chandler J, Shapiro D. Conducting clinical research using crowdsourced convenience samples . Annual Review of Clinical Psychology 2016; 12 :53–81. [ PubMed ] [ Google Scholar ]
• Cox C The Canadian Cannabis Act legalizes and regulates recreational cannabis use in 2018 . Health Policy 2018; 122 :205–209. [ PubMed ] [ Google Scholar ]
• De Winter JC, Dodou D. Five-point Likert items: t test versus Mann-Whitney-Wilcoxon . Practical Assessment, Research & Evaluation 2010; 15 :1–12. [ Google Scholar ]
• Fazel S, Bains P, Doll H. Substance abuse and dependence in prisoners: a systematic review . Addiction 2006; 101 :181–191. [ PubMed ] [ Google Scholar ]
• Geiger A About six-in-ten Americans support marijuana legalization . 2018. Retrieved from http://www.pewresearch.org/fact-tank/2018/01/05/americans-support-marijuana-legalization/ . Accessed May 22, 2018.
• Gerstein DR, Harwood HJ. Treating drug problems: A study of the evolution, effectiveness, and financing of public and private drug treatment systems (Vol. 1) . Washington, DC: Institute of Medicine, 1990. [ PubMed ] [ Google Scholar ]
• Goncalves R, Lourenco A, Silva SN. A social cost perspective in the wake of the Portuguese strategy for the fight against drugs . Int J Drug Policy 2015; 26 :199–209. [ PubMed ] [ Google Scholar ]
• Hall W The future of the international drug control system and national drug prohibitions . Addiction 2017; 113 ( 7 ):1210–1223. [ PubMed ] [ Google Scholar ]
• Lattimore PK, Steffey DM, Gfroerer J, et al. Arrestee substance use: comparison of estimates from the national survey on drug use and health and the arrestee drug abuse monitoring program . Rockville (MD): Substance Abuse and Mental Health Services Administration; 2014. [ PubMed ] [ Google Scholar ]
• Lo CC, Stephens RC. Drugs and prisoners: Treatment needs on entering prison . The American journal of drug and alcohol abuse 2000; 26 : 229–245. [ PubMed ] [ Google Scholar ]
• Lopez G Poll: The only drug Americans want to legalize is marijuana . 2016. Retrieved from https://www.vox.com/2016/3/15/11224500/marijuana-legalization-war-on-drugs-pol . Accessed May 22, 2018.
• Lubke GH, Muthén BO. Applying multigroup confirmatory factor models for continuous outcomes to Likert scale data complicates meaningful group comparisons . Structural equation modeling 2004; 11 :514–534. [ Google Scholar ]
• Mason D, Birmingham L, Grubin D. Substance use in remand prisoners: a consecutive case study . BMJ 1997; 315 :18–21. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Paolacci G, Chandler J, Ipeirotis PG. Running experiments on Amazon Mechanical Turk . Judgment and Decision Making 2010; 5 ( 5 ):411–419. [ Google Scholar ]
• Peer E, Vosgerau J, Acquisti A. Reputation as a sufficient condition for data quality on Amazon Mechanical Turk . Behavior research methods 2014; 46 :1023–1031. [ PubMed ] [ Google Scholar ]
• Room R Legalizing a market for cannabis for pleasure: Colorado, Washington, Uruguay and beyond . Addiction 2014; 109 ;345–351. [ PubMed ] [ Google Scholar ]
• Subbaraman MS, Kerr WC. Marijuana policy opinions in Washington state since legalization: would voters vote the same way? Contemporary drug problems 2016; 43 :369–380. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Trevino RA, Richard AJ. Attitudes towards drug legalization among drug users . Am J Drug Alcohol Abuse 2002; 28 :91–108. [ PubMed ] [ Google Scholar ]
• Whiteford HA, Degenhardt L, Rehm J, et al. Global burden of disease attributable to mental and substance use disorders: findings from the Global Burden of Disease Study 2010 . The Lancet 2013; 382 :1575–1586. [ PubMed ] [ Google Scholar ]

Decriminalisation or legalisation: injecting evidence in the drug law reform debate

Professor & Specialist in Drug Policy, UNSW Sydney

Disclosure statement

Alison Ritter receives funding from the NHMRC, the ARC and The Colonial Foundation Trust. She was a participant in the Australia 21 Roundtable held in January, 2012.

UNSW Sydney provides funding as a member of The Conversation AU.

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We should all be concerned about our laws on illegal drugs because they affect all of us – people who use drugs; who have family members using drugs; health professionals seeing people for drug-related problems; ambulance and police officers in the front line of drug harms; and all of us who pay high insurance premiums because drug-related crime is extensive.

Drug-related offences also take up the lion’s share of the work of police, courts and prisons. But what can we do? Some people feel that we should legalise drugs – treat them like alcohol and tobacco, as regulated products. And legalisation doesn’t necessarily need to apply for every illegal drug.

Why legalise?

One of the arguments for legalisation is that it would eliminate (or at least significantly reduce) the illegal black market and criminal networks associated with the drug trade. Other arguments include moving the problem away from police and the criminal justice system and concentrating responses within health.

Governments could accrue taxation revenue from illegal drugs as they currently do from gambling, alcohol and tobacco. A regulated government monopoly could secure direct income; our research suggests this may be as high as $600 million a year for a regulated cannabis market in New South Wales.

The strongest argument against legalisation is that it would result in significant increases in drug use. We know that currently legal drugs, such as alcohol and tobacco, are widely consumed and associated with an extensive economic burden to society – including hospital admissions, alcoholism treatment programs and public nuisance. So why create an environment where this may also come to pass for currently illegal drugs?

The moral argument against legalisation suggests the use of illegal drugs is amoral, anti-social and otherwise not acceptable in today’s society. The concern is that legalisation would “send the wrong message”.

Unfortunately, there’s no direct research evidence on legalisation because no country has legalised drugs yet. But suppositions can be made about the extent of cost-savings to society.

Indeed, some of our research on a regulated legal cannabis market suggests that there may not be the significant savings under a legalisation regime that some commentators have argued. But these are hypothetical exercises.

• Decriminalisation

An alternative to legalisation is decriminalisation. Experts don’t agree on the terminology and there’s much confusion. But, in essence, decriminalisation refers to a reduction of legal penalties. This can be done either by changing them to civil penalties, such as fines, or by diverting drug use offenders away from a criminal conviction and into education or treatment options (also known as “diversion”).

Decriminalisation largely applies to drug use and possession offences, not to the sale or supply of drugs. Arguments in favour of decriminalisation include its focus on drug users rather than drug suppliers. The idea is to provide users with a more humane and sensible response to their drug use.

Decriminalisation has the potential to reduce the burden on police and the criminal justice system. It also removes the negative consequences (including stigma) associated with criminal convictions for drug use.

One argument against decriminalisation is that it doesn’t address the black market and criminal networks of drug selling. There are also concerns that it may lead to increased drug use but this assumes that current criminal penalties operate as a deterrent for some people.

The moral arguments noted above also apply to decriminalisation – lesser penalties may suggest that society approves of drug use.

Many countries, including Australia, have decriminalised cannabis use: measures include providing diversion programs (all Australian states and territories), and moving from criminal penalties to civil penalties (such as fines in South Australia, Australian Capital Territory and the Northern Territory).

Our team’s research on Portugal suggests that drug use rates don’t rise under decriminalisation, and there are measurable savings to the criminal justice system.

In Australia also, there hasn’t been a rise in cannabis use rates despite states and territories introducing civil penalties for users. And research on diverting drug use offenders away from a criminal conviction and into treatment has shown that these individuals are just as likely to succeed in treatment as those who attend voluntarily.

At the same time, research has also noted a negative side effect to the way in which decriminalisation currently operates in Australia – “net widening” - whereby more people are swept up into the criminal justice system than would have occurred otherwise under full prohibition because discretion by police is less likely and/or they do not fulfil their obligations.

Despite the largely supportive evidence base, politicians appear reluctant to proceed along the decriminalisation path. Some commentators have speculated that this is because of public opinion – decriminalisation is regarded as an unpopular policy choice .

But public opinion is largely in support of decriminalisation, where it concerns cannabis (though not decriminalisation for other illegal drugs). In the last national survey , more than 80% of Australians supported decriminalisation options for cannabis. The other reason for equivocal policy support, I believe, is a lack of clarity about the issues.

There’s poor understanding about the different models of decriminalisation and some basic confusion exists. Many people equate decriminalisation with legalisation, but as detailed above, they are very different in policy, intent and action.

Decriminalisation is also sometimes incorrectly confused with harm reduction services, such as injecting centres or prescribed heroin programs.

The Australia21 Report released last week to stimulate informed public debate is an important step foward. In order for the debate to progress, we need clarity of terms, and dispassionate presentation of what evidence we have. Every policy has both risks and benefits and we need to talk about these.

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• Drug reform
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number 60 • Summer 2024

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This is Your Constitution on Drugs

Ilya shapiro, summer 2020.

Can something be legal and illegal at the same time? That may sound impossible, but it has increasingly become reality for cannabis in the United States. As more and more states legalize marijuana while Congress stands pat and the executive branch works out enforcement complexities, people across the country are asking themselves: What is this magical Schrödinger's weed?

The answer lies not in the nature of marijuana itself, but in America's system of dual sovereignty, which divides powers between the federal and state governments. When two overlapping sovereigns have policymaking authority, their laws and enforcement policies are bound to clash at times. Indeed, marijuana regulation is not the only policy area where state and federal laws have come into conflict, either historically or in recent years. States today are increasingly reasserting sovereignty in areas as diverse as health care, gun control, and immigration. Given the near inevitability of separate sovereigns' adopting contradictory laws, the real question is not whether conflicts will occur, but which law takes precedent when they do.

The Constitution's Supremacy Clause, which states that federal law trumps any state law to the contrary, appears to resolve the matter in favor of the federal government. Yet the answer is not so simple. The Supreme Court recognizes two limits on federal supremacy. First, the federal policy in question must have a valid constitutional basis, because the national government's powers are enumerated and thus limited. And second, even in areas where Congress can properly enact law, the Tenth Amendment prevents the federal government from using the states as instruments of governance.

The Supreme Court reiterated this latter limit — known as the "anti-commandeering" principle — as recently as the 2018 case of Murphy v. NCAA , a challenge to New Jersey's legalization of sports betting in the face of federal law that purported to stop states from taking such legislative action. Put simply, the doctrine asserts that Congress cannot compel the states to carry out federal law. In the marijuana context, a federal ban can only be implemented, practically speaking, through the greater law-enforcement resources of the states, as the federal government is responsible for just 1% of the 800,000 annual marijuana arrests. Meanwhile, an appropriations rider prevents the Justice Department from using federal funds to prosecute those who use medical marijuana in the 33 states (and the District of Columbia) where this activity is lawful. In any case, even in the shadow of the federal ban, state-level marijuana legalization has flourished, indicating that federal supremacy has its limits.

As for Congress's authority to prohibit the cultivation and use of marijuana in the first place — the first limit on federal supremacy noted above — the culprit is the Commerce Clause. More specifically, the authority derives from the Supreme Court's expansive interpretation of Congress's Article I, Section 8 power to regulate commerce "among the several States." This interpretation stems from the 1942 case Wickard v. Filburn , in which the Court ruled that Congress could regulate the wheat a farmer grew for noncommercial purposes because, in the aggregate, growing wheat affects interstate commerce.

Despite this flimsy rationale for allowing Congress's lawmaking reach to extend beyond trade among the states, the decision remains good law. Moving from wheat to weed, the Court declined the opportunity to push back on Wickard 63 years later, instead holding in Gonzales v. Raich that prohibiting the private cultivation and use of marijuana was still within the scope of the Commerce Clause; these, too, are economic activities that, in the aggregate, affect interstate commerce. It further held that banning the growth of marijuana for medical use — permitted in California, where the case originated — was a permissible way for the federal government to prevent access to marijuana for other uses.

The vote in Raich was 6-3. Justice John Paul Stevens wrote for the majority, with the other three liberal justices and Justice Anthony Kennedy joining his opinion. Meanwhile, Justice Antonin Scalia wrote a concurring opinion asserting that Congress can regulate noneconomic intrastate activities where failing to do so would undermine a broader regulation of interstate commerce. He grounded his concurrence in the Necessary and Proper Clause, which gives Congress the power "[t]o make all Laws which shall be necessary and proper for carrying into Execution" its enumerated powers.

Since Scalia had voted with the pro-federalism majorities that held unconstitutional Congress's creation of gun-free school zones ( United States v. Lopez in 1995) and a cause of action for victims of gender-motivated violence ( United States v. Morrison in 2000), Raich became known as the late justice's "drug-war exception" to the Constitution. To paraphrase Justice Clarence Thomas's Raich dissent, growing pot in one's own backyard for private use is emphatically not a form of interstate commerce. What's more, Thomas observed, "if the Federal Government can regulate growing a half-dozen cannabis plants for personal consumption (not because it is interstate commerce but because it is inextricably bound up with interstate commerce), then Congress' Article I powers — as expanded by the Necessary and Proper Clause — have no meaningful limits."

Ironically, the excessive regulation of commerce was one of the complaints the colonists laid at the feet of George III in the Declaration of Independence. Even if the founders had contemplated an expansive Commerce Clause that allowed for a federal police force and prison system to prosecute and punish local, often noncommercial, behavior, is it possible they understood the clause to allow for nearly half of federal prisoners to be imprisoned on drug charges? After all, when drawing up the list of crimes that had to be dealt with nationally, the framers chose just four: treason, piracy, counterfeiting, and crimes against the law of nations.

But this essay isn't just about marijuana federalism or the growth of federal power since the New Deal. Those are just gateways to a broader discussion of how drug policy — including at the state level, where most of the action is — has perverted constitutional understandings, undermining the idea that the federal government is one of limited powers, but also weakening our rights and freedoms more broadly. We are in the midst of a war on drugs that is at war with the Constitution. Indeed, the drug war has altered our constitutional consciousness.

THE PHILOSOPHICAL ROOTS OF THE WAR ON DRUGS

Our analysis starts at the Constitution's preamble. This introductory statement declares:

We the People of the United States, in Order to form a more perfect Union, establish Justice, insure domestic Tranquility, provide for the common defence, promote the general Welfare, and secure the Blessings of Liberty to ourselves and our Posterity, do ordain and establish this Constitution for the United States of America.

While rhetorically powerful, the preamble has no direct legal effect; as Joseph Story wrote in his Commentaries on the Constitution of the United States , the "true office" of the preamble is "to expound the nature and extent and application of the powers actually conferred by the Constitution, and not substantively to create them." Similarly, the General Welfare Clause — which echoes the preamble's reference to the "general Welfare" in opening the enumeration of legislative powers in Article I, Section 8 — does not grant Congress a general power to pass whatever laws it wants. Indeed, the idea that the clause justifies any legislation that gains a congressional majority — as opposed to limiting federal reach to truly national issues — emerged during the progressive era. After 1937's so-called "switch in time that saved nine," no legislation would be invalidated on federalism grounds until Lopez in 1995.

Yet promoting the general welfare is ostensibly the underlying justification for federal drug regulation. Consider the Controlled Substances Act (CSA), the statute that first established federal drug policy in 1971. The CSA reads, "The illegal importation, manufacture, distribution, and possession and improper use of controlled substances have a substantial and detrimental effect on the health and general welfare of the American people." According to this statement, federal lawmakers clearly thought (and still think) they have the power to decide which assortments of chemicals Americans can and cannot put into their bodies, based on whether consuming such chemicals is good or bad for the nation's general welfare.

President Richard Nixon agreed. When he signed the CSA, he said he wanted to help "save the lives of hundreds of thousands of our young people who otherwise would become hooked on drugs and be physically, mentally and morally destroyed." That may be a noble cause — especially for those who believe drug use is not only unhealthy but immoral — yet neither the president nor Congress is empowered to act as an arbiter or enforcer of morality in this way. As Justice Kennedy announced in one of the few clear-cut rules he articulated — with respect to both the LGBT community ( Lawrence v. Texas in 2003) and religious believers ( Masterpiece Cakeshop v. Colorado Civil Rights Commission in 2018) — moral disapproval is not a sufficient basis for government action.

It appears that the General Welfare Clause serves as the philosophical justification for federal drug legislation, but it does not suffice as a legal justification. To find the latter, one must look to Congress's powers as enumerated in Article I of the Constitution.

CONGRESS'S ENUMERATED POWERS

We begin our analysis of the Constitution's enforceable provisions in the drug-war context with Article I, Section 8. This section contains a list of Congress's enumerated powers, those powers that the Constitution expressly delegates to the federal legislature. The war on drugs has touched on, and at times twisted beyond recognition, our understanding of several of these provisions.

As discussed above, Congress has the express constitutional authority "[t]o regulate Commerce...among the several States." Setting aside Wickard and its progeny — through which Congress has extended its presence far beyond any limit set by this clause — the fledgling marijuana industry has also brought to light the harm caused by Congress's absence in the interstate-commerce realm. Interestingly, the Commerce Clause does not just authorize Congress to regulate interstate commerce; it has also been read to ensure the free flow of goods and services across state lines. This "dormant" Commerce Clause prohibits states from discriminating against out-of-state commercial interests or otherwise attempting to regulate conduct beyond their borders. Yet the federal ban on transporting marijuana across state lines means that businesses in the industry must vertically integrate all commerce within balkanized state marketplaces where marijuana is legal, leading to inefficiencies and by-design state protectionism. In other words, states that have legalized marijuana must show preference to in-state growers and sellers by default. When Congress gets around to modernizing federal cannabis law, it will need to ensure that, for residents of those states that legalize marijuana, trade among them is free, fair, and regular.

Also as mentioned above, the Constitution lists four federal crimes — counterfeiting, treason, piracy, and violations of the law of nations. The original federal code expanded that list to approximately 30 crimes, focusing solely on those offenses worthy of national attention. By the early 1980s — just after the drug war was declared — the number of federal criminal offenses stood at around 3,000. Today, researchers estimate that 5,000 federal statutes include criminal penalties. This number doesn't even include the penalties contained in an estimated 300,000 federal regulations. While the number of federal crimes had certainly risen between 1789 and 1980, the drug war has triggered nothing short of an explosion in these numbers.

Article I, Section 8 also contains a Postal Clause, which delegates to Congress the power "[t]o establish Post Offices." The skyrocketing number of mail- and wire-fraud crimes in the federal criminal code — the intersection of the Postal and Commerce Clauses — can in significant part be traced to the war on drugs. And that war has also affected the privacy of our mail. In the 1878 case Ex parte Jackson , the Supreme Court held that "[n]o law of Congress can place in the hands of officials connected with the postal service any authority to invade the secrecy of letters and such sealed packages in the mail." Yet with the Anti-Drug Abuse Act of 1988, Congress granted the U.S. Postal Service the authority to inspect any packages it thinks might contain drugs using dogs, scanning technology, and inferences akin to what the police use in establishing probable cause.

The next clause grants Congress the power to secure "for limited Times to Authors and Inventors the exclusive Right to their respective Writings and Discoveries." In other words, Congress can protect inventors' intellectual property by granting them patents, which gives them incentive to pursue new and potentially beneficial research. But because certain drugs are illegal at the federal level, most narcotics-related inventions cannot benefit from patent protection. Instead, the development of pharmaceuticals using illicit narcotics is contingent on executive-branch decisions regarding which drugs to prohibit and which research projects to allow. This gives the president, not Congress, authority over intellectual property.

Meanwhile, Article I, Section 8 could not be more clear in vesting Congress, not the executive, with the power to declare war. But it was President Nixon who first declared war on drugs. The phrase itself was initially just a rhetorical label, but it has since come to involve the extensive use of military force both within the United States and abroad. A prime example is Operation Just Cause — the 1989 invasion of Panama — where combating drug trafficking was one of President George Bush's stated goals. During the operation, nearly 26,000 American servicemen invaded Panama without any congressional declaration of war.

Then there's the Posse Comitatus Act, which deals with the government enlistment of civilians in law-enforcement tasks. The Act generally prevents the use of armed forces for domestic law enforcement but carves out an exception for military support of civilian agencies engaged in "drug interdiction and counter-drug activities." President Donald Trump invoked an exception to the Act in his 2019 emergency declaration regarding the southern border, which re-apportioned Defense Department funds to the construction of a wall between the United States and Mexico. The president justified his decision in part by pointing to the southern border as a "major entry point for...illicit narcotics."

The power "[t]o exercise exclusive Legislation" over the District of Columbia belongs to Congress as well, though in 1973, Congress granted the district home rule. D.C. is now largely governed by a mayor and city council, but Congress retains authority over the district's budget and can block any laws the council passes. This unique arrangement has had unusual consequences for marijuana policy. In 2014, D.C. residents passed Initiative 71, which legalized marijuana for recreational use. Congress then stepped in to prevent the district from regulating or taxing the drug. The result puts marijuana in a sort of legal limbo: Although people can legally possess and use marijuana in the nation's capital, it remains illegal to purchase it there.

In addition to exceeding the powers enumerated in Article I, Section 8, federal drug laws also allow the executive branch to bypass the legislative process, violating the separation of powers. For instance, the attorney general — in reality, bureaucrats at the Justice Department, the Food and Drug Administration, and the Drug Enforcement Administration — can add substances to the CSA schedules, in effect establishing new criminal offenses, without legislative or judicial review. Substances can also be de-scheduled or reclassified, thereby abolishing offenses or changing associated penalties and collateral consequences without congressional input.

In sum, there's no dispute that Congress has the constitutional authority to tax drugs, to borrow money to fund anti-drug programs, to regulate or restrict the interstate and international drug trade, and to otherwise exercise its Article I, Section 8 powers — in addition to passing all laws "necessary and proper" for carrying out these listed powers. But the source of its authority to prohibit the production, possession, sale, or use of drugs — at least within the states — remains questionable at best. The drug war has distorted our understanding of much of the Constitution, and that's even before we consider the Bill of Rights.

THE BILL OF RIGHTS

Although originally an afterthought, the Bill of Rights — comprising the first ten amendments to the Constitution — has come to represent America's enduring commitment to liberty. Yet here again, the war on drugs has chipped away at some of Americans' most cherished freedoms.

The First Amendment begins with the religion clauses, which bar Congress from interfering with the free exercise of religion and establishing a national religion. (Both clauses, like almost all Bill of Rights provisions, have also been applied to the states through the 14th Amendment.) Regarding the former, ongoing controversies over Obamacare's contraceptive mandate have thrust into prominence an unusual case called Employment Division v. Smith (1990). In that case, Native American employees of a drug-rehabilitation clinic were fired and rendered ineligible for unemployment insurance after they ingested peyote for religious purposes. The Supreme Court upheld that result, holding that neutral laws of general applicability — like Oregon's zero-tolerance drug policy — do not violate the right of religious exercise. Many, however, characterize the decision as undermining the Free Exercise Clause, even if it was written by Justice Scalia.

In response to public backlash against Smith , the House unanimously, and the Senate by a vote of 97-3, passed the Religious Freedom Restoration Act (RFRA), to ensure that courts would apply the highest level of scrutiny to laws that interfere with Americans' free exercise of religion. After the Supreme Court invalidated RFRA's application to the states in City of Boerne v. Flores (1997), 21 states adopted their own versions of the law, and state courts have added RFRA-like provisions in 10 others. As scholarly and public debate over Smith continues, the case itself would not have come about if Oregon hadn't adopted a zero-tolerance drug policy; even Prohibition-era laws allowed the production, sale, and use of sacramental wine.

There could also be an Establishment Clause problem with the drug war, because many diversion programs — which allow people to avoid being jailed for low-level drug crimes — require completing a 12-step program akin to Alcoholics Anonymous. It turns out that most of these programs require people to turn themselves over to God, ask God to cure them of moral defects, and otherwise share in a spiritual awakening. Several federal appeals courts have declared such coerced participation in religious activity by prisoners, parolees, and probationers unconstitutional.

In addition to protecting religious expression, the First Amendment also prohibits laws that interfere with the freedom of speech. Yet government actors appear all-too-ready to ignore this clause in situations involving drugs. In 2004, for instance, the American Civil Liberties Union and several drug-policy groups sued the U.S. Department of Transportation when the Washington Metropolitan Area Transit Authority (WMATA) refused to place an ad saying that "marijuana laws waste billions of taxpayer dollars to lock up non-violent Americans." Following the government's loss at trial, then-solicitor general and perennial appellate superstar Paul Clement refused to defend WMATA or congressional efforts to block similar ads nationwide, saying that he lacked a viable argument.

Public school students are also afforded expressive rights under the First Amendment; as Justice Abe Fortas declared in Tinker v. Des Moines Independent Community School District (1969), students do not "shed their constitutional rights to freedom of speech or expression at the schoolhouse gate." Unless, of course, it involves speech that alludes to illicit drugs. In Morse v. Frederick (2007), the Supreme Court upheld the suspension of a high-school student who displayed a banner reading "Bong Hits 4 Jesus" across the street from his school during the 2002 Olympic torch relay. Nobody really knows what the banner meant (if anything), but it could be interpreted as promoting drug use. A majority of the Court held that suppressing this kind of speech was a necessary part of the school's mission. In doing so, as Justice Stevens pointed out in dissent, the majority abandoned the general rule that speech advocating dangerous or unlawful activity could only be punished if it is likely to "incite imminent lawless action."

The First Amendment also preserves the right to assemble peacefully, yet many local ordinances targeting drug-gang activity throw the status of this right into question. A particularly egregious example occurred in the 1997 case of People ex rel. Gallo v. Acuna , where the California Supreme Court held that an injunction prohibiting suspected gang members from "[s]tanding, sitting, walking, driving, gathering or appearing anywhere in public view" with other suspected gang members did not violate the freedom of association.

The final clause of the First Amendment protects Americans' right "to petition the Government for a redress of grievances." Somehow, this message did not reach Washington state. In the run-up to a marijuana ballot measure that voters eventually approved, state police harassed and arrested activists collecting signatures to support legalization. Likewise, in Nevada, once it became clear that proponents of a similar measure would gather the requisite 10% of the population's signatures for approval, the government changed the rules and called for an additional 30,000 signatures. Fortunately, a judge set aside the new requirement, but the fact this case came about shows how far some officials will go to fight the drug war.

The Second Amendment prohibits the government from infringing the people's right to bear arms. But considering the fact that anyone convicted in any court of any offense where the potential — not actual — sentence is more than a year in prison cannot use a firearm, large swathes of Americans are forbidden from exercising this right. Moreover, anyone who is an unlawful user of, or is addicted to, any controlled substance cannot possess firearms or ammunition. This issue has come to the forefront recently in Hawaii, as the state both requires the registration of all firearms and allows the use of marijuana for medicinal purposes. Aside from the Second Amendment concerns such measures raise, the ban on firearms possession for those who use drugs reaches staggering levels of hypocrisy considering that Bill Clinton, Barack Obama, and George W. Bush have admitted to using illicit substances. But because they were never convicted, they were allowed to control the most powerful military in history — including its nuclear arsenal.

The war on drugs' biggest constitutional impact is undeniably in the area of criminal procedure, which implicates the Fourth Amendment. This amendment preserves the public's right against unreasonable searches and seizures. In Criminal Procedure  — a leading law-school casebook by Joseph Cook, Paul Marcus, and Melanie Wilson — 12 of 18 cases on probable cause, and 20 of 27 on warrantless searches and seizures, involve drugs. In most of these cases, the Court has whittled away or otherwise made exceptions to the Fourth Amendment.

Take the various exceptions to the amendment's warrant requirement for searches, many of which the Supreme Court either created or greatly expanded in cases arising from drug crimes. Typically, the Fourth Amendment guarantees protection from warrantless searches in places where people have a reasonable expectation of privacy. According to the amendment's text, these areas include one's person and one's home. Yet in United States v. Robinson (1973), the Court held it reasonable for police to search a person in custody not just for weapons that might pose a threat to the police, but for any contraband, even without reasonable suspicion that the person is carrying drugs. Ten years earlier, in Ker v. California , the Court established the imminent-destruction-of-evidence exception to the warrant requirement, which allows police to break into suspects' homes without knocking to prevent the destruction of narcotics or other contraband. And in 1984, the Court held in Oliver v. United States that landowners have no reasonable expectation of privacy in their land even if it is hidden from public view by a fence or other obstruction. In that case, police were acting on a tip that the landowner was growing marijuana on his property.

The Supreme Court has also read the Fourth Amendment to extend to one's automobile. Yet United States v. Ross (1982) all but did away with the amendment's warrant requirement in many circumstances involving vehicles by holding that if police have probable cause to believe that a car contains drugs, they can search it without a warrant. And in 1976, South Dakota v. Opperman authorized inventory searches of towed and impounded vehicles even without probable cause.

In terms of seizures of persons, otherwise known as "detentions," the Fourth Amendment forbids such action without probable cause — at least according to the text. Yet in United States v. Sokolow , the Supreme Court upheld the Drug Enforcement Administration's use of a "drug courier profile" to detain people at airports. Courier profiles — which vary based on the professional experiences of a given group of law enforcement officers — comprise a list of behavioral traits that tend to distinguish travelers carrying illicit drugs. Such traits include appearing nervous, making a phone call shortly after arriving, having little or no luggage, having a significant amount of luggage, using public transit, and paying cash for a ticket (the case was decided in 1989). In certain police departments, the list also includes activities like departing the plane first, last, or somewhere in between. The profile varies among agencies and transit hubs without any sort of consistency.

Warrantless seizures and searches can also take place in schools. A particularly egregious example occurred in Safford Unified School District v. Redding (2009), when the Supreme Court ruled that two school staff members who forced a 13-year-old girl to remove her clothes and shake out her underwear because they thought she was hiding contraband — ibuprofen (Advil) — could not be held liable for their actions. The Court found that the search was unreasonable but not obviously unconstitutional, meaning that the school employees were protected by the doctrine of qualified immunity. That is, the Court felt it was not clear that strip-searching a young girl to look for headache pills violated her rights. Why? Because until this case, several lower courts had upheld these types of searches based on schools' zero-tolerance drug policies.

The Fifth Amendment also preserves people's rights in the criminal-procedure context. Among the most crucial of these is the right to due process, which affords protection from government deprivations of one's life, liberty, and property without due process of law. At minimum, due process requires notice of the charges and an opportunity to be heard before a neutral judge. The practice of civil asset forfeiture, which often coincides with suspected drug activity, calls into question the government's commitment to upholding due process.

Civil forfeiture laws allow police to seize people's property without a hearing or even notice, much less a finding of guilt. In theory, the practice is authorized based on the property's suspected connection with criminal activity. Yet asset-forfeiture statutes frequently fail to distinguish between illicit proceeds from criminal activity and property that belongs to criminals or their family members but has no connection to any crime. (Incidentally, this implicates not only due process, but the Fifth Amendment's Takings Clause, which protects against government seizure of property without just compensation.) The burden of proving the forfeiture illegitimate is placed on either the owner or, oddly enough, the inanimate object itself. What's more, police are allowed to keep most of the proceeds acquired from the sale of seized property, creating a perverse incentive for officers to initiate forfeiture proceedings. Suffice it to say, most of the property forfeited under such laws is acquired pursuant to a narcotics investigation.

The courts have yet to outline a standard for the right to trial "without unnecessary delay" under the Sixth Amendment, but wait times for trial frequently exceed any reasonable interpretation of that phrase. In New York City, the average wait time for all criminal jury trials in 2011 was 414 days, up from 274 just 10 years earlier. The average wait time for a murder trial in 2011 was over 750 days. These numbers have only grown. And though not all crimes are drug-related, non-violent drug offenses are responsible for a substantial portion of all arrests. If these cases were eliminated, the entire system would move more quickly.

The massive number of people arrested and charged with drug offenses affects not only how long defendants have to wait for trial, but also the quality of their legal representation, which implicates the Sixth Amendment's right to assistance of counsel. The Bureau of Justice Statistics (BJS) estimates that more than three-quarters of indigent prisoners across the country are represented by a public defender. Thanks in large part to the drug war, public defenders' caseloads have increased dramatically since the 1970s, now far exceeding the maximum caseloads that the National Advisory Commission on Criminal Justice Standards and Goals recommended in 1973. What's more, public defenders are at a severe disadvantage when it comes to financial resources: A 2007 study of indigent defendants in Tennessee found that public defenders in these cases had less than half the funding of prosecutors (and this doesn't account for the free resources that the prosecutors can access, like crime labs and the police themselves). Citing BJS statistics, a 2011 meta-study found that spending in constant dollars per indigent defendant began to decrease rapidly in the early 1980s, which is right when the drug war kicked into high gear and the number of indigent defendants started to skyrocket. The decline in time and resources devoted to the defense of indigent defendants — many of whom are arrested on drug-related charges — is yet another undesirable consequence of the drug war that undermines Americans' constitutional rights.

The war on drugs has implications not only for the criminal-procedure protections of the Fourth, Fifth, and Sixth Amendments, but for the Eighth Amendment as well. The latter prohibits "excessive fines" and "cruel and unusual punishment," both of which have been interpreted to demand proportionality between sentence and offense. The Supreme Court applied the Excessive Fines Clause against the states just last year in Timbs v. Indiana . The plaintiff in that case, Tyson Timbs, had sold $400 worth of heroin to undercover police. He pleaded guilty and was sentenced to home-detention and probation. The state also ordered him to forfeit his $42,000 Land Rover, which he had acquired with funds from an inheritance, not proceeds from a crime. The vehicle was worth more than four times the maximum fine for his charge. An Indiana trial court found the forfeiture amount "excessive" and "grossly disproportional to the gravity of the Defendant's offense." Meanwhile, in South Carolina last year, a judge ruled that that state's civil forfeiture laws ran afoul of the Excessive Fines Clause.

Further on the subject of disproportionate punishment, in 2010, the average mandatory minimum for drug offenders was 132 months. That 11-year average sentence is equivalent to the sentence for a Class C felony, which covers voluntary manslaughter, bank robbery, and selling a person into slavery. The U.S. Sentencing Commission likes to brag that, with relief, the average sentence for drug offenders is reduced to 61 months, but this is not something to be proud of, either. Other offenses that carry a maximum sentence of less than 61 months include domestic assault, assault of a child with substantial bodily injury, female genital mutilation, and incitement of genocide.

Jurisdictions with habitual-offender laws — where the sentences imposed have no relationship to the severity of the crime — can inflict punishments for drug offenses that are outrageously disproportionate to the wrong committed. California is probably the worst offender: Under its three-strikes law, certain non-violent felony drug offenses can count as a third strike if the first two offenses were considered violent or serious. Committing three strikes can earn a defendant 25 years to life in prison. Non-violent possession offenses represent the archetypal victimless crime, so the harm caused to society is an abstraction at best. Yet even if the law should prevent people from harming themselves, one still has to ask which option is worse for a person's health and life prospects: smoking marijuana, or spending serious time in prison.

These excessive sentence lengths for drug-related offenses, coupled with the ramping up of drug-war enforcement efforts, are at least partially responsible for the grim conditions in many of our nation's prisons. Again, California provides a useful example. The state's prisons were built to hold 80,000 inmates; a decade ago, they held double that number. Because of this overcrowding, California was unable to provide inmates with adequate and timely medical care, and resorted to throwing the ill into "administrative segregation." One guard testified that up to 50 prisoners at a time would be held in a 12-by-20 foot cage for up to five hours while awaiting medical care, which works out to 4.8 square feet per person. By way of comparison, during the transatlantic slave trade, experts estimate that each slave had about six square feet. In Brown v. Plata (2011), the Supreme Court held that the unsanitary conditions created by overcrowding in California's prisons constituted cruel and unusual punishment in violation of the Eighth Amendment.

THE POST-CIVIL WAR AMENDMENTS

Between 1791 — when the Bill of Rights was ratified — and 1864, the Constitution was amended only twice. Then between 1865 and 1870, the 13th, 14th, and 15th Amendments were adopted in the wake of the Civil War. Collectively, these amendments abolished slavery, guaranteed constitutional rights against state action, and extended the right to vote to all citizens without regard to color or previous status as a slave. Yet despite these efforts to extend the blessings of liberty to all Americans, campaigns to prohibit or end drug use have had decidedly racial overtones.

For instance, the 14th Amendment promises equal protection of the laws, but in 1875, San Francisco passed an ordinance banning opium dens — probably the first narcotics prohibition in America — out of concern that Chinese proprietors were using them to lure white women. Early marijuana regulations targeted supposed Mexican lawlessness. And alcohol-prohibition campaigns, culminating in the 18th Amendment in 1919, were partly motivated by animus toward German Americans.

Even discounting racial motives, the enforcement of modern drug laws yields disproportionate results among different races. While marijuana-usage levels are relatively constant across racial groups, African Americans are nearly four times more likely to be arrested for possession than whites — a disparity that has only increased in the last 20 years. Stop-and-frisks — also known as Terry stops, where police pat down a suspect for weapons — have a racial dimension, too. Of the 685,000 people stopped by the New York Police Department in 2011 alone, 87% were black or Latino, even though the white individuals stopped were twice as likely to be found with a weapon. (Of the total number stopped, about 88% were innocent of any crime.)

While the 15th Amendment expanded the franchise to all male citizens regardless of color in 1870, tens of thousands of African Americans continue to be disenfranchised today due to the war on drugs. This is because they make up 40% of the nation's prisoners serving time for drug-related offenses, and many states restrict the voting rights of those with criminal records. Currently, 16 states and the District of Columbia restrict voting rights only during incarceration, and nearly half the states add restrictions during probation and parole. In some states, the restoration of voting rights post-confinement or supervision depends on certain conditions or individual petitions. And in three states — Iowa, Kentucky, and Virginia — a felony conviction means permanent disenfranchisement (although governors in Kentucky and Virginia have sought to relax or otherwise sidestep these bans in recent years). There are valid reasons for prohibiting felons from voting until and unless they've paid their debt to society — Maine and Vermont are real outliers in allowing them to vote from prison  — but it is hardly reasonable to deny these kinds of rights to non-violent drug offenders.

THE RULE OF LAW

The war on drugs has been fought largely with laws that were beyond Congress's powers to enact. Although it took a constitutional amendment to allow Congress to prohibit alcohol nationwide, the prohibition of now-illicit substances under the CSA took place without any such amendment. This is perhaps mainly a commentary on the Supreme Court's expansive reading of the Commerce Clause, but it should give pause to anyone who takes the Constitution seriously.

Beyond the modern drug war's legally dubious initiation, the strained legal interpretations and yawning exceptions officials have made to sustain the effort continue to warp our constitutional system. In prosecuting and expanding the war on drugs, the federal government has racked up colossal amounts of debt, fostered state protectionism, adopted countless new federal crimes, and invaded foreign countries without congressional authorization. Meanwhile, government actors at all levels have undermined Americans' freedoms of expression and religious exercise, deprived citizens of their rights to vote and bear arms, authorized warrantless searches and seizures of property without due process, and thrown tens of thousands of people — disproportionately racial minorities — into overcrowded prisons for sentences that are out of step with the crimes they've committed. These actions have changed our understanding of such foundational principles as limited government, federalism, and the separation of powers, all while casting doubt on America's commitment to the rule of law.

The Declaration of Independence may have affirmed Americans' unalienable rights to life, liberty, and the pursuit of happiness, but the drug war has undercut those rights at every turn. That fact does not argue for any particular reform, but it does demand that we consider the ongoing constitutional costs when we decide where to go from here.

Ilya Shapiro is director of the Robert A. Levy Center for Constitutional Studies at the Cato Institute and publisher of the Cato Supreme Court Review . He is also the author of Supreme Disorder: Judicial Nominations and the Politics of America’s Highest Court , due out from Regnery in September.

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Guest Essay

It’s Not Just About Pot. Our Entire Drug Policy Needs an Overhaul.

By Maia Szalavitz

Ms. Szalavitz is a contributing Opinion writer. She covers addiction and public policy.

The failure of American drug law, particularly marijuana policy, has long been obvious.

Finally, this October, President Biden ordered the Department of Health and Human Services and the attorney general to review what’s known as the “scheduling” status of cannabis. This legal process could lead to federal regulation of sales for recreational use or a national law that requires a prescription for marijuana. Mr. Biden also recently signed a law to ease onerous restrictions on marijuana research, and legislation is pending to allow cannabis businesses, now forced to use cash, to get access to banks .

Reform is much needed, with more than two-thirds of Americans favoring legalizing and regulating recreational use. Nearly half of Americans can or will soon be able to legally buy marijuana to get high in their state, which conflicts with federal law.

The details of new regulation, however, matter enormously. The current law, the Controlled Substances Act, is antiquated: It makes no scientific sense and grew out of legislation that was often driven by racist and anti-immigrant propaganda. While policymakers consider how to regulate marijuana specifically, they also need to rethink how the U.S. government classifies and controls psychoactive substances in general — not just drugs like marijuana and opioids, but also alcohol and tobacco.

The Controlled Substances Act was initially intended to regulate pleasurable substances that are risky. It has five categories, or “schedules,” which are supposed to reflect varying hazard levels. But it is filled with contradictions.

Schedule I, the most restrictive, bans the sale and possession of certain drugs for recreational use and limits their medical use to research. Those drugs include marijuana, heroin and LSD and most other psychedelics — all of which have wildly different risks. Each also has significant medical benefits .

The remaining four schedules put varying restrictions on medications. But some medically permissible drugs are more dangerous and addictive than some illegal substances — and the recreationally legal drugs alcohol and tobacco can be more dangerous than some prohibited ones and are not scheduled at all.

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• Open access
• Published: 09 December 2020

An ethical analysis of UK drug policy as an example of a criminal justice approach to drugs: a commentary on the short film Putting UK Drug Policy into Focus

• Adam Holland   ORCID: orcid.org/0000-0002-3617-1966 1  

Harm Reduction Journal volume  17 , Article number:  97 ( 2020 ) Cite this article

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Drug-related deaths in the UK are at the highest level on record—the war on drugs has failed. A short film has been produced intended for public and professional audiences featuring academics, representatives of advocacy organisations, police and policymakers outlining the problems with, and highlighting alternative approaches to, UK drug policy. A range of ethical arguments are alluded to, which are distilled here in greater depth for interested viewers and a wider professional and academic readership.

The war on drugs is seemingly driven by the idea that the consumption of illegal drugs is immoral. However, the meaning ascribed to ‘drug’ in the illicit sense encompasses a vast range of substances with different properties that have as much in common with legal drugs as they do with each other. The only property that distinguishes illegal from legal drugs is their legal status, which rather than being based on an assessment of how dangerous they are has been defined by centuries of socio-political idiosyncrasies. The consequences of criminalising people who use drugs often outweigh the risks they face from drug use, and there is not convincing evidence that this prevents wider drug use or drug-related harm. Additionally, punishing someone as a means, to the end of deterring others from drug use, is ethically problematic. Although criminalising the production of harmful drugs may seem more ethically tenable, it has not reduced the supply of drugs and it precludes effective regulation of the market. Other potential policy approaches are highlighted, which would be ethically preferable to existing punitive policy.

It is not possible to eliminate all drug use and associated harms. The current approach is not only ineffective in preventing drug-related harm but itself directly and indirectly causes incalculable harm to those who use drugs and to wider society. For policymakers to gain the mandate to rationalise drug policy, or to be held accountable if they do not, wider engagement with the electorate is required. It is hoped that this film will encourage at least a few to give pause and reflect on how drug policy might be improved.

In the UK, drug-related deaths are at the highest level on record [ 1 ], accounting in 2017 for more than a third of the drug-related deaths in the European Union [ 2 ]. Without the burden of ideology framing its aims in terms of a moral impetus, any other field of public policy similarly marred by failure would be swiftly overhauled. To the readership of this journal the problems with criminal justice focused drug policy, underscored by the rhetoric of the war on drugs may seem so plainly evident that they do not warrant stating. Nonetheless, it persists unabated in the UK and to degrees across the world. The propagation of punitive drug policy may be driven indirectly by the power relations between politicians and the electorate in democratic societies as the incentive of votes, or the threat of their loss, inspires a need to not be seen as being ‘soft on drugs’. Alternatively, it may be driven directly by policymakers; this could be due to their unconscious biases, as it is plainer than ever to see in contemporary politics that power does not preclude politicians from being all too human, or as others have despondently suggested, in some cases this could feasibly represent a conscious effort to further the interests of powerful actors and reinforce socioeconomic inequalities [ 3 ]. Whether the war on drugs is spurred on by one, or by a combination of these factors, to create a more just society it is necessary to engage with the public to highlight the problems with drug policy, particularly given the lack of transparency in much of contemporary political decision-making. Only through a shift in the understanding of the electorate will those in positions of power be given the mandate to rationalise drug policy or be held accountable if they do not.

With that in mind, with borrowed equipment and assistance gratefully received from friends and colleagues, I produced the short film Putting UK Drug Policy into Focus . In the film, the UK situation is used as an example to explore the problems with a criminal justice focused approach to drugs with the optimistic hope that viewers, both national and international, will be motivated to reflect on what a more ethically sound approach would look like. Fourteen stakeholders kindly agreed to be interviewed or to submit footage for the film including academics, representatives of advocacy organisations, police officers and policymakers. Although the film focuses on the UK, some contributors are from further afield as national policy is contingent on international context, and alternative international practice is highlighted. Contemporary arguments in favour of and against maintaining the status quo in drug policy are examined, rather than the antecedents of the current situation as the socio-political context of the past is not a reason to maintain the policy borne from it in the future; socio-political contexts change as does our understanding of the effects of policy decisions.

A range of ethical arguments is alluded to in the film, which are distilled here in greater depth for interested viewers and a wider professional and academic readership. Admittedly, discussion of the idealistic aims of drug policy is unlikely to directly influence those in power [ 4 ] and ethical argumentation alone is not sufficient to change policy; however, it is necessary to ensure the rigorous formulation of imperatives to do so [ 5 ]. Both deontological and consequentialist perspectives are explored. Deontological theories maintain that the rightness or wrongness of acts is determined by the nature of the acts themselves, the duties of those performing them and the rights of those affected. Consequentialist theories on the other hand maintain that the rightness or wrongness of acts is determined by their consequences [ 6 ]. Section one explores and critiques the idea that using those drugs that are illegal is morally wrong and doing so warrants punishment by virtue of its immorality. Sections two and three explore and critique the arguments for criminalising the possession, production and trafficking of drugs. Section four offers reflections on how drug policy in the UK and further afield can and should be modified to avert the ethical issues arising from a criminal justice focused approach.

The immorality of (some) drugs

For some, the impetus for punitive drug policy seemingly emanates from the deontological idea that there is something morally wrong about using those drugs that are illegal and that doing so warrants punishment [ 6 ]. The meaning ascribed to ‘drug’, in the illicit sense, which fuels drug policy discourse and the paradigm of the war on drugs [ 7 ] encompasses a vast range of substances with different effects, used by different groups in different circumstances that have as much in common with each other as they do with many legal substances. In fact, the only defining characteristic shared by those drugs that are illegal, distinguishing them from those that are not, such as alcohol, tobacco or coffee, is precisely that they are illegal. This generates a circular argument: illegal drugs are immoral because they are illegal, and they are illegal because they are immoral. It is this circularity that unfortunately means that the position is as logically unassailable for those who hold it as it is nonsensical for those who do not.

Proponents of the view that drug use is immoral may claim that its immorality stems from its potential to cause harm to a consumer. However, it is not obviously correct to say that the potential for an act to cause harm necessarily makes it immoral. Choosing to go skiing or lighting a campfire, for example, could result in an injury or a burn; however, these acts would not be afforded moral status by virtue of their harming potential alone. On the other hand, forcing someone with no training to ski down a steep mountain or setting them on fire before doing so is clearly ethically problematic. If it is the agency of the subject at risk of suffering harm as a result of an act that determines the morality of that act, then it is not immoral for somebody to voluntarily expose themselves to the risk of harm by using a drug. Contrary to this position, it can be argued that adults have a moral right to do what they want to do to their own bodies, which would include using drugs for recreational purposes [ 8 ]. Even if it was accepted that it was immoral for subjects to put themselves in harm’s way, and that this should determine the legal status of different drugs, this is not reflected in current policy as the legal classification of different drugs is not representative of the relative levels of harm that they are responsible for [ 9 ]. If this position was accepted, there would be profound consequences, not only in terms of the legal status of alcohol and tobacco, but also that of unhealthy foods, extreme sports and driving.

A more compelling argument would be to suggest that buying illegal drugs is morally wrong because it provides funding to criminal organisations thereby facilitating other criminal activities that cause harm to third parties. However, this argument once again leads to circularity as the relationship is contingent on contemporary policy: possessing a drug is illegal because buying it is morally wrong; buying it is morally wrong because it provides funding for organised criminal gangs; it provides funding for organised criminal gangs because they control the market for that drug; and they control the market for that drug because it is illegal to possess it.

The idea that the use of some drugs is immoral, and the war on drugs that emanates from this view is ideological; that is, it can be characterised by a configuration of power leading to the imposition of a set of ideas, which give some particular interests the appearance of being universal [ 10 ]. It is not a natural or inevitable state of affairs that the consumption of particular substances, such as coffee or alcohol is widely accepted, or even encouraged while the consumption of others, such as amphetamines or cannabis apparently justifies stigmatisation and punishment. It is only through the influence of powerful historical actors who served to benefit from the propagation of this view that it is now so widely accepted [ 11 ] and it is far from the case that any benefits from a punitive approach to drugs are shared universally. Without a sustained exertion of power, which is most clearly apparent in the enforcement of punitive drug laws, the incoherence of these distinctions would be more plainly obvious to those subject to that power, as would the dearth of beneficial consequences from the criminalisation of drugs. To divert attention from the incoherence of ideological viewpoints, proponents can direct intent focus on the specifics of the subject matter to inspire an emotive response [ 10 ]. In the case of illicit drugs, this often involves highlighting the harm that drug use causes, which indeed may be profound in some cases. However, as previously noted, potential to cause harm does not in itself obviously imbue an act with moral status and this view does not give credence to a moral distinction between harmful illicit drug use and harmful licit drug use or other potentially harmful activities.

These deontological arguments based on circular reasoning and ideology are not a sufficiently rigorous foundation upon which to base policy decisions. Accordingly, the ethical analysis of drug policy which follows is undertaken primarily through a consequentialist lens; that is, does it reduce harm? However, a further deontological argument will be examined regarding the use of criminal sanctions to deter drug use, which is more robust than those posed against drug use itself.

Criminalising the possession of drugs

When exercising punitive drug laws the use of force may lead to physical and psychological harm; contact with the criminal justice system is associated with a host of health and social inequalities which may be exacerbated by prosecution [ 12 ], and if leading to the deprivation of liberty, this is inherently harmful to the individual who is prevented from doing what they want to do. For this approach to be morally justified in consequentialist terms, it would need to prevent more harm than it causes. Proponents might claim that it results in a net reduction in harm to those being punished as it deters them from using drugs in the future. However, there is not convincing evidence that this is the case and even incarceration is not a reliable deterrent as more than one in four prisoners surveyed in the UK reported drug use in prison [ 13 ].

Regardless, data from the UK suggest that most people who take illicit drugs do not do so regularly [ 14 ] and as risk is cumulative, consumption and harm tend to be correlated [ 15 ]. Therefore, as Professor David Nutt highlights in the film, for the vast majority who use drugs, the negative impact of a criminal record would be much more significant than the negative impacts of continued infrequent drug use. For those who use drugs more frequently and problematically who are at the greatest risk of harm from doing so, use often develops in the context of adverse childhood experiences [ 16 ] and socioeconomic deprivation [ 17 ]. This is highlighted by Andria Efthimiou, who has first-hand experience of heroin use: “I was obviously reacting to … a very difficult childhood of illness that nearly killed me many times; difficult family circumstances, socially, economically; stressed out mother; absent father; and drugs were a great comfort so, having another punisher as it were with the police … what’s the point?” These antecedents of other health and social disadvantages are only exacerbated by contact with the criminal justice system and a criminal record.

Alternatively, proponents of punitive drug laws might argue that the harm they cause to individuals is justified by a net reduction in harm in society overall as others are deterred from drug use. Four challenges to this position follow: first, a direct empirical rebuttal; second, a consequentialist challenge related to the unintended negative impacts of criminalising possession; third, a deontological challenge in regard to the ethically problematic nature of using humans as a means to an end; and fourth, a procedural challenge highlighting the inequitable application of punitive drug laws.

First, there is no clear association between drug policy liberality and drug use prevalence, either contemporaneously across different countries [ 18 ] or subsequently in countries that have changed their drug policy [ 19 , 20 ]. Although it is feasible that punitive laws might reduce drug use in some settings, it is not a necessary condition of doing so as in Portugal the use of some drugs has continued to decrease after possession for personal use was decriminalised [ 21 ].

Second, the application of punitive drug laws may encourage behaviours that increase the risk of harm in the wider drug taking population. Fear of punishment might result in people using drugs in more secretive and riskier ways, for example by taking larger amounts before leaving the house or taking drugs that they bought hastily without examining them [ 22 ]. In addition, they may not as readily engage with harm reduction or treatment services, which would otherwise have mitigated the risks that they are exposed to [ 23 ].

Third, even if there was convincing evidence that the punishment of people who use drugs deterred wider use and did not have unintended negative impacts, it is still a morally problematic approach as illustrated by an event in Voltaire’s Candide. The eponymous protagonist refuses to step foot on English soil after witnessing an admiral being ceremoniously shot in the head. Upon asking why the admiral was executed, the characters are told “in this country we find it pays to shoot an admiral from time to time to encourage the others” [ 24 ]. Voltaire wrote Candide to confront the position of Enlightenment philosophers who argued that everything happens for a reason and that the world is truly as perfect as it would need to be to vindicate their belief in an omnipotent, benevolent god. Contrary to this, Voltaire accused the world of being “a senseless and detestable piece of work” typified by the profound injustice of the execution of the admiral and the rationale that led to it. This is the same rationale that persists in contemporary drug policy: that it is fine to use an individual as a means to an end by making an example of them pour encourager les autres (to encourage the others). When explicitly stated as such, this approach is clearly incompatible with contemporary public health ethical guidelines [ 25 ]; the ‘fundamental British value’ of ‘individual liberty’ taught in schools as directed by the same government that bolsters a criminal justice approach to drugs [ 26 ]; and the writings of the philosophers who laid the foundations of European political thought, such as Immanuel Kant and John Stuart Mill, who decried the instrumentalisation of human beings [ 27 , 28 ].

Finally, even if punitive drug laws deterred drug use, had no unintended negative consequences, and were otherwise morally justifiable, they are not applied equitably as members of some ethnic minority communities are punished for the possession of drugs disproportionately compared to the amount that they use drugs. This is notably the case in the USA [ 29 ] but also in the UK [ 30 ], persisting as a face of prejudice in a world acutely sensitised to the shadow of racial inequality. If there were benefits from a criminal justice approach to drugs, it would still be ethically problematic that these benefits were contingent on causing harm that was primarily shouldered by specific groups as determined by the colour of their skin.

Criminalising the production and trafficking of drugs

In deontological terms, punishing the production and distribution of harmful drugs might seem more ethically tenable than punishing the possession of drugs for personal consumption. However, on closer examination this too is not straightforward as it is not always clear whether drug market actors are more accurately characterised as perpetrators of crime or victims of extenuating circumstances. In the UK, exploited children and vulnerable adults play a prominent role in the recently identified county-lines drug market model [ 31 ], and internationally, marginalised and deprived communities face significant pressures, financial and otherwise, to produce drugs [ 32 ]. In addition, as was the case when distinguishing between the consumption of legal drugs such as coffee and alcohol and illegal drugs such as amphetamines and cannabis, the distinctions between producing them are nominally legal, beyond which there is not a clear ethical difference. If it is the potentially harmful nature of a product that warrants laws being enacted against its production, then the production of alcohol, tobacco, refined sugar, and cars should similarly be criminalised.

From a consequentialist perspective, proponents of the war on drugs might claim that it reduces drug-related harm as the seizure and destruction of drugs prevents their consumption and the punishment of producers and traffickers deters others from entering the market thereby further reducing drug availability. Four consequentialist challenges to this position follow: first, a direct empirical rebuttal; second, related to the unintended corollary of increasing innovation; third, highlighting the harm caused to third parties; and fourth, highlighting the preclusion of more refined regulation of the market.

First, as former undercover police officer Neil Woods highlights in the film, the ninth principle of British policing states that the test of police efficiency is not evidence of police action, but the absence of crime [ 33 ]. If the global illicit drug market is considered in criminal terms, domestic and international policing efforts have categorically failed this test. Although vast amounts of money and effort have been devoted to combating the illicit drug trade, the market continues to grow [ 34 ] with the short-term impacts of interdiction proving as unsustainable as decapitating one head of the proverbial hydra. The astronomical profit margins available to drug traffickers mean that the cost of drug seizures can easily be absorbed as a ‘tax’ on their operations [ 35 ] and marginalised drug producing communities can be incentivised to continue production in spite of efforts to deter them from doing so [ 32 ].

Second, efforts to stop the production and distribution of drugs promote innovation, which can exacerbate and lead to new types of harm. For example, new drugs are developed to circumvent existing detection methods and legislation [ 36 ]; in the last 2 decades, more than 670 new psychoactive substances have appeared on the European drug market [ 37 ], for most of which very little is known about in terms of their health impacts or how to mitigate them [ 38 ]. And new means of distribution are devised to avoid enforcement efforts; in the case of the darknet, this has made drugs more readily available [ 39 ]; and in the case of the UK county lines phenomenon, this has promoted new forms of criminality and exploitation [ 31 ].

Third, in some cases, efforts to combat the drug trade can cause harm to third parties as communities and the environment become collateral damage caught in the crossfire of the war on drugs. In Colombia, for example, swathes of the country have been fumigated to destroy coca crops [ 40 ]; a practice some commentators have argued was in contravention of international humanitarian law [ 41 ]. Fumigation was stopped in 2015 after the World Health Organisation declared that the chemicals being used were probably carcinogenic [ 42 ]; however, it looks likely to recommence in the foreseeable future following pressure from the Trump administration [ 43 ].

Finally, the illegality of drug production precludes governmental regulation of the market or enforcement of standards of production to reduce harm. Variable drug purity [ 44 ] and the adulteration of drugs with stronger and more harmful substances, particularly the adulteration of heroin with fentanyl analogues in the USA [ 45 ], have been identified as key factors contributing to increasing drug-related death rates. In addition, the government cannot financially regulate an illegal market. In 2017, in the European Union alone, the illegal drug market was estimated to be worth between 26 and 34 billion euros [ 46 ]. This money, which would otherwise need to be accounted for and could be taxed, may be used to fund harmful activities, including other forms of organised crime and exploitation [ 47 ] and potentially terrorism [ 48 ].

Ethical imperatives for drug policy

There is increasing political and academic support for countries to follow in the footsteps of Portugal and decriminalise the possession of drugs for personal use. This includes recommendations from the United Nations Chief Executives Board for Coordination [ 49 ], a 2019 UK House of Commons Select Committee on Drug Policy [ 50 ], the Royal Society of Public Health [ 51 ], the Canadian Association of Chiefs of Police [ 52 ] and the Lancet Commission on Drug Policy and Health [ 23 ]. Thus far, however, in the UK at least there seems to be little impetus for change.

Although the decriminalisation of the possession of drugs would be a step in the right direction, it does not confront the problems related to the unregulated nature of the criminal drug market. The legal regulation of all drugs would be more congruent, not only with the approach taken with drugs that are currently legal including alcohol and tobacco, but also with other products capable of causing harm, such as refined sugar and machinery. This is not to suggest that current models of regulation for legal products are necessarily correct and research on the commercial determinants of health highlights the need to approach questions of regulation extremely carefully [ 53 ]. A future in which all drugs are legally regulated is difficult to imagine; however, the prospect becomes more palatable when considering that opioid substitution and heroin-assisted therapy are essentially highly regulated markets for drugs, with convincing evidence in their favour that they reduce harm to individuals and wider society following reductions in acquisitive crime [ 54 , 55 ].

The legal status of drugs should not be the crux of the drug policy debate; rather, the key consideration should be how to mitigate the harm they cause, which crucially means minimising the unbridled opportunity for drug market actors to profit from their sale. Neoliberal tendencies can be seen in the marketing practices of both the legal and illegal markets for drugs, which disregard the health and well-being of consumers for want of profit [ 31 , 53 ]. Close regulation is required to ensure that if it was possible to make any profit from drugs, this is subsidiary to reducing the risk of harm and the prevalence of problematic use and dependence. This would include exerting control over how drugs are produced and who can buy them, where, when and with what caveats, as well as prohibiting marketing intended to widen the market. If the intention of regulating the drug market was to reduce the risk of harm and problematic drug use, this would clearly not be compatible with the institution of a free market for drugs, or for example, adverts for cocaine at the cinema. Equally, however, it does not necessarily mean that all those drugs that are currently illegal should only be accessible with a prescription as methadone is in the case of opioid substitution therapy. As one interviewee said in confidence, the key question is not whether illicit drugs should be legally regulated, but how . The regulation of different drugs should reflect the not so subtle differences between them; however, the global push to develop policies along the lines of the Psychoactive Substances Act in the UK, which prohibits the sale of any substances nebulously defined as ‘psychoactive’ aside from those arbitrarily exempted [ 56 ], further homogenises the management of a plethora of substances, which are defined by their granularity.

While a significant reprioritisation of drug policy in the UK is unlikely in the foreseeable future, more could be done to reduce the burden of drug-related harm without a drastic change in legislation. There is convincing evidence that drug treatment and harm reduction interventions including needle and syringe programmes are cost-effective investments that not only reduce harm, but also can lead to savings across many health, social and criminal justice services [ 57 , 58 ]. Despite this, drug treatment budgets in the UK have decreased by nearly 30% in recent years [ 50 ], and although numbers in treatment increased slightly in 2018/19, this follows a consistent fall since 2013 [ 59 ].

The harm reduction movement, which promotes the provision of interventions that reduce the risk that people are exposed to when they choose to use drugs, while admitting that it is not possible to eliminate all drug use [ 60 ] offers a practical conception of consequentialist ethical theory [ 6 ]. However, unfortunately, the concept of harm reduction is misted in controversy, which seems to stem from the flawed position tackled in section one of this article: that the use of some arbitrarily defined substances is immoral. Alternatively, critics might be allowing for the perfect to be the enemy of the good by holding out for the cessation of all drug use, which induction would suggest is an unrealistic goal judging by the ineffectual decades spent waging the war on drugs. Relatively minor tweaks to policy would allow the provision of other harm reduction interventions with promising evidence in their favour, which are currently prohibited under the auspices of UK legislation.  For example, the Home Office has repeatedly refused calls to allow the provision of crack pipes by drug treatment services, which would be particularly pertinent in the current climate to minimise the transmission of COVID-19 as well as providing a means of engagement with people who use crack cocaine [ 61 ]. And despite the successful implementation of drug consumption rooms in other European countries [ 62 ], multiple calls to allow them to be opened in the UK have been rejected [ 63 ].

None of these measures—the harm reduction movement, decriminalisation of the possession of drugs, or the regulation of the drug market—is a panacea, and even together they would not eliminate drug-related harm. However, neither will an ideological war on drugs, which is itself directly and indirectly responsible for incalculable harm to the significant proportion of the population who use drugs and to wider society. Some level of drug use and drug-related harm is as inevitable in the future as it has been present for millennia. Hopefully, one day this will be accepted by policymakers, and the vast resources spent waging the war on drugs will be redirected to reducing harm, rather than propagating it. Not only will the rights of those who use drugs need to be taken into account, but also the rights of the marginalised communities compelled to produce and distribute them if there is any hope of realising the optimistic future for all outlined by the United Nations Sustainable Development Goals.

The magnitude of the cultural gestalt switch and the level of international collaboration required for this to happen cannot be underestimated, and a future in which the war on drugs has ended is far from being realised. However, the COVID-19 pandemic has demonstrated that unprecedented policy change is possible in the face of overwhelming need. Although for most, the need for a change in drug policy is not as immediately tangible, from the perspective of those affected by the war on drugs, an overwhelming need is exactly what is faced. It should once again be stressed, however, that although rapid change is indicated in light of the many ethical problems arising from contemporary drug policy, extremely careful planning is required to mitigate the risk of unintended negative consequences, particularly in terms of the potential influence of actors who may wish to profit from the market. And, as the Lancet Commission on the legal determinants of health highlights, ongoing analysis is needed to ascertain how the law affects health, with the evaluation of new legislation, and consideration of its revision or repealment being as important, if not more so, than its drafting and enactment [ 64 ].

Although it is seemingly unlikely that the UK will spearhead a global rationalisation of drug policy, it is not beyond the realms of possibility following the sensible conclusions of the 2019 House of Commons Select Committee on Drug Policy [ 50 ]. Their initial report concluded that “UK drugs policy is failing” and among other things highlighted the potential benefits of decriminalising the possession of drugs, changing legislation to allow the opening of drug consumption rooms and increasing the provision of harm reduction interventions that are not widely available in the UK such as drug checking services and heroin assisted therapy.

For political actors to gain the mandate for change, however, it is necessary for the electorate to have a greater understanding of the intricacies of the issue, immeasurably more complex than a metaphorical understanding of drugs as an enemy that needs to be fought. Perhaps this is unrealistically optimistic; however, nothing has been achieved without optimism, and it is hoped that this short film might cause at least a few to give pause and reflect.

Link to film

The short film  Putting UK Drug Policy into Focus  is available at the following link. It is indended to be used for educational purposes and as a tool for engaging with the public, policymakers and other professional groups. No permission is required to screen or share the film. A shorter version, and a recording of the webinar at which the film was launched at the 2020 European Harm Reduction Conference are available on the YouTube channel 'Drug Policy in Focus'.  https://www.drugscience.org.uk/uk-drug-policy-focus/ .

Availability of data and materials

Not applicable.

Abbreviations

Coronavirus Disease 2019

United Kingdom

United States of America

Office for National Statistics. Deaths related to drug poisoning by selected substances. 2019. https://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/deaths/datasets/deathsrelatedtodrugpoisoningbyselectedsubstances . Accessed 21 Sept 2020.

European Monitoring Centre for Drugs and Drug Addiction. Drug-related deaths and mortality in Europe. 2019. https://www.emcdda.europa.eu/system/files/publications/11485/20193286_TD0319444ENN_PDF.pdf . Accessed 21 Sept 2020.

Friedman S. The Political Economy of Drug-user Scapegoating—and the philosophy and politics of resistance. Drugs Educ Prev Policy. 1998;5(1):15–32.

Article   Google Scholar  

Wolff J. Harm and hypocrisy—Have we got it wrong on drugs? Public Policy Res. 2007;14(2):126–35.

Coggon J. Legal, moral and political determinants within the social determinants of health: approaching transdisciplinary challenges through intradisciplinary reflection. Public Health Ethics. 2020;13(1):41–7.

Wodak A. Ethics and drug policy. Psychiatry. 2007;6(2):59–62.

Tupper K. Psychoactive substances and the English language: “Drugs,” discourses, and public policy. Contemp Drug Prob. 2012;39(3):461–92.

Husak D. Drugs and rights. Cambridge: Cambridge University Press; 1992.

Book   Google Scholar  

Nutt D, King L, Phillips L. Drug harms in the UK: a multicriteria decision analysis. The Lancet. 2010;376(9752):1558–65.

Geuss R. Philosophy and real politics. Oxford: Princeton University Press; 2008.

Mallea P. The war on drugs: a failed experiment. Toronto: Dundurn; 2014.

Google Scholar  

Revolving Doors Agency. Balancing Act—Addressing health inequalities among people in contact with the criminal justice system . 2013. https://www.revolving-doors.org.uk/sites/default/files/Documents/Balancing%20Act.pdf . Accessed 21 Sept 2020.

HM Inspectorate of Prisons. Changing patterns of substance misuse in adult prisons and service responses—a thematic review . 2015. https://www.justiceinspectorates.gov.uk/hmiprisons/wp-content/uploads/sites/4/2015/12/Substance-misuse-web-2015.pdf . Accessed 21 Sept 2020.

Home Office. Drugs misuse: findings from the 2018/19 crime survey for England and Wales. 2019. https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/832533/drug-misuse-2019-hosb2119.pdf . Accessed 21 Sept 2020.

Fischer B, Kendall P, Rehm J, Room R. Charting WHO—goals for licit and illicit drugs for the year 2000: Are we “on track”? Public Health. 1997;111(5):271–5.

CAS   PubMed   Google Scholar  

Bellis M, Ashton K, Hughes K, Ford K, Bishop J, Paranjothy S. Adverse childhood experiences and their impact on health-harming behaviours in the Welsh adult population . 2015. https://www2.nphs.wales.nhs.uk:8080/PRIDDocs.nsf/7c21215d6d0c613e80256f490030c05a/d488a3852491bc1d80257f370038919e/$FILE/ACE%20Report%20FINAL%20(E).pdf . Accessed 21 Sept 2020.

Marmot, M, Allen J, Goldblatt P, Boyce T, McNeish D, Grady M, et al. Fair society, healthy lives—the marmot review. 2010. https://www.instituteofhealthequity.org/resources-reports/fair-society-healthy-lives-the-marmot-review/fair-society-healthy-lives-full-report-pdf.pdf . Accessed 21 Sept 2020.

Home Office. Drugs: international comparators. 2014. https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/368489/DrugsInternationalComparators.pdf . Accessed 21 Sept 2020.

Stevens A. Is policy ‘liberalization’ associated with higher odds of adolescent cannabis use? A re-analysis of data from 38 countries. Int J Drug Policy. 2019;66:94–9.

Eastwood N, Fox E, Rosmarin A. A quiet revolution: drug decriminalisation across the globe. 2016. https://www.release.org.uk/sites/default/files/pdf/publications/A%20Quiet%20Revolution%20-%20Decriminalisation%20Across%20the%20Globe.pdf . Accessed 21 Sept 2020.

European Monitoring Centre for Drugs and Drug Addiction. Portugal Country Report 2019 . 2020. https://www.emcdda.europa.eu/system/files/publications/11331/portugal-cdr-2019_0.pdf . Accessed 21 Sept 2020.

Race K. Complex events: drug effects and emergent causality. Contemp Drug Prob. 2014;41(3):445–79.

Csete J, Kamarulzaman A, Kazatchkine M, Altice F, Balicki M, Buxton J, et al. Public health and international drug policy. Lancet Commissions. 2016;387(10026):1427–80.

Voltaire. Candide. London: Penguin; 1947 [1758].

Nuffield Council of Bioethics. Public health: ethical issues. 2007. https://nuffieldbioethics.org/wp-content/uploads/2014/07/Public-health-ethical-issues.pdf . Accessed 21 Sept 2020.

Department for Education. Promoting fundamental British values as part of SMSC in schools—departmental advice for maintained schools . 2014. https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/380595/SMSC_Guidance_Maintained_Schools.pdf . Accessed 21 Sept 2020.

Kant I. Groundwork of the metaphysics of morals . Cambridge: Cambridge University Press; 2012 [1785].

Mill JS. On liberty . Cambridge: Cambridge University Press; 2011 [1859].

The Sentencing Project. Report of the sentencing project to the United Nations special rapporteur on contemporary forms of racism, racial discrimination, xenophobia and related intolerance . 2018. https://www.sentencingproject.org/publications/un-report-on-racial-disparities/ . Accessed 21 Sept 2020.

Shiner M, Carre Z, Delsol R, Eastwood N. The colour of injustice: 'Race', drugs and law enforcement in England and Wales . 2018. https://www.release.org.uk/sites/default/files/pdf/publications/The%20Colour%20of%20Injustice.pdf . Accessed 21 Sept 2020.

Coomber R, Moyle L. The changing shape of street-level heroin and crack supply in England: commuting, holidaying and cuckooing drug dealers across “County Lines.” Br J Criminol. 2018;58(6):1323–42.

Moreno-Sanchez R, Kraybill D, Thompson S. An econometric analysis of coca eradication policy in Colombia. World Dev. 2003;31(2):375–83.

Home Office. Definition of policing by consent . 2012. https://www.gov.uk/government/publications/policing-by-consent/definition-of-policing-by-consent . Accessed 21 Sept 2020.

United Nations Office on Drugs and Crime. World drug report 2020—executive summary . 2020. https://wdr.unodc.org/wdr2020/field/WDR20_BOOKLET_1.pdf . Accessed 21 Sept 2020.

Global Commission on Drug policy. Regulation—the responsible control of drugs . 2018. https://www.globalcommissionondrugs.org/wp-content/uploads/2018/09/ENG-2018_Regulation_Report_WEB-FINAL.pdf . Accessed 21 Sept 2020.

Rolles S, Kushlick D. Prohibition is a key driver of the new psychoactive substances (NPS) phenomenon. Addiction. 2014;109(10):1589–90.

European Monitoring Centre for Drugs and Drug Addiction. Fentanils and synthetic cannabinoids: driving greater complexity into the drug situation—an update from the EU Early Warning System. 2018. https://www.emcdda.europa.eu/system/files/publications/8870/2018-2489-td0118414enn.pdf . Accessed 21 Sept 2020.

Mdege N, Meader N, Lloyd C, Parrott S, McCambridge J. The Novel Psychoactive Substances in the UK Project: empirical and conceptual review work to produce research recommendations. Public Health Res. 2017;5(4):1–11.

European Monitoring Centre for Drugs and Drug Addiction and Europol. Drugs and the darknet: perspectives for enforcement, research and policy . 2017. https://www.europol.europa.eu/publications-documents/drugs-and-darknet-perspectives-for-enforcement-research-and-policy . Accessed 21 Sept 2020.

Rincón-Rui A, Kallis G. Caught in the middle, Colombia’s war on drugs and its effects on forest and people. Geoforum. 2013;46:60–78.

Landel M. Are aerial fumigations in the context of the war in colombia a violation of the rules of international humanitarian law? Transnatl Law Contemp Prob. 2010;19:491–513.

World Health Organisation—International Agency for Research on Cancer. IARC monographs volume 112: evaluation of five organophosphate insecticides and herbicides . 2015. https://www.iarc.fr/wp-content/uploads/2018/07/MonographVolume112-1.pdf . Accessed 21 Sept 2020.

The White House. Remarks by President Trump and President Duque of Colombia before bilateral meeting. 2020. https://www.whitehouse.gov/briefings-statements/remarks-president-trump-president-duque-colombia-bilateral-meeting-2/ . Accessed 21 Sept 2020.

Public Health England. Understanding and preventing drug-related deaths . 2016. https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/669308/Understanding_and_preventing_drug_related_deaths_report.pdf . Accessed 21 Sept 2020.

Centers for Disease Control and Prevention. Annual surveillance report of drug-related risks and outcomes. 2019. https://www.cdc.gov/drugoverdose/pdf/pubs/2019-cdc-drug-surveillance-report.pdf . Accessed 21 Sept 2020.

European Monitoring Centre for Drugs and Drug Addiction. Estimating the size of the main illicit retail drug markets in Europe: an update . 2019. https://www.emcdda.europa.eu/system/files/publications/3096/Estimating%20the%20size%20of%20main%20drug%20markets.pdf . Accessed 21 Sept 2020.

Center for the study of democracy. Financing of organised crime. 2015. https://csd.bg/fileadmin/user_upload/publications_library/files/22423.pdf . Accessed 21 Sept 2020.

Omelicheva M, Markowitz L. Does drug trafficking impact terrorism? Afghan opioids and terrorist violence in Central Asia. Stud Confl Terror. 2019;42(12):1021–43.

United Nations Chief Executives Board for Coordination. Second regular session of 2018—summary of deliberations . 2019. https://digitallibrary.un.org/record/3792232?ln=en . Accessed 21 Sept 2020.

House of Commons Health and Social Care Committee on Drugs Policy. Drugs policy. 2019. https://publications.parliament.uk/pa/cm201919/cmselect/cmhealth/143/143.pdf . Accessed 21 Sept 2020.

Royal Society for Public Health. Taking a new line on drugs. 2016. https://www.rsph.org.uk/about-us/news/stop-criminalising-drug-users.html . Accessed 21 Sept 2020.

Canadian Association of Chiefs of Police. Canada’s police leaders recommend adopting a public health led diversionary approach to illicit substance use. 2020. https://www.cacp.ca/news/canadas-police-leaders-recommend-adopting-a-public-health-led-diversionary-approach-to-illicit-subst.html . Accessed 21 Sept 2020.

McKee M, Stuckler D. Revisiting the corporate and commercial determinants of health. Am J Public Health. 2018;108(9):1167–70.

Hickman M, Steer C, Tilling K, Lim AG, Marsden J, Milllar T, et al. The impact of buprenorphine and methadone on mortality: a primary care cohort study in the United Kingdom. Addiction. 2018;113(8):1461–76.

Ferri M, Davoli M, Perucci C. Heroin maintenance for chronic heroin-dependent individuals. Cochrane Database Syst Rev. 2011(12):CD003410.

Stevens A, Fortson R, Measham F, Sumnall H. Legally flawed, scientifically problematic, potentially harmful: the UK psychoactive substance bill. Int J Drug Policy. 2015;26(12):1167–70.

National Treatment Agency for Substance Misuse. Estimating the crime reduction benefits of drug treatment and recovery . 2012. https://webarchive.nationalarchives.gov.uk/20170807160642/http://www.nta.nhs.uk/uploads/vfm2012.pdf . Accessed 21 Sept 2020.

Sweeney S, Ward Z, Platt L, Guinness L, Hickman M, Hope V. Evaluating the cost-effectiveness of existing needle and syringe programmes in preventing hepatitis C transmission in people who inject drugs. Addiction. 2019;113(3):560–70.

Public Health England. Adult substance misuse treatment statistics 2018 to 2019: report. 2019. https://www.gov.uk/government/publications/substance-misuse-treatment-for-adults-statistics-2018-to-2019/adult-substance-misuse-treatment-statistics-2018-to-2019-report . Accessed 21 Sept 2020.

Race K. The use of pleasure in harm reduction: perspectives from the history of sexuality. Int J Drug Policy. 2008;19(5):417–23.

Harris M. An urgent impetus for action: safe inhalation interventions to reduce COVID-19 transmission and fatality risk among people who smoke crack cocaine in the United Kingdom. Int J Drug Policy. 2020;83:102829.

European Monitoring Centre for Drugs and Drug Addiction. Drug consumption rooms: an overview of provision and evidence . 2018. https://www.emcdda.europa.eu/system/files/publications/2734/POD_Drug%20consumption%20rooms.pdf . Accessed 21 Sept 2020.

Fortson R, McCulloch L. Evidence and issues concerning drug consumption rooms . Queen Mary University of London, School of Law Legal Studies Research Paper No. 279. 2018. https://papers.ssrn.com/sol3/papers.cfm?abstract_id=3182568 . Accessed 21 Sept 2020.

Gostin LO, Monahan JT, Kaldor J, DeBartolo M, Friedman EA, Gottschalk K, et al. The legal determinants of health: harnessing the power of law for global health and sustainable development. Lancet Commissions. 2019;393(10183):1857–910.

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Acknowledgements

An enormous thank you to: those who feature in the film, discussions with whom provided inspiration for this manuscript; Professor John Coggon for his invaluable and detailed comments on earlier drafts; Dr Jason Horsley for his thoughts on the incompatibility of drug policy with ‘fundamental British values’; and Professor Nick Crofts for his knowledge of Voltaire.

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Holland, A. An ethical analysis of UK drug policy as an example of a criminal justice approach to drugs: a commentary on the short film Putting UK Drug Policy into Focus . Harm Reduct J 17 , 97 (2020). https://doi.org/10.1186/s12954-020-00434-8

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"Recently, this opposition to science and human rights reached a new frontier. In 2010, Russia’s Chief Narcologist announced his endeavor to create a four-level system of “social pressure” in order to respond to the country’s “drug problem” [26]. The first level of this system involves “early detection” of drug use by way of school and workplace testing; the second level is voluntary drug treatment; the third level is compulsory treatment by referral from the criminal justice system; and the fourth level is compulsory treatment within the criminal justice system. By 2013, this system was fully implemented as state policy. Despite the fact that compulsory drug treatment was proclaimed unconstitutional in Russia in 1989, the punitive principles underlying Russia’s current drug policy allowed for widespread ignorance of this fact—not an unusual practice in Russia [27]. Correspondingly, in 2013–2014, several federal laws and regulations were amended to establish compulsory drug treatment [28–30], purportedly to motivate DDP and people who use illegal drugs to undergo medical treatment and rehabilitation [31]. For example, these amendments empower law enforcement agencies to coerce PWUD to undergo drug treatment and rehabilitation, empower courts to issue drug treatment orders to people who commit drug-related administrative offenses (such as non-medical use of narcotic drugs or possession of insignificant amounts of narcotic drugs) or to DDP who commit minor crimes (such as theft or the possession of significant amounts of drugs for personal use), introduce administrative punishment of up to 30 days of imprisonment for evasion of court-imposed drug treatment or rehabilitation, and require drug treatment and rehabilitation organizations to report to police those patients who do not fulfill court-imposed treatment or rehabilitation orders." Public health reviews vol. 39 12. 1 Jun. 2018, doi:10.1186/s40985-018-0088-5.

"People who use drugs (PWUD) are one of the most stigmatized and marginalized populations in Russia [1, 2]. People who inject drugs (PWID) are particularly vulnerable to HIV infection, HCV infection and fatal overdoses (OD) [3–7]. Unfortunately, harm reduction programs that have been proven to be effective for combatting HIV, HCV, and OD among PWID [8, 9] are not officially endorsed by the Russian government, their number is limited and access to them is low [10]. Moreover, the number of needle and syringe exchange programs (NSPs) in Russia has been decreasing since 2010 [11], while opioid agonist therapy (OAT) remains illegal [10]. In addition, harm reduction services were reported to be unattractive to young PWID in Russia [12]. "Thus, there is an urgent need for alternative ways of providing harm reduction services to improve their accessibility among a wider population of PWUD in Russia. This is especially true for harder-to-reach populations, such as young PWUD. One such way to increase accessibility is by integrating harm reduction services into online platforms." . Harm Reduct J 17, 98 (2020). doi.org/10.1186/s12954-020-00452-6.

"Based on the discourse analytical perspective (see Van Dijk, 1995, 2006, 2010) two main ideologies could be identified that constitute the basis of the Russian parliamentary discourse on illegal drugs. Firstly, an external threat ideology was identified, in which the drug problem is primarily regarded as an external problem, coming into Russia from other countries. In the Russian Duma, illegal drugs are seen as posing a threat to Russian society, mainly as a result of Afghan opium production. It is here possible to draw some parallels with the early US war on drugs rhetoric. One similarity with the early US war on drugs rhetoric is the strong focus on heroin as one of the main problems. For example, when President Nixon declared a “war on drugs” in 1969, the focus was on the growing heroin problem (Boyum & Reuter, 2005). Another similarity with the early US war on drugs rhetoric is the focus on supply reduction. In the US, for example, several American presidents have devoted resources to supply control efforts, e.g. Nixon, Ford, Carter, Reagan, Bush (Mathea, 1996). As in the US, this study of the Russian parliamentary discourse indicates a focus on supply rather than demand when debating the drug problem. For example, the politicians place a major emphasis on controlling the drugs entering Russia from foreign countries (especially Afghanistan), but focus less attention on rehabilitation and prevention. Secondly, a prohibitionist ideology was identified in the Russian parliamentary discourse. For example, there was a general consensus among politicians that Russian drug policy and legislation was too weak and that a more repressive policy was needed. However, this idea of drug prohibitionism is not unique to the Russian context but is similar to drug prohibition ideologies in other countries. For example, during the war on drugs in the US, prohibitionists defended strict legal sanctions against all illicit drugs (MacCoun & Reuter, 2001). "When analyzing political discourse it is often easier to identify what is said explicitly. "However, it is also important to identify ideas and ideologies that are not put into words. Based on the extensive research on injecting drug use and its impact on the spread of HIV in Russia, it is surprising that the Russian politicians examined in this study devoted so little attention to this topic. Further, the topic of substance treatment and injecting drugs was not discussed in the debate. It is therefore possible to argue that the results of this study indicate an absence of a harm reduction ideology in the Russian political debate." , Substance Use & Misuse, 56:7, 1010-1017, DOI: 10.1080/10826084.2021.1906275.

"One of the most common solutions to the drug problem in the Duma debate was that there was a need for more severe legislation. Politicians argued that Russian drug policy was too weak and that a more repressive policy was needed – for example that more legal substances should be classified as illegal, that the drug consumption legislation should be more severe or that the death penalty should be introduced for drug traffickers. Interestingly, only a few politicians discussed prevention and/or treatment as solutions to the problem. When prevention was discussed, many different forms were mentioned, such as school prevention, media campaigns and/or other forms of information campaigns directed at the public. Another form of prevention that the politicians talked about was protecting young people from information about drugs by educating and informing children about traditional Russian values. In line with this idea, some politicians were also overly positive about the use of different forms of legislation to control information about drugs, for example, by means of a propaganda law. The idea of criminalizing drug propaganda is also in line with the rhetoric used by President Putin. In October 2019, Putin called on lawmakers to toughen the anti-narcotics legislation and to impose jail sentences on those found guilty of online “drugs propaganda” (Carroll, 2019). However, the propaganda law has been heavily criticized by NGOs in Russia, and there are media reports about NGOs being sentenced to fines on the basis of this law because they are accused of having published propaganda on drugs (Carroll, 2019). The drug propaganda law has also impacted the situation for anti-drug NGOs in Russia. For example, the Andrey Rylkov Foundation decided in April 2020 to limit access to its website containing materials on Russian and international drug policy, health and human rights resources for people who use drugs (International Drug Policy Consortium, 2020)." , Substance Use & Misuse, 56:7, 1010-1017, DOI: 10.1080/10826084.2021.1906275.

"Analysis of court statistics demonstrates that the 2013–2014 amendments have not led to the expected outcome of “motivating” PWUD to undergo drug treatment or rehabilitation. Only about 2% of people convicted for drug administrative offenses chose to undergo treatment rather than punishment (about 1500 out of more than 70,000) [32] and only about 1% of 48,557 people who were involuntarily ordered to undergo drug dependence treatment remained drug-free within a year or more after treatment. Publically available judgments indicate that people have either simply not shown up for their appointments with narcologists or failed to visit narcologists after diagnostics (after which narcologists report truant patients to the police) [33]. Despite this obvious ineffectiveness, narcologists continue to express strong support for this system of “social pressure.” In June 2017, the Ministry of Health of the Russian Federation sponsored a large conference of narcologists. The conference’s final resolution included recommendations to health institutions in Russia to form a system of social pressure for people who use psychoactive substances, including a mechanism of legal “motivation” for treatment and rehabilitation as an alternative to administrative and criminal liability for people committing drug crimes. The same conference endorsed a bill to be introduced to the Federal Parliament in order to expand the coercive treatment measures of 2013–2014 to “problem alcohol users” [34]." Public health reviews vol. 39 12. 1 Jun. 2018, doi:10.1186/s40985-018-0088-5.

"According to multiple sources, drug users in Russia have numbered between 7.3 to 8.5 million for the past several years. At an October 2017 Saint Petersburg conference, experts reported that in 2016, there were 637,482 people incarcerated in Russia, for which 63 percent were for drug offenses, and 10 percent of whom are HIV positive. In addition, 54.5 percent of Russian narcologists list religion as 'the most suitable therapy' for drug addiction, and as a result, drug addiction in Russia is typically treated with antipsychotic drugs suited to treat schizophrenia, instead of agonist and antagonist agents. Analysts have also ascribed spotty progress and metrics to poor interagency and inter-sectoral cooperation, and to the lack of a cohesive national rehabilitation program." Washington, DC: March 2018, p. 257.

"Kazakhstan, Kyrgyzstan, Latvia, Lithuania, Moldova, Romania, Russia, Tajikistan, Turkmenistan, Ukraine and Uzbekistan). Together, these 18 countries accounted for over 87% of TB mortality in the WHO Europe region with the highest in Turkmenistan (10.4 deaths per 100,000), followed by Azerbaijan (10.1) and Ukraine (8.4). In addition, an estimated 20% to 25% of TB cases in Eurasia go undetected.[19] "The largest proportion of new and relapse cases (78,258, or 34.4%) come from Russia. The countries with the absolute highest number of TB cases over 10,000 are Russia (78,258), Ukraine (36,000), Uzbekistan (23,000), Romania (13,000) and Kazakhstan (12,000). There were an estimated 30,000 HIV-positive TB cases, with Russia (53%) and Ukraine (27%) contributing to the highest burden of coinfection. The TB notification rate exceeds 1,000 cases per 100,000 prison detainees in Azerbaijan, Kazakhstan, Kyrgyzstan, Moldova, Russia and Ukraine. The highest TB-related risks in prison are calculated to be in Slovakia (40.7), followed by Czechia (24.9), Ukraine (23.8), Russia (23.5) and Azerbaijan (22.1). Russia accounted for almost half of the deaths in the WHO EU Region in absolute numbers. Although few countries report TB in people who inject drugs, higher rates of notification (new cases) among this group supports evidence that people who use drugs are at higher risk of TB.[20] "OAT and drug treatment, even if available in the country, are largely unavailable in TB treatment facilities (for example Kazakhstan, Russia, Ukraine) and facilities are often restricted from prescribing controlled substances.[21] Consequently, people who use drugs often come into contact with the health system at late stages of the disease and are forced to interrupt treatment which, in turn, leads to high prevalence of multidrug-resistant TB.[1]" . London: Harm Reduction International.

"Harm reduction, while not always in these exact words, is mentioned in national government policies in 25 of the 29 countries in the region. Needle and syringe programmes (NSPs) are available in 27 out of 29 countries (excluding Turkmenistan and Bulgaria), and opioid agonist therapy (OAT) in 26 countries (except Russia, Uzbekistan and Turkmenistan). However, the coverage of services in most of the countries doesn’t reach the minimum 20% recommended by the World Health Organization (WHO)[4] and the quality of services remains low and not client-oriented. Consequently, nearly half of new HIV infections in 2019 in the post-Soviet part of the region were attributed to injecting drug use.[63] "Twenty-one countries provide OAT in prisons, and only five have needle and syringe programmes (NSPs). "Naloxone and overdose prevention education is explicitly stated as part of the harm reduction programme for people who use drugs in Georgia, Kyrgyzstan, Moldova, Tajiskistan and Uzbekistan.[9] Take-home naloxone is available at harm reduction sites in Estonia, Kazakhstan, Kyrgyzstan, Moldova and several cities in Russia, with support from international donors." . London: Harm Reduction International.

"As noted above, human rights organizations and UN bodies have documented human rights violations against PWUD [People Who Use Drugs] in Russia, including the absence of drug dependence treatment for people living with HIV and tuberculosis [56], the use of unscientific methods and the drug user registry in drug dependence treatment [57], and the prohibition on OST [57, 58]. Moreover, the UN Committee on Economic, Social and Cultural Rights (CESCR) has urged Russia to apply a human rights-based approach to PWUD so that they do not forfeit their right to health [59, 60], while the UN Human Rights Committee has recommended that Russia provide effective drug dependence treatment to people in police custody [61] and the UN Committee on the Elimination of Discrimination against Women has recommended that Russia provide drug-dependent women access to OST [62]. As of September 2017, there were also at least five applications pending before the European Court of Human Rights concerning the human rights of PWUD. "However, human rights violations arising from punitive drug policy are not limited to PWUD. Arguably, narcologists’ human rights are also infringed when Russian drug laws criminally prohibit evidence-based drug dependence treatment such as OST, thus subjecting narcologists who are willing to provide OST to their patients to life imprisonment for drug trafficking. Narcologists are also prohibited from openly supporting harm reduction activities, such as needle and syringe programs, because such support can lead to administrative or criminal sanctions for violations of drug propaganda laws [63, 64]. According to a former Chief Narcologist, Nikolay Ivanets, Russian narcologists would never speak in favor of OST because of the risks of prosecution [65]. Russian narcologists are pulled in two directions, representing polarized sets of obligations. On the one hand, they have responsibilities as doctors, acting in the best interest of their patients, which ostensibly includes employing the most effective, evidence-based treatment methods. On the other hand, narcologists are prohibited from providing or promoting such methods of treatment and care, such as OST and harm reduction programs, under the threat of criminal and administrative sanctions." Public health reviews vol. 39 12. 1 Jun. 2018, doi:10.1186/s40985-018-0088-5.

"The latest information, obtained directly by us from the Ministry, covers the year ending 2017, and reports the number of newly registered PLHIV [People Living with HIV] has increased by 105,844. Clearly, this is not an exact measure of incidence, but it gives an indication that numbers continue to rise unabated. Reasons for the absence of progress in Russia are numerous and include insufficient access to sterile injecting equipment, unavailability of opioid substitution therapy, and a shortage of treatment in populations where it is most needed, namely people who inject drugs and their partners, sex workers, and men who have sex with men." The Lancet, Editorial, Volume 393, Volume 10172, P612, Feb 16, 2019. doi.org/10.1016/S0140-6736(19)30359-9

"Now, when the regressive revision of criminal drug policy has been completed and when, based on the new rules, new amounts have been approved for defining large and exceptionally large amounts, two conclusions can be drawn on the basis of the figures: "1) Since February 11, 2006 there are additional grounds for the criminal prosecution of people who use narcotics. "2) Despite the most recent changes, compared with the situation existing until May 12, 2004, today's position does not seem to be as universally repressive as it was during the period when Academician Babayan's Summary Table was in use. "This can be confirmed by a comparative analysis of the threshold of criminal liability with respect to the most important substances on the list (table ​(table11). "If we consider the whole list, containing 232 items, we find that a decrease in amounts defined as large occurred in only 49 cases, while there were increases in 140. These amounts were increased in the majority of listed substances. "However, almost all of the 140 substances for which the amount deemed large was increased are substances only rarely involved in illegal trafficking, while decreases in threshold occurred for the majority of popular narcotics. "The bar for the amount criminally punishable decreased with respect to that established on May 12, 2004: by a factor of two for heroin (from 1 to 0.5), by a factor of five for opium (from 5 to 1 grams), for marijuana from 20 to 6 grams, for hashish from 5 to 2 grams, for ketamine by a factor of 5 (from 1 to 0.2 grams), for cocaine by a factor of three (from 1.5 to 0.5 grams), for LSD by a factor of 30 (from 0.003 to 0.0001 gram), for pervitine from 0.5 to 0.3 grams, for amphetamine by a factor of 5 (from 1 to 0.2 grams), and for ephedrine from 0.5 to 0.2 grams." . Harm reduction journal, 5, 22. doi.org/10.1186/1477-7517-5-22

"Corruption, misappropriation and embezzlement of public funds, tax evasion, fraud, and drug trafficking generate significant proceeds. There is a large shadow economy approaching 13 percent of the Russian GDP [Gross Domestic Product], according to the latest estimates by the Federal Statistics Service. Although cash in circulation as a percentage of total money supply has declined from a historical peak of 43 percent on November 1, 1998, to 21.6 percent on September 1, 2020, there was a 23.7 percent surge in the value of cash in circulation in January-September, largely related to COVID-19 restrictions. Financial flows from illicit activity linked to Russia have threatened weak financial institutions in neighboring countries; however, they also make their way to global financial centers, often through opaque shell companies. "The total amount of funds moved offshore through Russian commercial banks via suspicious transactions declined 72.2 percent year-on-year in the first half of the year to approximately $259.5 million, down from approximately $474.4 million in the same period in 2019, according to the Central Bank of Russia (CBR). Although Russia has made some progress on AML [Anti-Money Laundering], various investigations have alleged the existence of schemes designed to launder billions of dollars out of Russia." . Washington, DC: State Dept. Bureau of International Narcotics and Law Enforcement Affairs, March 2021.

"Official corruption at all levels of government constitutes one of the largest sources of laundered funds. Russia is also a transit and destination country for international narcotics traffickers, particularly from Afghanistan. Cybercrime remains a significant problem, and Russian hackers and organized crime structures continue to work together. Criminals launder funds through banks, hawala networks, real estate, industrial entities, and luxury goods. "Although Russia has encouraged domestic development of blockchain-based technologies, the Russian government does not have a consistent position on the regulation of virtual currency. "There is a large migrant worker population in Russia. Many remittances are sent through an informal value transfer system that may pose vulnerabilities for money laundering. Gaming is only allowed in specified regions. The FIU monitors casinos for AML/CFT compliance, while other agencies supervise other parts of the gaming sector. Online gaming is prohibited." . Washington, DC: State Dept. Bureau of International Narcotics and Law Enforcement Affairs, March 2021.

"Drug addiction in Russia is typically not treated according to evidence-based modern protocols but often with “cold turkey” abstinence-focused programs or antipsychotic drugs suited to treating schizophrenia and other mental illnesses.  Civil society experts have criticized Russian addiction treatment and rehabilitation programs due to poor interagency and inter-sectoral cooperation, as well as for the lack of a cohesive national rehabilitation program." Washington, DC: State Dept. Bureau for International Narcotics and Law Enforcement Affairs, March 2021.

"The prevalence of hepatitis C among people using drugs is very high in Eurasia, varying between 15% and 94%. Hepatitis C prevalence among people who inject drugs is above 50% in 18 countries in Eurasia, up from 16 in 2018 (see regional table, p.82). Russia is one of the four main contributors to the hepatitis C burden among people who use drugs in the world.[27] The main barriers in the region to reaching the goal of eliminating hepatitis C by 2030[28] are poor coverage of harm reduction services, restrictive drug policies, criminalisation of drug use, poor access to cost-efficient harm reduction services, low hepatitis C testing, poor linkage to care and treatment, restrictions for accessing direct-acting antiviral therapy and the lack of national strategies and government investment to support elimination goals.[27, 29]" . London: Harm Reduction International.

"Darknet-based drug marketplaces are frequently used by PWUD. 'Empire Market' [13], 'Hydra' (in Russia) [14] and other darknet markets operate similarly to regular online marketplaces: they give vendors and buyers a platform to conduct their online transactions on. However, darknet-based drug marketplaces are more difficult to access as they require special software which encrypts computer IP addresses (e.g., Tor Browser). Transactions are anonymized and performed with cryptocurrencies (e.g., Bitcoin); hence, darknet markets are also called ‘cryptomarkets’. In addition to making purchases on the cryptomarkets, users can also exchange information on the availability of particular drugs, experiences from using them, their effects and potential harms via integrated online forums [15–17]. "The use of drug marketplaces and drug-related online forums to facilitate harm reduction has started to gain the attention of researchers. A number of studies have shown that such online platforms could bring new opportunities to provision of harm reduction services [18–20]. Social media platforms have also shown potential to bring greater access to harm reduction services among PWUD [People Who Use Drugs] [21]. Harm reduction interventions via online platforms are often referred to as ‘web outreach’, ‘online outreach’ or ‘netreach’ work [22, 23]. "Web outreach work implies that harm reduction workers contact PWUD through online platforms and provide them with harm reduction information and counseling upon individual requests of users or distribute harm reduction information publicly via online forums. Such work helps to encourage risk reduction behaviors among hard-to-reach populations of PWUD, who do not attend brick-and-mortar harm reduction facilities [22, 23]. Moreover, the COVID-19 pandemic has introduced social distancing measures and shortages of medicines and harm reduction supplies, which makes it more difficult to provide in-person harm reduction services [24, 25]. Web outreach helps organizations continue to provide harm reduction services during the pandemic." . Harm Reduct J 17, 98 (2020). doi.org/10.1186/s12954-020-00452-6.

"Russia has a high prevalence of drug use and has already for some years suffered from a widespread injection drug use epidemic with an estimated over 2% of the population being people who inject drugs (PWID). In 2020, a total of 18,013 people overdosed on illicit drugs and 7,366 died as a consequence, which is a 16% increase compared to 2019 (Sárosi, 25 February, 2022). "Despite the problems escalation – such as PWID functioning as a major driver of Russia's HIV epidemic ( ) – the official strategy by authorities has mainly focused on drug traffickers and drug-related crime. During the past 30 years, the Russian Federation has introduced tough measures to combat the spread and use of illicit drugs. Over one fourth of the imprisoned population are estimated to have been punished for drug-related crimes. "The country is on a path of “treating users like criminals instead of people in need of treatment” ( ). A priority by authorities to set up “draconian laws” has been portrayed from the drug users’ perspective, for example in a 2019 story in Deutsche Welle. Examples include getting four years in prison for being caught with just a small amount of drugs ( ). The Eurasian Harm Reduction Association (EHRA) describes a misuse of power in a highly punitive and stigmatising environment: “law enforcement agencies have a virtual carte blanche to discriminate against people who use drugs” ( ). "A study from 2020 that scrutinises extrajudicial and illegal police drug controlling practices found “significant discontinuities in the weight distribution of seized heroin near minimum threshold amounts” ( , p. 378). Ruling out alternative explanations of the discontinuity, the author Alex Knorre concludes that the most likely source of the revealed discontinuities is police manipulations with seized heroin ( )." . Nordisk Alkohol Nark. 2022 Aug;39(4):343-346. doi: 10.1177/14550725221108789. Epub 2022 Aug 12. PMID: 36003121; PMCID: PMC9379298.

"The inaccessibility and poor quality of services pertaining to the treatment of drug dependence in Russia have been extensively documented. Treatment methods reported include flogging, beatings, punishment by starvation, long-term handcuffing to bed frames, 'coding' (hypnotherapy aimed at persuading the patient that drug use leads to death), electric shock, burying patients in the ground and xenoimplantation of guinea pig brains . The practice and acceptance of such methods clearly indicate that the government’s approach does not correspond to international drug treatment guidelines. "Such methods are not only cruel but ineffective. As the Russian Federal Drug Control Service has acknowledged, over 90% of drug treatment patients return to using illegal drugs within one year . As a result of the ineffective government approach to drug treatment and care, Russia has one of the largest numbers of people who use drugs—government estimate reaches 5 million , while UNODC’s 2009 World Drug Report estimated that 1.6 million people use opiates . Meanwhile, the number of people living with HIV in Russia continues to rise; in 2010 alone, a total of 58,633 new HIV cases were officially registered in the country . Injecting drug use has long been the predominant risk factor, with around 80% of all HIV cases registered in the country from 1987 to 2008 associated with the use of injecting drugs . The government’s refusal to respond adequately to the main transmission risk means that most of the funding goes to the management of the consequences rather than prevention of new infections. It is clear that 3% of the entire budget cannot possibly reach the most vulnerable population in an effective manner, and even the 3% spent on prevention is spent inefficiently." . Eurasian Harm Reduction Network (EHRN): Vilnius, Lithuania, 2012.

95% of all drug crimes registered in Russia in 2013–2014 were prosecuted under articles 228 and 228.1 of its Criminal Code. The severity of a penalty under these articles depends on the type of drug offense (drug use or drug sale) and on the weight of the drug seized, which are classified via threshold quantities as “significant”, “large” or “especially large” ( , and ). According to the law, the drug quantity seized is determined not by the weight of the pure drug substance but by the weight of the entire mixture. Therefore, if a police officer seizes, for example, one gram of heroin mixed with two grams of sugar, it will be considered to be three grams of heroin. "The punishment for drug possession of a “significant” quantity, with no intention to sell, is a fine of up to approximately $1,138 , corrective labor, restriction of liberty, or imprisonment for up to three years. For “large” and “especially large” quantities, the punishment is imprisonment for three to ten and ten to fifteen years, respectively. In the case of voluntary surrender of drugs to a police officer and active assistance during the investigation, an offender is exempted from criminal liability. If the quantity of drugs seized is less than significant, only administrative penalties of a fine of up to approximately $142 or arrest for up to fifteen days can be imposed. "Drug sale is punishable by imprisonment for four to eight years if the quantity is less than “significant”, eight to fifteen years for a “significant” quantity, and ten to twenty years for a “large” quantity. “Especially large” quantities carry a fifteen to twenty years or life sentence. Thus, the crime is serious if the quantity of drug seized is less than “significant”, and most serious if the quantity is “significant” or higher." , Journal of Economic Behavior & Organization, Volume 212, 2023, Pages 1143-1172, ISSN 0167-2681, doi.org/10.1016/j.jebo.2023.05.021.

"Seven years ago, in May 2015, members of the Russian Civil Society Mechanism for Monitoring of Drug Policy Reforms compiled a letter to the UN High Commissioner for Human Rights with the title “Violations of human rights in the name of drug control in Russia” ( ). The situation is aptly summarised by the subheading: “Stigmatizing language, overreliance on punitive restrictions, indifference to human rights, and obliteration of science”. The developments since have accelerated on the same trajectory. "In 2017, the UN Committee on Economic, Social and Cultural Rights recommended that Russia change its punitive policy approach with an 18-month transformation and to consider decriminalising drugs for personal consumption. But nothing has really changed. In May 2018, the same members of the drug policy reform civil society made an update to the May 2015 report ( ) summarising: “No changes have occurred in Russian drug policy since that time [May 2015]. Russia fails to fulfill its commitment to respect, protect and promote all human rights, fundamental freedoms and the inherent dignity of all individuals and the rule of law in the development and implementation of drug policies” ( , p. 1)." . Nordisk Alkohol Nark. 2022 Aug;39(4):343-346. doi: 10.1177/14550725221108789. Epub 2022 Aug 12. PMID: 36003121; PMCID: PMC9379298.

"Our research demonstrates that a number of harm reduction-related needs among PWUD [People Who Use Drugs] can be met entirely through web outreach work, while some can only be partially met online. These findings are in line with the existing literature on online platforms bringing new opportunities to harm reduction services provision [18–20]. They also contribute to the growing amount of literature regarding the processes of web outreach work [22, 23] and bring new evidence on how various needs of PWUD are addressed by web outreach services. "We identified a three-stage process of web outreach work. The process illustrates the benefits that PWUD gain from online harm reduction services provision without face-to-face contact with web outreach workers. An absence of requirement for physical presence of PWUD at a harm reduction organization facilitates greater level of anonymity in comparison with offline harm reduction services provision. In addition, the use of text messages brings greater convenience to PWUD, who do not feel comfortable with discussing drug use-related issues in person. These factors indicate that web outreach work helps to encourage harm reduction behaviors among PWUD who, otherwise, might not seek or have access to brick-and-mortar harm reduction services." . Harm Reduct J 17, 98 (2020). doi.org/10.1186/s12954-020-00452-6.

"Our analysis of the needs of PWUD [People Who Use Drugs] and services provided to them demonstrates two major functions performed by web outreach workers: 1. They can provide certain services completely online, and 2. They navigate clients within the organization in order to match the needs of the PWUD with a person who can address them. Our research on web outreach work indicates an increasing level of efficiency that comes from online provision of harm reduction services. Instead of traveling to a harm reduction facility, PWUD can contact the organization via an online platform. Furthermore, harm reduction services provided entirely online gain particular relevance amidst the COVID-19 pandemic when offline harm reduction organizations experienced new challenges to providing in-person outreach services. "Our findings suggest that online harm reduction services provision can be improved in terms of accessibility and efficiency. A challenge for web outreach work, as described by informants, was the inability of workers to communicate with PWUD after hours. One possible solution is to automatize some processes with Telegram bots, as it was done with the cases of OD [Overdoses]. Currently, web outreach workers manually send information to PWUD. If automatized, then PWUD themselves could use a bot to get necessary information at any time of the day. However, not all services can be automatized with a bot; therefore, it may be necessary to employ some workers, who could reply to clients’ requests after hours. This is especially important in emergency situations, such as OD. Another way to develop provision of online harm reduction services is to increase their presence on darknet forums. Greater presence could potentially make online services accessible to more groups of PWUD, who request urgent help after hours and/or who do not use Telegram. Another obstacle in increasing accessibility of online harm reduction services was that some clients refused to continue communication with web outreach workers via the phone. More research is needed to explore the needs that PWUD have in such cases, identify the reasons why certain PWUD refuse to communicate via the phone, and explore how web outreach work can be provided in such instances." . Harm Reduct J 17, 98 (2020). doi.org/10.1186/s12954-020-00452-6.

"Revised data for the Russian Federation indicate annual prevalence of the use of opioids to be 2.3 per cent and the annual prevalence of heroin use: 1.4 per cent. Of the 9,263 drug-related deaths reported in 2010, 6,324 were attributed to opioid use." , United Nations publication, Sales No. E.12.XI.1.

"However, one problem markedly reduces naltrexone’s efficacy and has limited its use for treating heroin and other forms of opioid dependence worldwide: patients often do not like it and do not take it on a daily basis. The dropout rate with oral naltrexone has been better in the limited number of patients in whom there is substantial external motivation to remain abstinent, such as physicians who are in monitoring programs and could lose their license if they relapse, those involved in the criminal justice system who could go to prison if they relapse, and those facing loss of employment [1•, 2–4]. "A few US studies have shown positive effects with psychosocial or behavioral therapies. In two, contingency management combined with naltrexone was helpful [5, 6]. In another, naltrexone combined with individual [7] and group [2] psychotherapy yielded positive effects. A third tested a behavioral therapy that used rewards for negative urine tests [8]; however, it had a relatively limited effect and was identified by Nunes et al. [9] as one of several examples indicating that there appears to be a ceiling effect on the degree to which behavioral interventions can be used to improve naltrexone treatment outcomes." Curr Psychiatry Rep. 2010 October; 12(5): 448–453. doi:10.1007/s11920-010-0135-5.

"The science and practice of drug treatment in Russia – narcology – developed out of psychiatry in close collaboration with other state mechanisms of social control, including police agencies (Elovich and Drucker, 2008). Close links between narcology and police agencies remain (Bobrova et al., 2006). Access to drug treatment automatically requires official registration as an addict, which involves the removal of various citizenship rights, such as the rights to employment, as well as exposure to social stigma (Bobrova et al., 2006). The effectiveness of drug treatment approaches (which are modelled on alcohol detoxification methods) remain questionable, are linked to high rates of relapse, and are framed by a policy response at Federal level which prohibits the use of (internationally accepted) methadone and buprenorphine as substitution treatment (Elovich and Drucker, 2008; Mendelevich, 2004; Human Rights Watch, 2007). This policy rests on the rationale that treating addicts as patients would challenge policy discourse that labels drug users first and foremost as 'criminals' (Elovich and Drucker, 2008)." Subst Use Misuse. 2010 May; 45(6): 813–864. doi: 10.3109/10826081003590938.

"The growing number of young people abusing drugs is a serious concern. Worryingly, the overwhelming majority of drug addicts are between 18 – 30 years old. Many of them are unemployed, have a chronic history of offending and commit a large number of crimes to finance their addiction. As is the case in many other countries, the so-called ‘dark figure’ of crime – the mismatch between crime estimates produced by victimization surveys and those recorded by the police - is a well-known concept in Russia and most commentators agree that a relatively small number of opiate addicts are responsible for a staggering amount of acquisitive and violent crime. In this context it is worth noting that the Russian police registered around 12,000 crimes (of which 63 percent were rated as serious or extremely serious) which had been committed by offenders whilst they were suffering drug intoxication. "The increase in drug abuse amongst otherwise law-abiding people, particularly adolescents, is causing a good deal of concern. Over the last few years, more and more young people have become ensnared in the cycle of drug abuse and crime. In 2006, more than 3,000 adolescents committed drug related crimes. Of these, some 845 cases involved the distribution of drugs. Young people’s increasing willingness to abuse drugs which too often leads to addiction, prostitution and homelessness, poses a real threat to community safety." . UNODC Regional Office for Russia and Belarus, April, 2008.

"In the three Russian cities participating in this study, we found policing practices targeting injecting drug users (IDUs) to violate health, as well as individual rights. The brutality of police practices violate health directly, but also indirectly through the reproduction of day-to-day social suffering, which in turn can be internalized as self-blame, lack of self-worth, and fatalism regarding risk. These findings illustrate how law enforcement practices, particularly extrajudicial practices, generate an atmosphere of fear and terror, which shapes everyday practices of risk avoidance and survival among IDUs. Policing practices contribute to the reproduction and experience of stigma, and linked to this, a sense of fatalistic acceptance of risk, which may become crucial in shaping health behaviour, including HIV prevention. Yet we also identify nonconforming cases of resistance to such oppression, characterised by strategies to preserve dignity and hope. This leads us to consider how hope for change provides an important resource of risk reduction as well as escape, if only temporarily, from the pervasiveness of social suffering."

"The joint UNODC/WHO/UNAIDS/World Bank estimate of the number of PWID worldwide in 2018 is 11.3 million (range: 8.9 million to 15.3 million), corresponding to 0.23 per cent (range: 0.18 to 0.31 per cent) of the population aged 15–64. This estimate is based on the most recent information available and assessment of the methodologies of the different sources. "There is no change between the 2017 and 2018 estimates of PWID; however, any trend data must be viewed with caution, as methodologies may have changed. The 2018 global estimate of PWID is based on 122 countries, representing almost 90 per cent of the global population aged 15–64, compared with 110 countries in 2017. Of all the available sources in 2018, the estimates for at least 74 countries (61 per cent) were based on a “class A methodology” such as indirect prevalence estimation methods (e.g., the capture-recapture method, network scale-up method and multiplier method). "Owing to the criminalization of drug use, punitive laws, stigma and discrimination against people who use or inject drugs in many parts of the world, conventional survey methods have been found to underestimate the actual population size because of the hidden nature of PWID; therefore, only indirect methods have been shown to reflect the situation of PWID with greater accuracy. Overall, new or updated estimates of PWID were available for 40 countries in 2018. "Although the exact extent of injecting drug use is not known, estimates are more precise in some regions than others as a result of better data coverage and/or methodologies and the use of more recent data. Data on PWID vary between the regions in terms of coverage of the total population aged 15–64, with Asia having the highest coverage, at 95 per cent, and Africa having the lowest, at 68 per cent. At the subregional level, North America, South-West Asia, South Asia, Eastern Europe and South-Eastern Europe are fully covered, whereas data on PWID in the Caribbean only covers just over one third of the total population; therefore, data from that subregion must be interpreted with caution. Compared with 2017, coverage of the population in Africa increased substantially overall, from 58 to 68 per cent in 2018. "The prevalence of PWID aged 15–64 in 2018 continues to be the highest in Eastern Europe (1.26 per cent) and Central Asia and Transcaucasia (0.63 per cent). Those percentages are, respectively, 5.5 and 2.8 times higher than the global average. More than a quarter of all PWID reside in East and South-East Asia, although the prevalence itself is relatively low (0.19 per cent). The three subregions with the largest numbers of PWID (East and South-East Asia, North America and Eastern Europe) together account for over half (58 per cent) of the global number of PWID. It is noteworthy that, as in previous years, while three countries – China, the Russian Federation and the United States – account for just 27 per cent of the global population aged 15–64, they are home to almost half (43 per cent) of all PWID."

"In particular, Russian law forbids substitution therapy for opioid dependence with methadone or buprenorphine. Naltrexone is the only specific pharmacotherapy that is currently approved for use in the Russian Federation and is available as an oral tablet in extended-release formulations."

"There were more than 240,000 drug crimes (acquisition, sale, manufacture etc.) registered by the Russian law enforcement agencies in 2006 - a 23 percent increase over 2005. "Most of the crimes were committed in the large cities and industrial centres such as Moscow, St. Petersburg, Krasnodar, Kemerovo, Samara and Rostov. All these regions are located along the major drug trafficking routes. "The number of crimes classified as “serious”and “extremely serious” has increased by 13 percent (from 134,988 cases in 2005 to 152,824 cases in 2006), although the overall number of drug crimes dropped by 5 percent (from 77 percent in 2005 to 72 percent in 2006). However, the definition of an “extremely serious crime” includes those cases where the offender has been arrested for possession of more than 2.5 grams of heroin. "A similar trend is observed in drug trafficking cases where the number of these crimes increased by 12 percent in 2006 (100,000 cases in 2005 to 123,000 cases in 2006). However, in the context of all drug crimes, the proportion of drug trafficking cases actually declined by 5 percent (from 63 percent in 2005 to 58 percent in 2006)."

Officially-Reported Intentional Homicides And Rates Per 100,000 Population Reported By The Russian Federation, 2008-2012 Year Rate Count 2008 11.6 16,617 2009 11.1 15,954 2010 10.1 14,574 2011 9.6 13,826 2012 9.2 13,120 UNODC Global Study on Homicide 2013 (United Nations publication, Sales No. 14.IV.1), Table 8.1, p. 130. http://www.unodc.org/document… "Street-level policing practices in Russia have been found to fuel a pervasive sense of risk, and fear of arrest, fine or detainment, among IDUs, which in turn is linked to their reluctance to carry needles and syringes, thereby increasing the chances of high risk syringe sharing at the point of drug sale (Rhodes et al., 2003). Police agencies themselves emphasise a rationale of intense surveillance of drug users, enforced through a combination of extremely restrictive criminal articles on possession and the use of administrative codes unrelated to drug use (Rhodes et al., 2003, 2006). Moreover, civil society responses to HIV prevention, treatment and care for IDUs remain weak, as does public health policy and infrastructure, which depends heavily upon international donation (Sarang et al., 2007; Wolfe, 2007). Officials and health professionals give very weak endorsement to concepts such as ‘harm reduction’, which are still characterised by some as a corrupting influence of the West, and instead defer to normative social constructions of drugs users as unproductive, dangerous, and criminal (Tkathchenko-Schmidt et al., 2008; Elovich and Drucker, 2008; Wolfe, 2007)." Sarang, Anya, Rhodes, Tim, Sheon, Nicolas, and Page, Kimberly, "Policing Drug Users in Russia: Risk, Fear, and Structural Violence." Subst Use Misuse. 2010 May; 45(6): 813–864. doi: 10.3109/10826081003590938 http://www.ncbi.nlm.nih.gov/p… "Eighty-seven thousand people were arrested for drug related crimes in 2006 – an increase of 24 percent over 2005. "The increase in arrests and the fact that more traffickers are being prosecuted suggests that the Russian law enforcement agencies are becoming more effective. It is certainly the case that they are carrying out more covert operations directed against organized criminal groups and drug trafficking networks." UNODC, "Illicit Drug Trends in the Russian Federation" (UNODC Regional Office for Russia and Belarus, April, 2008), p. 20. http://www.unodc.org/document… As of September 1, 2018,, the Russian Federation's officially reported incarceration rate was 402 inmates per 100,000 of national population, with a reported total prison population of 582,889 out of an estimated national population of 144.9 million. In 2000, there were an estimated 1,060,404 people behind bars in Russia, for an incarceration rate of 729 per 100,000 of national population. Walmsley, Roy, "World Prison Population List (Twelfth Edition)" (London, England: International Centre for Prison Studies, Birkbeck, University of London, Nov. 2018), p. 14. http://prisonstudies.org/rese… http://prisonstudies.org/site… "Researchers have found that police harassment is one of the most important factors that exacerbate risky behavior among drug users in Russia. In a 2002 study of drug use in five Russian cities, 44 percent of drug users said they had been stopped by the police in the month prior to being interviewed, and two third of these said that their injecting equipment had been confiscated by the police. Over 40 percent added that they rarely carried syringes for fear of encountering the police with them. In the Togliatti study, Rhodes and colleagues found that fear of being arrested or detained by the police was the most important factor behind the decision of drug users not to carry syringes, which in turn was an important determinant of sharing syringes during injection. This study concluded that drug users who had been arrested or detained by the police for drug-related offenses were over four times more likely than other users to have shared syringes in the previous four weeks. Drug users who feared the police in Togliatti tended to avoid not only syringe exchange services but also drug stores that sold syringes because police frequently targeted people buying syringes at such locations, a result also highlighted in a 2003 study of drug users in Moscow." Human Rights Watch, "Lessons Not Learned: Human Rights Abuses and HIV/AIDS in the Russian Federation," New York, NY: April 2004, Vol. 16, No. 5. "Being in prison or other state detention is an important risk factor for HIV in Russia. A very high percentage of drug users in the FSU [former Soviet Union] find themselves in state custody at some time in their lives. Injection drug use is reportedly widespread in Russian prisons, and HIV prevention services such as provision of sterile syringes, disinfectant materials for syringes and condoms are virtually absent. Official statistics indicate that from 1996 to 2003, HIV prevalence in Russian prisons rose more than thirty-fold from less than one per 1,000 inmates to 42.1 per 1,000 inmates. According to a 2002 report, about 34,000 HIV-positive persons—over 15 percent of the persons officially counted as HIV-positive in the country—were in state custody, of which the large majority found out about their HIV status in prison. The Kresty pretrial detention facility in Saint Petersburg was reported in 2002 to have about 1,000 HIV-positive persons among its 7,800 inmates. Some 300,000 prisoners are released each year from penal institutions in Russia, representing an important public health challenge." "This was a couple of years after Russia had toughened its drug laws, lowering the minimum punishable dose to such a level that virtually any user could land behind bars. By 2004, the Justice Ministry estimated that 300,000 people were serving drug-related sentences in Russian prisons. "That year the government -- responding in part to pressure from the Justice Ministry, which was fighting prison overpopulation -- raised the minimum punishable doses of illegal drugs, essentially ensuring that users who had no intent to sell would not be arrested. The police were incensed, arguing that some dealers took to carrying amounts just below the punishable level -- but still sufficient to satisfy between one and nine users. In other words, the police complained, they were being prevented from arresting users and small-time dealers and forced to focus on real drug dealers, whom they didn't want to touch with a 10-foot pole. "The more-liberal policy lasted less than two years. The minimum punishable dose has been lowered again -- in most cases, by more than 50 percent. The dose is not quite as low as pre-2004 levels, but still low enough to put even casual users at risk." Gessen, Masha, "Anti-Drug Laws for Drug Dealers," Moscow Times, February 16, 2006. http://www.mapinc.org/newscsd… "In 2010 an estimated 25 per cent of the 380 tons of heroin manufactured in Afghanistan -some 90 tons- was trafficked northwards through Central Asia via the Northern route and onward to the Russian Federation. The 90-ton total includes heroin consumed within Central Asia and the Russian Federation, as well as heroin seized by law enforcement or trafficked onward. More than three quarters of this amount are destined for the Russian market, with a small portion (approximately 3-4 tons) continuing to eastern and northern Europe.1 Furthermore, in 2010 between 35 and 40 tons of raw opium were trafficked through northern Afghanistan towards Central Asian markets. The entire 2010 opiate demand of the Northern route is required to transit or be produced in northern Afghanistan." United Nations Office on Drugs and Crime. Opiate Flows Through Northern Afghanistan and Central Asia: A Threat Assessment . UNODC Afghan Opiate Trade Project of the Studies and Threat Analysis Section (STAS), Division for Policy Analysis and Public Affairs, May 2012. "In Central Asia, traffickers have access to a well-developed road and rail network. Around 70-75 per cent of opiates are transported by truck or another vehicle across Central Asia through Kazakhstan to major cities in south-western Russia and western Siberia. 108 Trains and planes usually account for approximately 15-25 per cent of trafficking. Seizures on trains have been on the rise as of 2011, particularly in Uzbekistan. Based on available data for Central Asia and Russia, in 2011 the average size of heroin seizures on trains was 6 kg, out of a reported 55 seizures (at the time of this writing). Shipments can, however, be much larger, as shown by two heroin seizures of 191 kg and 118 kg made in 2010 in the Russian Federation and Tajikistan, respectively." United Nations Office on Drugs and Crime, "Opiate Flows Through Northern Afghanistan and Central Asia: A Threat Assessment" (UNODC Afghan Opiate Trade Project of the Studies and Threat Analysis Section (STAS), Division for Policy Analysis and Public Affairs, May 2012), p. 48. http://www.unodc.org/document… "Russia remains a major destination country for Afghan opiates and other illicit drugs. According to a major Russian media report that cited official sources, Russia consumes between 75 and 80 metric tons (MT) of heroin each year. Illegal drugs are smuggled across Russia's Baltic and Black Sea ports and extensive land and rail routes. "The amount of drugs seized by the Federal Drug Control Service (FSKN) increased from 24 MT in 2011 to 34 MT in 2012. FSKN seizures over the first six months of 2013 (18 MT) remained on pace to match or exceed 2012 totals. Significant interdictions included a 45 kilogram (kg) seizure of synthetic drugs in the Kurgan region and a 187 kg seizure of heroin in the Moscow region, estimated to be worth $180 million at street-value by FSKN." United States Department of State Bureau for International Narcotics and Law Enforcement Affairs, "International Narcotics Control Strategy Report: Volume I: Drug and Chemical Control," Washington, DC: March 2014. "The widespread trafficking of cannabis continues unabated. The trafficking is fuelled by the fact that cannabis grows wild in a number of regions in Russia and so is readily available. Indeed, the Russian Federation and neighbouring Kazakhstan contain the world’s largest areas of wild cannabis and the Russian authorities estimate that production of wild cannabis in Russia is around one million (1,000,000) hectares. Depending on the climate conditions, one hectare of cannabis may produce up to 1 million seeds with 5-8 years of reproduction cycle. The THC content of cannabis differs in different regions but tends not to exceed 5 percent. Since 1992, cannabis seizures steadily increased 8 times and reached 89.7 tons in 2004. However, seizures sharply decreased almost threefold in 2005 (30.6 tons) and continued to decrease in 2006 (23.7 tons)." United Nations Office on Drugs and Crime, "Illicit Drug Trends in the Russian Federation" (UNODC Regional Office for Russia and Belarus, April, 2008), p. 13. http://www.unodc.org/document… "Russia has the largest population of injecting drug users (IDUs) in the world — an estimated 1·8 million people. More than a third have HIV; in some regions, the proportion is nearer to three-quarters. Astonishingly, an estimated 90% of Russian IDUs have hepatitis C, and most patients co-infected with HIV and tuberculosis in Russia are drug-dependent." Talha Burki, "Russia’s drug policy fuels infectious disease epidemics," The Lancet, Vol. 12, April 2012, p. 275. "In the Russian Federation, decreased availability of heroin has led to its partial replacement with local and readily available substances such as acetylated opium, as in Belarus, and with desomorphine, a homemade preparation made from over-the-counter preparations containing codeine. 41 " UNODC, World Drug Report 2013 (United Nations publication, Sales No. E.13.XI.6), p. 17. https://www.unodc.org/wdr/ind… https://www.unodc.org/unodc/s… "The illicit manufacturing of synthetic drugs remains one of the major concerns. A thriving chemical industry, often lacking sufficient regulatory control, means that precursor chemicals are easily obtained by Russian criminals and are used in the production of synthetic drugs for both the domestic and foreign markets. The current trend seems to be that precursors used in the production of ATS are trafficked to European countries whilst precursors used in the production of heroin, are trafficked to Asia. "In terms of domestic production, so-called “kitchen labs”, still prevail. The majority of these laboratories produce relatively small amounts of pervitine (ATS) for local consumption. This drug is widely abused and in terms of injecting users, is second only to heroin and other opiates. "In 2006, there were 1,486 registered cases of illicit production of drugs (+14 percent compared to 2005). The main types of drugs illicitly produced in clandestine labs are amphetamines, methamphetamines, 3-methylfentanyl, and phencyclidine. It is rather reassuring to report that there are very few cases when illicit synthetic drugs were produced in laboratories at industrial facilities and most of the clandestine laboratories are either the “kitchen labs”, described above, or otherwise small scale, rudimentary enterprises." United Nations Office on Drugs and Crime, "Illicit Drug Trends in the Russian Federation" (UNODC Regional Office for Russia and Belarus, April, 2008), p. 14. http://www.unodc.org/document… "In 2002, an estimated 93 percent of persons registered by the government as HIV positive since the beginning of the epidemic were injection drug users. In contrast, in 2002 an estimated 12 percent of new HIV transmission was sexual -- that figure climbed to 17.5 percent in the first half of 2003 -- indicating the foothold that the epidemic is gaining in the general population. The European Centre for the Epidemiological Monitoring of AIDS (EuroHIV), a center affiliated with the World Health Organization, noted that HIV prevalence may have 'reached saturation levels in at least some of the currently affected drug user populations' in eastern Europe, including in Russia, but cautioned against complacency 'as new outbreaks could still emerge among injection drug users , particularly within the vast expanse of the Russian Federation.' Rhodes and colleagues in a February 2004 article echo this conclusion, noting evidence of recent examples of severe HIV outbreaks among drug users in Russia." "There is no doubt that drug use and heroin use particularly have risen meteorically in Russia since 1990. Mikhailov said the total number of drug users had risen 900 percent in the decade ending in early 2004. A Max Planck Institute study of the drug trade in Russia concluded that drug-related crimes increased twelve-fold from 1990 to 1999. Many analysts have traced the dramatic rise in use of injected heroin since the fall of the Soviet Union to economic collapse and attendant rises in unemployment, poverty and desperation and to increased availability of cheap heroin trafficked through central Asia and across the former Soviet states. Some observers have suggested that the aftermath of the events of September 11, 2001 in Afghanistan and central Asia has done nothing to stem the flow of heroin through the region and may even exacerbate it in the long run. Mikhailov of the SDCC has told the press on numerous occasions that the United States military intervention in Afghanistan has contributed to heroin consumption in Russia because the Taliban had been able to suppress opium production before they were overthrown. In 2003, Victor Cherkesov, head of the SDCC, said the drug trade in Russia was valued at about U.S. $8 billion a year." "The Russian Federation borders on a generalised epidemic with a population prevalence of 1.0% (95% CI 0.9% to 1.2%). 2 Official registration data from 2010 indicated over 38 000 prevalent cases in Moscow, 3 the largest city of the Federation and the political and economic hub. The continued rise of HIV parallels the increase in sexually transmitted infections (STIs), most notably syphilis and Chlamydia, in the years following the fall of the Soviet Union, 4 5 which subsequently stabilised to approximately 78.5 and 100.8 per 100 000, respectively, by 2004. 6 "Russia’s epidemic is largely concentrated among vulnerable populations. 2 7 Injection drug use (IDU), responsible for over half of all new infections, has been considered the primary driver. 8 Sexual transmission is increasingly common and contributes approximately one-third of new HIV cases. 8 9 Decker MR, Wirtz AL, Baral SD, et al., "Injection drug use, sexual risk, violence and STI/HIV among Moscow female sex workers," Sexually Transmitted Infections (2012), doi:10.1136/sextrans-2011-050171 http://sti.bmj.com/content/ea… "There is some controversy over the number of narcotic drug users in Russia. Dr. Vadim Pokrovsky of the Federal AIDS Center said that estimates of the number of active drug users in Russia in February 2004 ranged from 1 to 4 million, and he believed the high end of that range reflected the reality. On February 20, 2004, Alexander Mikhailov, the deputy director of the State Drug Control Committee (SDCC), a federal body, was cited in Pravda as saying that Russia had over 4 million drug users, and that the "gloomy prediction" of his office was that Russia could have over 35 million drug users by 2014. In early January 2004, the executive secretary of the Commonwealth of Independent States, which includes twelve former Soviet states, predicted that in 2010 the twelve countries would have 25 million drug users of whom 10 million would be living with HIV/AIDS, the vast majority in Russia." "By far the highest prevalence of HIV among PWID [People Who Inject Drugs] is in South-West Asia and in Eastern and South-Eastern Europe, with rates that are, respectively, 2.4 and 1.9 times the global average. Together, those two subregions account for 49 per cent of the total number of PWID worldwide living with HIV. Although the prevalence of HIV among PWID in East and South-East Asia is below the global average, 24 per cent of the global total of PWID living with HIV reside in that subregion. An estimated 53 per cent of PWID living with HIV worldwide in 2016 (662,000 people) resided in just three countries (China, Pakistan and the Russian Federation), which is disproportionately large compared with the percentage of the world’s PWID living in those three countries (35 per cent)." World Drug Report 2018. United Nations publication, Sales No. E.18.XI.9. https://www.unodc.org/wdr2018/ https://www.unodc.org/wdr2018… "In Russia, substitution therapy is forbidden by law, and naltrexone is the only available pharmacotherapy for heroin dependence. Due to the lack of alternatives to naltrexone and stronger family control of compliance (adherence), naltrexone is more effective for relapse prevention and abstinence stabilization in Russia than in Western countries. Long-acting, sustained-release formulations (injectable and implantable) seem particularly effective compared with oral formulations." Krupitsky, Evgeny, Zvartau, Edwin, and Woody, George, "Use of Naltrexone to Treat Opioid Addiction in a Country in Which Methadone and Buprenorphine Are Not Available," Current Psychiatry Reports, 2010 October; 12(5): 448–453. doi:10.1007/s11920-010-0135-5. http://www.ncbi.nlm.nih.gov/p… http://www.ncbi.nlm.nih.gov/p… "With a net profit of US$ 1.4 billion from the heroin trade alone, in 2010 drug traffickers earned the equivalent of a third of the GDP of Tajikistan (US$ 4.58 billion) or Kyrgyzstan, 269 but only 5 per cent that of Uzbekistan (US$ 28 billion) and 1 per cent of that of Kazakhstan. The economies of Kyrgyzstan and Tajikistan appear to be the most vulnerable in Central Asia, while in Kazakhstan the entire amount would constitute a very small part of total economic activity." United Nations Office on Drugs and Crime, "Opiate Flows Through Northern Afghanistan and Central Asia: A Threat Assessment" (UNODC Afghan Opiate Trade Project of the Studies and Threat Analysis Section (STAS), Division for Policy Analysis and Public Affairs, May 2012), pp. 85-86. http://www.unodc.org/document… "Studies conducted in St. Petersburg, Russia, for more than a decade have demonstrated the efficacy and safety of different naltrexone formulations (oral, implantable, injectable) for relapse prevention and maintenance of abstinence in detoxified opioid addicts. The positive results from different formulations seem related to two cultural factors. One is that relatives can be recruited to supervise daily dosing of the oral formulation. However, this advantage is decreasing as the addicted population ages. The second is that substitution therapy is not available; thus, naltrexone is the only effective medication available, which makes it easier to motivate patients to use it. Preliminary findings from studies of long-acting, slow-release formulations of naltrexone (implantable and injectable) suggest that they are more effective than the oral formulations and are likely to be important additions to current treatments. How they compare with maintenance treatment using methadone or buprenorphine in settings in which these three treatment options are available is a topic for future studies." Krupitsky, Evgeny, Zvartau, Edwin, and Woody, George, "Use of Naltrexone to Treat Opioid Addiction in a Country in Which Methadone and Buprenorphine Are Not Available," Curr Psychiatry Rep. 2010 October; 12(5): 448–453. doi:10.1007/s11920-010-0135-5. http://www.ncbi.nlm.nih.gov/p… http://www.ncbi.nlm.nih.gov/p… "More than half of all cases are related to drug possession with no intent to supply, which refers primarily to people who use drugs rather than traffickers. This highlights the fact that Russia prioritizes punishment of people who use drugs in its war against illegal drugs, a situation further underscored by the following: "• In 2010 about 108,000 people were convicted for drug crimes (under Articles 228–233 of the Criminal Code) 30 ; of them, nearly two-thirds (no fewer than 64.7%) were convicted for drug possession with no intent to supply 31 . More than 104,000 people were charged with fines and administrative arrest for mere drug use or possession of drugs in tiny amounts (e.g., 0.5 grams of heroin or less). 32 "• Russian laws define 'large' and 'extra large' amounts of drugs to be much lower than the average quantity necessary for daily use. That is because for some narcotic drugs, such as heroin, marijuana or methadone 33 , the 'large' and 'extra large' amounts are determined not by the weight of the pure substance but by the weight of the entire mixture seized 34 ." Merkinaite, S. A war against people who use drugs: the costs . Eurasian Harm Reduction Network (EHRN): Vilnius, Lithuania, 2012. "A dynamic model of HIV transmission among people who inject drugs in Russia suggests that assuming a baseline HIV prevalence of 15%, increasing coverage of OST from 0% to 25% of all people who inject drugs could decrease HIV incidence by between 44% and 53% 108 ." "Money laundering continues to cost the Russian economy billions of dollars every year. In 2012, the Central Bank of Russia (CBR) estimated that $49 billion left Russia illegally. Of this, $35 billion left Russia through what the CBR terms 'fictitious transactions,' which according to the CBR includes payment for narcotics, bribes to government officials, and tax evasion. While there has been significant progress in improving Russia's AML/CFT legal and enforcement framework, the prevalence of money laundering in Russia remains a major obstacle to financial sector development. Domestic sources of laundered funds include organized crime, evasion of tax and customs duties, fraud, smuggling operations, and corruption. "Official corruption remains a major problem at all levels of government. Despite several recent high profile anti-corruption actions by the Government of Russia, corruption is a major source of laundered funds, with proceeds frequently moved offshore. "Russia is considered a significant transit and destination country for international narcotics traffickers; criminal elements from Russia and neighboring countries continue to use Russia's financial system and foreign legal entities to launder money. Criminals invest and launder their proceeds in securities instruments, both domestic and foreign real estate, and luxury consumer goods." United States Department of State Bureau for International Narcotics and Law Enforcement Affairs, "International Narcotics Control Strategy Report: Volume II: Drug and Chemical Control," Washington, DC: March 2014. "In 2010 alone, the prosecution of drug offenders (for use and supply) cost at least $100 million in Russia. In comparison, under the Budget Law for 2011, HIV prevention programming is to receive less than 3% of the total $640 million to be allocated in 2012 through the Federal Budget Law for HIV, hepatitis B and C, and the government continues to prohibit internationally accepted drug treatment interventions such as OST [Opioid Substitution Treatment]. The government therefore will spend millions more treating people infected with HIV than it would have in protecting their health and reducing transmission." "It is important to note that profits made from trafficking Afghan opiates into Central Asia (USD 344 million) in 2010 are dwarfed by the net profit pocketed by criminals trafficking onwards to the Russian Federation, which was around US$ 1.4 billion in 2010. This calculation does not include other drugs such as those of the cannabis group, which are also trafficked through the region. "The mark-up on heroin brought into Central Asia and sold in the Russian Federation is as much as 600 per cent. As shown in the figure below, as prices increase purity decreases; this is explained by the growing distance from the source and by the practise of cutting the heroin with adulterants. This means that 1 kg of heroin at 70 per cent purity can become 2 kg at 35 per cent purity. This inversely proportional relationship between price increase and decrease in quality translates into greater profits for traffickers." United Nations Office on Drugs and Crime, "Opiate Flows Through Northern Afghanistan and Central Asia: A Threat Assessment" (UNODC Afghan Opiate Trade Project of the Studies and Threat Analysis Section (STAS), Division for Policy Analysis and Public Affairs, May 2012), p. 85. http://www.unodc.org/document… "It is important to note that Russian law enforcement agencies—including the Federal Drug Control Service (FDCS), which has an annual budget of $73 million35—often use drug charges as a way to silence political opponents, including human rights activists and journalists. A few examples: "• Since August 2011 Russian law enforcement agencies have been trying to suppress activities of the Andrey Rylkov Foundation (ARF), an organization that promotes and defends human rights of people who use drugs in Russia. First, ARF activist Irina Teplinskaya was planted with a tablet of methadone when she crossed the border from Ukraine to Russia in August 2011. Then in early 2012 the ARF website was shut down by the FDCS, which claimed that the information about OST posted on the ARF website should be categorized as drug propaganda, and thus prohibited under Russian drug laws 36 . "• Political activists Taisiya Osipova was prosecuted based on falsified drug charges by an anti-extremist police unit. In December 2011, despite obvious violations of procedural and substantial laws, Osipova was sentenced to 10 years in prison 37 . "• In April 2011 Evgeny Konyshev was planted with drugs by representatives of the 'City Without Drugs' Foundation after he openly testified on a federal TV channel about the Foundation’s ineffective and inhumane practices under the pretence of drug treatment. Despite multiple violations of procedural and substantial laws committed during the pre-trial investigation, by the end of February 2012 Konyshev remained in pre-trial detention facing a charge of possession of 'extra large' quantity of heroin (2.72 grams) with no intent to sell 38 . "• In 2010 anticorruption activist Denis Matveev was sentenced to six years imprisonment based on false accusation of drug trafficking after he reported corruption in his city involving police officers and members of the mayor’s office 39 ." "In the last three to five years an increasing number of reports suggest that people who inject drugs (PWID) in Russia, Ukraine and other countries are no longer using poppies or raw opium as their starting material, but turning to over-the-counter medications that contain codeine (e.g. Solpadeine, Codterpin or Codelac). Codeine is reportedly converted into desomorphine (UNODC, 2012; Gahr et al., 2012a, 2012b, 2012c; Skowronek, Celinski, & Chowaniec, 2012). The drug is called Russian Magic, referring to its potential for short lasting opioid intoxication or, more common, to its street name, krokodil. Krokodil refers both to chlorocodide, a codeine derivate, and to the excessive harms reported, such as the scale-like and discolored (green, black) skin of its users, resulting from large area skin infections and ulcers. At this point, Russia and Ukraine seem to be the countries most affected by the use of krokodil, but Georgia (Piralishvili, Gamkrelidze, Nikolaishvili, & Chavchanidze, 2013) and Kazakhstan (Ibragimov & Latypov, 2012; Yusopov et al., 2012) have reported krokodil use and related injuries as well." Grund, J. -P. C., et al. "Breaking worse: The emergence of krokodil and excessive injuries among people who inject drugs in Eurasia." International Journal of Drug Policy (2013), http://dx.doi.org/10.1016/j.d… http://www.ijdp.org/article/S… "In considering the drug krokodil, two aspects are of importance, its pharmacology and its chemistry. The short half-life, limited high after the impact effect and, in particular the need for frequent administration may narrow the attention of users on the (circular) process of acquiring, preparing and administering the drug, leaving little time for matters other than avoiding withdrawal and chasing high, as reported in several popular magazines (e.g. Shuster, 2011; Walker, 2011). However, when the layers of bootleg chemistry and attribution are peeled off, what’s left is an opioid analogue (or several ones) that, besides the variations in half-life, behaves pharmacologically not very different than heroin or Hanka (Haemmig, 2011). There are various paths to synthesize desomorphine from codeine, but the chemical process most commonly reported to be used by PWID in Russia and Ukraine is very similar to that of home-produced methamphetamine or Vint (Grund, Zábransky, Irwin, & Heimer, 2009; Zábransky, 2007) – a rudimentary version of a simple chemical reduction. The illicit production of krokodil reportedly involves the processing of codeine into the opiate analogue desomorphine (UNODC, 2012; Gahr et al., 2012a, 2012b, 2012c; Skowronek et al., 2012). Desomorphine (Dihydrodesoxymorphine-D or PermonidTM ) is an opiate analogue first synthesized by Small in 1932 (Small, Yuen, & Eilers, 1933). The analgesic effect of desomorphine is about ten times greater than that of morphine (and thus stronger than heroin), whereas its toxicity exceeds that of morphine by about three times (Weill & Weiss, 1951). The drug’s onset is described as very rapid but its action is of short duration, which may lead to rapid physical dependence and frequent administration." "In recent years, harm reduction and drug treatment services from Russia, Ukraine, Georgia and Kazakhstan began reporting severe health consequences associated with krokodil injecting. Although serious localized and systemic harms have previously been associated with injecting homemade opiates and stimulants in the region (Grund, 2002; Volik, 2008), the harms associated with krokodil injecting are extreme and unprecedented. The most common complications of krokodil appear to be serious venous damage and skin and soft tissue infections, rapidly followed by necrosis and gangrene (Gahr et al., 2012a, 2012b, 2012c; Skowronek et al., 2012). Our research further identified an impressive, undoubtedly incomplete, list of injuries and symptoms (Table 1), reported in the media (e.g. Shuster, 2011; Walker, 2011) and identified in YouTube clips and photographs on the internet. Importantly, this list includes several parts of the body that are not typically used as sites for injecting drugs. This suggests that the ill effects of krokodil are not limited to localized injuries, but spread throughout the body (Shuster, 2011; UNODC, 2012), with neurological, endocrine and organ damage associated with chemicals and heavy metals common to krokodil production (Lisitsyn, 2010). "It is important to note that the described harms seem to become manifest relatively shortly after krokodil injecting is initiated. Present accounts of krokodil related harms often concern young people presenting in emergency rooms and surgeries with extreme and advanced complications. According to NGOs that work with people who inject krokodil, these young people have relatively short histories of using the drug. Mortality rates among young krokodil users are reportedly high (Akhmedova, 2012; Shuster, 2011; Walker, 2011), with official reports associating krokodil use with half of all drug-related deaths in at least two Oblasts (Walker, 2011)." "The estimated number of PWID in Russia was close to 2 million in 2008 (Mathers et al., 2008). 2.3% of the Russian population uses opioids annually and 1.4% heroin, compared to an annual prevalence of 0.4% opioid use in Western and Central Europe (UNODC, 2012). While actual epidemiological data is not available, a number of academic and media reports suggest that 5% or more of Russian drug users (approximately 100,000 PWID) may be injecting krokodil (Walker, 2011), while 'various official estimates' place the numbers of Russian PWID using krokodil as high as one million (Shuster, 2011). Epidemiological data is critical to evaluating claims that the use of krokodil is reaching epidemic proportions in Russia (Walker, 2011), and potentially, the Ukraine. There are an estimated 290,000 to 375,000 PWID in Ukraine (Mathers et al., 2008). A recent national survey found that 7% of PWID have used krokodil in 2011 (Balakireva, 2012), suggesting that around 20,000 PWID in Ukraine may have used krokodil that year. Balakireva and colleagues furthermore found statistically significant differences in krokodil use between the cities in the study, with most krokodil use reported in Uzhhorod (35.6%), Simferopol (26.9%), Kyiv (21.7%), Chernivtsi (15.5%) and Donetsk (12.6%). Estimates from other countries are not available. Outside of the former Soviet region, krokodil has been reported in Germany (Der Spiegel, 2011) and in Tromsø in northern Norway (Lindblad, 2012)." "In sum, these observations suggest that the relatively limited availability of black market opiates and stimulants and the relative ease of harvesting legal precursors to powerful analogues from the countryside and pharmacies inspired and sustained a Soviet-style homemade drug culture in the Eastern European region that remains radically different from those observed in countries where narco-traffickers dominate the production and distribution of drugs (Booth, Kennedy, Brewster, & Semerik, 2003; Grund et al., 2009; Grund, 2005; Subata & Tsukanov, 1999; Zábransky, 2007). "The physical and logistical exigencies of home production; its locus in networks of drug injecting friends and the high degree of cooperative action involved (in foraging for, producing and using the drugs); the multiple roles and ambiguous status of injecting paraphernalia; the routine occurrence of well-known risk behaviours (e.g. syringe sharing, frontloading) and those currently less well understood, such as the slapdash nature of the bootleg drug synthesis and its unpredictable outcomes in terms of actual drug product, purity and pollution— indeed all of these factors contribute to and interact within the vastly complex high risk environment of home drug production in the region." "In Russia and many other post-Soviet countries, the old ideology lingers on in narcological institutes, out of sync with modern public and mental health concepts (Grund et al., 2009). Many narcologists continue to view addiction as criminal or moral deviance and not as a disease. Narcological dispensaries continue to share information with law enforcement (Mendelevich, 2011). The threat of removal of child custody rights may impede women’s access to health care in particular (Shields, 2009). Stigma and discrimination, hostile treatment and lack of confidentiality are persistent in the treatment of PWID and must be viewed as important barriers to timely seeking medical care (Beardsley & Latypov, 2012; Mendelevich, 2011; Wolfe et al., 2010). PWID have therefore strong incentives to avoid narcological facilities and, by association, other state health services. In their personal 'hierarchy of risk,' seeking help for significant health problems is subordinated by the need to stay under the radar of the authorities (Connors, 1992). Several of the YouTube clips on the internet furthermore document not only the gravity of harms among krokodil users, but also poor and inhumane treatment of those hospitalized with krokodil related injuries. In one video a man’s leg is sawn off under the knee with a lint saw in what seems not to be a surgical unit, but perhaps a common hospital ward. The man sits wide-awake in an ordinary wheelchair and holds his leg himself above a bucket, which was lined with a garbage bag just before. These videos and case reports (Asaeva et al., 2011; Daria Ocheret, personal communication, 2012; Sarah Evans, personal communication, 2012) suggest that the care provided to those with krokodil related injuries may be (grossly) substandard, sometimes exacerbated by improper diagnosis and faulty clinical decisions." "In June 2012, the government launched the 'State Counternarcotics Strategy until 2020' that calls all agencies and all levels of government to join in the fight against illicit drugs. The Strategy urges improvements in supply and demand reduction, and outlines new legislation aimed at deterring drug trafficking. An important development in implementing the Strategy in 2012 was the signing in March by then-President Medvedev of a law stipulating life sentences for trafficking large quantities of drugs. Previously, the maximum sentence was 20 years. The law also allows for the confiscation of property and money obtained by drug dealing." United States Department of State Bureau for International Narcotics and Law Enforcement Affairs, "International Narcotics Control Strategy Report: Volume I: Drug and Chemical Control" (Washington, DC: March 2013), p. 277. "The MVD and the Federal Security Service (FSB) are Russia’s two federal agencies responsible for drug-related investigations.  Minister of Internal Affairs Vladimir Kolokoltsev is the Chair of the State Anti-Drug Committee, which coordinates Russia’s drug control policy.  The Ministry of Health is the primary government body responsible for drug user rehabilitation.  The Ministry of Health, Ministry of Education, MVD, and a number of other agencies and public organizations administer drug abuse prevention programs." US Department of State, "International Narcotics Control Strategy Report: Volume I: Drug and Chemical Control," Washington, DC: State Dept. Bureau for International Narcotics and Law Enforcement Affairs, March 2021. "The system of penalties for juveniles facing criminal charges in Russia is based on suspended sentences or detention in educational correctional facilities, which house young offenders aged up to 21 years. The average sentence is four years. Only one quarter of adult recidivists considered a high-risk to society are said to have been admitted to a VK [educational correctional facilities] as juveniles." United Nations Office for Drug Control and Crime. Illicit Drug Trends in the Russian Federation, 2005 . Moscow, Russian Federation: UNODC Regional Office for Russia and Belarus, November 2006. "Although in Russia drug use per se is not criminalized as in Georgia, possession without intent to supply in amounts exceeding 0.5 grams for heroin, opium or desomorphine is considered a crime and is punished by incarceration for up to three years 27 . At the same time it is important to emphasize that even where drug use is not a criminal offence, most countries apply administrative liability for it; in Russia, drug use can therefore result in 15 days arrest, which according to the European Court on Human Rights is equal to criminal liability. "Experts estimate that in 2010 alone, prosecution for all drug offenders (demand and supply) cost an estimated $100 million in Russia 28 . That amount covers most expenses from the moment of arrest to the court decision, including those associated with operational-search measures, detention, preliminary investigation and court appearances (including payment for lawyers). It does not include the costs of pre-trial detention, incarceration after conviction or executing non-custodial sanctions, such as community service, fines, etc. 29 "• In 2010 about 108,000 people were convicted for drug crimes (under Articles 228–233 of the Criminal Code) 30 ; of them, nearly two-thirds (no fewer than 64.7%) were convicted for drug possession with no intent to supply 31 . More than 104,000 people were charged with fines and administrative arrest for mere drug use or possession of drugs in tiny amounts (e.g., 0.5 grams of heroin or less). "• Russian laws define “large” and “extra large” amounts of drugs to be much lower than the average quantity necessary for daily use. That is because for some narcotic drugs, such as heroin, marijuana or methadone 33 , the “large” and “extra large” amounts are determined not by the weight of the pure substance but by the weight of the entire mixture seized 34 ." "Substitution (or replacement) therapy such as methadone maintenance therapy, which has been widely credited with controlling HIV transmission among injection drug users in many countries, is illegal in Russia, and the 2003 amendments to the drug law did not change this. Methadone is classified as "illicit" by the terms of the three United Nations conventions on drug control, though most countries that are signatories to the conventions have methadone programs that are successful in substituting injected heroin with noninjected methadone. In this case, neither the SDCC [State Drug Control Committee] nor the Ministry of Health seems necessarily disposed to review the status quo. Dr. Golyusov of the Ministry of Health said that he is concerned by first-hand accounts from drug users that methadone is more addictive or "harder to get off" than heroin and that other countries' experiences have been "contradictory."" "Russia has a legislative and financial monitoring structure that facilitates the tracking, seizure, and forfeiture of all criminal proceeds. Russian legislation provides for investigative techniques such as wiretapping, search, seizure and the compulsory production of documents. Legislation passed in 2004, entitled: "On Protection of Victims, Witnesses and Other Participants in Criminal Proceedings" extends legal protection to all parties involved in a criminal trial. Prosecutors or investigators may recommend that a judge implement witness protection measures if they learn of a threat to the life or property of a participant in a trial." United States Department of State Bureau for International Narcotics and Law Enforcement Affairs, "International Narcotics Control Strategy Report: Volume I: Drug and Chemical Control," State Dept: Washington, DC, March 2012. "Because of drug laws that have historically criminalized the possession of very small amounts of narcotics, drug users in Russia face a high probability of spending time in prison or pretrial detention at some time in their lives. Injection drug use is widespread in prisons. But basic HIV prevention measures, including condoms and materials for sterilization of syringes, are largely lacking in Russian correctional facilities, making prisons across the country high-risk environments for AIDS. The vast numbers of prisoners released every year thus represent a public health challenge for the general population. Both in and outside of prison, the virtual absence of humane services to treat drug addiction and the illegality in Russia of methadone and other drugs used elsewhere to treat heroin addiction further compromise HIV prevention among drug users." "The main reasons cited for restricting the opportunity of drug users to obtain medical and social aid, including prevention services, are the legislative barriers and official policy course that emphasizes reducing supply through law enforcement and reducing demand by promotion of 'healthy lifestyle'. The Strategy of the Anti-Narcotic Policy of the Russian Federation until 2020 61 and the plan to implement the strategy reaffirmed that approach. The 10-year plan restricts all activities and advocacy associated with harm reduction and other evidence-based services for people who use drugs. OST [Opioid Substitution Treatment] and NSPs [Needle and Syringe Exchange Programs] are considered antithetical to the strategy because they are 'attempts to legalize substitution therapy with use of narcotic drugs and promotion of drug use under pretext of syringe replacement'. Non-governmental organizations (NGOs) are prohibited from providing information on OST and other treatment and prevention measures opposed by the government. Such restrictive policies clearly indicate that the punishment and social isolation of people who inject drugs is the basis of state’s strategic approach to drug demand reduction. These policies have high financial and social costs." "State action that impedes people from protecting themselves from a deadly epidemic is blatant interference with the right of Russians to the highest obtainable standard of health. There is no dispute as to the effectiveness of sterile syringes for preventing HIV, hepatitis C and other blood-borne infections. Public health experts are virtually unanimous in the view that providing access to sterile syringes neither encourages drug use nor dissuades drug users from entering drug treatment programs. In reality, the near absence of humane treatment programs for drug addiction in Russia and the very nature of drug use guarantee that there will always be people who either cannot or will not stop using drugs. Impeding this population from obtaining or using sterile syringes amounts to prescribing death as a punishment for illicit drug use." "The drug enforcement agencies are supported in their functions by strong drug control laws and high-level Governmental attention. While recent years have seen some increase in the resources devoted to the prevention of drug abuse and to the care for drug users, the major emphasis in the Government's policy is clearly targeted on addressing the problem of drug trafficking and production. "Some outside observers believe that this heavy emphasis on law enforcement sometimes hampers efforts to address the problems of drug abuse, particularly among the youth. For one thing, there is some evidence that many drug users are sent to prison for drug trafficking, although they are arrested with small quantities of drugs in their possession. Since 1997, with the introduction of a new Criminal Code, the possession of a "small amount of narcotics" is not considered a criminal offence, but an administrative infraction. However, the definitions of what constitutes a "small amount" of the various drugs are established at extremely low levels. In the case of heroin, there is no quantity that can be considered a "small amount" and, thus, the possession of any quantity of that drug can be prosecuted as drug trafficking. This phenomenon, coupled with the fact that there are no juvenile courts in Russia, has resulted in the incarceration of many young drug users in adult prisons where there are few, if any, drug treatment programmes, and where they may be exposed to risks of violence, and of infection with tuberculosis and HIV/AIDS." United Nations Office on Drugs and Crime. County Profile: Russian Federation . Moscow, Russia: UNODC Regional Office, Russian Federation, 2003. "Russia now has a 1 percent HIV prevalence rate among its young people and the fastest growing HIV/AIDS epidemic in the world. While the epidemic is still predominantly fuelled by injecting drug users and confined to their ranks, there are clear signs that the epidemic continues to spread to the general population, especially the youth." UNODC, "Illicit Drug Trends in the Russian Federation," UNODC Regional Office for Russia and Belarus, April 2008. "The epidemic disproportionately affects IDUs who comprise 87% of the cumulative number of registered HIV cases, however, with the epidemic becoming more mature, the infection tendency away from IDUs to heterosexual is also increasing with 68% of newly registered cases by the end of 2004 corresponding to IDU and 30% to heterosexuals (In the previous year heterosexual transmission accounted for 23.4% of new infections). The interpretation of the tendency towards less new infections diagnosed is not an indication of a slowing of the epidemic but rather reflective of the changes in HIV testing policy, the smaller number of tests performed in population groups with high-risk behaviors and also a shortage of test kits." United Nations Office for Drug Control and Crime, "Illicit Drug Trends in the Russian Federation, 2005," Moscow, Russian Federation: UNODC Regional Office for Russia and Belarus, November 2006. 482 IMAGES "Should Drugs Be Legalized?" Essay by Bennett Essay drugs legalization Drug Abuse on High School Students Free Essay Example Creating Drug Policy and Reforming Drug Laws Essay on International day against Drug Abuse The Impact of Drug Legalization on the Economy Essay VIDEO Drug abuse informative speech essay public speaking 2024 Speech on drug addiction in punjabi Does Berlin have a drug problem? Drug Addiction English grammar essay very important #music #english RJS Mains 2024 essay on drug addiction COMMENTS Impact evaluations of drug decriminalisation and legal regulation on drug use, health and social harms: a systematic review Conclusions Studies evaluating drug decriminalisation and legal regulation are concentrated in the USA and on cannabis legalisation. Despite the range of outcomes potentially impacted by drug law reform, extant research is narrowly focussed, with a particular emphasis on the prevalence of use. Should the United States Decriminalize the Possession of Drugs? Several states have voted to reform their drug laws in response to the opioid epidemic and as a way to address high rates of drug-related incarceration. What do you think of this, and other ... After 50 Years Of The War On Drugs, 'What Good Is It Doing For Us?' President Nixon called for an "all-out offensive" against drugs and addiction. The U.S. is now rethinking policies that led to mass incarceration and shattered families while drug deaths kept rising. Race, Mass Incarceration, and the Disastrous War on Drugs Race, Mass Incarceration, and the Disastrous War on Drugs. Unravelling decades of racially biased anti-drug policies is a monumental project. This essay is part of the Brennan Center's series examining the punitive excess that has come to define America's criminal legal system. I have a long view of the criminal punishment system, having ... Drug Legalization?: Time for a real debate Drug Legalization?: Time for a real debate. Whether Bill Clinton "inhaled" when trying marijuana as a college student was about the closest the last presidential campaign came to addressing ... America's New Drug Policy For decades, the U.S. focused on trying to scare people away from drugs, instituting tough criminal penalties and emphasizing law enforcement over addiction treatment. But a major change is ... The World's View on Drugs Is Changing. Which Side Are You On? Oregon went one step further, decriminalizing all drugs in small quantities, including heroin, cocaine and methamphetamine. Attitudes toward drugs have changed considerably over the years. Rethinking Drug Laws: Theory, History, Politics This book develops a new way of understanding what global drug prohibition is, the origins of the prohibition system, and the possibilities for alternative futures. The first part explores the intellectual resources available for analysing and explaining drug control. By framing drug control as a form of market regulation, it sets out a new ... Head to Head: Should drugs be decriminalised? No Although bans on the import, manufacture, sale, and possession of drugs such as marijuana, cocaine, and heroin should remain, drug policies do need a fix. Neither legalisation nor decriminalisation is the answer. Rather, more resources and energy should be devoted to research, prevention, and treatment, and each citizen and institution should ... Drug Legalization and Decriminalization Beliefs Among Substance-Using There has been advocacy for legalization of abusable substances, but systematic data on societal beliefs regarding such legalization are limited. People who use substances may have unique beliefs about legalization, and this study assessed whether they ... Decriminalisation or legalisation: injecting evidence in the drug law Decriminalisation largely applies to drug use and possession offences, not to the sale or supply of drugs. Arguments in favour of decriminalisation include its focus on drug users rather than drug ... This is Your Constitution on Drugs The war on drugs was launched a half-century ago through laws that were arguably beyond Congress's powers to enact. Subsequent efforts to expand upon, interpret, and enforce these laws have undermined the idea that the federal government is one of li... Drug Laws: Balancing Law Enforcement and Treatment Issues Essay This article explores the challenges and potential solutions in reforming drug laws and the need for a new law that addresses both law enforcement and drug treatment issues. It's Not Just About Pot. Our Entire Drug Policy Needs an Overhaul These laws treated the possession and sale of marijuana, cocaine and heroin as equally bad, with mandatory sentences starting at two to five years, and higher for repeat offenses. "Criminalization Causes the Stigma": Perspectives From People Who Use Drugs The views of people who use drugs toward drug policy and drug law reform in the Canadian context are essential, yet largely missing from the conversation. The aim of this study was to capture the opinions, ideas, and attitudes of people who use drugs toward Canadian drug laws and potential future alternatives. An ethical analysis of UK drug policy as an example of a criminal Background Drug-related deaths in the UK are at the highest level on record—the war on drugs has failed. A short film has been produced intended for public and professional audiences featuring academics, representatives of advocacy organisations, police and policymakers outlining the problems with, and highlighting alternative approaches to, UK drug policy. A range of ethical arguments are ... H.R.4020 (e) Public education regarding drugs and drug use.—Notwithstanding any other provision of law, any Federal funds used for designing, administering, or supporting programs to provide education regarding drugs or drug use shall provide scientifically-accurate, culturally and gender competent, trauma-informed, and evidence-based information ... Russian Federation Correspondingly, in 2013-2014, several federal laws and regulations were amended to establish compulsory drug treatment [28-30], purportedly to motivate DDP and people who use illegal drugs to undergo medical treatment and rehabilitation [31]. Drug control and human rights in the Russian Federation Russia fails to fulfill its commitment to respect, protect and promote all human rights, fundamental freedoms and the inherent dignity of all individuals and the rule of law in the development and implementation of drug policies" (Russian Civil Society Mechanism for Monitoring of Drug Policy Reforms in Russia, 2018, p. 1). Russian Political Discourse on Illegal Drugs: A Thematic Analysis of Background: Since the beginning of the twenty first century, there has been an intensified political debate about drugs in Russia. The drug problem is now regarded as one of the country's most seri... assignment essay homework paper phd report resume review speech thesis