Drug Policy Harm Part Five: Conclusion (and bibliography)

Please note this paper was drafted April 2009 and has not been updated



Continued from ... Drug Policy Harms Part Four: The Legal Harms


Conclusion

There is a clear relationship between violence and illegal drugs and alcohol. Indeed alcohol and illegal drugs contribute to a range of social harms. In exploring these harms we need to differentiate between those which are consequences of the substances and those which are generated by policy. We can not completely remove the harms of drugs; but an effective drug policy, covering both currently legal and illegal drugs can minimise the harms these substances cause.

Figure 11 (Source TDPF 2009:21)


Controls over supplier

• Hours of opening
• Location/appearance of outlet, number of outlets
• Licensing/training of vendors/staff
• Controls over marketing/advertising

Controls over purchaser

• Age controls (minimum age, ID / proof of age required for purchase)
• Restriction of sale if purchaser is intoxicated
• Volume rationing
• Purchase tracking
• Licensing of purchaser
• Delay between order and pick up
• Required membership of group or union for purchase
• Consumption on licensed premises only

Controls over product

• Packaging (plain packaging, tamper proofing, health and safety warnings etc)
• Preparation, dosage, quantity
• Coded for individual licensed purchaser

Such a policy must involve government taking responsibility for regulation of these substances markets. This would include intervention on pricing and would allow a range of controls, as set out in Figure 11 above.  Clearly treatment and law enforcement have a role to play under such a regime but they would no longer be the key to the minimisation of harm or indeed violence. By rejecting the idea that harm and violence is the consequence of individuals making irresponsible choices in an unregulated market we can adopt a new policy paradigm. The policy, based on scientific evidence, will allow us to significantly reduce violence and other harms by implementing effective regulation and control, based on the public health principles of promoting well being and minimising harm. Criminologists can contribute to this, but only if they escape the straight jacket of their discipline and approach the issues using a broader social harm perspective.

J.M. Moore

j.moore@uwe.ac.uk
23 April 2009

Bibliography

 
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Behr, E. (1996) Prohibition: thirteen years that changed America New York, Arcade Publishing

Brown, J & Langton, D. (2007) ‘Legalise all drugs: chief constable demands end to ‘immoral law’ Independent 15 October 2007

Burnham, A. (2008) Written ministerial statement by Andy Burnham on the Evaluation of the impact of the Licensing Act 2003 Online at:
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Caulkins, J.P. & Reuter, P. (1998) ‚What price data tell us about drug markets’. pp. 593-613 in Journal of Drug Issues No. 28, Vol.3.

Dills, A.K., Miron, J.A. and Summers, G (2008) ‘What do economists know about crime?’ Working Paper 13759 National Bureau of Economic Research Cambridge, MA

Donaldson, L. (2009) 150 years of the Annual Report of the Chief Medical Officer, London, Department of Health

Dorling D., Gordon, D., Hillyard, P., Pantazis, C., Pemperton, S. and Tombs, S. (2008) Criminal Obsessions: Why harm matters more than crime. (2nd Edition) London, Crime and Society Foundation.

Easton, M. (2009) ‘Could we save billions by legalising drugs?’ BBC News online at: http://www.bbc.co.uk/blogs/thereporters/markeaston/2009/04/heroin_and_cocaine_cost_britai.html (Accessed 11 April 2009)

Glenny, M (2008) McMafia: Seriously Organised Crime London Vintage Books

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Gordon, L,. Tinsley, L, Godfrey, C and Parrott, S (2008) ‘The economic and social cost of Class A drug use in England and Wales, 2003/4’ pp. 41-45 in Singleton, N., Murray, R. and Tinsley, L. Measuring different aspects of problem drug use: methodological developments (2nd Edition) London, Home Office

Haldeman, H.R. (1994) The Haldeman Diaries: Inside the Nixon White House. New York, G. P. Putnams Sons

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Hillyard, P and Tombs, S. (2008), ‘Beyond Criminalogy?’, pp. 6–23 in Dorling D., Gordon, D., Hillyard, P., Pantazis, C., Pemperton, S. and Tombs, S. Criminal Obsessions: Why harm matters more than crime. (2nd Edition) London, Crime and Society Foundation

Hoare, J and Flately, J Drug Use Declared: Findings from the 2007/08 British Crime Survey England and Wales London, Home Office

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Hough, M., Hunter, G., Jacobson, J. and Cossalter, S. (2008) The Impact of the Licensing Act 203 on levels of crime and disorder: an evaluation. London Home Office

Howker, E. (2009) ‘The Big Question: Do we need a new debate about relaxing drugs policy in Britain?’ The Independent 11th February 2009

Human Rights Watch (2004) Not enough graves: The War on Drugs, HIV/AIDS, and violations of Human Rights, New York, Human Rights watch

Hunter, G. and May, T (2004) Solutions and Strategies: Drug Problems and Street Markets, London, Home Office

Independent (2009) ‘PM rejects minimum alcohol price idea’ Independent 16th March 2009 online at: http://www.independent.co.uk/news/uk/politics/pm-rejects-minimum-alcohol-price-idea-1646077.html (Accessed 23 April 2009)

Jason-Lloyd, L (2007) Misuse of Drugs: A Straightforward Guide to the Law Winchester, Waterside Press

Jones, S., Miller-Mack, E. & Ahrens, L. (2005) Prisoners of the War on Drugs, Northampton Ma, The Real Cost of Prisons Project

Joseph, M (2000) Ecstasy, London, Carlton Books

Labour Party (1991) Drugs: A Consultation Document London, Labour Party

London Ambulance Service (2009) ‘Alcohol-related calls’ Available online at: http://www.londonambulance.nhs.uk/news/alcohol-related_calls.aspx (Accessed 23 April 2009)

Marks, H. (1996) Mr Nice London, Secker and Warburg

McGreal, C (2009) ‘Retaliation theory as president of Guinea-Bissau is assassinated.’ Guardian 3rd March 2009 Online at: http://www.guardian.co.uk/world/2009/mar/03/guinea-bissau-africa-president-assassination (Accessed 21 April 2009)

McSweeney, T., Turnbull, P.J. & Hough, M. (2008) Tackling Drug Markets and Distribution Networks in the UK: A review of the recent literature London, UK Drug Policy Commission

National Statistics (2009) ‘Alcohol Deaths: Rates stabilise in the UK’ online at http://www.statistics.gov.uk/CCI/nugget.asp?ID=1091&Pos=1&ColRank=2&Rank=1000 (Accessed 19 April 2009)

Newton, A., Sarker, S.J., Pahal, G.S., van den Bergh, E. and Young, C. (2007) ‘Impact of the new UK licensing law on emergency hospital attendances: a cohort study’ pp. 532-534 in Emergency Medical Journal Vol. 24.

Newton, A., Hirschfield, A., Armitage, A., Rogerson, M., Monchuk, L. and Wilcox, A. (2008e) Evaluation of Licensing Act: Measuring Crime and Disorder in and around Licensed Premises, Home Office Research Study SRG/05/007 Final Report. Huddersfield: University of Huddersfield Applied Criminology Centre.

Norris, P, & Williams, D. (2008) ‘Binge Drinking, anti-social behaviour, and alcohol-related disorder: examining the 2003 Licensing Act’ pp. 257-272 in Squires, P. Asbo nation: The Criminalisation of Nuisance Bristol, Policy Press

Nutt, D.J. (2009) ‘Equasy: An overlooked addiction with implications for the current debate on drug harms’ pp 3-5 in Journal of Psychopharmacolgy Vol. 23. No. 3.

Nutt, D.J. (2006) ‘A tale of two Es’ pp. 315-317 in Journal of Psychopharmacology No. 20, Vol. 3.

Nutt, D.J., King, L.A., Saulsbury, W. & Blakemore, C (2007) ‘Developing a rational scale for assessing the risks of drugs of potential misuse’. Pp. 1047–1053 in the Lancet Vol. 369:

ONS (Office for National Statistics) (2005) ‘Alcohol related death rates in England and Wales, 2001 to 2003.’ Available online at http://www.statistics.gov.uk/STATBASE/ssdataset.asp?vlnk=8905 (Accessed 20 April 2009)

Pemperton. S (2007) ‘Social harm future(s): exploring the potential of the social harm approach’ pp. 27-41 in Crime, Law and Social Change Vol. 48, Nos. 1-2.

Phillips, M. (2009) ‘Drugs no worse than horse-riding? The folly of those ‘experts’ simply beggars belief’ Daily Mail 9th Feb. 2009

Rayner, G. (2006) pp. 174-182 in Griffiths, S. & Hunter, D.J. (2006) New perspectives in public health, Oxford, Radcliffe Publishing

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Rolles, S., Kushlick, D. and Jay, M. (2006) After the War on Drugs: Options for Control Bristol, Transform Drug Policy Foundation

Rush, B.R., Gliksman, L. and Brook, R. (1986) ‘Alcohol Availability, Alcohol Consumption and Alcohol-Related Damage: The Distribution of Consumption Model’ pp. 1-10 in Journal of Studies on Alcohol and Drugs Vol. 47, No. 1.

Sivarajasingam, V., Moore, S. and Shepherd, J. P. (2007) Violence in England and Wales 2006: an accident and emergency perspective. Violence Research Group, Cardiff University Available Online: http://www.cf.ac.uk/dentl/resources/Trends_violence_England_Wales_2006.pdf (Accessed 21 April 2009)

Smart, C (1990) ‘Feminist approaches to criminology or post modern woman meets atavistic man.’ pp. 70-84 in Gelsthorpe, L. & Morris, (eds.) A. Feminist perspectives in criminology. Milton Keynes, Open University Press

SU Drugs Project (2003) Phase 1 Report: Understanding the Issues Leaked to Guardian and available at: http://image.guardian.co.uk/sys-files/Guardian/documents/2005/07/05/Report.pdf (accessed 11 April 2009)

TDPF (2009) A Comparison of the Cost-effectiveness of the Prohibition and Regulation of Drugs, Bristol, Transform Drug Policy Foundation Full Document Available Online at: http://www.tdpf.org.uk/TransformCBApaper.pdf (accessed 12 April 2009)

Tree, S. (2007) What Darwin teaches us about the drug war (online at http://www.commondreams.org/archive/2007/12/27/6018) (Accessed 12 April 2009)

Wilson, L. and Stevens, A. (2008) Understanding Drug Markets and How to Influence Them. Oxford, The Beckley Foundation

Drug Policy Harm Part Four: The legal harms

Please note this paper was drafted April 2009 and has not been updated

Continued from ... Drug Policy Harm Part Three: The Failure to Regulate



Alcohol – A failure of regulation


Having highlighted the scale of the failure of prohibition and the ensuing violence in the case of illegal drugs my argument has been implicitly suggesting that these are problems that could be solved by abandoning the policy of prohibition. Using the example of existing policies applied to alcohol it is possible to highlight that whilst legalisation offers the opportunity of minimising harm, this potential can only be fully realised if the substances are subjected to a regime of control and regulation, driven by public health considerations which resist the pressure of commercial interests. As prohibition in America demonstrated alcohol would cause considerably more harm and generate a massive amount of violence if it was illegal. (Behr 1996) However it still causes considerable harm and generates levels of violence that could be significantly reduced by effective public health led regulation.

New Labour’s policy on alcohol has, since 1997, been driven by the demands of the alcohol industry and is characterised by progressive deregulation and a taxation policy that has led to alcohol becoming progressively more affordable. (Rayner 2006:179-181) The link between availability of alcohol, its consumption and alcohol related harms is clearly established. (Rush et al 1986) Availability can be controlled both by price and restrictions on where and when it can be sold. The 2003 Licensing Act was the culmination of the process of deregulation begun decades earlier. Public health considerations were effectively marginalised; when the 2003 Act was implemented in 2005, alcohol deaths in England and Wales had risen by 20% in the preceding five years. (ONS 2005) It was in line with the New Labour’s government’s commitment to the alcohol industry, summed up by its Better Regulation Task Force’s call for action to remove ‘unnecessary burdens from this important industry and allow it to grow in the modern world’. (Cabinet Office 1998) In an editorial in the Emergency Medical Journal the legislation was described as ‘an act of stupidity’ which, despite being unlikely to have an immediate impact, would contribute to the ‘continuing progression of an already depressing situation.’ (Goodacre 2005:682) But as we saw above when discussing ecstasy, alcohol kills on a scale that dwarfs the fatalities of all illicit drugs. Figure 8 below demonstrates how over the past two decades alcohol deaths have virtually doubled.

Figure 8 - Alcohol-related death rates by sex, United Kingdom, 1991-2007
(Source:  National Statistics 2009)

Despite an overwhelming body of scientific evidence showing links between availability, price, harm and death, the Government’s Alcohol Harm Reduction Strategy claims ‘our analysis showed that the drivers of consumption are much more complex than merely price and availability’. (Cabinet Office 2004:18) Figure 9 charts alcohol prices and levels of consumption. Price is showing a steady decline, consumption a steady increase and in Figure 8 we saw the upward trend of alcohol related deaths.



Figure 9 (Source: The Academy of Medical Sciences 2004:18)

  Andy Burnham, the relevant minister, in a statement last year claimed a review of the 2003 Act’s impact revealed a ‘mixed picture’, highlighting its successes as being ‘a considerable reduction in red tape – estimated at £99m per annum’ and that ‘millions of people have been able to able to enjoy … socialising in restaurants, bars and cafés beyond 11pm.’ (Burnham 2008) His main conclusions were

that people are using the freedoms but people are not sufficiently using the considerable powers granted by the Act to tackle problems, and that there is a need to rebalance action towards enforcement and crack down on irresponsible behaviour. (Ibid)

In support of the Minister’s statement was a body of criminological research. (Hough et al 2008, Newton et al 2008) Hough et al (2008) conclude that there are not ‘any clear signs yet that the abolition of a standard closing time has significantly reduced problems of crime and disorder.’ (Hough et al 2008:1 Emphasis added) This report is unfortunately typical of much Home Office funded criminological research. For example it refers only in passing to the Alcohol Misuse Enforcement Campaign, a Home Office funded operation carried out by 43 police forces following the implementation of this legislation, implying it was an ‘existing … initiative’ and fails to consider the possibility that it potential caused a short term distortion to levels of alcohol related crime. (Norris & Williams 2008:264, Hough et al 2008:4) In looking at information from attendances at Accident and Emergency Departments Hough et al (2008) highlight the research of Sivarajasingam et al (2007) which reported on serious violence recorded by a sample of A&E departments. None of its data is specifically about alcohol and although it makes a number of assertions about the 2003 Act, there is no evidence base to sustain these. Research carried out in hospitals showing significant increases in alcohol related A&E attendances and by ambulance services is also mentioned although its evidence is not adequately explored. (Newton et al 2007) The London ambulance service figures at the time Hough et al (2008:9) completed their report showed during the first ten months following implementation of the Act, alcohol related call outs had increased by 2%. A year later they had increased by 12% and the most recent figures show a 28% increase. (London Ambulance Service 2009) The evidence, particularly from medical sources, suggests that the impact of the Act has been consistent with overall alcohol policy, and is contributing to increased harm and violence.

Regulating the legal harms
Earlier this year Liam Donaldson, the Government’s Chief Medical Advisor recommended a minimum price for a unit of alcohol. His advice was clear



Quite simply, England is drinking far too much. England has an alcohol problem. Alcohol is not simply a problem for the minority who are dependent on it - it is a problem for everybody … There is a clear relationship between price and consumption of alcohol … Price increases generally reduce heavy drinkers' consumption by a greater proportion than they reduce moderate drinkers' consumption. (Donaldson 2002:22)



Figure 10 (Source Donaldson 2009:21)

 Figure 10 illustrates this. The benefits of this policy would be considerable; the Chief Medical Officer argues that a 50p minimum unit price would reduce crimes by 46,000 a year and reduce hospital admissions by 100,000 a year. (Donaldson 2009:22) However the minimum price has been rejected by Prime Minister Gordon Brown because

It is right for society to bear down on, and deal with, anti-social behaviour that is associated with drinking ... (but) it is also right that we do not want the responsible, sensible majority of moderate drinkers to have to pay more, or suffer, as a result of the excesses of a small minority. (Cited in Independent 2009)

Yet again the problem is presented as being about individuals and the evidence of government policy generating harm and violence is ignored. Alcohol policy is more sensitive to the producers, distributors and retailers of the drug than it is to both the Government’s Chief Medical Officer and the substantial body of scientific research supporting his arguments.

Continued ... Drug Policy Harm Part Five: Conclusion (and bibliography)

Drug Policy Harm Part Three: The Failure to Regulate

Continued from ... Drug Policy Harm Part Two: Misrepresenting Harms




Prohibition – Generating Harms



If we look at other aspects of prohibition we see the generation of significant violence and harms.  The MDA makes all consumers criminals. A third of the population admits drug use in the British Crime Survey. (Hoare and Flately 2008:5) Of course all these people are not subjected to criminal justice intervention, the system simply couldn’t cope, but all of them are liable to arrest, a criminal record and imprisonment. Events that could have a dramatic bearing on their lives. Jobs and homes are lost regularly by consumers who come into contact with the criminal justice system.  The impact of this is not spread evenly across the community. I have not been able to calculate the racial profile in the UK but figure 5 below shows how this process plays out for African-Americans.

Figure 5 (Source Jones et al 2005:13)

The war in drugs was launched by Richard Nixon. His Chief of Staff recorded in his diary, that Nixon had ‘emphasized that you have to face the fact that the whole problem is really the blacks. The key is to devise a system that recognises this while not appearing to.’ Halderman 1994:53) The war on drugs has proved to be such a system.


The inequality generated by the selective enforcement of drug prohibition in Britain urgently requires detailed research. The Home Office was required to carry out an Equality Impact Assessment on their new drugs strategy in 2007. The first section of the assessment, titled Preliminary Screening, includes the question: ‘Could the aims of the policy be in conflict with equal opportunity, elimination of discrimination, promotion of good relations?‘ (Home Office 2008) To which the Home Office replied ‘NO’. This and the document in general demonstrate contempt for equality, which is reduced to a form filling exercise cynically ignoring a considerable body of evidence of inequality generated by the war on drugs.

The illegality of substances does not just impact on crime by criminalising their consumers. It has much wider impacts both within the UK and internationally and generates dramatic levels of harm. Central to this generation of crime and violence is prohibition, which in terms of policy, places the entire market, production, distribution, wholesale and retail, into the hands of organised crime. The illegal drug market is a state sponsored, tax free monopoly for criminals. The consequences of this are dramatic; however because of limited space I will restrict myself to a few examples

1.    Generation of acquisitive crime

Figure 6 below shows the cost of drug use for a heavy user in 2003. Having a Cocaine or heroin habit is expensive, raising £300, £400 or even £500 a week is impossible for most people through legal means. They resort to crime. The Strategy Unit estimated that 56% of the total number of crimes; some thirty six million crimes, are ‘drug-motivated crimes’ committed by drug users. (SU Drugs Project 2003:22) This is illustrated in Figure 7, again copied from the Strategy unit report to the cabinet.

Figure 6 (Source: SU Drugs Project 2003:12)

Figure 7 (Source: SU Drugs Project 2003:22)

Home Office Research has estimated that drug-motivated crime in total costs victims just under ten billion pounds per year and the economic costs to the community of the average ‘problematic drug user’ is in excess of £44,000. (Gordon et al 2006:44 & 41) In this market, unregulated prices emerge which lead to increased crime. The government’s own analysis finds that over half of all crime and victimisation are linked to behaviours generated by the economics of this market - which the government chooses not to regulate.


2. Prostitution of drug users

For many women and girls and a few men and boys, fundraising is achieved not through acquisitive crime but by prostituting themselves. Research carried out for the Home Office has shown that the drug and sex markets are intrinsically linked. (Hunter and May 2004) The same factors detailed above for acquisitive crime drive adults and children into prostitution. The Home Office’s Equality Impact Assessment makes no mention of the contribution of drugs policy in generating supply within prostitution nor does it acknowledge the gendered status of prostitution. (Home Office 2008)

3. Generation of Violence

In a review of economists’ contribution to the study of crime, Dills et al (2008:3) concluded that ‘economists know little about the empirically relevant determinants of crime.’ Applying various hypotheses on subjects as varied as arrest rates, capital punishment, gun laws and abortion rates, to an examination of aggregate data over long time periods and across countries exposed the various theories as wanting. However, they did ‘find one theory that is consistent with the aggregate time series and cross-country data on crime: the view that enforcement of drug prohibition encourages violent dispute resolution.’ (Ibid:22) Drug markets operate outside the law and have no recourse to legal procedure to resolve disputes. Drug dealers use violence to collect debts, they use violence to resolve disputes between themselves and they use violence to resist law enforcement efforts. Prohibition makes violence a cost effective business strategy. It introduces guns and knives on to our streets as routine business tools. Sometimes the state responds with violence. China celebrated UN world anti-drugs day in 2002 with the mass execution of 64 drug offenders. (Rolles et al 2006) Thailand’s security services murdered almost two and half thousand alleged drug dealers in just three months, in pursuit of the war on drugs. (Human Rights Watch 2004) Even lawful criminal justice responses generate perverse outcomes. As Sanho Tree has argued, law enforcement operates as a Darwinian natural selector removing less ruthless and less violent market participants. (Tree 2007) Over time law enforcement has driven out the non violent hippys like Howard Marks and replaced them with brutal, callous and vicious gangsters. (Marks 1996, Glenny 2008) The violence of the market raises prices; Caulkins & Reuter (1998) estimate that 33 per cent of the retail price of cocaine is paid to compensate dealers for their risk of death or injury. This in turn increases the fundraising requirements of problematic users, thus increasing crime and its associated victimisation.

4. Destabilisation of producer and transit countries

As well as generating considerable levels of violence in consumer countries like the UK the drug business has a far more dramatic impact on producer and transit nations. In Latin America, the Caribbean, Africa and Asia nations have been destabilised as a direct consequence of the so called war on drugs. Last year Michael Schulenburg, the UN Mission Chief in Sierra Leone observed ‘that the exposure to the international drug trade is the single biggest risk affecting the future of Sierra Leone’. (Reuters 2008) Guinea-Bissau has seen both its President and army chief murdered this year, killings directly linked to the country’s status as a transit country for the cocaine trade. (McGreal 2009) Internationally the war on drugs has subjected many poor nations to wave after wave of violence.

Continued ... Drug Policy Harm Part Four: The legal harms

Drug Policy Harm Part Two: Misrepresenting Harms

Continued from Drug Policy Harm Part One: Social Harm Theory -v- Criminology

The Myth of the Misuse of Drugs Act and Harm


The prohibition of certain classes of drugs is a policy decision which has cross-party consensus with both the last Labour and the current Conservative/Liberal Democratic Governments supporting this arrangement and indeed keen to include any new drugs that emerge on the market.  The core piece of legislation underpinning this policy is the Misuse of Drugs Act 1971 (MDA) which seeks to control specific drugs through criminal justice interventions based on the scientific classification of their harms. (Jason-Lloyd 2007) Although harm appears to be an established component of this regime this is an illusion than needs exposing. To do this I want to highlight the work of David Nutt, an eminent scientist and former chair of the scientific committee, established by the MDA, to advise the Home Secretary on drug policy.

Nutt (2009:4) raises ‘the critical question of why society tolerates –indeed encourages – certain forms of potentially harmful behaviour but not others’, highlighting the comparative risks of ecstasy and alcohol, ecstasy and horse riding and the relative harms of legal and illegal drugs. (Nutt 2006, 2009 & Nutt et al 2007) In figure 1 below Nutt (2006:316) compares the relative harms of the two E drugs, ethanol, better known as alcohol, and ecstasy and his figures make clear that the harms caused by alcohol are dramatically greater than ecstasy. 

Figure 1 (Source: Nutt 2006:316)

In fact what is clear from this is how much harm alcohol causes; twenty two thousand premature deaths, one thousand five hundred road traffic deaths and over 10,000 cases of interpersonal violence per annum, and how little harm is caused by ecstasy. Yet earlier in 2009 the government choose to retain ecstasy’s classification as a class A drug under the MDA. (Home Office 2009, ACMD 2009)

In an interesting analysis Nutt et al (2007) attempted to incorporate both legal and illegal drugs in a single hierarchy of harm. The results, published in the Lancet and shown in figure 2 below, clearly demonstrate the lack of any clear correlation between a drug’s harm and it’s classification under the MDA. Methodologically this study is not unproblematic and remains trapped in the paradigm of prohibition. For example, considering the most harmful drug, heroin, it fails to separate those harms intrinsic to it as a chemical substance and those harms that are generated by its legal status. (TDPF 2009:12-13) Hopefully this exercise will be repeated with the harms directly attributable to prohibition disaggregated. Would illegal street heroin have exactly the same level of risk of harm as prescribed heroin?


Figure 2 (Source Nutt et al 2007:1050)

 In an editorial in the Journal of Psychopharmacology, Nutt returned to comparisons of the relative harm of two ‘e’s, this time Ecstasy and Equasy (Equine Addiction Syndrome). Figure 3 below summarises his results. The legitimacy of his comparison of their respective harms generated a strong backlash with, the Home Secretary, Jacqui Smith, declaring that she was  ‘sure most people would simply not accept the link that he makes up in his article between horse riding and illegal drug taking.’ (BBC 2009) 

Figure 3 (Source: Nutt  2009:4)


Melanie Phillips (2009) commenting on Nutt’s paper declared ‘The only reason there are not many more deaths from ecstasy is that unlike horse riding, it is illegal.’ In fact the relationship between ecstasy’s illegality and fatalities associated with use are more complex. Its illegality removes the opportunity for any quality controls, it has led to moral panics, misinformation and has potentially impacted on levels of consumption. Lack of quality control means the consumer has no reliable information about ingredients and this lack of regulation leaves the control of the exact composition of the product retailed, and the health and welfare of consumers in the hands of organised crime. Moral panics over ecstasy have undoubtedly created harm; Leah Betts, the iconic ecstasy victim, died from water intoxication, consumed on the misunderstanding promoted by the press that vast quantities of water were the antidote to ecstasy. (Joseph 2000:91) Illegality therefore certainly increases the risk of death but does it deter use, thereby reducing the risk as well?

The Home Office claims that ‘(d)rugs are controlled because they are harmful. The law provides an important deterrent to drug use and legalisation would risk a huge increase in consumption’; though they provide no evidence to support their assertion. (Easton 2009) The Number Ten Strategy Unit, whose confidential report on drug policy to the cabinet in 2003 was leaked to the Guardian, concluded that ‘attempts to intervene have not resulted in sustainable disruption to the market at any level.’ (SU Drugs Project 2003:104) This conclusion was backed up by the UK Drug Policy Commission whose research concluded that ‘seizures and enforcement efforts have had little adverse effect on the availability, purity and price of illicit drugs in the UK ‘ and that ‘(s)ince 2000, average street prices in the UK have fallen consistently for heroin, cocaine, ecstasy and cannabis.’ (Mc Sweeny et al 2008:48 & 40)

Figure 4 below is reproduced directly from the Number 10 Strategy Unit’s report to the Cabinet. It demonstrates how effectively use of Heroin has been controlled since the introduction of the MDA. Illegal drugs are today widely available, at historically low prices, suggesting that prohibition has neither reduced supply nor demand, both of which have actually grown dramatically over the last forty years. Whatever their ambitions it is clear that the MDA and the prohibitionist paradigm in which it operates have not reduced harms.



Figure 4 (Source: SU Drugs Project 2003:38)
The lighter columns are addicts notified to the Home Office, and the darker columns from 1997 when the HO notification system was shelved, are numbers in treatment.



Continued ... Drug Policy Harm Part Three: The Failure to Regulate

Drug Policy Harm Part One: Social Harm Theory -v- Criminology

This post is based on a paper I delivered at the University of Wales, Newport in 2009.  I am delivering a modified version at the University of Bath this Friday.

The Elephant in the Room: Drug and Alcohol Policy as Generators of Violence and other Social Harms

The wide-scale use and abuse of legal substances such as alcohol and tobacco inflicts far more harm on individuals and society than illicit drugs … We need a calm non-sensational approach to policy development in this area and one which places these serious problems in context. (Labour Party (1991) Drugs: A Consultation Document)

Things have gone from bad to worse; there is no possibility of an honest discussion now. Anyone who sticks their head above the parapet and calls for a rational consideration of the drug laws gets it shot off and kicked around by a horde of lunatics (Austin Mitchell, Labour M.P. 10 Feb. 2009 cited in Howker 2009)

This paper seeks to do two things. Firstly to introduce an emerging theoretical paradigm, social harm theory, which seeks to refocus our attention from behaviours defined as 'crime' to a wider set of behaviours, those that generate harm. Secondly it seeks to rethink the issues of alcohol and drug harms and violence by incorporating those caused by state policy alongside those generated by individual consumers, producers and suppliers of currently illegal drugs and alcohol.

My conclusion is that violence and other social harms associated with illicit drugs and alcohol could be dramatically reduced. However this reduction will not be achieved through a focus on the individual user or indeed on drug and alcohol services. Such initiatives, whilst undoubtedly making significant positive contributions to the lives of individual problematic consumers, are effectively swimming against the tide of avoidable violence and other harms generated by existing policy. Reducing violence and other social harms associated with both legal and illegal drugs requires the government to accept its responsibility for public health and to implement an effective framework to regulate all drugs.

Social Harm Theory

Criminology focuses on crime, the criminal and the resolution of problems through the criminal justice system. However, the events and actors we label crimes and criminals operate in a wider context that criminology often ignores. As Carol Smart (1990:77) has observed, the great weakness of criminology is that it:

cannot locate rape or child sexual abuse in the domain of sexuality or theft in the domain of economic activity or drug use in the domain of health. To do so … would involve abandoning the idea of a unified problem which requires a unified response.

This limitation has inspired the development of a social harm perspective which seeks ‘to move beyond the narrow confines of criminology, with its focus on harms defined by whether or not they constitute a crime’ and instead calls for ‘(a)ll forms of harms’ to be ‘considered and analysed together.’ (Hillyard et al 2004:1,2) We are all vulnerable to a wide range of social harms throughout our life course and social harm theory argues that to separate out crimes from other harms considered ‘outcomes of the market economy, … accidents or mistakes’ creates ‘a very distorted view of the world’. (Ibid:1,2) Social Harm approaches lead away from a focus on individual blame and towards policy responses designed to minimise future harms. (Dorling et al 2008)

Social harm theory rejects the boundaries of criminology and the exclusive focus on crime and criminals. It seeks to place crime in the context of other harms, an approach which allows us to respond to the totality of harms generated by a particular problem. For example it allows us in the case of alcohol to consider the harms generated by deregulation alongside the harms caused by the individual drunk and the harms suffered by the solitary middle aged heavy drinker in the quiet of his own home alongside the harms caused by the drunken teenager disturbing the peace of her local community. Social harm theory seeks to embrace not only physical harms but also financial/economic, emotional and psychological harms. (Hillyard & Tombs 2008:15)

Simon Pemberton (2007:33-36) has highlighted the potential of the social harm perspective to explain the failure of criminal justice policies and generate the space for alternative social policies which, freed from the rhetoric of law and order, can genuinely reduce the harm communities experience. Relating this paradigm to alcohol and unlawful drugs provides the opportunity of exploring the impact of these substances within a much wider perspective than criminology offers. It enables us to give equal consideration to legal and illegal acts, explore individual, corporate and state behaviours and to measure the harms directly associated with the drugs alongside the harms generated by failures to control and regulate their market places.  Most significantly for this talk it allows us to look at all drugs, both legal and illegal, within the same paradigm.

Continued ... Drug Policy Harm Part Two: Misrepresenting Harms

Criminal Justice Matters - Limited Free Access

I was having problem with my athens log in today as I tried to access Criminal Justice Matters - My computer became convinced I was from various institutions and would forget my UWE log in within about 3 seconds. However for those of you who do not benefit from a university subscription service I noticed Volume 71 was offering free access. Certainly worth a visit! It was particularly pleasing that that specific edition was available given that it contains an article of mine: Prison: More than detention?

All UWE students should have access to all editions.

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