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April 2009



Transform Cost-Effectiveness Study Slams Prohibition, UK Government

The inestimable Transform Drug Policy Foundation has done it again.

Their newest report is A Comparison of the Cost-effectiveness of the Prohibition and Regulation of Drugs (pdf), which is that, plus a kick in the pants.

In a field where governments have gone out of their way to avoid and even prevent useful efficacy studies, Transform is stepping up to bat and doing (to the best of their ability) the work that should be done by the prohibitionists — actually looking at whether prohibition is cost-effective. And the result of their extremely conservative analysis (they even chose to not include a number of potentially controversial topics such as tax income or improved safety in drug preparation) shows that a regulated legalization of cocaine and heroin would save money over prohibition in all of four usage change models (50% decrease in use, no change in use, 50% increase in use, 100% increase in use).

But this report not only is a powerful jumping off point for future study, it is a scathing indictment of all the weasels who have defended prohibition by saying that legalization would be too “expensive” to even consider while refusing to justify the cost-effectiveness of prohibition or prove any actual deterrence — the UK Government, the UNODC, the US Government, and yes, even the prohibition apologists.

Despite being such an important issue, there has never been a cost-benefit analysis at the level of sophistication required, either of prohibition (its legislative instruments and their enforcement) or of policy alternatives, carried out anywhere in the world and certainly not for the UK. Furthermore, and disappointingly, the comparatively scant relevant research that has been undertaken by Government departments has frequently been suppressed.

The whole report is full of useful information and quotable material, so what I discuss here will only be a taste of some of the things that particularly caught my attention.

The report takes some important space to address the important understanding that drug policy causes harm.

Yet despite these issues being apparently understood and frequently acknowledged at the highest level, in the majority of political, media and public discourses no such distinction is made between the harms that result from drug use per se and those that are either entirely or partially the result of policy, specifically the overarching policy paradigm of prohibition. The result is that both sets of harms are conflated and then simplistically blamed on drugs or, by default, drug users. The failure to disaggregate drug use harms from drug policy harms or, specifically, prohibition harms, is a major obstacle to meaningful evaluation of existing policy and consequently, to the rational development of potentially more effective policy responses. […]

This conceptual problem has also had direct political consequences. Logical fallacies flow from this error, such as the inclusion of the epidemic of HIV/AIDS amongst injecting drug users as an example of ‘drug harms‰ to defend the prohibitionist status quo. In this case a specific drug-related harm that is almost exclusively the result of the high risk behaviours, rituals, products and environments that stem directly from prohibition and the default underground drug cultures it creates, is perversely being used both to justify the continuation of the very policy that has fostered it in the first instance, and also to argue against the policy that would largely eliminate it.

There’s a fair amount of discussion about the lack of evidence for the deterrence factor that all prohibitionists claim is the holy grail of criminalizing drugs (and the notion that regulated legalization would open the flood-gates to an entire population of drug-addicted zombies).

The relatively small amount of independent research that has been done in this area suggests that the law and enforcement are, at best, marginal factors in drug taking decisions. This especially holds true for the socially excluded groups who are most vulnerable to problematic use, including young people, those with mental health problems, and those from socially deprived communities. Dependent users of heroin and crack in particular, who are both highly likely to have a criminal record already and whose demand is generally resistant to any interventions, are also – as discussed above – the population creating the vast majority of social and economic costs. Thus the group that creates most of prohibition‰s costs are also the group least likely to be susceptible to its deterrent effects.

One of the things not specifically figured into Transform’s cost-effectiveness study is the significant potential health savings from regulated legalization.

One concept that this paper does not explore nor attempt to cost is the impact that the shift from illicit to legally regulated supply might have on patterns of use in terms of shifts in choice of drug and preparation of drug. One observed effect of prohibition is that the economic pressures of the illicit market tend to cause increased concentration of available drug preparations, which are more profitable per unit of weight. Just as under alcohol prohibition the trade in beers and wines gave way to more concentrated, profitable and dangerous spirits, the same trend has been observed over the past century with opiates — from opium (smoked or in drinkable preparations) through to snorted, smoked and injectable heroin, and more recently with the cannabis market being increasingly saturated with more potent/profitable varieties. With coca-based products the transformation has been dramatic from coca leaf, through coca based
drinks (tea, wines, and other drinks, once including Coca Cola) through cocaine powder and ultimately to smokable crack.

It seems likely that users, if a range of drugs and preparations are available, will tend to make rational decisions and shift towards the less harmful drugs, less harmful preparations and less risky behaviours and modes of administration. This phenomenon was observed following the repeal of alcohol prohibition when the market shifted away from spirits back towards beers and wines. Such a shift would be actively promoted and encouraged by a public health guided policy involving targeted education about drug risks combined with differential application of regulatory controls i.e. stricter controls (e.g. higher prices, restricted availability) for more dangerous drugs or preparations. Evaluating potential impacts of such approaches is beyond the remit of this paper but is again a potentially useful arena for future study.

Good stuff. A must-read for all policy leaders and politicians dealing with drug policy. It’s a challenge and a starting point for a difficult, but essential field of study.

Many of the “academics” in this country have said that such study is impossible, so there’s no point in discussing legalization. The truth, however, is that justifying prohibition without undertaking such study is irresponsible and dishonest.
Update: The UK Government actually managed to prove both its incompetence and its inability to read with its response:

But a Home Office spokesman said: “Drugs are controlled because they are harmful. The law provides an important deterrent to drug use and legalisation would risk a huge increase in consumption with an associated cost to public health.

“The legalisation of drugs would not eliminate the crime committed by organised career criminals; such criminals would simply seek new sources of illicit revenue through crime. Neither would a regulated market eliminate illicit supplies, as alcohol and tobacco smuggling demonstrate.”

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