Last month, the United Nations General Assembly met for the first time in history to reconsider international drug prohibition with an eye toward policies focused on health and human rights. Facing unprecedented drug gang–related violence, Mexico, Colombia, and Guatemala had insisted the global confab be moved up by two years. Yet somehow there was no sense of urgency, and no actual changes were made, in large part due to the intransigence of Russia and China.
Still, the meeting did clearly illustrate one reality: Because the US itself is violating international drug conventions by allowing individual states to legalize marijuana, America has basically resigned as the world's lead narcotics cops. (At least until President Donald Trump is a thing.) And that means countries like Canada and Jamaica, which are legalizing or plan to legalize marijuana, will be able to do so without facing threats of trade war or other sanctions, as they have in the past. The consensus that prohibition is the only possible approach to drug use has been broken.
So what would it take to bring real change? The UN will revisit the issue around 2019, and there are some critical questions reformers must address between now and then to set the stage for better drug policy in decades ahead.
The first, and probably most pressing, is to increase public understanding of the real nature of addiction and its causes. Only 10 to 20 percent of people who take even the most addictive drugs like heroin and meth actually become addicted—the vast majority of drug use never results in addiction, or any other type of harm. Once this is understood, the real question for drug policy becomes: How do we prevent addiction and other drug-related harm?
This is the heart of the drug policy strategy known as "harm reduction."
Unfortunately, decades of racist propaganda and media scare tactics have obscured the fact that addiction is rarely, if ever, caused by simple exposure to particular drugs. Typically, addiction results from young people's attempts to medicate emotional and social despair, with 90 percent of all addictions starting before the mid 20s.
Pretending that this system has some kind of rational basis simply serves to perpetuate bad outcomes.
And importantly, the people with the most severe addictions often start in their teens or earlier, and use multiple drugs. At least two thirds have suffered from traumatic childhoods and more than 50 percent mental illness or personality disorders. Drugs are not the sole source of their problems; in their eyes, drugs are an apparent solution that went wrong.
Consequently, stamping out particular drugs—if that were even possible—won't change the fact that people vulnerable to addiction exist, and will often seek ways to make their consciousness more bearable. Recognizing that addiction is not "created" by shady doctors or drug dealers but by a complex tangle of developmental experience is crucial, as is realizing that reducing drug-related harm—not use—is the only plausible goal.
When the UN last met on drug policy in 1998, the outcome was a document that suggested we would have a drug free world by now. At least this time, the agency is aiming for a world free of "drug abuse," which might be a tiny bit more realistic.
Indeed, the history of world drug policy is a sad story of panics over particular drugs followed by crackdowns, which, at best, shift production from one country to another while failing to affect long-term supply. And during these panics, the people who suffer most tend to be the racial minorities that politicians associate with the drugs, and the people who nonetheless became addicted, as well as their families.
To create better policy, we need to focus on the humanity of drug users, and the fact that world drug law is based on racist myths and colonial power grabs, not science. No rational policymaker could ever determine that alcohol and tobacco should be legal while marijuana is legal—the reason that some drugs are legal and others aren't is related to who had power and who did not when the laws were made, plain and simple. Pretending that this system has some kind of rational basis simply serves to perpetuate bad outcomes.
We also need a better understanding of how much substitution there is between different classes of drugs. Some research suggests, for example, that medical marijuana legalization is linked with reduced rates of opioid overdose deaths, which makes sense because both can be used as painkillers. But there is little data on how often this substitution occurs and how large an effect it has—and similarly, we don't know enough about substitution between alcohol and marijuana.
If people simply add marijuana to their current drinking habits, this won't reduce harm. But if people drink significantly less when they smoke or eat more pot, that would be an overall positive effect. Using computer modeling to try to answer such questions seems like an obvious tactic, because variables like pricing can be changed to explore potential effects.
Another key unanswered question centers on the effects of commercialization on drug markets. We know that decriminalizing personal possession and shifting the savings to treatment doesn't necessarily increase use. In fact, when Portugal did so in 2001, the result was dramatic reductions in HIV and IV drug use, without increases in drug use that were any different from their neighbors (which had maintained criminalization).
But what about legalizing drug sales? How much of an effect does advertising really have? There is some evidence from the Netherlands that marijuana use didn't increase after the Dutch made it quasi-legal to sell and buy in "coffee shops"—at least not until those shops proliferated and became more visible. Even then, however, use by young people remained (and still does) below the levels America has under strict prohibition. More research is needed on the effects of marketing and price. Clearly, even with a highly addictive drug like tobacco, high prices and counter marketing matter.
To put this all together, we also need to improve public understanding of the concept of "harm reduction" as the primary goal of drug policy. For years, prohibitionists and others have argued that harm reduction is a Trojan horse for legalization, a sort of softer rebranding to sell a dangerous policy. In fact, harm reduction as a philosophy of drug policy is neutral on legalization. But in reality, harm-reduction supporters overwhelmingly support decriminalization of drug possession and may also favor legalization of sales.
The reason is that the core of harm reduction is keeping people safe and healthy. Harm reductionists don't care whether using psychoactive drugs per se is bad; they care about ensuring that it doesn't do damage. And once you start looking at minimizing harm rather than simply assuming drugs are evil, you also must start looking at harm that comes from drug policy, as opposed to bad things that stem directly from use. That's where harm reductionists tend rapidly to become legalizers. Data we already have from around the world makes it screamingly obvious that criminal laws targeting drug users don't protect the public from high levels of drug use. But they do harm drug users—and trafficking related violence has killed tens of thousands of people in Mexico alone.
Before the next UN meeting on drugs, and as individual states and nations consider how to regulate marijuana and other drugs, drug reformers need to get this message out to policymakers and politicians. A prohibition approach that increases violence, disease, and disability in the name of fighting immoral substances, while failing to move the needle on use levels and making life hellish for users is not viable in the modern world.
Follow Maia Szalavitz on Twitter.