The World Drug Report 2013 admits that “the international drug control system is floundering … under the speed and creativity of the phenomenon [of new designer drugs].” In a statement that comes close to conceding defeat, this report says that banning the new drugs is possible, but a “very challenging undertaking” due to “the sheer rapidity of emerging NPS.” In Canada alone, fifty-nine NPS were created over the first two quarters of 2012. Users were also experimenting with salvia, jimson weed, datura, and ketamine.
Whereas the U.N. report insists that public health is “pivotal to [the United Nations’] overall strategy,” in fact, the United Nations is and has always been mainly preoccupied with how to control the new trade in designer drugs by law enforcement. One observer, noting the new attitude to legalizing marijuana in Latin American countries, says, “The distinct sounds of circling wagons characterized the rhetoric at the launch of the 2013 World Drug Report.”[23] And at the same time that NPS are proliferating, the United Nations reports that cocaine use decreased by 40 percent in the United States between 2006 and 2011, while heroin use was stable or falling around the world.
Most of the new designer drugs are stand-ins for MDMA (ecstasy), marijuana, LSD, and magic mushrooms.[24] Ecstasy is the only one of these drugs that is known to cause overdoses in users, and this only happens if the drug is not taken properly. All of them, though, are illegal. NPS, on the other hand (which are emerging at the rate of one per week) are created in labs and are legal until banned.[25] There is no way for a user to know how dangerous they are. There are seven hundred websites in the European Union alone that are selling them. “Moves to ban new drugs simply inspire chemical innovation that sidesteps the law,” so this is yet another way that the law enforcement model is failing to prevail.
A final recent area of concern is the abuse of prescription drugs. A new report from the Canadian Council on Substance Abuse (CCSA) describes the problem, which is generally agreed to be serious.[26] Double-doctoring and the diversion of pharmaceuticals are practices that feed addictions to painkillers and other drugs. The rash of deaths attributed to abuse of oxycodone, for example, is well documented. No mention is made by the CCSA of the fact that drug companies aggressively market their drugs, or that they sometimes fail to reveal side effects identified in clinical trials. The report does not talk about possible treatment options for those already addicted.[27] Much, though, is made of the need for more resources for law enforcement.
A prime example of prescription drug abuse is illustrated by the recent removal of oxycodone from pharmacy shelves in the United States. Twenty years ago, this drug was marketed by its manufacturer, Purdue Pharma, as the new miracle painkiller.[28] By 2012, the addiction numbers were so high that the company replaced the drug with an equivalent formulation that was harder for people to abuse (because it could not be dissolved and injected). In 2007, Purdue and three of its top executives pleaded guilty to misleading doctors, regulators, and patients about the risk of addiction, and paid millions of dollars in fines. In the meantime, though, many addicts had turned to heroin as a cheaper alternative. They also turned to alternatives such as morphine and codeine. These alternatives have the same or a higher risk of overdose. They also present a scenario where needle-sharing is likely, leading to the spread of disease. Meanwhile, the withdrawal of the original formula for oxycodone led to an increase in street prices for it, resulting in increased market volatility and related crime. The fact that Canada still permits oxycodone to be prescribed in its original form is causing friction with the United States, since users are smuggling the Canadian product — known as hillbilly heroin — across the border.[29]
Withdrawal from oxycodone is excruciating and long-lasting. Once it was banned in its injectable form, addicts turned to alternatives. One of those was fentanyl, a synthetic opioid. Fentanyl is legal and prescribed as a patch so that the active ingredient can be released gradually. Addicts learned that they could scrape the substance off a patch and smoke it to obtain relief.[30] Or they could ingest the whole patch, or cut it up and apply it to their gums. Fentanyl is one hundred times stronger than morphine, and is normally used for palliative care or for cancer-induced pain. Fentanyl can kill.
Not incidentally, a recent study published in The Lancet said that more than half of the deaths caused by illegal drug use (in a global survey for 2010) were caused by prescription drug abuse.[31] The worst death rates were found in countries with harsh anti-drug regimes.
Intended Consequences
The official, prohibitionist approach to plant-based illegal drugs (marijuana, cocaine, and heroin) has become basic to the world’s approach to all illegal drugs. These three are significantly representative of the public’s serious concerns as to the choices people make about their preferred high, or about their preferred medicine.
Any discussion of legalization or decriminalization of illegal drugs usually devolves into a discussion of marijuana, which is among the least harmful of all banned drugs.[32] The more difficult question, though, is what to do about those drugs that are regarded to be more harmful to individuals who use or abuse them (heroin, for example). On this question, the experts are divided. Some say that the least harmful model includes the outright legalization, control, and regulation of all illegal drugs, adjusting the details to recognize and deal with the differences among drugs. Others who might allow for some relaxation of the laws around marijuana are dead against the idea of similar treatment for heroin and cocaine, referring to the harms these can cause to individuals and families.
There are, however, well-documented consequences arising, not from the use of the drugs themselves, but from the fact that they are prohibited. An examination of these so-called “unintended” consequences of prohibition is important when it comes to deciding whether to continue the status quo of prohibition or adopt a new approach. It has to be said, though, that we are well past the point where we can call such consequences “unintended.” They include the well-known damage caused by prison sentences and criminal records, the destruction to families and communities whose members are in prison, the health consequences of allowing crime bosses to distribute uncontrolled and unsafe products, the violence and corruption associated with organized crime, and the health consequences of spreading HIV, Hepatitis C, and other diseases to users and to the community. These are serious and devastating harms. They are easily anticipated and can be alleviated by policy changes that recognize the damage done by prohibition.
In addition to these, there are harms caused to offenders who are saddled with criminal records. In the United States, a felony conviction can result in the loss of the right to vote, to obtain public housing, federal education assistance, welfare benefits, food stamps, and other services.[33] In Canada, the ability to obtain employment and to travel freely is permanently impaired by a criminal record. In all cases, the shame and stigma of a record is very damaging. These consequences have been clearly recognized for years. Proponents of prohibition can therefore be said to both understand and “intend” the serious and debilitating consequences of the criminalization of drugs.
As one small example, I was once approached by a middle-aged woman — I’ll call her Jane — to defend her on a simple possession charge. She had been arrested for possession of a small amount of marijuana, and intended to plead guilty and pay the fine. She also worked at a retail outlet downtown, and was most concerned about losing her job.
Jane told me that the night before she was arrested, she had been partying with a group of people, all smoking marijuana, and the group included members of the local RCMP. These turned out to be the same people who arrested her the very next day. She was, of course, at a loss as to why they would arrest her for smoking marijuana when they themselves had been partaking.
Despite our best efforts, Jane’s employer soon learned of the conviction. Jane was laid off immediately. I expect she has not worked at a decent job