Broken taboo

This comes at a time when drug prohibition is collapsing,” says Alex Wodak, the recently retired director of the Alcohol and Drug Service at St Vincent’s Hospital in Sydney, Australia, and former head of Harm Reduction International. “The long debate is now over and the political phase has started. More and more people  are realising that drug prohibition is getting harder and harder to defend and the taboo has been broken on discussing alternatives.” He says the outcome is a groundswell in countries looking for alternatives. Uruguay has just become the first country  to fully legalise cannabis. Pharmacies  are allowed to sell 40 grams a month to individuals, people can grow up to six plants themselves and “cannabis clubs” can grow  up to 99. Other Latin American countries are dissenting, too. In 2011, Bolivia withdrew from the 1961 Single Convention on Narcotic Drugs and rejoined last year with qualifications that allow the use of coca leaves. The presidents of Guatemala and Colombia are both calling for prohibition to end. In 2012 a summit of the Organization of American States – an international organisation of 35 countries from across the Americas and the Caribbean, including the US – resisted US pressure to duck the issue, and discussed alternatives to the war on drugs. Last year it released an options paper that included legalisation as one possible way to go. Within the US itself, two states – Colorado and Washington – have legalised cannabis.
The UK’s deputy prime minister Nick Clegg has also come out in support of a debate  about prohibition. These efforts are likely to snowball, says Wodak. After cannabis was legalised in Colorado and Washington, public support for cannabis legalisation all over the US jumped to 58 per cent – the first time there has been a clear majority in favour. “Other US states will follow. All this is coming about because it is now inescapable that global drug prohibition has been ineffective, counter-productive and very expensive,” he says. But it won’t happen overnight, Wodak predicts. “Global drug prohibition took about 80 years to construct so I would not be surprised if the post-prohibition policy also takes a while to build.” Wodak says the New Zealand approach will have obvious contradictions, with relatively unknown synthetic cannabis being legal  while natural cannabis is still banned despite being well studied. But synthetic drugs are  a good place to start since banning them is particularly problematic, he says. New Zealand’s laws might be giving us a glimpse of what a post-prohibition world will look like. “It’s the first attempt to regulate the market and not just reduce the harm caused by prohibition,” Wodak says. “It is a good example of the start of evidence-based policy,” adds Nutt. In 2016, the UN will hold a special assembly to review its approach to drug control. Nutt  is hoping international momentum against prohibition will lead to a change of heart, and he’s pushing New Zealand to lead the meeting. The US will undoubtedly exert pressure to maintain a hard line on drug prohibition, but won’t find it easy, says James Dunne. “If the  US decides it wants to push for maintenance of the current system, there would have  to be some fancy footwork to explain how Colorado and Washington legalising the sale  of marijuana is OK but Uruguay doing it  is not.” He says the New Zealand approach attracted a lot of interest at the most recent  UN Office of Drugs and Crime meeting. And together with South America, and to a lesser extent Europe, there will be a significant  block pushing for change. Ultimately, whether the rest of the world follows New Zealand’s lead depends on the results of its experiment. And saying no to prohibition, even in a limited way, might not be risk-free. Evidence suggests prohibition does sometimes reduce drug use. When Wilkins studied legal highs in New Zealand in 2006 while BZP was still legal, he found 15 per cent of people had tried a legal high in the past year. By 2009 – a year after it was banned – he found that figure had dropped to just 3.2 per cent. The reasons aren’t clear. Wilkins says it might just be that BZP was harder to find, and new legal highs hadn’t yet gained popularity. But there was an indication that prohibition was also turning users off: 30 per cent of people who stopped using BZP gave the ban as a reason. That raises the question of whether making drugs legal would encourage people who would otherwise abstain, or prompt current users to take more. If the BZP study is indicative of what might happen, New Zealand could be in trouble, says Wilkins. “If the prevalence of legal high use tripled, you might end up with more total problems even if the product was low harm.” Whether that will happen isn’t clear. When the Netherlands liberalised control of cannabis in the 1970s, there was no  major rise in cannabis use. When Portugal decriminalised personal use of all drugs, drug use stayed about level, but the negative health effects of drug use decreased significantly. What’s more, looking around the world, there seems to be no correlation between stricter drug laws and decreased consumption. at least according to a World Health Organization study from 2008. Some researchers say New Zealand’s law is already having positive effects. “Since the bill was enacted we have seen fewer hospital admissions and emergency presentations associated with use of synthetics,” says Paul Glue, head of psychological medicine at Dunedin School of Medicine. Wilkins says New Zealand’s experiment will “stand or fall” depending on whether people replace bad drugs – cocaine, heroin and maybe even alcohol – with the safer ones, or simply take more drugs. There is some evidence that legalising marijuana in the US correlates with a reduction in heavy drinking among 18 to 29-year-olds. Whether New Zealanders will swap booze for pills is still a huge unknown. Wilkins has applied for funding to study this crucial question and has set up an international research group so the world  can learn from New Zealand’s experiment. “There is a possibility of a big public health gain on the one hand, or a really big public health disaster on the other,” he says. “But there will be no one more excited than me  if we find it is successful.”  ■