High Time?….. Yes!

Frances Cairncross presents the case for the legalisation and regulation of certain drugs


Thank you very much. I became interested in the subject just over a year ago when The Economist decided that it wanted me to write a survey, one of these long, signed articles which appear as centrefolds, on the subject of drugs. The Economist has been in favour of legalising drugs for a long time, but on sort of general guts-liberal principles rather than for any better reason than that, and it decided it was time to discover whether or not its gut feelings were justified by the odd fact. So I was dispatched to discover the odd fact. I was very relieved to find when I came back that basically the facts as I perceived them supported the line that The Economist had always taken give or take a qualification or two.


So you know now where I'm going to end up. There are reprints of the piece that I wrote on sale today – so if you don't agree with me by the time I get to the end go and buy a copy of it and maybe by the time you've read that you will disagree with me even more – who knows.


Before I begin there are two things I want to say just in order to avoid any misunderstanding.


First all that I am not in the business of promoting drug taking. It's very easy if you take the liberal stance to be regarded as somebody who is promoting drug taking. That is not what I am saying. I'm trying to think through how one might organise the most sensible way of dealing with these particular substances.


Secondly, I am under strict instructions from my vicar Father Allan Scott who's actually in the audience to cheer me on, to explain to you that I am not some atheistic liberal journalist here to corrupt the morals of the Church of England. I am a moderately regular churchgoer and I'm very pleased indeed to see the Church of England taking an interest in this issue. You're one of the few institutions which works seriously in the inner-city, really tries to do something for people in the inner-city – I think a lot of you probably work in inner-cities – and therefore have seen this problem at first hand and in that sense will have strong views I am sure of your own.


Now what I want to do is to talk a little bit about the growth and scale of the drugs market industry, a little bit about supply, a bit about present policies and why I think they fail and then say something about what I think a better policy might be.


Let me start though with a bit of history because I think one readily forgets both how long people have been taking what are now illegal drugs, and how recently in the broad span of human history drugs became illegal.


Heroin, or rather opium, is something that people were cultivating and using 8,000 years ago. Coca is something people were doing at least 2,000 years ago. People for centuries used these two drugs in ways that we use whole cabinets full of pharmaceuticals today. We use them in order to get a decent night's sleep. Marcus Aurelius the Roman Emperor took small amounts of opium in order to get off to sleep and stop worrying about the state of the Roman Empire. More nefariously Nero used opium to poison Britannicus, knowing clearly that large doses were dangerous and small doses were less so.


Drugs were used in Victorian England by all sorts of people. By that stage they had begun to use them in ways that we would describe as recreational. George IV when he was Prince of Wales took laudanum which was a compound of opium and alcohol to still the pain of a sprained ankle which he wrenched while rather improbably dancing a Highland fling. After that he found it very hard to give the stuff up. He reportedly needed 100 drops of laudanum before he could face Lord Aberdeen, the Foreign Secretary. History doesn't report whether Lord Aberdeen also needed 100 drops of laudanum in order to face George IV. I suspect he probably did. And other characters whom we think of as more upstanding than George IV, whose morals, of course, left much to be desired, also used laudanum in various ways: for example, William Gladstone took some before he made big speeches; Wilberforce too, Coleridge Samuel Taylor Coleridge, took it as well, though he complained bitterly about the way in which the lower orders overdosed on the stuff; but he took it himself. Wilkie Collins found it a very effective anti-depressant. And of course Victorian child rearing and child-minding which was the basis of the whole industrial revolution – without child-minding how would all those women have gone off to work in the mills? – Victorian child minders found a whole array of compounds based on opium extremely useful for dealing with their fractious charges.


So these things have been medicines for hundreds and thousands of years, and it was only really in the 19th century that people began to worry about the way they were used, and particularly about Britain's role in the way they were used. Gladstone himself worried about the way in which Britain had pressured and fought against China in order to persuade China to accept imports of opium from India in exchange for Chinese tea. Gladstone said, memorably, that he was "in dread of the judgement of God upon England for our national iniquity" towards China. And it was as opium became a large item in international trade that people began to worry about its various side-effects.


But the bottom line in all of this is that, for most of recorded history, and right through the 19th century, drugs that are now illegal were both legal and widely used. What worried the people who founded Saint Albans in the 19th century far more than drugs was alcohol, and it was alcohol that was the focus of all the campaigning movements of the late 19th century. Indeed, one of the curious things that happened in the 20th century was that public attitudes towards alcohol eventually became more liberal whereas public attitudes towards drugs became less liberal. In my view, it might perfectly well have turned out the other way around. But that's what's happened.


So, in the very last years of the 19th century, and in the early years of the twentieth-century, the United States began to make various drugs illegal - not because of worries about their broad social effects but because politicians didn't like the way in which various minority groups, black people in the case of cannabis, Chinese in the case of opium, used these drugs. There was an element of anti-immigrant and indeed racism in the early legislation. But America’s laws then began to have an effect on other countries, as the United States began to pressure other countries to follow its lead. A familiar approach of course of American politicians.


Well now, the drug market today: how big is it? That's a very difficult question to answer because of course it's illegal so nobody quite knows how big it is. But the best guess I've come across is that it's probably something in the order of $150 billion, that's if you take the value of what's bought on the street and measure it that way. That puts it roughly in the same league as consumer spending on tobacco which is about $200 billion, and a bit behind spending on alcohol which is about $250 billion; but there are other guesses which will produce larger numbers.


This market is on the whole supplied by a rather narrow range of countries. Basically drugs are of two sorts: the chemicals that are man-made; and the agricultural products that are harvested. The agricultural products are basically opium, coca and cannabis. Cannabis tends to be grown mainly in the countries that consume it; because it has lower value that the others and is rather bulky relative to its value and is therefore not quite such good thing to transport around – you are much more likely to get caught. Moreover, as generations of undergraduates have discovered, it is the sort of thing that you can grow on a windowsill. One of my friends has a son who in his teens was particularly hopeless at school and couldn't get anything done – he is now of course an extremely successful music producer in Canada – but for her the nadir came when she found behind the curtains in his room a drooping cannabis sativa plant and said to her husband, "dear me, he can't even do that right!"


The farmed drugs are grown largely in two countries: something like two-thirds of the world's opium comes from Afghanistan – that portion declined at the peak of the Taliban regime as the Taliban found extremely effective ways of stopping people growing the stuff – that has now broken down and one of the things the British Foreign Office is absolutely terrified about at the present moment is the huge crop of opium about to be harvested in Afghanistan now that the Taliban and are safely out of the way. The rest is grown on the whole is in Myanmar, a particularly nasty country that used to be known as Burma. As for coca, four fifths of the world's supply comes from Colombia.


So one of the curiosities is that these crops which are very simple to grow, very easy, are actually grown in very small number of countries, and on the whole in relatively small parts of a small number of countries.


Why is this the case? There's a chap called Francisco Thoumi who's a great expert on the coca production in Latin America who argues that the reasons a few countries end up as big coca growers are to a large extent cultural and social. He points to Ecuador, which is a country that is poorer than Colombia, but one where the Catholic Church still has a great deal of sway, and he thinks that is one of the reasons why Ecuador has not emerged as one of the producers of coca in the way that Colombia which is a much more fragmented society has done.


The most striking feature to my mind of the whole distribution of illegal drugs is the way in which the numbers, the money that goes to the person or actually grows the stuff, bears absolutely no relation to the money paid by the drug taker on the streets. If you take opium: the Pakistani farmer who grew a kilo of opium in the mid-Nineties would have got about $90 for it. That has gone up, I think, but that would have been what the farmer then got. On the wholesale market in Pakistan, a kilo of opium would have fetched about $3,000. Import it into the United States and the wholesale price goes up from $3,000 to $80,000; and when sold on the streets that kilo is worth about $300,000. In other words the wholesale price of $3,000 that Pakistan receives is roughly one per cent of the retail value of $300,000 and what the farmer gets is a tiny, tiny fraction.


The gap between the $90 that the farmer gets and the $300,000 that is the street value of a kilo of opium is extremely striking, and is a reflection of course of the fact that this stuff is illegal and therefore extremely expensive to transport. But that price difference has enormous consequences for anyone who thinks that one way of stopping drugs trading is to find alternative activities for farmers in poor countries or indeed to interrupt the distribution chain. You could pay that farmer twice as much per kilo to grow bananas, say, and the money the farmer would receive might go up from $90 to $180, but as you can see, if the street price is nearly $300,000 at the far end, the dealers in Pakistan can easily match that price and more so.


As for interrupting the supply-chain, that too is a hopeless cause: the same arithmetic, the same gap, occurs between the price of coca leaves to the farmer and cocaine once refined and sold on the streets. And an American economist calculated that a pilot who demands half a million dollars for flying a plane with 250 kilos of cocaine is generating costs of only $2,000 a kilo, which is less than two per cent of the retail price. So even if a half-million dollar plane had to be abandoned after only one flight, it adds only another $2,000 to the kilogram price. So you could ditch a plane after each flight and you would add only two per cent to the retail price - which means that trying to down planes full of cocaine is not going to make an enormous difference to the final price on the streets.


So much for the supply; what about the demand? Well, there are a relatively small number of countries that account for supply but a large number of countries that account for demand. And most of the demand for drugs, in terms of numbers of kilos sold, doesn't come from rich countries like ours; it comes from the poor world. One of the tragedies that will unfold over the next 50 years – is already unfolding – is the spread of drugs used in poor countries: the largest consumption in terms of actual kilos of heroin is actually in Thailand, in China, in Pakistan and in Iran. Those four countries are enormous consumers of heroin in terms of absolute quantity. Eastern Europe, and the former Soviet Union, are very rapidly growing markets. Wherever you have fragmenting societies, rapid urbanisation, or a rootless poor there you get the spread of drugs use.


Countries like that have also far fewer resources to tackle the side-effects of spreading drugs use. One of the most terrible of those has been the spread of HIV Aids as people share needles to use drugs intravenously; and that is a particular problem in prisons. Whilst I was researching this piece I talked to a very interesting Australian doctor called Alex Wodak who came from St Vincent's Hospital in Sydney, Australia. He told me that in Australia's prisons at least half of the inmates were injecting drug users and half of those people continued to inject when they left jail. They learnt how to do it in jail and then they continued to do it when they left. The most depressing thing was that while outside jail they shared needles perhaps only three times in a hundred, inside jail sharing needles was pretty well the norm. Indeed, they typically shared needles with about 100 people a year while in jail, which of course is a sure-fire way of spreading AIDS.


Dr Wodak was even more worried about what was happening in Thailand where he felt that the AIDS epidemic which has been of course particularly serious could be traced directly to what went on in Thai prisons. Intravenous drug use with shared needles was extremely common there, and those people contracted Aids and went home and spread AIDS among their families and so out through society at large. He saw that this was the way in which AIDS in many Asian countries gathered speed and spread throughout society.


From now on I want to talk about drug use in rich countries, and what we do about it. I think there are a number of misconceptions here. One is that drug users are in some sense a homogenous group: that's not true. Most users of most drugs are occasional users, not addicts in any true sense of the word. Indeed addiction in the sense of making you physically ill when you stop doing it as happens with nicotine – nicotine makes you physically ill when you stop using it – the only drug that people are sure has this effect is heroin. Other drugs are very difficult to give up for some people, but doing so doesn’t make you physically ill for a substantial period of time in the way that giving up heroin is apt to.


In addition to that, drug-users in a curious way are rational about what they do. You may think it's not particularly rational to put into your body a mind-changing substance of uncertain quality bought from somebody you don't know and are never likely to see again and taken in circumstances that are less than ideal – all that may sound to you deeply irrational. But there is a certain rationality in that the drugs most people take most of the time are the ones that have the most modest effect. Most drug taking involves cannabis, but also amphetamines, Ecstasy, cocaine. All of those are drugs where the pattern of use is not like smoking. This isn't something that you do regularly day-in day-out. It's something that's more in that sense like alcohol – you do it socially, you do it several times a week or you do it several times a month; you do it with friends and you do it in a social context. So that's the most frequent type of drug use. And in the case of each drug, most of the consumption is by the minority of heavy users: most people in each case who are trying the drug are occasional users. Something like the 80:20 Rule applies: 80 percent of users account for 20 per cent of use; 20 percent of users account for 80 per cent of use. Those are not the precise numbers but that's the pattern everywhere and in that sense the 80 percent of users are clearly behaving in a relatively rational way.


Another misconception is that all drugs are exceedingly harmful to health and all drugs tend to be causes of death. In fact the deaths that are caused by drugs even in Britain which has a serious number of people taking drugs are relatively rare. More smokers die of smoking than heroin users die of heroin. Cigarettes and alcohol are bigger killers of their users than drugs are of the number of people that use them.


Moreover, deaths from drugs are frequently related to contamination. If drugs are contaminated then they are obviously much more likely to kill people than if they are not. In the case of heroin, deaths tend to be related to periods of abstinence because what very often happens is that people stop using heroin, go cold turkey for a bit, then start using again, misjudge the dose, because the dose they used to be taking when they were addicted could be tolerated. But after a period of abstinence, the dose they can tolerate is lower and they either don't know that or misjudge it – that's how they kill themselves. Incidentally that has implications for the treatment of heroin users: it means that treatment through abstinence is more dangerous than treatment through stabilising the dose. That is extremely hard to get across to people who don't know very much about drugs.


Even in the Netherlands which has a less aggressive approach to drugs than we do or the Americans do, only about 100 people a year die from causes related to heroin but only one or two people died from causes related to cocaine and only about one person a year dies from causes related to Ecstasy and that's remarkable when you consider that the Netherlands is widely regarded as the world's main entrepot country for the trade in Ecstasy.


Now let me turn to policies. There are basically two kinds of approach: one is the American version, and one is the European continental approach particularly as practised in the Netherlands and in Switzerland.


The American approach is very much one of a War on Drugs. It began in the 1980s when America was suffering from an epidemic of crack cocaine. President Reagan’s vice-president, a chap named George Bush, set out to lead what he called a war on drugs. That war has continued even though the crack cocaine epidemic has subsided and is now of course still pursued under his son - another George Bush.


The American approach is very much to try and lock-up drug takers in jail and deal with the whole thing in a very head-on, ban-it-don't-allow-it, way. What's interesting is the similarities between America's approach to drugs and its approach in the 1920s to alcohol at the time of Prohibition. In fact the drugs policy is tougher than the Prohibition on alcohol was, because people were allowed to consume alcohol in their own homes, and of course America does not allow that to people taking drugs.


In the case of Prohibition the consequences, as we now know, were exceedingly perverse in all sorts of ways. One saw the corruption of justice, the rise of gangs, a rise in the consumption of hard liquor and spirits, a rise in the number of deaths which were alcohol related and a general corrosion of civil life. Prohibition was not emulated in other countries, although there were Temperance movements in lots of countries including this one. It remained an American approach to this problem. The damaging impacts of Prohibition were confined to the United States; in the case of American policy on drugs, because drugs are internationally traded on such a large scale, the consequences have spilled over to the rest of the world and have made it impossible for rich countries that want to head down a different track to do anything very different from the United States has done, although we can now see attempts to do so.


To my mind, the most deplorable effects of the American drugs policy have not been the curious fact that drug prices have declined not risen in the United States – if the policy was really being effective you'd think the drug prices would rise when in fact they are actually lower than they were before the war on drugs began. But that hasn't been the worst effect, neither has the enormous rise in imprisonment – so that the United States, has a higher imprisonment rate for drug offences than most continental European countries have for offences of all kinds – that's not the most serious effect. The most serious effect I think is the way in which it is ethnic-minority and particularly young black people who have ended up in prison as a result of America's drug policy. America, as you know, has more young black people in jail then in university, and that is largely a side-effect of the drugs policy.


Here are some figures to make your hair stand on end. Black people in the United States account for 13 percent of monthly drug users; for 35 per cent of those arrested for possessing drugs; for 55 per cent of those convicted for the possession of drugs; and 74 per cent of those sentenced to prison. So, 13 per cent of drug-users – 74 per cent of those sent to prison. And that seems to me inexcusable and indefensible.


Now I haven't talked about the damaging side-effects that drug-taking has. Other speakers are going to talk to you later on this morning about the physical damage that drug-taking causes and I certainly wouldn't try and minimise that. Drugs aren't good for you, any more than are smoking or drinking too much alcohol. It's also the case that drug-taking is highly correlated with crime. I see you have someone coming to talk from the Metropolitan Police later on. He will also no doubt make that point. One group of 1,000 drug users studied in Britain turned out to have committed 75,000 crimes in a period of just three months. So drug taking is strongly correlated with crime and of course particularly drug-taking by that minority that take drugs intensively and are called by academics chaotic drug users.


What's the alternative policy? Well in the course of doing my survey I went to both the Netherlands and Switzerland and I saw two things that really interested me. In the Netherlands I saw an approach that was based on what that country calls the "principle of expediency". They also apply this principle in the case of abortion and euthanasia. It's a very good way of dealing with those difficult moral issues that the law finds hard to cope with. What they basically do is to say "this sort of behaviour is illegal but under certain circumstances the Public Prosecutor's Office won't take action", and that approach has allowed them to develop a policy of trying to keep apart users of hard drugs and of soft drugs through establishing cafes in which you can go to smoke marijuana but where you can't buy anything more serious. I have to say the cafe owner whom I went to interview grumbled like mad about the policy, partly because it remains illegal for him to buy marijuana which makes it very difficult for him to run his business although the police and he have a modus vivendi there; partly because he got inspected by tax authorities all the time and all small businessmen grumble as you know about the tax authorities; but partly because the ordinary cafe just down the road, he said, kept cocaine under the counter and supplied it to anybody who wanted it and was willing to pay the right price.


But an even more interesting scheme which I saw was that pursued in Switzerland, where the country has set up heroin-maintenance clinics. These are for heroin users who are particularly desperate, people who really cannot be weaned off in any other way, and who have been in hospital on numerous occasions, have tried to commit suicide on more than one occasion, suffer severely from depression, and have probably been in trouble with the law. These clinics have had an extraordinary success in stabilising the behaviour of addicts. The users come in two or three times a day to receive a dose of heroin to administer it to themselves under carefully controlled conditions, and to receive other drugs that they may need – a lot of them are HIV-positive, a lot of them are suffering from depression and have other problems. They receive treatment for those conditions, and the effects have been really very surprising in that the number of crimes they commit has fallen dramatically, quite a lot of them have got steady jobs, most of them find their depression is more manageable and a lot of them are using less cocaine (addicted heroin addicts tend to use cocaine as well). The clinic I saw in Berne in Switzerland seems to me to be a model of its kind. The people who ran it said you can only do this in a country where you have a culture of reasonably honest medical practitioners; it's not for everyone. They were very realistic about it. But it seems to me to be an admirable approach.


Now what do I conclude from all of this? Well I conclude that in various ways and with a lot of care and slowly and deliberately we should find ways to legalise drugs that are now illegal. I don't mean that they should all be available on the shelves at Sainsbury's. We should be aware that the drugs which are legally available to people in society at the moment are available in different ways. You can get a shot of caffeine if you come here to St Albans, and take this particular drug freely even if you are a clergyman; you can get a shot of alcohol, as some of us will at lunchtime just done the road, as long as they are confident that you're over 18 and you buy it from premises that have been licensed to sell it to you. But if you want Prozac, you have to go to your GP and get a prescription. And I don't see why this principle of differentiating among different kinds of drugs and could not be applied to those drugs which are currently illegal.


Why should we go down this route? Well there are two sorts of argument. One is ethical. I'm a child of the Liberal Generation and I believe in the words of John Stuart Mill whole in his famous essay on Liberty said this:


"The only duty for which power can be rightfully exercised [by the state] over any member of a civilised community against his will is to prevent harm to others; over himself over his own body and mind, the individual is sovereign."


That principle of individual sovereignty applies here. We allow individuals to do many dangerous things: we allow them to ride bicycles round Hyde Park Corner without a helmet; we allow them to climb mountains; we allow them to go bungee jumping. None of these activities is illegal. They scare the living daylights out of insurance companies and mothers but we still allow them to take place. We don't try and outlaw them. And I think the same principle could reasonably be applied to drugs.


However, I'm not just a liberal: worse, I'm an economist too. So I think one also has to look at the issue in terms of costs and benefits.


Anybody advocating legalisation is first under a duty to acknowledge that there would be costs. Some of those costs would be serious. If you make drugs that are now illegal, legal, they would acquire some social respectability that they don't now have. That would undoubtedly increase the number of people who experimented with them. They would be more accessible. No longer would you have to know who to go to round the corner in Stoke Newington to get your little packet; anybody would be able to acquire drugs respectably. Most important, the price would fall – dramatically. The price is as high as it is because it is a reflection of illegality. Even if you slapped on the tax, still the price would fall. Cocaine in the United States apparently costs about $100 a gram. It might well cost something like $5 a gram, three quid a gram. That would have an enormous effect on people's willingness to dabble, and a proportion of those who dabbled and experimented would undoubtedly become addicted. So the absolute number of addicts - the absolute number of people who are dependent on drugs psychologically and socially - would undoubtedly increase. It is immoral in my view to argue for legalisation of drugs without accepting that a consequence would be a rise in the number of people who took drugs and a rise in the number of people who then could not give them up.


On the other hand there would be benefits which in my judgment are greater than the costs. Those benefits would include some reduction in crime – not a total reduction in crime, because after all alcoholics commit crime in order to afford their can of Tennants stout. There would be a decline in imprisonment of people for taking or trading in drugs. There would be a decline in corruption: it's very difficult for the police to convict people for drug-related crimes without an occasional temptation to fiddle with the evidence because after all this is a transaction between a willing buyer and a willing seller, who are often the only two witnesses. But what convinces me most of all is that there would be opportunities for regulation. You can't regulate something that's illegal. There would be opportunities for quality control. There would be opportunities to license outlets; there would be opportunities to set age limits.


Now we all know from what happens with alcohol and what happens with tobacco that there would still be plenty of under-aged users. There might still be plenty of rough stuff on the market; but basically there would be a way for those who experiment anyway to experiment more safely than they currently do. And that is why as the mother of two daughters at the age when drug dabbling is all too common, I think that it is ultimately safer for society for drugs to be legal and regulated than for them to remain illegal and therefore unregulated.


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