We just have not done enough - international efforts to control illegal drugs

UN Chronicle, Summer, 1998 by Vis Navaratnam

It's been nearly thirty years since I was introduced to the field of drug dependency. In 1970, I became involved in research in the neuropsychopharmacology of benzodiazepines. Since then, my interest and work have spread to include issues related to the epidemiology, treatment and rehabilitation, prevention, policy development and evaluation at local, national, regional and international levels. My first attempt to review the efforts in the field of drug abuse was described in the book "Drug Abuse in East Asia" in 1981.

Now, 25 plus years since my initiation into the field, I feel it is time, with the international community, to look again at our global efforts and analyze them, specifically to address some of the following questions: What did we do right? What would we repeat? What have we learnt? And what can others learn from our experiences?

I believe we need to stimulate a process of review at all levels which might hopefully lead to the development of more practical, focused and cost-effective programmes and policies in the field of drug abuse control.

My own review has led me to conclude the following: the abuse of licit and illicit drugs represents a major security, social and public health problem, which remains a significant societal concern in most countries. The concern stems from the costs to society caused by the problem. These costs include: premature death of productive individuals due to drug-related illnesses; accidents; economic costs related to lost productivity; health care; and crime prevention. Furthermore, many infectious and social ills plaguing a number of countries - the HIV/AIDS epidemic, increased levels of violence, petty crimes - in many instances are linked to the abuse of drugs. In addition, it has been clearly demonstrated that the consequences of drug abuse have had an impact on people within every economic, racial, religious and political group.

The international community has responded by enacting a multitude of treaties, declarations and laws, and by developing policies and introducing programmes to redress the situation. Yet, despite all these international efforts, we have to acknowledge that producer countries as a whole produce more than ever, and consumer countries consume more than ever, without any real change having been induced by the policies and programmes being implemented on this larger scale, and despite the financial investments being made on an even larger scale.

Why has this happened? Obviously there can be no single or even a general set of reasons to explain such a complex issue as drug abuse. However, let me venture to put forward some tentative observations.

Firstly, while we talk about a "balanced approach" in respect to supply versus demand reduction in the development of our policies and programmes, in reality, we have adopted an "unbalanced approach". If one analyzes the financial allocations at global or national levels, it is clear that a larger percentage of funds are devoted to supply side activities. Such a decision can easily be supported. However, have these programmes and activities been evaluated vigorously and independently to ascertain the extent to which they have succeeded in reducing the production, distribution and local availability of drugs of abuse? Such an analysis would indicate the cost effectiveness, as well as the intensity and time frame required, for these efforts to make a measurable impact.

Current supply reduction policy revolves around the eradication of production, which has been labeled as eradication of cultivation", "crop substitution" or more recently, "alternative development"; and the law enforcement, which emphasizes interdiction, as well as arrest, prosecution and incarceration of drug traffickers and distributors.

Reviewing available reports, there is a growing base of evidence and opinion which suggests that the international supply reduction policies have not met expectations to date. In fact, the evidence suggests that the efforts have failed to markedly reduce drug importation, distribution and street availability. Equally, they have failed to significantly deter individuals and criminal groups from becoming involved in the illicit drug trade. While I support the need for law enforcement activities as part of any comprehensive effort, it is nevertheless timely to evaluate our strategies, priorities and programmes in this sector.

Reflecting on the "unbalanced" part, that is, demand reduction, here the situation is even more depressing. If one accepts that the appropriate goal of international demand reduction policies must aim to decrease the prevalence and spread of drag abuse and reduce the harms associated with such drug-using behaviour, then it would appear they have not achieved expectations.

Prevention, treatment and rehabilitation have been the mainstay of this sector. There exists a substantial body of knowledge regarding potential risks and protective factors, particularly for children and adolescents, yet the current programmes appear not to have significantly reduced drug use in these populations.