Just as drug problems vary across nations, there is a great deal of diversity in the approaches that nations take to deal with illegal drugs, even though all countries prohibit the same psychoactive substances and almost the same activities related to those substances, reflecting the three international conventions on psychoactive drugs.43 Some governments provide many services for individuals experiencing drug problems and treat the enforcement of the criminal law as a last resort, aimed primarily at protecting the public from predatory and dangerous activities related to drug selling; this list includes the Netherlands and Switzerland. Other nations see law enforcement as central to controlling drug use and related problems, with services for problematic users available only on a very limited basis; Russia and the United States are leading instances of this group. Many countries have no clear strategy or policy, even if they have a formal document labelled “Drug Strategy”; that is true for example of Brazil and South Africa. The purpose of this section is to describe the variation in actual policies; the next section provides an assessment of the consequences of the differences.
In general we see evidence of convergence of policies. Harm reduction (HR), once controversial as a concept, has been accepted in a growing number of countries, albeit in an inconsistent fashion. Some countries for whom tough enforcement had been absolutely central, notably China and Iran, now accept methadone maintenance as an important instrument for reducing heroin related problems. Globally, methadone maintenance has become much more widely available. Sweden, rhetorically at the forefront of the opposition to Harm Reduction in Europe, has now adopted many HR programmes (Van der Gouwe et al., 2006). Even in the United States, whose federal government has aggressively challenged HR in international fora, state and municipal governments have begun to implement such programs domestically. Iran, long among the very toughest in its response to violators of drug laws, has moved toward the provision of services instead; literally hundreds of thousands are now being treated in methadone and other harm reduction programs (UNODC, 2008).
A variety of legal changes have reduced the criminal sanctions against drug users, both in Western countries and elsewhere. Cannabis in particular has been the subject of reductions in legal penalties in many countries (EMCDDA, 2008; Room et al., 2008). Portugal removed criminal sanctions for simple possession of any illegal drug in 2001. In a complementary fashion, more countries are finding ways of diverting criminal offenders whose activities are motivated by drug use, from the criminal justice system, an initiative which has been very much inspired by United States efforts to develop drug courts that use the power of judges to get drug-dependent offenders to seek treatment (e.g. Nolan, 2008). For example, the United Kingdom has used such programs since 2000 to massively increase the number of drug users in treatment from 100,000 in 2000 to 180,000 in 2005 (Reuter & Stevens, 2007).
At the same time, there has been a modest toughening of enforcement against sellers in many countries, including most of the European Union Member States. Even the Netherlands, an early and prominent proponent of more tolerant approaches to drug users, has become tough in its efforts to control cannabis production and trafficking, while also attempting to cut down on the number of coffee shops that sell primarily to foreign tourists. It undertook an extremely aggressive effort to deal with the smuggling of cocaine from the Netherlands Antilles into Amsterdam airport (World Bank/UNODC, 2007). The United Kingdom may actively espouse harm reduction programs but it has increased the number and length of sentencing for drug sellers in the last decade (Reuter & Stevens, 2007).
Data from non-Western countries do not show a clear trend of increasingly punitive measures toward drug sellers and producers.
Prevention programs are increasingly central to the rhetoric of drug policy. All strategy documents emphasize that in the long-run, stopping youth from beginning drug use is essentially to controlling the drug problem. For example, in the United Kingdom the national strategy of 1998 Tackling drugs to build a better Britain identified “to help young people to resist drugs” as the first of its four goals.
However the limited available evidence suggests that little money is spent on primary prevention activities44 and that programs are generally of limited effectiveness. Estimates of drug control expenditures for the Netherlands (Rigter, 2006) and Sweden (Ramsted, 2006) show that prevention programs account for a very small part of the total, 2% in the case of the Netherlands and 1% in the case of Sweden. Australia is an outlier, with an estimated 23 percent of the drug control budget going to prevention (Moore, 2005). For most countries such estimates are not available. The principal funded programs are school based; some countries eschew mass media campaigns.
Though there is research evidence that effective school based programs are possible the programs that are adopted often have no demonstrated effectiveness (EMCDDA, 2008). Moreover, they are poorly implemented (see e.g. Gottfredson, 1997).
Most prominently, in the United States by far the most popular school-based prevention program is DARE (Drug Abuse Resistance Education), which has been frequently evaluated, with generally negative results (Samples and Aber, 1998) and is now being redesigned .
In countries facing major drug use for the first time, the prevention response has been uneven. China, despite very low prevalence of drug use, has both wide spread school based prevention programs and mass media campaigns involving sports and media stars. For Brazil and Russia there also appears to be increasing numbers of prevention programs. On the other hand India still has little systematic prevention efforts. For most countries, systematic data are not available on changes in the extent and nature of prevention services between 1998 and 2007.
In contrast to prevention, there is a substantial body of positive evaluations of implemented treatment programs (e.g., McLellan and Meyers, 2004) though few of the evaluations have been done outside of rich Western nations. Studies show that on average treatment reduces the extent of drug use and related health and social problems in those who enter programs. Few of those who enter become lifelong abstinent thereafter but they are abstinent more frequently and for longer episodes over
the following years. The evidence is much stronger for opiate substitution treatment (OST) than for any other kind of service.
Opiates dominate treatment demand in most countries around the world; however that is not true for the United States and
is decreasingly true for a number of European Union countries. Cannabis treatment demand has been rising throughout the
Western world. For example, a study of Ontario treatment admissions in 2000 found that cannabis was the drug most frequently
cited as the primary cause for admission (Urbanoski, Strike and Rush, 2005). The EMCDDA reports that cannabis treatment
admissions accounted for 30 percent of entries in France and the Netherlands in recent years (EMCDDA, 2008).
Nonetheless, the total number of patients in methadone maintenance programs has grown substantially across the world.
In the European Union alone, there is now an estimated 600,000 methadone clients, much increased from the late 1990s45.
The new programs in Iran and China have added substantially to the totals; for Iran the number of methadone patients may
be close to 200,000 in late 2008. In some countries (e.g. Switzerland, the Netherlands and the United Kingdom) over half of
the estimated opiate dependent population is now in treatment, mostly involving OST. Buprenorphine, a much more recently
developed opiate agonist/antagonist substitute, is also now available in many countries, but is used extensively only in France
and the Czech Republic.
However, some other countries, with established methadone programs, such as the United States and Sweden, continue
to serve quite a small fraction, perhaps less than one quarter. Russia, despite its large population of dependent heroin
users, continues to stand firmly against allowing any substitution programs. India, with a large addict population,
provides few treatment services of any kind; the total number of service facilities is less than 500. Limited services are
available in Brazil, Colombia and Mexico as well, though for none of them is heroin dependence a major element of
their drug problem.
For drugs other than opiates the available treatments are psychosocial rather than substitution therapy. There are efficacy
studies with positive results of such interventions for cannabis, cocaine and methamphetamine but the reductions in drug
use are smaller and less reliable than for opiate substitution treatment.46 In almost all countries the share of those in need of
treatment for these other drugs who are receiving services is smaller than for opiates.
4.4 Harm reduction
Starting in the 1980s in the United Kingdom, when HIV related to needle sharing first emerged, and in the Netherlands a
set of programs were developed that focused on reducing drug problems not by lowering the prevalence of drug use but by
directly targeting the harms of drug use. These have been controversial since inception. Opponents argue that the programs
are dangerous because they condone an illegal and dangerous behaviour; proponents argue that they are founded on the
reality that some individuals will not be persuaded to give up drug use (MacCoun & Reuter, 2001).
Most harm reduction efforts are focused on injecting drug use. The canonical program, debated in many settings, involves
the provision of clean needles by legally sanctioned operators (SEP: Syringe Exchange Programs). Other Harm Reduction
interventions include safe injecting facilities or provision of Naloxone to injecting drug users so that they can revive friends
who have overdosed. See Van der Gouwe et al. (2006) for an inventory of HR programmes in the European Union and a
summary of the available evidence on their effectiveness.
Most European Union member states have implemented many HR programs, as have Australia, Canada and Switzerland
among the eighteen countries in our sample. Even amongst these countries though there is resistance to some elements
of Harm Reduction. For example, safe injecting rooms are rare and heron maintenance, pioneered in Switzerland, is so far
available on a routine basis in only two other countries, Germany47 and the Netherlands (Fischer et al., 2007).
The Russian Federation, until the early part of this decade amongst the most punitive of nations in its response to drug use,
has begun to implement a variety of HR programs, such as SEP and safe use education, even though it does not explicitly
acknowledge the change in policy and continues to prohibit the distribution of methadone. A few Asian countries have begun
implementing SEP as well (International Harm Reduction Association, 2008).
There continues to be vigorous resistance in some countries. Apart from the United States, the opponents are mostly countries
that have modest drug problems, such as Egypt and a group of Middle Eastern nations. HR remains essentially unknown in
Latin America, where injecting drug use is not a primary concern. The United States government, though a major sponsor
of methadone maintenance (which is now viewed as a Harm Reduction intervention), in international fora resists formal
endorsement of SEP and other HR interventions. However SEP is available in many United States cities, funded either by
private organizations or municipal government; the same is true for safe use programmes.48
Drug enforcement efforts take many forms. The categorization used here focuses on the targeted activity: production, smuggling,
high level trafficking and retailing. Though it is properly a demand reduction activity, we also consider enforcement
targeted against use in this sub-section. Table 6 presents a matching of programs to targets: It provides the basis for assessing
program effectiveness, since it suggests which part of the distribution chain should be primarily affected by a specific type
Efforts to control opium production have been of mixed intensity during most of the study period. Myanmar has seen tough
enforcement against the opium farmers in the Shan State by the separatist group in charge of that region of the country
(the United Wa State Army) rather than the national government. The governments of Colombia and Mexico have been
aggressive in their efforts against poppy growers, as indicated by the high share of planted poppy fields that have been
sprayed with herbicides. However, Afghanistan, far and away the dominant producer throughout the period 1998-2007,
has lacked an effective government for most of the time. The President of Afghanistan has often spoken of the need for
stringent enforcement of the ban on opium growing and trafficking (Islamic Republic of Afghanistan, 2005, 2006); however
his government has been opposed to the spraying of planted crops, a program pressed by the United States, which might
threaten the political stability of the country. The government has been unable to consistently mount to mount either other
kinds of eradication or effective alternative livelihoods programs (Rubin and Sherman, 2008).
The eradication efforts against coca fields in the Andes have been consistently intense. Colombia, where coca growing is now
centered, has, with the support of the United States backed Plan Colombia, sprayed hundreds of thousands of hectares each
year; it now also offers alternative livelihoods, a new initiative. In Bolivia relatively large sums (much provided by European
and United States agencies) were spent on an array of programs aimed at developing legitimate economic opportunities in
the principal coca growing area, the Chapare.49 For example, European funders invested in developing roads and schools.
Following, the election of Evo Morales, former head of the coca growers association, as president in late 2005 there was
some reduction in foreign funding of such programs. Bolivia also maintained its eradication program, employing the military
for manual destruction of crops. In Peru the effort was primarily enforcement.
Because cannabis production is so dispersed around the globe, it is much more difficult to describe actions against growers.
Mexico, one of the two major exporting countries, has been aggressive in spraying cannabis fields. Morocco, the other major
international supplier, has adopted a more varied set of programs to deal with the problem, including alternative livelihoods
(Gamella and Rodrigo, 2008; Department of State, 2008). In the consumer countries that are also producers, enforcement has
generally been modest, partly reflecting the elusiveness of the target. The Netherlands, which is believed to be an exporter
to Europe, is aggressive against the growers who supply the tolerated coffee shop outlets; it arrests over 4,000 individuals
each year for cannabis production. The United States has regular eradication and enforcement campaigns against domestic
cannabis growers (Drug Enforcement Administration, n.d.). Elsewhere enforcement is haphazard.
Enforcement against ATS producers involves quite different techniques, in part because the production itself is so unlike the
growing of opium and coca. It is much more like investigation of traffickers or interdiction.
The flow of drugs across international borders, particularly those of Europe, is a disturbing reminder of the failure of rich
and powerful governments to control what enters their countries. That may explain why there has been increasing attention
to interdiction, the effort to seize drugs, couriers and vehicles on their way into major markets. For example, the UK 2008
Strategy gives emphasis to “creat[ing] more international partnerships to intercept drugs being trafficked to the United
Kingdom and to implement[ing] border controls in countries of departure.” (U.K. Home Office, 2008, p 14)
However, interdiction is not only a rich country activity. Indeed, perhaps the most intense national efforts are those of the
Iranian government, which has tried to intercept opiate shipments from Afghanistan (some indirectly through Turkmenistan).
Iran estimates that 250 border guards have died in recent years in these efforts and invests substantial sums in the effort.50
The smugglers are heavily armed, even occasionally using military tanks for these purposes. Mexico has also targeted drug
smugglers from its side of the border with the United States.
Global seizures have risen substantially for both cocaine and heroin, both in absolute terms and as a share of estimated
global production. The most recent estimate, for 2007, suggests that 42 percent of cocaine is seized, up from 29 percent in
1998. The figure for heroin is lower but has also risen sharply from 13 percent in 1996 to 23 percent in 2006. The figures for
cannabis are less reliable, both with respect to production (as discussed above) and to the interceptions; often these latter are
denominated in “plants” rather than the quantity of drugs and thus cannot be summed.51
Investigation of high level dealers
Though high level dealers make attractive targets for law enforcement, offering the opportunity to remove entrepreneurial
energy and organizational leadership from the drug trade, there is almost no systematic information available about programs
aimed at accomplishing this. The 18 country reports rarely contained any description of targeted efforts.
In the United States the federal government targets such dealers and now has about 100,000 persons incarcerated for drug
offenses, the vast majority for some involvement in high level trafficking (Mumola and Karberg, 2006). However, many of
those incarcerated for such offenses were convicted because they were caught with large quantities; their actual responsibilities
may have been minor. State prisons and local jails in the United States include approximately another 400,000 inmates
incarcerated because of drug offenses; most are imprisoned for low level drug dealing.52
Most drug enforcement efforts in any country are aimed at the retail market, either at the seller or the user. That is in part
because most participants in the trade operate at that level; if each high level dealer has ten low level dealers as customers
(a plausible but untested figure) [Ref.], then about 90 percent of the dealers are at the retail end, some as look-outs or
protectors rather than sellers themselves.
The retail market is also the most visible part of the market, at least in some countries and for some drugs. For example,
numerous countries report active street markets for heroin addicts, whose needs are urgent and unpredictable and whose
behaviour is threatening enough that a dealer may want to avoid exposing himself to in his own home. In contrast, for
cannabis the retail market is not a major target because such a small share of transactions takes place in public or near-public
spaces; many sales are conducted in the house or apartment of the seller and are hardly accessible to the police at all.53
Thus most of those arrested and incarcerated are low level dealers. Information in many countries is restricted to the number
arrested. Table 7 provides data on drug arrests, by type of drug, in the European Union over the period 2001-2006. Earlier
data are available only on an occasional basis.
Note that cannabis dominates arrests for European nations, accounting for nearly 60 percent of the total. The same is true for
other Western countries. In the United States cannabis arrests account for nearly one half of all drug arrests in recent years.
For Switzerland the figure is about 60 percent. Drug specific arrest rates are not available for the developing and transitional
It turns out that the offense of arrest is usually possession; that is discussed below. Incarceration, a much rarer event, involves
drug sellers. Weatherburn and Jones (2001) report that in the Australian state of New South Wales in 1999, just 1.2 percent
of those convicted of cannabis possession or use were sentenced to prison, and such punishments typically came when the
cannabis use offense happened in conjunction with other offenses and/or the offender had an extensive criminal record. In
the United States an analysis of self-report data from those incarcerated for drug offenses found that a majority of those who
said that they were in prison for conviction on drug possession chares reported that they had in fact been involved in drug
selling in some way (Sevigny and Caulkins, 2004). This represents the effect of plea bargaining.54
Enforcement against users
A majority of arrests in most countries (typically over 60%) are for possession rather than distribution of drugs; the Netherlands,
because of its de facto legalization of cannabis in coffee houses, has a much lower percentage. In some arrests the
offender maybe guilty of distribution but the police officer was unable to obtain evidence for that and could only charge
possession of the drug. The numbers of persons arrested is large for some countries. For example, in Switzerland, the total
number of possession arrests, mostly for cannabis, amounted to about 25,000 in 2006, a rate of about 500 per 100,000
inhabitants over the age of 12. In the United States cannabis possession arrest rates were about 250 per 100,000. More
relevant though is the rate of arrests per user or per use episode. Even in the United States it is likely that a cannabis user has
less than a 1 in 3,000 risk of being arrested for any given incident of cannabis use.
Considerable prominence has been given to efforts aimed at seizing the assets of drug dealers. Much of the initial impetus
for creating the international money laundering control system arose from the belief that this could be used to cripple the
international drug trade. In fact the seizures of drug related assets have been slight in all countries, at least relative to what
is believed to be the scale of the trade (Reuter and Truman, 2004).
43 The three conventions are the 1961 Single Convention on Narcotic Drugs, the 1971 Convention on Psychotropic Drugs and the 1988 Convention
against Illicit Trafficking of Narcotic Drugs and Psychotropic Substances.
44 There are some indications that expenditure is rising.
45 It is unclear whether this number includes all patients receiving their methadone from general practitioners, a common practice in countries such
as Switzerland and France.
46 For example, Higgins et al., 1994 report improvement in outcomes for treatment of cocaine dependence from offering incentives for abstinence,
typical of a growing literature on such interventions. However a review of interventions aimed at amphetamines (Srisurapanont , Jarusuraisin and
Kittirattanapaiboon, 2001) found limited evidence on treatment outcomes and most of that evidence pointing to modest effects.
47 In Germany implementation remains very partial.
48 “Many states moved to amend their legal code to allow for or authorize syringe-exchange programs to operate legally and generally extended
some legal protection to drug injectors participating in these programs… An estimated 225 syringe-exchange programs currently operate in the
United States, run by a variety of community-based nonprofit groups, health clinics and hospitals, and city public health departments” (Clear,
n.d.) See also Beckwith e al. (2006) for an example of a state level intervention.
49 It is estimated that the U.S. narcotics related assistance amounted to about 1-2% of Bolivia’s GDP between 2000 and 2005. The majority of that
assistance was for programs other than eradication and law enforcement.
50 For example, Sami (2006) reports a senior Iranian official statement that his government had spent more than $900 million on building fences,
towers etc. to protect borders with Afghanistan and Pakistan from drug smugglers.
51 Note also that there is no adjustment for potency. Increased seizures from Mexico, known as a low potency producer, might not balance out
declines in seizures of high quality Canadian exports, in terms of the total THC content removed from the market.
52 Local jails include a substantial number of persons who have not yet been tried. Some of those classified as in jail for drug offenses may in fact not
be found guilty of those charges. On the composition of the state and federal prison drug offender populations see Sevigny and Caulkins (2004).
53 Caulkins and Pacula (2006) analyze responses to the U.S. National Survey on Drug Use and Health to show that much marijuana dealing is
imbedded in social relations.
54 In a plea bargain, the defendant agrees to plead guilty to a lesser charge in return for a reduced penalty.