Challenging the global prohibition regime
It was my good fortune a few years ago, when I was teaching at Princeton University and writing and speaking about drug policy, to get it call out of the blue from a billionaire named George Soros. He invited me to lunch and I made a nice connection with this man. The result was a decision, on his part, to commit millions of dollars each year to two objectives: first, to advance harm reduction approaches to drug policy around the world, especially in the USA and Central and Eastern Europe; and second, to broaden debate and understanding about drug policy generally.
In the case of the USA, my own government has vigorously attempted to suppress any debate over harm reduction. In the US Congress and in the state legislatures, there have been thousands of hearings held on every minutia of' drug policy but almost none questioning the basic, punitive prohibitionist paradigm within which so much of the actual harm related to drugs has arisen.
2. The 'taboo' of harm reduction
For its part, the US State Department exerts its efforts to suppress any discussions or debates about harm reduction. Heaven forbid there should ever be any mention of legalization or tile phrase prohibition within the international health and drug communities, whether at a UNDCP conference in Bangkok some years ago or at it meeting in India last month. Panel,, are cancelled, meetings are postponed, invitations are withdrawn because of pressure from my government and other governments such as those of Sweden, France, Japan, and Malaysia who will not tolerate ideas or discussion which deviate from the status quo.
There is, of course, an element of fear prompting this suppression, of' knowing that this system of global drug prohibition is, in many respects, the emperor with no clothes. The aversion to debate reflects not only the fear of' legitimizing an alternative perspective, but the understanding among some who support drug prohibition most vociferously that it is a naked policy. These individuals know that prohibition cannot stand up to an analysis which measures it by the very criteria with which its existence is justified. They know it is not based upon science. They know it is fundamentally in violation of human rights. They are aware that the construction of a global drug prohibition regime has been based upon a repressive ideology in direct conflict with the more liberal values that permeate other global regimes. They recognize these things and so they fear real discussion and open debate.
3. The building blocks of change
Fortunately, George Soros likes to stir up debate. In Eastern Europe we saw an opportunity because the Soros Foundation was already so deeply involved in Central and Eastern Europe. We began to look for people who shared some of our values. Who was thinking about harm reduction? Who. if they did not know about harm reduction, at least had their ears open'? There was a sense of societies in flux, of enormously repressive forces at work, but also bubblings of opportunities. And we began to bring these people together.
In this vein, I am deeply indebted to my friend and colleague Jean-Paul Grund, who has developed aremarkable series of initiatives throughout Central and Eastern Europe. There are now ten harm reduction projects throughout the region, matched with harm reduction programs in the USA and Western Europe, and dozens of other initiatives underway. We hope to expand these efforts to other regions, including Central Asia. And we hope there is a chance here to head off' the disasters that have happened elsewhere.
When we see, for example, what is happening in Ukraine or Moldova or Belarus, where we are observing sudden, dramatic increases in the number of drug addicts infected with HIV, we hope that perhaps there is a chance to prevent the disasters that have befallen Burma, Thailand, the USA and so many other countries. Perhaps.
We know, of course, that there are tremendous forces opposed to this. We know the conventional view is a prohibitionist view that puts the ideology of abstinence on a pedestal. We know the forces perpetuating this view are terribly threatened by a harm reduction paradigm that might somehow enable drug users to be safer drug users, or tolerates anything other than abstinence.
4. Open societies?
In my early conversations with Soros, we were able to draw parallels between his concerns about the workings of socialist dictatorships in Central and Eastern Europe and my concerns about the apparatus of' drug prohibition in the USA and elsewhere. Both are rigid systems of control based upon the assumption that adults must be treated like children in order to protect them from their own weaknesses. Both rely upon the notion that the state knows what is best, that you have no human rights to diverge from popular opinion, to deviate in some way that is not acceptable to the majority as enshrined by the state.
Similar too are the tactics used to enforce these notions. Socialist dictatorships rely on the use of' surveillance: electronic surveillance, personal surveillance, the use of' informants, the use of totalitarian methodologies and information systems. Compare these with the tactics of drug prohibition, where over half of all wire taps in America involve the enforcement of drug laws, where the number one reason for the recruitment of informants-not just from the criminal milieu but even among high school children- is to enforce the drug laws, where physical surveillance and even bodily surveillance through drug testing is increasingly pervasive.
When one looks at the evolution of Central and Eastern Europe over the last 10 years, one sees some remarkable developments but also some very troubling things. One of our fears in looking at Central and Eastern Europe were the hundreds of' thousands of people who had survived under socialist dictatorships by working for the security apparatuses of these countries. Suddenly, there was a vast reservoir of former agents and bureaucrats whose skills and talents were suited to nothing so much as becoming drug enforcement agents, an endless supply of' drug war soldiers to fight against a limitless enemy. Similarly, in the USA, a military complex bloated by years of cold war needed a new and preferably perpetual mission in order to justify its size and budget. And here as well we find an enormous supply of men and women. trained for war.
Underlying all of this, of course, are the people's fears. Because socialist dictatorships depended upon not only offering people a measure of security, which they did both for better and for worse, but also the people's fears of the alternatives, the fears of' capitalism and the fears of democracy, the years of freedom--- all the good things but all the bad things too.
Compare this with the debates over drug policy in the USA, where every call for change is met by vivid fears that somehow if we fake even one small step in this direction we will be headed down a slippery slope toward a Sodom and Gomorrah of drug legalization with drugs rampant and our children addicts.
So when people from Central and Eastern Europe describe their efforts to implement needle exchange and methadone maintenance, which we are helping them to establish. as small oases of' humanity in the desert of repressive punitive prohibition, they are describing challenges similar to those we face in the USA, in France, and throughout the world.
But perhaps there are opportunities. After all, the machinery of' drug prohibition is riot as entrenched nor as sophisticated in Central and Eastern Europe. There are opportunities. With issues like preventing the spread of HIV gaining general support, we are forming alliances and beginning to see the openness we seek.
5. Evaluating 'success'
The basic principles of' harm reduction begin with the understanding that drugs are here to stay. There will never be a drug-free society and in fact there has never been a drug-free society in civilized human history. Our challenge is not how to eliminate drugs from our midst, nor how to hold them at bay outside our borders and our homes. Rather, our objective is to learn to live with drugs in such a way that they cause the least possible harm and, ideally, offer the greatest possible benefits.
It is how we evaluate our drug policy that distinguishes our philosophy from the prevailing mind set of punitive prohibition. The primary evaluative criteria that are typically used in the USA and elsewhere focus on the number of people who have violated a drug law, who have used an illegal drug in the past week or month or year. For example, it is common in the USA to hear people say that the 1980s were a tremendous success in drug policy. Why'? Because in 1980 it was estimated that approximately forty million Americans had tried an illegal drug at least once in the past year. By 1990, that number had fallen in half to roughly twenty million. So those who supported the drug war claimed this was a tremendous success. They gave credit to the Republican administrations of Ronald Reagan and George Bush for this, and they fault the Clinton administration and others in recent years for the increase in illicit drug use, especially among teenagers.
However, it seems to me that the number of' people who have used an illegal drug is one of the less important criteria by which to evaluate the success or failure of it drug policy. Far more important, it seems to me, is to ask, 'What has been the impact of our policies on the death, disease, crime and suffering associated with drug use and with our drug control policies. These are the criteria of harm reduction.
When I re-analyze American drug policy by these criteria, I look at the year 1980 and I think that in 1980, nobody had ever heard of' crack cocaine, by 1990 it was regarded as a national plague. In 1980 nobody had ever heard of drug-related HIV or AIDS; today, hundreds of' thousands of people are dead or dying of drug-related HIV and AIDS. In 1980 the federal government was spending one billion dollars on drug enforcement, and the states and localities perhaps twice that. This year the federal government is spending seventeen billion dollars on enforcing drug prohibition, and state and local governments are spending at least that again. In 1980 there were fifty thousand people behind bars in America for violating a drug law. Now there are four hundred thousand people behind bars in America for violating a drug law.
I look at the last 10 or 15 years of American drug policy and what I see is not success but disaster.
6. Rethinking our terminology
The key, of' course, is getting people to re-conceptualize the nature of the problem, to begin to redefine the problem. This is why, for example, referring to our current drug policy as a prohibition policy is so crucial. It is important in the context of the USA because Americans still have some national memory of alcohol prohibition and its futility and excesses. To the extent that Americans can come to recognize the fundamental similarities between drug prohibition and alcohol prohibition, we have some chance to move toward a more sensible analysis of out- current policies.
Of course, one of' the problems with using the language of' prohibition is that it is instantly assumed, ipso facto, that you must be in favor of legalization. As we know, 'legalization' has become the tag word that is used to smear harm reduction efforts in many countries. Any small step toward harm reduction, whether it means making clean needles or methadone available, whether it means proposing a heroin prescription experiment, or simply accepting that drugs are here to stay, is instantly called a version of' legalization. This false thinking is like referring to any effort to reduce unwanted pregnancy as a 'pro abortion effort'. Like calling any effort to restore civil rights in America it 'black supremacy effort'. But it is effective as a smear because the vast majority of the world opposes legalization.
Nonetheless, we must speak of prohibition. We have to speak of prohibition because it is analytically, politically, and rhetorically important. Because it is only by identifying and distinguishing between the negative consequences of drug use and the negative consequences of prohibition that we can move forward. It is understanding that at this point in history and for the foreseeable future, harm reduction is essentially about making drug prohibition work better--but according to outsets of criteria, not theirs. According to a set of criteria which focuses not simply on the reduction of drug use but on the reduction of the death, disease, crime and suffering associated with drugs and drug policies.
7. A mensch-like drug policy
Sometimes people say to me, well then, what is it that you favor, exactly, if not legalization'? My answer in recent times has been to say, 'Well, what I favor is amensch -like drug policy. Mensch is a Yiddish word referring to a person with a good heart and a good mind who finds ways to integrate them. What I favor is a mensch-like drug policy.
To favor amensch -like drug policy is to say that when we construct a drug policy it must be based upon basic values of common sense and science, public health and human rights, and a dose of compassion. It is to recognize the extent to which current drug policies are fundamentally based upon a combination of fear, ignorance, prejudice and profit. It is also to understand that the fear is not entirely illegitimate-- that the greatest obstacle to more sensible and humane drug policies is the fear of all people for their children, the fear that drugs can penetrate their children, and the desire of all parents to put their children in a bubble and to hope it will never be pierced by a needle or anything else.
In the USA right now the entire war on drugs is typically justified as a child protection measure. Do you know why we have four hundred thousand people behind bars'? To protect the children. Do you know why we don't have clean needles" To protect the children. Do you know why we can't have innovative drug policy experiments with methadone or heroin prescription'? Do you know why we cannot work systematically and humanely with drug users by reaching out to them'? It's about the children. In America we see the gradual building up of a policy that increasingly seems fascistic, in the classic sense of that term to protect our children.
It was so rewarding to see so many sessions at this International Conference on the Reduction of Drug Related Harm in Paris which focused on children. because ultimately this is our greatest challenge. We must demonstrate that protecting our children means not just discouraging them from using drugs in the first place, but teaching them the different risks associated with different drugs, and between responsible and irresponsible drug use. Our ultimate success depends fundamentally upon our capacity to demonstrate that drug policy reform, not the drug war. best protects our children.
8. In the belly of the beast
Harm reduction, as a phrase, is Still unknown to the vast majority of' Americans, but it is increasingly accepted in the public health community. Efforts to smear harm reduction as legalization continue but have less and less legitimacy. In Washington, DC, there is no progress. Washington is the bastion of repressive, punitive prohibition. It will be. perhaps, the last place where we will see change in the USA. But as in Europe, where harm reduction is stimulated at the local levels and slowly seeps up to affect national debates and policies, so the process has begun in the USA.
Needle exchange and the provision of clean needles to drug addicts is still enormously difficult to achieve. Perhaps only one in ten active injecting drug users have easy access to sterile syringes even today. The USA remains the only national government in the advanced, industrialized world, I believe, at least in the West, in which not a penny of federal money can be spent to provide a clean needle to a drug addict, despite overwhelming evidence of its benefits.
Moreover, while other countries in Europe and Australia have moved forward quickly in making methadone readily available through general practitioners, ordinary medical care, and methadone vans. in the USA the methadone system remains locked in an oppressive, onerous, over regulated, discriminatory regulatory system. There are reasons to believe this will change in the next few years, but it is still difficult.
9. Change is coming
It is wonderful to see what has happened in Switzerland with the heroin prescription experiments. Now with the Netherlands, about to begin the same, and in Australia at least a serious national discussion, change is coming. In Germany, for those of you who saw the cover story of Der Spiegel in February 1997, a majority of big city police chiefs support a heroin prescription experiment. In Denmark there is some discussion; in Turin, Italy, some advocacy for this. In a sense, these instances are important riot because they will lead to immediate, dramatic reductions in the death and disease associated with heroin use, but because of the opportunities they provide for public education. It is so important to our efforts that we de-demonize drugs, that we normalize drugs and the people who use drugs, that we begin to remove the stigma without encouraging drug abuse among children. If heroin prescription is important for now it is because of its capacity to enlighten public thinking, to force national debates and increase public understanding of this feared drug. In the USA, unfortunately, it is still almost impossible to move forward with such an experiment. But perhaps we will see some movement.
Nevertheless, something nice happened in the USA in the November 1996 elections. The USA, as in many of your countries, has what is called a ballot initiative process in some states in which political activists can put an issue directly to the public for a vote. In California and Arizona two drug policy reform ballot initiatives were put before the public. In California, the issue was whether doctors should be allowed to recommend marijuana, in smokeable form, as medicine for people suffering the nausea associated with chemotherapy, people suffering from the AIDS wasting syndrome, and people who suffer from multiple sclerosis and other nerve and muscle diseases. In Arizona, a similar initiative proposed that doctors should be allowed to recommend marijuana and other illicit drugs for medical use, and included provisions essentially decriminalizing simple possession of illegal drugs while providing greater funding for education, treatment, and prevention, as well as tougher penalties for violent offenders.
We are all aware that money and politics go hand in hand. When the money changes, people's views change. There would be a radical transformation in global drug policy if the money shifted to a harm reduction policy. All of a sudden, all sorts of people who are vigorous advocates of punitive prohibition would become vigorous advocates of harm reduction.
Well, for once we had an opportunity to rise some money on our side. Half a dozen American businessmen, concerned with the excesses of the drug war. and interested in provoking a broader debate, agreed to support the electoral effort to put these initiatives on the ballot in California and Arizona.
In response, the drug czar of the USA, retired General Barry McCaffrey, came out to California and Arizona and campaigned against these initiatives. He argued they were simply 'Trojan horses' for legalization. The leading drug warriors came out and opposed them. All of the former presidents of the USA, except one, signed statements opposing these initiatives. Yet, the initiatives won. They won. We won. We won one! For the first time in the USA since the repeal of Prohibition, the citizenry went to the polls and voted for some specific reversals in the war on drugs. These efforts were labeled legalization efforts, but the public said, 'Bullshit! It's not legalization, we know exactly what this is. This is a simple step to pull back on some of' the worst excesses of the drug war. That is what we Lire dining here. We don't want to keep wasting our tax dollars throwing non-violent drug users behind bars. We don't want the policeman in the doctor's office.'
Well, the medical marijuana issue might have remained a narrow one. A side issue, a fringe issue. Except here we must thank the foolishness of the drug warriors who could not leave well enough alone and insisted that these little successes in California and Arizona were really about something bigger. They succeeded in generating the beginnings of a national debate in the USA such as we have never seen before about drug policy. And they did this on an issue, medical marijuana, where 60-70% of public opinion supports reform, not the government policy.
10. The lessons we've learned, guiding us into the future
The victories in California and Arizona sent a powerful message. They showed that the public can be ahead of' the politicians when it comes to sensible thinking about drug policy. They showed that the public can distinguish between outright legalization and more moderate reform measures. They showed that tire public is willing to look skeptically at the claims of the drug czar and the politicians about drugs. They showed that there can be bipartisan support for drug policy reform in the USA.
Perhaps most importantly, the success of' these initiatives shows that the public is not just increasingly willing to recognize the futility of the drug war but increasingly willing to do something concrete to advance an alternative policy. As many of' you know, and this has often been the case in the USA, majorities of' public opinion understand that the drug war has failed and majorities even understand that the drug war cannot succeed. But their when you ask the public if they support the alternatives, they become Fearful. They are stuck right now. They know tire current policy does not work, they are beginning to understand that it is making the problems even worse, but they are afraid of the alternatives.
Well, now our efforts in the USA are directed toward building on these lessons. In a way this is very much, still, a struggle of David versus Goliath. The few million dollars put in by George Soros, the few million by a few other businessmen and a few million by ordinary citizens are a tiny, tiny fraction of the tens of' billions spent each year to promote the drug war. But their, we have truth, compassion, honesty, humanity on our side. So how can we lose'?
Of course. we have no choice but to fight the struggle in the USA, because if there is one overridingly powerful force sustaining global drug prohibition, one 'evil empire' standing in the way of reform in foreign countries, it is the US government. If we cannot transform thinking and policies in the heart of the beast it will be difficult to effect major transformation elsewhere. It will mean the policies that are painstakingly developed in countries like the Netherlands and Switzerland and Germany and Australia may suddenly be suppressed by the US government and the global machinery over which it exerts such powerful influence.
11. Getting people to listen and see
So what is our strategy? We are becoming a little more sophisticated. We are beginning to spend money riot just on needle exchanges, but on focus groups and public opinion polls. We are beginning to test our messages because, as we all know, this is a battle that is fought most cruciably at the level of the media. The mass interpretations of drugs and the role of' drugs in society happens through the media, and much of what people think about drugs and drug policy comes through the media. Even people's own personal experiences with either responsible drug use or the devastation of drug addiction are often interpreted through the lenses of the media. It is in this realm of' images and information that we need to fight many of our future battles.
We take some lessons from the repeal of alcohol prohibition. We know, for example, that no single argument was crucial to the repeal of alcohol prohibition. In fact, a great variety of people and organizations had very different .4concerns about what was most wrong with alcohol prohibition in the USA. Some did not like the development of corruption and violence. Sonic regretted criminalizing millions of otherwise law abiding American citizens. Many resented the expenditure of tax dollars. while others were critical of the restriction of civil liberties. Many were simply disgusted by the futility of the entire enterprise.
All of these people also had dramatically different views about what should come after alcohol prohibition. Should there be local control, state control or federal control'? Should we legalize and regulate only beer or should we include wine and hard liquor? Should we have a licensing system, or a state monopoly system, or some other system? But all agreed that there was something fundamentally wrong with alcohol prohibition. The same is true today. There are conservatives who don't care about drug addicts but they care about tax dollars. There are people living in the cities who are willing to pay higher taxes, but they don't want to be mugged and they are concerned about the crime. There are people in the medical community whose job it is to prevent the spread of disease, and they care most about the public health element.
So now our challenge is to find ways to shift the nature of the debate, to engage the public, to find ways to use our meager resources to repeat our message over and over. The drug war has failed. We have no choice but to learn how to live with drugs. There are other ways.
To repeat our message over and over. To think in sophisticated ways about engaging the media. As a small example, imagine the effect if each of us who thinks in this way and who does not come from the USA were to pick up a telephone and call the correspondents of American newspapers and television in our various countries and say, 'I want to show you something'. Tell them that there is a story here. If there is an innovative harm reduction program, get them engaged, get them to listen. Push! The popular media reaches hundreds of thousands. Our academic articles reach at most a few thousands, if' not hundreds. Yes, it is sometimes better to act discretely and make a tiny positive public health initiative happen quietly. But we cannot transform the system unless we take some risks in order to educate the public.
12. Drugs and human rights
I want to close by making one final analogy here and connecting it to the broader theme of human rights. It seems to me that one can draw various analogies between drug policy reform and harm reduction on the one hand and similar political movements in modern history: civil rights, women's rights, the abolition of slavery. All involve both moral and economic factors, and some involve a hegemonic power, like the USA or Great Britain before, promoting or resisting particular policies or changes.
But the one which most fascinates me is the movement for the rights of gays and lesbians, where we have seen an astonishing rnetamorphosis in public attitudes and policy over the last generation in the USA and elsewhere. The notion of the human rights of gay and lesbian people sounded as strange to the ear 25 years ago as the notion of the human rights of drug users sounds today. It is an indicator of how the willingness of people to come out and identify themselves as drug users may be central to the changes we seek to effect.
Let us not forget. for example, that everybody in America knew a homosexual 25 years ago. They just didn't know they knew a homosexual. So their images of who homosexuals were, were commonly based on the media, and the most deviant caricatures of homosexuals. Now, of course, almost everybody in America knows it homosexual and they know they know a homosexual. It may be their cousin, or their coworker, or a teacher, or good friend. Images change.
Similarly, everybody in America knows a drug user; they just don't always know they know a drug user. And therefore their images of drug users are shaped largely by the ones who end up on television and in the newspapers because of their irresponsible use of drugs or their victimization by the forces of the drug war. What is needed here is the language and the means to 'come Out', to speak out, to identify. The hundreds of' millions of responsible illegal drug users around the world and the tens of millions of those who have serious problems with illegal drugs can and should recognize their alliance in the struggle for change.
This doesn't mean that You don't pursue one strategy and repress another periodically, For tactical and strategic reasons. It means that you recognize the common interest in moving forward. It means that even as, on one hand, we fight to enlighten people about the facts concerning marijuana, on the other hand we are fighting for needle exchange. It means that while we struggle to pave the way for discussion about an international, legally regulated market in low potency cocabased products, we also continue to advocate for improved access to methadone and innovative, non-coercive, treatment strategies. And even though we may keep these struggles separate for tactical and strategic reasons, you and I recognize that underneath it all these are each about opposing a deep injustice in our societies.
It is difficult to sometimes be obliged to make choices between funding a needle exchange program that one knows will save lives today and funding a PR campaign that will save no lives today but hopefully will lead to a transformation of opinion down the road. These are the choices, and the changes, we must face.
The Lindesmith Center, working together with other organizations, is in the midst of a very significant campaign in the USA, and in other countries as well, which boils down to telling the truth about marijuana. We now have a situation where great numbers of people have used marijuana and even more people know people who have used marijuana responsibly. So the government is vigorously trying to persuade people that marijuana is really more dangerous than we have ever thought-even though this is not true.
The Lindesmith Center has published a book by Professors Lynn Zimmer and John P. Morgan called Marijuana Myths, Marijuana Facts: A Review of the Scientific Evidence. 2 We have
printed 25000 copies, and we are going to translate it into numerous languages. The book examines 20 of the most common myths about marijuana and provides very careful and detailed analysis of the scientific research. We are going to work with the media to present these arguments. Marijuana Myths, Marijuana Facts is a significant resource with which we can begin
to challenge the current regime on the level of information.
If I can ask just one thing, it is that everyone think about putting the message out there as broadly as possible. Change can happen, but if we become consumed by our small efforts and forget about using our voices to direct them at a broader public, we are missing opportunities to shift in entire paradigm. If we forget about engaging the media, if we forget about engaging the politicians, it' we see ourselves as powerless and as voiceless, then we will remain so. But it' we begin to think about ourselves in a new light, to see our potential and to learn from the lessons of history where other movements whose prospects were once as weak as ours have prevailed, we will be able to transform not just our own societies, but global society.
Ethan Nadelmann The Lindesmith Center400 West 59th Street New YorkNY 10019 USATel.: + 1 212 5480695 Fax: + 1 212 548 4670E-mail: