The recreational use of drugs is widespread throughout the world, as indeed are the problems of drug dependence and addiction. The debate on drugs is polarised and there are many conflicting views about the way forward. There can, however, be no doubt about some of the consequences.
According to the Office of National Statistics, there were 2,917 deaths in 2018 from illicit drugs in England and Wales. Most of these deaths were due to opioids, which range from natural and semi-synthetic opiates such as morphine and heroin to the newer synthetic opioids such as fentanyl. Both illicit and prescription opioids have contributed to an epidemic in the US, which was declared as a national emergency by President Trump in August 2017.
There are many suggested approaches to the problem of combating drug use. The commonest approach involves criminalisation, in which there is an ideologically-driven zero tolerance for drugs and both users and suppliers are dealt with through the criminal justice system. An alternative approach of decriminalisation has become increasingly popular in recent years. With decriminalisation, legal penalties for the personal possession and use of drugs are reduced or abolished, while other aspects of drug enforcement remain unaltered. Growing numbers of people advocate the complete legalisation of all currently illegal drugs. This suggested approach, however, does not form part of the drugs policy in any country at present.
The extensive supply chain and the large financial rewards of drug dealing are the biggest obstacles to the control of drug use. Drug trafficking is a multi-billion-dollar global trade, which includes the cultivation, manufacture, distribution and sale of a variety of substances. Drug wars and street-level crime have been linked to the resulting high-stakes territorial disputes between suppliers.
There are many well-established supply routes for drugs. Cocaine is trafficked from South America to North America and Europe, while heroin is transported from the Golden Crescent of southwest Asia and the Golden Triangle of southeast Asia along the Balkan and northern trafficking corridors to Western Europe and the Russian Federation respectively. Synthetic substances, including newer psychoactive drugs, are frequently manufactured covertly in secret laboratories worldwide.
In contrast with the highly lucrative and well-resourced drug market, most anti-drug initiatives are low-level interventions, leading to the arrest and incarceration of users and small-time street-level suppliers. Once in a while, a major drugs haul is reported, which probably only represents a fraction of the total activity. Crime breeds crime and in this case is self-perpetuating. Large-scale drug dealers and drug cartels have diversified their activities into human trafficking, kidnapping and extortion. Money laundering schemes are being used to hide away the huge unexplained gains of the drug trade.
Some believe that a legalised and regulated market would remove the black market in drugs and ensure purity, safety and a controlled supply of these drugs. It also would allow the government to raise tax revenues, which could then be reinvested in harm reduction and drug education and treatment programmes. However, many people have moral objections, believing that such an approach sanctions and encourages drug misuse along with all of its harmful consequences.
All personal drug use was decriminalised in Portugal in 2001. The first country to decriminalise drugs was Costa Rica, in 1988. Drug possession is no longer a criminal offence in Portugal, but an administrative one, for which a fine may be imposed. The drug policy owes its success to associated harm reduction and social rehabilitation programmes. There has been a steep reduction in drug-related deaths since, and a fall in the numbers of HIV-positive drug addicts. The anticipated increase in drug use has not materialised, while spending on prevention and treatment have increased. This approach is gaining wider support. Some countries and American states are thus making a start by decriminalising the use of cannabis in the first instance.
There is no single approach that is equally applicable to all recreational drugs. The clear message is that drugs like heroin and fentanyl lead to harm and there is no benefit to society that can be attributed to their use. A controlled and regulated state-run supply of drugs combined with anti-drugs education and rehabilitation initiatives may provide a short-term answer for such “hard” drugs. It is unlikely, in the near future, that any government will have the political will to undertake a major rethink of drugs policy as this is likely to offend the moral sensibilities of the wider non-drug-using electorate.
Ashis Banerjee (ex-NHS; have treated many people with drug-related problems)