Nine countries in Europe, North and Central America and Asia were represented at the conference and participants brought to the discussions a wide spectrum of experience of dealing with the drugs problem: from various branches of the medical profession, health education, foreign affairs, health and home affairs ministries, voluntary agencies, law enforcement, politics, academia and journalism, as well as from inner city community projects working with those at risk. Many resulting subtleties in the complex discussions inevitably have to be omitted from this brief note.
There was general agreement that the threat posed to all our societies by drugs, licit and illicit, was great (some thought it was increasing, a few believed it to be on the decline) and that the response so far had proved inadequate. It was also clear that the nature, complexity and scale of the drug problem and of policies currently in place to confront it varied considerably from country to country - historical, cultural, social and political factors were crucial here - and that the problems posed by illegal drugs (such as marijuana, heroin, cocaine, LSD, crack and amphetamines) could not, and should not, be considered in isolation from the ‘socially acceptable’ drugs, alcohol and tobacco. It was pointed out early in the proceedings that around 110,000 premature deaths occurred in the UK each year as a result of cigarette smoking, tens of thousands from excessive alcohol consumption while only 250 were directly associated with illegal drugs. Despite well- targeted campaigns over many years, which had drawn attention to the medically proven risks implicit in smoking and drinking, large numbers of people continued to ignore the message. (It is perhaps pertinent to note that consumption of wine at this Ditchley conference was not below average and the proportion of smokers among participants noticeably higher than the norm.)
Two inter-related debates tended to dominate the weekend’s discussions: on the one hand how resources to combat illegal drugs should be most effectively allocated as between supply reduction (i.e. measures to counter production and trafficking) and demand reduction (health education and treatment), encapsulated by one participant as “cops versus docs”; on the other hand the relative merits within ‘consumer’ countries of prohibition and legalisation (or decriminalisation, the term preferred by most).
At present, a preponderant proportion of resources was spent on enforcement policies - especially in the United States, the major market for illegal drugs, where the problem was defined primarily as a criminal rather than a public health problem and the focus was on curtailing supply: the eradication of illicit production in other countries, prevention of entry into the US and law enforcement at home. So long as a market for drugs existed in the West, however, it was argued, measures aimed at cutting production in Third World source countries were perhaps doomed to fail. Although crop substitution programmes should be encouraged, marijuana, opium poppies and coca leaf were nine times more profitable than alternative crops, it was said, and experience suggested that reduction or elimination of these crops in some source countries tended to be matched by the readiness of other poor Third World countries to fill the gap. The potential for future production was vast, not least in Africa. Source countries doing their best to stamp out production were hampered by lack of resources and, more importantly, by the corrupting effect of drug trafficking on their own enforcement agencies. Also noted was their resentment of Western demands that they curb production of illegal drugs destined for Western markets while their own populations were increasingly targeted by Western manufacturers of (high tar) cigarettes and alcohol. Most of these countries had no health education programmes at all.
Enforcement at point of entry to Western markets, again, could be of only limited effectiveness: drugs seized represented only the tip of the iceberg and it was officially estimated that as much as 90% of illegal drugs remained undetected. The apprehension of individual drugs users occupied much police manpower and prison was not the most helpful form of therapy. Measures introduced by many countries to trace and seize assets derived from drugs trafficking were, however, applauded and participants agreed that such legislation should be strengthened, with a greater proportion of the confiscated funds earmarked for drug enforcement and, especially, treatment and health education programmes.
There was a consensus that there should be much more emphasis on demand reduction. This would also address side-effects of drugs abuse such as violence, crime and family breakdown. Lessons could be learned from campaigns against smoking and alcohol abuse. Deglamorisation was very important: the message to be conveyed, it was suggested, was that drugs were “stupid, uncool, unsexy and boring”, although one health education expert emphasised that it was important to tell the truth and that such campaigns should not become another form of manipulation. All were aware of the problem of competing with media images and commercial advertising by tobacco and drinks manufacturers, backed by greater resources, which continued to associate consumption of their products with glamour, excitement or virility. Several speakers suggested that alcohol should carry a health warning. What was required was a complex strategy of drug prevention and health promotion in the broadest sense, beginning at an early age. The education and engagement of the whole community was vital: few citizens (parents, teachers or social workers), suggested a grass roots volunteer, understood the variety of drugs available, how to recognise symptoms of drug use in a friend or work colleague and how to find appropriate help. There was a good deal of discussion about the role of workplace testing: a controversial debate in the US. General impairment tests (rather than specific tests for drugs or alcohol), it was agreed, were perhaps more appropriate and acceptable and necessary for those whose work involved responsibility for others’ lives, such as airline pilots, public service vehicle drivers or defence forces. A pilot who had a hangover or had spent a sleepless night after a row with his wife might endanger his passengers as much as one who had recently consumed alcohol or marijuana. Where drug or alcohol abuse was detected, it was in the interest of employers and society as a whole that confidential advice about treatment should be given in the first instance. The lack of drug treatment and education in prisons was widely condemned.
More than one participant argued that if one were starting from scratch, present knowledge of the harmful effects would suggest that alcohol and tobacco should be banned, although all agreed that this was not now an option. The debate about the decriminalisation of marijuana, and even of hard drugs, permeated much of the discussion. Most agreed that leisure use of marijuana was less harmful to health than either alcohol or tobacco, although one participant disputed this, adducing evidence that marijuana gave rise to damaging biochemical changes in brain tissues and fertility. Supporters of legalisation/ decriminalisation (a small minority) asserted that illegality discouraged abusers from seeking treatment and led to criminal violence and gangsterism: legalisation of possession could take the profit out of trafficking, remove the incentive for it and, if accompanied by a controlled system of production and distribution, also lead to a massive reduction in crimes committed by users to raise the cash to pay for drugs. In the particular circumstances of the Netherlands, it was claimed that such a system of controlled decriminalisation worked. Against this, it was argued that illegality deterred large numbers of people from using drugs and that the removal of controls and social stigma could lead to a vast surge in drug abuse and addiction, more overdoses, more need for treatment and more drug-induced deaths; nor was there any guarantee that legalisation would eliminate drug-related criminality. The debate was inconclusive, and no converts were detectable in either direction.
Although it was agreed that differing national strategies were appropriate to deal with the drugs problem as it presented itself in individual countries, several participants suggested that there was scope for more international cooperation, perhaps through the UN. Some disagreed - it was suggested that conferences usually called for international action as a last resort when national policies failed to work - but most thought that there was a role for UN agencies, if only in the provision of better data and the dissemination of knowledge.
This Note reflects the Director's personal impressions of the conference. No participant is in any way committed to its content or expression.
Chairman: The Rt Hon the Baroness Masham of Ilton
Life Peer (Independent); Vice Chairman, Parliamentary Drug Misuse Committee
LIST OF PARTICIPANTS
Mr W J Burroughs
Assistant Secretary, Alcohol, Drugs and Tobacco Policy, Department of Health
Mr Chris Butler MP
Member, House of Commons (Conservative), Warrington South; Member, Select Committee on Employment
Mr Timothy J David
Counsellor and Head of Narcotics Control and AIDS Department, Foreign and Commonwealth Office
Dr Nicholas Dorn
Development Director, Institute for the Study of Drug Dependence
Mr Peter C Edwards
Assistant Secretary, Criminal Policy Department, Home Office
Mr Nicholas Harman
Latin America Editor, The Economist
Mr Eddie Ishag
Chairman and Managing Director, European Investments and Development pic; Chairman, Business Against Drugs, London
Mr Tony Kerpel MBE
Political Adviser to the Home Secretary
The Hon Mark Lennox-Boyd MP
Member, House of Commons (Conservative), Morecambe and Lunesdale; Parliamentary Under-Secretary of State, Foreign and Commonwealth Office
Dr Graham Lucas
Adviser in Mental Health, Health and Safety Executive, and Consultant Psychiatrist, King’s College Hospital, London
Mr Peter A Penfold OBE
Head, West Indian and Atlantic Department, Foreign and Commonwealth Office
Dr John Strang
Consultant Psychiatrist in Drug Dependence and Director of the Drug Unit, National Addictions Centre, Maudsley and Bethlem Royal Hospitals, London; Consultant Adviser on Drugs to the Department of Health; Member, Advisory Council on the Misuse of Drugs; Member, Expert Advisory Group on AIDS; Board of Directors, Phoenix House UK; Trustee, National AIDS Trust
Mr Ben Whitaker
Director, The Gulbenkian Foundation (UK)
Miss Rosamond Wynn-Pope MBE
Director, Action on Addiction, London
Ms Kathy O’Hara
Assistant Deputy Minister, Policy Planning and Information Branch, Department of National Health and Welfare, Ottawa; senior policy analyst then Director of Operations, Social Development Secretariat, Privy Council Office.
Mr Mark R F Taylor
President, Addiction Research Foundation, Toronto
M François Hervé
Psychologist; working for past ten years with “Trait d’Union” - one of main centres for treating drug addicts in Paris
Dr Elisabeth Pott
Director, Federal Office for Health Education, Cologne
Detective Chief Inspector Stuart Cameron-Waller
Metropolitan Police Officer (London), attached to European Secretariat, Interpol, Lyons
Professor Ernesto Savona
Professor of Criminology, Faculty of Law, University of Trento and Senior Scientific Consultant of UNICRI (United Nations Interregional Crime and Justice Research Institute), Rome
Ambassador Isamu Nitta
Ambassador of Japan in Democratic Socialist Republic of Sri Lanka
HE Señor Bernardo Sepúlveda
Ambassador of Mexico to the Court of St James’s
Dr Eddy L Engelsman
Head, Alcohol, Drugs and Tobacco Branch, Ministry of Welfare, Public Health and Cultural Affairs, The Netherlands
Professor Dr C Frederik Rüter
Professor of Criminal Law, “Van Hamel” Institute of Criminal Law, University of Amsterdam
Mr Henk Jan van Vliet
Director, Metropolink Consultancy Research, Amsterdam.
Mr Stephen D Cain
Student, Georgetown University; voluntary youth worker
Mr Henry I DeGeneste
Vice President and Director, Corporate Security, Prudential-Bache Securities Inc
Mr Lee I Dogoloff
Executive Director, The American Council for Drug Education and adviser to the President on Drug Advisory Council
Ms Mathea Falco
Lawyer and Visiting Fellow, New York Hospital-Cornell Medical Center; member, Mayor David Dinkins’ 1990 Drug Strategy Group; author; Chief counsel, US State Judiciary Subcommittee on Juvenile Delinquency
Mr Sterling Johnson
Special Narcotics Prosecutor, New York State Office of Special Narcotics
Father Ray Kemp
Holy Comforter Church, Washington DC
Professor Mark A R Kleiman
Lecturer in Public Policy and Research Fellow, Programme in Criminal Justice Policy and Management, John F Kennedy School of Government, Harvard University; author
Dr Robert B Millman
Saul P Steinberg Distinguished Professor of Psychiatry and Public Health, Cornell University Medical College, and Director, Drug and Alcohol Abuse Treatment and Research Programmes, New York Hospital; has worked in field of drug and alcohol abuse for over 20 years
Dr Gabriel Nahas OBE
Professor, Department of Anaesthesiology, Research, College of Physicians & Surgeons, Columbia University; Attending Anaesthesiologist, Presbyterian Hospital; Board of Advisors, Cousteau Society; Consultant, UN Commission on Narcotics; Distinguished Visiting Scientist, Addiction Research Center NIDA; Member: American Society for Pharmacology & Experimental Therapeutics, New York Academy of Sciences (Fellow), American Society for Clinical Pharmacology; author.
Dr Peter Reuter
Senior Economist, Washington Office, the RAND Corporation and Co-director, RAND’s Drug Policy Research Center, dealing with the role of drug selling in the economic life of poverty populations and with the proper allocation of resources among drug programs