* Comparative European and American Drug Control Policy: An
Examination of Efficacy and Contributing Factors
By William P. Bloss, The Citadel
* An earlier version of this paper was
presented at the European and International Research Group on Crime, Ethics,
and Social Philosophy meeting in St. Petersburg, Russia. This study is funded
by the Citadel Foundation and all views expressed herein are those solely of
the author.
Comparative European and
American Drug Control Policy: An Examination of Efficacy and Contributing
Factors
Abstract
Much of the global
demand-side drug control policy has been influenced by an American-led
prohibitionist ideology. However, some European countries have instead
advocated a public health “harm reduction” approach that relies upon
prevention, education, and treatment as a means of reducing drug user
demand. Considerable debate has emerged
about the apparent lack of efficacy of a one-dimensional prohibitionist strategy
in reducing user demand and collateral risks within the drug using community.
As noted by Krajewski (2004) and others, European drug demand control policy is
not as unified as the American prohibitionist approach, and therefore, numerous
models have emerged. Using U.S. and European policies, this paper compares and
analyzes the ideological approaches used to control drug demand. The paper
further examines the factors that contribute to divergent crime control and
public health approaches and their efficacy in reducing drug user demand. These
findings show that determining the most effective demand reduction approach is
often illusive due to the influence of legal, public health, and
socio-political factors that affect policy ideology and objective.
Introduction
Drug control policy
efficacy has been the subject of considerable study in recent years. Policy
makers and scholars have debated the merits of methods designed to reduce drug
user demand. Demand reduction policies are subject to internal and external
influences that act to shape their guiding principles and approaches. Among these, three global conditions have
affected policies seeking to control the proliferation of illicit drugs. These
circumstances have contributed to a paradigmatic shift in drug and crime
control responses (Erickson and Butter, 1998). First, drug control strategies
have been significantly influenced by the transnational nature of modern crime.
With the advent of digital platforms, increasing mobility of populations and
advances in technology, traditional street crime has been joined by borderless
crime committed by increasingly agile transnational offenders. Second, the globalization effect in the
post-modern world has led to efforts by nations to regionalize their national security,
economy, trade, social service, and crime control efforts (e.g., European
Union). Architects of regional
consolidation envision collective units, as opposed to individual sovereign
states, that are more effective in promoting state security, bolstering
economies, and combating drugs and crime.
Third, is the convergence
of drug offenses with transnational crime, organized crime, and terrorism
(Dorn, 2004). In the past, drug trafficking was viewed as an independent
criminal enterprise. However, the drug trade is now being seen as one of
several interrelated acts of criminality (i.e., narco-terrorism) that affect
the security of nations (Office of National Drug Policy, 2005; United Nations,
2004). In 2004, the United Nations called for a new paradigm in the approach to
drug policy finding that a “more holistic perception of the drug problem
[should] be vigorously applied to the twin sectors of drugs and crime control”
(United Nations, 2004, p. 54). Further, the United Nations stresses the need to
address international crime, illegal trade in arms, drugs, natural resources
and people as part of a holistic human security agenda (Commission on Human
Security, 2003).
Invariably, such efforts
encounter challenges when consolidating ideologies, policies, and practices. To
avoid losing their cultural identity, many countries develop policies that
strive to maintain their independence while effectively responding to their
individual drug and crime control needs. Nowhere is this more evident than in
illicit drug control policies.
Several factors influence
individual ideologies and the formulation of a national drug policy. Among
those is the distinction between the demand and supply aspect of the illicit
drug trade. Demand approaches consider the consumer’s desire to use or abuse
chemical drug substances. Conversely,
the supply-side approach views the drug problem as one of cultivation,
production, and transportation of illicit substances to the consumer market
(See Lyman and Potter, 2003).
Two major approaches to
drug control policy have emerged since the mid-twentieth century¾crime control and public health. The
labels often used for these divergent ideologies are “prohibitionist,” used to
describe crime control enforcement practices, and “harm reduction,” used to
represent a public health perspective that relies on education, prevention, and
treatment (MacCoun and Reuters, 2001). Though many nations utilize both of
these approaches in their drug control policies, often one position dominates
the policy. Some scholars assert, however, that harm reduction has emerged as
the new paradigm in demand control drug policy (Erickson and Butter, 1998).
This paper examines
contrasting drug demand control policies involving the U.S.-backed
prohibitionist approach and the harm reduction perspective promoted by some
European countries. Based on current policies and practices, the paper explores
the factors that influence these two perspectives in demand reduction as a drug
control strategy.
Fundamental
Elements of the Prohibitionist and Harm Reduction Approach
Prohibitionist
Ideology
United
States prohibitionist drug control policy has historically been influenced by
an “alien conspiracy” perspective that blames foreign groups for the
importation of illicit substances. Musto (1991) asserts that American drug
policy has been characterized by fear and anger directed at the sources of both
drug demand and supply. In this view, outsider groups are believed to be
responsible for the American drug problem. Therefore, the reasoning holds that
targeting these groups with enforcement can limit drug availability and reduce
demand.
The
prohibitionist perspective favors crime control, police enforcement, and
interdiction while eschewing methods such as decriminalization or medical responses.
A cornerstone of the prohibitionist approach is a zero-tolerance position that
relies upon criminalization of drug use to reduce drug demand and to act as a
deterrent. MacCoun, Saiger, Kahan, and Reuter (1993, cited in Hilte, 1999, p.
308) explain the prohibitionist approach as “based on the implementation of a
punitive policy in which criminal law is used aggressively against both users
and dealers.”
Harm
Reduction Approach
A
harm reduction perspective seeks to reduce drug demand through social and medical
responses that strive to minimize the drug use harm on the user and the
community (Nadelmann, 1996). This view considers the deleterious effects of
drug use and how it contributes to the proliferation of communicable disease,
destabilization of families, loss of productivity, and crime. Many of the harm
reduction strategies include education, prevention, and treatment strategies
(Goode, 2000). Medical, therapeutic, behavioral, and community partnership
programs are benchmarks of the harm reduction perspective.
Bullington,
Bollinger and Shelley (2004, p. 481) describe European harm reduction policies
as prioritizing public health concerns over criminal justice responses and may
include methods such as:
- Drug injection rooms;
- Decriminalization of marijuana in general;
- Heroin maintenance trials;
- Low-threshold drop-in centers for street users;
- Facilities that dispense free syringes, condoms, and
health information;
- Pill testing at youth events;
- Prevention efforts that emphasize “safe use” practices;
and
- Police participation in health and social service
referrals to users.
Drug Control
Ideologies
Numerous factors
contribute to the development and analysis of drug demand control policy. As
indicated in Figure 1, an analytical framework is helpful in structuring the
investigation of the factors that influence the formulation of drug control
policy. The heuristic model adapted from MacCoun and Reuter (2002, p. 12)
reflects the variation of control policy goals, implementation, exogenous
factors, and outcomes. This paper uses the model to examine the factors that
contribute to the creation of U.S. and European drug demand control policies.
As indicated in Table 1,
four distinct drug control ideologies have emerged in recent policy. Each
ideology proffers formulae for solving the drug use problem; however, often
these plans are eclectically drawn to reflect a broad approach. In spite of
this tendency, drug reduction policies tend to be subject to ideological
hegemony.
___________________________
Table
1
Drug
Policy Ideologies
Ideology Fundamental
Principles
Prohibition
Emphasizes
criminalization,
penalization, crime control, interdiction,
supply control
Securitization Emphasizes an integration of drug
enforcement with national security and includes a nexus to transnational crime
and terrorism
Harm Emphasizes
an anti-prohibitionist stance that promotes
Reduction soci-medical
responses, education, prevention, and treatment
Demand Emphasizes
macro-level socio-economic changes to reduce
Reduction drug
interest among marginalized elements of society
___________________________
Among
these primary ideologies, the debate between U.S. and European policies is
drawn from basically two perspectives—U.S. prohibition and European harm
reduction (see MacCoun, Saiger, Kahan, and Reuter, 1993). Prohibitionist and harm reduction proponents
develop their respective ideologies based on basic assumptions. For prohibitionists, the governing principle
is that drug-free societies are both possible and desirable. Their view is that
through criminalization and repressive measures members of society can be
persuaded to reject drug use.
Conversely, the harm reduction
perspective holds that the prohibitionist vision of a drug-free society is
unrealistic and unattainable. Hence, reductionists are interested in minimizing
the collateral social harm that comes from drug use and criminalization
policies (Bullington, Bollinger and Shelley, 2004). By advocating a public
health approach, they contend that the objective should be the prioritization
of policy and practice based on a “minimization” of harm perspective (Dorn,
2004).
Several factors contribute
to framing internal elements of the respective policies. First, drug control
policies inherent to both perspectives contain elements of the two prevailing
ideologies. Second, there are both prohibitionist and harm reduction proponents
in both camps. For instance, several states in the U.S. have adopted harm
reduction-style policies such as methadone maintenance and medical marijuana
use, though the U.S. Supreme Court has prohibited the latter (Lyman and Potter,
2003). And not all European countries
abide by harm reduction perspectives such as seen in Sweden and Poland’s
prohibitionist policies. Third, both U.S. and UN prohibitionist hegemony has
influenced the legislation and policy in countries worldwide, including in
Europe and the Americas.
Influence of
Prominent Policy Groups
Though
numerous governing bodies and treaties affect the formulation of drug control
policies, this paper specifically examines the stated ideology of the United
Nations, European Union, and United States.
Because of the prominence of these bodies in the world, each has exerted
influence in the formulation of global, regional, and individual country drug
control policies.
The United
Nations Position
Following
two prior drug control conventions in 1961 and 1971, the United Nations drafted
the United Nations Convention against Illicit Traffic in Narcotic Drugs and
Psychotropic Substances of 1988. Although the policy model was
multi-dimensional in terms of containing both prohibitionist and reductionist
elements, it had an evident U.S.-influenced prohibitionist tone (Goode, 2002).
The 1988 Convention model established a blueprint for national drug policy
worldwide. It not only added most member nations as signatories but also
signaled fundamental policy expectations for each. This model acted as a basis
for both international drug policy treaties and policy relationships with the
UN world body. As with any drug policy, elements had to be refined as the world
and drug situations changed over time.
Though past statements
were prohibitionist in tone, the UN stated objectives in drug reduction have
taken on a more balanced rhetoric in the latest position statement as reflected
in the 2004 World Report. As seen in Table 2, within its five major principles
the report advocated the pursuit of a holistic approach that included an
epidemiological perspective. The plan includes both prohibitionist and harm
reduction components (United Nations, 2004).
_________________________
Table 2
UN
World Drug Report 2004
Approach
Strategy
Holistic
Approach
·
Addressing
the drug problem in a broader sustainable development context;
·
Providing
an integrated response to the drug and crime nexus;
·
Addressing
the drug and crime nexus under the new paradigm of human security;
·
A more synergistic approach; and
·
A more dynamic approach.
Epidemiological
Approach
·
Understanding and controlling drug epidemics
Source: UN World Drug Report (2004).
_______________________
The
statement acknowledged the interrelationship that exists between the global
drug problem and other social, development, crime, disease contagion, health,
transnational trafficking, terrorism, and human rights issues. In fact, the
position holds that the majority of the criminal and terrorist activity in the
world community is funded by the drug trade calling it a “ruthless and
lucrative market” that is at the center of transnational activity (United
Nations, 2004, p 3).
The European
Union Position
Bearing
a similar tone, the Council of Europe drafted an action plan to serve as a
model to guide European drug control efforts. In its “Action Plan to Combat
Drugs 2000-2004,” the plan stated “a global, multidisciplinary and integrated
strategy to fight drugs [is needed] if it is to be effective. The social and
health implications of the drug problem need to be addressed, as do the links
between drug-taking and crime and delinquency. A balanced approach to reducing
demand and supply is therefore needed” (Council of Europe, 2000, p.1). As seen
in Table 3, the statement outlined five fundamental objectives for the drug
control policy.
________________
Table 3
Council of
Action Plan to Combat Drugs
2000-2004
General Objectives
·
To
ensure that the fight against drugs continues to be a major priority for EU
internal and external action;
·
To
continue the integrated and balanced approach to reducing supply and demand;
·
To
continue the processing of information with the support of the EMCDDA (European
Centre for Drugs and Drug Addiction) and Europol;
·
To
promote international cooperation, particularly through the United Nations; and
·
To mobilize the necessary resources.
Source: Council
of Europe (2000).
__________________
As with the UN position, the
Council of Europe advocated an integrated and
balanced approach to drug control. However the
European community, though comprised of diverse states, would lean to a more
reductionist position (Dorn, Jepson and Savona, 1996). As noted, drug policies
often evolve from an amalgamation of treaties, agreements, and policy models
(MacCoun and Reuter, 2001). As such, Article 152 of the European Community
Treaty asserts that public health must be taken into account in all community policies and actions. This
mandate establishes public health as a priority in the policy-making activities
of EC signatories. Anti-prohibitionists place a significant emphasis on
socio-medical responses as part of a larger reductionist view of drug addict
care and the collateral social effects of drug use (Nadelmann, 1999).
The United
States Position
The
United States’ position on drug control is clearly prohibitionist. Using a
“securitization” approach (Dorn, 2004), the U.S. State Department’s
International Narcotics Control Strategy Report 2005 defined the illicit drug
trade as “a threat to national security and international stability. It is
inextricably linked with transnational organized crime and many terrorist
organizations. Drug trafficking organizations direct the drug flows that poison
societies, foster corruption, and finance international crime and terrorism.”
The U.S. National Drug Control Strategy
(2005, p. 4) cites three priorities and two goals in its five-year plan.
________________
Table 4
U.S.
National Drug Control Strategy 2005
Priorities
and Goals
Priorities
·
Stopping Drug Use Before It Starts
·
Healing America’s Drug Users
·
Disrupting the Market
Goals 2-5
years
2 years 10 percent reduction in illegal
drug use among youth and adults
5 years 25 percent reduction in illegal
drug use among youth and adults
Source: U.S. National Drug Control Strategy (2005).
__________________
Again,
citing the National Presidential Security Directive # 25 on International Drug
Control Policy (NPSD) (2004) the U.S. statement considers
rising global demand for
illicit drugs as the principal narcotics-related threat to the US. The NPSD
also noted that international drug trafficking organizations and their
connection to international terrorist organizations constitutes a serious
threat to US national security. Demand reduction efforts aimed at reducing
worldwide drug consumption therefore took on increased importance and served
the national interest due to its potential for reducing the income that
criminal and terrorist organizations derive from narcotics trafficking and for
reducing crime/strengthening security in foreign countries that are key
strategic allies of the U.S. (International Narcotics Control, 2005, pp. 1 and
9).
In
addition to assuming a staunch prohibitionist position, U.S. drug control
policy places considerable emphasis on cooperative support in international
interdiction and supply control efforts. The U.S. exerts pressure on other
nations, especially those responsible for primary drug-production (i.e., Andean
region for coca, opium and cannabis and Mexico for border transshipment, opium
and cannabis production) of substances destined for American drug users, to
implement prohibitionist policies. The
U.S. compels its allies to adopt prohibitionist methods through the
Presidential “certification” program enacted under the Foreign Authorization
Act appropriation of the Foreign Assistance Act of 1961, et seq. (22 USC § 2291). Using foreign aid and economic assistance
programs as incentives, the policy seeks to have foreign countries develop
policies and practices that comply with the provisions of the United Nations
Convention Against Illicit Traffic in Narcotic Drugs and Psychotropic
Substances of 1988. The objective is to require “the parties to take legal
measures to outlaw and punish all forms of illicit drug production,
trafficking, and money laundering, to control chemicals that can be used to
process illicit drugs, and to cooperate in international efforts to these
ends.”
Specifically,
“the statute lists action by foreign countries on the following issues as
relevant to evaluating performance under the 1988 UN Drug Convention: illicit
cultivation, production, distribution, sale, transport and financing, and money
laundering, asset seizure, extradition, mutual legal assistance, law
enforcement and transit cooperation, precursor chemical control, and demand
reduction.” (Bureau for International Narcotics and Law Enforcement Affairs,
2005, p. 9).
A
review of the proposed 2006 U.S. national drug control policy budget provides a
clear indication of the policies’ priorities. The overall U.S. proposed drug
control budget for 2006 is $12.42 billion of which 61percent is devoted to
interdiction, law enforcement, and supply control (trafficking) and 39 percent
is marked for treatment, prevention, and research. However, within this figure
no funds are specifically designated to provide direct services to addicts, but
rather, melds the money with research funding (Office of National Drug Control
Policy, 2005, p. 5).
Factors
Contributing to Diverse Viewpoints
The United States prohibitionist
approach is discernibly one dimensional, particularly with its penchant for
criminalization and penalization. Though European policies are
multi-dimensional and more diverse, many legal and social factors contribute to
the formulation of their ideologies (Krajewski, 2004).
Factors
Contributing to European Diversity
Scholars
have asserted that in spite of efforts at consolidation among the European
Union member states, wide diversity exists among the drug control policies
across Europe (MacCoun and Reuter, 2001; Krajewski, 2004). As noted previously
in MacCoun and Reuter’s (2001) model, numerous “exogenous” factors contribute
to the development of drug policy. Hence, health and welfare policies,
demographics, and the social construction of the drug problem all act to frame
the socio-political environment in which drug control policy is crafted. In the
case of European policy, significant differences in historical, cultural,
social, and political traditions partially explain the breadth of variation.
Many European countries base their drug control ideology on harm reduction and
modify applications to satisfy individual preferences. Some European countries
abide by local laws in spite of pressure from treaties or external authorities
(i.e., UN or European Union). Examples would include the German constitutional
prohibition against criminally punishing someone who harms themselves, Dutch
decriminalization, and British depenalization (Bullington, Bollinger and
Shelley, 2004).
In a
comparison of six European country drug control policies, differences were
observed based on not only the social construction of drug use but also on a
subjective moralism regarding drug using behavior (Cattacin, Lucas, and Vetter,
1996). As an example, Sweden’s drug policy is primarily prohibitionist and uses
the rationale that drug use is a moralistic failing and advocates temperance.
Conversely, Dutch policy seeks to avoid moral condemnation of drug using
behavior. It relies on a non-moralistic approach that believes that repressive
and stigmatizing policies may contribute to a rising interest in drug use among
young people. Thus, exacerbating the problem or driving the drug-using behavior
underground (Cattacin, Lucas and Vetter, 1996; Ministry of Health,
Welfare and Sport, 1999).
Harm
Minimization
In
the United Kingdom (UK) drug policies seek to prioritize enforcement based upon
an assessment of extent of potential harm caused by a particular drug
substance. As with many countries, the UK makes a clear distinction between not
only drug trafficking and possession, but also, establishes priorities among
“hard” (i.e., cocaine, heroin, amphetamine) and “soft” (i.e., cannabis) drugs.
Hence, personal use of cannabis and other drugs deemed “soft” are considered
unproblematic and generally de-emphasized. This means that most of these
behaviors are overlooked and depenalized, often not referred for prosecution by
the police even though they may be officially illegal (European Monitoring
Centre for Drugs and Drug Addiction, 2002).
In contrast, drug control efforts are focused on the harder drugs
believed to produce the greatest harm in terms of disease contagion, overdose
risk or correlation to crime (Dorn, 2004).
As
with many European countries that favor harm reduction, a rigid distinction is
made between drug possession and trafficking. This has become a common theme
among anti-prohibitionists (Grossman, Chaloupka and Shim, 2002). Dorn and
Jamieson (2001) argue that the criminalization of individual possession is
subject to the constitutional principles of each country, and therefore, may be
considered subject to a harm minimization analysis.
“Greatest Harm
Perspective” Influence on Policy
Drug control policy
prioritization is influenced by the prevalence of perceived threat (Dorn,
2004). In the case of Europe, heroin and amphetamine-type synthetic (ATS) use
have been designated as the most serious problems facing policy makers
(European Monitoring Centre for Drugs and Drug Addiction, 2002). Several
European countries prioritize their demand control policy predicated upon a greatest harm
perspective. As an example, some of the clean needle policies utilized in the
United Kingdom and Switzerland are in a direct response to the risk of disease
contagion among intravenous (IV) heroin users (Kaplan, 1999). In other cases,
threat of transnational crime and terrorism caused policy makers to focus on
trafficking as a more serious societal threat than personal use (Europol, 2003;
2004).
Some European heroin maintenance programs are designed to
disrupt the drug-crime relationship whereby IV drug addicts are more likely to
engage in crime to support their addiction. Methadone and heroin prescription
treatments can be viewed as both addict care and harm reduction strategies
designed to reduce collateral crime effects on society (Goldberg, 1999).
In an effort to reduce
criminal offending among chronic heroin addicts, Swiss federal authorities
established a heroin maintenance program in 1999. In a longitudinal study of
addicts participating in a Swiss heroin medical prescription program, Ribeaud,
Killias, and Aebi (2004) found a significant reduction in collateral
criminality among those who remained in the program for four years. The study
findings show that addicts in the program not only reduced their use of other
substances (i.e., cocaine, etc.), but also, criminal offending dropped by 72
percent with the onset of the treatment (Ribeaud et al., 2004).
As noted, many drug
control policies are influenced by a perception of harm. This manifests itself
in programmatic and policy priorities involving trafficking versus
possession/personal use, hard versus soft drug responses, and collateral harm
versus criminalization (Hilte, 1999). The policy and priority diversity
observed among European countries is a product of perceived harm and a desire
to reduce that harm. In the most recent Europol assessment, synthetic drugs are
considered to be the greatest perceived harm, and therefore, are the current
focus of counter-drug responses (Europol, 2004).
In contrast to the harm
reduction prevalence in many European policies, U.S. harm assessment is
influenced by a different dynamic. First, U.S. policy assumes a “securitization”
(Dorn, 2004) position because its drug harm perception is related to terrorism,
transnational crime, and threats to national security (Office of National Drug
Control Policy, 2005). Second, U.S. criminalization of drug possession and
trafficking is based on a perceived convergence between illicit drugs and the
economics of terrorism, organized crime, and transnational crime. In short, the
U.S. prohibitionist stance is in reaction to the prevalence of the drug-crime
nexus using empirical evidence of extensive street crime and criminal violence
(Jensen and Gerber, 1998). This observation offers no explanation on the
efficacy of the U.S. criminalization and penalization response, but merely,
notes that U.S. policy is a reaction to a drug-crime-terrorism nexus that is
perceived as the greatest harm (Office of National Drug Control Policy, 2005).
As indicated in Table 5, perceived
greatest harm can be one of the factors that shapes drug control policy.
__________________
____________________
A tremendous amount of variation
exists among intra-European and comparative international drug policies. This
diversity can present one of several challenges to assessing policy efficacy in
cross-national comparisons.
Determining
Efficacy: Difficulties in Cross-National Comparison
Scholars
and policy makers have found cross-national comparisons of drug control
policies problematic (Goldberg, 1999; Kraus, Augustin, Frischer, Kummler, Uhl and
Weissing, 2003). Hence, efforts to assess the efficacy of opposing policies
such as prohibition and harm reduction are fraught with validity concerns.
MacCoun and Reuter (2002, p. 8-9) note four primary analytical challenges to
effective cross-national comparison:
1.
Data Scarcity
2.
Poor data quality and comparability
a.
Differential definitions (i.e., drug-related death, drug
arrest, etc.)
3.
Weak Causal Inference
4.
Unknown Generalizability
These comparison problems are present in both U.S. and
European drug
definitions,
data collection and measurement efforts. One of the measures commonly used is
estimating drug use prevalence. Kraus, Augustin, Frischer, Kummler, Uhl and
Weissing (2003) recommend using a multi-method approach in making drug use
estimates across countries due to inadequate epidemiological data and an
inability to control for inconsistencies. The UN, EU and U.S. policies have all
called for improved standardization in drug use data collection methodology and
measurement (United Nations, 2004; Office of National Drug Control Policy,
2005; European Monitoring Centre for Drugs and Drug Addiction, 2004).
However, it is difficult to
determine drug policy efficacy with any precision. Even efforts to analyze
intra-country data correlation between drug use, drug trafficking, drug-crime
relationships, etc. can be confounding. As an example, 2002 U.S. federal prison
data show 55.1 percent of inmates are incarcerated for drug offenses, including
both possession and trafficking. This high number provides evidence of the U.S.
prohibitionist approach that focuses on criminalization and penalization (U.S.
Bureau of Prisons, 2002). Yet, in
questioning whether the drug war has abated Farrell and Carter’s (2003)
examination of U.S. federal prison data from 1990-2000 show a stabilization of
drug offense incarceration at a .03 percent increase over the decade with the
proportional rate the same in 1990 and 2000. Their conclusion is that the
appearance of declining drug incarceration is an illusion. Instead, they argue
that non-drug classified incarcerations have risen and may be blended with
transnational and trafficking offenses (Farrell and Carter, 2003). This is but
one example of the difficulty in teasing out causality or correlation in
drug-related measures. U.S. incarceration rates for drug offenses at 149 per
100,000 in 1995 far exceeds those for total crime rates in Europe (Grossman,
Chaloupka, and Shim, 2002; See also European Sourcebook on Crime and Criminal
Justice Statistics, 2003 regarding their consolidation of drug offending
behaviors). These data may signify the success or failure of U.S.
prohibitionist policy depending on the interpretation.
The cross-national drug control
literature is replete with efforts to measure policy and program efficacy.
Though knowledge can be gained from intra and inter-country study, much of the
efficacy findings are subjective due to differences and inaccuracies in the
data. Policy makers have called for improved measures and organizations such as
the European Monitoring Centre on Drugs and Drug Addiction have progressed in
their effort to collect data that are comparison friendly (MacCoun and Reuter,
2002). However in spite of these advances, directly comparing arrest,
mortality, self-report use, and drug-crime nexus data is problematic. Hence,
some policy makers have accepted their local policies because they are well
suited for their constituencies, even though they may defy accurate
measurement. Perhaps as a result of these obstacles, policy efficacy
determinations are best made in the context of the analysis of exogenous
factors that contribute to policy formulation rather than striving to compare
police or prevalence data.
Discussion
It is challenging to clearly divide
drug control policies between prohibition and harm reduction. Though there are
examples of one-dimensional ideologies such as the
U. S.
prohibitionist-based criminalization and penalization strategy, most policies
exist within a continuum. Many European countries approach their drug control
policies by using both prohibitionist and harm reductionist elements. Even
then, there are multiple dimensions of ideology and policy imbedded within a
prevalent stance such as either prohibition or anti-prohibition (Dorn and
Jamieson, 2001; Cattacin, Lucas, Vetter, 1996). As noted by MacCoun and Reuter
(2002) many historical, cultural, socio-political, legal, demographic and
practical factors contribute to the demand control policy. Much of the drug
control perspective hinges on a perceived greatest harm that acts to shape priorities.
Countries develop policies often in reaction to perceived health, social, or
crime threats to their citizens. Since these determinations are subjective,
drug demand control policies are multi-dimensional and lead to tremendous
diversity.
The question of which approach is
more effective is again subjective depending upon the larger ideological
context. Though there are exceptions, European countries tend to be more
oriented toward harm reduction perspectives than the U.S. Again, these policies
should be plotted along a continuum since even in Europe there are degrees of
harm reduction policies. The Netherlands, Switzerland, and UK are among some
reductionists that have been subject to criticism by other European countries,
such as Sweden, for their user and addict care policies. Many feel that harm
reduction offers better efficacy and improves the lives of those affected by
drug use (Goode, 2000; Nadelmann, 1996; Bullington, Bollinger and Shelley,
2004). However, before one policy is deemed better than another much more must
be learned about these complex dynamics.
Concerns about the complexities and
inaccuracies of cross-national comparison of demand control policies are well
documented. Hence, measuring efficacy is at best illusive until more consistent
data collection and measurement methods are developed. In spite of these
challenges, much progress has been made and much more study needs to be
conducted. Drug demand control policies are subject to the influence of many
exogenous factors within a society. As witnessed in the transition from mostly
reductionist to more prohibitionist in Poland’s policy, there exists a complex
interplay between socio-political pressures (Krajewski, 2004). It may be fairly
concluded, at least in Europe, that demand control policies are subject to
change and sensitive to these influences. In the case of the U.S.
prohibitionist position, it may become even more intractable due to an
increasing “securitization” perspective.
The deleterious effect of drug
misuse and collateral social cost on the user and society are clear. Countries around the world are striving to
improve the health and social condition of their people by reducing the
negative effects of illicit drug use. Much more study needs to be focused on
the efficacy of drug demand control policies. As the world changes with the ebb
and flow of globalization, control of illicit drug use will continue to be a
daunting challenge. Improved data and scientific analysis will contribute to a
better understanding of the “best practice” in drug demand control policy
(Kaplan, 1999).
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