Introduction
Drug use has developed historically as part of wider social practices. Drug-related harms, including harms to health and social order, need to be understood in a sociocultural context, as do the regulatory frameworks that have developed to control drug demand, supply, and use. Contemporary drug policy reflects an uneasy balance between public health and law enforcement responses. This dichotomy creates avoidable complications and unintended consequences for associated regulatory practices. Balanced approaches to drug control and regulation should consider a number of central issues, including the role of science and evidence, ethics, public opinion, and the socioeconomic and political context.
Historical Overview
The Role Of Drug Use In Context
The use of naturally occurring psychoactive substances predates modern history, with evidence of tobacco, cannabis, alcohol, opium, coca, psilocybin, and peyote occupying important cultural, spiritual, medicinal, and economic roles in ancient societies. Historically, the distribution and use of psychoactive substances was not State regulated in the manner that is seen today, although in some countries taxes on psychoactive substances provided a significant source of government funding which predated income taxation systems.
Indian opium was imported into the UK as early as 1606 by trade ships chartered by Elizabeth I. In the seventeenth and eighteenth centuries, hemp cropping for rope and sail manufacture was widespread in the North American colonies. In many countries, opium, morphine, and cocaine were used widely in a range of home remedies and tonics. Since the advent of modern toxicology in the early nineteenth century, the manufacture of new drugs for medicinal and other purposes has steadily increased the available range of psychoactive drugs.
Responses To Drug Use
It is beyond the scope of this research paper to fully discuss the antecedents of the regulatory legal approach to the control of drug supply and use (for a detailed history refer to Courtwright, 2001; MacCoun and Reuter, 2001; Davenport-Hines, 2004). Some of the key events and social changes are overviewed here to illustrate the shift toward progressively inclusive drug regulation and control by the State, together with harsher penalties for drug use, supply, and manufacture.
A number of important socioeconomic and political developments influenced the development of international drug control conventions and treaties and related jurisdictional laws. The Opium Wars of 1839–42 and 1856–80 were the result of clashes involving international politics, commercial interests, and moral opinion on drugs. The conflicts followed the persistent supply of opium to China by the Dutch, Portuguese, English, and British India despite the 1729 ban on importation and the 1799 prohibition of importation, cultivation, and use.
A key post-industrial revolution theme that developed as populations became more mobile was a sense of moral panic about drug use. This legitimized prejudice against the lower socioeconomic classes and minority immigrant groups, their drugs of preference, and perceived racial and cultural difference. In some countries during the nineteenth century gold rush era, this was first evident in relation to Chinese immigrants and their use of opium, culminating in fears about social order and laws banning opium smoking directed at the Chinese opium dens (Goode and Ben-Yehuda, 1994).
State concerns about the prevention of drug-related health harms can be traced in England back to the 1868 Pharmacy Act, involving the first regulation of drugs. This was prompted by accidental and intentional drug poisonings and the recreational use of opium and chloral hydrate by the working classes. Initial concerns around the need for regulation of the patent medicine industry via State legislation paved the way for the early foundations of an international drug control system.
The 1912 Hague Opium Convention focused on reduced production, distribution, and consumption of opiates; restricted use for legitimate medical purposes; and domestic legislation to prevent narcotics abuse. Since then drug control measures have become progressively more inclusive and more punitive (for a description of development of international conventions on drugs, see Courtwright, 2001; MacCoun and Reuter, 2001; Davenport-Hines, 2004).
Another important development was the rise of the Temperance Movement in the UK and United States, leading to prohibition in those and other countries. Prohibition became a popular vehicle for social control in the context of industrial expansion, urbanization, increased population, immigration, and associated social order problems. Prohibition initially focused on alcohol but later extended to opium and other drugs, taking a punitive moral stance toward drug use and users. This laid the foundations for the medical-disease model of addiction in which drug use was seen as a marker of individual deficit and lack of agency, thus requiring the paternalism of both law enforcement and public health responses (Berridge, 1980).
Although the pursuit of altered consciousness through drug use has been a constant in human history, the shifting public and State view on the permissibility of this owes a debt to the emphasis during the seventeenth and eighteenth century Enlightenment on reason and rationality as the underpinnings of the perfect society.
Current Situation: Drug Use And Harms
Drug use practices and the associated harms, both individual and social, continue to be shaped by changing sociocultural, economic, and political norms. Although it is difficult to find comparable data across nations, the available estimates show that tobacco and alcohol use is prevalent in most populations, and accordingly is responsible for the majority of drug-related mortality and morbidity compared with illicit drugs.
Worldwide there are an estimated 2 billion people who consume alcoholic beverages and 1.3 billion people who currently smoke cigarettes or use other tobacco products (Shafey et al., 2003; World Health Organization, 2004). Alcohol-related harms largely occur in developed countries, but these harms are increasing in some developing countries as a result of commercial interests establishing alcohol beverage markets. Globally, there are around 76 million people with a diagnosable alcohol use disorder. Alcohol use is estimated to cause ‘‘around 20–30% of esophageal cancer, liver cancer, cirrhosis of the liver, homicides, epileptic seizures, and motor vehicle accidents worldwide’’ (World Health Organization, 2004: 1).
Tobacco use is also a major cause of morbidity and mortality in developed nations, and as with alcohol, it is a growing problem in developing countries where increasing affluence is associated with increased use and associated health harms. There were an estimated 4.9 million premature deaths worldwide in the year 2000 from smoking. By 2020 the global burden is expected to exceed 9 million deaths annually, with 7 million of these occurring in economically developing countries (Shafey, 2003: 7).
The annual global prevalence of illicit drug use has been estimated to be 200 million people between 15–64 years of age (5% of the world population), with around 25 million people (0.6% of the world population) having problematic drug use (United Nations Office of Drugs and Crime, 2006). The most prevalent illicit drug is cannabis, followed by amfetamine-type stimulants (amfetamines and ecstasy), cocaine, and opiates. Illicit drug use has been greatest in developed countries, although here, too, the pattern has been shifting. The demand for treatment for problematic amfetamine-type stimulants use, for example, is highest in Asia, followed by Oceania, North America, Europe, and Africa (United Nations Office of Drugs and Crime, 2006: 9).