DRUGS (ILLEGAL).A CHANGING PROBLEM
THE INTERNATIONAL DIMENSION
CONTROLLING DRUGS ON THE NATIONAL LEVEL
THE HARD AND SOFT DRUGS CONTROVERSY
MAINTENANCE TREATMENT AND HARM REDUCTION
DRUG POLICY BEYOND THE NATIONAL STATES
Illegal drugs represent only a selection among a range of psychoactive substances. Historically they were natural products such as coca and opium, which were used for religious, medical, or recreational purposes. Opium plays the most prominent role in the history of illegal drugs. It was a remedy sold over the counter for two centuries before it gradually became more regulated, first restricted to the pharmacists' shops in the mid-nineteenth century and then losing its role in medicine during the twentieth century. Opium and later its extract, morphine, were shown to have an extraordinary potential for pain relief as well as having a positive influence on mood. It was the excessive smoking of opium that first created concern. The intoxicating effect, consequences for mental and physical health, and addictive potential became the model criteria for the determination of whether a psychoactive substance is considered a dangerous, and therefore potentially illegal, drug.
Heroin, amphetamines, and LSD all went from being considered useful medicines to becoming illegal drugs. Amphetamines were widely used by soldiers during World War II, and in the years to follow they were popular stimulants used for self-medication. LSD was introduced as a promising new drug in psychiatric treatment before it became a recreational drug favored by the counterculture of the 1960s. By the end of the twentieth century a number of new synthetic drugs had been developed, of which ecstasy is the most well-known.
What became the youth drug problem in the 1960s had been at the start of the twentieth century something quite different. There was fear that use of opium among immigrant groups in Europe and the United States could spread to the national population. Established opium dens for habitual users were more or less abolished after World War I. During the years to come the drug problem was related to three groups of users: those addicted because of long-term use or misuse of prescription drugs; medical professionals who had easy access to controlled substances; and groups such as artists, the aristocracy, and soldiers, who were inclined to use drugs recreationally.
Illegal drug use and addiction in the youth population became a dominant public concern beginning in the 1960s. Drugs in general, and especially cannabis and LSD, became important elements of the popular youth movement. During the 1970s and 1980s the use of heroin increased dramatically in a number of European countries. Cocaine, ecstasy, and LSD were key ingredients of the club (or "rave") culture of the 1990s.
The principles for regulating these illegal drugs were to a large extent determined by international cooperation beginning in the early twentieth century. Regulation and control of the opium trade became one of the first themes for collective action by independent national states in nonpolitical international affairs. The anti-opium protest movements, especially in countries as Britain and the United States, at the beginning of the 1900s contributed to the political pressure that convinced the international community to create a number of enduring international control instruments.
The first conference on the opium trade was held in Shanghai in 1909, followed by conferences in The Hague in 1911–1912, which resulted in the Hague International Opium Convention of 1912. Smoking of opium had caused the popular concern, but the handling of the problem in the international arena was to a large extent determined by the interests of trade. The colonial powers, Britain and the Netherlands, wanted to protect their monopolies. France, Switzerland, and Germany wanted to protect their pharmaceutical industry. The initiatives of the League of Nations for further regulation of the drugs market resulted in the Geneva International Opium Convention of 1925. That convention settled a system for state monopolies for import, distribution, and sale of raw materials of opium and coca products and a system for control of production and sale of the derivates as morphine and cocaine. Cannabis was included on the list of substances that should be used only for medical and scientific purposes. The Convention obliged the participants to develop legal sanctions against actions offending the rules of the convention.
The success of decreasing the legal production and market created the opportunity for profitable clandestine cultivation and manufacture of illegal drugs. In 1936 the League of Nations agreed on the first treaty designed to suppress the illicit drug traffic. The initiatives to set up this convention stemmed from the organization that later became known as INTERPOL.
The United Nations (UN) followed in the track of the League of Nations when they negotiated the Single Convention on Narcotic Drugs in 1961. The convention is, together with the Convention on Psychotropic Drugs from 1971 and the Convention against Illicit Traffic in Narcotic Drugs and Psychotropic Substances from 1988, the basis for international cooperation today. The Single Convention settled the area of drug policy. It signified the prohibition of cannabis and made recommendations to the parties that they should provide facilities for the treatment, rehabilitation, and care of drug addicts. It states which substances should be regulated and it restricts legal use of these substances to medical and scientific use only.
At the core of the handling of illegal drugs is the boundary drawn between substances deemed to be therapeutic and the ones whose use is legally proscribed and punished. This boundary is in no way fixed. Some sketches from different European countries can give an indication of the number of factors that influence how these distinctions are made as well as their practical effects.
The principles of the three UN conventions have been muddled through the different national institutional systems of the European countries. Thus, the policies on illegal drugs vary considerably among the European countries. Legal traditions, the professional knowledge base, role of the professions in the legal process, and the status of elites in relation to the public are among the factors that contribute to these differences. The drug policy of a particular nation indicates how its social and governmental infrastructure responds to crime, deviance, subcultures, and social and health problems. It is a commonality among nations, however, that drug use as a form of rebellion among students and cultural elites in the 1960s became a symptom of social marginalization, poverty, and bad health through the 1970s.
The Hague Convention was the basis for the first Opium Laws of the European countries. These laws mainly regulated import, export, and the medical profession's handling of opium, cocaine, and morphine. The potential for conflicts around these laws was highly determined by the traditions for use of these drugs in treatment and for recreation. In Britain the Dangerous Drugs Act of 1920 at an early stage became a battleground for the Home Office and the Ministry of Health. The Home Office wanted to use the law also to control the practices of the medical profession. Brit Bergersen Lind's historical study of drug control in Norway shows that the very limited experience of recreational use made the sharing of responsibilities much easier. The health authorities were in the Norwegian context given full responsibility over the legal distribution of these substances.
Early-twenty-first-century regulations of illegal drugs for the most part have their roots in the 1950s and 1960s. Many countries experienced an escalation of repression of the counterculture and associated drug use during the 1970s and 1980s. Norway represents a very strong illustration of this. The use of illegal drugs was criminalized in 1968. In 1972 and 1981 the maximum penalty for serious drug crimes by professional criminals was raised first from six to ten years, and then subsequently to fifteen years. In 1984 the structure of the laws was changed so that more criminal offenses were placed into the Penal Code. Finally the maximum penalty was raised to the absolute limit, twenty-one years, for particularly aggravated drug crimes. The raising of the penalty levels were most of all aimed at combatting drug trafficking, but some changes were also made in order to hold the users more accountable. By 1984 most of the legal basis for regulating illegal drugs was included in the Penal Code and the crimes were defined as felonies. Only use and possession for personal use were accepted as misdemeanors.
The differences between the laws of the different nations revealed differences in the drug-policy climates in those countries. Countries including Italy, the Netherlands, Austria, and Spain had an explicit differentiation between "soft" and "hard" drugs and between users and traffickers in their laws, whereas France, Norway, and Sweden did not make these distinctions. The balance between penal provisions and administrative measures also varied considerably. Finally, the expediency principle that allows the police authorities to make priorities between cases and not prosecute minor offenses has de facto legalized possession and consumption of illegal drugs in some countries, for instance the Netherlands.
European integration has contributed to a growing space for regulation and administrative measures in drug policy within the European Union, especially from the early 1990s. Nicholas Dorn and Simone White conclude in 1999 in a study of twelve European countries that the balance between administrative and criminal measures in national policy still varies but that most countries restricted the clear criminal measures to drugs trade, selling and possession of larger amounts, or activities involving more dangerous drugs. In cases of nuisance, administrative and criminal measures were mixed, whereas administrative measures dominated in the handling of local planning, licensing, and possession of illegal drugs in general.
From the end of the 1990s most changes in the European laws on drugs have moved the systems in a more liberal direction. Possession and use of drugs have either changed status from a crime to an offense or have been fully decriminalized in countries as Italy, Spain, Greece, and Portugal. Others, such as Britain and Belgium, restrict this lenience to cannabis only.
In practical policy and legal practices hard and soft drugs are treated differently in the European countries. That cannabis should be included in the international conventions on illegal drugs at all was contested from the beginning. Experts commonly recognize that cannabis does not have the same medical and psychological risks as do most of the other drugs on the list of illegal drugs, but in the political debates cannabis still has an important symbolic status. It is considered to be a gateway drug that easily leads to further drug problems for individuals.
The most well-known examples of de facto legalized trade in soft drugs are the "Free City of Christiania" in Denmark and the coffee-shop policy of the Netherlands. In 1971 some large barracks situated almost in the center of Copenhagen were abandoned by the military. Shortly thereafter they were occupied by squatters, who nicknamed them "The Free City of Christiania." In the beginning this was a clearly politicized social experiment opposing the established way of life. There has been a continual debate about Christiania among the Danish public, but all the same the "Pusher Street" in Christiania has survived for more than thirty years as a permanent venue for open trade in hashish. This history has not only to do with the Danish permissiveness in moral questions. It has most of all to do with the principle of making a separation between hard and soft drugs that was set down in the legal practice by the attorney general in 1969 and supported by the chief medical officer of the capital. It is thus possible for the police not to intervene in Christiania as long as hard drugs are not being sold.
The role of the elite of the public services is quite similar in the Netherlands. The Dutch chiefs of police and justice officials recommended legalization of cannabis in the late 1960s. They argued for the necessity of concentrating police resources on drug trafficking rather than on petty crime. The Baan Committee's report of 1972 settled the principle that the regulation and level of punishment in drug cases should be determined by the health risk posed by the particular drug. Experts in the Netherlands agreed on the conclusion that cannabis was less dangerous than other drugs. During the 1970s and 1980s the system of retail sale of cannabis in coffee shops developed, and by the early 1990s the government planned to legalize production of Dutch cannabis (nederwiet). These plans were stopped, however, and Paulette Kurzer (2001) argues that there have been considerable differences between popular belief and the attitudes of the elite toward the drug question. The reaction in the society together with pressure from the European Union have led to an increasingly restrictive regulation of the coffee shops and a much stronger focus on nuisance during the 1990s. But still the Netherlands stands out as the one European country that actually has a strategy for a regulated legal trade in cannabis.
The medicalization of the drug problem is best illustrated by strategies for maintenance treatment and prescription practices. Among the best-known strategies for this is the "British system" and the recent heroin trials in Switzerland. The British system has a long history while the Swiss trials are clearly a part of the movement toward harm reduction from the early 1990s.
The Rolleston Committee report from 1926 settled, according to Berridge (1999), a partnership between the professional ideology of doctors and the aims of legal control. This was the start of the so-called British system that most of all was based on an establishment of a therapeutic relationship between a doctor and a patient who agreed on the patient's being ill and in need of treatment. The system worked pretty well until the late 1950s when prescribed drugs started to flow into a growing illegal market for recreational use. The Brain Committee of 1966 prepared the introduction of specialized drug dependence units (called clinics) in 1968. They were designed to provide maintenance treatment for heroin and cocaine. By the start of the 1980s it was clear that the clinics neither met the goal of making the addicts accessible for treatment nor stopped the supply of legal drugs to the illegal market. There was also a growing doubt about the practices from a professional point of view, and most practitioners preferred to discontinue the administration of injectable heroin in favor of oral methadone. Even if the practices of the clinics were quite contested by the mid-1980s, the system represented a very useful infrastructure for the rapid change needed when the HIV epidemic occurred. The choice of strategy when confronted with this new threat associated with intravenous drug use was well-founded in the previous tradition of public health. Medically assisted treatment, advice, and information as well as needle exchange programs could be administered through the clinics. By the end of the century the administration of oral methadone and increasingly buprenorphine came to dominate the treatment of opiate dependent patients. Numbers from 2002 show that only 1 percent of these patients receive injectable heroin.
The background for the Swiss heroin trials was somewhat different. During the 1980s Switzerland was confronted with some of the largest open drug scenes in Europe. Heroin trials were started in the early 1990s and were shown to have a very efficient positive impact on the problem of drug crimes and health problems among the addicts. Compared to the British system, the Swiss treatment is much more controlled and puts the patient under a strict set of rules. It has made heroin addiction into "a painstakingly monitored illness" (Aarburg and Stauffacher, p. 41). Switzerland experienced a rapid increase in the prevalence of heroin addiction up to 1993/94, followed by a gradual decline in the following ten years. Thus the Swiss authorities consider their treatment strategy as quite successful. Medically assisted treatment, especially with methadone, has become an important part of harm-reduction strategies in Europe. Together with securing the supply of clean syringes, establishing injection rooms, and providing addicts with information, medical involvement in drug policy has contributed to the limitation of the spreading of HIV as well as other infectious diseases.
Drug policy was among the first topics for international cooperation, as shown by the international conventions. It has also proven to be a very fertile soil for cooperation in Europe. It is easy to agree on the necessity of cooperation, and, in spite of differences in practical policy, to fight drugs is deemed a good cause. Among the Nordic countries the cooperation was set up in the early 1970s, through meetings between the Nordic ministers, cooperation in epidemiological research, police cooperation, and special services for youth from other Nordic countries in Copenhagen.
The Pompidou Group was set up in 1972 as a cooperative effort between the six members of the European Economic Community (EEC) and the United Kingdom. It started as a multidisciplinary cooperation program on drugs covering health, education, information, enforcement, and legislation. To state the necessity of international cooperation not only in control but also in handling the drug problem as a social problem and a problem of public health was an important contribution of this cooperation. In 1980 the Pompidou Group become a "partial agreement" under the Council of Europe. Since 1982 experts have cooperated to develop administrative monitoring systems for the assessment of public health and social problems related to drug abuse. This cooperation evolved over the years through cooperation in school surveys and a multicity study of drug indicators.
When the European Union decided to set up its own drug-monitoring institution, the European Monitoring Centre for Drugs and Drug Addiction, in 1993, it could build on the traditions from the Pompidou Group. The EMCDDA consolidated the monitoring effort in Europe and drew national civil services into a more comprehensive cooperation on epidemiological studies as well as other aspects of prevention and treatment in the drug field.
The European Union's involvement in drug policy and enforcement expanded after the Maastricht Treaty of 1992, first through cooperation between police forces and customs. Drug trafficking and international crime became a focus of police cooperation among the EU member states beginning in the mid-1980s. The Europol Drug Unit was set up in 1993 before the negotiations about the Europol convention finished. Measures to control the trade in the precursors of illegal drugs and to prevent money-laundering were put in place by the early 1990s. Together with the cooperation in research and knowledge production, these elements express a European approach to illegal drugs. The problem of illegal drugs should be handled with a wide range of strategies from fighting international crime to implementing knowledge-based strategies for treatment, prevention, and harm reduction.
Aarburg, Hans-Peter von, and Michael Stauffacher. "From Law Enforcement to Care: Changed Benefits and Harm of Heroin Use in Switzerland through a Shift in Drug Policy." In European Studies in Drugs and Drug Policy, edited by Tom Decorte and Dirk Korf, 21–46. Brussels, 2004.
Albrecht, Hans-Jörg, and Anton van Kalmthout. Drug Policies in Western Europe. Freiburg, Germany, 1989.
Berridge, Virginia. Opium and the People: Opiate Use and Drug Control Policy in Nineteenth and Early Twentieth Century England. Rev. ed. London, 1999.
Bruggeman, Willy. "Europol and the Europol Drugs Unit: Their Problems and Potential for Development." In Justice and Home Affairs in the European Union: The Development of the Third Pillar, edited by Roland Bieber and Joerg Monar, 217–230. Brussels, 1995.
Bruun, Kettil, Lynn Pan, and Ingemar Rexed. The Gentlemen's Club: International Control of Drugs and Alcohol. Chicago, 1975.
Dorn, Nicholas, and Simone White. "Drug Trafficking, Nuisance and Use: Opportunities for a Regulatory Space." In Regulating European Drug Problems, edited by Nicholas Dorn, 293–290. The Hague, 1999.
Fjær, Svanaug. "Rules or Values? Production of Knowledge and the Question of Institutionalization in European Drugs Cooperation." Contemporary Drug Problems 28, no. 2 (2001): 307–331.
——. "From Social Radicalism to Repression: The Construction of the Norwegian Drug Policy in the 1970s." In Public Health and Preventive Medicine, 1800–2000: Knowledge, Co-operation and Conflict, edited by Astri Andresen, Kari Tove Elvbakken, and William H. Hubbard. Bergen, Norway, 2004.
Garde, Peter. "Denmark: Regulating Drug Trafficking, Nuisance and Use." In Regulating European Drug Problems, edited by Nicholas Dorn, 67–86. The Hague, 1999.
Hakkarainen, Pekka, Lau Laursen, and Christoffer Tigerstedt, eds. Discussing Drugs and Control Policy: Comparative Studies on Four Nordic Countries. Helsinki, Finland, 1996.
Hartnoll, Richard. Drugs and Drug Dependence: Linking Research, Policy and Practice. Strasbourg, France, 2004.
Kurzer, Paulette. Markets and Moral Regulation: Cultural Change in the European Union. Cambridge, U.K., 2001.
Lind, Brit Bergersen. Narkotikakonflikten: Stoffbruk og Myndighetskontroll. Oslo, Norway, 1974.
Strang, John, and Michael Gossop, eds. Heroin Addiction and the British System. London, 2005.