Legalise? Decriminalise? Ban? Getting to the Bottom of Drug Policy

Drugs kill hundreds of thousands of people a year. The war on drugs hasn't solved the problem. Could legalisation be the answer?

Featuring: 

Dr Keith Scott  - retired general practitioner and co-founder of the South African Drug Policy Initiative

Jonathan Caulkins - professor of public policy at Carnegie Mellon University's Heinz College and co-director at RAND's Drug Policy Research Center

Music by: Lexin Music from Pixabay

Transcript

Cait Macleod:

Drugs are as old as civilization. And yet the question of what to do about them is as urgent now as it has ever been.  From the opioid crisis in the US which is claiming 75,000 lives a year, to drug-funded gangs that keep South Africa's annual murder rate roughly the same as the wartime civilian death toll in Ukraine. The drug trade is a global story of death, violence, and political corruption.

Hundreds of years of experience doesn't seem to have revealed the answer as to how best we can deal with this evergreen problem. In recent years, a strong sentiment has emerged that using the full might of the law to come down on drug users is a cruel and expensive way to achieve very little. The US, for example, has spent over a trillion dollars since the seventies combating drugs. And yet they're almost as easy to come by as a Happy Meal.

Many countries are ditching the war on drugs model and moving towards an approach known as harm reduction where the focus is on treating addiction like an illness. A growing number of places have decriminalized cannabis and it's fully legal in some US states. Portugal has decriminalized all narcotics. And places like Canada are trialing heroin clinics where addicts can use more safely. 

All of that seems intuitive to me. But letting adults smoke a joint would be the thin end of the wedge. Can we really contemplate putting something like cocaine or heroin on a pharmacy shelf? And how would it feel to watch private companies profit off  addicts?

You're listening to Wood for the Trees, the podcast about the messy questions. I'm Cait Macleod. On each episode of Wood for the Trees, I interview experts with different points of view to try to get to the bottom of controversial social and political debates. This series is all about crime, policing, and justice. And this is episode three: Legalise? Decriminalise? Ban? Getting to the Bottom of Drug Policy. 

I'm very excited about the two experts I have for you today. Later we'll be talking to Jonathan Caulkins who's a public policy professor at Carnegie Mellon University's Heinz College and co-director of RAND's Drug Policy Research Center. But first we have an appointment with the doctor. 

Keith Scott:

My name is Keith Scott. I'm a retired general practitioner and I'm a co-founder and present chair of an organization called the South African Drug Policy Initiative. It was formed by a group of professional people and our membership is mainly professionals, medical people, previous professors, deans of medicine, criminologists, lawyers, et cetera, who feel that we need to move towards legalisation and regulation of all drugs in order to combat the harms of the drug laws that have been around for nearly a century.

 Cait Macleod:

And how did you become interested in this area?   

 Keith Scott:

Well like most people, when I was in practice, I thought drugs were a bad thing, it was probably good they were banned, but I have had a number of friends, close friends, over the years who've taken a lot of drugs, recreationally. They're still alive. They've led productive lives and they've taken serious drugs, not just cannabis.

And then I met somebody else who I got to know reasonably well. And he was involved in trying to legalize cannabis in South Africa. And he was involved with a couple who are at the forefront of cannabis legalization in South Africa. They're called the dagga couple, dagga being the colloquial name for cannabis in South Africa.

They were caught growing cannabis in their smallholding. They were taken to prison. They were offered to be released on a bail of about 60,000 Rand each. They refused. And they decided to take this to our Constitutional Court. So they laid charges against 7 government departments, and the court case went on for years.

So I looked at it a lot more closely and I teamed up with a former Dean of medicine of who had written an article in the South African Medical Journal where he was actually an editor as well, where he called for the decriminalisation of cannabis.

So together looked at the whole issue in more detail and took it from there.

 Cait Macleod:

And so what did you conclude? I mean, what is your general attitude towards drugs broadly speaking? 

Keith Scott:

Yes well all drugs are harmful. There's obviously a grade of harmfulness or toxicity if you like. And at the top of that list is alcohol and alcohol is legal.

I think it's important for people to appreciate that the use of drugs in itself, the use of any drug is actually a victimless crime. There are no victims when someone uses a drug, unless they do something against the law or harmful.

Whenever you hear a question about any drug, whether it be heroin, cocaine, crack, just look at alcohol.  If you see someone drinking a beer or whiskey at their pub, is there any victim involved? No. If they get drunk and they get in their car and they have an accident because their blood level is very high, there are victims. If they go home and beat someone up, there are victims. But then you prosecute the crime. You don't prosecute the drug. So drug use in itself is a victimless crime. There are people who use heroin all the time. Heroin, of course, doesn't make people violent whereas alcohol does.

I think morals have absolutely no place in the legal regulation or otherwise of drugs. We need to take a cold look at the facts. We have to look at the harms versus benefits of the drugs and of the laws that control the drugs.

 Cait Macleod:

So there are lots of different approaches that policymakers can take to drugs from banning everything, including cigarettes and alcohol, all the way to making heroin a legal over-the-counter drug that's available at your local pharmacy. And then there's also decriminalisation, which is sort of a middle ground between legalising and banning a drug. So I mean, where does The South African Drug Policy Initiative stand? 

Keith Scott:

The short answer is legalise everything because the prohibition of a drug is also going to cause harms. Therefore, if we're looking at legislation to control drugs or legalize or ban them then we have to look at the harms of the laws versus the harms of the drugs. And if you look historically, the harms of the laws are always far worse than the drug, no matter what that drug is, whether it's alcohol, we know from prohibition in the United States, in the 20s and 30s and in Russia, before that, that the laws caused all sorts of problems and they far outweighed the harms of the drugs.

The South African Drug Policy Initiative, like many similar organisations,  does not condone the selling or giving of drugs to children. Just like we do with alcohol, it's against the law. So I would just like to make that very clear because people, when they hear us say that they say, 'what about the children?'

When in fact, what about the children? Because when you have prohibition of drugs, what happens is the children are used by gangs to run the drugs.  In the UK, it's a huge problem with the county lines system, where children are used to run drugs. And then of course, when they get caught, they can't be fully prosecuted because they underage. In South Africa, they can. Anyone over the age of 12 in the city where I live can be arrested for drug possession still. 

Now drug decriminalisation refers to removing the sanctions against people who use drugs and possess drugs,  they still maintain the laws against trading drugs. Now that is only a step towards harm reduction and sensible drug policies. A good example of that  is in Portugal, where they've decriminalised all drugs.

So people are not prosecuted. They obviously get help. They provide jobs, et cetera. And that's been a model of decriminalization, but the people who are still taking drugs are dealing with criminals and they're stimulating the illegal drug trade because they're not getting drugs from anywhere else.

So decriminalisation has a lot of negative points and it's only a stepping stone. As an end point, it is not the answer. The reason Portugal only went as far as decriminalisation, not to full legalisation, which means that drugs can be legally sold and regulated - full legalisation is equivalent to say, the control of alcohol in the UK and South Africa.

And the reason that Portugal did not go that route, the full route, was because of the United Nations conventions on narcotic substances that most countries are signatures to so if they'd started legalising, there would've been a huge backlash from the other countries.

That's the important thing to understand. Decriminalisation means the user is not prosecuted or the possessor of small amounts, but the trade goes on in the underworld and that doesn't help the violence and the serious crime that the banning of drugs actually stimulates.

 Cait Macleod:

And what would legalisation of banned drugs actually look like in practice? 

 Keith Scott:

 One of these suggested ways is to have a gradation of regulation. So in other words, if you've got a potentially lethal drug, like heroin, where you can overdose easily, you have a pharmacy-only situation where people can get a prescription. If they have drug dependency or addiction, they can actually get those prescriptions filled at a pharmacy. Or they can go to one of these safe injection places where they're given the heroin and it's supervised by medical staff. So that's one extreme.

Then you can get an over-the-counter product, which would be maybe even cocaine or something else, but it depends on the situation. And then you get other ones like cannabis where you can grow your own. You can use your own, but you cannot trade in it unless you have a license, Unless you've got quality so that people like alcohol they know they're getting a glass of wine with 14% alcohol or they getting a shot of tequila whatever that's 60 70%. That's on the bottle You know what you're getting.

It's logical, it's sensible and it has shown to work if you're legally regulate and shown to cause huge amounts of harm if you go to full prohibition of any drug.

 Cait Macleod:

Okay. So let's talk about that. Can you run me through what you see as the other problems associated with the prohibition of drugs?

 Keith Scott:

Okay, well, let's go back to the prime example.  Prohibition , in the US started in the late 20s and early 30s.   At the time it was basically a decriminalisation situation and people who used alcohol were not prosecuted. They prosecuted the drug trade. So this is a decriminalisation, which a lot of people don't think. They think it was a complete prohibition, but it was similar to decriminalising say cannabis nowadays.

And what happened was that the organised crime syndicates, the gangsters, the famous ones Al Capone and all that - they were given a massive amount of money on a plate. They had the whole trade. And so what happened there was because they are on the fringes, the outlaws, all these bootleggers as they call them, the people that are selling alcohol, they haven't got the courts to resort to if they have a dispute. So they've got their territories. They've got their patches. It's the same all over the world now. We have it in Cape Town, the gangs fighting. We have it in Mexico, South America.

So the way they settle their disputes is by killing each other. And then of course  escalates further because it has to be the toughest-looking gang or syndicate that actually dominates. And so the violence actually escalates. People get caught in the crossfire and the crime syndicates get wealthier and wealthier until they actually control certain sectors of the community, which is exactly what's happened in Cape Town in the Cape Flats areas , the poorer areas, the gangs control that area, millions of people. They've got total control there because they've got all the money and most of their money is from the drug trade. They trade, well, cannabis has been a big one. That's changing, a bit now,  but they will still continue supplying people who can't grow their own cannabis.

Two years ago,  the premier in this province called in the army and we warned him, don't call in the army. You cannot militarise the police against the whole drug situation. And of course it did absolutely no good. The cartels, the gangs, just went somewhere else. 

Of course, South America, Central America, it's been the same thing. We know about  the cocaine trade. Well, originally it was cannabis coming in and then cannabis was basically legalised in the USA, which is the biggest market. So what happened was they started selling more cocaine. So you go from a much milder, less harmful drug to a much more harmful drug because the cartels need to make their money. And they do that with a banned drug because there's no one else supplying an insatiable demand, which is the United States.

There are 10,000 deaths annually on the Mexican border because of cartels fighting. The violence is unheard of, decapitations, heads being hung from bridges, terrible stuff.  And that's purely because of prohibition and it's because of the American market.

So that's it. That's what prohibition does and what it also does, it corrupts the police forces. It corrupts politicians. And that goes for the UK as well, you only have to read ' Good Cop, Bad War', that book, and that's by Neil Woods, an undercover policeman who exposed the whole thing, and how corrupt the politicians are in the UK. It's not just in South America and South Africa. And how the violence is escalating accordingly. The more you clamp down, on the criminal syndicates, the more violent the people who are who take over.

So that's prohibition in a nutshell, and there lots of sub-problems you can imagine where you've got almost lawlessness.

 Cait Macleod:

What are the problems in terms of how it affects drug users?

 Keith Scott:

 Here, the United States is a good example. Before prohibition most people drank wine and beer. And then when prohibition started you know, the smaller your package you move across borders or smuggle, the more valuable it is. So in other words, if you can sell an alcohol product, that's say 60%  alcohol say vodka or whiskey, or whatever, it's a small package and it's easier to hide.

So instead of taking a crate of beer, you take one bottle of whiskey and you still make the same profit. So that's what happened then. The bootleggers, all these speakeasies, they had those nightclubs, illegal ones, they were selling hardtack so immediately high percentage alcohol drinks became much more prevalent than before . And you see the same thing exactly here 

So you've got these cannabis products called skunk, which is a very high THC -THC tetrahydrocannabinol, which is the psychoactive component of cannabis that makes people high - the levels of THC in some of the cannabis species now varieties is, is much higher than it used to. It used to be about 4% or 5% and naturally, so that's one of the things about prohibition.

In terms of users, let's go to Switzerland. Okay, now, Switzerland, I think until about 20 years ago, they had a huge heroin problem in the parks and everything. There were needles lying around and obviously the drug addiction to heroin was a big issue. And eventually, the president at the time, Mrs. Dreyfus, she saw the light, like some of us do eventually and she instituted a program which is still going where you they provided the heroin and the needles and all the paraphernalia to these people who would come in, people who are addicted or using, and they haven't had one death since then. And they don't get needles lying around, you know, people with HIV issues.

And in fact,  in the UK, until the 1980s, they had a similar program up in  Liverpool where they virtually stopped heroin-related crime, because they introduced a system similar to  Switzerland, and then the British government under pressure from the United States actually reversed that very successful policy.

And the other thing is when you legalise a drug you actually reduce harms because you know what's inside the drug. At the moment, you don't, you don't know what's in that heroin dose. You don't know what's in the cocaine, but if you package it and it's licensed, the dealers are licensed the manufacturers are licensed then you know, you're getting 4% THC in your cannabis, or you're getting 18% and you just started using cannabis and you're going to pass out.

Like let's take heroin for instance, if you look up the side effects of heroin drug use, you will see a whole list of conditions but most of those conditions are not due to the heroin itself. They caused by dirty needles, sharing needles,  adulterated heroin. 

If you go and look online and you go and look at diamorphine. That is pharmaceutical heroin. And it's used in hospitals, in the UK and some other countries,  but if you look at the side effects there, they are far, far lower than the side effects that you'll see on a website because, the heroin itself, although it is extremely dangerous, -it's got a very narrow margin of safety, in other words, you can overdose very quickly on it, there are very few long-term side effects. People can take care of when their whole lives and as long as they don't overdose, they may get a rash and they might get constipated and that's about it. Obviously they can have problems if they're addicted and they withdraw without medical help.

So that's heroin. I mean, that's how dangerous heroin is. If it didn't have such a narrow margin of safety, it would be one of the safest drugs. And then as soon as you ban it, then people are taking contaminated drugs and that's a problem.

 Cait Macleod:

I can't help thinking that Dr. Scott is understating the harms of heroin. The side effects of the drug itself are almost irrelevant. The problem is addiction. At least according to one study, around a third of opioid users develop an addiction. The harms don't occur while the drug is in the user's system. They occur when the drug wears off. This is known as being dopesick and addicts say the symptoms are so severe it makes them wish they were dead.

So, yes, perhaps for two out of three users, heroin is really not so bad. As long as they don't overdose. But those who do suffer from addiction are saddled with an incurable chronic illness that is incredibly difficult to manage. In fact, some studies report post-treatment relapse rates as high as 90%. Although new approaches like methadone treatment are proving more promising.

In short contaminated drugs are extremely dangerous and legalisation could give users access to pure products. But if legalisation also leads to an increase in users, It's certainly not a clear way up. 

 Keith Scott:

So are people going to take more drugs if you legalise? Well, the experience in the U S states shows that in fact, the use amongst the youth of cannabis actually dropped when they legalised in most states. So in other countries it has gone up a little bit, but  it's negligible in relation to the reduction in the harms.

 Cait Macleod:

And what about the black market? Because one of the arguments for legalisation is that you get rid of these drug lords and the criminal system that runs the supply. But is it not possible that that black market will continue to exist once drugs become available legally because if we're say charging VAT on drugs or trying to keep the price high to reduce the number of people using. Also the fact that we're be excluding minors and people like inmates from accessing drugs. Is it not possible that the black market will continue in order to supply people who either find it inconvenient or are excluded from accessing them legally?

Keith Scott:

Ja. The black market always be there because obviously sometimes it's related to large thefts of the product, from a legitimate source, but you're absolutely right. One of the big problems is when the ministers of finance at their annual budget presentation in parliament, give a little smile and increase the sin taxes.

 So that is a big problem. We warning against at the moment. The bills going through parliament, the cannabis bill, and we want cannabis legalised, but we warning don't hammer it with taxes because what will happen is exactly what you've said.

 During lockdown, our government banned the sale of alcohol and tobacco. Completely. Totally. Now, as an organisation, we put out a press release saying that this is going to lead to a huge increase in contraband products. And sure enough,  the contraband tobacco market Took about 20% of the trade in South Africa away from the legitimate market.  And currently it's 40%. So lockdown caused an increase in contraband tobacco. Doubled it and, and obviously reduced the legitimate tobacco market

Now the tax on, on a packet of 20 cigarettes standard, I think it's like 18 or 20 Rand, which is just over a pound. So the price of a packet of cigarettes contraband cigarettes is five Rand, which is almost one-fifth the cost of a legitimate packet of cigarettes. So that's why it's at 40% now. And the same goes for alcohol.

 Cait Macleod:

If you'd like to learn a little bit more about the impact of South Africa's ban on alcohol during the COVID-19 lockdown, you can listen to one of my previous episodes, which is titled, What Can We Do about Douth Africa's drinking problem? It also explores how we could better regulate the alcohol industry. 

But don't sin taxes, have a valuable role to play in keeping prices up so that you can discourage people from excessive use?

 Keith Scott:

There's this idea, and there's some studies that back up this idea, that if you increase the price of alcohol then you will reduce the consumption, but it's not valid enough for, for the very poor people, because if you put on those masses of excise taxes you're basically instituting a discriminatory prohibition on poor people who live on, say, 300 Rand a month and can barely buy food.

And some do-gooders say, 'well, that's good because they drink too much'. Well, that's basically racist and discriminatory. So if people aren't allowed to buy what we call a papsak of wine, which is a cheap form of, containerized wine, because there's a huge tax on it and the tax is 5, 6 times the actual value, then you've immediately got a market for the contraband product.

Cait Macleod:

One of the most interesting arguments that came out of my conversation with Dr. Scott is the idea not only that individuals have a right to use drugs but that we should ensure equitable access. It definitely sounds wrong to say 'there's no harm in bankers doing a line after hours, but don't let the poor get their hands on this stuff. '

But on the other hand, I don't believe that either impoverished addicts or their families are thrilled to have drugs moving through the community. However I do see the enforcement of drug laws can be discriminatory because the wealthy have lots of private spaces in which to take drugs without getting caught. They can also more easily afford fines and lawyers. Dr Scott complaints that South African law is discriminatory because it only allows the use of home grown cannabis and only in private.

 Keith Scott:

Now they forgot about the 4 to 5 million people who live in 3 by 4 meter tin shacks with 10 people in there. So where are they going to grow their cannabis? Nowhere, because those tin shacks are all next to each other for kilometers. Where are they going to smoke it? They have to go into the street. That's a public place. So they're going to be arrested for smoking in the presence of children. And then they go outside and they get arrested for smoking in the street. That's the problem we have. We don't think of the poor people. They're the ones that get arrested. They're the ones that are used as cannon fodder by the gangs and by the police.

 Cait Macleod:

Let's get back to this question of the black market. It sounds like if we do legalise drugs, we'd still need to continue investing in efforts to fight the illegal supply of drugs. Is that right? 

 Keith Scott:

We will have to, but you know, nothing's perfect. It's a question of looking at harms versus benefits and creating a regulatory platform that allows for that and that we keep an eye on. There's an interesting graph, which is a U-shaped curve relating  full decriminalization to complete prohibition. And there's a sweet spot in the middle of that curve where legal regulation actually operates.  And it's flexible. Obviously different countries will have different needs, different ways of going about it, but that U-shaped curve which has been around a long time. Too much freedom, you're going to get a lot of problems. Too much regulation, we're going to get a lot of problems, and it's a, it's a happy medium.

 Cait Macleod:

 You know these cartels obviously behave extremely badly, but from a different point of view, private companies, they don't behave perfectly.  The opioid crisis started with regulated legal drugs prescribed by doctors basically because private companies behaved poorly. They did misleading marketing. They did pushy marketing that made doctors make poor decisions. is it possible that when we legalize drugs, that we're going to have problems with private entities behaving badly and creating problems of their own?

Keith Scott:

That's  an issue that comes up time and time again. And obviously that Purdue has had a lot of publicity and they did some very bad things, but I didn't hear anything about Purdue having a shootout with another company producing opiates.  Apart from the issue, which was serious,  you didn't get all the collateral damage of politicians being bribed, of police being bribed, people getting caught in the crossfire and having their heads chopped off and hung from a bridge. There was no gangsters involved. There was no shooting. 

The problem with them was the regulatory system. And that's the thing about regulations. If you're going to regulate, you have to do it properly. In America, as opposed to the UK and certainly South Africa, they allowed to advertise drugs to the public. So that's important. And the same goes for alcohol.  I don't think people should be allowed to advertise alcohol, the same with tobacco, but that's a regulatory issue.

And the way they, pushed the drugs was really bad. But then we've got a problem there with the medical profession. You know,  if a rep comes to me and tells me that this opiate, they've just designed doesn't cause any long-term addiction problem. 'It's a moderate, blah blah blah,' all the blurb that they went to, the doctors, I've got a responsibility to check that out.

And I just simply have to go onto the internet and find out where are these studies that prove that. I won't find any. So that's the doctors are the problem. It's a regulatory issue, it's simple. And then you regulate it. You control it and make sure the outlets aren't selling, to underage people. And if they are, you take away their license. That's in the system. You're not going to have one-off license, having a shootout with another one.

 Cait Macleod:

I agree with Dr. Scott, that we should just do regulation properly. But that's a bit like saying we should just never have any corruption in government. We can all agree. It's a good idea. But whether society is set up in a way that makes that likely is another question.

Private companies get greedy and they always will. Regulators are sometimes corrupt or incompetent. Doctors are fallible and some are downright dodgy. That's the society we live in and we have to make policy decisions accordingly. 

So just talking about doing legislation properly, is it possible that all this time we've just been doing the so-called war on drugs badly? I mean, is it possible that if we were allocating police resources better, if we had better intelligence, we could stop these gangs and the people producing these drugs and prevent the supply of them and actually end the drug problem in that way? Or is it just an impossible task?

 Keith Scott:

You know,  that's another good point, but history has told us that it doesn't matter what you do. If you try to ban the trade in anything that people really want, whether it's a drug, whether it's alcohol, whether it's rhino horn, whether it is ivory,  instead of actually eliminating the trade, you're just simply going to drive it underground.

 And the thing with drugs, as opposed to things like rhino horn and elephant tusks is that they're easy to make and that huge numbers of people want to take drugs.  So that is why the prohibition of drugs has never worked. It's got absolutely nothing to do with the way it's managed.

People have been taking psychoactive drugs since prehistory. The neanderthals were taking magic mushrooms. We have evidence of that. People like to get high. People like to be euphoric.  People self-medicate. People who doctors can't help. People with mental illnesses have a much higher incidence of drug use than people without mental illnesses.

 Adverse childhood experiences are a massive cause of drug use and addiction later on in life. Those people who are born into a situation where there's only violence and no love. If they get a taste of heroin, they hooked for life because that's the only time ever they've experienced euphoria or love. And so people will seek out drugs and that's why prohibition doesn't work.

 Cait Macleod:

So, what I want to ask is what kind of culture should we be creating around drugs? What kind of messages should we be sending about drugs? Because obviously they do cause a lot of harm. And from a public health perspective. Legalizing them we'll send a particular message about how drugs should be perceived. So is that something we should be tackling with education or should we just leave people to make their own judgements? What do you think about that? 

 Keith Scott:

Well, I think you brought up a very, very important point, and that's education. That's paramount in drug use, and that's where legalization actually can help because you have labels and tobacco is the example. 

Globally we fought against tobacco companies because they had all sorts of dirty tricks and so-called clinical studies to show tobacco wasn't harmful back in the sixties, but then gradually the reason tobacco use has decreased in most Western countries, and it's decreased substantially, is because of education.

 And the stopping of advertising.  We should never have advertising. I believe in plain packaging. I don't care what it is, whether it's alcohol or tobacco or heroin. One should never, never glamorize a drug.  And then there should be educational programs as we've done with tobacco. The reduction of tobacco smoking in the West was successful and is continuing to be so because of education. 

 If one wants to look at the moral aspect of this, I would say, it is immoral to tell somebody from your moral perspective, they should not take X, Y, or Z. There should be a label telling them how much they should take, the dangers, like you have one cigarette packets, and then it's up to the adult individual.

 Cait Macleod:

So what are the political challenges involved in making legalisation happen?

 Keith Scott:

 that's also an excellent question. And that's one of the biggest obstacles to drug law reform.  So the problem politically is that politicians don't lead. They follow. Privately, the politicians will tell you. And I've had meetings with many politicians and I understand their perspective. They say, 'we agree with you entirely. Legalisation of cannabis or whatever is a no-brainer.' I've heard that term used a lot, 'but, but, but, but, if we, the ones that push it, we are going to lose votes'.  So that is a big issue. 

There's an organisation in the UK, which has done great work. It's called Transform and they have got an offshoot called Anyone's Child. Anyone's child is run by people who've lost family members, loved ones to addiction, drugs that have killed them mainly because those drugs were contaminated or they didn't get the help they needed because people were too scared to call an ambulance, et cetera, et cetera.

And they find that the people who've lost loved ones who've realised that the problem is prohibition, not the drug, they are the ones that are actually making the most inroads because they use the emotions of those losses. Whereas if you're go and talk to politicians and I've done as much talking as I can in this country for six years you get the same answer: we not going to do it, but we know it's the right thing to do.

And so there's this feedback loop with the communities and in South Africa, I've been to meetings with people crying and their children who have been caught in gunfire, crossfire with the gangs. And they just think that drugs are the demons in this world. And the politicians feedback in that, because that's where the vote is. That's where the education comes in to say, look, this is the situation. It is not the drugs so much killing people. It is prohibition policies we've got.

 Cait Macleod:

Let's recap, Dr. Scott's arguments.

One. Drug use is a victimless crime. And there's nothing morally wrong with using a drug. So there's no need to punish users.

Two. Legalization will crush the organized crime that goes along with the illicit drug trade and causes enormous harm. Decriminalization alone doesn't achieve that.

Three. Legalization protects users because they can access pure labeled products without having to commit a crime.

What I like about these arguments is that they come from a place of compassion. And they're intuitive. Offer role doing the same thing over and over and expecting different results is a sign of madness and that's more or less what we've been doing.

But I still have questions. I want to understand more about the mechanics of the drug economy. And what we've already learned from the trade of cannabis in the us. That's where my next guest fits in.

Jonathan Caulkins:

I'm Jon Caulkins. I'm a professor at Carnegie Mellon University's Heinz College, and also affiliated with Rand's Drug Policy Research Center.

Cait Macleod:

 And can you talk a bit about your research interests?

 Jonathan Caulkins:

Yeah, I am interested in drug policy to be sure, but I'm also interested in all sorts of illegal markets. My training is in engineering and systems analysis, so my peers would be analyzing the supply chain for airplanes and automobiles. I like to think about the markets and supply chains for illegal goods and services. Most of the work is in drug policy, but I'm also interested in human trafficking, wildlife trafficking, other kinds of illegal markets.

 Cait Macleod:

Okay. Interesting. So in an interview that you gave, you shared a quote from the late scholar, Mark Kleiman, who said, "You can choose your drug problem, but you can't choose not to have a drug problem". What does that mean?

Jonathan Caulkins:

It means my mentor was brilliant. So, Mark was on my dissertation committee when he was at Harvard and I was at MIT and he made that idea the centerpiece of his wonderful 1992 book Against Excess.

And the central idea is that if we allow consumers free access to things they sometimes lose control of, then you have some problems of overuse. But if you ban those things, there are going to be markets that emerge to supply them illegally, and those markets create problems, as does the attempt to control those markets.

So every society has to make these decisions and almost every society bans something. For instance, most societies ban the sale and private ownership of nuclear weapons. And at the other extreme, almost every society allows caffeinated beverages. So for drugs, most societies for most of the things we think of as illegal psychoactive drugs have chosen the benefits of reduced access, reduced use, reduced dependence, and tolerated the harms that come with having illegal criminal markets and, and associated problems.

But, but it's a balancing act.  What we would love to have is no dependence and also no illegal. But you tend not to be able to have that. When you legalize the market as  many states have done with cannabis, you have big declines in price, big increases in availability, big increases in use.

So you, you get to choose your poison, but you can't choose not to have either.

 Cait Macleod:

And what are the policy options that you can use to address that situation?

 Jonathan Caulkins:

Well, I mean, the most fundamental thing is, is gonna be legal or, or not. And as a practical matter, in a free market, capitalistic society like the United States and like many OECD countries, often that decision to legalize means deciding to allow people to make money producing, selling, and marketing.  And that is what the United States and Canada have done with cannabis. There are for-profit corporations out there making money by maximizing consumption of that good.  So that's like the most fundamental choice.

Within a legal regime there are different options. So for instance, oxycodone is an opioid that's legal for medicine, but in the United States, you wouldn't be able to just go to the grocery store and buy it. You'd only be able to obtain access through the medical system.

Likewise, if you choose to prohibit. There's still lots of choices about how aggressively you're going to enforce that prohibition. The punishments in the United States in places that banned consumer fireworks would typically be things like a hundred and thousand dollars fines, whereas the punishments for possession of heroin could be much more substantial.

And likewise, in most Western countries, we draw a distinction between how much we punish the user and how much we punish the supplier. But there are other countries around the world that are really very harsh, even against just the users.

 Cait Macleod:

Right. And if you were the king of the US tomorrow and you could institute any drug policy that you wanted, what broadly do you think you would do?

 Jonathan Caulkins:

Well, that's a great question. And I guess I'll start with cannabis and I'll quote that Mark Kleiman again. He had a lovely phrase, grudging toleration. So I think that the majority of Americans became disenchanted with banning cannabis. And so some form of legalization is what the median voter wants, but that doesn't mean one has to embrace and celebrate and do backflips over the idea that this dependence inducing intoxicant is going to be more widely used.

We could recognize that good grief, marijuana smoke, cannabis smoke has carcinogens in it, and we don't normally celebrate when consumer goods intentionally expose consumers to carcinogens. So his phrase of grudging toleration, I think is a very useful concept that says, we'll allow legal access to the point that we undercut and eliminate most of the illegal market. But we don't necessarily want to pretend that cannabis is no different than breakfast cereal.

And on the other substances, I think this is a time when countries really have to reevaluate. For many decades, the basic policy was to try to keep prices high and availability low to minimize the number of people who were using, but synthetic drugs have dropped the prices enormously compared to the crop- based drugs.

So in the United States, for the opioids that's synthetic fentanyl rapidly displacing heroin, much less costly. And on the stimulant side, it's methamphetamine driving out plant-based cocaine. It may be that the jig is up for trying to keep these things expensive enough to deter use  and on the supply side, it may be time to focus energy on minimizing violence and corruption of those illegal markets and no longer pushing drug law enforcement to try to constrain supply enough to be the main impediment to greater use.

 Cait Macleod:

What do you mean when you say that the basic policy was to keep prices high? Can you explain that a bit more? 

 Jonathan Caulkins:

Sure. Historically, drugs like heroin and cocaine were extremely expensive.   And price matters. When price goes up, people use less. When price goes down, people use more.  In that sense, drugs are just a consumer good. And the basic law of demand applies to drugs as much as it does to t-shirts and cereal.

And for a long time, law enforcement has been amazingly successful at making substances like cocaine and heroin be ridiculously more expensive than they would be if they were legally available a hundred times higher price. And that has meant that far fewer people have used those substances, and especially used them often and heavily than would've been the case if they were legally available. So that's in the win column.

But synthetics are transforming the supply chains and making it much, much harder to keep the prices so high and one response to that might be to say to law enforcement, you're no longer responsible for trying to keep prices up where they have been historically but we do want you to be very aggressive at taking down the drug trafficking organizations that shoot people and be very aggressive at taking down the drug trafficking organizations that corrupt government officials.

Because there are a lot of different drug trafficking organizations, there are a lot of different drug trafficking tactics. An organization that sneaks drugs into the country may be less damaging to the country than the one that brings them in by corrupting a government official. So law enforcement can focus on the kinds of trafficking that create the most harms, rather than trying to stop all trafficking across the board enough to drive the prices way up.

 Cait Macleod:

So if we, if we do look at, at a legalised model, would it be advisable to try to continue to keep the price up in that situation? Or do we have to accept then that the price will come down and, we'll just have increased use?

 Jonathan Caulkins:

So that's a fantastic question. I think it really depends whether or not we're in the classroom at a chalkboard or if we're in the real political world. And it may make a difference whether we're in a country with a culture of the United States or a country with the culture of continental Europe. And let me explain that.

So in theory, the best policy would be let it be legal. The government has a monopoly and the government keeps the prices high or you do allow a for-profit sector, but you use taxes to keep the price high. As a practical matter, that is not a politically viable solution.

In the United States, we are struggling to have cannabis taxes be more than 15 or 20%, but cannabis prices have fallen by 80 or 90%. So, pick whatever currency you want to, say that it used to be $20 a gram and now it's fallen to the equivalent of $2 a gram. The price is actually higher, but the potency went up. So the THC- adjusted price has dropped by close to 90%.

If after you've cut the price by 90%, you then multiply it by 1.2, you don't get anywhere near back to where it was before, and I don't see it as a politically viable option in the United States to have the sort of taxes that would prevent a price collapse.

 I can tell an interesting story. Quite a while ago, after California considered a legalization bill in 2010, I was briefing a bunch of very progressive academics in continental Europe, mostly Dutch, who thought that they were pro liberalization of cannabis policy, and I described the California plan, which, which didn't pass, but it came close to passing, which would've brought in free market for-profit companies and competition and so on. And they were all appalled. They would say, nobody's dumb enough to do that.

And, you know, and that that's what we're we're doing. And so, there can be a big gap between the ideal legalisation that you draw up on a chalkboard and what actually happens. And a lot of times when people compare prohibition to legalisation they forget that they're comparing an ugly, wordy political compromise prohibition to their naive, idealistic idea of what a perfect legalisation would look like, but that's not what we're gonna get. We're gonna get the kind of legalisation that emerges from a messy political process where the for-profit industry has a lot of of influence over what the laws and regulations look like.

 Cait Macleod:

Do you think that the outcome of marijuana legalisation is going to live up to what pundits hoped it would?

 Jonathan Caulkins:

Oh, I think we already know that the answer is sort of yes and no, and there have been some surprises. So on the positive side, it has not influenced use by youth as much as some people fear. So I am pleasantly surprised that youth use has not gone up much. I don't think very many people realised how much adult use was going to go up and in the way it was going to.

Back when things got started, people talked about number of users. The number of users has gone up, doubled their triple, no big deal. But the intensity of use is a totally different ballgame. It used to be that relatively few cannabis users use daily or near daily now like 40% of cannabis users use daily or near daily, and the number of milligrams of THC that are being consumed per day has gone way up. We didn't anticipate that. We didn't anticipate the big increase in potency.

 Cait Macleod:

This is interesting. Professor Caulkin's places a lot more emphasis on increased use than Dr. Scott, and while Dr. Scott describes prohibition pushing up potency. Professor Caulkins notes that cannabis has become more potent since legalisation

 Jonathan Caulkins:

There were a lot of, of surprises in, in how it played out. But in some sense, being surprised should not be a surprise. Legalisation is a fundamental change. The idea that it's just same old, same old without the arrests is very naive. You are just fundamentally restructuring the whole industry and the whole market, and you're gonna get lots of surprises.

 Cait Macleod:

So let's talk about arrests. I think a lot of people's reason for supporting decriminalisation or legalisation is the idea that America's prisons are just full of these  marijuana users who've never committed a violent crime, and they're just being-

 Jonathan Caulkins:

Totally false. Yeah. It, it is. So one of the dynamics to get back to the politics is the discourse becomes dominated by whatever discourse advances the interests of whoever's got the most money. And it was convenient for the people who wanted policy change to tell a story.  But that story is grossly exaggerated.

Let's try to back up to the facts. First of all, the United States never had that many cannabis offenders in prison at all. 90% of the people in prison were for hard drugs. Historically it was cocaine, meth, and heroin.  It wasn't mostly cannabis and of the people who were in prison for cannabis, that was suppliers.

The federal government for a long time had a policy that it would mostly ignore cases involving less than a hundred pounds, roughly 40 kilograms, unless there were special circumstances. If you were bringing it across the international border or if you were in a place where the federal government kind of serves as the local police force, like at a national park. So yeah,  that was basically wrong.

So how did we get that discourse though? There are a very large number of arrests for cannabis for the simple reason that there are a lot of people using cannabis, but the number of arrests user was not even all that different in the United States than it was in Europe. And the most common consequences for an arrest were relatively minor unless there were special circumstances. So if you had already been convicted of robbery and then the marijuana possession offense was a violation of your terms of community release , then you might end up getting extra time behind bars because of that interaction effect.

The arrests were disproportionate to the racial makeup of the country, mostly because the arrest stemmed  from other interaction with the criminal justice system and minority populations have greater interaction with criminal justice system across the board.

And then the second, thing that put you at risk for an arrest was, using in plain site to law enforcement. So if you were a suburbanite using inside your own home, very little likelihood that was going to produce an arrest. But if you were a city dweller in a small apartment and you lived your life outside because you didn't have air conditioning and part of your living life outside was using cannabis, you are more likely to come to the attention of police. So there were definitely disparities in arrest, but that was presumed to apply to incarceration in a particular imprisonment, which, which wasn't true. 

But the main story here is you can get rid of that disparity just by decriminalising use. You don't have to legalize supply. You can just say use is either going to be completely allowed or we'll treat it like a parking ticket. No criminal record. You do not have to legalize supply in order to address that problem. But the people who wanted to legalize supply seized on that to say, prohibition is automatically a failure in this way, as opposed to saying, the particular way we're pursuing prohibition right now fails so let's address that particular failure.

 Cait Macleod:

And then what if we kind of work backwards through the supply chain? So maybe decriminalizing use is a good idea and we just let law enforcement focus on when that use perhaps relates to another crime. But what about then, you know, your local dealer, those individuals, you know, they get arrested and then they come out again. I don't really see how it's really adding a lot of value to arrest kind of lower echelons of the supply chain..

 Jonathan Caulkins:

So this is a great question and it gets back to my, earlier statement about what are we actually asking drug law enforcement to do it. It is not realistic to arrest enough retail sellers to make retail availability go away, but not all of those retail sellers are equally problematic for their neighborhood.

Some retail sellers are armed. They sell in place-based markets to stranger and they intimidate people who live around them in various ways. Other retail sellers just sell to friends surreptitiously, and you don't even know that they are there. If there is someone who is armed and threatening people in the course of their business operation that is damaging the community and I would approve of law enforcement taking that individual down.

And in some sense, what you're asking law enforcement to do is kind of set some rules. Now let me give a concrete example of where I think this does happen, albeit quietly.  It is really very rare for Latin American major drug trafficking organizations to assassinate a US law enforcement officer or any other officer of the US government. When that did happen, I think this was late eighties or early nineties, there was a particular incident, all of the force of US law enforcement came down very hard on that organization, and so the organizations kind of know the rules. They will make a lot of money shipping drugs in the United States, but they do not assassinate US government officials and law enforcement people.

That same kind of thinking can apply at the local level. Law enforcement can say, in this neighborhood, here are the rules. If you're gonna sell quietly, you're probably gonna get away with it. But no, we're not gonna let you sell in ways that destroy the quality of life for the neighbors who live there. And if you just do totally hands off and say, I will never ever arrest a retail seller, no matter what they do, you're basically giving people permission to not only sell at retail, but to sell in ways that are really harmful, like setting up shop right outside a drug treatment center.

 I don't want that. I want police to be able to go to a dealer standing in front of a drug treatment center and say, no, you, you can't do that here.

 Cait Macleod:

Right. And if we move a bit further up the supply chain, is there anything that we can actually do about these big cartels? Is there any point spending lots of money on law enforcement to try to tackle, you know, Sinaloa or one of these kind of gangs?

 Jonathan Caulkins:

 Yes, in certain limited cases, but you have to be focused about it. So there are instances in which high-level operations have created blips or disruptions in the market that noticeably reduced availability or increased price and did it in a way that reduced harms and overdoses for a while. So sometimes you can shock the market and disrupt it in a way that creates a a temporary benefit.

Occasionally you can actually create a lasting benefit. But these are less common. Australia disrupted its heroin market at the very beginning of 2001 in a way that left that market unrecovered for multiple years afterwards.

The US law enforcement took down a major LSD producer  and it turned out that production of LSD was highly concentrated and it took quite a while for the market to recover from that. Those are tough, but you also can apply this same sort of harm reduction focus at the higher level trafficking level.

So you can think for instance of Colombia back in the 1980s when the major trafficking organisations did things like assassinate presidential candidates, they crossed a line and Colombia pushed back hard. So when the trafficking organisations are threatening the democratic institutions of the country, and I think that really should be taken seriously, even if it doesn't change the number of people using drugs in London.

 Cait Macleod:

Let's go back to what we know from what's happened so far with marijuana legalisation. So we spoke a little bit about the impact on arrests and on use. What about the black market? Has it continued to thrive and exist or has it been reduced at all by legalisation?

 Jonathan Caulkins:

So, yeah, it's an excellent question and the data on this understandably, are imperfect, but I think the way to say it is the following. The share of cannabis supplied in the states that have legalised that comes from the illegal market is very much reduced. So it used to be a hundred percent illegal market. Now maybe it's a quarter, maybe it's a third, and I think those numbers are ballpark right in Canada as well.

There's two caveats or two catches. One is there are portions of the United States that do not yet have legal supply, and there are definitely people who produce in the states that have legalised to export to the states that have not. So, Colorado for instance, never was an exporter of cannabis, but after it legalised some entities said, this looks like a good place for us to set up shop to supply other states. And that domestic illegal production has been at the expense of Mexican illegal production.

But the second thing is the whole market is just enormously larger than it used to be. The total number of self-reported days of use when you survey the American public over the era of policy liberalisation, so I'm going all the way back to the early nineties with the early medical liberalisations, has been like an eight or ninefold increase. So the total size in the market is very much larger.

The share of the market that's illegal supplied is much smaller and also the prices have come way down. Mm-hmm. So I think the answer is the quantity supplied by illegal markets has decreased, but not as much as it would've if the total volume hadn't gone up.

But the money made from illegal supply has decreased quite a bit because in addition to bigger market, smaller market share prices have also gone.

It's trending in the right direction. And if the United States ever actually legalised as a country, right? We're in a very weird situation right now. It's still federally illegal. It's legal in the state. It's a very weird transitory system. But if the United States as a nation legalised, I think that total money made from illegal production would become relatively small. And most of the illegal distribution would look like illegal distribution of alcohol. Like a 22-year-old buying alcohol and selling to a 19-year-old, you would still have that, but that is diversion of legally produced product. And I think that we'd still have that kind of thing going on, but that's not the sort of activity that funds major organised crime.

 Cait Macleod:

Professor Caulkins and Dr. Scott agree on a very important point here. Legalisation, at least in the case of cannabis, crushes the black market  and all the harms that go along with it. What they don't agree on is where that fact fits into a broader cost benefit analysis particularly with so-called hard drugs.

And would that be different, do you think, with other drugs?

 Jonathan Caulkins:

Well, I guess one type of other drug is a relatively non-addictive psychedelic or something like that. And that also could end up maybe looking like cannabis, but legalizing something like heroin or cocaine is a totally different ball game and I, I would not think that we know how that will turn out because of what we've seen with cannabis.

Cocaine and heroin are, are much more powerful, much, much more dangerous substances. The fact that you can pull off legalisation of cannabis should not in any way, be seen as proof that it, it would go well if we legalised cocaine. That's a really big gamble. I wouldn't advise it like, like if I were whispering to the UK I'd say let some other country 5,000 miles away, try it for 10 years first. That's a really, really risky gamble.

 Cait Macleod:

And is that just because of the potency of the drug?

 Jonathan Caulkins:

Uh, in short, yes.  The other phenomenon is the potential for the price to decline, uh, cannabis. Prices have fallen, I should be more precise, THC, the active ingredient prices have fallen like 90%.  They didn't fall farther in part because they were not high to begin with, but the potential for a price decline, especially if you had no controls whatsoever on a synthetic opioid like fentanyl the decline could be even more dramatic. So mostly it's the danger of the substance, but also the, the change is a bigger change cuz the cannabis prohibition was already a somewhat lackadaisical prohibition, whereas the prohibition on heroin and crack is a more energetically enforced prohibition. So a bigger change.

 Cait Macleod:

That makes sense. So, I mean, you just have to look at Purdue to understand that a profit motive in the drug business is gonna have some harms.

 Jonathan Caulkins:

Let me stop you right there and say, I'm so glad that you realised that and you are bringing that up because one of the most common things that people who are in favor of legalisation say is, 'Oh, no, no. We don't mean a total free market. We mean a market with regulation' and, and what they're forgetting there, first of all, is in a modern economy, almost everything is regulated. Like if I get my hair cut, it's cut by somebody who's licensed by the state. You know, everything is regulated and almost nothing is regulated more thoroughly than pharmaceuticals.

Nonetheless we had a catastrophic self-inflicted disaster in North America with literally five or 6 million people becoming opioid use dependent destroying their lives, and now close to a hundred thousand are dying every year. The people who are dying of heroin and fentanyl now, 80% of them became addicted  on products of Purdue and other pharmaceutical companies.

So when people have this great optimism about how wonderful a regulated market is at controlling drugs, I, I just like, I'm astonished. And, and I ask essentially what you were asking before I rudely interrupted . Yeah. How can you look at what Purdue did and say, we know how to regulate for-profit companies selling dependence inducing intoxicants.

 Cait Macleod:

I mean, what's the solution? Do we just completely take profit outta the equation or is there, you know, is there something that we can do to mitigate and still have some kind of free market? I, I can't picture the US having kind of a centralized government owned cocaine department or something. 

 Jonathan Caulkins:

Yeah. No, I think you are right. We, we are a strange and different culture that really does not trust government much. And so trusting government to do that well is, it's a tough, tough sell here. I have greater optimism that there are one or more countries in Europe that might have enough faith in their governments to, to, to go down that path.

 So philosophically, many people, and I put myself in this camp, we love the dynamic creative power of the free market and we love the idea of trusting people to mostly look after their own self-interest. I don't want the government telling me what shirt I should buy. But you can believe that for most consumer products, but still carve out an exception for chemicals that physically change your brain, the decision making organ that is supposed to help you make good choices.

If you're very paternalistic and not freedom loving, you might wanna extend that to things like carbonated sugared beverages, soda and pop. So it's, it's not clear where to stop and I respect the people who say it's a slippery slope and I don't want to go down that slope. But I think we should at least have the conversation about whether or not we can, based on modern neuroscience and common sense, carve out a limited number of goods and activities that we say,  we're just going to approach those differently than we approach other consumer goods.

So that's sort of philosophy. On the politics  this also is a Mark Kleiman observation , originally mark recognised that the alcohol industry has been singularly successful at avoiding tough regulation at least in the United States because it has a hundred million very happy supporters who are all the light drinkers and they provide great political protection by contrast with the tobacco industry. Most consumers  are not really very happy with the cigarette companies. They're kind of mad at the cigarette companies. So the cigarette companies don't have that same political protection.

And now let's come over to cannabis. Whereas there are many alcohol consumer who are happy with the alcohol most of them don't define their identity by it. But in cannabis you have a fervent following who are passionate about that product who do make it part of their identity and whenever the cannabis industry wants to get a bunch of letters written to Congress or people to show up at a regulatory hearing they can rely on those passionate enthusiastic consumers of their product very much the way the National Rifle Association can depend on some gun owners to not only say I am content with the accuracy of my gun but I define who I am as a person by my gun ownership And I will be a loud and forceful presence in the political process defending the people who supply me with my gun or with my cannabis.

 Cait Macleod:

Yeah, and I imagine there's a lobbying interest from commercial parts of the industry as well that, that are able to wangle their way in by other means.

 Jonathan Caulkins:

Oh, a hundred percent. I mean, one of the interesting analyses is just to look at the donors to these elections.   And the first thing is that the total money given in favor of propositions is massively, massively larger than the money given opposing the legalization propositions. But then you can also look at where the money comes from.

And in the first generation of propositions, the great majority of it came from a really small number of billionaires and they were not trying to make another billion dollars. They were doing it cuz they thought that was a, a good thing.  That has receded and now it's it's industry. The industry recognises this is a 50 billion a year market. They wanna make.  and, uh, they are the main drivers  of the funding.

 Cait Macleod:

We spoke a little bit before about decriminalizing marijuana. Well cannabis. Um do you think that's a good idea for other drugs?

 Jonathan Caulkins:

 It's very much something that should be on the table should be discussed. Pros and cons, where I spoke before about legalising supply of heroin as a giant role of the dice and a game changer, just decriminalisation is not, and a number of countries have done it. 

I think that there are advantages in keeping something not flagrant and not normalized. So if you fully legalise use it is possible that it's gonna become much more visible to the average 16 or 17 year old, and they're going to see it as not necessarily a virtue or a health product, but kind of no big deal. And I'd rather preserve the fact that heroin, it is a big deal.

It is a really dangerous chemical and it is possible that the form of decriminalisation that retains the ability for police to write you the equivalent of a parking ticket, if you're using in public, may be a useful tool. For protecting against that normalisation. And I don't think that the harms to the person who receives a parking ticket are at all in the same league as the harms to a person who gets arrested for a criminal offense.

 Cait Macleod:

And what about preventative measures? So things like educational programs in schools making sure people have economic opportunities that aren't drug related, things like that.

 Jonathan Caulkins:

Yep. So I've written a few books on this, and one of my favorite lines from one of those is the classic prevention programs, like what you do in schools are cost effective even though they're not effective. In other words, they're, they're really pretty cheap so by all means do them. But you just can't hold your breath and expect that you're going to change young people's behavior. And, you know, I I, I am a parent of three,  people in their twenties now. , I observed my capacity to change their behavior over even things like chewing with your mouth open. It's just, it's not that easy to change the behavior of kids. so those classic prevention programs, by all means we should do them, but just don't be unrealistic.

The second half of the thing you said is basically, why don't we just create a utopian world in which nobody is poor and everybody is completely self actuated without having to fall back on drugs and won't that make the drug problem go away?

And if you have that ability to snap your fingers and easily make the whole world wonderful, then I encourage you to do it but I don't really think that the best reason for fighting poverty is because that's going to reduce drug use. There's a whole bunch of reasons why we should be trying to reduce poverty, reduce inequity, reduce racism, and so on, and one fringe benefit may be that there will be fewer people whose use escalates to problematic levels. , but it's, as far as I know, there's no politician who's got that magic bullet and they've just forgotten to use it yet.

 Cait Macleod:

Do you think there's a political appetite for evidence based policy making when it comes to drugs? 

 Jonathan Caulkins:

 The way that I look at things is over my 35 years of working in this area, I have certainly discovered things that were fed into the democratic process, and which I believe had a, a constructive effect and on the margin led to better policy. I have colleagues who are much more frustrated than I am, but I think that they have a naive image of how public policy ought to be made.

I think their image is, they believe some pointy-headed geek ought to just compute what ought to happen, and then the elected officials should jump up, salute, and immediately go implement whatever the pointy-headed geek thinks. And, I don't actually wanna live in a society like that, so, so I have much humbler ambitions.

My image is that I am a scientist trying to understand this phenomenon. And I feed what I hope is a better understanding these phenomenon into the very messy political process. And I think on the margin that's better than having a poorly informed, messy political process, but it's still gonna be a messy political process.

 Cait Macleod:

Professor Caulkin's stance is a little more difficult to pin down than Dr. Scott's and he is more wary of the unknowns. But here's some of what I gleaned about his opinions from the interview.

We don't want the drug trade in the hands of the free market, because they are incentivised to maximise consumption. And they lobby against regulation and taxes.

Decriminalisation reduces harms to users, but retaining minor penalties, like fines can prevent normalisation.

Legalising hard drugs will lead to a price crash and probably a boom in use. But heroin clinics that provide the drug in a controlled environment are something we should at least talk about.

And it's still worth tackling dealers and trafficking groups but law enforcement should focus on the most harmful behavior like violence rather than trying to push up the price by disrupting supply.

These arguments feel like they're grounded in reality and are conscious of the political factors at play.  We're clearly at a watershed moment in drug policy where things need to shift away from our old approach. The devil is going to be in the details, not just whether we prohibit decriminalized or legalized, but how we do so. We need to proceed with caution. And perhaps most importantly, with due attention to the sociopolitical factors at play in the state or country we're looking at.

Regulation is a case in point. Regulation of private markets may be deeply flawed, but it's not entirely pointless. Germany, for example, rejected Purdue's bird to make their opioid Oxycontin more widely prescribed. Countries have had success with changing the packaging and pricing of alcohol. And companies pedalling hard drugs would be under a lot more public scrutiny. It may not be viable for cannabis in the US, but for other drugs in other places an imperfect regulated market may be a good idea.

Did I miss anything out? Anything important?

 Jonathan Caulkins:

I think that if I were sitting in any country outside North America, one of the big questions on my mind would be, is Fentanyl going to come here? So in simple terms, fentanyl relative to heroin, cuts the raw materials costs of the high level drug traffickers by 99%. There's a very powerful economic incentive for them to switch the market over from heroin to fentanyl. It's hard to switch a market over. They can't take out a national television advertising campaign but the conditions are ripe for synthetic opioids to displace heroin in other continents.

And good gracious, there has been nothing more horrible than what has happened here in the last six or seven years, and I don't know a good reason why it's not over time gonna happen in other places.  And if it does, it will like quintuple the death rates.

 Cait Macleod:

And what is the US doing now? Is there anything being done? I mean, is anything working?

 Jonathan Caulkins:

Are we trying to do stuff? Absolutely. Is it working? Short answer is we're, we're still looking at 75 or 80,000 opioid related deaths a year, and it's not obvious it's gonna come down in the short run.  And it's not because our leaders are corrupt or incompetent. This is just a horrible situation. We got about five ish million people dependent on opioids. Just before the illegal opioid market became way, way more deadly. And that combination is, , it's really tough.  So may you not see that up close.  So that's my wish for you.

 Cait Macleod:

 That's it for Wood for the Trees. A big thank you to my guests, Keith Scott and Jonathan Caulkins. Throughout the season, I'll be exploring lots of messy questions about the theme of crime and justice. Episode four is all about prison reform. But before that I'll be dropping a bonus episode about psychedelics. 

Ronan Levy is the founder of Field Trip Health, a group of centers offering psychedelic enhanced psychotherapy. You can listen to that interview wherever you're listening to this.  

If you enjoyed this episode, why not subscribe? And if you'd like to support the podcast, you can leave a tip at buymeacoffee.com/woodforthetrees. There are links to some of the facts I've mentioned in the shownotes. For more information, visit cantseethewood.com or you can get in touch at cait@cantseethewood.com.

Thank you so much for listening.