Crises and radical thinking on drug policy

Reform has always been a “two-steps forward, one-step back” undertaking.

It’s sad that drug policy reform must always be wrapped tragedy but alas – in the context of drugs – crisis has historically been the mother of invention.

It was in the face of thousands of overdoses and the highest HIV prevalence in Western Europe that Switzerland introduced effective heroin-prescription programmes, safe injection facilities, needle and syringe-exchange programmes and low-threshold methadone services.

Helped along by lawmakers who were not afraid to lead from the front, these policies resulted in making Switzerland’s HIV prevalence among people who use drugs one the lowest in Western Europe, at about 1.4 per cent.

In Portugal, the year the country witnessed 1,430 new HIV infections among people who use drugs (accounting 52 per cent of all new infections), the government introduced dramatic reforms, decriminalising all drugs and establishing model services for drug users.

Almost 10 years later, new HIV infections among people who use drugs dropped to 164 (15% of all new infections).

It was a similar HIV crisis in the UK in the mid-1980s that spurred the then-Conservative government to launch a number of harm reduction interventions that greatly reduced HIV among people who inject drugs.

Now, as Latin America faces its own supply-side crises with tens of thousands of drug-related killings, gross human rights abuses and overflowing prisons, governments are increasingly vocalising a desire to take bold action toward reform of failed prohibitionist policies. 

In 2009, the Latin American Commission on Drugs and Democracy – including the former presidents of Mexico, Colombia and Brazil, as well as leaders in journalism, politics, academia and literature – called for a paradigm shift in the approach to drugs. This was followed by a report by the Global Commission on Drug Policy that encouraged “experimentation by governments with models of legal regulation of drugs to undermine the power of organized crime and safeguard the health and security of their citizens.”

Subsequently, numerous Latin American governments have openly discussed forms of regulation, including government sale of marijuana or licencing private facilities.

However, drug policy reform has always been a “two-steps forward, one-step back” undertaking and while creativity is being sought in the Americas, Europe is losing some of its pioneering spirit.

Austerity, in some contexts, is a danger to gains made in HIV prevention, among people who use drugs. In Greece, the European Monitoring Centre on Drugs and Drug Addiction (EMCDDA) warned of an increase in the number of newly identified HIV cases among people who use drugs, from between 3 and 19 a year from 2001 to 2010, to 113 new HIV cases as of July 2011.

The Greek government has increased services for drug users to address the situation but the EMCDDA cautions, that “the level of activity is still insufficient to meet the demand within the injecting drug using population.”

In other cases, a nascent abstinence-agenda is trying to manufacture a bogus tension between treatment models – suggesting that providing life-saving services to drug users, like needle-and-syringe exchange programmes, is at odds with ensuring availability of abstinence-based treatment for those who want it.

Some other lawmakers may argue that services to drug users are poor investments in lean times, ignoring the fact that it is immensely cheaper to prevent blood-borne viruses and bacterial infections like HIV, than treat them.

This is the current global paradox in drug policy.

While a new approach may indeed be rolled out to reduce black market violence in Latin America and other parts of the world, a regression to old, expensive and failed ideas in Europe may revise costly and avoidable crises from the past. 

And, perhaps, inspire some fresh thinking once again.

Kasia Malinowska-Sempruch is the director of Open Society Foundations Global Drug Policy Program

A drug user injects heroin. Photograph: Getty Images

Kasia Malinowska-Sempruch is the director of Open Society Foundations Global Drug Policy Program.

Photo: Getty
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How the Conservatives lost the argument over austerity

After repeatedly missing their deficit targets, the Tories can no longer present spending cuts as essential.

“The age of irresponsibility is giving way to the age of austerity,” declared David Cameron at the Conservatives' 2009 spring conference. Fear of spending cuts helped deny his party a majority a year later, but by 2015 the Tories claimed vindication. By framing austerity as unavoidable, they had trapped Labour in a political no man's land. Though voters did not relish cuts, polling consistently showed that they regarded them as necessary.

But only two years later, it is the Conservatives who appear trapped. An austerity-weary electorate has deprived them of their majority and the argument for fiscal restraint is growing weaker by the day. If cuts are the supposed rule, then the £1bn gifted to the Democratic Unionist Party is the most glaring exception. Michael Fallon, the Defence Secretary, sought to justify this largesse as "investment" into "the infrastructure of Northern Ireland" from "which everybody will benefit" – a classic Keynesian argument. But this did not, he hastened to add, mean the end of austerity: "Austerity is never over until we clear the deficit."

Britain's deficit (which peaked at £153bn in 2009-10) was the original and pre-eminent justification for cuts. Unless borrowing was largely eliminated by 2015, George Osborne warned, Britain's public finances would become unsustainable. But as time has passed, this argument has become progressively weaker. The UK has cumulatively borrowed £200bn more than promised by Osborne, yet apocalypse has been averted. With its low borrowing costs, an independent currency and a lender of last resort (the Bank of England), the UK is able to tolerate consistent deficits (borrowing stood at £46.6bn in 2016-17).

In defiance of all this, Osborne vowed to achieve a budget surplus by 2019-20 (a goal achieved by the UK in just 12 years since 1948). The Tories made the target in the knowledge that promised tax cuts and spending increases would make it almost impossible to attain – but it was a political weapon with which to wound Labour.

Brexit, however, forced the Conservatives to disarm. Mindful of the economic instability to come, Philip Hammond postponed the surplus target to 2025 (15 years after Osborne's original goal). Britain's past and future borrowing levels mean the deficit has lost its political potency.

In these circumstances, it is unsurprising that voters are increasingly inclined to look for full-scale alternatives. Labour has remade itself as an unambiguously anti-austerity party and Britain's public realm is frayed from seven years of cuts: overburdened schools and hospitals, dilapidated infrastructure, potholed roads, uncollected bins.

Through a shift in rhetoric, Theresa May acknowledged voters' weariness with austerity but her policies did not match. Though the pace of cuts was slowed, signature measures such as the public sector pay cap and the freeze in working-age benefits endured. May's cold insistence to an underpaid nurse that there was no "magic money tree" exemplified the Tories' predicament.

In his recent Mansion House speech, Philip Hammond conceded that voters were impatient "after seven years of hard slog” but vowed to "make anew the case" for austerity. But other Tories believe they need to stop fighting a losing battle. The Conservatives' historic strength has been their adaptability. Depending on circumstance, they have been Europhile and Eurosceptic, statist and laissez-faire, isolationist and interventionist. If the Tories are to retain power, yet another metamorphosis may be needed: from austerity to stimulus.

George Eaton is political editor of the New Statesman.

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