Free, Safe, Legal: Why we need to legalise drugs
In Issue 5, Rupture featured a piece from Nicole McCarthy entitled ‘When They Go Low, We Get High’ which argued for decriminalisation of all drugs. In response to this, Rupture is delighted to feature the following piece by Sarah Frazer, which argues that decriminalisation does not go far enough, and argues instead for full legalisation.
Rupture intends for both articles to form part of an ongoing discussion and welcomes further contributions on the subject.
by Sarah Frazer
I was firmly of the opinion that decriminalisation of drugs was the only way to go. That was until I started working in one of Dublin’s largest homeless hostels, and then later as a social worker in the criminal justice system where I worked directly with poly-substance use, mental health issues, and trauma. It was after this experience that I began to question how drug policy should be designed. The hostels had an unwritten rule that when there were questionable overdoses we texted other hostels letting them know that there might be a bad batch going around. Talking to the service users about drug policy and how it impacts them shifted my understanding. Decriminalisation is not enough, full legalisation is the safest and most sensible way to address the issues faced by people who use drugs.
Article originally published in Issue 7 of Rupture, Ireland’s eco-socialist quarterly, buy the print issue:
The issue is not fully engaged with by the left. It is time to consider a total shift away from the “Pushers Out” Irish anti-drug movement and the liberal cries for decriminalisation, and consider the realities of drug use and the benefits of full legalisation of substances.[1] This article will explore the possibility of full legalisation, and its realities under capitalism and socialism, through a personal lens of working with people dealing with addiction.
Decriminalisation v. Legalisation
There is confusion about the difference between decriminalisation and legalisation, often wrongly used interchangeably. Decriminalisation is the act of removing criminal sanctions against an act, article, or behaviour.[2] Drug decriminalisation would eliminate criminal penalties for possession, but not sale and supply.[3] Decriminalisation is virtually noncommittal about how drugs are produced and sold. The lack of a position on drug producers and sellers highlights just how decriminalisation is not a comprehensive drugs policy.
““Legalisation is an all-encompassing policy position, and can address gaps left by decriminalisation.””
Ultimately, decriminalisation will only create and aid black market capitalism. Drug trade will continue with little change. Gangland violence will still be affecting communities as “off the books” sellers will continue to take advantage of the need for drugs. People who use drugs will remain at risk, beholden to dealers, and in drug debt. They’ll remain at risk through the content of their substances and be unaware of the purity or potency. Under decriminalisation, they may be able to test their drugs, not get picked up by the Gardaí as easily, and use drugs more “openly” (I use inverted commas here, as decriminalisation will only do so much for the shame and stigma associated with drug use, which I will return to later), but the problems are still not properly, safely, or effectively dealt with. A further well-known implication of decriminalisation’s “half policy” is that illegal drug importation would continue, which is tied to international organised crime, human rights abuses, and trafficking. Herein lies the problem and why I do not believe decriminalisation to be enough.
Legalisation, however, is an all-encompassing policy position, and can address gaps left by decriminalisation. The benefits of legalisation include eliminating the black market, providing higher levels of drug purity making drugs safer, better direct engagement with drug users at the source of buying and selling, and reducing the shame and stigma much more than decriminalisation.[4] However, from a left-wing perspective, we should also consider the concerns of working-class communities related to legalisation.
Addressing the concerns
Given the failure of the “Pushers Out” approach to impact on the levels of addiction, buying, and selling of drugs within our communities, another option must be considered. We must address a number of concerns before the hard-hit working class accepts legalisation.
The main concern is that legalisation would increase substance use and addiction within our communities. We’ve heard this argument before about Naloxone, a competitive opioid antagonist used in medical emergencies to reverse the effects of heroin or other opioid overdose. Take Home Naloxone (THN) programmes have been rapidly upscaled in response to increasing opioid related mortality.[5] There was great concern that Naloxone provision would increase opioid use. A review of the research, seven studies with 2578 participants, found no evidence of increased heroin or other substance use associated with the roll out of THN programmes.[6] So why isn’t this taken into account in the case for legalisation?
This is also seen in Canada where, in 2018, cannabis was legalised and regulated. Access to cannabis is restricted by age, with a ban on sales to those under 18. However, fears remained as to whether legalisation would increase youth drug use. Statistics show that this is not the case. Figures from the 2019 Canadian Student, Tobacco and Drug Survey show that 18% of students in grades 7-12 reported using cannabis in the previous year, unchanged from 2016-17, prior to the legalisation of cannabis.[7] Data from a recent survey into the high school cohort found no significant difference in usage between 2016 and 2019 – pre and post legalisation. A review from Melchior et. al. in 2019 found that the liberalisation of cannabis control (both for medical and non-medical use) appeared to have “little effect on the patterns of use among people [under 25]” when assessed both at the 30-day and 12-month mark post-liberalisation.[8]
Prohibition and restrictive drugs policy also undermines the health outcomes for people who use drugs, as there are currently no regulations relating to the purity and potency of street-sale substances. Street-sale substances are often cut with dangerous additives and have unpredictable potency, which directly correlates to overdoses, infections, and abscesses. While decriminalisation allows people to report altered substances, nothing can be actively done by the authorities as the sale and production of drugs would still be criminalised. When heroin was available on prescription in both the US in the late 1910s and in the UK up until the 1960s, overdoses were nearly at zero.[9] Legalisation would allow for the regulation of the purity and potency of substances.
The thought of legalising drugs such as heroin or crack can be difficult to come to terms with particularly in working class communities hit hardest by addiction and its fallout. These communities are the primary victims of gang and drug related violence and crime. However, the current crisis in heroin use and associated overdose is linked to prohibitionist policies and the deregulation of the pharmaceutical industry. Legalisation addresses these concerns by better engaging with people who actively use drugs and redirecting them to adequately resourced safe centres supported by trained professionals.
The commercialisation of drugs
While there are benefits to legalisation, the potential for drugs to become commercialised through legalisation is very real under capitalism.
Consider the prescription opioid OxyContin and the dangers of commercialisation become clear. A sharp increase in the use of prescription opioids followed FDA approval in 1995. OxyContin sales went from $45 million in 1996 to $3.1 billion in 2010.[10] Manufacturers claimed OxyContin was less addictive than other opioids, and should be prescribed to treat pain. But these claims were blown out of the water as patients did become addicted. The FDA and DEA took steps to control its availability and restricted medical prescriptions, leaving millions without legal access to the drug that they had become dependent on. People were forced to pay high prices on the black market that emerged or switch to heroin as a cheaper but more dangerous alternative.[11]
““While there are benefits to legalisation, the potential for drugs to become commercialised through legalisation is very real under capitalism.””
The commercialisation of drugs after legalisation can be seen in Canada. With cannabis legalisation in 2020, the market made around $7 billion in sales of cannabis. Interestingly, 50% of cannabis users continue to buy their drug from illegal sellers; presumably due to the market price of legally available cannabis.[12] What is there to stop capitalists from advertising other drugs the same way tobacco and alcohol are commonly advertised? An alternative approach to legalisation under capitalism is necessary.
The socialist approach to legalisation
Drug use is unlikely to decline under capitalism, a system which alienates people from their own sense of self and humanity. People are focused on mundane tasks over which they don’t have autonomy or ownership. This increases the need for, or reliance on, drug use. For some, the only way to escape poverty is through selling drugs. For others, the only way to distract themselves from this capitalism-induced trauma is through drug use. Alternative options are limited and often out of financial reach. Therapists cost a prohibitive amount of money, and available support resources are underfunded and understaffed. While its benefits are clear, legalisation in the current capitalist system would not be without fault or fully protect people who use drugs.
The only solution to this is through socialism. It is naive to think there will be no drug users in a socialist society. The current drug crisis would naturally continue to exist during the transition from capitalism to socialism. The socialist approach to legalisation should be against the criminalisation of drug users and small-time dealers, drug related activities, and workers within the illegal drug industry. However, it should also be against the commodification of drugs and allowing capitalists to profit off drug use and addiction. Such an approach would form part of a public health model.
Legalisation is the key to managing these problems safely without creating a black market. We need policies which are relevant, practical, and ethical - rather than moralistic. I will preface the following points by stating that this is by no means the only blueprint for legalisation under socialism. There are no examples to follow and no international best practice. This is based solely on my own experience of working hands-on with addiction and speaking with people who use drugs.
““Drug use is unlikely to decline under capitalism, a system which alienates people from their own sense of self and humanity.” ”
During the transition from capitalism to socialism, drug sale and supply should be taken into control by an established workers council and de-commodified. Drugs would be available free of charge for those who need and want them through state-run dispensaries and collected in sanitary and respectful conditions. People who use drugs can be engaged at the dispensary, offered support from medical and allied health professionals, such as social workers and psychologists, similar to the model of safe injection centres. On-site professionals engage with the service users and support them to seek counselling, detoxification, or rehabilitation. Under legalisation, this model would provide a one stop shop for people who use drugs (similar to the Barnahus model for children[13]). People new to drugs can be engaged with at an early stage, increasing the possibility of deterrence through the availability of alternative options – counselling, social supports, education, etc.
The legalisation and de-commodification of drugs would also alleviate the shame and stigma experienced by drug users. Open and accepting access would undermine the shame and stigma surrounding drug use and addiction. Narcotic drugs and other medications can be collected side by side further reducing the stigma, normalising people with addiction as an accepted part of society, and aiding their integration or reintegration into the community. This approach is proven to increase prosocial community behaviours and it will positively impact people with addiction by reducing social isolation and producing prosocial capital like resilience and self-efficacy.[14]
Conclusion
The “pushers out” approach has failed. The calls for decriminalisation are not enough, as they continue to leave those who use drugs at risk. We need to seriously consider legalisation and move away from the moralistic standpoint of “drugs are bad” versus the liberal “free the weed”. The need for legalisation of all substances is not because drugs are safe, but rather to remove the power from drug gangs. The market should be regulated and people protected. Drugs should also not be commodified through capitalism. A socialist approach to legalisation is the only means of ensuring all of the above – drug users will never be safe under capitalism. We need drugs to be safe, free, and legal. Only then will we see improvements for people who use drugs - fewer deaths, fewer overdoses, and a system better able to support those who need it.
Notes
1. Patrick Freyne (2021), “Legalising drugs: Drug use should be treated as a normal adult behaviour”, Irish Times, 3 July. Available at: https://www.irishtimes.com/life-and-style/health-family/legalising-drugs-drug-use-should-be-treated-as-normal-adult-behaviour-1.4609071.
2. Douglas Husak (2002). “Legalise This! The case for decriminalising drugs”, Verso.
3. Alex S. Vitale (2018). “The End of Policing”, Verso.
4. Leah Williams (2022) “Drug Policy Explained: Legalisation, Decriminalisation, and Prohibition”, Journal of Drug Science. Available at: https://www.drugscience.org.uk/drug-policy-explained-legalisation-decriminalisation-and-prohibition/
5. European Monitoring Centre for Drugs and Drug Addiction (2019), Take Home Naloxone: https://www.emcdda.europa.eu/publications/topic-overviews/take-home-naloxone_en.
6. Wai Chung Tse, et. al., (2021), “Does naloxone provision lead to increased substance use? A systematic review to assess if there is evidence of a ‘moral hazard’ associated with naloxone supply”, International Journal of Drug Policy. Available at: https://pubmed.ncbi.nlm.nih.gov/34798434/#
7. Health Canada, (2019). “Summary of results for the Canadian Student Tobacco, Alcohol and Drugs Survey 2018-19”. Available at: https://www.canada.ca/en/health-canada/services/canadian-student-tobacco-alcohol-drugs-survey/2018-2019-summary.html.
8. Melchior M, et. al., (2019) “Does liberalisation of cannabis policy influence levels of use in adolescents and young adults? A systematic review and meta-analysis” British Medical Journal, 9(7). Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6624043/.
9. Alex S. Vitale (2018). “The End of Policing”, Verso, pp. 142-144.
10. Mike Mariani (2015), “How the American opiate epidemic was started by one pharmaceutical company”, Pacific Standard, March 4. Available at: https://psmag.com/social-justice/how-the-american-opiate-epidemic-was-started-by-one-pharmaceutical-company.
11. Theodore J. Cicero, et. al., (2012), “Effects of Abuse-Deterrent Formulation of OxyContin”, The New England Journal of Medicine, 367(1). Available at: https://www.nejm.org/doi/full/10.1056/NEJMc1204141.
12. Health Canada (2021) “Market Data under Access to Cannabis”. Available at: https://www.canada.ca/en/health-canada/services/drugs-medication/cannabis/licensed-producers/market-data.html.
13. PROMISE (2021) “Barnahus Network”. Available at: https://www.barnahus.eu/en/.
14. Beth Collinson, et. al. (2019), “Promoting Recovery from Substance Misuse through Engagement with Community Assets: Asset Based Community Engagement”, SAGE Journals, 13(1). Available at: https://journals.sagepub.com/doi/full/10.1177/1178221819876575