"Just say no" is not an "alternative approach" to the drug problem. It's been tried – and it doesn't work

Dr Hans-Christian Raabe, who was removed from the Advisory Council on the Misuse of Drugs after one month, this week wrote two rather provocative articles on the Conservative Woman website. Aside from claiming that the British Medical Journal is, in effect, corrupt for running an in-depth article about the public health impacts of various emerging models of legal cannabis regulation around the world, which my Transform colleague, Steve Rolles, was asked to provide some fact-checking support on, Raabe’s main argument is that a better, “alternative approach to the drug problem” would be to create a “drug-free society”. As the headline of the article says, “Our drugs dilemma is all in the mind. We just need the will to say No.”

It’s not a very innovative solution, though. After all, punitive, zero-tolerance, abstinence-based approaches have been the dominant drug policy model in most parts of the world for over half a century now – and they haven’t worked. They’ve caused a great deal of harm and haven’t really stopped people taking drugs. D.A.R.E., the archetypal “just say no” drug prevention programme in the US, has been studied extensively, and researchers have concluded (pdf) children who participate in it “are just as likely to use drugs as are children who do not participate in the program.”

 

Nancy Reagan "just saying no" way back in the 1980s

 

That’s not to say that prevention can never work or isn’t important; obviously it’s better to prevent problematic drug use developing than to deal with its consequences afterwards – but we need to be realistic. Harm reduction and treatment are also proven, vital, and cost effective interventions.  There is good evidence that certain types of targeted prevention can be effective at reducing key drug related harms – but these are not approaches driven by political imperatives to be “seen to be doing something” or unrealistic ideological visions of drug-free worlds.  

As the Global Commission on Drug Policy (which is incidentally in favour of legal regulation) recommends (pdf):

“Eschew simplistic ‘just say no’ messages and ‘zero tolerance’ policies in favor of educational efforts grounded in credible information and prevention programs that focus on social skills and peer influences.”

But what about Sweden, which (along with Japan) Raabe says drug policy reformers never mention? (Steve has in fact engaged directly with this specific question many times, including as far back as 2007, when he wrote a piece for Druglink magazine on it.) Sweden has apparently aimed to create a drug-free society and, as Raabe states, “has among the lowest rates of drug misuse (including cannabis) in Europe”. This contrasts with Portugal, “where drug use and problem drug use has risen since it decriminalised personal possession.”

So should we all follow the Swedish example, and “just say no” while pursuing a punitive approach to drugs? I’m not so sure. Let’s compare Sweden with Portugal, like Raabe does. (I should add here that the usual caveats apply when comparing countries, particularly when looking at reported prevalence of drug use. Often different types of surveys are used, and obviously some people just lie, but the figures below are taken from the European Monitoring Centre for Drugs and Drug Addiction, which is probably the most reliable and unbiased official source of such data.)

By two out of three measures, Sweden has higher rates of cannabis use among the general population than Portugal. Doesn’t look like the Swedes are really “just saying no”.

And then there are the costs of criminalising and stigmatising people who use drugs as part of an attempt to create a drug-free society. This contrasts with the benefits of adopting a pragmatic, health-based drug policy. (Another caveat: it would obviously be pointless to compare the below raw numbers if Portugal and Sweden’s populations were vastly different, but they’re not. Sweden’s is 9.5 million and Portugal’s is 10.5 million, so it’s probably OK in this instance.)

Encouraging healthy lifestyle choices is a legitimate aim of government, but criminalising people to do so is misguided – it is both unethical and ineffective.  

Raabe’s implicit claim that legal regulation is being proposed as a panacea to the drug problem  grossly misrepresents the case being made by advocates of drug policy reform. In ‘After the War on Drugs: Blueprint for Regulation’ (p. 10), for example, Transform explicitly says that legal regulation is no “silver bullet” and that “public health education and prevention, treatment and recovery, and the role of broader social policy concerns” all require consideration and action.

The idea that prevention or other health interventions are the only alternative is a classic false binary. If Raabe took time to read Transform’s materials he would learn that we argue prevention and health interventions are crucially important, but that we believe they are undermined by criminalisation and prohibition. We argue that decriminalising the target populations and strictly regulating markets would create an enabling environment for all public health interventions,  removing political obstacles to evidence-based responses and freeing up resources to fund them that are currently spent on counterproductive enforcement.

There would probably be less reactionary responses to any discussion of regulatory models if some of their opponents took the time to inform themselves about the positions of the people with whom they are arguing, instead of fighting straw men they have constructed themselves. Usually there will be a lot less disagreement than they imagine.