BETWEEN THE LICIT AND THE ILLICIT: A REFLECTION ON THE DECRIMINALIZATION OF DRUG USE
The debate on individual freedom versus drug control is one of the most controversial in society and has been the subject of discussion for a long time. The health and scientific consensus on the matter establish that addictions are indeed mental health disorders (DSM 5, 2013, pp. 481-590). As with any mental health disorder, this must be seen from a bio-psycho-social perspective: there are genetic elements that constitute a-priori vulnerability factors for the subject, as well as psychosocial, economic and cultural factors that condition the psychodevelopment of a person. All these factors, in turn, interact with each other. In addition, between 50% and 75% of substance use disorders are comorbid with other disorders, for example, depression. In turn, in fact, most people who ever try a substance do not develop an addiction. In 2020, worldwide, 1 in 18 people aged 15-64 years - 284 million people - (5.6% of the world's population), had used a drug in the 12 months prior to the survey. But only 13% developed dependence (United Nations World Drug Report, 2022, p. 61).
However, our societies and cultures have tended to see them as moral failures or behavioral weaknesses, and this is still largely the case. If we place ourselves in this position, it is true that addictions present themselves to the eye in a different way; their phenomenology is different. In the mental disorders usually recognized as such - let us suppose schizophrenia - the subject has no way of controlling the onset of its pathological manifestations. When a subject has a psychotic break, hallucinations simply "wake up" and occur during the acute phase of the illness, and the subject can do nothing about it. In contrast, addiction is actually different in its phenomenology: it requires the individual to engage in the deliberate behavior of going, getting the substance, and self-supplying it. Here the so-called "free will" comes into play, and that is why the drug-dependent subject is attributed moral and aptitudinal weaknesses from the perspective of popular thought. However, an addiction problem is much more than self-administration of the substance: there are several risk factors that pre-condition the individual, in addition to the possible existence of another disorder already in progress. This is why these conditions are often referred to as "dual pathologies", i.e. there is a comorbidity, a very frequent coexistence between a substance use disorder and, for example, a pre-existing depression, anxiety disorder or certain personality disorders.
We must ask ourselves, how free is the agency of a mind affected by a substance use disorder...? We cannot consider the drug dependent subject as a rational agent in the decision-making process. The drug distorts brain activity (the organ of behaviour), altering its biochemical patterns. (Kuhar, 2016, p. 64) How much "free will" does a person addicted to crack or fentanyl possess? M. Romani says in his preface to the work of sociologist Alain Labrousse: "'Drug' is a polysemic and polemic term. Its mere mention evokes and unfolds myths, legends, social representations, which are not only contextual. They carry implicit ideological and political contents with history and meaning". (2011, p. 7)
The issue of freedom from drug use has been one of the hottest social debates in the contemporary world. It involves major geopolitical conflicts, not only dilemmas about the valuation of behavior and the consequent health challenges. By geopolitics applied to the issue of drugs, we mean conflicts of power for the control of territories, their wealth and the human factor involved in the production of raw materials, processing and final synthesis of the substance for consumption (Labrousse, 2011, p. 13). This implies the existence of large mafias certainly linked to the political and state structures of various countries (and not only in the so-called "third world" as some might believe). It also implies the existence of major public problems at the legal and criminal level. In 1971, President Nixon declared that drug addiction was public enemy number one in the USA, and since then, the prison population has increased so much in the USA that it is the country with the highest number of prisoners per capita in the world, both in state and private prisons (Thornton, 1991, p. 125). The USA represents only 5% of the world's population, but more than 20% of the world's incarcerated population; even more than in totalitarian regimes such as China.
On the one hand, critics of the freedom to choose what to consume point to the likelihood of resources being channeled through drug production and trade, increased crime and the impact on public health. On the other hand, as we have suggested, there are voices that consider that the freedom to obtain controlled or illicit substances is based on the fundamental principle of individual freedom. From this perspective, drug use is seen as a private matter with no need for state intervention. There is no doubt that this dilemma has given rise to permanent debates between those who advocate personal freedom and those who think that the State should be the arbiter of what is acceptable or not for the common good.
On the one hand, then, there is the belief that people should be free to choose what they consume and how they live their lives, as long as they do not harm others. This is the liberal-libertarian position on the matter. Should the state intervene in the individual's freedom to choose whether or not to consume psychoactive substances? If the presumed intention is to "take care" of the citizen from himself, why not ban junk food stores to prevent obesity...? After all, many more people die worldwide from cardiovascular accidents than from critical substance abuse. In fact, the State has no intervention at all in this field: supermarkets are flooded with labeled products where the Ministry of Public Health mentions "excess sugars", "excess trans fats", "excess saturated fats", etc. Where do we draw the line if we want a model of society where individual freedom is respected, and who draws it? In the name of what...?
As we see here, drug abuse does not even appear among the 20 leading global causes of death, being widely preceded by cardiovascular diseases, cancer, respiratory diseases, infections, digestive diseases, suicides, neonatal diseases or homicides, among others.
In Turkmenistan, its autocratic ruler Gurbangulí Berdimujammédov forbids black cars; they must all be painted white, simply because he orders them to be so. If someone wishes to express interest in a car, let's say, black, it is punishable by imprisonment. Seen from the outside in the West, this seems laughable and a joke in bad taste, but for those who live in the West, owning a black car is no different from holding 1 kilogram of cocaine in your hands in the USA or Uruguay.
Gold statue in honor of the dictator of Turkmenistan.
On the other hand, there is concern about the negative consequences of drugs on the health and well-being of individuals, as well as on society in general. This is the so-called interventionist position: do certain people have the right to harm themselves, burdening society with health costs at a time when health systems are often socialized or semi-socialized and financed by the taxes of all taxpayers...? The interventionist position presupposes, philosophically, that individuals are treated as "minors", in the conceptual sense that the German philosopher Immanuel Kant gave to this expression. In his work "Was ist Aufklärung?" ("What is Enlightenment?"), Kant argues that many individuals depend on the guidance and authority of others, such as political figures, religious leaders or experts who may form a technocracy, to guide their beliefs and actions. This presumed intellectual "coming of age" of many people would be due to a lack of fearlessness and willingness to think for themselves and exercise their own individual reason, which would be remedied by a process of assimilating the Enlightenment for self-liberation. Encouraging oneself to think ("sapere aude") without the guidance of a moral or intellectual tutor thus constitutes an act of emancipation of the subject. (Kant [1784] 2004, pp. 84 ff).
In general, the zero-tolerance approach to drugs is based on the idea that drugs are dangerous and should be banned in order to protect the health and welfare of society. On the other hand, the harm reduction stance, a 'more sympathetic' option, is based on the idea that, given the reality that some people are going to use drugs anyway, it is important to minimise the negative effects associated with their use and to provide people with access to quality medical and mental health care services.
So should the State, along with its political elite and technocracy, take this stance to "take care of citizens from themselves" with respect to drug use, or should it leave individuals to their own free will in making decisions? In general, most people would defend the idea that the state should not intervene negatively in their personal choices and preferences, as has happened historically in regimes that neutralize individual liberty and private property, such as Soviet socialism or corrupt statist oligarchies of all hours. (Thornton, 1991, pp. 3 ff).
History shows that Prohibition did not work in the USA (Thornton, 1991, pp. 56 ff.), although it must also be said that the health consequences of alcohol abuse and addiction are not minor. But people never stopped accessing alcohol in spite of Prohibition in that country - because it was always available clandestinely - or the high alcohol taxes in Scandinavia. There is a demand, and if there is demand there will be supply, such is the inescapable iron law of the market.
The position of legalising absolutely all drugs (some are already legal in the West, such as alcohol or cannabis, the latter for example in Uruguay) has been defended by many ideologues and technicians, ranging from the left (Antonio Escohotado), libertarians such as Thomas Szasz, or liberals such as Milton Friedman.
Let us begin by mentioning the position of Milton Friedman, Nobel Prize-winning economist and member of the Chicago School of economics, usually referred to by his detractors as "neoliberalism", a concept that does not exist within the liberal school of thought, but which has been created from outside as a semantic weapon of condemnation and ideological signalling. In an interview given by journalist Randy Paige for America's Drug Forum in 1991, Friedman expresses his position.
Friedman was in favor of legalizing all drugs. His main perspective and argument is that this would put an end to the black market, and therefore to the outlaw drug suppliers who become dangerous criminal gangs and cartels, creating serious problems of public safety, health (the user does not know the quality of the substance he consumes), homicides, public corruption and prison problems. Furthermore, in countries such as the USA (not so in Uruguay), the individual becomes a criminal for the mere fact of obtaining the substance.
If all drugs were legal, consuming drugs would be no different than consuming unhealthy food in a fast food store. In his opinion, crack (cocaine base paste) would never have existed if cocaine had not become very expensive, precisely in the illegal market. We believe this is debatable, since the fact that a market is a black market does not make the laws of supply and demand any different in nature than in markets in general. Does crack really arise because of the seizures of the war on drugs...? If cocaine became more expensive, could it be that it simply began to be more in demand by those who could pay for it? Not everyone could do this, so a cheaper alternative such as crack cocaine emerged.
A very interesting point that Friedman raises is that the interventions and war on drugs by governments from the State, ends up benefiting the big monopolists and drug cartels. For example, if a small entrepreneur wanted to enter the business of buying and selling drugs, it would be impossible for him to evade sophisticated government controls and interventions. On the other hand, only those who possess great resources and accumulated capital, such as private airplanes, armaments, infrastructure, etc., can be in a position to evade the great legal controls. Therefore, governments with their war on drugs directly and indirectly benefit the big drug lords, who end up being a few monopolists of this business. We could go a step further and ask ourselves whether governments are not aware of this, after decades of failed experimentation, and whether there is perhaps a certain complicity between both sides, for example, when it comes to obtaining campaign financing or to "encourage investment" (money laundering), typically in the area of infrastructure and real estate. In the official fight against drugs, for example, large-scale fumigation campaigns are carried out in countries such as Colombia. At the beginning of the 21st century, the USA had sprayed 33,330 hectares of cannabis plantations (Labrousse, 2011, p. 37). This is somewhat misleading, given that cannabis is bulky and visible to transport, making it easier to "fight". The same cannot be said for cocaine, let alone fentanyl, of which 1 kilogram of Fentanyl yields more than 1 million doses, transportable in a few suitcases.
Another interesting point is that Friedman admits that legalizing drugs would bring in a certain amount of "additional drug addicts". (YouTube, [1991] 2008) In fact, the amount of exposure and availability of the drug is known to be a risk factor for substance use disorder. Michael Kuhar, Ph.D., states, "The main factor in becoming a drug user is obviously the availability of drugs. If drugs are not available, then there will be no users. However, drugs are available in many places and staying away from them is critical in addiction recovery (and for everyone of course)." (Kuhar, 2016, p. 106)
This is an irrefutable fact. In Uruguay, the law legalising the state-supervised production of cannabis was passed in 2013, and its implementation came later. While the illicit market has by no means disappeared (both co-exist and even compete), cannabis consumption has only increased:
Note: Data from local pollster Factum published in the Uruguayan weekly Newspaper Búsqueda. The data goes up to the year 2017.
Here we can see that the trend since the beginning of the century has always been upward, both for occasional users (purple line) and for more regular users (green line). However, precisely at the time of legalization, there is a turning point that marks an even more upward trend. This sort of sociological experiment in Uruguay confirms that Friedman's intuition was right: there were and will be more additional consumers.
And this is the weak point of Friedman's argument, for perhaps his position solves the problem of criminality associated with drug cartels, but it does not solve the health consequences of individuals vis-à-vis society. In the name of free will the individual is free to take drugs, but in the USA as in many countries, either the federal or national governments subsidize the health systems with the money of all taxpayers. Therefore, the free choice of the individual also ends up affecting others: bearing the costs of health care harm. Perhaps, for this system to work coherently, we should move towards an almost 100% privately managed health care model, as is the case in Singapore. And each individual should be truly responsible for his or her "free choice" without affecting others with the costs of his or her decisions.
Let us now present some arguments of psychiatrist Thomas Szasz, even more radical than those of Friedman. “Our Right to Drugs. The Case for a Free Market” of 1992, is the work where this psychiatrist (belonging to the so-called current of Anti-psychiatry) exposes his thesis on the issue of drugs. Szasz starts from the assumption that we desire drugs for the same reason that we desire other goods in general. He states, "We desire drugs to mitigate our pain, cure our diseases, increase our stamina, change our mood, put us to sleep, or simply feel better, just as we desire bicycles and automobiles, trucks and tractors, ladders and chainsaws, skis and swings, to make our lives more productive and more enjoyable." (1992, p. 20) For Szasz, both taxation and drug prohibition are coercive and violent interventions by the state, and both are ideologically justified first and foremost on paternalistic grounds. Dr. Szasz goes so far as to assert that many alleged anti-drug programs and drug treatments are coercive "religious-therapeutic dogmas" that mask a state policy of retrogressive constitutional rights, for the right to chew hemp would even predate the right to vote, he says. The war on drugs, he asserts, is a puritanical moral crusade that wears a medical mask (1992, p. 93), where the subjects end up in “mental concentration camps”. Such interventionism implies a Sovietization of the drug market, and this would have led us to live in a social and economic order that is a "chemical communism": "Since we call state control over the production and distribution of goods and services "socialism" (or "communism"), I suggest that we call state control over the production and distribution of drugs "chemical socialism (or communism). " (1992, p. 130) In a scathing and highly ironic style, libertarian and psychiatrist Thomas Szasz attacks even what he would seem to consider a nefarious American political right wing:
"In 1979, when Ronald Reagan ran for president, he ran as a conservative, with a capital C. The liberals were hippies who had smoked pot, had their girlfriends have abortions and neglected their children. Liberals were hippies who had smoked pot, encouraged their girlfriends to have abortions and neglected their children. Such, at least, was the stereotypical image of liberal Democrats to conservative Republicans. By contrast, conservatives-exemplified by Ronald and Nancy Reagan-represented morality, tradition, and family values. These statements, in my opinion, will go down in history as the most transparent hypocrisies of the Reagan presidency. Whatever iniquities were committed in the name of drugs by Reagan's predecessors, it was he who, repeating a stupid anti-drug slogan, taught American kids to spy on their parents and report them to the police. (...) They cultivated one of the greatest, most characteristic and despicable practices of the great socialist states of the 20th century: turning children against their parents in a holy war against the enemies of the state." (1992, p. 113) (Translated from the Spanish Edition)
Ronald and Nancy Reagan.
