In June, the Global Commission on Drug Policy, an international body of experts, released a controversial report on the war on drugs that concluded, “The global war on drugs has failed, with devastating consequences for individuals and societies around the world.
Fundamental reforms in national and global drug control policies are urgently needed.” We asked Pat Flynn, director of TCU’s Institute for Behavioral Research and an internationally recognized expert on drug rehabilitation programs, what he thought about the report.

The Global Commission says the global war on drugs has failed. Do you consider it a “war”? If so, who is winning?

Rather than use terms of armed conflict, I’d prefer to focus on the disease of addiction as a public health issue. I don’t particularly like the terminology of war, and I don’t think anyone is winning at this point.

We can manage addiction but we can’t cure it. Similar to diabetes, hypertension, asthma and other chronic disorders — hypertension, for example — we know what happens if we stop the treatment plan of healthy diet, more exercise and less stress. The person relapses and blood pressure goes back up.

A similar thing happens with substance abuse: An individual goes into treatment and they do well while they’re receiving care. What I think what we haven’t done yet is work out the level of care that an individual in recovery needs. Recovering from addiction probably means requiring care throughout one’s life.

Back to the war on drugs — sure, I can say that it has failed on the supply-interdiction side. We know interdiction isn’t working, but we do know that treatment works.

Throughout the report, there’s an underlying theme song that keeps getting sung around legalization. That seems to be the preferred solution for some, but not for me. Marijuana is the drug that they keep pushing for legalization, but that’s smokable marijuana and I think that’s just crazy. There has been legislation in about 15 different states in the last 15 years concerning legalization of smokable marijuana. We’re starting to experience some of the consequences from that movement. In Denver, they have more marijuana dispensaries than they have Starbucks.

Meeting with parole and probation folks from different states recently, I asked if legislation was affecting them. One director from a nearby state said yes, it’s a real problem. Someone gets a medical card in California, gets marijuana and is allowed to travel or move to our state and has positive urine results for cannabis.

Since the 1970s, IBR has compiled statistics on individuals entering U.S. drug treatment programs that community agencies rely on for funding and policy making. The Global Commission challenges governments to “offer health and treatment services to those in need.” Aren’t we already doing that in the U.S.? What else should we be doing?

You’re right, we are already offering health and treatment services to those in need. Drug use has declined in the U.S. since the 1970s. The question is really complicated because there are so many substances that people get addicted to. We’ve seen increases in subpopulations in terms of use and declines in others. We’ve seen a general decline but there have been new drugs, and abuse of prescription drugs. We’ve got some new stuff, like K2 and spice and club drugs and things like that. So in subpopulations it’s increasing, and in other populations it’s decreasing.

There has been a lot of discussion recently about parity in health care reform. There have been instances of parents remortgaging the home in order to afford substance abuse treatment for a child. We need to do something for those with no insurance. We have a two-tier treatment system in the U.S.: A private proprietary and a public system of treatment. We can do better if we focus more on drug addiction and drug problems as a public health problem as opposed to an interdiction problem.

The commission calls on governments to “abolish abusive practices carried out in the name of treatment — such as forced detention.” Is there any evidence that court-ordered (non-voluntary) drug treatment works? And if so, can decriminalization be a good thing?

We know that legal pressure helps to increase lengths of stay in treatment. Based on years of research, we know that longer lengths of stay produce better treatment outcomes. We also know from the National Institute of Justice research that drug courts can reduce recidivism and promote positive outcomes. Legal pressure is very helpful in terms of drug treatment, and if we were to decriminalize it, we would lose a segment that would benefit from treatment because that legal pressure would be removed.

We’ve got some gaps in terms of problematic use and those who get into treatment. There’s a segment of the population that is just not ready for treatment and there’s probably a good portion of those under decriminalization who would only incur minor misdemeanors and probably wouldn’t have enough pressure to get into treatment where they could get some benefit.

The Global Commission calls for legalization, especially of cannabis. This, says the report, would act to “undermine the power of organized crime and safeguard the health and safety of citizens.” Do you agree?

Organized crime will redouble efforts with other drugs if cannabis is legalized. Marijuana is just another piece of organized crime. The cartels big producers are heroin, cocaine and marijuana. Marijuana is probably not the most profitable. Taking it away will leave the cartels with other substances to deal. Legalization, to me, is not the answer. The answer is in demand reduction, prevention and treatment and focusing on healthy and pro-social lifestyles.

Explain what you mean by demand reduction and interdiction.

On the demand and supply side: If we take a look at the Federal Drug Control budget, we see that about 65 percent of this year’s $15.5 billion is spent on supplier interdiction and 35 percent on demand. In terms of the drug control budget, if we shifted just 5 percent of that from interdiction into treatment, that would be $750 million to go into public-sector treatment to improve it and move it toward the standards of the elite private-sector centers. So that’s something I think we should be doing.

Interdiction is a broad area that includes the supply of drugs outside of the country coming into the U.S. as well as efforts through the military in Columbia and other countries to eradicate cocaine production. It’s also about policing in the U.S., trying to interdict or capture the drugs in the U.S.

The demand side is the treatment side, the public health issue part of it. That’s dealing with the people who have drug problems. We really need to put more of our dollars in the demand side. We know that treatment works. The commission is saying that interdiction doesn’t work, that it’s failed. So for me it’s taking money from the failed side and moving it into something we know works.

The report asserts that imprisoning people “in the lower ends of illegal drug markets, such as farmers, couriers and petty sellers,” has done nothing to stop the war on drugs. We should invest instead in at-risk groups and try to dissuade young people from using in the first place with “programs that focus on social skills and peer influences.” How is that different from what we are doing today?

What the Commission asks for is not really any different than what we are doing today. In the 1970s, New York Governor Nelson Rockefeller, against advice of his advisors, handed down strict sentencing, getting tough on drug users in New York and then nationally. Back then, drug interdiction was the prevention of choice — criminalization of drug users and locking them up. A large percentage of those were on the lower level and were users who could be treated. We’ve progressed, fortunately, since the ’1970s, and I think our criminal justice system is kinder and friendlier today than it has been in the past. We have drug court programs now, we have probation and parole conditions that permit proper use of treatment. So I think we have a better understanding of the rehabilitation potential of drug users and evidence-based prevention programs being used in the U.S.

This push toward legalization of cannabis scares me because it encourages attitudes towards use and making it okay. It’s the negative corollary to Just Say No. Legalizing it would Just Make it OK.

There was a Rand report investigating cannabis decriminalization, and it was found that the demand for marijuana among youth is affected by penalties incurred for its use. Based on this report, legalization would lead to increased use. We know that drug abuse is a preventable behavior, and we also know that treatment works and prevention works. For me a lot of it’s about economics. We need to put the money into these areas to attack the problem.

In terms of scheduling drugs, the Commission criticizes the “flawed categorization of cannabis, coca leaf and MDMA.” Do you agree that these drugs are wrongly categorized? Would re-categorizing them help win the war on drugs?

I like your question. It really gets me animated. My understanding is that cannabis and MDMA are Schedule 1 and cocoa leaves are Schedule 2 drugs, as classified by the federal government. There are five schedules and classifications, which are made up by criteria such as potential for abuse and medical use, and there are probably some international considerations such as agreements or treaties. But the basic difference between Schedule 1 and Schedule 2 is that Schedule 1 has no currently accepted medical use and Schedule 2 does.
Synthetic THC, the main ingredient in marijuana, is widely available in capsule form through prescription. Cocoa leaf is used to produce cocaine, and MDMA or ecstasy is a synthetic psychoactive drug. I don’t agree that they are wrongly categorized. I can’t for the life of me think how re-categorizing will help win the conflict or war on drugs. Re-categorizing or helping to make them more available would only reduce consequences and encourage attitudes towards using them as being OK.

Want to know what I really think? I think that anyone who wants to reduce beliefs and consequences and encourage attitudes of acceptance of the use of harmful substances — and that’s what these are — I think those individuals are probably smoking something.

Was the commission’s report useful? Were you surprised by its conclusions?

In general I don’t agree, but I think it’s thought provoking and will promote more debate and raise awareness around these issues of drug use and drug abuse. That’s what we need, more of that, and I think it’s only going to help us to remind people that we do have some alternatives here, that treatment does work, that we can attack this problem and we’ve got solutions that work. Any report that raises public awareness around these issues — whether I agree with them or not — promotes healthy debate and a healthy dialog for us.
On the Web:
To read the Commission’s report: www.globalcommissionondrugs.org
For more on IBR: www.ibr.tcu.edu