The Pompidou Group of the Council of Europe has published a new report, Costs and unintended consequences of drug control policies.1 The overall aim of the report is to define and identify costs and unintended negative effects of drug control policies, borne by individuals and society (p. 9). The findings are based on a wider study carried out by the Pompidou Group in cooperation with the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA).

In the previous issue of Drugnet Ireland,2 the findings of two reports on drug-related public expenditure were discussed.3,4 The first part of current report echoes many of the key findings reported in that article. It explores what drug-related public expenditure is, why it matters, and the methodological challenges faced in estimating its value. These are not repeated here; instead, this article focuses on the second part of the report – the unintended negative consequences of drug control policies.

Unintended negative consequences

The authors define unintended consequences as those ‘that are not deliberate or intentional; they are not the targeted effects of any given action’ (p. 9). These vary between countries: affected by, for example, the national drug legislation and its implementation, as well as the social and economic context, and the types of substances considered. The authors outline in detail the health and non-health (social and economic) consequences for both users and non-users of drugs (p. 10), as well as almost 40 ‘possible interventions’ to ameliorate these unintended (although not always unexpected) consequences. Below is a broad summary of the unintended consequences covered in this report.

Health-related consequences

Three broad categories of health-related consequences are identified:

• Effects from restricted availability of controlled medicines: One of ‘the most serious’ (p. 46) consequences of control policies for non-users of illegal drugs (p. 46) is the unmet pain relief and palliative care needs of patients due to the strict enforcement of the UN conventions. For opioid dependent users (p. 46), the strict controls mean the denial of access in some countries to the ‘most effective treatment’ for them, i.e. opioid substitution treatment (OST). More broadly, restricted access to marijuana has made it more difficult to conduct research on its medical use.
• Effects due to enforcement of drug prohibition: Four unintended consequences are identified in this category. First, people may switch to using more hazardous substances because they are ‘legal’. The authors argue that the health risks associated with the new psychoactive substances are unknown and they are often ‘dangerous and potentially lethal substances’ (p. 27). Second, because of the elevated price that comes as a result of a drug being prohibited, people can use them in a more cost-effective but riskier way. For example, they move from smoking to injecting heroin. Third, the variation in purity of substances available on the black market means an increased risk of mortality and morbidity for people who use. Finally, use of a prohibited substance tends to be stigmatised. This can discourage people from seeking help and support, can have a negative impact on their self-esteem and mental wellbeing, and may lead to healthcare providers having negative attitudes towards people who use.
• Effects from enforcement actions: First, where there are periods of intensified police activity to enforce drug laws, this can have a negative impact on attendance at services. This can, for example, increase the risk of the spread of drug-related infectious diseases, and make it less likely for people to contact emergency services when someone has overdosed. Second, where there is contact between the police and ‘suspects of drug law offenders’ (p. 32), the authors argue that there is a risk of inappropriate use of force, violation of rights, and physical and mental harm. Third, there can be barriers to providing appropriate services to those who are in detention. This can increase the risk of the spread of drug-related infectious diseases.

Social and economic related consequences

Three broad categories of non-health-related effects are identified:

• Effects of high profit margins and price levels of illegal drugs: First, the high profit margins offered by the illegal drugs market attract and finance organised crime groups, including those involved with terrorism. It also encourages trafficking of people and other items through the same networks, as well as the associated corruption of officials. This all feeds into an environment characterised by ‘high levels of violence, criminal motivation and risk-taking’ (p. 36). Second, the high price levels associated with illegal drugs mean that people commit acquisitive crime to finance their drug use.
• Effects of stigmatisation due to perceptions of people who use drugs as criminals: Feeling stigmatised can lead to low self-esteem and reduced motivation to engage in economic and social activity, and to access community life and services. The authors argue that it can exacerbate existing forms of discrimination and increase people’s readiness to get involved in illegal activities. The stigma associated with drug use can mean people who use drugs are at increased risk of arrest and pre-trial detention, when compared with people involved in some other criminal activities.
• Effects of criminal records and imprisonment for drug offences: First, having a criminal record limits a person’s future opportunities. As well as increasing the risk of stigmatisation and social exclusion, it can impact negatively on employment opportunities, access to housing, and access to education. Second, where people have been imprisoned for a period this can lead to ‘shattered ties with individual social support networks’ (p. 41), an increase in the risk of reoffending, and increased exposure to violence.

Concluding comment

The authors conclude that to evaluate and improve drug policy, stakeholders need to know how much these policies are costing, and take into account all possible effects of the associated interventions and actions, including the unintended negative consequences. They also argue that many of these consequences are predictable and therefore appropriate interventions should be put in place to minimise their impact on people who use drugs and wider society.

1    Bretteville-Jensen AL, Mikulic S, Bem P, Papamalis F, Harel-Fisch Y, Sieroslawski J, et al. (EMCDDA) (2017) Costs and unintended consequences of drug control policies. Brussels: Council of Europe. http://www.drugsandalcohol.ie/28536/

2    Dillon L (2018) Exploring drug-related public expenditure. Drugnet Ireland, 64: 15‒16.

3    Bretteville-Jensen AL, Costa Storti C, Kattau T, Mikulic S, Trigueiros F, Papamalis F, et al. (EMCDDA) (2017) Public expenditure on supply reduction policies. Brussels: Council of Europe. http://www.drugsandalcohol.ie/27458/;

4    European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) (2017) Drug treatment expenditure: a methodological overview, EMCDDA Insights 24. Luxembourg: Publications Office of the European Union. http://www.drugsandalcohol.ie/28010/