Last week, I had the pleasure of meeting Dr. Alex Wodak, a physician and the director of the Alcohol and Drug Service, at St Vincent's Hospital in Sydney. Alex is one of the world’s leading advocates for pragmatic and public health focused reform of laws and policies on drugs. The WHO and the Ministry of Health invited him to Laos to offer advice on our draft Drug Control Master Plan.
Having spent his entire professional life trying to find better and smarter ways of mitigating the harm caused by drugs, both to users and to society, Alex was able to suggest a number of relatively cheap and simple interventions, which are likely to save the lives of many, and improve the lives of many, many more.
But what perhaps made an even stronger impression on me, personally, was his analysis of the cause and effect relationship between various drug policy options and the drug markets. An example is the ‘iron law of prohibition’ to which Alex introduced us in one of his presentations. So, what is this law? Well, it is based on the premise that when drugs or alcohol are prohibited, they will be produced on illegal markets in more concentrated and powerful forms, because these more potent forms offer better business efficiency—they take up less space in storage, less weight in transportation (thus minimising he risk of detection), and they sell for more money.
In much of Asia, we saw the effects the iron law of prohibition in the late 20th century. Bulky and pungent opium was made illegal, so refined and nearly odourless heroin became more prevalent, albeit with significant risk of blood-borne disease when injected by needle, and far greater risk of death from overdose. In the Americas, cannabis was also found too bulky and troublesome to smuggle across borders, so smugglers turned to refined cocaine with its much higher potency and profit per pound. Crack cocaine is entirely a product of the prohibition and so is crystal methamphetamine.
There is very little data around drug use patterns in Laos. However, looking back over the last two decades, two clear trends can be observed: opium for domestic consumption has fallen considerably, and so has the number of opium users. Most of the opium grown today is destined for export, refinement into heroin, and sale on international markets. At the same time, ever more people have begun using various amphetamine type stimulants (ATS) or yabaa, as it is known locally. Luckily, the habit of injecting heroin has not spread as quickly in Laos as it has in many neighbouring countries.
But can the yabaa trend be a product of the iron law of prohibition? The inconveniences of producing opium are many; large tracts of land are needed, and the plant is a little picky; it requires certain conditions to grow well. Opium plantations can easily be spotted from the air, and even from space with the help of a satellite – in fact this is why we know on how many hectares of land opium is cultivated. Being a plant, opium has to be planted (on fields carved out from dense jungle vegetation), it has to be looked after and harvested, all of which is labour intensive. And it is of course subject to same risks as all other crops; too much or too little rain, too hot or too cold – and much of the investment can be lost. Compare that to ATS – it can be made anywhere, regardless of climate, in small and mobile laboratories, that can be set up in sheds, basements, barns, attics, old warehouses – anywhere. Certainly nothing that will stand out on a satellite photo. ATS can be produced around the clock, every day of the year, regardless of seasons – and the precursors are readily available in abundance in any country with a pharmaceutical industry. So, it is not so hard to imagine that when law enforcement threw spanners in the machinery of opium production, it may inadvertently have encouraged the industry to look for easier and more pliable alternatives.
Of course, opium production carries on, but it is no longer produced for the Lao market. The costs and inconveniences of production today are only justifiable if the raw opium is processed into heroin and sold on markets where retail prices are far higher than in Laos. Maybe Lao consumers are still too poor to constitute a good retail market for heroin. On the domestic Lao drug market opium has instead completely lost out to yabaa, which is selling at record low prices to a seemingly ever-expanding customer base.
One should certainly not be too nostalgic about opium. The widespread opium use of the olden days had serious implications, but as Alex pointed out, it was a drug used primarily by an older generation. Yabaa, on the other hand, is a drug used mostly among young people, so its effects on society are very different. Nobody (to my knowledge) has done any scientific socio-economic impact studies on opium versus ATS, so it is not possible to tell exactly what consequences the shift from opium to ATS has had on Lao society and its economy.
What we now do know, however, is that deploying law enforcement to crack down on the drug industry is a huge gamble. History has taught us the iron law of prohibition: rather than just accepting defeat and dissolving itself, the drug industry is likely, not only to fight back, but also to adapt and reinvent itself by launching alternative drugs. And more often than not, these alternatives will be both more dangerous and more difficult to control than the drugs they replace.
The lesson for us all to take away is that when it comes to drug policy, law enforcement is an instrument that policy makers should use surgically only very sparingly. As Dr. Alex Wodak demonstrated, there are far more effective ways of taking control over drug use and its consequences.
Written by Marcus Baltzer