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790 September 24, 1990 FIGHTING DRUGS IN FOUR COUNTRlESt LESSONS FOR AMERICA INTRODUCTION Policy makers debating America's anti-drug policies often loopforeign countries for examples. Proponents of drug legalization, for instance, often cite Britain or the Netherlands as e v idence that legalization "wo;ks in the sense of reducing drug usefirough non-criminal justice mechanisms. Proponents of tougher criminal laws against drugs often cite Japan and Singa ore to support ar guments in favor of tougher enforcement in the United States. This raises the question of whether general conclusions can be drawn from the experiences of countries as diverse as Japan and Britain, Singapore and the Netherlands. And, even if they could, would they be relevant for the U.S In fact, there are a number of difficulties in making comparisons of national drug policies.There are problems with data: no two countries collect precisely the same figures in the same way. There are semantic problems: the term "rehabilita tion for example, means one thing i n Japan and something very different in Britain or the U.S. There are cultural and historical differences. Misleading Reports. Policy makers thus must be cautious about adopting the conventional Wisdom on overseas drug programs as a guide for American policy. At least with respect to Britain, Japan, the Netherlands, and Singapore, four countries whose drug programs frequently are cited, it is clear that much of what has been written is misleading with respect to both their current policies and their succes s in controlling drugs s I I I I I 1 See, for example, War by Other Means The Economist, February 10,1990, p. 50 2 See, for example, A.M. Rosenthal The Japanese Mystery New York Ti, April 7,1989. There is no evidence that the decriminalization policies of Britain (limited decriminalization of heroin and relatively lax enforcement against drug users) or the Netherlands (virtual legalization of all kinds of drug use) have limited either drug use or its consequences. Both countries have substantial drug prob lems, with the attendant crime and social decay, and little progress is apparent toward reduc ing drug use in either country. By contrast, there is some evidence that the tougher policies pursued by Japan and Singapore have reduced drug use and its attenda nt costs. Both countries have suffered serious drug epidemics in the past, and both subsequently brought their drug problems under control -something that cannot be said for Britain, the Netherlands, or America Reasons for Success. The success of Japan an d Singapore in controlling their drug problems can be attributed to three main factors: First, both countries have adopted very aggressive policies to stop the supply of drugs including, in Singapores case, use of the death penalty for major drug dealers. S econd, both countries have adopted tough user accountability policies, including widespread use of drug testing to identify drug users and incarceration of users in work camps designed both to punish and to rehabilitate.Third, both countries have been suc cessful in recruiting large numbers of citizen volunteers into the fight agaihst drugs. While caution must be exercised in drawing conclusions that could have implica tions for the U.S the pattern that emerges from studying these four countries sup ports a tougher rather than a more permissive approach to drug abuse, focussed especially on drug users as the most promising strategy for reducing drug use in the United States DRUG POLICIES IN FOUR COUNTRIES HOW THEY EVOLVED Perhaps the most important element t o be considered in assessing overseas drug policies is the historical and cultural context.Todays drug problems are, at least in part, a function of the historical prevalence of drugs in each society. Current drug policies, moreover, are themselves a reac t ion to past experiences Britain permitting doctors to prescribe heroin and other hard drugs to drug addicts Less well publicized are two other important facts: First, the British experiment with prescribing heroin to addicts ended, for all practical purpo ses, in the mid 1970s; second, the British have and enforce laws against all forms of drug posses sion.Thus there is no broad policy of decriminalization in Britain. The British policy of providing heroin and morphine to addicts originated after World War I. In 1926, the Rolleston Report, named after the chairman of the government committee that prepared ib found that there were a limited number of heroin and morphine addicts, many of whom became addicted after being Heroin and the British System. Britain is most widely known for its policy of 2 treated for wounds during the war. Lacking any available cure, the government adopted the committees recommendati n to errnit doctors to prescribe heroin to these addicts on a maintenance basis. By the early 1960s, it was apparent that heroin use was rising dramatically. Another government committee was convened to review the situation, and its 1965 report (the Brain Committee Report, named, again, for the chairman) con firmed a vast increase in the-number of heroin addicts, especially among the young. More troubling still, the report concluded that BP the major source of supply has been the activity of a very few doctors who have prescribed excessively for addicts.Thus we were informed in 1962 t hat one doctor alone prescribed ahoy 600,000 tablets of heroin (Le. 6 kilograms) for addicts. As a result of this report, the right of doctors in Britain to prescribe heroin was limited, effective in 1967, to those physicians specially licensed by the government. In addition, the government moved to set up special treatment clinics specifically for the purpose of treating heroin addicts, including prescribing heroin. Reducing Dependence. While there is much debate (and little hard evidence) on precisely wh at happened at the clinics during the 1970s: it is clear that there was a gradual evolution away from prescribing heroin, in favor of methadone, and that the general practice moved away from providing long-term maintenance doses and toward efforts to get heroin users to reduce and eventually terminate their use altogether! Despite these changes, the governments policies toward heroin were anything but effective in restraining its use. Indeed, a 1989 study estimates that heroin con sumption grew at an avera ge annual rate of 10 percent over the period 1974-1981 and 21 percent over the period 1982-19 84. Thus, Britain entered the late 1980s with a substantial heroin problem and a growing consensus on the need for a change in its policies 3 7-9,s. See also Gri fith Edwards, Evolutions of the British System, in problems of DtugAbuse in Britain: Papem hsented at the Cropwood Roundtable Confewnce (Cambridge, England University of Cambridge 4 lbid.,p.ll. 5 For the best available summary, see Edwards, pp. 25-36. 6 B y 1987, only 186 (1.8 percent) of the 10,398 drug addicts receiving drugs under prescription were receiving heroin. Nearly all the others received methadone. See Statistics of the Misuse of Drugs, United Kingdom 1987 Home Office Statistical Bulletin 25/88, September 6,1988.Table 3.4 7 A. Wagstaff and A. Maynard, Economic Aspects of the Illicit Drug Market and Drug Enforcement Policies in the United Kingdom, Bdkh Joumul OfAddiction 84 (1989), p. 465 See P. Bucknell and H. Ghodse, Bucknell and Ghodse on Misus e of Drug (London: Waterlow, 1986 pp 1978), pp. 1-41 3 While British use of other drugs, from cannabis to cocaine, has generally lagged behind Americas, its policies have evolved along a similar path. As in the U.S criminal penalties for trafficking and po s session of illicit drugs, including cannabis were established in Britain following World War I, and have been updated since Enforcement of these laws has also followed the pattern in the U.S with the most emphasis on stopping the supply of drugs and relat i vely little emphasis on prosecuting drug users8 Japan Despite Japans reputation as a highly-regimented, culturally conservative na tion it has seen three major outbreaks of drug use, involving stimulants and heroin, since World War 11. In each case, the J apanese have responded with a for ceful program focussed on interdicting supply and eradicating (to use Japans term) drug users. And in each case, the result has been a relatively rapid and dramatic reduction in drug use. With respect to other drugs, the J apanese have applied the same tough policies as applied to heroin and stimulants, but with even greater success. Cocaine marijuana, PCP, and LSD use in Japan has been and remains virtually insignificant Stimulants: the First Epidemic. Japans first drug ep i demic occurred during the late 1940s and early 195Os, and involved the use of stimulants (primarily metham phetamines which were widely distributed to Japanese soldiers during the World War I1 to improve fighting performance. By the mid-l950s, an estimate d 2,000,000 Japanese were using stimulants illegally, and 550,000 were regular abusers a sig nificant epidemic, even by modem U.S. standards? Japans reaction to this sudden outbreak of drug abuse, the first in its history was swift and tough. In 1951, Japa n substantially toughened its laws against stimulant sales and possession and began jailing dealers and users. When the epidemic reached its height during 1954, some 55,654 people were arrested. When this approach failed to achieve the desired results, th e Japanese in 1954 increased penalties for manufacture, added new penalties for precursor drugs (the chemical compounds from which stimulants are manufactured) and inaugurated a system of forced hospitalization for chronic drug users. Under this policy, d rug users were rounded up in droves, forced to go through cold-turkey withdrawal and placed in work camps for periods ranging from a few months to several years. This approach to drug users, still in force today, is seen by the Japanese as a humane policy focussed primarily on rehabilitation. By American standards, how ever, these rehabilitation programs would be seen as very tough, if not 8 Comparison, Jooumuf of Drug Issues, Fall 1979, pp. 491-99 9 Japan 1945-55, Seminars in Psychiutty 1;2 (May 1%9 pp. 1 7 9-194 10 See Brill and Hirose, p. 179 11 See Anti-DmgActivities in Jupun (Tokyo: National Police Agency of Japan, 1989 p. 20 See Gerald E Uelmen, Sentencing Narcotics Offenders in Great Britain and the United States: A See Henry Brill, M.D. and Tetsuya Hi r ose, M.D., The Rise and Fall of a Methamphetamine Epidemic 4 draconian, punishment.The Japanese from the very beginning have opted for a cold-turkey drug withdrawal.Thus, every heroin addict identified in Japan is re quired to enter a hospital or treatmen t facility, where they go immediately through withdrawal. Conviction through the criminal justice system is not necessary for commitment. Any addict identified, either through examination by physicians or through urine testing, is committed through an admi nistrative process As a result courts are not burdened with heavy caseloads of drug users, drug users are not sad dled with criminal records and punishment for drug users is swift and sure. The government also launched a substantial public education campai gn, includ ing distributing anti-drug messages through government-controlled television movies, radio, newspapers, magazines and books, and posters in airports, railroad stations, bus terminals, and public buildings. Cabinet ministers, governors, mayors a nd other public officials regularly conducted public forums on the perils of drug use. These policies dramatically and rapidly cut drug use. Within four years of the 1954 amendments, the number of people arrested for violating the Stimulant Con trol Law dr opped from 55,654 to only 271 in 1958.3 Heroin in the Early 1960s. Unlike many Asian countries, Japan had no histori cal pattern of opiate use prior to the But late in that decade, just as the stimulants epidemic was winding down, Japan began experiencing serious problems with heroin By 1961 it is estimated that there were over 40,000 heroin addicts in Japan.s to their new problem with heroin by imposing, in 1963, still tougher penalties against importation and selling, and by imposing a mandatory rehabili tation regime for addicts. The results of Japans tough heroin program mirrored those of its successful fight against stimulants. The number of arrests for heroin sale and possession fell from a high in 1962 of 2,139 to only 33 in 1966 and have never risen above 100 since. Stimulants Make A Comeback Japans successful fight against stimulants in the 1950s resulted in a decade of dramatically reduced use. After peaking at 55,664 ar 12 Using their successful fight against stimulants as a model, the Japanese reacted 12 See Kiyo s hi Morimoto, The Problem of the Abuse of Methamphetamines in Japan, Bulletin on Natcotics July-September 1957 pp. 8-12 13 See Brill and Hirose, pp. 180-1 14 This fact is attributed by the Japanese to their tough anti-drug policies (including the death pen a lty for opium use) and isolation from other nations. SeeAnti-DnqActivifies in Jam, p. 18 15 See BriefAccount of DmgAbuse and Countemeasum in Jam, (Tokyo: Ministry of Health and Welfare 1989), p 21. See also Donald Kirk and Susanne Kirk, Kicking the Habit i n Japan, Sahtrday ReviewWodd Magazine, June 15,1974, pp. 55-59.The Kirks estimate the number of heroin addicts in 1960 at 200,ooO 5 rests in 1955, the number of people apprehended for stimulant offenses fell below 1,OOO in 1958 and remained there every ye ar through 19 69. In 1970, however, the number rose to 1,682, and thereafter doubled every year through 19 74. Stronger laws, especially on precursor drugs, resulted in a 40 percent drop in arrests in 1975, but the upward trend resumed in 1976 and by 1984 , the number of arrests had risen to over 24,000 An important component of Japans efforts to control drug use has been the ex tensive involvement of citizen volunteers. More than 15,000 volunteers distribute anti-drug abuse information, and more than 60,0 0 0 re voluntary probation of ficers, regularly visiting the homes of former addicts.lTaken together with the police-citizen cooperation fostered by Japans Koban system of local police of ficers, these volunteer programs guarantee a high level of citizen pa rticipation in Japans anti-drug efforts sensus that law enforcement is the key to winning the fight against drug abuse. Japans policies remain among the toughest in the world. The Netherlands until the late 1960s. When the problem became serious, in the mid-l970s, the government reacted by loosening restrictions on drug use and taking an explicitly expedient approach to the problem as a whole; it legalized drug use. Along with most developed countries, including the U.S Britain, and Japan, the Netherlands signed the 1912 Hague Convention calling for international restric tions on trafficking in and using opium.18 Legislation enforcing the Convention and imposing criminal penalties on the possession and sale of opium and its deriva tives, took effect throu gh the Opium Act of 19 19. In 1928 and 1976, the law was amended to bring it into line with international treaties calling for prohibitions on illicit substances. Like most other countries, therefore, the Netherlands has a long history of drug prohibition . And throughout most of the post-war period, the Netherlands was vir tually a drug-free society. As recently as 1965, drug use (mainly opium) there was limited to a small Chinese population, and drug convictions during the early 1960s Japans successful f i ghts against stimulants and heroin have created a strong con Drugs were late in coming to the Netherlands; there was no substantial problem 16 See Brief Account, p. 10 17 See William Clifford, Some Characteristics of the Application of the Criminal Justic e System in Japan Selected Issues in Crinainal Justice 4 (1985), pp. 7-8 18 For background on the Hague Convention, see David E Musto, me American Disease: Origins of Nmotics Contml (New York: Oxford University Press, 1983, pp. 49-53 6 averaged only 23 per year.l9 Thus, while there were laws against drug use, there was no historical need for significant enforcement. This changed by the mid-1970s. Heroin, LSD, marijuana, and hashish appeared in the Netherlands in abundance during the early 197Os, making Amst erdam a mecca for young drug users The problem was exacerbated by the sudden influx of 35,000 immigrants from Surinam (formerly Dutch Guiana) in 1975, many of whom were un ble to et work and .became part-of a substantial, by Dutch standards, un derclass. T here appear to be no solid statistics on the extent of drug use in the Netherlands during this period, but drugs clear13posed enough of a problem to prompt a major re-examination of drug policies The Expediency Principle. The result of this re-examination was the revision in 1976 of the Opium Act, and the issuance, concomitantly, of enforcement regula tions. While the revised Opium Act did not explicitly legalize any drugs in fact, it increased penalties for drug trafficking -regulations issued under the a c t called for police to ignore possession and sale of small quantities of cannabis, and generally, to ignore small quantities of cocaine, heroin, and other hard drugs.22 These regulations were based explicitly on what the Dutch refer to as the ex pediency principle the idea that prosecutors should be empowered to refrain from instituting criminal proceedings if there are weigh considered on grounds deriving from the public good. Responding to an increase in heroin use in the late 197Os, the government adopt ed the principle of harm-reduction as the overall goal of drug policy: the main objective is not the fight against drugs as such but the minimization of harm caused by illegal drugs to the drug user and to socie ty Then, in the early 1980s,.the Dutch adde d a third principle: normalization. This means, according to the government, that drug use should be shorn of its taboo image and its sensational and emotional overtones drug users, or even ad dicts, should not be regarded primarily as criminals nor as dep endent, helpless patients Ig ublic interests to be 9 124 The Dutch established a widespread network of drug rehabilitation programs and treatment centers, the goal of which has been to maintain contact with and 19 See Frits Ruter, The Pragmatic Dutch Appr o ach to Drug Control: Does It Work May 25,1988,Text of lecture delivered in Washington, D.C sponsored by the Drug Policy Foundation p. 6 20 See Rosemary Brady, In Dutch, Fobs, February 27,1984, p. 46 21 See Henk Jan Van Vliet, Syringe Exchange; AIDS-Preven t ion and Drug Policy in the Netherlands, Paper presented at the annual meeting of the Society for the Study of Social Problems, Atlanta, Georgia, August 2023,1988, p. 7 22 See Ruter, p. 7 23 See Fact Sheet on the Netherlands Drug Policyl (Fact Sheet 19-E-8 9 , Ministry of Welfare, Health and Cultural Affairs, The Netherlands, 1989 p. 2 24 See Van Vliet, p. 7 25 Fact Sheet, p. 4 7 prevent the alienation and isolation of drug users. By the late 198Os, the govern ment was maintaining nearly 100 drug treatment fa c ilities nationwide, in addition to methadone supply centers in 55 municigalities and residential treatment facilities with a total capacity of 900 beds The Dutch outreach effort uses what Americans surely regard as unusual ap proaches. In Amsterdam, for e x ample, methadone is distributed by mobile buses in an effort to make sure.that it -is available to anyone who wants it. Drug addicts meanwhile, are encouraged to participate in the political process through Junky Unions, political organizations that lobby on drug policy issues on behalf of drug addicts. The Dutch appear to see these developments as natural outgrowths of their pragmatic approach and, indeed, as helpful in their efforts to make sure that drugs are not relegated to the fringes of legitimate s ociety. There are virtually no reliable historical statistics on the overall drug use in the Netherlands.The suwey data that are available su est that drug use remained stable from the late 1970s through the early 1980s. Though drug use did not ex plode ou t of control, little if any progress was made in reducing it.The result, until recently was a domestic consensus that drug use was, if not declining, at least under control.This consensus is now crumbling because of recent increases in drug use and associ ated crime Singapore Singapores experience with drugs is nearly the opposite of the Netherlands: A long history of drug use, strong emphasis on criminal enforcement, and significant progress in reducing the number of users. As in many Asian cultures, Singa pore has a long tradition of opium use. An al most all-Chinese city, substantial portions of its inhabitants used opium at the tum of the century. Regulations against opium use were tightened during the 193oS leading to what is believed to have been a dec line in the number of addicts.The lack of control under Japanese occupation of Singapore from 1942 to 1945, how ever, is thought to have increased use. In 1946, with the restoration of British rule, opium was finally made illegal in Singapore and aggressive efforts were made to limit supply. A residential treat ment facility was opened in 1954, to which opium addicts were committed for one year stays. By 1970, it is estimated that th e number of o ium addicts had fallen to less than 8,000, down from an estimated 30,000 in 1945. Western Corruption. Just as the opium problem was finally disappearing, heroin began appearing in Singapore in substantial quantities, often in conjunction with marijuana and methaqualones (depressants In contrast to the old group of opium addicts, the new drug users were young, multi-drug users influenced, the Sin 26 See Fact Sheet, p. 5 27 See Ruter for the best available compilation 28 See W.H. McGlothin, The Singapore Heroin Control Programme, in DnrgAbuse in Singupom, pp. 39-52 8 gaporeans believe, by rock and roll and the permissive Western culture. Whatever the cause, the growth of drug abuse in the early 197 explosive: From 1972 to 1975, total heroin arre sts soared from just 4 to 2,263 Singapores reaction was to pass one of the worlds toughest anti-drug laws, the Misuse of Drugs Act of 19 73. The law calls for mandatory commitment of all drug users to Drug Rehabilitation Centers; permits commitment through an administra tive process, on the basis of a urine.testor the opinions of two physicians; allows for unlimited re-commitment for users not considered to be rehabilitated im poses tough penalties for drug dealing, including corporal punishment (caning an d , under a 1975 amendment, imposes a mandatory death penalty for anyone con victed of smuggling a large quantity of any drug, including marijuana Aggressive Enforcement. The law has been backed up since 1977 with extremely aggressive enforcement. Between A p ril and December 1977, nearly 20,000 suspected drug users were rounded up by police sweeps of known places of con gregation and given urine t sts. Of these, 7,725 tested positive (nearly all for heroin) and were detained. Drug sniffing dogs patrolled the borders, where 323 people were arrested for drug trafficking in 1977 alone. Under this policy, tough sentences were meted out to both drug users and traf fickers. For drug users, the penalty is administrative commitment to one of five Drug Rehabilitation C enters (DRCs) for a six-month regime of cold-turkey withdrawal, physical exercise (including military-type calisthenics and work programs. Upon release, addicts are channeled into an intensive supemision pro gram that includes urine testing every five day s.Those who test positive are re committed, this time for periods ranging up to 36 months. For traffickers, the penalties are far more severe. Mandatory minimum senten ces of five years, plus five strokes of the cane, are levied on even small-time heroin d ealers; three years and three strokes of the cane for marijuana sellers. Large traf fickers either receive the death penalty or, under the Criminal Law (Temporary Provisions) Act, are arrested and detained indefinitely. Between 1977 and 1983 2,440 drug tr a ffickers were convicted and sentenced to prison, 15 were executed and five more were sentenced to die Involving Citizens. As in Japan, an important element of Singapores approach is very active citizen participation. The Singapore Anti-Narcotics Associati o n SANA a public-private partnership that receives one-third of its funding from the government and the remainder from private sources, was founded in 1972 to recruit volunteer counsellors for addicts after their release from Drug Rehabilita 30 51 32 29 Se e Drug Control Programme in Singapore, Singapore Central Narcotics Bureau, 1989, p. 2 30 Drug Control Programme in Singapore, p. 3-4 31 See Drug Abuse in Singapon p. 42 32 See DrugAbiise in Singapom pp. 43-46 33 See Drug Abuse in Singapow, p. 18 9 tion Cen t ers and to assist with public information campaigns. With a full-time staff of 50 people, SANA provides one-on-one counselling for about one-third of those released, offering one counsellor for every 1.4 individuals supervised.34 SANA counsellors visit th e homes of those whom they supervise, conduct group counsell ing, and try to involve former drug users in religious activities. In addition, SANA provides drug education and prevention ervices, with active programs in busi nesses, high schools, and parent groups. The result of Singapores comprehensive approach to drug abuse was a sig nificant reduction in drug use. At the peak of the heroin epidemic, in 1977, there were an estimated 13,000 addicts; by 1983 the number had dropped to only 6,000. The number of students arrested fell from 175 in 1977 to 2 in 1983, and the shar of those arrested classified as new addicts fell fiom 67 percent to 20 percent. Singapore was not successful in completely eradicating drug use. During the 1980s, heroin and other drugs remained a problem, and there is evidence that usage has been increasing since the end of the 1980s. Yet, Singapore is not backing away, apparently convinced that tough policies have worked and will continue to do so if rigorously applied 3s 3 WHERE THEY STAND TODAY: ASSESSING THE RESULTS The question for American policy makers is: Are the experiences of countries as diverse as Singapore and the Netherlands relevant for American drug policies? Cultural differences and limitations in data make it difficult to draw precise or final conclusions. Data limitations are especially problematic. In the Netherlands survey data are available on the extent of drug use in the population, but little data 1 are published on drug arrests; in Britain, the opposite is true. And, even where comparable data are available, differences in collection methodologies make cross national comparisons difficult. Important, too, are the very different historical pat terns of drug use and the impact of varying ethnic and cultural mixes. Yet some strong inferences can be drawn about each countrys drug policies by looking at these kinds of data. First, what are the trends (where data are available in drug use in each country? Have the policies reduced drug use and its attendant costs, rela tive to historical patterns? Second, how does each country assess the ef fectiveness of its own policies. Do citizens and policy makers see their policies achieving the desired results, or are their policies failing on their own terms? Third, based on the little empirical data available, what can be inferred about the extent of drug use across countries Trends in Drug Use 34 See Dtug Abuse in Singapom pp. 48-49 35 See Selected Readings in DtugAbuse (Singapore: Singapore Anti-Narcotics Association, 1989 pp. 30-33 36 Statistics provided by Singapore Central Narcotics Bureau 10 Both Japan and Singapore successfully dealt with earlier episodes of drug use neither Britain nor the Netherlands can claim such success. Yet, recent data from both Japan and Singapore indicate that drug abuse is mounting. Perhaps, there fore, drug abuse is immune to permanent solutions. Staying the Course in Japan. Japans success in controlling stimulants in the 1950s and heroin in the early 1960s was followed by nearly a decade of rela tively little drug use. Stimulant use,-however, began a sustained climb during the 1970s and 1980s. with the number of arrests peaking at over 24,000 in 1984 Since then, the Japanese appear to have again turned the comer, with the num ber of arrests falli ng each year, to 16,612 in 19 89. Importantly, the number of juvenile arrests (a leading indicator) fell from 2,552 (10.6 percent of the total) in 1984 to 1,273 (6.2 percent of the total) in 19 88. And, the amount of stimulants seized fell dramatically from 1987 to 1988, from 1,364 pounds to 471 pounds. Trends with respect to other drugs appear to be relatively flat. Fewer than 100 people have been arrested in Japan for narcotics-related crimes in each year since 1974; arrests fo r opium possession and cultivation, at 199 in 1988, are at the level that prevailed throughout the 1970s and 1980s; and, while the number of arrests for cannabis increased from 1,173 in 1980 to 1,464 in 1988, these numbers are so small relative to Japans total population of 122 million as to be insignificant. And 37 there is virtually no evidence of any infiltration of cocaine or crack into Japan. Singapores Problem Growing Slowly The estimated number of heroin addicts in Singapore fell from 13,000 in 1977 to 6,000 in 1983, but by 1988 it had risen again to 9,0 00. Similar trends were seen in the number of arrests and commit ments to Drug Rehabilitation Centers, with arrests rising from 3,449 in 1983 to 5,451 in 1988 and the number of commitments to Drug R ehabilitation Centers rising from 2,687 in 1983 to 4,474 in 1988 More troubling is that new addicts now make up nearly 25 percent of all those arrested, up from 20 percent in 1983; 10 percent of those arrested are under age 20 compared with less than 7 pe r cent in 1983 Singapores recent problems appear to be largely the result of an influx of Malaysian immigrants, many of whom use drugs. Malays accounted for 27 percent of all drug arrests in 1983, but in 1988 the Malay share was 52 percent As in Japan, rece n t drug use in Singapore is almost entirely confined to a single drug (in this case, heroin and there is little evidence of significant problems with either opium or marijuana. And as in Ja an, there is no evidence of any sig nificant penetration of cocain e or crack. Good News, Bad News for Britain? After rising continually for nearly a decade there is evidence that drug use in Britain may have reached a plateau in the mid 8 37 All statistics in this section are taken fromAnti-DnrgActivities in Jav 38 All s tatistics cited in this section were provided by the Singapore Central Narcotics Bureau 11 1980s. But there is also evidence of increased use of cocaine and marijuana, and no evidence at all of any significant decline. The good news in Britain involves he roin.The number of newly-identified heroin addicts, after rising continually since 1977, fell in 1986 and 1987 from a peak of 5,930 in 1985 to 4,082 in 1987.The amount of heroin seized also fell, from 805 pounds in 1985 to 517 pounds in 1987 The bad news concerns other drugs. With respect to heroin, the number of ad dicts receiving methadone and other drugs from the government reached an all time high in 1987, at more than 10,0 00. Marijuana arrests nearly doubled between 1977 (10,607) and 1983 (20,066 and rose further to a record 21,475 in 1987 Even more troubling, cocaine use appears to be growing rapidly. The number of cocaine seizures was up 13 percent in 1987, and the amount seized set an all-time record of 893 pounds more than quadruple the amount fo r 1986 and nearly as much as the previous t n ears combined. And, there is now evidence that crack is spreading into Britain. In short, Britain appears to be a long way from winning its war against drug abuse. Putting Up a Good Front in the Netherlands. Perhaps because of the often criti cal international focus on the Netherlands drug policies, official Dutch statements on drug policy are reflexively upbeat. Yet trends are disturbing. One source of data on drug use trends in the Netherlands is a 1987 surv ey of the general population,a in which one question asked drug users when they first began using drugs. The finding: More people began using drugs between 1983 and 1986 than at any time during the previous 30 years. Among the seven classes of drugs surve yed, the rate of new users was down only for cannabis and LSD; first use of amphetamines, cocaine, hypnotics, opiates, and sedatives was higher than during any previous three-year period. This survey appears to confirm other evidence now emerging from the Nether lands. One study, for example, finds that the number of addicts a ng for treat ment in Amsterdam more than doubled between 1981 and 19 86. Another study i9 41 39 The statistics that appear in this section are taken from Statistics of the Misuse of Dmg, Unifed Kingdom 1987 40 Overall, the survey found levels of drug use roughly similar to those in the U.S. Regular marijuana use among 23-34 year-olds, for example, was estimated at 145 percent of the population, compared with 17.4 percent in the U.S. Six out of every thousand people were regular users of cocaine, compared with 11 out of a thousand in the U.S. See Fact Sheet, p. 1 41 See Ruter, pp. 17-20 42 See Engelsman, p.212 12 finds that, contrary to government assertions, crack use is not at all a rarity.43 And, the Dutch government admits that drug abuse seems to have increased among groups in a relatively disadvantaged social and economic position and that the use of cocaine is increasing The most that the Dutch government, in a 1989 statement, c a n claim for the overall pr blem is that it appears to be stabilis ing and is even decreasing in some cities In short, there is virtually noevidence that drug use in the Netherlands is falling there is some evidence that it continues to grow Self-Evaluatio n s Another way of evaluating the success of each countrys drug policies is to ex amine how those policies are assessed internally Popular Support. In Japan and Singapore, there is little criticism of the tough policies. Both countries have been very succes s ful in recruiting broad segments of the population into the drug programs, as volunteer counselors and probation of ficers, in raising money for private-sector treatment facilities and serving, in the case of business as sources of expertise. In response t o recent increases in drug use, Japan and Singapore opt for more of the same: tougher laws, more enforce ment, greater insistence on user accountability and longer sentences for drug dealers In Britain, there clearly was dissatisfaction with the permissiv e policies of the 1970s and 1980s.The result is that Britain has moved away from its early experi ment with legalized heroin prescription and drug maintenance, moving instead toward the use of methadone in decreasing doses until the drug use is stopped en t irely. In addition, and with little fanfare, the British have toughened their sentenc ing policies significantly. Between 1977 and 1987, the average sentence for all drug crimes rose from 16.4 years to 20.5 years, while the proportion of drug offenders wh o received prison sentences rose from 11 percent to 13 percent. Nearly twice as many prison sentences were handed out in drug possession cases 1,730 in 1987 compared with 922 in 1977 Pressures to modify the British System further are strong and growing. Gr i f fith Edwards, one of Britains leading drug policy experts, last year responded to suggestions that America copy the British experiment, stated that the situation [in Britain] is messy and unsatisfacto ry theres really nothing now for the Americans to co p y academics who designed the current policies, are deeply committed to staying the A Voices of Dissent. As for the Netherlands, there the government, and many 43 See Jean-Paul C. Grund, Where Do We Go From Here? The Future of Dutch Drug Policy, British Jo u mcrl ofA&ction Research (September 1989 pp. 992-995 44 See Foct Sheet, p. 1 45 See Foct Sheet, p. 1 46 See Statistics of the Misuse of Dtugr 47 Quoted in Anthony Meune, NO Quick Drug Fq National Review, March 24,1989, p. 21 13 TOTAL AND PER CAPITA DRUG SE I ZURES IN FOUR COUNTRIES Heroin,Cocaine Stimulants Marijuana Haehirh I I BRITAIN I JAPAN I NETHERLANDS I SINGAPORE I 0.014 0.006 0.073 0.021 0.16 0.02 1.50 0.05 0.14 3.14 0.0 course. But voices of dissent increasingly are being raised. One reason for this i s the rise in drug-related crime. Surprisingly, one of the most powerful statements of the problem comes from one of the most ardent defenders of the current Dutch policies, Professor Frits Ruter of the University of Amsterdam. In a May 1988 ad dress in W ashington, D.C he noted that It is estimated that the Dutch police spend half their time on investigating drug trafficking and drug-related crimes. Over 75 percent of the suspects taken into custody in Amsterdam are connected in some way with drugs, and 70 percent of the persons remanded in custody by the examining magistrate are either drug traffickers or involved in drug-related crimes. In our pris o ns nearly 50 percent of the inmates are drug addi cts A recent survey showed that 40 percent of the inhabitants of Amsterdam considered that the protection offered by the police was insufficient The Netherlands policies are also coming under attack in the political realm. Amsterdam Mayor Eduard vanThijn has been especially critical, telling a reporter that In the past 15 years, tolerance became synonymous with permissiveness weakheartedness and softness on law-and-order. Today, backlash and debate about wh ere Dutch society is going are in the air.9 48 Ruter, p. 11 49 See Tolerance Finds Its Limits, lime, August 31,1987, p. 28 14 Comparative Statistics countries. Some countries keep statistics on arrests, others on convictions; some use surveys to estimate the number of users, others register addicts. One statistic that is kept in Britain, Japan, the Netherlands and Singapore, how ever is the amount of drugs seized by police and customs officials.These statistics offer some means of estimating the amount of drugs used in each country. Divid ing by the popalation they also infer per capita drug consumption, at least on a relative scale The lack of adequate data makes it difficult to compare rates of drug use across Dramatic Data. The table above shows the tot a l and per capita drug seizures in each of the four countries examined in this study for three classes of drugs: 1 heroin, cocaine, and stimulants; 2) marijuana; and 3) hashish. What it shows is that seizures per capita (the lower half of the table) are dr a matically higher in,the Netherlands than in the other three countries. For the hard drugs (cocaine heroin, and stimulants the Netherlands seize more than triple the per capita amount for Singapore and more than five times as much as Japan. Even more drama t ic contrasts appear for marijuana and hashish: Nearly ten times as much marijuana is seized, per capita, in the Netherlands than in Britain, its nearest rival and, for hashish, over three grams of hashish are seized, each year, for every in habitant of th e Netherlands. While these statistics could be overstated because of Rotterdams important role as a drug transshipment point (that is, it could be argued that much of what is seized in the Netherlands is bound for consumption elsewhere it may also be true that the Netherlands takes a more relaxed attitude toward enforcement, espe cially with respect to marijuana and hashish, than any of the other three countries and its seizure rate is therefore likely to be understated CONCLUSIONS Two basic facts about th e history and current status of drug abuse in Britain Japan, the Netherlands and Singapore cannot be avoided. First, the two countries with the toughest policies, Japan and Singapore, dramatically reduced drug use over the past 20 to 30 years. By contrast, the countries with the more lax policies Britain and the Netherlands, have made little if any progress in fighting their drug 50 Two assumptions must hold for this comparison to be valid. First, it must be assumed that police seize roughly the same propor t ion of the drug supply in all four countries (and, thus, that roughly the same proportion gets through). While it seems unlikely that seizure rates are precisely equal in the four countries examined here, all four do have aggressive anti-trafficking progr a ms and there is no obvious reason to reject this assumption. It also must be assumed that drugs seized in each country are in fact bound for domestic drug users and not being transshipped. Of the four countries, only the Netherlands is a substantial drug t ransshipment center, and the figures that result from this analysis could therefore be somewhat overstated (though it seems unlikely they are overstated enough to account for the surpriSiag findings 15 problems during the 1970s and 198oS. While get-tough policies have not eradi cated drugs altogether, they have done better than the alternative. Second, Japan and Singapore have developed and pursued long-run approaches to drug abuse that have won the broad support of their populations and to which they rema in fully committed. By contrast, neither Britain nor the Netherlands has been successful in finding a long-run formula winning ongoing support. Japan and Singapore have no intention ofchanging their approaches; Britain and the Nether lands are either in t he process of changing or seriously considering it. The lessons for the U.S. in the experiences of these four countries 1) Britain and the Netherlands offer no evidence that legalization of some or all drugs offers hope of reducing drug use or its conseque nces. Indeed, the U.S. has been far more successful in reducing drug use under its current policies than either Britain or the Netherlands 2) The experiences in Japan and Singapore offer some guideposts for American reforms. While the more draconian aspec t s of these policies, such as unlimited detention of drug traffickers without trial, would not be appropriate in the U.S other components of the Japanese and Singaporean programs, such as mandatory drug rehabilitation for users, increased use of urine test i ng within the criminal jus tice system and the death penalty for serious traffickers, could result in increased progress if applied in America. And, without question, America could benefit greatly from the kinds of active citizen participation in the war on drugs seen in both Japan and Singapore. Jeffrey Eisenach Visiting Fellow Andrew Cowin Research Associate 16
790 September 24, 1990 FIGHTING DRUGS IN FOUR COUNTRlESt LESSONS FOR AMERICA INTRODUCTION Policy makers debating America's anti-drug policies often loopforeign countries for examples. Proponents of drug legalization, for instance, often cite Britain or the Netherlands as e v idence that legalization "wo;ks in the sense of reducing drug usefirough non-criminal justice mechanisms. Proponents of tougher criminal laws against drugs often cite Japan and Singa ore to support ar guments in favor of tougher enforcement in the United States. This raises the question of whether general conclusions can be drawn from the experiences of countries as diverse as Japan and Britain, Singapore and the Netherlands. And, even if they could, would they be relevant for the U.S In fact, there are a number of difficulties in making comparisons of national drug policies.There are problems with data: no two countries collect precisely the same figures in the same way. There are semantic problems: the term "rehabilita tion for example, means one thing i n Japan and something very different in Britain or the U.S. There are cultural and historical differences. Misleading Reports. Policy makers thus must be cautious about adopting the conventional Wisdom on overseas drug programs as a guide for American policy. At least with respect to Britain, Japan, the Netherlands, and Singapore, four countries whose drug programs frequently are cited, it is clear that much of what has been written is misleading with respect to both their current policies and their succes s in controlling drugs s I I I I I 1 See, for example, War by Other Means The Economist, February 10,1990, p. 50 2 See, for example, A.M. Rosenthal The Japanese Mystery New York Ti, April 7,1989. There is no evidence that the decriminalization policies of Britain (limited decriminalization of heroin and relatively lax enforcement against drug users) or the Netherlands (virtual legalization of all kinds of drug use) have limited either drug use or its consequences. Both countries have substantial drug prob lems, with the attendant crime and social decay, and little progress is apparent toward reduc ing drug use in either country. By contrast, there is some evidence that the tougher policies pursued by Japan and Singapore have reduced drug use and its attenda nt costs. Both countries have suffered serious drug epidemics in the past, and both subsequently brought their drug problems under control -something that cannot be said for Britain, the Netherlands, or America Reasons for Success. The success of Japan an d Singapore in controlling their drug problems can be attributed to three main factors: First, both countries have adopted very aggressive policies to stop the supply of drugs including, in Singapores case, use of the death penalty for major drug dealers. S econd, both countries have adopted tough user accountability policies, including widespread use of drug testing to identify drug users and incarceration of users in work camps designed both to punish and to rehabilitate.Third, both countries have been suc cessful in recruiting large numbers of citizen volunteers into the fight agaihst drugs. While caution must be exercised in drawing conclusions that could have implica tions for the U.S the pattern that emerges from studying these four countries sup ports a tougher rather than a more permissive approach to drug abuse, focussed especially on drug users as the most promising strategy for reducing drug use in the United States DRUG POLICIES IN FOUR COUNTRIES HOW THEY EVOLVED Perhaps the most important element t o be considered in assessing overseas drug policies is the historical and cultural context.Todays drug problems are, at least in part, a function of the historical prevalence of drugs in each society. Current drug policies, moreover, are themselves a reac t ion to past experiences Britain permitting doctors to prescribe heroin and other hard drugs to drug addicts Less well publicized are two other important facts: First, the British experiment with prescribing heroin to addicts ended, for all practical purpo ses, in the mid 1970s; second, the British have and enforce laws against all forms of drug posses sion.Thus there is no broad policy of decriminalization in Britain. The British policy of providing heroin and morphine to addicts originated after World War I. In 1926, the Rolleston Report, named after the chairman of the government committee that prepared ib found that there were a limited number of heroin and morphine addicts, many of whom became addicted after being Heroin and the British System. Britain is most widely known for its policy of 2 treated for wounds during the war. Lacking any available cure, the government adopted the committees recommendati n to errnit doctors to prescribe heroin to these addicts on a maintenance basis. By the early 1960s, it was apparent that heroin use was rising dramatically. Another government committee was convened to review the situation, and its 1965 report (the Brain Committee Report, named, again, for the chairman) con firmed a vast increase in the-number of heroin addicts, especially among the young. More troubling still, the report concluded that BP the major source of supply has been the activity of a very few doctors who have prescribed excessively for addicts.Thus we were informed in 1962 t hat one doctor alone prescribed ahoy 600,000 tablets of heroin (Le. 6 kilograms) for addicts. As a result of this report, the right of doctors in Britain to prescribe heroin was limited, effective in 1967, to those physicians specially licensed by the government. In addition, the government moved to set up special treatment clinics specifically for the purpose of treating heroin addicts, including prescribing heroin. Reducing Dependence. While there is much debate (and little hard evidence) on precisely wh at happened at the clinics during the 1970s: it is clear that there was a gradual evolution away from prescribing heroin, in favor of methadone, and that the general practice moved away from providing long-term maintenance doses and toward efforts to get heroin users to reduce and eventually terminate their use altogether! Despite these changes, the governments policies toward heroin were anything but effective in restraining its use. Indeed, a 1989 study estimates that heroin con sumption grew at an avera ge annual rate of 10 percent over the period 1974-1981 and 21 percent over the period 1982-19 84. Thus, Britain entered the late 1980s with a substantial heroin problem and a growing consensus on the need for a change in its policies 3 7-9,s. See also Gri fith Edwards, Evolutions of the British System, in problems of DtugAbuse in Britain: Papem hsented at the Cropwood Roundtable Confewnce (Cambridge, England University of Cambridge 4 lbid.,p.ll. 5 For the best available summary, see Edwards, pp. 25-36. 6 B y 1987, only 186 (1.8 percent) of the 10,398 drug addicts receiving drugs under prescription were receiving heroin. Nearly all the others received methadone. See Statistics of the Misuse of Drugs, United Kingdom 1987 Home Office Statistical Bulletin 25/88, September 6,1988.Table 3.4 7 A. Wagstaff and A. Maynard, Economic Aspects of the Illicit Drug Market and Drug Enforcement Policies in the United Kingdom, Bdkh Joumul OfAddiction 84 (1989), p. 465 See P. Bucknell and H. Ghodse, Bucknell and Ghodse on Misus e of Drug (London: Waterlow, 1986 pp 1978), pp. 1-41 3 While British use of other drugs, from cannabis to cocaine, has generally lagged behind Americas, its policies have evolved along a similar path. As in the U.S criminal penalties for trafficking and po s session of illicit drugs, including cannabis were established in Britain following World War I, and have been updated since Enforcement of these laws has also followed the pattern in the U.S with the most emphasis on stopping the supply of drugs and relat i vely little emphasis on prosecuting drug users8 Japan Despite Japans reputation as a highly-regimented, culturally conservative na tion it has seen three major outbreaks of drug use, involving stimulants and heroin, since World War 11. In each case, the J apanese have responded with a for ceful program focussed on interdicting supply and eradicating (to use Japans term) drug users. And in each case, the result has been a relatively rapid and dramatic reduction in drug use. With respect to other drugs, the J apanese have applied the same tough policies as applied to heroin and stimulants, but with even greater success. Cocaine marijuana, PCP, and LSD use in Japan has been and remains virtually insignificant Stimulants: the First Epidemic. Japans first drug ep i demic occurred during the late 1940s and early 195Os, and involved the use of stimulants (primarily metham phetamines which were widely distributed to Japanese soldiers during the World War I1 to improve fighting performance. By the mid-l950s, an estimate d 2,000,000 Japanese were using stimulants illegally, and 550,000 were regular abusers a sig nificant epidemic, even by modem U.S. standards? Japans reaction to this sudden outbreak of drug abuse, the first in its history was swift and tough. In 1951, Japa n substantially toughened its laws against stimulant sales and possession and began jailing dealers and users. When the epidemic reached its height during 1954, some 55,654 people were arrested. When this approach failed to achieve the desired results, th e Japanese in 1954 increased penalties for manufacture, added new penalties for precursor drugs (the chemical compounds from which stimulants are manufactured) and inaugurated a system of forced hospitalization for chronic drug users. Under this policy, d rug users were rounded up in droves, forced to go through cold-turkey withdrawal and placed in work camps for periods ranging from a few months to several years. This approach to drug users, still in force today, is seen by the Japanese as a humane policy focussed primarily on rehabilitation. By American standards, how ever, these rehabilitation programs would be seen as very tough, if not 8 Comparison, Jooumuf of Drug Issues, Fall 1979, pp. 491-99 9 Japan 1945-55, Seminars in Psychiutty 1;2 (May 1%9 pp. 1 7 9-194 10 See Brill and Hirose, p. 179 11 See Anti-DmgActivities in Jupun (Tokyo: National Police Agency of Japan, 1989 p. 20 See Gerald E Uelmen, Sentencing Narcotics Offenders in Great Britain and the United States: A See Henry Brill, M.D. and Tetsuya Hi r ose, M.D., The Rise and Fall of a Methamphetamine Epidemic 4 draconian, punishment.The Japanese from the very beginning have opted for a cold-turkey drug withdrawal.Thus, every heroin addict identified in Japan is re quired to enter a hospital or treatmen t facility, where they go immediately through withdrawal. Conviction through the criminal justice system is not necessary for commitment. Any addict identified, either through examination by physicians or through urine testing, is committed through an admi nistrative process As a result courts are not burdened with heavy caseloads of drug users, drug users are not sad dled with criminal records and punishment for drug users is swift and sure. The government also launched a substantial public education campai gn, includ ing distributing anti-drug messages through government-controlled television movies, radio, newspapers, magazines and books, and posters in airports, railroad stations, bus terminals, and public buildings. Cabinet ministers, governors, mayors a nd other public officials regularly conducted public forums on the perils of drug use. These policies dramatically and rapidly cut drug use. Within four years of the 1954 amendments, the number of people arrested for violating the Stimulant Con trol Law dr opped from 55,654 to only 271 in 1958.3 Heroin in the Early 1960s. Unlike many Asian countries, Japan had no histori cal pattern of opiate use prior to the But late in that decade, just as the stimulants epidemic was winding down, Japan began experiencing serious problems with heroin By 1961 it is estimated that there were over 40,000 heroin addicts in Japan.s to their new problem with heroin by imposing, in 1963, still tougher penalties against importation and selling, and by imposing a mandatory rehabili tation regime for addicts. The results of Japans tough heroin program mirrored those of its successful fight against stimulants. The number of arrests for heroin sale and possession fell from a high in 1962 of 2,139 to only 33 in 1966 and have never risen above 100 since. Stimulants Make A Comeback Japans successful fight against stimulants in the 1950s resulted in a decade of dramatically reduced use. After peaking at 55,664 ar 12 Using their successful fight against stimulants as a model, the Japanese reacted 12 See Kiyo s hi Morimoto, The Problem of the Abuse of Methamphetamines in Japan, Bulletin on Natcotics July-September 1957 pp. 8-12 13 See Brill and Hirose, pp. 180-1 14 This fact is attributed by the Japanese to their tough anti-drug policies (including the death pen a lty for opium use) and isolation from other nations. SeeAnti-DnqActivifies in Jam, p. 18 15 See BriefAccount of DmgAbuse and Countemeasum in Jam, (Tokyo: Ministry of Health and Welfare 1989), p 21. See also Donald Kirk and Susanne Kirk, Kicking the Habit i n Japan, Sahtrday ReviewWodd Magazine, June 15,1974, pp. 55-59.The Kirks estimate the number of heroin addicts in 1960 at 200,ooO 5 rests in 1955, the number of people apprehended for stimulant offenses fell below 1,OOO in 1958 and remained there every ye ar through 19 69. In 1970, however, the number rose to 1,682, and thereafter doubled every year through 19 74. Stronger laws, especially on precursor drugs, resulted in a 40 percent drop in arrests in 1975, but the upward trend resumed in 1976 and by 1984 , the number of arrests had risen to over 24,000 An important component of Japans efforts to control drug use has been the ex tensive involvement of citizen volunteers. More than 15,000 volunteers distribute anti-drug abuse information, and more than 60,0 0 0 re voluntary probation of ficers, regularly visiting the homes of former addicts.lTaken together with the police-citizen cooperation fostered by Japans Koban system of local police of ficers, these volunteer programs guarantee a high level of citizen pa rticipation in Japans anti-drug efforts sensus that law enforcement is the key to winning the fight against drug abuse. Japans policies remain among the toughest in the world. The Netherlands until the late 1960s. When the problem became serious, in the mid-l970s, the government reacted by loosening restrictions on drug use and taking an explicitly expedient approach to the problem as a whole; it legalized drug use. Along with most developed countries, including the U.S Britain, and Japan, the Netherlands signed the 1912 Hague Convention calling for international restric tions on trafficking in and using opium.18 Legislation enforcing the Convention and imposing criminal penalties on the possession and sale of opium and its deriva tives, took effect throu gh the Opium Act of 19 19. In 1928 and 1976, the law was amended to bring it into line with international treaties calling for prohibitions on illicit substances. Like most other countries, therefore, the Netherlands has a long history of drug prohibition . And throughout most of the post-war period, the Netherlands was vir tually a drug-free society. As recently as 1965, drug use (mainly opium) there was limited to a small Chinese population, and drug convictions during the early 1960s Japans successful f i ghts against stimulants and heroin have created a strong con Drugs were late in coming to the Netherlands; there was no substantial problem 16 See Brief Account, p. 10 17 See William Clifford, Some Characteristics of the Application of the Criminal Justic e System in Japan Selected Issues in Crinainal Justice 4 (1985), pp. 7-8 18 For background on the Hague Convention, see David E Musto, me American Disease: Origins of Nmotics Contml (New York: Oxford University Press, 1983, pp. 49-53 6 averaged only 23 per year.l9 Thus, while there were laws against drug use, there was no historical need for significant enforcement. This changed by the mid-1970s. Heroin, LSD, marijuana, and hashish appeared in the Netherlands in abundance during the early 197Os, making Amst erdam a mecca for young drug users The problem was exacerbated by the sudden influx of 35,000 immigrants from Surinam (formerly Dutch Guiana) in 1975, many of whom were un ble to et work and .became part-of a substantial, by Dutch standards, un derclass. T here appear to be no solid statistics on the extent of drug use in the Netherlands during this period, but drugs clear13posed enough of a problem to prompt a major re-examination of drug policies The Expediency Principle. The result of this re-examination was the revision in 1976 of the Opium Act, and the issuance, concomitantly, of enforcement regula tions. While the revised Opium Act did not explicitly legalize any drugs in fact, it increased penalties for drug trafficking -regulations issued under the a c t called for police to ignore possession and sale of small quantities of cannabis, and generally, to ignore small quantities of cocaine, heroin, and other hard drugs.22 These regulations were based explicitly on what the Dutch refer to as the ex pediency principle the idea that prosecutors should be empowered to refrain from instituting criminal proceedings if there are weigh considered on grounds deriving from the public good. Responding to an increase in heroin use in the late 197Os, the government adopt ed the principle of harm-reduction as the overall goal of drug policy: the main objective is not the fight against drugs as such but the minimization of harm caused by illegal drugs to the drug user and to socie ty Then, in the early 1980s,.the Dutch adde d a third principle: normalization. This means, according to the government, that drug use should be shorn of its taboo image and its sensational and emotional overtones drug users, or even ad dicts, should not be regarded primarily as criminals nor as dep endent, helpless patients Ig ublic interests to be 9 124 The Dutch established a widespread network of drug rehabilitation programs and treatment centers, the goal of which has been to maintain contact with and 19 See Frits Ruter, The Pragmatic Dutch Appr o ach to Drug Control: Does It Work May 25,1988,Text of lecture delivered in Washington, D.C sponsored by the Drug Policy Foundation p. 6 20 See Rosemary Brady, In Dutch, Fobs, February 27,1984, p. 46 21 See Henk Jan Van Vliet, Syringe Exchange; AIDS-Preven t ion and Drug Policy in the Netherlands, Paper presented at the annual meeting of the Society for the Study of Social Problems, Atlanta, Georgia, August 2023,1988, p. 7 22 See Ruter, p. 7 23 See Fact Sheet on the Netherlands Drug Policyl (Fact Sheet 19-E-8 9 , Ministry of Welfare, Health and Cultural Affairs, The Netherlands, 1989 p. 2 24 See Van Vliet, p. 7 25 Fact Sheet, p. 4 7 prevent the alienation and isolation of drug users. By the late 198Os, the govern ment was maintaining nearly 100 drug treatment fa c ilities nationwide, in addition to methadone supply centers in 55 municigalities and residential treatment facilities with a total capacity of 900 beds The Dutch outreach effort uses what Americans surely regard as unusual ap proaches. In Amsterdam, for e x ample, methadone is distributed by mobile buses in an effort to make sure.that it -is available to anyone who wants it. Drug addicts meanwhile, are encouraged to participate in the political process through Junky Unions, political organizations that lobby on drug policy issues on behalf of drug addicts. The Dutch appear to see these developments as natural outgrowths of their pragmatic approach and, indeed, as helpful in their efforts to make sure that drugs are not relegated to the fringes of legitimate s ociety. There are virtually no reliable historical statistics on the overall drug use in the Netherlands.The suwey data that are available su est that drug use remained stable from the late 1970s through the early 1980s. Though drug use did not ex plode ou t of control, little if any progress was made in reducing it.The result, until recently was a domestic consensus that drug use was, if not declining, at least under control.This consensus is now crumbling because of recent increases in drug use and associ ated crime Singapore Singapores experience with drugs is nearly the opposite of the Netherlands: A long history of drug use, strong emphasis on criminal enforcement, and significant progress in reducing the number of users. As in many Asian cultures, Singa pore has a long tradition of opium use. An al most all-Chinese city, substantial portions of its inhabitants used opium at the tum of the century. Regulations against opium use were tightened during the 193oS leading to what is believed to have been a dec line in the number of addicts.The lack of control under Japanese occupation of Singapore from 1942 to 1945, how ever, is thought to have increased use. In 1946, with the restoration of British rule, opium was finally made illegal in Singapore and aggressive efforts were made to limit supply. A residential treat ment facility was opened in 1954, to which opium addicts were committed for one year stays. By 1970, it is estimated that th e number of o ium addicts had fallen to less than 8,000, down from an estimated 30,000 in 1945. Western Corruption. Just as the opium problem was finally disappearing, heroin began appearing in Singapore in substantial quantities, often in conjunction with marijuana and methaqualones (depressants In contrast to the old group of opium addicts, the new drug users were young, multi-drug users influenced, the Sin 26 See Fact Sheet, p. 5 27 See Ruter for the best available compilation 28 See W.H. McGlothin, The Singapore Heroin Control Programme, in DnrgAbuse in Singupom, pp. 39-52 8 gaporeans believe, by rock and roll and the permissive Western culture. Whatever the cause, the growth of drug abuse in the early 197 explosive: From 1972 to 1975, total heroin arre sts soared from just 4 to 2,263 Singapores reaction was to pass one of the worlds toughest anti-drug laws, the Misuse of Drugs Act of 19 73. The law calls for mandatory commitment of all drug users to Drug Rehabilitation Centers; permits commitment through an administra tive process, on the basis of a urine.testor the opinions of two physicians; allows for unlimited re-commitment for users not considered to be rehabilitated im poses tough penalties for drug dealing, including corporal punishment (caning an d , under a 1975 amendment, imposes a mandatory death penalty for anyone con victed of smuggling a large quantity of any drug, including marijuana Aggressive Enforcement. The law has been backed up since 1977 with extremely aggressive enforcement. Between A p ril and December 1977, nearly 20,000 suspected drug users were rounded up by police sweeps of known places of con gregation and given urine t sts. Of these, 7,725 tested positive (nearly all for heroin) and were detained. Drug sniffing dogs patrolled the borders, where 323 people were arrested for drug trafficking in 1977 alone. Under this policy, tough sentences were meted out to both drug users and traf fickers. For drug users, the penalty is administrative commitment to one of five Drug Rehabilitation C enters (DRCs) for a six-month regime of cold-turkey withdrawal, physical exercise (including military-type calisthenics and work programs. Upon release, addicts are channeled into an intensive supemision pro gram that includes urine testing every five day s.Those who test positive are re committed, this time for periods ranging up to 36 months. For traffickers, the penalties are far more severe. Mandatory minimum senten ces of five years, plus five strokes of the cane, are levied on even small-time heroin d ealers; three years and three strokes of the cane for marijuana sellers. Large traf fickers either receive the death penalty or, under the Criminal Law (Temporary Provisions) Act, are arrested and detained indefinitely. Between 1977 and 1983 2,440 drug tr a ffickers were convicted and sentenced to prison, 15 were executed and five more were sentenced to die Involving Citizens. As in Japan, an important element of Singapores approach is very active citizen participation. The Singapore Anti-Narcotics Associati o n SANA a public-private partnership that receives one-third of its funding from the government and the remainder from private sources, was founded in 1972 to recruit volunteer counsellors for addicts after their release from Drug Rehabilita 30 51 32 29 Se e Drug Control Programme in Singapore, Singapore Central Narcotics Bureau, 1989, p. 2 30 Drug Control Programme in Singapore, p. 3-4 31 See Drug Abuse in Singapon p. 42 32 See DrugAbiise in Singapom pp. 43-46 33 See Drug Abuse in Singapow, p. 18 9 tion Cen t ers and to assist with public information campaigns. With a full-time staff of 50 people, SANA provides one-on-one counselling for about one-third of those released, offering one counsellor for every 1.4 individuals supervised.34 SANA counsellors visit th e homes of those whom they supervise, conduct group counsell ing, and try to involve former drug users in religious activities. In addition, SANA provides drug education and prevention ervices, with active programs in busi nesses, high schools, and parent groups. The result of Singapores comprehensive approach to drug abuse was a sig nificant reduction in drug use. At the peak of the heroin epidemic, in 1977, there were an estimated 13,000 addicts; by 1983 the number had dropped to only 6,000. The number of students arrested fell from 175 in 1977 to 2 in 1983, and the shar of those arrested classified as new addicts fell fiom 67 percent to 20 percent. Singapore was not successful in completely eradicating drug use. During the 1980s, heroin and other drugs remained a problem, and there is evidence that usage has been increasing since the end of the 1980s. Yet, Singapore is not backing away, apparently convinced that tough policies have worked and will continue to do so if rigorously applied 3s 3 WHERE THEY STAND TODAY: ASSESSING THE RESULTS The question for American policy makers is: Are the experiences of countries as diverse as Singapore and the Netherlands relevant for American drug policies? Cultural differences and limitations in data make it difficult to draw precise or final conclusions. Data limitations are especially problematic. In the Netherlands survey data are available on the extent of drug use in the population, but little data 1 are published on drug arrests; in Britain, the opposite is true. And, even where comparable data are available, differences in collection methodologies make cross national comparisons difficult. Important, too, are the very different historical pat terns of drug use and the impact of varying ethnic and cultural mixes. Yet some strong inferences can be drawn about each countrys drug policies by looking at these kinds of data. First, what are the trends (where data are available in drug use in each country? Have the policies reduced drug use and its attendant costs, rela tive to historical patterns? Second, how does each country assess the ef fectiveness of its own policies. Do citizens and policy makers see their policies achieving the desired results, or are their policies failing on their own terms? Third, based on the little empirical data available, what can be inferred about the extent of drug use across countries Trends in Drug Use 34 See Dtug Abuse in Singapom pp. 48-49 35 See Selected Readings in DtugAbuse (Singapore: Singapore Anti-Narcotics Association, 1989 pp. 30-33 36 Statistics provided by Singapore Central Narcotics Bureau 10 Both Japan and Singapore successfully dealt with earlier episodes of drug use neither Britain nor the Netherlands can claim such success. Yet, recent data from both Japan and Singapore indicate that drug abuse is mounting. Perhaps, there fore, drug abuse is immune to permanent solutions. Staying the Course in Japan. Japans success in controlling stimulants in the 1950s and heroin in the early 1960s was followed by nearly a decade of rela tively little drug use. Stimulant use,-however, began a sustained climb during the 1970s and 1980s. with the number of arrests peaking at over 24,000 in 1984 Since then, the Japanese appear to have again turned the comer, with the num ber of arrests falli ng each year, to 16,612 in 19 89. Importantly, the number of juvenile arrests (a leading indicator) fell from 2,552 (10.6 percent of the total) in 1984 to 1,273 (6.2 percent of the total) in 19 88. And, the amount of stimulants seized fell dramatically from 1987 to 1988, from 1,364 pounds to 471 pounds. Trends with respect to other drugs appear to be relatively flat. Fewer than 100 people have been arrested in Japan for narcotics-related crimes in each year since 1974; arrests fo r opium possession and cultivation, at 199 in 1988, are at the level that prevailed throughout the 1970s and 1980s; and, while the number of arrests for cannabis increased from 1,173 in 1980 to 1,464 in 1988, these numbers are so small relative to Japans total population of 122 million as to be insignificant. And 37 there is virtually no evidence of any infiltration of cocaine or crack into Japan. Singapores Problem Growing Slowly The estimated number of heroin addicts in Singapore fell from 13,000 in 1977 to 6,000 in 1983, but by 1988 it had risen again to 9,0 00. Similar trends were seen in the number of arrests and commit ments to Drug Rehabilitation Centers, with arrests rising from 3,449 in 1983 to 5,451 in 1988 and the number of commitments to Drug R ehabilitation Centers rising from 2,687 in 1983 to 4,474 in 1988 More troubling is that new addicts now make up nearly 25 percent of all those arrested, up from 20 percent in 1983; 10 percent of those arrested are under age 20 compared with less than 7 pe r cent in 1983 Singapores recent problems appear to be largely the result of an influx of Malaysian immigrants, many of whom use drugs. Malays accounted for 27 percent of all drug arrests in 1983, but in 1988 the Malay share was 52 percent As in Japan, rece n t drug use in Singapore is almost entirely confined to a single drug (in this case, heroin and there is little evidence of significant problems with either opium or marijuana. And as in Ja an, there is no evidence of any sig nificant penetration of cocain e or crack. Good News, Bad News for Britain? After rising continually for nearly a decade there is evidence that drug use in Britain may have reached a plateau in the mid 8 37 All statistics in this section are taken fromAnti-DnrgActivities in Jav 38 All s tatistics cited in this section were provided by the Singapore Central Narcotics Bureau 11 1980s. But there is also evidence of increased use of cocaine and marijuana, and no evidence at all of any significant decline. The good news in Britain involves he roin.The number of newly-identified heroin addicts, after rising continually since 1977, fell in 1986 and 1987 from a peak of 5,930 in 1985 to 4,082 in 1987.The amount of heroin seized also fell, from 805 pounds in 1985 to 517 pounds in 1987 The bad news concerns other drugs. With respect to heroin, the number of ad dicts receiving methadone and other drugs from the government reached an all time high in 1987, at more than 10,0 00. Marijuana arrests nearly doubled between 1977 (10,607) and 1983 (20,066 and rose further to a record 21,475 in 1987 Even more troubling, cocaine use appears to be growing rapidly. The number of cocaine seizures was up 13 percent in 1987, and the amount seized set an all-time record of 893 pounds more than quadruple the amount fo r 1986 and nearly as much as the previous t n ears combined. And, there is now evidence that crack is spreading into Britain. In short, Britain appears to be a long way from winning its war against drug abuse. Putting Up a Good Front in the Netherlands. Perhaps because of the often criti cal international focus on the Netherlands drug policies, official Dutch statements on drug policy are reflexively upbeat. Yet trends are disturbing. One source of data on drug use trends in the Netherlands is a 1987 surv ey of the general population,a in which one question asked drug users when they first began using drugs. The finding: More people began using drugs between 1983 and 1986 than at any time during the previous 30 years. Among the seven classes of drugs surve yed, the rate of new users was down only for cannabis and LSD; first use of amphetamines, cocaine, hypnotics, opiates, and sedatives was higher than during any previous three-year period. This survey appears to confirm other evidence now emerging from the Nether lands. One study, for example, finds that the number of addicts a ng for treat ment in Amsterdam more than doubled between 1981 and 19 86. Another study i9 41 39 The statistics that appear in this section are taken from Statistics of the Misuse of Dmg, Unifed Kingdom 1987 40 Overall, the survey found levels of drug use roughly similar to those in the U.S. Regular marijuana use among 23-34 year-olds, for example, was estimated at 145 percent of the population, compared with 17.4 percent in the U.S. Six out of every thousand people were regular users of cocaine, compared with 11 out of a thousand in the U.S. See Fact Sheet, p. 1 41 See Ruter, pp. 17-20 42 See Engelsman, p.212 12 finds that, contrary to government assertions, crack use is not at all a rarity.43 And, the Dutch government admits that drug abuse seems to have increased among groups in a relatively disadvantaged social and economic position and that the use of cocaine is increasing The most that the Dutch government, in a 1989 statement, c a n claim for the overall pr blem is that it appears to be stabilis ing and is even decreasing in some cities In short, there is virtually noevidence that drug use in the Netherlands is falling there is some evidence that it continues to grow Self-Evaluatio n s Another way of evaluating the success of each countrys drug policies is to ex amine how those policies are assessed internally Popular Support. In Japan and Singapore, there is little criticism of the tough policies. Both countries have been very succes s ful in recruiting broad segments of the population into the drug programs, as volunteer counselors and probation of ficers, in raising money for private-sector treatment facilities and serving, in the case of business as sources of expertise. In response t o recent increases in drug use, Japan and Singapore opt for more of the same: tougher laws, more enforce ment, greater insistence on user accountability and longer sentences for drug dealers In Britain, there clearly was dissatisfaction with the permissiv e policies of the 1970s and 1980s.The result is that Britain has moved away from its early experi ment with legalized heroin prescription and drug maintenance, moving instead toward the use of methadone in decreasing doses until the drug use is stopped en t irely. In addition, and with little fanfare, the British have toughened their sentenc ing policies significantly. Between 1977 and 1987, the average sentence for all drug crimes rose from 16.4 years to 20.5 years, while the proportion of drug offenders wh o received prison sentences rose from 11 percent to 13 percent. Nearly twice as many prison sentences were handed out in drug possession cases 1,730 in 1987 compared with 922 in 1977 Pressures to modify the British System further are strong and growing. Gr i f fith Edwards, one of Britains leading drug policy experts, last year responded to suggestions that America copy the British experiment, stated that the situation [in Britain] is messy and unsatisfacto ry theres really nothing now for the Americans to co p y academics who designed the current policies, are deeply committed to staying the A Voices of Dissent. As for the Netherlands, there the government, and many 43 See Jean-Paul C. Grund, Where Do We Go From Here? The Future of Dutch Drug Policy, British Jo u mcrl ofA&ction Research (September 1989 pp. 992-995 44 See Foct Sheet, p. 1 45 See Foct Sheet, p. 1 46 See Statistics of the Misuse of Dtugr 47 Quoted in Anthony Meune, NO Quick Drug Fq National Review, March 24,1989, p. 21 13 TOTAL AND PER CAPITA DRUG SE I ZURES IN FOUR COUNTRIES Heroin,Cocaine Stimulants Marijuana Haehirh I I BRITAIN I JAPAN I NETHERLANDS I SINGAPORE I 0.014 0.006 0.073 0.021 0.16 0.02 1.50 0.05 0.14 3.14 0.0 course. But voices of dissent increasingly are being raised. One reason for this i s the rise in drug-related crime. Surprisingly, one of the most powerful statements of the problem comes from one of the most ardent defenders of the current Dutch policies, Professor Frits Ruter of the University of Amsterdam. In a May 1988 ad dress in W ashington, D.C he noted that It is estimated that the Dutch police spend half their time on investigating drug trafficking and drug-related crimes. Over 75 percent of the suspects taken into custody in Amsterdam are connected in some way with drugs, and 70 percent of the persons remanded in custody by the examining magistrate are either drug traffickers or involved in drug-related crimes. In our pris o ns nearly 50 percent of the inmates are drug addi cts A recent survey showed that 40 percent of the inhabitants of Amsterdam considered that the protection offered by the police was insufficient The Netherlands policies are also coming under attack in the political realm. Amsterdam Mayor Eduard vanThijn has been especially critical, telling a reporter that In the past 15 years, tolerance became synonymous with permissiveness weakheartedness and softness on law-and-order. Today, backlash and debate about wh ere Dutch society is going are in the air.9 48 Ruter, p. 11 49 See Tolerance Finds Its Limits, lime, August 31,1987, p. 28 14 Comparative Statistics countries. Some countries keep statistics on arrests, others on convictions; some use surveys to estimate the number of users, others register addicts. One statistic that is kept in Britain, Japan, the Netherlands and Singapore, how ever is the amount of drugs seized by police and customs officials.These statistics offer some means of estimating the amount of drugs used in each country. Divid ing by the popalation they also infer per capita drug consumption, at least on a relative scale The lack of adequate data makes it difficult to compare rates of drug use across Dramatic Data. The table above shows the tot a l and per capita drug seizures in each of the four countries examined in this study for three classes of drugs: 1 heroin, cocaine, and stimulants; 2) marijuana; and 3) hashish. What it shows is that seizures per capita (the lower half of the table) are dr a matically higher in,the Netherlands than in the other three countries. For the hard drugs (cocaine heroin, and stimulants the Netherlands seize more than triple the per capita amount for Singapore and more than five times as much as Japan. Even more drama t ic contrasts appear for marijuana and hashish: Nearly ten times as much marijuana is seized, per capita, in the Netherlands than in Britain, its nearest rival and, for hashish, over three grams of hashish are seized, each year, for every in habitant of th e Netherlands. While these statistics could be overstated because of Rotterdams important role as a drug transshipment point (that is, it could be argued that much of what is seized in the Netherlands is bound for consumption elsewhere it may also be true that the Netherlands takes a more relaxed attitude toward enforcement, espe cially with respect to marijuana and hashish, than any of the other three countries and its seizure rate is therefore likely to be understated CONCLUSIONS Two basic facts about th e history and current status of drug abuse in Britain Japan, the Netherlands and Singapore cannot be avoided. First, the two countries with the toughest policies, Japan and Singapore, dramatically reduced drug use over the past 20 to 30 years. By contrast, the countries with the more lax policies Britain and the Netherlands, have made little if any progress in fighting their drug 50 Two assumptions must hold for this comparison to be valid. First, it must be assumed that police seize roughly the same propor t ion of the drug supply in all four countries (and, thus, that roughly the same proportion gets through). While it seems unlikely that seizure rates are precisely equal in the four countries examined here, all four do have aggressive anti-trafficking progr a ms and there is no obvious reason to reject this assumption. It also must be assumed that drugs seized in each country are in fact bound for domestic drug users and not being transshipped. Of the four countries, only the Netherlands is a substantial drug t ransshipment center, and the figures that result from this analysis could therefore be somewhat overstated (though it seems unlikely they are overstated enough to account for the surpriSiag findings 15 problems during the 1970s and 198oS. While get-tough policies have not eradi cated drugs altogether, they have done better than the alternative. Second, Japan and Singapore have developed and pursued long-run approaches to drug abuse that have won the broad support of their populations and to which they rema in fully committed. By contrast, neither Britain nor the Netherlands has been successful in finding a long-run formula winning ongoing support. Japan and Singapore have no intention ofchanging their approaches; Britain and the Nether lands are either in t he process of changing or seriously considering it. The lessons for the U.S. in the experiences of these four countries 1) Britain and the Netherlands offer no evidence that legalization of some or all drugs offers hope of reducing drug use or its conseque nces. Indeed, the U.S. has been far more successful in reducing drug use under its current policies than either Britain or the Netherlands 2) The experiences in Japan and Singapore offer some guideposts for American reforms. While the more draconian aspec t s of these policies, such as unlimited detention of drug traffickers without trial, would not be appropriate in the U.S other components of the Japanese and Singaporean programs, such as mandatory drug rehabilitation for users, increased use of urine test i ng within the criminal jus tice system and the death penalty for serious traffickers, could result in increased progress if applied in America. And, without question, America could benefit greatly from the kinds of active citizen participation in the war on drugs seen in both Japan and Singapore. Jeffrey Eisenach Visiting Fellow Andrew Cowin Research Associate 16
