Key Policy Dilemmas in Coca and Opium Reduction Strategies

17 November 2005
Article
 
Martin Jelsma

Key Policy Dilemmas in Coca and Opium Reduction Strategies
Martin Jelsma - TNI Fellow

778th Wilton Park Conference "Drug Abuse: How can it be reduced?", Monday 21 March 2005

Speaking notes

1. Effectiveness of Supply Reduction

A "Balanced Approach"?

Since the Special Session in 1998, the need for a balanced approach between supply and demand reduction strategies has become one of the 'mantras' in current drug control vocabulary. Exactly how to balance interventions on both sides of the chain, however, is not a question that receives much attention. It is a hopeful sign that the INCB has chosen this issue as the priority theme in its latest report, in the section "Integration of supply and demand reduction strategies: moving beyond a balanced approach".

In fact, remarkably little is still known about the real functioning of the various local, regional and global illicit markets and about the true interaction between supply and demand. As the INCB notes, in many cases demand reduction and supply reduction agencies have conflicting agendas and approaches. In practice there is hardly any coordination at all. Law enforcement agencies try to seize, arrest and destroy as much as they can, health authorities try to prevent, treat and reduce harm. It is simply presumed that both smoothly and complementary contribute to the same objective.

Just a small example from my country to illustrate that it is not always as easy as that. Authorities recently and relatively successfully reduced the availability of lidocaine, a cocaine-like pharmaceutical substance often used in the adulteration of cocaine before it is sold on the streets. The only impact on the market, however, and not surprisingly, is that now cocaine is diluted with other and more harmful substances such as fenacetine and atropine. Health services are thus now confronted with an increase in cocaine-related health problems.

Another example of a more general nature: as the INCB points out supply reduction efforts may produce results in the short-term, but that by itself it does not and cannot have a long-term effect because new sources soon materialize to meet continuing demand. Supply reduction efforts have proven to be capable of shifting locations of production and routes of trafficking. Proximity to production or trafficking routes usually shows an increase of use, evidencing the fact that supply not only satisfies demand, but can also stimulate it. So, forcing locations and routes to shift risks adding new user populations to the existing ones. These do not replace existing populations because mature demand markets usually find their ways to adapt to such changes and ensure supply.

Aims and Measures of Success

Supply reduction is not an aim in itself. The ultimate goal of both supply and demand reduction strategies is the same: to minimize the use of illicit drugs and reduce the negative consequences of drugs consumption. The ultimate measure of success for supply-side interventions, therefore, is the question whether they reduce availability for demand in such a way that it diminishes the total level of problems related to drug consumption. As we know, that is not always easy to measure, requires some basic understanding of the functioning of the market. It is a question that by preference is avoided. It's easier to list all the efforts undertaken, improved cooperation mechanisms, new precursor initiatives, and point to outcomes such as quantities of seized shipments or hectares destroyed.

The evaluation of the EU Action Plan 2000-2004, does the same but at least points out the inherent contradiction. While describing in very positive terms all the advances in supply control measures that have been undertaken in these past five years, in the brief section on the 'Assessment of the impact on the drug situation' the evaluation concludes that "the available information does not suggest that the availability of drugs has been reduced substantially".

Today two weeks ago, in his opening statement at the CND in Vienna, Antonio Maria Costa, executive director of UNODC, pointed at the same contradiction when he said that the efforts to curb drug supply have produced important results. He said that in 2005, we see drug cultivation and production down practically everywhere. On the other hand, he said, results of global demand reduction measures in recent years had been 'lacklustre' and 'uninspiring', adding that, in the final analysis, that might compromise success on the supply side.

Coca and Opium Reductions?

The supply reduction success Mr Costa referred to is based on the statistics of coca and opium production, principally the decline of coca cultivation in Colombia and of poppy cultivation in Southeast Asia. Calling it 'success' is somewhat premature, firstly because the other main drug markets do not show any such downward trends. Reliable figures for developments in the cannabis, Ecstasy and Amphetamine-type Stimulants (ATS) markets are very hard to get but there are no indications that supply or demand are slowing down, to the contrary. But also with regard to coca and opium we still need to be careful with trumpeting victory. Basically we do not know yet how the market will respond. In the case of coca it is important to point out that so far the international cocaine markets have not yet shown signs of supply shortage, purity is not falling, prices have not risen, consumers do not yet complain about lack of availability. In the Andean region we see some signs of adaptations that might still prove to be capable in coming years to restore a balance in the market: increased yields per hectare, the appearance of production in new regions in Colombia, and some increases in production figures for Bolivia and Peru.

As for the opium/heroin market, the southeast Asian production decline is likely to have only a regional impact, because European and U.S. markets are almost entirely fed from opium production in Afghanistan and Latin America (Colombia/Mexico). The big question mark in South-east Asia will be how the Chinese market is going to respond to the production decline. The majority of Burmese opium seems to be consumed nowadays in China which still is somewhat of a black box when it comes to predictions about responses. It is definitely a well-timed decision of the Chinese government to open 1000 methadone treatment centres. But to what extent could poppy cultivation resume inside the country, is that happening already? On the global level, given the prominence of Afghan production, much depends what will happen there. Last year showed a new record in terms of hectares, but early indications for this year's harvest do point at a potentially significant reduction this year.

2006: Major Market Impacts?

Too early to cry victory, but we should not rule out that by next year we could begin to see historical and significant supply disruptions on the international cocaine and heroin markets. The UNODC office in Colombia predicts a significant impact on cocaine prices when current stocks will be depleted and production decline in Colombia will start to be felt on the market. For 2006 the heroin market is likely to feel a considerable impact of the Wa opium ban that will come into effect in Shan State this year in June. If that would be accompanied by a significant decline of Afghan production as a result of no-planting decisions by farmers under heavy threat this season and forced eradication operations these coming months, the global market could experience an impact comparable to the sudden but short-lived disruption after the Taleban opium ban in 2000/2001.

This brings us to a series of policy dilemmas. First, should the world applaud these declines given the fact that in all three countries, Colombia, Afghanistan and Burma, they are the result of highly repressive supply reduction efforts, or are there humanitarian principles that argue against them. And secondly, suppose it would come to major impacts in 2006, what would be the net result, taking into account the dynamics between the illicit and licit markets?

2. Humanitarian Restraints on Supply Control

Mainstreaming Drug Control in Development Strategies

More and more emphasis is given these past years to the need to provide alternative livelihoods to farmers and the need to mainstream drug control in overall development strategies. These terms step by step are conquering a place in the accepted drug control discourse. A resolution adopted at the CND ten days ago underlined the importance of these concepts. But what would it mean in practice for supply reduction efforts to apply these principles in a serious way, beyond allowing them to become part of the global discourse and pay lip-service to such pleasant-sounding words.

Mainstreaming drug control does not only mean that all governmental, non-governmental and multilateral agencies should pay more attention to drug-related problems in developing countries and somehow incorporate them into their intervention strategies. It also means that drug policy objectives have to find their right place among other developmental goals: poverty reduction, conflict prevention and resolution, protection of human rights, good governance, health promotion, HIV/AIDS prevention, etc. It means that the design of development strategies should take into account their effect in terms of drug demand and supply reduction. And vice-versa: the impact of drug control efforts on all these related developmental aims has to be taken into account. It means that potential contradictions have to be discussed and somehow resolved. Drug control cannot be implemented in such a way that it conflicts with poverty reduction objectives, that it triggers conflict instead of preventing them, or that it violates human rights. While that may seem logical, in practice serious policy dilemmas surface if mainstreaming would be taken serious.

Human Rights amd Development Goals

Respect for human rights or placing drug control in the broader context of the UN Millennium Development Goals, puts restraints on supply reduction. Some drug control measures are simply not compatible with accepted norms in the human rights or development fields.

The Universal Declaration of Human Rights talks about the right to an "existence worthy of human dignity" and that "Everyone has the right to a standard of living adequate for the health and well-being of himself and of his family, including food, clothing, housing and medical care and necessary social services". The International Covenant on Economic, Social and Cultural Rights mentions "the fundamental right of everyone to be free from hunger".

Mr Costa also referred to such restraints in his speech two weeks ago, saying that "we need governments to concentrate their resources and policies so that communities that abandon drug cultivation do not fall victim to humanitarian disasters that can occur when one source of income disappears before another materializes."

The 'sequencing' issue is a key and strongly debated issue here. Let me put it clearly. In my view, the current pace and methods of supply reduction that are the background to the production decline 'successes' in all three cases, Burma, Afghanistan and Colombia, are not compatible with international human rights standards and broader development objectives. They do destroy the livelihoods of many families before alternative sources have materialized. They do create humanitarian disasters and deprive many people of their right to an "existence worthy of human dignity". Forced eradication under circumstances where other sources of income are not yet guaranteed is a violation of basic human rights. So I will not refer to current developments in these three countries as 'successes'. At best -as the speaker before me has said at another conference about the Taleban opium ban- they might be seen as major successes in terms of drug control, but in humanitarian terms they are major dramas.

Sustainability

The Action Plan on International Cooperation on Eradication of Illicit Drug Crops and on Alternative Development, approved at the 1998 UNGASS included some heavily negotiated paragraphs on the issue of 'sequencing': "In areas where alternative development programs have not yet created viable alternative income opportunities, the application of forced eradication might endanger the success of alternative development programs." The document also affirmed that in "cases of low-income production structures among peasants, alternative development is more sustainable and socially and economically more appropriate than forced eradication."

The fate of the Taleban opium ban provides us with a good example. The effects lasted only one year. Still today, many families are entrapped in the vicious cycle of debt accumulation caused by the ban and reinforced by eradication operations more recently. A major offensive to destroy poppy fields now, as is under consideration as we speak today, would trigger a humanitarian drama of even bigger proportions. This would also -once again- put into jeopardy the sustainability of any short-term opium reduction.

That is what mainstreaming is all about: the recognition that developmental problems, including drug-related ones, are interconnected and can only be addressed in a coordinated and comprehensive manner. Pressing for short-term reductions in drugs production to the detriment of other developmental goals does not work. Sustainable supply reduction can only be achieved if it is in rhythm with progress in the field of human rights protection, poverty reduction, conflict resolution, good governance and demand reduction.

Dynamics between Illicit and Licit Markets

Shifts from Heroin to Pharmaceutical Substitutes

In the case of a sudden supply interruption, the burden of finding short-term solutions to their craving will fall upon opium and heroin user groups, first in the region and later on further down the supply chain when stocks are depleted. Given the current state of health support systems and treatment programmes in the regions around Afghanistan and Burma, those users unable to simply quit their habit or addiction will be forced to use strongly adulterated heroin or opt for 'licit' pharmaceutical replacements. In health terms, this is not likely to result in an improvement. In the short term, drug markets often react to supply disruptions by adjusting the purity rather than the price. Declining heroin purity may lead to increased use of injection, with all the added risks of spreading HIV/AIDS and other blood-borne diseases. Heroin can be smoked, snorted or dissolved in water and injected, the latter giving the most direct effect. The lower the purity, the more addicts are tempted to choose the needle, simply to get 'more bang for their buck'.

A dramatic example of changed consumer behaviour in response to reduced heroin availability can be found in North-East India, especially in the states bordering Burma/Myanmar. Large numbers of users there have switched to injecting Spasmo Proxyvon ("SP"), a synthetic preparation based on dextropropoxyphene, a non-soluble opioid that tends to stick to the walls of the veins causing abscesses, gangrene, sometimes resulting in the need to amputate limbs. Last year's national survey on drug abuse in India stated that "The reasons for switching to injecting of pharmaceutical substances were reported to be due to non-availability and increasing street price of heroin".

The number of Proxyvon injectors in Manipur alone is estimated to be about 5000 already, and there are many undocumented cases of deaths and amputations in that state. This is an alarming example of how, in absence of existing infrastructure of health care and treatment options, simply reducing supply may actually have a negative impact on the demand side. Such implications are rarely taken into account by drug law enforcers working on the basis of the erroneous assumption that reducing supply automatically reduces problems related to drug consumption.

Also in Northern markets further down the supply chain, diversion from licit opiates markets is approaching crisis proportions, which might, at some point, challenge the very reasoning behind the urge to eliminate illicit opium crops in Afghanistan, Burma or Colombia. More and more powerful morphine-like pharmaceutical substances are appearing on the prescription market. Clear examples are hydrocodone and oxycodone, both thebaine-derived semi-synthetic opiates and sold under brand names Vicodin, OxyContin, and others. As these are preparations produced on the basis of thebaine-rich poppy straw concentrate originating from poppy fields in Australia or France, the connection to the illicit heroin market is rarely made. On the streets, however, the distinction between the two apparently distinct markets fades easily. OxyContin has already been dubbed the 'poor man's heroin' on the streets in North America.

A quote from the INCB report for 2004: "a nationwide survey in the U.S. in 2003 indicated that the extent of non-medical use of prescription drugs among young people was second only to the extent of cannabis abuse. Among persons in their final year of secondary school (ages 17-18) the abuse of hydrocodone was more than double the abuse of cocaine, Ecstasy or methamphetamine. Among the persons in that age group, 10 per cent reported non-medical use of hydrocodone and about 5 per cent reported non-medical use of oxycodone."

What we lack is insight in drug user responses to shortage of their drug-of-choice. For supply side, UNODC undertook farmers' intentions studies, because if we don't know what the precise reasons are for farmers to become involved in drug cultivation, it is difficult if not impossible to influence their decision to plant or not to plant. Similar studies are needed to provide insight in consumer behaviour, what are their reasons to take drugs and what are their options on moments the availability of drugs is disrupted. Only then can we begin to understand what the potential impacts are of supply reduction for the demand side of the market.

Opium Licensing. An Option for Afghanistan/Myanmar?

The very delicate balance between the licit and illicit markets offers a range of additional options for market adaptations and consumer choices in response to a decline in illicit production. The cases mentioned above are negative examples of this interaction between illicit and licit markets. But these dynamics may also offer beneficial options to reduce the extent of the illicit market by expanding the licit market.

The licit opiates market is comparable in size or even bigger than the illicit one. The opium poppy contains a variety of natural alkaloids, especially morphine, codeine and thebaine. These alkaloids are used widely by the pharmaceutical industry for the production of medicines, and all belong to the family of 'opiates', including the semi-synthetic substances produced from them, such as heroin, oxycodone, hydrocodone, and buprenorphine - the latter used in heroin treatment programmes similar to the use of methadone. The more inclusive term of 'opioids' is used to also include morphine-like but purely synthetical preparations such as methadone and dextropropoxyphene.

A fundamental contradiction arises when looking at recent developments in the licit versus illicit market. Licit production is expanding rapidly. Australia more then doubled its production in the past four years and Spanish production tripled. At the same time, the international community is desperately trying to find alternative income opportunities for illicit farmers in countries like Afghanistan, Burma and Colombia. Unable to find developmental solutions, illicit poppy fields are eradicated by force causing humanitarian dramas, while licit production expands in countries like Australia, France and Spain.

The status of so-called 'traditional opium cultivating countries' with special privileges in the licit market is currently restricted to India and Turkey only. A dubious definition, because even at the time of the negotiations of the 1961 Convention, there was controversy about whether the right to continue to export opium -for medicinal purposes- should apply only to India and Turkey or whether a broader group of countries could apply for that status. According to the Commentary to the treaty, the authors of the Single Convention, held the view that Afghanistan and Burma could apply for that status aw well.

The INCB for understandable reasons prefers to keep new countries out of the regulatory system, especially countries like Afghanistan or Burma, where implementing control systems under current circumstances is viewed as a nightmare mission for UN administrators. The system is difficult enough to administer and there is much concern about the risks of leakage to the illicit market. Still, it is difficult to understand why the UK, leading nation in international drug control strategy for Afghanistan and next to the US the country most pressing to apply repressive eradication efforts, can even consider at the same time to start its own licit opium poppy cultivation here domestically. It just does not make sense.

Potential for a Licit Market of Coca Products

The question what might happen in case of a cocaine shortage on the market is not as easy to answer, since we do not have examples of 'cocaine droughts' in practice to rely on. The cocaine market is divided into quite distinct consumer groups, ranging from occasional recreational users who relatively easily shift to ecstasy or alcohol in case powder cocaine is temporarily out of reach, to more problematic base-cocaine or crack users closer to the poly-drug user scene involved in heroin use.

In contrast to the well-developed licit opiates market, a licit market for coca products does not exist outside the traditional producing countries of Bolivia and Peru. Exploring the potential of a licit coca market is a long-standing wish often voiced from the Andes, not only to enable the rest of the world to share the benefits of coca consumption, but also as an option to reduce the diversion of coca cultivation to illicit cocaine production. The INCB and the WHO both have pointed out the contradictions of current scheduling of the coca leaf as an unintended obstacle to an expansion of the licit production and trade in coca products, and have undertaken unsuccessful attempts to put it on the international agenda. It is about time to correct the historical errors made in this regard in the 1950s and 1960s and to open up legal possibilities for a licit coca market.

If one compares the treatment in legal terms of other plants, and their respective psychoactive ingredients and derivatives, many inconsistencies can be found. For example the peyote cactus vis-à-vis mescaline, or the ephedra plant versus ephedrine. Currently, discussions are heating up whether or not plants such as ephedra, qat or cava should be placed under international control. In comparison with the criminalisation of coca, the inconsistency is obvious. But rather than bringing ephedra, qat and cava (and in the future maybe coffee, guarana and other plants with comparable psychoactive effects) in line with the current status of coca by placing them under schedule 1 of the 1961 convention as well, it would make much more sense to take coca out of the current control system. Probably the preferable option in terms of a more consistent approach would be to take natural plants out of the drug control treaty system altogether.

Conclusions

  1. Reduction of supply and demand of illicit drugs is in principle a worthy goal, but the prevailing assumption that reducing supply automatically reduces problems related to drug consumption needs to be challenged.
  2. Drug control has to be compatible with human rights standard. As the World Bank concluded in its recent report about Afghanistan: "there is a moral, political and economic case for having alternative livelihoods programs in place before commencing eradication".
  3. More understanding is required about the functioning of the various illicit markets in order to increase the effectiveness of supply-side interventions. Many lessons can be learned from geographical shifts, interaction between various markets, and consumer responses to disrupted availability.
  4. The risks of shifts from heroin to pharmaceutical substitutes should be analysed carefully, in order to design pragmatic strategies to deal with new epidemics, but also to re-think the merits of simplistic supply-side interventions and deadline thinking around the 'elimination' of the traditional opium/heroin market.
  5. The privileged cartel-like position of a limited number of countries producing for the licit opiates market should be questioned. Possibilities for countries like Afghanistan and Burma to acquire a place in the expanding market of licit opiates should be discussed openly in the context of considered attempts to reduce their role in the illicit market.
  6. The potential of a licit international market for coca products should be taken serious. The inclusion of the coca leaf in the 1961 convention needs to be reconsidered. A harmonised approach needs to be discussed for the legal treatment of plants and their psychoactive ingredients and derivatives, and maybe plants should be taken out of the control system altogether.
  7. 'Mainstreaming' drug control requires a recognition that developmental problems, including drug-related ones, are interconnected and can only be addressed in a comprehensive manner. Pressing for short-term reductions in drugs production to the detriment of other developmental goals does not work. Sustainable supply reduction can only be achieved if it is in rhythm with progress in the field of human rights protection, poverty reduction, conflict resolution, good governance and demand reduction.