International Journal of Drug Policy 15 (2004) 225230

Commentary
Regulation of illegal drugs: an exploration of public health tools

Mark Haden

Vancouver Coastal Health Authority: Addiction Services, Pacic Spirit Community Health Centre,
2110 West 43rd Ave., Vancouver, BC, Canada V6M 2E1
Received 8 November 2003; received in revised form 3 March 2004; accepted 17 March 2004
Abstract
This commentary explores the concept of a regulated market for currently illegal drugs. It details a variety of specic public health tools
which could be used in a regulatory regimen to control access to these substances. The distinction between administrative and social controlling
mechanisms is discussed. The author concludes that a regulated market for drugs founded on inclusive public health and moral principles is
a rational approach to the pervasive global concern of illegal drugs in our society.
2004 Elsevier B.V. All rights reserved.
Keywords: Illegal drug control; Market regulation; Drug legalisation; Public health
There is currently a transition in the global debate over
how illegal drugs are controlled. This debate is fuelled
largely by the growing acknowledgement that criminal
justice tools, in isolation, are ineffective at controlling the
criminal, health and social problems associated with illegal
drug use. The problems caused by drug prohibition have
been well documented (Auditor General of Canada, 2001;
Bertram et al., 1996; Haden, 2002; MacCoun & Reuter,
2001) and there is growing agreement that public health
tools can be more effective at managing this pervasive social
concern. A recent issue of the International Journal of Drug
Policy explored the expanding global awareness of the fail-
ure of drug prohibition. In this issue, authors considered the
current crisis this approach is facing (Levine, 2003; Wodak,
2003) and suggested ways of challenging the international
treaties which dictate an enforcement based approach to
drugs which are currently illegal (Bewley-Taylor, 2003).
In Canada, there have been several recent Federal reports
which have recommended signicant changes to our dom-
inant enforcement model of drug control (Canadas Drug
Strategy, 2001; Canadian HIV/AIDS Legal Network, 1999;
Report of the Special Committee on Non-Medical Use of
Drugs, 2002).

The opinions in this article are those of the author and are not a
reection of the policies or procedures of the Vancouver Coastal Health
Authority.

Tel.: +1-604-267-3975; fax: +1-604-267-2611.

E-mail address: mark haden@vrhb.bc.ca (M. Haden).
The debate has recently been advanced in Canada by
a Senate Committee (The Special Senate Committee on
Illegal Drugs, 2002), which moved beyond criticisms of pro-
hibition and took a bold next step. This report suggested that
a regulated market for cannabis would reduce many of the
problems that are created by our current prohibitionist ap-
proach. After analysing data from many countries this report
concluded that a regulated market would not signicantly
increase cannabis consumption. When presenting this report
Senator Pierre Claude Nolin stated that while his report fo-
cused on cannabis, the conclusions were applicable to all
currently illegal drugs (Nolin, 2003).
This commentary seeks to expand the discussion by ex-
ploring what the term regulated market means. In order to
discuss the concept of a regulated market we need to move
beyond the historical debate which only gives us two options:
the dichotomy of criminalisation and legalisation. Criminal-
isation has clearly failed, as increased spending on enforce-
ment strategies has not decreased availability of illegal drugs
(US Department of Justice, DEA, 2003) and has been as-
sociated with other signicant health (Canadian HIV/AIDS
Legal Network, 1999; The National Action Plan Task Force,
1997; National Association for Public Health Policy, 2000;
Wharry, 1999) and social (Brochu, 1995; Nadelmann, 1989;
Riley, 1998) pathologies.
Currently there is no unied consensus of the denition
of the word legalisation but there is general agreement
amongst authors that legalisation is not desirable if this word
is equated with an open free market. The models used to sell
0955-3959/$ see front matter 2004 Elsevier B.V. All rights reserved.
doi:10.1016/j.drugpo.2004.03.006
226 M. Haden / International Journal of Drug Policy 15 (2004) 225230
hot dogs and blue jeans do not work very well for chemicals
which have signicant potential for harm. We can predict
that if we adopted a legalisation paradigm for the distribu-
tion of currently illegal drugs, which included advertising
and promotion, we would have signicant associated social
and health problems. This paper assumes that there is a fer-
tile middle ground between the polar opposites of criminal-
isation and free market legalisation where the principles of
public health ourish. The aim of this commentary is to ex-
plore the concept of market regulation using a public health
framework.
Regulatory options can be divided into two groups: those
which are aimed at regulating the purchaser and consumer
and those which are directed at regulating the product. North
American society is skilled at regulating products, as we con-
trol content, packaging, price, distribution, advertising and
marketing of a wide range of products like food, pharma-
ceuticals and alcohol. Our society, however, has yet to fully
explore the numerous options available to regulate and/or
restrict the purchasers and consumers of these products.
This paper will explore a wide variety of possible regulatory
mechanisms focusing on those who buy and use drugs.
The following is a list of 14 possible regulatory ap-
proaches and mechanisms that could be used for controlling
drugs that are currently illegal:
Age: In Canada, there is provincial legislation which con-
trols access to alcohol and tobacco based on age. In
most provinces the legal drinking age is 19, although
Alberta and Quebec allow young adults to drink at the
age of 18. Access to tobacco in Canada is allowed at
either age 18 or 19 depending on the province. It is a
strange paradox in our society that we control the age
of purchasers of alcohol and tobacco but we do not
have any control of the age when illegal drugs can be
purchased. Illegal drug dealers, who thrive under the
prohibition model and predominantly target youth,
never ask customers for age identication. It is, there-
fore, no surprise that youth drug use surveys indicate
that young people have easier access to drugs than alco-
hol (The National Centre on Addiction and Substance
Abuse at Columbia University, 2002).
Degree of intoxication: Currently, the sale of alcohol in
Canada is restricted based on the degree of intoxica-
tion of the purchaser. Customers are refused service if
they are perceived by staff to be engaging in high-risk
substance using behaviour.
Volume rationing: The Netherlands restricts its coffee
shops by volume rationing when selling cannabis
products. Consumers are allowed to purchase a max-
imum of 5 g at a time. This amount is intended to
supply an individual with enough for personal con-
sumption for a few days. The concern that drugs might
be smuggled into other countries could be reduced if
the quantity an individual was allowed to purchase was
limited to small amounts for personal consumption.
Proof of residency with purchase: In the Netherlands the
drug tourist trade has been a mixed experience. Some
coffee shops where cannabis products are sold are de-
signed to target the tourist market. While tourists bring
new money into the country they can also behave in
socially undesirable ways. Societies that have formed
relatively healthy, unproblematic relationships with a
substance have gone through a process of developing
culturally specic social controlling mechanisms which
often manifest as ritualistic behaviours. Drug tourists
who are not integrated into the culture may not ad-
here to these restraining social practices. This potential
problem could be reduced if purchasers are residents
of the country, province, city or neighbourhood.
Locations of use could be restricted: This controlling
technique is currently used in Canada with alcohol
(bars and home use) and tobacco (some indoor public
spaces are smoke free). Location of substance use could
vary depending on the potential for harm. For instance,
use of injectable substances could be limited to super-
vised injection sites, smoking of heroin and cocaine
could be limited to supervised consumption rooms, and
weak oral solutions of drugs of known purity and quan-
tity could be restricted to home use.
Required training prior to purchase: Drugs can be pow-
erful substances that have a greater potential for harm
when used by nave users. Training programs could
provide knowledge and skills to drug users with the
goals of discouraging drug use, reducing the amount of
drug use, or reducing the harm of drug use. Training
programs could also raise awareness about addiction
concerns, available treatment services, and other public
health issues such as blood borne, and sexually trans-
mitted diseases. Successful training program graduates
could be issued a certicate which would have to be
shown prior to purchase.
Registration of purchasers: Tracking of purchasers allows
an opportunity for engagement and brief health fo-
cused education. This may also discourage some indi-
viduals from participation in the program.
Licensing of users: Graduated licenses for new motor ve-
hicle drivers could provide a model for licensed drug
consumption. New drivers can be restricted where and
when they drive and who they are permitted to drive
with. Research as shown that having an experienced,
responsible adult in the car and controlling for age and
the number of other passengers with a new driver will
diminish the chances of an accident (Insurance Institute
for Highway Safety and Trafc Injury Research Foun-
dation, 2003). New substance users could have similar
controls implemented where time, place and associa-
tions are controlled. A graduated program in which, re-
sponsible, non-harmful drug use is modelled increases
the chance of new users adopting benign relationships
with drugs. Licenses could be forfeited in the event
of conviction of driving under the inuence, providing
M. Haden / International Journal of Drug Policy 15 (2004) 225230 227
drugs to unlicensed users, or public intoxication. As
with a drivers license accumulated demerit points for
multiple smaller infractions could also result in license
suspension or removal. License suspension could result
in the need to take further training to re-establish the
license. Loss or suspension of a license would not pre-
vent other civil or legal sanctions from occurring. Some
careers may preclude the possibility of obtaining a li-
cense. Airplane pilots or taxi drivers, for instance, may
not be allowed to have a license to purchase long act-
ing drugs which impair motor skills. Transport licenses
have gradings which allow for operation of different
types of vehicles. Licenses for users could also specify
different levels of access to different substances, based
on training and experience.
Need to pass a test of knowledge prior to purchase: Poten-
tial customers may be required to demonstrate knowl-
edge of safe use of the drug prior to purchase. A short
test could be administered in the distribution centre, to
allow staff to assess whether the customer has sufcient
knowledge to use the substance in a manner which is
likely to minimise harm.
Tracking of consumption habits: Registered purchasers
could have the volume and frequency of purchases
tracked. In British Columbia (Canada) this process of
data collection is beginning to occur through a shared
data system called pharmanet where consumption of
prescription drugs is monitored. This data could be used
to instigate health interventions from health workers
(i.e. pharmacist or other health care worker) who could
register concern about the individuals physical, social
or emotional health and offer assistance if a problem
is identied. Having health workers distribute drugs
could result in the provision of written and verbal health
related information about the drugs and drug interac-
tions being made available to customers. Immediate
personal feedback about consumption habits may have
a moderating inuence on patterns of use. Tracking of
consumption habits may also be linked with purchase
deterrents. The unit price of the product may be grad-
uated so that the price goes up past a certain volume
threshold.
Required membership in a group prior to purchase: Drug
users advocacy groups or unions can serve a variety
of functions. Although they currently act as political
advocacy groups and provide peer-based support and
education for their members (Health Canada, Popula-
tion and Public Health Branch, 2001) these functions
could be expanded so user groups could have a greater
inuence over the behaviour of their members. These
groups could then be engaged in a process where they
played a more formal role in the regulation of con-
sumption of substances. An example of a type of group
that has a substantial inuence over the behaviour of its
members are the many discipline specic, professional
regulatory bodies that provide practice guidelines for
their members. These groups enforce norms in their
members through a variety of peer processes and edu-
cation. In the event that a member continues to practice
outside the established norms of the discipline, the reg-
ulatory body can eventually refuse membership to an
individual. This process produces shared responsibility
between the group and its members. Shared responsi-
bility within a drug user group could result in mod-
eration of behaviour due to a similar peer educational
process. Group licenses could be revoked in the event
of frequent infractions (i.e. driving while intoxicated)
by the group members.
Shared responsibility between the provider and the con-
sumer: The roots of this concept are found in todays
Server Intervention programs where providers of alco-
hol are partially responsible if an intoxicated customer
is involved in an automobile accident (Single & Tocher,
1991). Sellers could be held partially responsible for
the behavior of consumers. Providers may be required
to supervise the environment where the drug is used
and to restrict sales based on the consumers behavior.
Retailers could be ned or lose their sales license if cus-
tomers are involved in accidents (automobile or other)
or other socially destructive incidents for a specied pe-
riod of time after the substance has been consumed. A
balance would be needed where both the provider and
the consumer were held responsible. Retailer responsi-
bility should not absolve the consumer from receiving
social or legal sanctions for undesirable behaviour.
Proof of dependence prior to purchase: Those who are
assessed (by a health worker) to be substance dependent
could be allowed to purchase a rationed amount to be
used in designated spaces.
Proof of need prior to purchase: Our society may ex-
pand potential consumers to other groups beyond just
those who are substance dependent. A number of cur-
rently illegal drugs (e.g. LSD and ecstasy) have been
shown to have potential psychotherapeutic benets if
used in controlled therapeutic environments (Grinspoon
& Bakalar, 1979). Registered and trained psychiatrists
and psychologists could access substances for profes-
sional use with clients.
Another example of potential benet can be seen by
examination of groups like the Native American Church,
which use peyote in accordance with ancient traditions.
Anecdotal evidence indicates a reduction in alcoholism
and violence in communities involved with this peyote
medicine practice (Stewart, 1987). Research evidence
indicates that consumption of ayahuasca, a plant based
entheogen (a hallucinogenic drug used in shamanic rituals
or religious ceremonies (Ruck et al., 1979) when used in
South America in controlled ritualistic settings can pro-
duce a remission of psychopathology and improved social
functioning in the participants (Grob et al., 1996). The de-
nition of proof of need prior to purchase must be exible
228 M. Haden / International Journal of Drug Policy 15 (2004) 225230
enough to allow for the potential of social or psychological
benets from drugs for specic members of our society.
Drugs vary widely in their potential for dependence, phys-
ical and psychological harmand potential benet. It is, there-
fore, logical that a range of different regulatory techniques
be utilised for different drugs and different preparations.
Cannabis, ecstasy, LSD, heroin and crack cocaine, for exam-
ple, each have completely different pharmacological proper-
ties and their ingestion produces very different behaviours.
As the potential for benet and harm varies widely between
these fundamentally different groups of chemicals different
regulatory mechanisms are warranted. This is why the reg-
ulatory options in this paper range from intrusive and con-
trolling to non-intrusive. The goal of policy makers will be
to match the drug with the appropriate regulation in a way
which balances societys need to control (through formal
and informal mechanisms) the behaviour of its members and
each individuals right to freedom.
While the above regulatory tools range from intrusive to
non-intrusive they are all administrative in nature. Drug use
has, throughout the centuries, been managed in societies
by non-administrative (and non-criminal) processes or so-
cial controls which often manifest as predictable drug us-
ing rituals. There are many examples of social rituals which
control amount of consumption and constrain the behaviour
of those involved. Restriction of alcohol to meal times is
one example of a modern day social norm which controls
for context, amount consumed, and length of time of use
of this common sedative drug. The pairing of alcohol and
food also reduces the physically harmful effects of alco-
hol as the food in the stomach slows alcohol absorption.
Structured coffee breaks moderate consumption of this
stimulant drug in mainstream society. The Native American
Churchs peyote ceremony is an example of a highly ritu-
alised, sacred social control process which regulates a drug
used by an indigenous group. Social controls can evolve to
meet changing needs. The sacred rituals which control the
use of ayahuasca in South America were started by abo-
riginal people but have expanded beyond this population to
include many non-indigenous people (Grob, 1999).
A rational approach to drug control would stipulate that
more intrusive and administrative levels of restriction be re-
served for drugs which have greater potential for harm, and
that social controls be used for drugs which have a lower
potential for harm. When conceptualising a more functional
paradigm for drug control we need to acknowledge that so-
cial controlling norms that promote non-harmful drug use
behaviours will take time to develop.
There is signicant complexity in any attempt to discuss
realistic alternatives to drug prohibition. One of the issues
is the need for alternatives to compete with the global drug
black market which spawns signicant health, social and
economic pathologies and provides easy access to drugs.
Challenging these illegal drug distribution networks is vi-
tal for the success of an alternate paradigm. Cannabis, for
example, has proven to be very difcult to regulate in any
country partly due to the ease in which this hardy plant can
be cultivated. A drug whose production is simple and widely
available indicates the need for less restrictive regulatory
mechanisms in order to challenge the economic realities of
the black market. Drugs like methamphetamine, which are
more complicated to manufacture and have the potential to
produce greater social and individual harms, could have mul-
tiple restrictive regulatory mechanisms and still challenge
the black market availability.
Another factor to consider in the discussion of a regulated
market is the inclusion or exclusion of marginalised pop-
ulations. Many Canadian reports have observed that crim-
inalisation of drugs is a signicant exclusionary force in
society which results in the creation of marginalised popu-
lations (BC Aboriginal HIV/AIDS Task Force, 1999; Cain,
1994; Canadian HIV/AIDS Legal Network, 1999). The sig-
nicant economic, social and individual costs of the poli-
tics of exclusion have been documented (Hermer & Mosher,
2002). Countries like the Switzerland and the Netherlands
describe their goal as normalisation which is the same as
inclusion. The belief underlying the word normalisation
is that if a country can engage and include drug users in
mainstreamculture this normative process will result in these
individuals living more balanced and constructive lives.
Countries like Australia, Denmark, The Netherlands and
Canada have drug users advocacy groups contributing a
signicant perspective to the drug policy debate. Countries
which support, fund and include these groups in a meaning-
ful way have advantages for both mainstream society and
these groups themselves as normalisation works in two di-
rections. First, this increased participation in normal so-
ciety enhances the ease of transition for members who wish
to join the ranks of mainstream society; and second, this
would allow normal society to inuence the behaviour of
the members of this group. This results in reduced harm to
both individuals who use drugs and the society as a whole.
Countries which support the concept of inclusion or normal-
isation are more able to entertain a serious discussion about
more effective drug policies.
We need to ask new questions. The question how do we
stop drug use? is not as useful as the question how do
we regulate the market for drugs in a way which increases
social cohesion and minimises harms?. One of the themes
of the above list of regulatory mechanisms is the intent to
increase inclusion of marginalised populations and, there-
fore, improve a societys social cohesion. There are numer-
ous individual, family and community benets of increased
social cohesion such as reduced crime rates (Braithwaite,
1989), improved economic functioning (Dayton-Johnson,
2001) and enhanced epidemiological health status indicators
(Levy & Persosolido, 2002).
The debate about how to best control illegal drugs is
as global as the distribution networks which supply these
drugs. This worldwide discussion has resulted in the sug-
gestion that a group of like-minded revision oriented coun-
tries take collective action to challenge drug prohibition
M. Haden / International Journal of Drug Policy 15 (2004) 225230 229
(Bewley-Taylor, 2003). This potential worldwide movement
would be greatly assisted if there was a clear unied vision
to which they aspired. The concept of a regulated market,
based on the inclusive public health principles listed above
could be a signicant asset in the development of this shared
vision.
Drug prohibition is a blunt instrument that paradoxi-
cally produces unregulated access to drugs. Currently, ille-
gal drugs are too powerful to be left to the control of corrupt
criminal organisations. A public health approach to market
regulation which attempts to minimise harm to individuals,
families and society as a whole, is a rational approach to
this pervasive global health and social problem. This new
approach needs to be guided not just by public health prin-
ciples but also moral values. It is amoral to allow the contin-
uation of an enforcement dominated drug control paradigm,
which has so clearly failed to achieve its objectives, and has
itself led to so much crime, disease, violence, corruption and
death.
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