Battle in Print: In drug policy, pragmatism is the only moral approach

Roger Howard & Leo Barasi, 24 October 2011

The battle about how we control recreational drugs is supposedly fought between visionary idealists and value-free pragmatists. One side claims to have right on their side, the other has cold facts. But the closer you look, the more it becomes clear that the pragmatists should never have allowed themselves to be painted as knowing the price of everything and the value of nothing.

In the minefield of arguments about the supposed right to use drugs, information programmes in schools and harm-reduction measures like needle exchanges, one principle dominates. That is, that the measure of success of a drug policy is whether it reduces the damage caused by drug use and supply to users, families, communities, and institutions.

According to this approach, intrinsic morality and values have little practical application. The drug-free life may be valued, but because it imposes no drug-related harms, and not because it is seen as intrinsically admirable.

Likewise, the focus by policymakers on harms like crime means that the advantages some gain from drug use are either ignored, or at most, factored into a cost-benefit equation that includes their potential medical use. There is virtually no role in public policy for a measure of gains that could be derived from mind-altering affects.

But we rarely stop to ask whether this framing is balanced. It is important to question whether we make a mistake in excluding intrinsic morality from debates about drug use, or indeed whether the dominant pragmatic harm-minimisation approach is already one that draws on unacknowledged moral values.

An intrinsic morality of drug use


When morality is applied to non-medical use of drugs, it is usually in condemnation. In its purest form, drug use is seen to be wrong in all circumstances because it offends certain arbitrary morals.

In principle, there is nothing wrong with this form of argument. As a society, we agree that some activities are nearly always unacceptable. Even though such arbitrary morals do shift over time and space, they are not meaningless by the standards of their location. Perhaps ‘recreational’ drug use contravenes modern morals and so we should be content that the action is unacceptable, without needing to explore the underpinning moral arguments.

But the trouble with this intrinsic moral response to drug use is its utter inability to deal with the grey areas that make up so much of the debate. Using ecstasy for a night out seems clearly different from injecting insulin for diabetes, but it is not obvious that taking heroin to deal with memories of childhood abuse is so unlike using prescribed anti-depressants for the same problem. An absolutist system that tells us to abhor all recreational use of mind-altering substances is no help here. We cannot rely on existing intuitive morality about recreational drugs because, on closer inspection, there are no general rules that can be applied.

The related argument that drug use is wrong because it is illegal is also of limited value. The key question is whether or not it is appropriate for the law to seek to restrict drug use. While we might agree that the law should generally be obeyed, this tells us nothing about whether the law should be rewritten.

The fall-back defence is that drug use is immoral because the apparent benefits it brings are somehow inauthentic(1). The drug user may feel happy, but their pleasure is insubstantial and transitory in a way that other experiences are not. It also distorts reality so that sensible behaviour is edged out.

No doubt this is often true, but it is tilting at a straw man. Its first weakness is the suggestion that someone can either take drugs and experience at best inauthentic happiness, or they can pursue other activities and experience deep and lasting happiness. In practice, there is no reason why someone cannot do both. Few would suggest that someone who has the occasional alcoholic drink cannot achieve fulfilment in life.

Indeed, even if one accepts that some happiness is more authentic than others, it is not clear why this would mean that drug use was immoral. It would be a peculiarly ascetic definition of morality which insisted that happiness can, all other things being equal, only legitimately come from certain sources, and not from others. To accept this would require us to think it immoral to get passing excitement from a roller coaster or scary film.

A further counter-argument to this criticism of drug use suggests a very different view. The Greek philosopher Epicurus argued that we should prioritise pleasure seeking over all else; thus we needn’t account for where the pleasure comes from, or whether it is derived from authentic sources.

However, there is a danger in focusing too narrowly on the pursuit of pleasure. It is inescapable that one person’s pleasure-seeking has an impact on someone else’s attempts to do the same. Indeed, the same challenge undermines the libertarian argument that drug use is a matter only for individual choice.

JS Mill argued that individual liberty should only be restricted when to not do so would allow harm to be caused to other people(2). But for better or worse, the world has too few solitary desert islands for drug use to take place without its consequences, whatever they may be, reaching beyond the user.

Abstract rules fail because they can never achieve moral consistency. Instead, we need to look at the consequences of drug use on users and the people around them. This is not to say that we consider moral arguments to be irrelevant; in fact, we suggest that a moral view is strongly applied in our analysis.

The wider impacts of drug use


In general, we as citizens disapprove of actions that have a negative effect on others. It could further be argued that we should disapprove of actions that do not actively promote the common good(3).

Some drug use often does have a destructive effect. Some people with severe drug addictions commit substantial amounts of acquisitive crime to be able to pay for drugs. Consumption supports a long chain of organised crime. Many users require treatment that is expensive for taxpayers. There is also an emotional and social cost to the families of people with serious drug problems. Crucially, it is extremely difficult to predict who, out of all of those who try a recreational drug, will go on to develop a drug problem that causes these harm to other people. As Aquinas argued, what matters is not just the actual consequences of an individual’s behaviour, but the likely consequences of a type of behaviour(4).

From the perspective of the non drug user, the least harm would be caused by other people not using drugs at all, even allowing for the short-term violence-reducing effects of some depressants like ketamine, and the mind-altering effects that inspired countless artists from Byron to Lennon.

From this perspective alone, all drug use should be regarded as morally wrong. But then so should other activities that impinge on others without benefitting them, like driving fuel-inefficient cars or playing many high-risk sports. Clearly what matters is the total extent of the harms caused, set alongside the benefits gained.

We can also take a wider perspective of harms caused by drug use. It can be seen as self-focused, diminishing citizens’ ability both to devote time and energy to caring for others and to being fully productive. Hogarth’s Gin Lane reminds us that we would not be the first to fear the consequences to society of overindulgence.

A parallel comes from alcohol restrictions. As a society we live with some of the restrictions on alcohol imposed in 1914 to improve Britain’s war effort, even though not many think that alcohol use is always morally wrong. A riposte to the Epicurean view, argued by the Stoics, is that restraints on our pleasure-seeking are necessary so that we are better prepared to survive leaner times(5). Under these principles we see a moral basis for restrictions even on drugs that cause no physiological damage.

Yet, it is not clear why we should single out drug use as the subject of these arguments. Other unproductive and self-indulgent activities like the playing of video games are widely accepted(6), so long as they are not pursued to extremes. This seems to us to be a weakness in the argument of those who say that the impact of drugs on a user’s responsibilities to other people is a reason why it must be avoided(7). Their logic would extend to all manner of pleasure-seeking activities that few currently see as immoral.

The solution is to recognise that some drug use is uniquely harmful to other people. But, clearly what matters is the extent of the harms caused, balanced against any benefits gained.

Impact of drugs on the user


Does the harm that drugs can cause to the user mean that the act is immoral? Probably the majority of people who have taken drugs have done so without any significant problems, though some have suffered greatly.

It might be argued that people choose to take drugs knowing the risks involved. But this is true only in a very limited sense. People start using drugs for a variety of reasons, and generally expect to gain some benefit, even if the risks are high. Many who are trapped in dependency want to stop, but cannot. For these people, drug use can become very harmful, and a situation they have entered without making rational choices.

As many drugs workers point out, no-one chooses to be an addict. We accept it to be morally right to restrict the freedoms of children, and those with severe psychiatric disorders. With those parallels, we may well question how far drug use should be left as a free choice.

Yet even if we think it may be morally acceptable to restrict the supply of drugs in order to minimise harms, this is not the same as saying that the act of using drugs is itself immoral. Even suicide is now generally not seen as immoral, except in terms of the impact it has on survivors.

It should also be noted that the harms caused by drug use are to a great extent influenced by how the illicit drug markets are constructed and the laws applied. Pure heroin, cheaply or freely available to addicts in a controlled way is likely to do far less damage to each user than the contaminated and expensive rubbish usually for sale on the street. The rules that are in place because drug use is seen as unacceptable are part of the reason it can be so harmful. The logic becomes self-fulfilling.

It may be argued in response that without moral disapproval, drug use would be much more widespread, and so the total harms could be much greater, even if the harm to each individual user might be lower(8). There is not enough evidence to prove whether this is true; the important point for now is that it is not inevitable that drug use should cause the levels of harm that it currently does. It would be hard to justify policies whose aim was to reduce harms, but whose consequences were the opposite.

Set against these harms, there should be no doubt that drug use does bring benefits to many participants. Why else would two million people a year use cannabis? Most users are not addicted yet the drugs market remains strong: there is clearly an attraction to rational people, as anyone who enjoys a cup of coffee, or a glass of wine knows. The question is how to respond to this desire in a way that increases the sum of everyone’s happiness and keeps to a minimum the collateral harms.

The final calculation

There is no strong argument that illicit drug use is intrinsically unacceptable, as many parallels can be made with other activities that society deems morally permissible, like dangerous sports and use of legal drugs, and modern morals are a poor guide when applied to real-life examples of drug use. The solution has to be some better calculation of the benefits and costs of drug use across a full range of consequences.

We may question whether this calculation is even possible; some argue that there are far too many unpredictable consequences of any action for this to be realistic(9). But, having seen that arguments based on the intrinsic morality of drug use do not stand up to scrutiny, not attempting a calculation of costs and benefits would leave us with no guide to the morality of drug use. We still need to take a view, even if the calculation will be hard.

This is not the place to work through the full calculus. But some principles are clear. We would need to take into account short and long-term costs to others, both direct and in terms of opportunity costs. The costs and harms of enforcing the law have to be accounted for. We also need to recognise the role of risk: most benefit from drug use, but some suffer greatly, and the unpredictability of this is important. But set against these drawbacks are the advantages to users: of happiness, pain relief, and liberty to choose their own actions.

The starting point is agnosticism, and the aspiration to achieve the best results possible. By being guided by evidence, not ideology, and continually striving to improve our responses, the pragmatic approach allows us to be flexible and recognise that drug use cannot be seen in isolation from its context or its impacts.

Although prosaic, the pragmatic calculations that form evidence-based drug policies are in fact the ones infused with morality: about protecting life, and improving physical, mental and social wellbeing. Compared with those bound by iron rules, these are the calculations that allow us to save the most lives and disrupt the fewest others.

 

Author

Roger Howard & Leo Barasi, UK Drug Policy Commission

References

(1) Pike, Gregory K; Putting ethics in its place – right at the heart of drug policy; The Journal of Global Drug Policy and Practice; Volume 1, Issue 4, Winter 2007
(2) Mill, JS; On Liberty; 1859
(3) Pike, Gregory K; op cit
(4) Fieser, James; Moral Issues that Divide Us; 2008
(5) Ibid
(6) Foddy, Bennett & Savulescu, Julian; Addiction is not an affliction: addictive desires are merely pleasure-oriented desires; The American Journal of Bioethics; 7:1, 29 – 32; 2007
(7) McKeganey, Neil; Controversies in Drug Policy and Practice; 2011
(8) Ibid
(9) Pike, Gregory; op cit

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