It is abundantly clear, given decades of trial and error and escalating scientific evidence, that prohibition only makes risky drug use even riskier. If we actually want to reduce mortality and other health problems associated with drugs, it makes more sense to regulate legal drug markets than to incentivize illicit ones. So-called “hard” drugs like cocaine and methamphetamine are no exception.
Prohibition of cannabis and psychedelics is slowly unraveling in some places, but for stimulants it’s a tougher sell at the moment. Even someone who thinks psilocybin mushrooms should be allowed in therapy, or that cannabis should be sold as freely as beer, may have trouble accepting a legal market for cocaine.
This is not stopping Steve Rolles, a senior policy analyst at the Transform Drug Policy Foundation, a British think tank. He is hoping that nations will soon regulate and legalize the sale, possession and use of “uppers.” He isn’t saying these drugs don’t have risks—but he notes that prohibition does nothing to address these risks, and that we need a different approach.
“The danger of a particular drug is the reason to regulate it, not the reason to run away from it,” said Rolles. “For me, it doesn’t really matter how dangerous a particular drug is. If people are using it, we have to accept that prohibition is still going to make it more dangerous and regulation is going to make it safer. It’s a fundamentally pragmatic position.”
Rolles is the author of How To Regulate Cannabis: A Practical Guide, a book used in Canada and Uruguay to help shape their marijuana legalization frameworks. Mexican officials recently cited his work in drafts of recreational marijuana legislation.
Use of drugs like crack and meth is on the rise, but seemingly ignored by most media and governments in the context of ever-increasing opioid-related deaths. That means this could be a pivotal moment to consider this kind of legislation. Rolles cites evidence that access to pure drugs with known dosages could not only prevent fatal overdoses, but help put an end to the bloody cartel wars in Latin America.
“There’s been an alarming rise in stimulant deaths. [Of] about 70,000 deaths in the US [in 2017], 10,000-15,000 of them are stimulant-related,” Rolles says. “I think if it hadn’t been for the opioid crisis, people would’ve paid more attention to that fact, and they’re not. Even in the United Kingdom, we’ve seen a rapid increase in deaths from cocaine and MDMA. Around the world, this is a growing issue that is not getting the attention that it needs,” said Rolles. “Unregulated cocaine is already widely available and used, but regulating cocaine will make it much safer.”
Legal markets could address this growing problem. To choose an example, let’s focus on cocaine. A legal market for coke may seem absurd, but the drug was sold widely in the US a century ago, as a baldness cure and more famously as an early ingredient in Coca-Cola. Could a regulated market for cocaine work 100 years later? And what could convince policymakers to seriously consider this idea?
“It’s worth reminding ourselves that unregulated cocaine is already widely available and used, but regulating cocaine will make it much safer,” said Julian Buchanan, a harm reduction veteran and retired professor at Victoria University of Wellington.
“The question is not ‘should cocaine be legal,’ but why on earth, given the evidence before us, should we continue with drug prohibition? The regime is a global disgrace that will be remembered in history as one of the greatest atrocities and human rights abuses in living memory. Where do we stand in this historic period of change?”
So what would it look like to bring cocaine in from the shadows? Would it resemble cannabis dispensaries like in California or Canada? Or operate more like prescription heroin programs in Switzerland and the UK?
Where Cocaine Is Already Legal
A handful of countries have already legalized, rather than just decriminalized, small amounts of cocaine. Colombia, currently the world’s biggest cocaine exporter, allows possession of up to a gram, but forbids sales. Mexico has a similar model, but only permits possession of half a gram. In Peru, it’s two grams, but in 1949 the government created ENACO, the state-run National Coca Company, which cultivates coca for medicinal products like teas.
Incidentally, the US is the only country that buys Peru’s medical-grade cocaine, which is (uncommonly) used for sinus surgeries. Cocaine is a great vasoconstrictor—it narrows the blood vessels—and as a 2016 review noted, “there is no direct replacement for its useful unique characteristics.”
Bolivia is the only other country where cocaine is truly legal, not just decriminalized like in Portugal. In 2008, the country dramatically expelled the US Drug Enforcement Administration and withdrew from the United Nations’ Single Convention on Narcotic Drugs. The nation re-enrolled in 2013, but with an exemption for coca. Today some 3 million people in Bolivia use coca leaf.
At the same time, Bolivia began its “Coca sí, Cocaína no” program, which enshrined coca into the constitution but demonized cocaine in powder form. This makes some sense, given coca is historically deeply intertwined in Bolivian national identity, whereas cocaine powder is associated with “neoliberalism” and capitalist exploitation, according to Paul Gootenberg of Stony Brook University.
“It’s also ironic—if predictable—that the United States has failed to recognize the legitimacy of the Bolivian national experiment in drug control, despite evidence it works—probably since it is an open challenge to supply control ideology,” Gootenberg noted in a 2017 analysis.
Legal cocaine markets in other countries might expand on these Latin American models. But in addition to the nature of regulation and sales, we need to consider potential limits on grams purchased per person—and which forms of cocaine might be permitted.
Different Approaches to Different Forms of Cocaine
Whether it’s leaves from the coca plant or a line of white powder or freebased coke (crack), it’s all the same drug—but differing concentrations and routes of administration can have vastly different effects.
“Cocaine is actually a very good illustration of how the preparation of the drug and how a particular drug is used can have hugely significant impacts on levels of health harm,” Rolles says.
For 3,000 years, Andean communities in South America have chewed coca leaves to combat altitude sickness. The buzz is about as mild as coffee and may even have some health benefits. The leaves are sometimes mixed into teas and other drinks, but the concentration of cocaine is so small, it’s difficult to get very high or become dependent.
Then, of course, you have powdered salt forms of cocaine, which are typically snorted. The results are more immediate, with a stronger kick. Because cocaine salt is water-soluble, it can also be injected.
Finally, cocaine in freebase form has a lower boiling point, so it can be vaporized and smoked, giving the drug a powerful rush. Low-purity freebase made with baking soda is known as “crack” due to the sound it makes when heated. Freebase cocaine has a shorter duration, but the high is more intense, lending to greater patterns of problematic use than snorted cocaine or coca tea.
Rolles supports making milder alternatives to salt or freebase cocaine available—but says that continuing to ban the other forms outright wouldn’t do much to dent the damages of prohibition.
So clearly not all forms of cocaine are created equal. Should some be allowed while others are banned? To start, Rolles supports making milder alternatives to salt or freebase cocaine available—but says that continuing to ban the other forms outright wouldn’t do much to dent the damages of prohibition. The severe and continuing harms to black communities caused by the US government’s extra-harsh approach to crack cocaine are a stark illustration of this.
“From a public health point of view, if people are going to use cocaine you’d want them to be moving away from the more potent and risky products,” Rolles says. “I’m quite interested in some of these milder cocaine products that sit between coca leaf and cocaine powder.”
He suggests cocaine gums, lozenges and energy drinks—even snus-like packets that are placed in the upper lip, simply replacing tobacco with coca leaves. Regulating these and other “mild” forms of the drug would put a dent in the illicit cocaine trade, disempowering gangs and protecting people from adulterated products.
“What prohibition does is it tilts the market towards the most dangerous products because they are the most potent and profitable,” Rolles explains, summarizing what’s known as the Iron Law of Prohibition. “Now, you’re never gonna get rid of all of it. Some people are always going to want cocaine powder. They want that rush, they want that sensation. But if you could draw away 30, 40, 50 percent of the cocaine powder users … from a public health point of view that’s still a good thing.”
A powder cocaine market should be much more strictly regulated than one for milder products, Rolles suggests, and vendors should be required to highlight safer products and discuss harm reduction approaches with customers. He also suggests forbidding secondary sales and requiring licensed access to prevent folks from buying in bulk. “It’ll be limited,” he says. “Something sensible like two grams a week or whatever.”
How Feasible Is This?
Progressive drug policy seems to be taking hold in the US. Just a decade ago, recreational cannabis wasn’t legally available anywhere, but now 10 states have adopted legalization, with many others moving in that direction. Considering esketamine’s recent FDA approval—with MDMA and psilocybin psychotherapy not far behind—psychedelic drugs seem like the next in line to be released from prohibition, at least in part.
But are stimulants really that far behind?
“Getting widespread support for relaxing laws concerning the use of stimulants will be difficult, especially under the current administration in DC,” said Khary Rigg, a researcher at the College of Behavioral and Community Sciences at University of South Florida. “But that said, even though it may not be the best time politically to propose these ideas doesn’t mean it shouldn’t be proposed. If it’s a good idea, it’s a good idea.”
You have to start somewhere—and discussing the issue is a first step.
Legalizing cocaine will require a major shift of the Overton Window—the range of ideas acceptable to the general public. One 2016 poll showed 76 percent of Americans were opposed to the decriminalization of cocaine, with only 16 percent in favor.
But you have to start somewhere—remembering the dramatic rise achieved in public support for cannabis legalization—and discussing the issue is a first step. This year’s Global Drug Survey, for example, is asking respondents whether they would be prepared to pay extra for ethically sourced, “fair trade” cocaine. Rolles aims for his yet-to-be-titled book, which he hopes will be published later this year, to further rouse that dialogue.
“When policymakers are interested in moving forward with this, they will have a solid foundation to base their advocacy on,” Rolles says. “The time is right to push the regulation debate beyond cannabis to starting to look at some of these other drugs. Stimulants seem like the obvious next place.”