Safer Solutions: Is Prohibition the Solution to the Complexity of Substance Use?
Developing policies to prevent, manage, and treat substance dependence is complex. Different stakeholders have varying priorities and perspectives that often conflict, and unintended consequences can create new challenges. This complexity makes it easy to think, “Just get rid of the substances!” When this type of thinking prevails, heavy regulation, criminalization, and/or prohibition often follow. But is this the best solution?
Can Prohibition Succeed?
The unsatisfying answer to this question is another question: “Succeed at what?”
Consider alcohol prohibition. Banning alcohol in the early 1900s initially resulted in a significant decrease in use; however, consumption quickly rose again before stabilizing at a level somewhat lower than before Prohibition. Consumption remained roughly at this level even after the 21st Amendment reversed the ban. Is that success? If the only goal of Prohibition was to reduce alcohol use, then it had some level of success, at least at the start.
The challenge with prohibiting substances is that it causes unintended consequences. Organized crime and other criminal activities thrived during Prohibition, and courts were clogged with related violations. Additionally, some illicit alcohol contained harmful chemical additives that caused death and/or paralysis.
Today, alcohol consumption in the United States is regulated and restricted; however, similar challenges make success hard to define when it comes to prohibiting or regulating other substances. We have seen serious unintended consequences with opioids, including dangerous changes to the illicit drug supply and burdens to the legal and carceral systems. Heavy regulation has also impacted nicotine e-cigarettes. Here, extensive regulatory burdens have created a quasi-prohibition, allowing unregulated products to overwhelm regulated ones in the market. Let’s look closer at opioids and nicotine e-cigarettes as examples.
Prohibited Substances Can Become More Dangerous
Attempts to cut off the supply of illicit drugs—especially without addressing demand in a meaningful and comprehensive way—tend to make the drug supply even more dangerous. This is the “Iron Law of Prohibition,” which asserts that, over time, policies that attempt to decrease the supply of illicit substances incentivize producers to create alternatives that are more potent.
Opioids provide an excellent example of this phenomenon. Government restrictions on successive waves of opioid products incentivized drug traffickers to produce new synthetic substances to meet user needs and better evade law enforcement. Over time, traffickers developed drugs like fentanyl that are more potent and easier to conceal, smuggle, and transform into a large number of doses for sale—exactly as the “Iron Law of Prohibition” predicts. The result is a greater risk of overdose for anyone who consumes illicit drugs habitually, occasionally, or even just once (and maybe accidentally).
Extensive Regulations Can Create Effects Similar to Prohibition
Another way governments attempt to restrict supply and discourage use is by highly regulating substances that can cause physical dependence. However, regulation rarely eliminates demand. While some regulation of substances is essential to protect consumers and public health, overregulation can do its own harm.
E-cigarettes are an example of how illicit products will meet the demand left when the overregulation of legal versions creates a quasi-prohibition. As e-cigarettes grew in popularity in the 2010s, there was increasing public pressure to keep vapes off the market—and especially out of the hands of minors. In response, the Food and Drug Administration (FDA) created a burdensome regulatory process for approving the domestic sale of e-cigarettes and approved the legal sale of only a few products. While this throttling of legal supply dramatically diminished the availability of regulated nicotine e-cigarettes in the United States, it didn’t prevent people from seeking e-cigarettes as their preferred product or as a reduced-risk alternative to smoking.
Enter unregulated, illicit vapes from abroad (think products like Elf Bar and Puff Bar), which filled the empty space in the market. Today, nearly any convenience store is likely to stock these products even though the FDA has not authorized them for sale. As a result, the market is full of products made without federal regulatory oversight on their production or ingredients and no mechanism by which to recall those found to be dangerous.
Addressing Complexity with Policy
Unfortunately, there’s no silver bullet to address the complex and messy reality of substance use. Prohibition or overregulation might reduce substance use, but they are also likely to entice new, unregulated, and potentially more dangerous products into the market. Decreasing use requires a holistic approach that addresses the availability of substances and people’s desire to use them. This requires an integrated approach to treatment alongside tools to reduce people’s risks when they do consume substances. Without comprehensive, accessible, and evidence-based options that address demand, the gains from shrinking supply may be overshadowed by the unintended (and often deadly) consequences.