EVALUATING WORLD DRUG POLICIES

(Towards a cost-effectiveness analysis of initiatives undertaken.)

Carla Rossi

Department of Mathematics, University of Rome "Tor Vergata"

Rome, Italy

and

Osservatorio delle Leggi sulla Droga (OLD)

Coordinamento Radicale Antiproibizionista (CORA)

Via di Torre Argentina 760 0186 ROME, Italy

1. Introduction.

A number of different stands have been taken recently with regard to the ineffectiveness of drug policies adopted by the countries with the aim of reducing the production, traffic, and consumption of substances defined as "drugs." It is now being acknowledged that producer countries continue to produce more than ever and consumer countries to consume more than ever, without any real change having been effected by actions carried out on a massive scale, and financial investments made on an even greater scale.

Yet again, however, the analysis has been based on incomplete information and without the phenomena being quantified on a scientific basis that would permit an accurate cost-effectiveness analysis of the diverse drug policies and an objective comparison of the results obtained in the different countries with the aim of evolving more or less adequate strategies to control the phenomenon. All too often the analyses effected are governed by a priori hypotheses and based on incomplete data and assumptions, rather than being grounded in scientifically-tested research methodologies.

Later, an indicator will be proposed that would allow a "global" quantification based on statistical indexes of the phenomena in question. It is our intention, therefore, to utilize available international data to determine a corresponding value in the different countries, in order to create a system on the basis of the effectiveness of the policies adopted to control the drugs phenomenon that would eventually permit the less effective ones to be cast aside.

It must be noted that the lack of methodologies for quantifying the impact of the diverse drug policies seems to have resulted not only in the continual reproposal of analyses based solely on ideological hypotheses but also in the total unreliability of official data gathered in the various countries, to the point that the United Nations itself does not distribute the data it receives from Member States via questionnaires, but reduces it to a "discursive" summary that is included in an annual report of little interest and use when it comes to any kind of monitoring of the phenomenon.

It must also be noted that the majority of approaches to this issue start with a "humanistic" analysis that is far more often directed at studying actions taken against drug addiction that only constitutes one aspect of the drug phenomenon - which from a global point of view is perhaps not even the most important - while there is a tendency to ignore the economic aspects and those linked to the market, which are more significant than the phenomenon of "drug addiction", and even others that are far more serious; such as, organized and petty crime; corruption of the legal economy by drug money laundering; enmeshing of criminal and political organizations; collusion between criminal organizations and the forces in charge of repressive intervention. References about different quantitative studies in the field of substance abuse can be found in Robson and Single (1995).

Whereas to analyse such a complex phenomenon it is necessary to adopt a wholly scientific approach which, as it is a question of analysing "collective" and not individual phenomena, cannot exclude the use of statistical methodolgies both to describe and interpret the actual situation, and to predict and analyse the probable impact of policies that should be adopted to control the phenomenon. It would also be desirable, amongst other things, to use scientific methodologies also to evaluate the action taken to rehabilitate drug addicts, also because of the considerable public and private investment made in this area (financing of live-in rehabilitation centres, etc.), while almost nothing is known in qualitative and quantitative terms about the results of such action. It is to be hoped that similar evaluations will be made concerning action undertaken with regard to harm reduction, now that there finally seems to be a way to apply this strategy in various countries.

In order to effect these types of analysis on the collective phenomena linked to the drug problem, however, it is necessary to have access to reliable data on the different aspects involved.

2. Drug related phenomena.

The drug problem does not only involve all those phenomena linked to addiction in the strict sense, like drug-related deaths (caused by overdose, infectious diseases, endocarditis, cyrrosis) and the medical assistance offered to drug abusers (assistance from the national health service, periods spent in live-in rehabilitation centres), but also many other aspects that have considerable impact also on those people who have no connection whatsoever with drug addiction: one only has to think of all the victims of petty crimes linked to drug addiction (it is estimated that at least 60-80% of the bag-snatchings, thefts and robberies committed in Italy are perpetrated by addicts to get money to buy drugs).

2.1. Health aspects.

Here we are dealing with all the phenomena that impact on health service structures: cases of illness linked to drug addiction in that it can cause specific diseases (hepatitis, endocarditis, septicemia, AIDS, etc.); action undertaken by the health service to rehabilitate drug addicts (outpatient and inpatient facilities, mobile units, etc.); juvenile mortality linked to drug addiction (overdose, AIDS, violent deaths, deaths caused by infections and other drug-related syndromes).

Such phenomena can be quantified in different ways:

- For example, it is possible to effect a quantification in terms of immediate economic impact on the community; in this case one can calculate the absolute annual (or periodic) frequency of such cases, multiply this by the average cost of each case, and then divide it by the total number of the population who supports the related cost during that same period. In this way, it is possible to obtain and to compare the "per capita price" of the different phenomena in the various countries on which sufficient data is available.

- It is also possible, however, to assess the impact more generally by working out the ratio between the absolute frequencies of cases related to the phenomena under study and the respective populations; for example, the number of AIDS victims among drug addicts in ratio to the total number of AIDS victims; the number of drug-related deaths in ratio to the total number of deaths in the juvenile population, which can eventually be stratified according to sex and age groups; the estimated number of drug addicts in ratio to the population, with regard to the same sex and age groups; the number of individuals interested in receiving assistance in ratio to the total number of drug addicts, and so on.

2.2. Aspects linked to repression.

Here it is a question of analysing, in particular, police operations connected with the repression of money laundering, or the consumption of and trafficking in substances defined by the various legislations as narcotics or psychotropic substances; people detained for drug-related crimes (for breaking drug laws or for being addicts who have committed serious or petty crimes connected with the drugs market); and relative civil or penal proceedings.

Also for these phenomena it is possible, as we have seen above, to arrive at two fundamental types of quantification: a purely economic quantification, on the one hand, and another related to the more general impact on the populations under study, by working out the ratio between the number of drug-related police operations and the total number of operations; the number of drug-related criminal proceedings and the total number of criminal proceedings; the number of prisoners convicted of drug-related crimes and the total number of prisoners, and so on. In Italy, for instance, 55% of prisoners, at the end of 1994, were, in some way, related to the illicit market of drugs.

2.3. Aspects linked to the illegal market.

With regard to the narcotics market it is possible to arrive at a quantification by finding or estimating the number of people occupied in this economic sector, and the relative values added. It is also possible to make the two types of impact evaluation described above. In particular, to obtain a relative measure of impact it is possible to effect a comparison with an important sector of the legal economy; for example, one could take the car industry, agriculture or tourism sectors in Italy.

2.4. Aspects linked to organized and petty crime.

Here we are dealing with all those "crimes" linked either to the drug addict's particular "condition" (petty larceny, bag-snatching, picking pockets, etc.) or to the running of the illegal drug market (production of and trafficking in drugs, crimes committed by criminal organizations against persons belonging to rival "cartels", etc.).

Regarding the first category, it is a known fact that a high percentage of these crimes are committed by drug addicts. To work out the cost to society one simply has to multiply the recurring frequency by the mean value of the overall damage caused, if necessary allowing for the number of crimes that are not denounced (statistics exist in several countries that permit the number of these crimes to be assessed).

On the other hand, to obtain an impact indicator one can work out the ratio between the number of these crimes and the total number of petty crimes committed.

Regarding the second category, it is possible to proceed in a similar way, bearing in mind that the assessment of the costs is somewhat more complex, while to obtain an impact indicator one can once again work out the ratio between the total number of drug-related crimes and the total number of cases of organized crime.

If we consider, for example, the number of persons in jail for organized drug trafficking in Italy (September 30th 1994) and calculate the ratio with respect to the total number of persons in jail for organized crime, we obtain 38.5%, that is to say that drug tafficking alone accounts for more than 1/3 of the organized crimes. We must consider that this is surely an underestimation of the real impact as, in Italy, if a person is convicted both for "mafia" related crimes and for drug crimes he/she is accounted as convicted for "mafia".

We should also add to this the cost to, or impact on, the legal system, which can be estimated with the recurring frequency and the average cost of consequent legal actions.

3. Towards a "global" indicator.

To obtain a global indicator of the cost, on the basis of purely economic quantifications, one simply has to calculate the per capita average cost.

Whereas to obtain a global indicator of the impact, it is necessary to effect a weighted mean of all the ratios related to the different aspects analysed.

It is possible to effect different types of analysis based on these indicators:

- analyses of an individual country;

- longitudinal analyses;

- cross-sectional analyses.

Examples of such analyses follow in which, given the above-mentioned lack of uniformity in the data produced by the various countries, it did not seem opportune to proceed with the calculation of the global indicators; therefore, the different ratios are dealt with separately, and the analysis of the impact of the different drug policies can be carried out on the basis of various comparisons made between the different partial indicators.

Naturally, the value of such indicators of effectiveness must be related to the different legislations and policies on the basis of indicators of "quality" established for the individual aspects of the policies themselves.

Here we would like to introduce the notations necessary to make the calculations:

- Let Nij(i)(t) be the number of events that occurred in

the period of time t, with relation to the aspect j(i)-nth of the phenomenon i-nth.

For example, if we decide that the phenomen i=1 is "repression" and the aspect j(i)=3 is the number of police actions reported every quarter, and the analysis starts with the first quarter in 1990, then:

N13(5) is the number of police actions in the first quarter of 1991.

The two indices are thus defined:

- impact index: II(i,j(i),t) = Nij(i)(t)/N(t),

- cost index: CI(i,j(i),t) = cij(i)(t)Nij(i)(t)/N(t),

where, in both cases, N(t) is the population under study during the period being analysed and cij(i)(t) is the average cost associated with each event.

It must be pointed out that to make things simple we have utilized the same notation N(t) in both cases, but the reference population can be different in each case, as specified above.

3.1. Analyses effected for individual countries.

Let us take income linked to the illegal market and estimate the per capita average income by using assessments made for Italy by Prof. Guido Rey, in 1993 (IAL report 1994).

Table 1. Per capita annual income of traffickers and dealers in illegal psychotropic substances.

---------------------------------------------------------------

Persons Total Sales Value Per Capita Per Capita

Involved Added Sales Value

Added

Traff. 10,000 3683+1000 2109 358 210

Dealers 55,000 6305+900 2298 115 42

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On the basis of the values listed in the table it is possible to effect comparative analyses with sectors of the legal economy, to assess the social cost of the illegal market, to compare the Italian situation with that of other countries (cross-sectional analyses), or even to analyse the development of the market over a number of years (longitudinal analyses).

3.2. Longitudinal Analyses

As an example of longitudinal analysis, let us examine the prisoner trend over a period of time and assess the impact on the Italian population.

Table 2. Prisoners in Italian jails over a period of seven years and the percentage of Intravenous Drug Users.

Year Prisoners Detention IDU %

Rate

(per 100,000)

------------------------------------------------------------

1986 33609 59 18

1987 31773 55 16

1988 31382 55 24

1989 30680 53 25

1990 25931 45 28

1991 35469 61 33

1992 47316 82 30

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Without going into greater detail, the influence on the phenomenon of Law 162/90 (Jervolino-Vassalli) is clearly evident in the table (increased detention rate since 1990).

3.3. Cross-sectional analyses.

Let us take deaths caused by drugs, which are mistakenly seen as one of the main indicators of the impact (postive or negative) of the provisions made over the years or in different countries.

Table 3. Deaths caused by drugs in different countries (source: Substance Abuse related Mortality: a Worldwide Review, UN, 1994).

Country Year Deaths Per Capita Value

(Residents in thousands)

---------------------------------------------------------------

Austria 1991 116 0.015

Belgium 1990 91 0.0l

Canada 1988 414 0.016

France 1991 411 0.007

Germany 1992 2099 0.03

Holland 1989 52 0.0035

Italy 1990 1152 0.02

Spain 1991 579 0.015

Switzerland 1991 405 0.06

UK 1991 1356 0.023

US 1993 6000 (estimate) 0.024

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In table 3 are indicated the values relating to more or less the same years in different countries (the table shows how we are dealing with non-uniform data, at least with regard to the year under study so the comparisons are made just to show how to use the methodology. It should be also noted that the definition of "drug-related death" is different in different countries).

Without going into details, it can be seen clearly from the above table that the impact of deaths caused by drugs is much smaller in Holland than in all the other countries, which have indicators of the same order of magnitude.

4. Conclusions.

To overcome the problem of non-uniform data it is also possible to use ordinal indicators (grading). All one has to do is arrange the different countries according to the partial indicators and to use, for the cost-effectiveness analyses, a grading system that is less affected by shifts and errors in the basic data (it is the procedure commonly adopted for analysing the quality of life in the various cities).

With regard to the data in the above table, for example, one would obtain the following table.

Table 4. Ratings showing the impact of drug-related deaths on the different countries.

Country Deaths Per Capita Rating

(thousands)

---------------------------------------------------------------

Switzerland 405 0.06 1

Germany 2099 0.03 2

US 6000 0.024 3

UK 1356 0.023 4

Italy 1152 0.02 5

Canada 414 0.016 6

Austria 116 0.015 7

Spain 579 0.015 7

Belgium 91 0.01 8

France 411 0.007 9

Holland 52 0.0035 10

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The above methodology was applied to some international data which, although non-uniform, allowed some interesting comparisons to be made (IAL report, 1994)

REFERENCES

International Antiprohibitionist League ed. "Questioning Prohibition", IAL report, Bruxelles 1994;

Robson L. and Single E. "Literature Review of Studies on the economic Costs of Substance Abuse", report of the Canadian Centre on Substance Abuse, March 1995;

UN report "Substance Abuse Related Mortality: A Worldwide Review", United Nations International Drug Control Program, Vienna International Centre, March 1994.