The Social Epidemiology of International Drug ...

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Many approaches to drug use control have focused on the source of supply and the distribution .... Mexico, Southeast Asia (especially Burma and Thailand), and Southwest Asia .... After the Second World War, there was a shift in illicit dis-.

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The International Journal of the Addictions, 25(5), 557-577,1990

The Social Epidemiology of International Drug Trafficking: Comparison of Source of Supply and Distribution Networks* Michael Montagnef , PhD College of Pharmacy and Allied Health Professions Northeastern University, Boston. Massachusetts

Abstract

A variety of strategies have been implemented in an attempt to limit or prevent drug trafficking. Efforts have focused on reducing the supply of drugs, but they have not been very effective. There has been a shift recently to demand-reduction activities, but it is uncertain whether this approach will prove to be valuable. Most of the strategies that are employed are based upon the law enforcement approach. Alternative perspectives, based on principles of epidemiology and social network analysis, are presented and discussed in the context of studying drug trafficking on a global scale. More research and better sources of data and information are needed to delineate the relationship between availability and use, so that we might more effectively focus prevention activities.

*A shorter version of this paper was presented at the Symposium on the International Marketing of Alcohol, Tobacco, and Other Drugs at the 115th Annual Meeting of the American Public Health Association, New Orleans, Louisiana, October 19, 1987. tSend correspondence to the author at the College of Pharmacy and Allied Health Professions, 113 Mugar Hall, Northeastern University, 360 Huntington Avenue, Boston, Massachusetts 021 15. 557 Copyright 0 1990 by Marcel Dekker, Inc.

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One of the most important factors in the medical or nonmedical use of just about any drug is the availability or accessibility of the substance. Along with the drug’s basic pharmacological activity and the individual’s reason for use, the ease of obtaining and ingesting the substance can be influential in determinations to use a drug. It can be the main reason for deciding to use a drug or for continuing use over a period of time (Lettieri et al., 1980). Many approaches to drug use control have focused on the source of supply and the distribution networks for certain substances (Peele, 1987). The primary emphasis of past efforts has been the notion of deterrence, which is defined and structured through legislation. The deterrence model has been connected to the notion of supply and demand, and as a result, most efforts to prevent or control drug use are centered on the threat of punishment for buying o r selling certain substances as defined by law (Anon., 1983, 1984; Bruun, 1983;Ross, 1984). The classic example of this approach was the prohibition of alcohol in the U.S. during the early part of this century. This prohibitionist approach guides most drug use control programs in the U.S., the British Commonwealth, and the Scandanavian countries, and it is becoming more common in many European and Asian nations. But in reality, has this approach been effective in preventing or limiting drug use problems? And are there other perspectives that can be helpful in determining the sources of supply and distribution networks for specific substances? The purpose of this review, then, is to examine the basis for current strategies aimed at curtailing the use of certain substances. In particular, this analysis is placed in the context of the “flow” of drugs on an international level, and it considers specific issues and problems in research and policy development that need to be addressed in the future.

NATURE AND EXTENT OF DRUG TRAFFICKING The most valid statement that can be made about drug trafficking is that it does occur. The typical market behaviors surrounding rare commodities are very evident in the “black market” for drugs. Value foundations also direct this market behavior; for instance, capitalism contributes both a principle and specific methods to the current illicit drug distribution system, most notably as it applies to opiates such as heroin (McBride, 1983). Most of the information on the nature and extent of drug trafficking is collected by governmental agencies on a national (Anon., 1982; Stamler et al., 1983, 1984) or international level (UN Secretariat, 1983, 1987a), or by journalists (Auger, 1978; Editors of Newsday, 1974; Lamour and Lamberti, 1974 ;McCoy, 1972). The most commonly used definition of drug trafficking refers t o it as “the cultivation, production, processing, transportation, distribution, or sale of drugs’’ (President’s Commission, 1986). On an international scale, the organized

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illicit drug industry has been described as consisting of four activities: cultivation and production, export (smuggling), distribution in the consumer country, and the processing of money (Wisotsky, 1983). These activities can be influenced by economic, political, sociocultural, legal, geographical, meterological, and many other factors. Information on the cultivation and eradication of psychoactive plants, the production and importation of substances, seizures of drugs, and other data come from a variety of sources (Montagne, 1988). The League of Nation’s Permanent Control Opium Board (PCOB; in 1962, the name was changed t o the Permanent Central Narcotics Board) was the first group organized to collect data and to analyze the international flow of narcotic drugs. This board provided annual estimates of the need for licit narcotic drugs for each country, which are based on amounts required for medicinal consumption, manufacturing processes, and reserve stocks. The United Nation’s Single Convention on Narcotic Drugs reorganized the PCOB in 1961 and established the International Narcotics Control Board (INCB) to administer a statistical control system and t o make estimates of the worldwide distribution and use of narcotics (U.N. Secretariat, 1 9 8 7 ~ ) .The INCB became active in 1968, and it generated annual summary reports of the world’s requirements for narcotic drugs. These reports provide estimates of narcotic drug cultivation and production, licit consumption, exports and imports of licit drugs, and seizure data for each participating country. The U.S. State Department’s Bureau of International Narcotics Matters (INM) collects data on cultivation and production, mostly through its regional offices, w h c h are located in producer countries. The National Narcotics Intelligence Consumers Committee (NNICC) was established in the U.S. in 1978 (Anon., 1983). NNICC is a collection of agencies in the enforcement and intelligence communities (e.g., U.S. Coast Guard and Customs Service,]FBI, DEA, Departments of State and Defense), which combine their resources in arriving at annual estimates of trafficking activity that are based on the amount of money in the traffic, the number of users, seizure data, and estimates on cultivation and production (U.S. Congress OTA, 1987). These estimates of the illicit drug market are published annually in the Narcotics Intelligence Estimate. Internal estimates of narcotic drug cultivation and production are made by a variety of governmental agencies in the producer countries, such as ministries of agriculture, the interior, and taxation. Estimates have also been made, on an irregular basis, by research centers, independent scholars, agronomists, and investigative reporters (Montagne, 1988). Seizure data are collected and analysed, in different ways by the various U.S. agencies involved, as an indicator of trafficking activity. The El Paso (Texas) Intelligence Center (EPIC) is the repository for these data, but they rarely identify the agency responsible for individual seizures (US.Congress OTA, 1987).

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The trafficking situation can also be viewed from the demand side (i.e., consumption instead of production), with a focus on illicit importation. Estimates of illicit drug importation are calculated in two different ways (NNICC, 1987; Wisotsky, 1983). A production-based estimate is calculated by estimating the total number of acres under cultivation and multiplying this number by the average amount of narcotic drug plant that a single acre yields. This value varies depending upon the specific region where the plant is cultivated. The total amount of plant substance produced is numerically reduced by subtracting out the amounts needed for domestic use, licit pharmaceutical manufacturing, and other legal uses. This combined amount of licit production is often referred to as the “accountable stock.” The remaining amount is the potential “unaccountable stock,” which is available for illicit processing and distribution. This amount of plant substance is converted into the amount of extracted or refined drug that theoretically could be produced. The value for the estimated maximum amount of drug that could be produced is further reduced numerically by subtracting out the amount that is seized or lost/stolen in transit and the amount (an estimate) that is not converted due to inefficient production, spoilage, and other problems in the manufacturing process. The figure that remains (in metric tons) represents a production-based estimate of the drug that is available for illicit consumption. The consumption-based approach to calculating illicit importation starts from the demand side, rather than from the supply side (”ICC, 1987;Wisotsky, 1983). The annual number of drug users, based on a variety of surveys, is broken down by pattern of use;this variable represents an estimate of how much is consumed per session (e.g., dose) and how many sessions occur each year (e.g., frequency) for each type of user. Within each category, the number of users is multiplied by the average amount consumed annually, with an adjustment for the purity of the product that is being consumed. All the categories are summed, and the result is an estimate of the quantity of drug consumed (in metric tons) for that given year, and thus the amount of drug that must have been imported. These estimates of the total amount of drug trafficking are not subjected to retrospective validation. Statistical sampling techniques are not employed by any agency or group in analyzing the level of drug trafficking or in determining the effectiveness of drug control efforts. In addition, some estimates used in these calculations are out of date, there are insufficient data concerning price and purity, background data used to develop the estimates are not published, and the whole “methodology has been criticized as ‘analysis by negotiation’ with final estimates resulting from a bargaining process among the member agencies” (President’s Commission, 1986). The NNICC itself has stated that “because of gaps in some of the data used to derive the estimates, there is a high degree of uncertainty to the resulting estimates” (NNICC, 1984). These sources

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Table 1

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Source Countries - Cultivation

Coca/Cocaine

Opium/heroin

Peru Bolivia Colombia Ecuador Argentina

Iran Pakistan Afghanistan Burma Thailand Mexico United States

Marijuana Colombia Mexico Jamaica Belize Thailand United States

are, however, the “best” available for providing some data on illicit drug trafficking. The sources of supply and the distribution networks for most illicit drugs are truly global in nature. The cultivation of coca, the opium poppy, and cannabis occurs in a variety of countries, as shown in Table 1 (Montagne, 1988; NNICC, 1987; President’s Commission, 1986). Coca is cultivated in many South American countries, and it has also been grown, in the past, in parts of Indonesia and India. Cultivation of the opium poppy occurs predominantly in three areas: Mexico, Southeast Asia (especially Burma and Thailand), and Southwest Asia (mostly Iran, Pakistan, and Afghanistan). The opium poppy was also grown in some regions of the United States during the early part of this century. Cultivation has been noted more recently in California, Washington, Vermont, and Michgan (President’s Commission, 1986). Cannabis grows in the wild, and it is cultivated throughout the world. The major areas of cultivation include many parts of Central and South America, and most of the United States. Besides cultivation, countries can be sources of supply through their involvement in the transshipment of illicit substances (see Table 2). Some countries, Table 2 Source Countries - Transshioment

Coca/Cocaine -

Opium/heroin

Colombia Panama Caribbean Islands Bahamas Jamaica Haiti Nicaragua Costa Rica Mexico Hawaii

India Malaysia West Africa Nigeria Lebanon Netherlands Philippines Turkey Australia

Marijuana

Mexico Caribbean Islands

Bahamas Jamaica Trinidad/Tobago Central America PWma

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which are primarily the location for cultivation activities, are also involved in the distribution of more finished illicit drug products. In the case of coca and cocaine, most South American countries can be viewed as both cultivation and transshipment sources. Central American countries and the Caribbean Islands are not involved in the cultivation of coca, but they represent the primary channel for distribution of coca paste and cocaine to the United States, Canada, and European countries. This part of the globe is also extensively involved in both the cultivation and distribution of cannabis products. The extent of cultivation and eradication of selected plant substances is described in Table 3. The most dramatic increase has been in the cultivation of coca in South America. Most of the cultivation occurs in Peru and Bolivia, but acreage under cultivation is increasing in many other countries of the region (Montagne, 1988). The cultivation of cannabis (marijuana) has declined in recent years after a peak in demand (and thus supply) in the late 1970s and early 1980s. It should be realized, however, that the domestic (within the U.S.) cultivation of cannabis has been increasing steadily throughout the 1980s, and it might now represent up to 25% of the total amount consumed in the U.S. (President’s Commission, 1986). Cultivation well beyond potential or real demand is occurring for all three substances. For instance, it has been estimated that the amount of coca that is now being cultivated is 8 to 10 times greater than the amount needed to fulfill current demand for both licit and illicit cocaine (Montagne, 1988; NNICC, 1987; President’s Commission, 1986). Eradication data, of any quality, are limited t o coca cultivation. This is due to the more structured efforts recently focused at the coca crop, and to the fact that cultivation is limited to a more defined region of the world. Such data for cannabis and the opium poppy are more tenuous because of the extensive range of cultivation and poorer recordkeeping on the part of the source countries. Eradication efforts have been sporadic, and at best, only a very small proportion of the crop is destroyed each year. Eradication of the opium poppy has been successful in some countries (e.g., Turkey in the early 1970s, and parts of Mexico in the late 1970s), but eradication efforts have failed in most Asian countries. The eradication of cannabis crops has occurred only on a very limited basis. The annual illicit importation of various substances into the U.S., based upon consumption data, is presented in Table 4. While the amount of imported heroin has remained constant and the importation of marijuana has declined, coca leaf (note: on average, 500 kg of coca leaf will yield 1 kg of cocaine, and 1,000 kg equals 1 metric ton) and cocaine imports have increased dramatically. Since this is a consumption-based estimate, it simply represents the great increase in cocaine use in the U.S. At best, agencies of the U.S. government estimate that they intercept approximately 15% of the total supply of illicit drugs that enter the country

1,680-2,815 9,700-13,400

1,875-2990

9,545-16,585

152,000-188,000 3,570

1986

Sources: NNICC, 1984-1987; U.S.DEA; UN, INCB.

coca Cultivation: Eradication: OpiUm Cultivation Marijuana Cultivation:

1987

10,374-12,224

1,293-1,623

125,000-137,000 7,380

1985

16,030-18,880

1,416-1,666

135,000-170,000 8,594

1984

1983

19,225-21,555

1,532-1,922

11 3,000-150,000 2,680

Cultivation and Eradication of Various Plant Substances (in metric tons)

Table 3

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1,424-1,699

90,000-135,000 2,055

1982

6,700-9,400 1,050 1,030-1,260

1,060-1,260

6.00

23.8

150

1986

6,545-12385

178

1987

Sources: NNICC, 1984-1987; U.S. DEA; UN INCB.

Amount imported Marijuana Amount imported Amount seized HdIiSh Amount imported

Heroin

coca leaf Amount imported Cocaine Amount seized

1.150-1,380

6,4004,300 1,455

6.02

18.0

110-145

1985

8104,225

7,280-10,760 1,760

5.97

15.0

71-137

1984

Illicit Importation and Seizure of Drugs (U.S. - in metric tons)

Table 4

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10,200-14,500

6.04

8.0

54-7 1

1983

5.47

5.2

4045

1982

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(Skolnick, 1984). This estimate is based upon very tenuous information about the total amount of drug that is produced and made available to illicit distribution networks (see Table 4). In fact, in most seizure reports, just the numerator figure is given;and sometimes it is only in the form of the monetary value of the drug on the “street” and not by weight or volume, which can also introduce an erroneous or misrepresentative estimate (Wardlaw, 1986; Williamson, 1983). The big problem, then, is that statistical information on seizures at ports of entry and clandestine labs is not based on a ratio; in most instances, the denominator (i.e., total amount of drug in the distribution system) is not known.

THE INTERNATIONAL FLOW OF DRUGS A brief historical review of trafficking activities for specific drugs is instructive (Austin and Macari, 1978; Petersen, 1978), beginning with the opiates. The evolution and great extent of opiate use in China shaped the development of international trade in opium from the early 1800s to the mid-1900s. Most of the opium came from India. In 1949 the revolutionary government of China then instituted policies and programs which greatly reduced use in that country (Solomon, 1978a). After the Second World War, there was a shift in illicit distribution to markets in Europe and the East Coast of the United States. Crime organizations began their monopolization of the heroin supply for addict populations in large metropolitan areas (Gaffney, 1969). Turkey, the source of legitimate opium for pharmaceutical manufacturing, became the source for illicit opium, when many legitimate growers began t o withhold some of their crop for the black market. This source of supply was fairly constant until the famous “French Connection” (through Marseilles) was disrupted by legal authorities in the early 1970s (Editors of Newsday, 1974; Lamour and Lamberti, 1974), and the U.S. and Turkish governments developed policies to greatly limit cultivation (J. Warner, 1983). The source of dlicit opium, especially to the U.S., then shifted to Mexico, parts of the Middle East, and Southeast Asia. After treaties and enforcement efforts limited the flow of opium from Mexico, the major source of supply shifted primarily to Southeast Asia (Solomon, 1 9 7 8 ~ )Law . enforcement efforts followed suit, focusing on the “Golden Triangle” (Auger, 1978). While these efforts, even to this day, have not been very successful in reducing cultivation, poor harvests in 1978-1980 shifted the source of supply again, this time to Southwest Asia (Solomon, 1979a; Stamler et al., 1983). Most recently, the cultivation of opium poppies has increased in Mexico (Gavin, 1985). Some research suggests that through all of these shifts in sources of supply, the number or volume of arrests and seizures, and the price or purity of the product, did not affect the spread of opiates into a specific population or geographical area (Brecher, 1972; Skolnick, 1984; Wardlaw, 1986; Weissman, 1978).

MONTAGNE

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The flow of marijuana into the U.S., for most of this century, came through Mexico. Enforcement efforts in the late 1960s and early 1970s led to a shift in the source of supply to a number of South American countries, primarily Colombia. In the 1980s the major sources of supply have shifted back to Mexico and the Caribbean Islands (Gavin, 1985). There has also been a significant shift in the source of supply of marijuana from foreign to domestic growers, mostly because importation has become riskier and less profitable when compared to the other illicit substances. Most of the hashish consumed in Europe and the U.S. comes from Middle Eastern countries (Austin and Macari, 1978). Due to a long history and cultural tradition, coca has been cultivated in a number of South American countries, especially Bolivia, Colombia, and Peru (Antonil, 1978). Efforts have attempted to eradicate crops in those areas (Strug, 1983), but it has been noted that coca plants would also thrive in other parts of the globe, such as Indonesia and Madagascar (Brecher, 1972). Countries which are currently used as transit points and distribution centers (such as the Bahamas) have experienced marked increases in the use of this drug (Allen, 1987), as have the producing countries themselves. Different forms of cocaine, such as coca paste and free-base cocaine (crack), have become a large part of this market in recent years (Allen, 1987). Most of what is produced in South America is distributed to illicit markets in Europe and the U.S. (Anon., 1982). Inhalants and synthetic pharmaceuticals (e.g., amphetamines, barbiturates, tranquilizers, and nonpsychotherapeutic agents such as oral contraceptives and drugs to treat AIDS) are usually produced domestically and distributed internally (Skinner, 1969). It has been estimated that 90% of the diversion of legitimately produced pharmaceuticals occurs at the level of the physician’s office and pharmacies (Anon, 1985a, 1985b). There are some exceptions, especially when a drug is taken off the market in a particular country (e.g., methaqualone); in which case, clandestine labs in neighboring countries enter into production. Besides the diversion of pharmaceuticals from legitimate distribution systems, counterfeit products are produced in clandestine labs both internally and in other countries. The number of clandestine labs especially increases when more control is exerted over the diversion of legitimately produced products (Morgan and Kagan, 1978;R. C. Smith, 1969;D. E. Smith and Wesson, 1972). Hallucinogenic agents are also produced domestically in clandestine labs, and many such substances which are consumed in the form of the original plant material are being grown domestically (E. G. Warner, 1969).

THE LAW ENFORCEMENT APPROACH The law enforcement approach works on the basis of national laws and international treaties. The international treaty system is part of the United Nations (Kusevic, 1977; Petersen, 1978). The legal approach is based upon the deter-

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rence model, with a focus on reducing both supply and demand (Uelmen, (1983). The general notion is that reduction in demand for a drug would occur through efforts in education, prevention, and detoxification and treatment programs; and reduction in supply would occur through crop eradication programs and seizures at borders (Williamson, 1983). Some examples of specific strategies in the law enforcement effort include: a general strengthening of law enforcement agencies and programs (Anon., 1983), crop control in producer countries (Anon., 1983; U.N. Secretariat, 1983), mutual assistance treaties to direct seizures (Caffrey, 1984; Cagliotti, 1983), forfeitures of property (Nagler, 1984), systems to identify the laundering of money through international banking (Mangan, 1983), the “controlled delivery” of products to identify and monitor the flow of a drug through a distribution system (Cutting, 1983), the use of analytical labs in drug detection (Fernandez, 1984), identification of criminal organizations (Anon., 1984 ; Mullen, 1983) and international terrorist groups (Westrate, 1985) that are behind illicit drug distribution, and controlling the diversion of pharmaceuticals (Anon., 1985a; Bayer, 1983). In 1961 the World Health Organization developed the Single Convention on Narcotic Drugs, which was designed to be effective in controlling the trafficking in opiates but not in cannabis or coca (Bayer, 1983; Liu, 1979). It is also not well designed to prevent the diversion of psychotropic drugs from legitimate sources to dlicit channels. For instance, there are no appropriate provisions in the Convention for monitoring and controlling international transactions of these substances. The WHO has recognized that without national policies, treaties and activities at the international level won’t be effective. In 1983 the U.S. government presented its general strategy, based upon a 1975 White Paper on Drug Abuse and a 1982 policy statement (Anon., 1983). The U.S. federal strategy had two priorities: (1) controlling the cultivation of crops at their source and ( 2 ) stopping the transportation of drugs as close to the source as possible. The focus then broadened to include the disruption of the organized trafficking in drugs, internationally and in the U.S. (Anon., 1984). Most recently, the U.S. effort has shifted its focus to reducing demand within its own borders. It is aimed at greatly decreasing the number of new users, increasing the number of current users who abandon use, decreasing the consumption of drugs by those who continue to use, and increasing the demand for treatment. One outcome of this new strategy, as indicated by U.S. agencies, is that there will be an increase in the crime rate in the short term. This is primarily due to the reduced availability or the inaccessibility of substances while there is still a strong demand for them. The crime rate would increase as users attempt to secure scarce, higher-priced drugs, either through criminal activity within the illicit drug market or through involvement in other money-producing crimes (Moore, 1979; Wardlaw, 1986).

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The stance of the World Health Organization is less strict than that of the American government. The WHO is oriented towards supply reduction strategies, and it is very concerned about the effects of such programs on people and traditional cultures (Edwards and Arif, 1980; U.S. Secretariat, 1983). There is a basic idea that each country has a responsibility t o reduce the supply of illicit substances within its own borders. The international community, in general, should also help developing countries in their efforts. There is a notion among law enforcement agencies, and perhaps governments and societies by extension, that improvements in technology (for identifying, locating, and seizing illicit supplies of drugs) will greatly enhance the effectiveness of their efforts and the ability of these agencies to solve our drug use problems. The deterrence model is assumed to be effective if enough money, manpower, and technology is provided for specific targeted activities. The same rationale holds for preventing the trafficking of drugs into a country. This assumption, however, has not proven valid to date. The deterrence model doesn’t seem to work, primarily because the risk of arrest or punishment is perceived to be, or actually is, very low (Grizzle, 1981). Governments have perhaps expected too much of prohibitory laws and the deterrence approach (Skolnick, 1984). The international law enforcement model has two basic flaws: there is not a proportionate equality between crop size and the needs of a particular market (for instance, much more is grown than can or would be consumed in the U.S.), and the model makes the faulty assumption that only one organization is ever behind trafficking (especially given the ease of setting up clandestine labs and in producing and distributing drugs). The shift in the supply of opiates to other organizations after the disruption of the “French Connection” (Skolnick, 1984) and the current situation with the trafficking in cocaine in a number of South American countries are examples of how this reasoning is flawed. Additional problems include the level of corruption, which is very high in the current situation (Skolnick, 1984), and the chaotic political and economic conditions in some countries, which can greatly hinder any effort (Warner, 1983).

THE EPIDEMIOLOGICAL AND SOCIAL NETWORK PERSPECTIVES Other perspectives, in addition to the law enforcement approach, are useful in identifying some aspects of drug trafficking. One such perspective is epidemiological, which considers drug use in the context of the host-agent-environment model of classic, infectious disease epidemiology (Anthony, 1983). In this model, there is the notion that a psychotherapeutic drug reservoir exists, and that drugs (agents) are distributed by carriers from these reservoirs to potential

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users in a population. This approach can be helpful in identifying the source of supply, as well as the flow of drugs throughout the population. Hazards or problems resulting from drug use can also be identified, and measures can be implemented to reduce the damage from such events (Josephson and Carroll, 1974). A number of epidemiological studies of drug use and drug distribution have provided much useful information about localized trafficking. Most of these have focused on the epidemiology of opiate (heroin) use (Chein et al., 1964; Johnson et al., 1985; Moore, 1977). One classic study identified and described the spread of heroin use through a community (de Alarcon, 1969). In another study, increases in heroin use in Great Britain were attributed, in part, to Canadian addicts who had moved there in the 1960s (Spear and Glatt, 1971). The spread of amphetamine use has also been studied from this perspective (Brill and Hirose, 1969; de Alarcon, 1972; Ellinwood, 1974; D. E. Smith and Wesson, 1972). In these latter studies, it was possible to determine, in a crude way, the effectiveness of legal restraints on amphetamine production as a means for controlling an epidemic of use. A more social approach tends to focus on the social system or network that comprises users and sellers, and on how sociocultural factors might be useful in explaining differences in societies around the world. In this perspective, which has some similarities to the epidemiological approach, the social nature of drug trafficking can be noted (Atkyns and Hanneman, 1976). For instance, the increased demand for certain drugs within the network can influence the distribution and sale of other drugs (Allen, 1987; Brecher, 1986). This perspective has been employed in studies of the use of psychedelic drugs and marijuana (Clark et al., 1975; Foulks and Eisenman, 1969), the use and distribution of heroin (Could et al., 1974; Johnson et al., 1985; Preble and Casey, 1976), and the diversion of methadone by patients in treatment (Spunt et al., 1986). Many of these studies, especially those on heroin distribution, have shown that selling, and not use alone, is what leads an individual to increased participation in a drug subculture (Johnson, 1973; McBride, 1983). The illegality of the drug market is oftentimes what maintains the market within the subculture (Johnson et a]., 1985). Some aspects of these markets actually benefit the existence and maintenance of the subculture (McBride, 1983). It has been found that these markets are based upon the difficulty of transporting drugs, law enforcement activities, and the dependence liability of the particular substance (Soref, 1981). The greater the difficulty in bringing the drug to the user, and the greater the degree of enforcement, the greater the vertical differentiation in the organization of drug distribution, and the higher the price. These perspectives should be employed, to a much greater extent, on a national and international level to aid in delineating the nature and extent of drug-trafficking activities.

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THE CREATION OF SOLUTIONS OR PROBLEMS The “drug abuse” situation continues to deteriorate in most parts of the world, most notably with major escalations in the use of opiates and cocaine (U.N. Secretariat, 1987a). A variety of approaches have been implemented to limit or prevent use, but the effectiveness of any of these is not well known (U.N. Secretariat, 1987b). There is a general sense that current approaches are not going to be effective, and that trafficking and use will continue to increase. In fact, the relationship between availability and use is still not well known (Austin and Macari, 1978). The major focus of contemporary activities, in the U.S., has switched from attempts to reduce the supply of substances to strategies to reduce the demand from users. The reduction of supplies at the source is still the emphasis on the international level. Most of these efforts involve specific laws or international treaties. Both the supply- and demand-reduction approaches have failed because of irregular economies (e.g., inelastic in nature) which operate in these drug distribution systems (Dorn and South, 1986), and also because these distribution systems are based upon capitalist principles which drive them towards stability by reducing some of the risks (McBride, 1983). Some of these markets are diverse, decentralized, and very competitive, and criminal organizations behind them are very fluid (Wardlaw, 1986). The growth of a domestic industry, involved in cultivating or manufacturing a variety of substances, may negate the effects of efforts to reduce supplies from sources outside the country. And in areas where these industries are thriving (for instance, the cannabis growers in northern California), a multiplier effect has occurred, and the economic vitality of unrelated businesses becomes heavily dependent upon the illicit industry (Raphael, 1985). This effect is most pronounced in South American countries, which have national economies and foreign exchanges based primarily on the overproduction of coca (DiCarlo, 1982; Stamler et al., 1984). The supply-reduction effort alone won’t solve many problems. Attempts to prioritize which drugs should be the focus of such efforts will probably miss new “epidemics,” as was the case in the 1970s when the impending increases in cocaine use were not identified, even with advance information on increases in coca production (Antonil, 1978; Moore, 1979). The most effective of the supply-reduction strategies, to date, appears to be the control or prevention of drug diversion from legitimate drug distribution systems. But even then, new problems can be created in such an effort. The scheduling of amphetamines in 1970 controlled diversion activities by greatly reducing production, but amphetamines from clandestine labs and look-alike stimulant products quickly entered the market, and the price on the street went up while quality went down (Morgan and Kagan, 1978).

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Demand-reduction strategies have varied considerably. The major focus is on deterrence of law enforcement, but the risk of being identified or apprehended is perceived among users and sellers as being very low (Moore, 1977; Ross, 1984). Educational programming, focusing on prevention, and the altering of cultural awareness and acceptance of certain substances, has also been popular. Adequate facilities, manpower, and programs for treating those individuals with drug use problems can also influence the demand for drugs. All of these strategies might be effective in some small way, more so in certain populations and situations, but none of them have been effective in reducing demand considerably. The costs of total prohibition can be high, and it can result in a variety of new problems (Leader-Elliot, 1986; Mugford, 1986). It is important to realize that there have been some successful attempts at controlling epidemic drug use in the past (Austin and Macari, 1978). Opium use in China was greatly reduced after the Second World War as a result of a massive governmental effort. This effort was a part of the society-wide Communist Revolution that occurred in 1949. This antiopium campaign included agricultural reform t o end opium cultivation and changes in the ideologies of use, with the provision of massive treatment and rehabilitation programs for all users who wanted to stop (Lowinger, 1972). The change in ideology in young people greatly limited the creation of a new addict population, while addicts themselves were encouraged to seek medical care in a nonpunitive atmosphere with a great deal of support from the community. Amphetamine use in Japan and Sweden in the postwar years, and especially in the 1950s, was greatly reduced through legislation which enacted production quotas (Brill and Hirose, 1969). Control of opium cultivation in India has worked, but similar attempts to control the cultivation of khat have not been successful (Bayer, 1983). In attempting to control or prevent the flow of drugs through populations, or on a global scale, new problems can arise. Some of these result from certain constraints or barriers to program implementation. Improvements in transportation technologies and increases in commercial transportation and personal travel, as well as the ease of travel in general, have allowed for trafficking. International cooperation, even in the development of treaties, but especially in implementation and enforcement can be very difficult between countries, particularly countries with long-standing disputes or poor diplomatic relations. A great deal of friction and new political problems between countries can arise. The use of certain substances can be embedded in cultural norms, beliefs, and rituals, wluch have evolved over a very long period of time; and these ways of thinking and acting can be very difficult to change, especially in the shortterm. Importing new ideas, strategies, and technologies without considerations for differences in cultural norms or environmental conditions can doom them to failure (Edwards and Arif, 1980). The effect of drug trafficking on local economies, politics, and social groups must also be considered; otherwise efforts to

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limit or prevent production will not succeed. A good example of this is the growth in coca production in South American countries, which really began in the early 1970s and isn’t just a phenomenon of increased use of cocaine in the 1980s (Antonil, 1978). If enforcement efforts focus on specific sources or channels of distribution, then corresponding shifts to less constrained geographical point should be expected. In these instances, there can also be a shift to different drug products or dosage forms which are manufactured and distributed (Allen, 1987; Wardlaw, 1986). A classic case involves the trafficking in cocaine. The increased flow of free-base cocaine (crack) in 1982-1983 through the Bahamas greatly influenced drug markets there (Allen, 1987). Due to the increased availability of crack, drug dealers in the Bahamas switched from selling cocaine powder and marijuana to exclusively selling crack. The sellers became a key force in altering the patterns of drug use (both the type of drug and the dosage form) in that country. Many efforts are not well documented or evaluated to allow for some assessment of their effectiveness and ways to improve them. Most governmental reports of success or effectiveness are based on anecdotal reports of amounts seized or on case studies. In both instances, only numerator data are reported, and often these data are misused in stating conclusions (Goldman, 1981). There is also no single organization (nationally or internationally) behind our efforts, and this can lead to a variety of problems and an overall ineffectual effort. Corruption is a very important issue, particularly in local enforcement and in international efforts. Drug trafficking can become a political issue, and the profits from such activities can be tied to insurgency groups (Solomon, 1978a, 1979b). Violence is also becoming more prominent in drug trafficking, not only internationally but also domestically, as the value of cultivated crops continues to increase. And finally, domestic growing, manufacturing, and distributing has become a major force in the supply of a variety of substances over the past two decades (especially marijuana, hallucinogens, and some “designer drugs”). It has been noted historically that control over legitimate production will lead to the development of clandestine labs, since the economics of drug trafficking make it too profitable to avoid doing it (Parssinen and Kerner, 1981; P. A. Morgan, 1983). In 1972 Brecher suggested that efforts to limit or prevent drug use problems should stop the following: emphasizing measures designed to keep drugs away from people, publicizing the horrors of the drug menace, increasing damage done by drugs through changes caused by these efforts, misclassifying drugs, viewing drug problems as national ones (they might only be a collection of local or regional ones), and pursuing goals of complete eradication of all illicit use. He has noted, more recently, that these activities unfortunately still make up our approach to dealing with drug use problems, and that this approach has failed miserably (Brecher, 1986). It seems that some countries could learn from the experiences of others. It has been argued that increases in methaqualone use

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in the U.S. in the mid-1970s could have been limited by learning from similar, earlier increases in use in Germany, Japan, and Great Britain (Falco, 1976); and that increases in the use of cocaine and crack in the 1980s could have been limited if the earlier experiences of many South American and Caribbean countries had been noted and studied (Allen, 1987). It is time, given the continual occurrence of drug use problems, to examine alternative approaches to limiting and preventing drug trafficking. And it is also time to recognize that research on drug trafficking and on the effectiveness of prevention and control strategies is most desperately needed. THE AUTHOR

Michael Montagne, PhD Dr. Montagne is an Associate Professor of Social Pharmacy at Northeastern University. He has degrees in both pharmacy and sociology, and a primary interest in the social and cultural aspects of drug-taking behaviors. Recent research activities include epidemiological studies of cocaine use and of international illicit drug trafficking, philosophical studies of drug giving and drug taking, and work on drug education programming.

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