The symbolic value of drugs may not favour rational policy decisions

To the authors of the commentary [1], the negative outcome of the referendum seems rather disappointing. They look for answers along political and demographic lines (conservative-liberal, rural–urban, age). But recent experiences with referenda in the European Union (EU) show that the outcomes are hard to predict. A vote in Britain for its exit from the EU (‘Brexit’) was deemed unlikely, until the day after. In the Netherlands, the first popular (non-binding, advisory) referendum on the Ukraine–European Union Association Agreement was held in 2016. With a turn-out rate of only 32%, the outcome rejecting the agreement was deemed legal, yet hardly substantial, with 19% of all potential votes against and 12% in favour [2]. Few people were aware of the details of the agreement. Politically, the referendum was used by a coalition of conservatives who admitted they were not interested in the agreement or Ukraine as such, but generally were using it as a tool to object to EU influence in Dutch politics. They later founded a new and successful neo-conservative party (Forum voor Democratie). The Brexit referendum in the UK did not look much different, although the UK Independence Party and Brexit parties failed to build a political base after their singular goal was achieved. However, the vote did change the balance between major political parties in the UK. So, apart from their immediate direct effect, referenda may be potent political tools as game-changers. Historically, drug issues have a high symbolic value. Think of prohibition in the USA, when a democratic majority of drinkers voted to ban alcohol from their society, or of other examples of what Joseph Gusfield called symbolic crusades [3]. A current example is the Mexican proposal for cannabis legalisation where a majority in parliament is not supported by a popular majority [4]. Looking back, we think that had the reforms in Dutch drug policy in the 1970s and 1990s been put to a popular vote, they probably would have failed. The 1976 Dutch policy reform made a distinction between cannabis as a soft drug and more damaging hard drugs. It was the outcome of tumultuous changes in society, with young people breaking the law on cannabis on a large scale. After a long period of absence, the Labour party (PvdA) was part of a coalition government, which made changes deemed ‘progressive’ possible. In the lead-up to the 1976 change, the son of the health minister read out price guidelines of hashish and marijuana on the national radio. But although the discourse on drugs had shifted, popular ideas on drugs were still quite negative. The change in 1976 laid the ground for what has become known as the Dutch approach. Increasingly based on harm reduction principles, a white paper on Dutch drug policy was published, formalising existing practices and unifying the rules for licenced sale of cannabis across the country [5]. The core of the policy is that municipal councils have the right to permit the sale of small quantities of cannabis in licenced establishments (so-called coffee shops). The cannabis policy was, and is, strictly regulated and intensively supervised. Publication of the white paper caused quite a stir internationally, particularly from the French government. In terms of Dutch popular discourse, the policy is now reasonably supported and not controversial politically. No political party would try to turn back the clock on this point. We think this could, however, change dramatically if a referendum would be organised around this or other drug issues, with an unpredictable outcome. More recent changes in policy in the Netherlands have been the introduction of a heroin maintenance regime in treatment for opioid addiction (for the political turmoil it caused, see [6]), and initiation of an experiment on legalisation of production of cannabis in a number of selected municipalities, which were both passed in parliament [7]. In both cases, advocates and opponents used a highly symbolic rhetoric, with academics doing their best to produce a balanced factual base, emphasizing the medical aspect for heroin maintenance. For cannabis legalisation, utility in fighting organised crime was the argument, by creating a closed circuit of production, distribution, retail and use of cannabis. These were thus presented as small steps that do not stir nationwide emotions. Similarly, in 2003 a legal medical marijuana regime was set up without much opposition in parliament and hardly any media coverage, with all steps from production to distribution supervised by the Ministry of Health. If the Dutch people had been consulted in a referendum, these measures would not have passed as easily. Referendum results are often not based on rational, evidence-based information. Careful research and planning may be wiped out by a populist storm. In Rychert and Wilkins' commentary [1], no mention is made of the UN Conventions on drugs. In 2013, the then Dutch justice minister Opstelten argued against the cannabis legalisation experiment, saying that any legalisation was impossible because of binding international treaties [8]. Researchers at Nijmegen University initially seemed to confirm this point [9]. However, the same authors later revoked their initial conclusion with an appeal based on human rights conventions [10]. This paved the way for a subsequent Dutch cabinet to propose the legalisation experiment currently underway. Among the five conditions mentioned by the Nijmegen researchers was that the policy should have a definite human rights interest and advantages, have sufficient popular support and that it be taken to a democratic vote. The latter two are interpreted as support by municipal councils, academia, police authorities, public health institutes, etc., rather than as a topic for a referendum. The basic rationale for legalisation of cannabis production and distribution was in terms of the large involvement of organised crime in production of cannabis, and the positive public health experiences with the regulated sales of cannabis in coffee shops. With such arguments, and the invocation of human rights conventions, Dutch politicians were persuaded to look past the UN drug conventions. Any effort towards legalisation of cannabis needs careful planning to counter potential arguments against the proposed change, such as was the case in Washington state and Colorado with a potential increase in driving casualties as a major concern. Here, and in other US states, and contrary to our argument above, a popular vote decided in favour of legalisation, with state legislatures being reluctant, perhaps for political reasons rather than public health. Other important issues after legalisation are expected pressures to expand the market commercially, with the need for provisions to limit availability and control promotion [11]

Brexit · Economics · European union · International economics · Political economy · Political science · Politics · Referendum · Health Policy Implementation Science · HIV, Drug Use, Sexual Risk · Law · Public Administration · Substance Abuse Treatment and Outcomes

• Response to commentaries

  Open Access•Marta Rychert, Chris Wilkins•Drug and Alcohol Review•2021

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• The culture of public problems

  Joseph R Gusfield•The culture of public problems•1981

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• Why did New Zealand's referendum to legalise recreational cannabis fail

  Open Access•Marta Rychert, Chris Wilkins•Drug and Alcohol Review•2021

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