Review: The Next Fix. The Winners and Losers in the Future of Drugs, by Kojo Koram

Kojo Koram is a lawyer and professor at Loughborough University, UK, and author of Uncommon Wealth: Britain and the Aftermath of Empire. In this new book, he turns to recent transformations in the regulation of psychoactive drugs and asks who the winners and losers will be from these changes. He emphasises the role of law in shaping perceptions and policies and the need to look not only at the goals of laws, but also at their consequences.

Koram's interest in drugs was heightened through a visit in 2012 to the largest maximum-security prison in the USA, in Louisiana, known colloquially as Angola, a reference to its plantation origins. He remembers his shock on seeing shackled prisoners toiling in the fields, a scene reminiscent of the days of slave labour. Many were incarcerated for multiple non-violent drug offences. While the USA has been distinctive in the way its drugs policies entrenched racial division, the United Nations estimates that 20 per cent of the global prison population are sentenced for drug offences.

Koram began to question ‘war on drugs’ policies. These rely on a simple script: some drugs are bad. Bad people use them. Worse people sell them and, without a war on drugs, society would collapse. This menu is repeated in the speeches of politicians and government policy documents in many countries, including in the UK. In practice, however, the consequences of these policies have been mass incarceration, paramilitary conflict, environmental devastation and restricted access to medicines. Illicit drugs get stronger while drug users are criminalised and marginalised. The underground economy grows bigger, richer and more violent.

Returning to the issue ten years later, Koram found that there had been a remarkable change in policy in many countries, notably in the USA, where cannabis, at first recognised as having medicinal value, is now widely available. Radical changes in cannabis legislation have taken place in many countries, with its use becoming largely accepted, but with important variations in the ways in which it is produced, distributed and regulated. Now, however, Koram has noticed, this about-turn is increasingly attracting commercial interest. He asks, will multinational companies be the big winners from drug law reform? Will acceptance of cannabis spread to other substances like psilocybin, MDMA, LSD, ibogaine and even cocaine, in time?

Pertinently, he argues, the policy question is now not ‘to legalise or not to legalise’, but ‘how should we legalise drugs’? Which drugs will change their status from bad to good, crossing the boundary from narcotic to medicine, with some moving from harmful to pleasurable, to be taken in moderation like alcohol, nicotine and sugar. What is likely to happen and—differently, but importantly—what would we like to happen? In discussing this, he uses historical and comparative evidence to show that perceptions of substances have always shifted over time and place, with their legal or cultural status changing accordingly.

Koram's presentation is organised around a series of questions: can we stop people dying from drugs? Can we stop people dying for drugs? Can drugs save the economy? Could drugs unlock new ‘miracle’ cures? Can drugs heal our mental health? Can drugs change who is included in society? Could drugs become the new cash crops? His answers rest on evidence from wide reading of scholarly literature and public information, along with personal interviews with people living in places where the real-life impact of drugs is visible. These include Louisiana, Colorado and Washington in the USA and Glasgow in Scotland, where drug deaths are the highest in Europe. Then there is Colombia with its interwoven civil wars and illicit cocaine trade; and Ghana, a sternly Christian country, which has nevertheless legalised cannabis cultivation for industrial and medicinal purposes.

This is a familiar story to those in the drugs field, but Koram tells it with vigour and clarity, in a way that will get across to that general audience who must become engaged if policies are to change. Moving human interest portraits shows why blanket laws are inappropriate and why we should abandon the simplistic concept of ‘drugs’, which only sets up prejudicial barriers, shutting off the possibility of new ways of thinking.

Reading this intelligent and insightful discussion, I was driven to ask why is Britain so often now such an infuriating and disappointing outlier in a range of social, health and criminal justice policies when compared to our near neighbours. Koram tells us about a young art student, Louis Petit, living on an east London housing estate, waiting years for an NHS cannabis prescription to help manage his rare form of complex epilepsy. He describes the battles fought by Hannah Deacon, whose son Alfie suffered from paralysing seizures. These cases demonstrate starkly the sclerosis in British political culture. Even after cannabis's legal status changed, in practice, its use is still restricted to those who can afford to pay. Other psychoactive substances are increasingly seen as having potential for treating depression or enhancing creativity, not least by the techno-entrepreneurs of San Francisco. But, innovation in these areas, Koram argues, is likely to be developed by and in the private, commercial medical sector.

So, the main question which intrigued Kojo Koram was how could two contrasting things be happening at the same time? How could it be that the global architecture of mass incarceration, deriving from international laws on narcotics, co-exists with moves to legalise cannabis and develop an associated lucrative commercial market? It is important to note, however, that this transformation is taking place only in some Western societies. Such changes are viewed by non-Westerners as signs of decadence. So, in Russia, China, Iran and Singapore, for example, the war on drugs continues. (In Iran, last year, at least 795 people were hanged for drug offences, often low-level dealing.)

Koram's lucid presentation of the paradox and sensitive appreciation of its historical context is what distinguishes his account from more run-of-the-mill analyses. The book should appeal to a wide range of readers and encourage them to engage with this important subject. For Koram, the policy transformation now taking place offers a vital—but possibly transient—opportunity for pragmatic and humane actors to intervene and influence change. Engagement and action now could be influential in halting a move to dominance by exploitative global capitalism. First steps and priority areas to support would include: comprehensive decriminalisation; non-commercial cooperative supply chains; common ownership and open access to knowledge; and inclusion of policies of reparation and social justice for those harmed by the previous war on drugs. Legalising drugs does not have to mean a libertarian free-for-all. The question to ask is what kind of regulation do we want? This might apply also to how best to regulate a wide range of behaviours and interests—gambling, alcohol, fossil fuels, sugary and processed food or social media. Answering this requires us to decide what kind of society we want and to look humbly for ideas in the policies already adopted in countries which share our values.

The Next Fix: The Winners and Losers in the Future of Drugs, by Kojo Koram. John Murray Publishing. 304 pp. £22.