How to regulate stimulants: A practical guide

By Steve Rolles, Harvey Slade, James Nicholls / Transform

The legal regulation of cannabis has gained momentum, and an increasing number of countries (including major world economies) have moved to allow adult, non-medical use. At the same time, we are seeing more research on the therapeutic uses of psychedelic drugs, leading to calls for change in their legal status. The global consensus on prohibition is starting to fracture. These developments are welcome, but mark only a partial shift in the larger question of how we should regulate psychoactive substances. It is quite possible, for example, to legalise cannabis and psychedelics while maintaining a blanket prohibition on other substances. Transform, however, has long argued for comprehensive change. Our case for legal regulation is not limited to lower-risk drugs, because we believe that the opportunities for harm reduction offered by regulation apply to all substances, even allowing for (and, indeed, because of) differences in potential harm.

How we might regulate a legal market in stimulant drugs remains one of the most important, but least explored, questions for drug policy reform. By stimulants we primarily mean cocaine, amphetamines and MDMA, which make up the large majority of the illegal stimulants consumed globally. Stimulant use continues to increase, but too often remains at the margins of policy reform discussions. This is perhaps understandable, given the particular range of challenges that stimulant use presents, but it cannot be a reason for avoiding the question. If we agree that the ‘war on drugs’ has failed, then we need a vision of how to regulate drugs — including stimulants — after the war has ended.

Exploring stimulant policy options creates very particular political challenges. Public support for changing cannabis regulation is linked to the fact that it is perceived as relatively low risk, but also very widely used and culturally embedded in many societies. MDMA, cocaine, and amphetamines sit in a different cultural space. Stimulants are widely perceived as being relatively risky compared to cannabis, and the use of pills and powders can seem more ‘unnatural’ and alien. They are also often perceived as indulgent and hedonistic, or associated with unpredictable behaviour. Particularly in their more concentrated forms, some stimulants have the potential to lead to severe dependency and considerable health harms.

Yet stimulants are increasingly widely used, and production is expanding to meet the growing demand. The latest United Nations Office on Drugs and Crime (UNODC) global data suggests (probably conservatively) that in 2018, 27 million people used amphetamines, 21 million people used MDMA, and 19 million people used cocaine. The health risks faced by people who use illegal stimulants are significant, with MDMA and cocaine increasing in potency, ongoing risks from mis-selling, bulking agents and adulterants, and a complete lack of information about either strength or purity to inform safer use. In England and Wales, cocaine-related deaths rose for the seventh consecutive year in 2018, to 637, marking a threefold rise in just over a decade, and a tenfold rise over 20 years. In the US, stimulant-related deaths doubled between 2015 and 2017, reaching record levels.