Dear Mr Costa, Wise up or shut up.

In this morning's Observer Antonio Maria Costa, outgoing executive director of the United Nations Office on Drugs and Crime, accuses those who advocate “a radical new approach” as a means to reduce substance abuse of being “deluded” and says “those in favour of legalisation have lost sight of health as their priority.” http://bit.ly/bOcPmo

I'm sorry Antonio, but you either haven't been listening to or you have failed to understand the motivations of the progressive section of reform advocates who favour strict controls. As a member of that group I find your juxtaposition of “those who dream of a world free of drugs and those who hope for a world of free drugs” childish and insulting.

As a non-drug-using reform advocate my motivations stem almost entirely from a desire to reduce health, social, and emotional harms related to drug use and the illegal drug trade, and I believe that strictly controlling a legal market is the best way to bring about that reduction in harm. I read with interest of the Portuguese experience of drug policy reform (http://bit.ly/bB3MOD), and can't help but feel that we can achieve so much more by being ambitious but also appropriately cautious at the same time.

Portugal has done well in recognising that drug use is a social and health problem and not an issue for criminal courts, and the population has benefited from more drug users entering treatment and being able to confront and be open about their problems without risk of criminalisation. But the Portuguese system still relies on referral of drug users following contact with police. This system is grossly inefficient and reactive when considered alongside the potential opportunities for intervention in a situation of strictly regulated legal supply.

It is useful now to take a journey through the time-line of a typical drug user's journey.

In the Portuguese and the prohibition model, first contact with drugs will be with either a friend or an illegal dealer marketing the drug to a young person in the hope of recruiting a regular customer. This first contact is more likely to be initiated by the friend or dealer. The drugs are coming to the individual rather than the individual seeking out the drugs.

Consider now the ideal situation in a condition of strictly regulated legal supply: Social supply and dealing of drugs remains a criminal offence and dealers will hopefully struggle to compete with the legal market. I would hope the vast majority of first contacts with drugs would occur at the instigation of the potential user. Curiosity about drugs leads them to enter a pharmacist and request the drug they are interested in. Rather than being marketed a product with some lie about the quality accompanied with enthusiastic encouragement, the individual would be provided detailed information on the possible health, social and economic consequences of use, information on points of contact should they wish to receive confidential advice, and would be able to make a truly informed choice on whether to consume the drug in question.

Let's jump to 6 months down the line, the drug of abuse is cannabis, and our drug user is experiencing signs of early psychosis. In the prohibition path, the user has no knowledge of the warning signs of psychosis, their friends don't either, and so there is not an obvious point of intervention to help arrest the decline in their mental health. In our Portuguese model they may have encountered education about the risks of cannabis, but not delivered in a one-to-one setting so the level of attention paid is unpredictable. They are more likely to have been diverted into services by police intervention and through the activity of the panels, but this is entirely dependent upon them being caught in possession of the drug. In conversation with the panel the issue of psychosis might arise and our drug user might discuss some of the issues they are having, consider associating them with their drug use and perhaps cease their use of cannabis.

In the situation of strictly regulated legal supply, our drug user will have been educated about potential links with psychosis immediately before being licensed to use the drug for the first time, they may have recognised feelings of paranoia, delusions or hallucinations, or their friends who have been similarly educated might raise concerns. They have the option of returning to the pharmacy, discussing their experience, and requesting a less potent strain, or they might simply not want to chance it and cease their use altogether. A system of licensing also raises the possibility of levels of drug use being monitored (only accessible to the individual and health professionals with their consent), so heavy users can be discreetly encouraged to consult with their doctor more often than light users, allowing early intervention should issues arise. A further important feature of a legal market specifically relevant to cannabis is the increased availability of strains of various strength and potency. The dominance of potent skunk strains in the UK market would be broken, allowing users to settle on the strain of the drug they most enjoy and that hopefully does not jeopardise their mental health.

Apply this analysis to all drugs and it seems to me quite clear that the regulatory model that would best safeguard health is the one of strict control and regulation of a legal market. Individuals should face less pressure to experiment with drugs in the first place, will be considerably more aware of the health and social implications of drug use, and will find it much easier to confront any health problems that arise.

So Mr. Costa: Health is my priority, and the model of control and regulation I am proposing reflects that. I will concede that such a regulatory model is best implemented in a well-developed economy that has the resources to ensure the system runs smoothly. To discourage a country such as Britain from taking such a step is to condemn the whole world to more of the same, and I for one do not share you positive interpretation of the statistics that show a stubborn lack of progress towards your “world free of drugs” fantasy.