International Law, Public Health and Addiction

Abstract

What is the relationship between international law, public health and addiction? This chapter addresses three straightforward questions: (1) what is international law; (2) how does international law relate to addiction; and (3) why is international law relevant to domestic practitioners struggling with the legal, medical and policy dimensions of addiction? The notion of practitioner is intentionally left vague. It includes research scientists studying addiction and physicians treating addiction. It includes lawyers and judges dealing with the legal aspects of addiction. It also includes social workers, community activists and policymakers confronting the problems of addiction and thinking creatively about law reform. The focus on practitioners reflects a deeper interest in the ways that members of global civil society are playing an increasingly important role in shaping the contours of international law.

The interface between addiction and international law embraces a range of different substances: drugs, alcohol and tobacco. Drugs and alcohol have long been subjects of international law. The first International Opium Convention was adopted in 1912. The precursor to the World Health Organization (WHO), the health component of the short-lived League of Nations, began addressing alcoholism as a medical problem as early as 1928. In contrast, despite its addictive characteristics and now obvious adverse health effects, tobacco was not an historic target of international control. Indeed, rather than restrictions, international law in the free trade regimes of the General Agreement on Tariffs and Trade (GATT) and the World Trade Organization (WTO) has been used to force open tobacco markets, especially in developing countries. However, times change, as well as do laws. The WHO Framework Convention on Tobacco Control (2003) commits countries to ambitious tobacco control regimes and illustrates a creative use of international law as a tool for policy reform and public health advocacy. Without doubt, however, the dominant focus of international law and addiction has been, and continues to be, drugs and other controlled substances.

Not surprisingly, the tensions one finds at the international level roughly mirror the policy tensions and disputes found at the domestic level. On one side is the law enforcement perspective, with its focus on supply-side control, criminalization and the coercive power of the state. On the other side is the public health perspective, with its focus on demand-side control, treatment, education and the softer instruments of state power. At both the domestic and the international level, law enforcement and supply-side restrictions dominate, leaving public health and demand-side control playing subsidiary roles.