Understanding marihuana policy change in Uruguay: towards policy coherence?

Abstract

BACKGROUND: In 2013, Uruguay became the first country in the world to comprehensively regulate the production, distribution and sale of marihuana for recreational purposes. Officials involved in developing Uruguay’s landmark legislation have framed it as part of the government’s strategy to regulate marihuana, tobacco and alcohol reflecting the state’s wider commitments to public health and rights-based approaches. While Uruguay’s regulation of marihuana has been widely depicted as an innovative alternative to both prohibition and commercialisation, there is limited empirical research exploring the political considerations that influenced its approach. In particular, there is a lack of evidence regarding the extent to which marihuana regulation was shaped or constrained by efforts to develop consistent regulation across unhealthy commodities, the specific context of the supply system in Uruguay, and international norms and agreements. This thesis sets out to address these neglected dimensions, exploring whether the development of Uruguay’s marihuana regulation can be understood with reference to the pursuit of policy coherence in health governance across horizontal and vertical dimensions.

METHODS: This thesis is based on qualitative research conducted in Montevideo, Uruguay from October 2017 to September 2018. This encompasses data from 43 interviews with policymakers and stakeholders engaged in the development of marihuana regulation, as well as government documents, reports produced by NGOs and newspaper articles and fieldwork observations.

RESULTS: The results are organised around four analytical themes. These are: 1. Analysis of how the ‘problem’ and potential ‘solutions’ to marihuana criminalisation were constructed within Uruguay’s marihuana policy debate, including the diverse priorities, concerns and positions influencing these various articulations; 2. Exploration of the extent to which Uruguay’s regulatory approach was influenced by a desire to promote policy coherence within health and across other policy spheres, with particular reference to public security, in a nationally specific context; 3. Examination of the extent to which marihuana regulation was shaped by international norms and commitments, including in relation to both drug control and financial systems; and 4. Consideration of how Uruguay’s regulatory framework was influenced by policy approaches in other countries – including in relation to retail and supply chains, product traceability, and user registration.

Taken together, the results suggest that Uruguay’s approach to marihuana regulation was shaped by a confluence of domestic policy actors with diverse perspectives on individual liberties, anti-authoritarianism, harm reduction, public security and population health, who nevertheless exhibited a broadly shared desire to develop an alternative to marihuana criminalisation. Domestic policy actors selectively promoted limited horizontal policy coherence across marihuana, tobacco and alcohol regulation to achieve the implicit goal of legitimating marihuana production and use without creating a commercial driver or structural force that would promote excessive consumption.

Visible tensions and anticipated expectations of key regional actors – namely Argentina, Brazil and the US government – have also shaped Uruguay’s marihuana regulation, resulting in a comparatively restrictive supply system that makes marihuana legally available under certain conditions as determined by the state and other government authorities. Paradoxically, the UN drug conventions were found to be less directly constraining on domestic policy space compared to the norms and practices of the international banking sector, which have exerted powerful influence over Uruguay’s ability to fully implement aspects of marihuana supply that require access to the formal financial system. Finally, Uruguay’s distinctive approach to state regulated marihuana supply can be understood as a form of ‘hybridisation’ in which aspects of policy models in other countries were selected, blended and adapted to the unique political and legal features of Uruguayan society, leading to the development of an innovative approach that nevertheless reflects elements found in existing marihuana supply systems.

CONCLUSION: These findings qualify claims concerning the extent to which Uruguay’s approach to marihuana regulation was part of a coherent strategy to regulate unhealthy commodities. Drawing upon a diverse range of empirical data, alongside contemporary theories of policy change, this study demonstrates how national public security and crime-oriented frameworks, and international actors, norms and practices have shaped and constrained the development and implementation of a national health policy innovation. This research makes a distinctive contribution to the public health literature in exploring the impacts on policy space arising from conflicts between marihuana regulation and the practices of international finance. The findings raise important concerns about the extent to which public security and crime-oriented frameworks might circumscribe Uruguay’s ability to autonomously pursue its health goals in marihuana policy and for public health more broadly.